Pharmacokinetics and safety of repeated oral dosing of acetaminophen in adult horses.

BACKGROUND: There are no published studies on the pharmacokinetics of acetaminophen at the dosage used clinically (20 mg/kg), nor has the safety of multiple doses in horses been investigated. OBJECTIVE: Define the pharmacokinetic parameters of oral acetaminophen at 20 mg/kg in adult horses as a single dose, and twice daily for 14 days to assess the safety of multiple dosing. STUDY DESIGN: Pharmacokinetic study, multiple dose safety study. METHODS: Eight healthy Thoroughbred geldings were given acetaminophen (20 mg/kg; 500 mg tablets) orally as a single dose followed by doses every 12 h for 14 days. Serial blood samples were collected for determination of plasma acetaminophen concentrations using high performance liquid chromatography with ultraviolet detection. Serum biochemical analysis, gastroscopy and liver biopsy were examined during the safety study. RESULTS: Following a single dose, mean maximum concentration (Cmax ) was 16.61 µg/mL at 1.35 h (Tmax ), and drug concentration was below the lower limit of detection in most horses by 24 h. Elimination half-life (T1/2 ) was 2.78 h. No significant accumulation was noted following multiple doses. Average Cmax of acetaminophen following multiple oral dosing was 15.85 µg/mL, with a Tmax of 0.99 h and T1/2 of 4 h. Serum activities of sorbitol dehydrogenase were significantly decreased and total bilirubin concentrations were significantly increased following the last dose. No statistically significant changes were noted in gastroscopy scores. MAIN LIMITATIONS: Only one dose level (20 mg/kg) was studied, sample size was small and only a single breed and sex was used, with no pretreatment liver biopsies. CONCLUSION: This study described the pharmacokinetics of acetaminophen following single and multiple 20 mg/kg oral doses in adult horses and demonstrated the safety of acetaminophen with multiple oral dosing over 14 days. The summary is available in Portuguese - see Supporting information.

Condom use after voluntary counselling and testing in central Mozambique.

OBJECTIVE: To evaluate the efficacy of voluntary counselling and testing (VCT) for HIV/AIDS in changing risky sexual behaviour in central Mozambique. METHOD: Longitudinal cohort study of men and women aged at least 18 years from October 2002 to June 2003. We interviewed 622 participants in VCT groups and 598 in non-VCT groups. The interviews occurred before counselling and 4 and 6 months afterwards. RESULTS: Reported use of condoms while having sex with a friends/prostitute increased over each time period in the VCT group and between baseline and first visit in the non-VCT group. Both men and women in the VCT group increased their condom use over time, but the women in the non-VCT group did not. Reported always/sometimes use of condoms for both literate and illiterate subjects was higher and rose over time in the VCT group. CONCLUSION: People who undergo voluntary counselling and testing fro HIV/AIDS change their behaviour, presumably as a result of their counselling.

Antenatal syphilis in sub-Saharan Africa: missed opportunities for mortality reduction.

PURPOSE: Between 4-15% of pregnant women are believed to be infected with syphilis in sub-Saharan Africa. Active infection with syphilis in pregnant women results in foetal or infant death or disability for 50-80% of affected pregnancies, and is a major cause of adult morbidity as well. Antenatal syphilis screening is cheap and effective; however, it is often poorly implemented in countries with high syphilis risk. This study sought to estimate the missed opportunities for antenatal syphilis screening in sub-Saharan Africa. METHODS: Survey data were collected from 22 ministries of health in sub-Saharan Africa, complemented by data from published sources and key informants. Informants described their country's policies and experience with antenatal syphilis screening and estimated their national syphilis screening rates. FINDINGS: Seventy-three percent of women are reported by WHO to receive antenatal care in the study countries. Of women in antenatal care, 38% were estimated by survey respondents to be screened for syphilis. Costs and the organization of services were the principal reported obstacles to screening. With syphilis seroprevalence estimated at 8.3%, approximately 1 640 000 pregnant women with syphilis are undetected annually, including 1 030 000 women who attend antenatal care. DISCUSSION: Syphilis testing and treatment is a cost-effective intervention that deserves much greater attention, particularly in sub-Saharan Africa and other countries where syphilis infection is high.

Environmental health consequences of land mines.

This article reviews the literature on the environmental effects of anti-personnel land mines globally. Land mines represent an immediate environmental health problem. Between 60 and 70 million land mines are currently in place in over 70 countries. Designed to kill or main humans, including civilians, they injure an estimated 1, 200 persons and kill another 800 every week. Land-mine injuries tend to be serious; an estimated 300,000 persons worldwide have been disabled by them. The problem, politically very controversial, can be resolved only by preventing the further placement of mines, by demining of areas already mined, and by coping with the personal and environmental devastation that they have already caused. Environmental health personnel should be involved in promoting awareness of the problem, in improving services for land-mine victims, and in promoting political efforts to ban further use of land mines.

Rapid KABP survey for evaluation of NGO HIV/AIDS prevention projects.

The Johns Hopkins University HAPA Support Program (HSP) provided technical assistance to Save the Children (SC), a U.S.-based nongovernmental organization, to conduct a survey of knowledge, attitudes, beliefs, and practices (KABP) related to AIDS among rural Zimbabweans. The objectives of the HSP technical assistance were to field test a rapid KABP survey methodology and to assist SC to provide data that would contribute to their final project evaluation. The entire process of planning, implementation, preliminary data analysis, and preparation of a draft report of survey results was completed in a four-week period. A total of 660 respondents, aged 18-45 years, selected by a modified 30-cluster sampling method, were interviewed in two SC project areas. Although knowledge about HIV/AIDS was high, a number of misconceptions about HIV transmission and unfavorable attitudes to people with AIDS were noted. Of five knowledge and attitude variables that could be compared with the baseline survey results, 4 showed favorable changes and 1 showed an unfavorable trend. Comparing responses from those who were educated by SC with those who had other sources of information about HIV/AIDS, higher levels of knowledge were seen in the SC-educated group and, in one area, somewhat greater willingness to care for family members with AIDS. However, there were no differences seen in other attitudes, beliefs, or in practices regarding condom use. The rapid KABP survey approach was successful in providing, with a relatively modest investment of resources, quantitative data useful for project evaluation, and for developing HIV/AIDS-intervention strategies.

Understanding cultural obstacles to HIV/AIDS prevention in Africa.

Global efforts to prevent further spread of the human immunodeficiency virus (HIV) are faced with tremendous obstacles, and limited understanding of the cultural and social context of HIV and AIDS is an important factor hindering prevention efforts to date. Examples from the authors' experience in providing technical support to 7 nongovernmental projects for HIV/AIDS prevention in Africa illustrate the importance of including qualitative data in initial baseline studies for projects responding to the problem. Qualitative data are needed to provide a deeper understanding of the meanings of behavior and other phenomena that are identified through quantitative methods. Runyoka is discussed as an example of a traditionally-defined illness in Zimbabwe that appears to affect local understanding of HIV/AIDS. The authors suggest approaches that would assist HIV/AIDS projects to better understand and respond to the social and cultural context of AIDS in local settings.

The role of non-governmental organizations in the global response to AIDS.

PIP: This article describes the role of non-governmental organizations (NGOs)in AIDS prevention worldwide, highlights successful NGO projects, assesses NGO strengths and weaknesses, and provides recommendations for supporting the work of NGOs. While NGOs vary in their scope, all share a dedication to a set of social values that guides their organizational missions. In industrialized nations, NGOs established trends for AIDS prevention and treatment, including the targeting of educational materials to specific groups, peer education, and increasing access to experimental drugs. In the developing world, NGOs have been the first to respond to the epidemic, promoting access to counselling and healthcare to people with AIDS. The article briefly describes successful NGO projects for AIDS prevention and care in developing countries. Examples include the establishment of the Rio de Janeiro Prostitutes Association, designed to fight AIDS and STDs among prostitutes in Brazil, and the formation of the NGO Consortium in Kenya, which serves as a bridge between the AIDS Programme Secretariat and the private sector. Among their strengths, NGOs are able to respond quickly, address controversial issues, reach the community more quickly and effectively, reach marginalized groups, and mobilize local resources. Some of their disadvantages include funding difficulties, staff attrition, and lack of cooperation among organizations. Noting the enormous potential of NGOs to play a major role in AIDS prevention, the article provides 9 specific recommendations for supporting NGOs.^ieng

Tuberculosis risk among migrant farm workers on the Delmarva peninsula.

A survey was conducted to ascertain the risk of tuberculosis (TB) among migrant farm workers on the Delmarva peninsula. Relevant histories were obtained from 842 migrants; a total of 709 skin tests were completed, and 239 sputum specimens were examined for acid-fast bacilli (AFB) and culture. No cases of infectious tuberculosis were ascertained by history or AFB examination. One sputum culture was positive for M. tuberculosis and 13 were positive for various species of nontuberculous mycobacteria. Thirty-seven per cent of migrants tested had significant skin test reactions of 10 mm or more. Reaction rates for men were 41 per cent and for women 25 per cent. Age specific rates ranged from 14 per cent in children aged 5-14 to 54 per cent for ages 45-54. Rates for the principal national/ethnic groups were Haitians 55 per cent, Mexicans 36 per cent, US Blacks 29 per cent and US-born Latinos 20 per cent. Based on these results and other information currently available, it is recommended that current Centers for Disease Control (CDC) recommendations for TB prophylaxis continue to be applied for migrant workers, but that mass screening by skin testing in camp populations not be emphasized. Other recommendations focus on: case finding of active disease, improving continuity and follow-up, increasing coordination among involved agencies, and actively supporting improved economic and living conditions for migrant farm workers.