Value of different staging systems for predicting neurological outcome in childhood tuberculous meningitis.

BACKGROUND: The stage of tuberculous meningitis (TBM) at presentation is strongly associated with prognosis. OBJECTIVE: To compare different staging systems for TBM in predicting outcome. METHODS: The associations of different staging systems with neurological outcome were assessed using clinical, diagnostic and outcome data of 554 TBM children admitted to Tygerberg Children's Hospital from January 1985 to April 2005. RESULTS: The refined Medical Research Council (MRC) scale after 1 week (84%, 95%CI 81-88) had the highest discriminatory power in predicting neurological morbidity. The Glasgow Coma Score (GCS) on admission, GCS after 1 week, the 'refined' MRC scale on admission and Tygerberg Children's Hospital (TCH) staging method all had excellent discriminatory powers in predicting outcome. Improvement of staging after 1 week occurred in children who did not have signs of raised intracranial pressure (P = 0.004) or brainstem dysfunction on admission (P = 0.030). CONCLUSIONS: The 'refined' MRC scale 1 week after diagnosis showed the best association with neurological outcome after 6 months of treatment. The excellent discriminatory power of the TCH scale and its simplicity of use make it the ideal scale for use in resource-poor settings.

The targeting of nutritionally at-risk children attending a primary health care facility in the Western Cape Province of South Africa.

AIM: The aim of this study was to determine the practices of primary health care (PHC) nurses in targeting nutritionally at-risk infants and children for intervention at a PHC facility in a peri-urban area of the Western Cape Province of South Africa. METHODOLOGY: Nutritional risk status of infants and children <6 years of age was based on criteria specified in standardised nutrition case management guidelines developed for PHC facilities in the province. Children were identified as being nutritionally at-risk if their weight was below the 3rd centile, their birth weight was less than 2500 g, and their growth curve showed flattening or dropping off for at least two consecutive monthly visits. The study assessed the practices of nurses in identifying children who were nutritionally at-risk and the entry of these children into the food supplementation programme (formerly the Protein-Energy Malnutrition Scheme) of the health facility. Structured interviews were conducted with nurses to determine their knowledge of the case management guidelines; interviews were also conducted with caregivers to determine their sociodemographic status. RESULTS: One hundred and thirty-four children were enrolled in the study. The mean age of their caregivers was 29.5 (standard deviation 7.5) years and only 47 (38%) were married. Of the caregivers, 77% were unemployed, 46% had poor household food security and 40% were financially dependent on non-family members. Significantly more children were nutritionally at-risk if the caregiver was unemployed (54%) compared with employed (32%) (P=0.04) and when there was household food insecurity (63%) compared with household food security (37%) (P<0.004). Significantly more children were found not to be nutritionally at-risk if the caregiver was financially self-supporting or supported by their partners (61%) compared with those who were financially dependent on non-family members (35%) (P=0.003). The weight results of the nurses and the researcher differed significantly (P<0.001), which was largely due to the different scales used and weighing methods. The researcher's weight measurements were consistently higher than the nurses' (P<0.00). The researcher identified 67 (50%) infants and children as being nutritionally at-risk compared with 14 (10%) by the nurses. The nurses' poor detection and targeting of nutritionally at-risk children were largely a result of failure to plot weights on the weight-for-age chart (55%) and poor utilisation of the Road to Health Chart. CONCLUSIONS: Problems identified in the practices of PHC nurses must be addressed in targeting children at nutritional risk so that appropriate intervention and support can be provided. More attention must be given to socio-economic criteria in identifying children who are nutritionally at-risk to ensure their access to adequate social security networks.

Iron status of South African women working in a fruit-packing factory.

OBJECTIVE: The aim of this study was to determine the iron status, and the risk factors for iron deficiency (ID) and iron-deficiency anaemia (IDA), of non-pregnant adult women working in a fruit-packing factory. DESIGN: A cross-sectional analytical study was done on 338 women, 18 to 55 years of age. Information on demographic data, risk factors for ID, smoking, and the consumption of red meat, chicken and fish was collected by questionnaire. Height and weight were measured and the body mass index (BMI) calculated. A non-fasting venous blood sample was analysed for haemoglobin (Hb), serum ferritin (SF), serum iron, serum transferrin and C-reactive protein; transferrin saturation (TFS) was calculated. SETTING: Fruit-packing factory in the Western Cape, South Africa. RESULTS: The mean value for Hb was 13.06 (standard deviation (SD) 1.16) g dl-1 and for SF 48.0 (SD 47.8) microg l-1 (geometric mean 26.44 microg l-1). Women were categorised on the basis of iron status: 60% had a normal iron status (NIS); 12.6% had low TFS (<16%) but normal Hb (>or=12 g dl-1) and SF (>or=12 microg l-1) concentrations (LTS); and 27.4% had low iron status (LIS), defined as combinations of low SF (<12 microg l-1 or <20 microg l-1), low TFS (<16%) and low Hb (<12 g dl-1). More than 30% of the women were obese The risk ratio for LIS (LIS vs. NIS) was 3.8 (95% confidence interval (CI) 1.9-7.6) if women were still menstruating or 3.2 (95% CI 1.6-6.2) if they were pregnant during the past 12 months. Women with LIS consumed significantly smaller portions of red meat, chicken and fish than did women in the other two groups. CONCLUSIONS: IDA (low Hb, SF and TFS) and ID (low SF and TFS) did not seem to be a major problem. Women who were still menstruating or were pregnant during the past 12 months were at greater risk for ID. The consumption of smaller portions of red meat, chicken and fish was related to LIS. A high prevalence of obesity, which demonstrated the coexistence of both under- and overnutrition, was observed.

Endometrial function in vervet monkeys (Cercopithecus aethiops): morphology, beta3 integrin and insulin-like growth factor binding protein-1 expression during the menstrual cycle and pregnancy in the normal and disrupted endometrium.

The expression of endometrial beta3 integrin and insulin-like growth factor binding protein-1 (IGFBP-1) was studied in cycling and pregnant vervet monkeys. There were clear changes of beta3 integrin expression during the menstrual cycle, with the strongest immunostaining observed on day 26. Moderate to strong expression was observed during pregnancy. The expression of IGFBP-1 during the menstrual cycle was weak but upregulated during pregnancy with moderate to strong staining. The administration of a single dose of onapristone at 10 mg/kg on days 17, 21 and 22 of the menstrual cycle, followed by a biopsy on days 22, 22 and 26, respectively, and during pregnancy (34-44 days menstrual age) 24 h before the biopsy, disrupted and desynchronized the endometrium. However, no effect on beta3 integrin expression could be observed and staining reflected the untreated patterns. The same applied to IGFBP-1 except that during pregnancy the expression of this protein was reduced or abolished. The results suggest that beta3 integrin is associated with endometrial receptivity in vervet monkeys and that IGFBP-1 plays an important role during pregnancy in this species. The administration of onapristone appeared to only influence IGFBP-1 expression. To our knowledge, this is the first time that these endometrial proteins have been investigated in vervet monkeys. This study should therefore contribute to improving our understanding of the reproductive function of this species.

The effect of adjuvant steroid treatment on serial cerebrospinal fluid changes in tuberculous meningitis.

Three recent studies found that corticosteroids improve clinical outcome and mortality in tuberculous meningitis (TBM), although the exact mechanism of action of the drug remains speculative. A number of reports on the effect of corticosteroids on cerebrospinal fluid (CSF) findings in TBM have been published, often with conflicting results regarding serial cell counts and protein levels. As part of a controlled, randomized trial on the effect of oral prednisone on outcome in childhood TBM at our institution, CSF was collected and analysed weekly during the 1st month of treatment. We found no significant difference in serial CSF cell counts between the steroid and non-steroid groups in the study. However, the steroid group had significantly lower CSF protein and globulin levels after the 1st month of treatment, and a more steady rise in CSF glucose levels than the non-steroid group. Knowledge of the different CSF responses during the course of anti-tuberculosis therapy is important in clinical decision-making.

Poor nutritional status in older black South Africans.

A cross-sectional analytical study was undertaken to describe the nutritional status and dietary intake of the elderly black population of Cape Town. A stratified proportional sample of 148 men and women aged 60 years and older (mean = 68.9+/-5.7) was selected from informal and formal peri-urban settlements. The study population was predominantly urbanized, although most subjects had migrated from non-urban areas. Trained fieldworkers conducted a 24-h recall dietary assessment and performed anthropometrical measurements. Mean energy intakes fell below the recommended dietary allowance (RDA) for both men and women; 27% and 36% of men and women, respectively, had energy intakes <67% RDA. Total fat intake was low and contributed 24-26% total energy. Mean dietary fibre intake was low at 11-16 g/day. Mean intakes fell below the RDA for vitamin D, calcium, zinc and vitamin B6. Less than two and a half servings per day were consumed from the vegetable and fruit group and less than one serving per day from the calcium-rich food group. Over half (51.3%) of the women and 18% of the male were obese (body mass index > or =30). We concluded that older black subjects in Cape Town have energy profiles in line with prudent dietary guidelines and more favorable than other elderly groups in the country, with regard to atherogenic risk. However, micronutrient and dietary fiber intake is inadequate, largely due to low reported energy intakes, particularly in women.

Serial lumbar CSF presure measurements and cranial computed tomographic findings in childhood tuberculous meningitits.

Intracranial pressure (ICP) was monitored in 218 consecutive children with hydrocephalus secondary to tuberculous meningitis (TBM). All children underwent cranial computerized tomographic (CT) scanning and continuous lumbar cerebrospinal (CSF) pressure monitoring on admission. Noncommunicating hydrocephalus (37 children), as determined by air encephalography, was treated by ventriculoperitoneal (VP) shunting and communicating hydrocephalus (181 children), by means of daily acetazolamide and frusemide. Response of ICP to treatment in the group with communicating hydrocephalus was assessed by means of repeated CSF pressure monitoring and CT scanning. One hundred and eighty-five of the 218 patients survived the 1st month of treatment. The aim of this study was the retrospective determination of (1) the relationship between ICP measurements and CT findings on admission and (2) the characteristics of the ICP recording which correlated best with the CT criteria of compensated hydrocephalus after the 1st month of treatment. No relationship was found between the level of baseline CSF pressure and the degree of hydrocephalus, as demonstrated by CT scanning, on admission. Seventy-five per cent of the patients with communicating hydrocephalus that survived the 1st month of treatment complied with the CT criteria for compensated hydrocephalus. All these patients had a baseline CSF pressure below 15 mmHg and absence of high-amplitude B waves on the pressure recording done at the end of the 1st month. In this study repeated lumbar CSF pressure monitoring proved to be an effective instrument to assess the response of communicating tuberculous hydrocephalus to medical treatment and also accurately predicted the timing of compensation of the hydrocephalus.

Effects of a prudent diet containing either lean beef and mutton or fish and skinless chicken on the plasma lipoproteins and fatty acid composition of triacylglycerol and cholesteryl ester of hypercholesterolemic subjects.

In this two-phase crossover study, 39 hypercholesterolemic subjects followed a prudent diet with either lean red meat or fish and skinless chicken (treatment groups), and 13 subjects (reference group) followed their habitual diet. Fasting blood samples were analyzed for plasma total cholesterol, triacylglycerol (TAG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein one- and two-cholesterol, apolipoprotein-B, very low density lipoprotein cholesterol, and very low density lipoprotein TAG, and fatty acid composition of plasma TAG and cholesteryl ester (CE). Body mass and blood pressure were determined. Seven-day dietary records were kept once at baseline and twice during the treatment periods. Significant differences were observed in dietary intake between the baseline and treatment diets and between the two treatment diets. HDL-C (P < 0.05) and diastolic blood pressure (P < 0.01) were higher in patients on the red meat diet than in those on the chicken-fish diet. No other significant differences in lipoproteins were observed between the effects of the two treatment diets. The linoleic acid (%), eicosapentaenoic acid (%), and the eicosapentaenoic acid/arachidonic acid ratios in TAG and CE were higher (P < 0.01) in subjects on the chicken-fish diet than in those on the red meat diet. In conclusion, this study showed that the effect of two lipid-lowering diets containing either lean red meat or skinless chicken and fish on the atherogenic lipoproteins did not differ significantly. A prudent diet with skinless chicken and fish, however, had a more favorable effect on the fatty acid composition of the plasma TAG and the CE than did the lean red meat diet.

Effect of corticosteroids on intracranial pressure, computed tomographic findings, and clinical outcome in young children with tuberculous meningitis.

OBJECTIVE: To study the effect of highdose prednisone on intracranial pressure (ICP), cranial computed tomographic (CT) findings, and clinical outcome in young children with moderate to severe tuberculous meningitis (TBM). STUDY DESIGN: Prospective, controlled, randomized study. METHODS: Continuous lumbar, cerebrospinal fluid pressure monitoring and contrasted CT scanning were performed in 141 consecutive children with TBM at admission. All children were then randomly allocated to a nonsteroid group (71 children) or a steroid group (70 children) who received prednisone (first 16 children, 2 mg/kg per day; next 54 children, 4 mg/kg per day) for the first month of treatment. ICP monitoring and CT scanning were repeated regularly, and clinical outcome was assessed after 6 months of antituberculosis treatment. RESULTS: No statistically significant difference in ICP or the degree of hydrocephalus (as demonstrated by CT scan) was found between the steroid and nonsteroid groups after the first month of treatment. Basal ganglia infarcts developed in 16% of children in the steroid group and 24% in the nonsteroid group during the first month of treatment. Neither this incidence nor the eventual size of infarcts present at admission differed significantly between the two treatment groups. Single or multiple tuberculomas were seen on the first CT scans of 7 children (5%), whereas tuberculomas developed in 11 children (8%) at treatment. Both the response of the tuberculomas to treatment and the incidence of new tuberculomas were significantly improved by steroid therapy. Basal enhancement was also significantly less in the steroid group after 1 month of treatment. Steroids lowered mortality in stage III TBM significantly. Similarly, more surviving children in the steroid group had IQs of greater than 75 than did the those in the nonsteroid group. No significant difference was found in the incidence of motor deficit, blindness, or deafness. CONCLUSIONS: Corticosteroids significantly improved the survival rate and intellectual outcome of children with TBM. Enhanced resolution of the basal exudate and tuberculomas by steroids was shown by serial CT scanning. Corticosteroids did not affect ICP or the incidence of basal ganglia infarction significantly.

Response to an iron fortification programme in relation to vitamin A status in 6-12-year-old school children.

Plasma retinol and indices of iron status were measured in 148 school children (6-12 years) receiving a soup fortified with iron and vitamin C for a period of 15 weeks. The most significant change in serum iron (P = 0.0005) and transferrin saturation (P = 0.0002) was seen in subjects with plasma retinol > or = 40 micrograms/dl, while subjects with plasma retinol < 20 micrograms/dl showed no response. Serum ferritin improved most in the retinol categories < 40 micrograms/dl, suggesting that the absorption of iron was not impaired by marginal vitamin A status, but that it was rather the mobilisation of iron from stores that was affected. Changes in vitamin A status correlated positively and significantly with changes in serum iron (r = 0.37; P = 0.0001) transferrin saturation (r = 0.27; P = 0.004) and haemoglobin (r = 0.21; P = 0.03), but negatively with serum ferritin (r = -0.28; P = 0.003). The presence of marginal vitamin A deficiency in a community may limit the effectiveness of an iron intervention programme and vitamin A status should therefore also be considered when such programmes are planned.

Serial CT scanning in childhood tuberculous meningitis: prognostic features in 198 cases.

Serial cranial computed tomographic (CT) scanning and intracranial pressure monitoring were performed on 198 children with stage II and III tuberculous meningitis. The aims of the study were to document the course of tuberculous hydrocephalus during medical and surgical treatment, as well as the prognostic significance of parenchymal changes in the brain as demonstrated by CT. Lumbar cerebrospinal fluid pressure was monitored continuously for a 1-hour period in all patients on admission and at weekly intervals in patients with communicating hydrocephalus for the 1st month of treatment. Cranial CT scanning was done on admission and repeated in survivors after 1 month and again after 6 months of antituberculous therapy. The raised intracranial pressure of 112 children with communicating hydrocephalus, as demonstrated by air-encephalography, was treated medically (with daily acetazolamide and furosemide) for 1 month. Thirty-one children with noncommunicating hydrocephalus were referred for immediate ventriculoperitoneal shunting. No significant difference was found in the eventual ventricular size or clinical outcome between the two treatment groups. Lumbar cerebrospinal fluid pressure changes in the children with communicating hydrocephalus closely followed changes in the degree of hydrocephalus during the course of treatment. The main cause of permanent neurologic disability was basal ganglia infarction, which occurred unilaterally in 21% and bilaterally in 10% of patients on admission and developed in a further 22% of children during treatment. A prominent subarachnoid space, which was seen on the CT scan of 36% of patients after the 1st month of treatment and which reverted to normal, probably relates to the poor nutritional state of these patients on admission.(ABSTRACT TRUNCATED AT 250 WORDS)

Nutritional status of 3-6 year-old African children in the Cape Peninsula.

A survey was conducted in the Cape Town metropolitan area in 1990 to determine the dietary intake and anthropometric status of 3-6 year-old African children (N = 163). Dietary data obtained from 24-hour recalls revealed that mean energy intake (5200 kJ) was low and that mean intakes of most nutrients fell considerably below the recommended dietary allowances (RDAs). The average diet included an adequate number of portions from the meat and cereal groups, but was inadequate with respect to the milk and fruit/vegetable groups when compared with the recommendations of the Department of Health Services and Welfare. The macronutrient energy distribution was within prudent dietary guidelines, with 28.1% of energy (E) being obtained from total fat, 63.7% from carbohydrate and 13.2% from protein. Anthropometric profiles expressed in terms of the National Centre for Health Statistics' (NCHS) standards, revealed evidence of growth retardation and wasting in this population, coexisting with emergent obesity. The development of a nutrition and health policy to address the problems of both deficit and excess represents a pressing challenge.

PIP: During the first quarter of 1990, Xhosa-speaking nurses interviewed mothers and took anthropometric measurements of 163 children 3-6 years old living in squatter and formal housing areas of Cape Town, South Africa, to determine the nutritional status of the children. 39% of the children received less than 67% of the recommended daily allowance (RDA) of calories (i.e., deficiency) and 3% received more than 120% of the RDA. Most children were deficient in calcium (80%), iron (77%), vitamin A (64%), riboflavin (52%), niacin (53%), vitamin B6 (58%), and vitamin C (76%). Most children received more than 120% of the RDA for folic acid (68%) and for vitamin B12 (63%). Milk consumption was low (median intake, 0.5 portion vs. 2-3 portions as recommended by the department of national health and population development guidelines). The diet was also deficient in vegetables and fruit intake (1.32 vs. =or 4 portions) and fat intake (2.5 vs. =or 4 portions). Children did receive adequate portions of meat and foods from the cereal group, however. Macronutrient energy distribution fell within prudent dietary guidelines: 28.1% of energy from total fat, 63.7% from carbohydrates, and 13.2% from protein. 44.8% of children had only 2 meals with more than 600 kJ. 15 children (9.2%) had only 1 meal. 27.6% were stunted. 7.7% were underweight. 7.9% were wasted. 20.1% were obese. The undernourished children and the obese children consumed a diet low in micronutrients. These anthropometric findings indicate a population in transition--acutely and chronically undernourished children coexisting with obesity. The overall findings suggest a need to develop a nutrition and health policy to address nutrient deficit and excess.

The food and meal pattern in the urban African population of the Cape Peninsula, South Africa: the BRISK Study.

A cross sectional dietary study, utilising the 24 hour recall method, was conducted among 983 African adults aged 15 to 64 years resident in the Cape Peninsula during 1990. An evaluation of the dietary intake pattern revealed a diet confined to a relatively narrow range of foods, but little evidence of nutrient-empty food intake. In terms of recommendations, insufficient dairy products and vegetables and fruits were consumed, while requirements for intakes of cereals and components of the meat and fat groups were met. Supper emerged as the main meal of the day, contributing most of the energy and was consumed by 89 pc of respondents. Between meal eating made a valuable contribution to total nutrient intake. The low intakes of dairy products and vegetables and fruits and the apparent move away from the traditional diet present particularly great challenges.

The relationship between plaque index scores, fluoride content of plaque, plaque pH, dental caries experience and fluoride concentration in drinking water in a group of primary school children.

The aim of this study was to determine the relationship between fluoride in drinking water, plaque and dental caries experience in a sample of primary school children from a fruit farming (mainly grapes) area. The children who qualified for the study (n = 177) were placed into three groups according to the concentration of fluoride in their drinking water namely, less than 0.4 ppm (group A), between 0.4 and 1.6 ppm (group B) and more than 1.6 ppm (group C). Most children (78.5%) did not have a toothbrush. Plaque scores were significantly lower in groups B and C. A statistically significant inverse correlation was observed between plaque scores and fluoride content of plaque (p < 0.05). Plaque pH did not differ significantly between the groups. The concentration of fluoride in plaque was high and increased with increasing concentration of fluoride in the drinking water. Dental caries experience was relatively low in primary (dmft = 2.15; 2.07; 1.79) (p > 0.05) and permanent teeth (DMFT = 1.22; 1.43; 1.38) (p > 0.05). Paradoxically, there was also no significant inverse correlation between dental caries experience and fluoride concentration in drinking water. However, the significant inverse correlation between fluoride content of plaque and caries experience supports the contention that fluoride can be accumulated in plaque and act as a reservoir which provides prolonged elevated levels of fluoride to produce a cariostatic effect. It is postulated that the high fluoride levels in the plaque reservoir is responsible for the relatively low caries experience, the significant differences in caries experience between the groups and the poor correlation between dental caries experience and fluoride concentration in drinking water.

Nutrient intake in the urban African population of the Cape Peninsula, South Africa. The Brisk study.

In a dietary study on a representative sample of 983 adult African men and women aged 15-64 years, resident in the Cape Peninsula, South Africa, trained professional nurses administered a 24 hour recall interview. This formed part of a cross-sectional study on the prevalence of coronary risk factors (BRISK) in this population. The macronutrient profile reflected a diet meeting the Prudent Dietary Guidelines, but low in fibre. Mean intakes of vitamins and minerals indicated a nutritionally depleted diet. Comparisons with rural African populations have revealed that the dietary intake of this urbanising study population represents a transitional phase towards a progressively atherogenic Western diet.

Attitudes of private general practitioners towards health care in South Africa.

The need for health care reform in South Africa is acknowledged by the government as well as by the non-governmental health sector. There is, however, no unanimity regarding the nature of the envisaged reform. A country-wide postal survey of 700 private sector general practitioners (GPs) from a commercial database of 5,000 was conducted to explore attitudes towards health care. A response rate of 67.4% was obtained. Respondents were mostly male (92%) and urban-based (64%). The median age was 42 years. Most respondents: (i) believed health care to be a right for all citizens; (ii) favoured private or a combination of private and public funding mechanisms with fee-for-service arrangements; (iii) opposed cost-containment measures imposed by funders, e.g. medical aids; and (iv) believed doctors should be responsible for primary care in under-served areas. After sex, age, location (urban versus rural) and GP postgraduate qualification had been controlled for by means of logistic regression techniques, the university at which a respondent's basic degree was obtained emerged as the only independent predictor of attitudes to the following: (i) comprehensive care as a right; (ii) integration of the public and private sectors; (iii) preferred funding source for a future health system; and (iv) preference for fee-for-service remuneration. Both university and gender independently predicted attitudes on GPs' income. Graduates of white, Afrikaans-medium universities were strongly in favour of a privately funded and fee-for-service orientated system. Those who qualified at black universities, on the other hand, favoured public funding with less emphasison fee-for-service.(ABSTRACT TRUNCATED AT 250 WORDS)

An evaluation of an education programme on HIV infection using puppetry and street theatre.

'Puppets Against AIDS' is a novel educational medium being used to try to reduce the spread of HIV infection in South Africa. It involves the use of street theatre employing two-metre-high puppets who act out a story of how one person, who is infected with HIV, passes it onto a series of other people until he eventually dies. The puppet show was evaluated in two phases. The first involved a content analysis of a video recording of the show by a multidisciplinary group, according to a set of criteria for appropriate education on HIV infection. This show was found to be professional and comprehensive in terms of the educational messages provided. Some suggestions were made for improvements. The second phase was a before and after study of the impact on the audience at a series of live shows. The show made a significant contribution to knowledge and intended behaviour in the short term. Overall it was felt that the show does make a valuable contribution, but could be made more effective if incorporated into existing community-based education programmes on HIV infection.

PIP: A program of street theater has been developed in South Africa to disseminate educational messages at the community level on the prevention of HIV infection. Puppets Against AIDS employs 2-meter tall puppets to recount the story of how an HIV-positive person infects others until his eventual death. Aimed at the general community, these entertaining and educational shows include music, and are put on without advance publicity. Sex and death often being sensitive taboo issues, puppets were chosen as safe, non-threatening communicators for culturally diverse populations. The presentation was deemed professional and comprehensive. Suggestions were made for improvement. 2nd-stage evaluation questioned appropriateness and effectiveness at the community level, and consisted of a before and after audience impact study based upon a series of 21 live performances in 9 locales. Improvements and positive changes were measured for respondents' self-perceived knowledge about AIDS, expressed concern about AIDS, perceptions of who can get AIDS, perceptions of who will not get AIDS, knowledge of the healthy carrier state, knowledge of modes of transmission, perceived fatality of AIDS, and knowledge of protective behavior. Moreover, 97% of respondents stated that they had enjoyed the show. Overall, the paper urges further evaluation of the show, and incorporation of it into a multi-sectoral, ongoing campaign to effect maximum impact.

In vitro demineralization of enamel by orange juice, apple juice, Pepsi Cola and Diet Pepsi Cola.

Enamel demineralization was studied over periods related to normal use of an orange juice, an apple juice, Pepsi Cola and Diet Pepsi Cola. Rectangular blocks of intact human enamel (3 mm x 3 mm) were cut from teeth, coated with nail varnish except for the enamel surface and exposed to the drinks for 2, 4, 5, 6 or 40 minutes. The amount of calcium released from the enamel into solution was determined with the use of an atomic absorption spectrophotometer. The results showed the following degree of enamel demineralization: Pepsi Cola = orange juice greater than apple juice greater than Diet Pepsi Cola. The results suggest that diet colas are less demineralizing than other acid drinks, and complementary plaque studies indicate that they are also less cariogenic. The study emphasized the importance of acid-type, buffer capacity, pH and the presence of other components on the degree of enamel demineralization.