Utilisation of village clinics in Southwest China: evidence from Yunnan Province.

INTRODUCTION: Primary healthcare in rural China is underutilised, especially in village clinics in Southwest China. The aim of this study was to explore any relationships among the ethnicity of the healthcare provider, the clinical competence of the healthcare provider, and the utilisation of village clinics in Southwest China. METHODS: This cross-sectional survey study involved 330 village healthcare providers from three prefectures in Yunnan Province in 2017. Multiple logistic regressions were adopted to investigate the utilisation of primary healthcare among different ethnic healthcare providers. RESULTS: Primary healthcare utilisation was higher in village clinics where healthcare providers were Han Chinese than those where healthcare providers were ethnic minority (151 vs 101, P=0.008). The logistic regression analysis showed that clinical competence was positively associated with the utilisation of primary healthcare (odds ratio [OR]=1.49, 95% confidence interval [CI]=1.12-2.00; P=0.007) and that inadequate clinical competence of ethnic minority health workers may lead to a lag in the utilisation of primary healthcare (OR=0.45, 95% CI=0.23-0.89; P=0.022). CONCLUSION: Our results confirm differences in the utilisation of primary healthcare in rural Yunnan Province among healthcare providers of different ethnicities. Appropriate enhancements of clinical competence could be conducive to improving the utilisation of primary healthcare, especially among ethnic minority healthcare providers.

Postscript relating to new allegations made by Edward Hooper at The Royal Society Discussion Meeting on 11 September 2000.

At The Royal Society Discussion Meeting, Origins of HIV and the AIDS epidemic, which this issue records, Edward Hooper added two new 'smoking guns' to the accusations published previously in The river. These were proposed as conclusive evidence for the hypothesis that simian immunodeficiency virus-contaminated CHAT polio vaccine caused the HIV-1 group M epidemic. We have investigated the facts in relation to these 'smoking guns'.

The Jezierski papers: live polio vaccine development in colobus monkey cells but not chimpanzee cells in the Belgian Congo, 1952-1958.

A reading of ten relevant papers by Alexandre Jezierski provides evidence for the only attempt in Central Africa to develop a live oral polio vaccine (OPV) from growing reference wild polio strains to 210 passages in colobus monkey tissue culture, and experimental administration to about 25 humans. Chimpanzees were used as a human model, but their tissues or kidneys were absent from the passage and production line of the proposed vaccine. Thus, the implication published by Hooper that Jezierski had produced a candidate OPV that might have contained chimpanzee viruses, possibly simian immunodeficiency virus cpz or the precursor of human immunodeficiency virus-1 group M, is incorrect.

Development of an acellular pertussis vaccine and its administration as a booster in healthy adults.

An acellular pertussis vaccine which contains highly purified pertussis toxoid (PT) and filamentous haemagglutinin (FHA) has been developed. These proteins have been shown to be stable, with essentially no significant reversion of the pertussis toxoid after a new detoxification procedure. Two clinical trials using this vaccine as a booster in 45 healthy adults have been performed. Results show that the vaccine was well tolerated, causing essentially mild, transient symptoms after administration. It induced an increase in anti-PT and anti-FHA antibody titres in all vaccinees.

Measles, mumps and rubella immunization at nine months in a developing country.

The antibody responses and reactogenicity of a measles, mumps and rubella vaccine in 9-month-old and 15-month-old black children in South Africa were compared. The antibody response to the measles component was marginally better in the older group, but no differences were observed in the response to the mumps and rubella components. Reactogenicity was similar in the two age groups. Therefore it is possible that a trivalent measles, mumps and rubella vaccine can safely and effectively replace routine measles immunization at 9 months of age in this population. Whether routine immunization policy should incorporate such a vaccine depends on the extent of acceptance of measles vaccination. In urban populations of developing countries with high rates of measles immunization, routine vaccination at 9 months might interrupt circulating wild type rubella and provide sufficient herd immunity to protect susceptible women of childbearing age. It also should decrease significantly the complications associated with wild type mumps infection. The replacement of measles vaccine by a trivalent vaccine may be very cost-effective.

Response to RIT 4237 oral rotavirus vaccine in human milk, adapted-and soy-formula fed infants.

During the first month of life 28 full-term newborns were breast-fed (18 males and 11 females). Thereafter 8 infants continued breast-feeding while the remainder were randomly fed on either an adapted milk formula (n=13) or a soy-formula (n=7). At five months, after an oral dose of RIT 4237 rotavirus vaccine of bovine origin was given, growth and IgM/IgG type antibodies against rotavirus were measured. Weight gain was similar in all infants. There were 2 IgM and 1 IgG responders out of 7 soy fed infants, compared with 4 out of 8 human milk fed (both IgM and IgG) and 7 out of 13 IgM and 6/12 IgG formula fed infants responding to vaccination. This observation confirms previous results obtained with polio, diphtheria tetanus and pertussis vaccines indicating that soy-protein formulas may interfere with immunization processes.

A trial of RIT-4237 rotavirus vaccine in 1-month-old infants.

In a double blind placebo-controlled study rotavirus vaccine RIT 4237 was offered to young infants after the fourth week of life. The vaccine was very well tolerated. Fifty-seven out of 100 vaccine recipients and 10 out of 103 placebo recipients developed rotavirus-IgM-antibodies during the 1 month follow-up period. During a 6 month follow-up, stool samples from 2 out of 12 vaccinees and from 5 out of 12 placebo recipients contained rotavirus.

Acute interstitial pneumonitis and carbamazepine therapy.

A 14-year-old girl with skin rash and acute interstitial pneumonitis is presented. She had been taking carbamazepine for two months. Withdrawal of carbamazepine resulted in a prompt improvement of the clinical picture and a normalization of lung function tests. A hypersensitivity reaction to carbamazepine is suggested and the importance of a skin rash as first sign of a generalized reaction is stressed. Lymphocyte-stimulation-tests with carbamazepine were strongly positive in the patient and not in healthy persons nor in patients taking carbamazepine without adverse effects.

Incidence, growth and oestradiol-receptor levels of 7, 12-dimethylbenz (alpha) anthracene-induced mammary tumours in rats: effects of neonatal sex steroids and oestradiol implants.

The effects of neonatally administered steroids on the sensitivity of the mammary gland to tumour induction by 7, 12-dimethylbenz (alpha) anthracene was studied as a model for delayed (de) differentiating effects of steroid hormones. Immediately after birth male and female rats were gonadectomized and treated with testosterone, oestradiol or oil. Control animals were left intact. On day 45 all the gonadectomized animals and some of the control animals received an implant which delivered continuous low levels of oestradiol. The carcinogen was administered on day 55. The administration of an oestradiol implant, which increased prolactin levels in all animals, markedly reduced tumour incidence in intact female rats and increased tumour incidence in intact male rats. Neonatal administration of testosterone or oestradiol did not significantly influence tumour incidence, histopathology or oestradiol responsiveness in neonatally gonadectomized rats but tended to decrease tumour animals suggests that the effects observed by other authors in intact rats are mediated by changes in gonadal secretions. It is concluded that the hormonal environment during and after tumour induction plays a major role in the development of 7, 12-dimethylbenz (alpha) anthracene-induced mammary carcinomas.