The geographic variation in stroke incidence in two areas of the southeastern stroke belt: the Anderson and Pee Dee Stroke Study.

BACKGROUND AND PURPOSE: South Carolina and the southeastern United States have maintained the highest stroke mortality in the country. The Anderson and Pee Dee Stroke Study is an assessment of cerebrovascular disease incidence in 2 geographically defined communities in the stroke belt. METHODS: Strokes were identified in the Anderson and Pee Dee areas of South Carolina. All hospitalized and out-of-hospital deaths occurring during 1990 among the residents of these 2 areas were included. Strokes were classified by an independent panel of neurologists using a standard protocol that included specific criteria for stroke and subtypes. RESULTS: The overall age-adjusted stroke incidence rates (per 100 000 population) were significantly higher in the Pee Dee population (293.1) compared with Anderson (211.2). The geographic differences were more dramatic in the younger age groups of 35 to 64 years. Likewise, incidence rates for blacks were nearly twice the rates for whites. The rates in the Pee Dee were higher than the rates from other studies in the United States and other parts of the world. Although the stroke subtypes did not vary between the 2 regions, race-sex differences were identified. CONCLUSIONS: High stroke incidence and disease rates persist for all 4 race-sex groups in the Southeast and reflect similar risks as mortality rates. However, geographic variability in stroke rates suggests that the pattern of disease in the region is not so much a "belt" of increased stroke in contiguous areas but rather more a "necklace" of different levels of risk. These results should be useful in the identification of factors associated with this geographic enigma.

A simple method for the comparison of commercially available ATP hygiene-monitoring systems.

The purpose of this study was to evaluate a methodology which could easily be used in any test laboratory in a uniform and consistent way for determining the sensitivity and reproducibility of results obtained with three ATP hygiene-monitoring systems. The test protocol discussed here allows such comparison to be made, thereby establishing a method of benchmarking both new systems and developments of existing systems. The sensitivity of the LUMINOMETER K, PocketSwab (Charm Sciences) was found to be between 0.4 and 4.0 nmol of ATP with poor reproducibility at the 40.0 nmol level (CV, 35%). The sensitivity of the IDEXX LIGHTING system and the Biotrace UNILITE Xcel were both between 0.04 and 0.4 nmol with coefficients of variation (CVs) of between 9% at 0.04 nmol and 10% at 0.4 nmol for the IDEXX system and 17% at 0.04 nmol and 21% at 0.4 nmol for the Biotrace system. The three systems were tested with a range of dilutions of different food residues: orange juice, raw milk, and ground beef slurry. All three test systems allowed detection of orange juice and raw milk at dilutions of 1:1,000, although the CV of results from the Charm system (54 and 74% respectively) was poor at this dilution for both residues. The sensitivity of the test systems was poorer for ground beef slurry than it was for orange juice and raw milk. Both the Biotrace and IDEXX systems were able to detect a 1:100 dilution of beef slurry (with CVs of 17 and 10% respectively), whilst at this dilution results from the Charm system had a CV of 55%. It was possible by using the method described in this paper to rank in order of sensitivity and reproducibility the three single-shot ATP hygiene-monitoring systems investigated, with the IDEXX LIGHTNING being the best, followed by the Biotrace UNILITE Xcel, and then the charm LUMINOMETER K, PocketSwab.

Detection of Escherichia coli in potable water using direct impedance technology.

Direct impedance measurement utilizing a medium previously described as being specific for Escherichia coli and which contains trimethylamine N-oxide (TMAO) and glucuronic acid was used to detect E. coli in water samples. The system was compared with the Colilert presence/absence test and the United Kingdom standard membrane filtration technique using membrane lauryl sulphate broth. The impedance method correlated well with both the traditional membrane method (93%) and the Colilert method (93.95%) for a number of different water types. No interference from Citrobacter spp. (as reported in previous studies) was detected in this study although some Salmonella spp. did give false-positive results. The data presented here suggest that the use of direct impedance may offer an alternative to conventional methods for the detection of E. coli in water.

Subacute combined degeneration of the spinal cord: MR findings.

The authors present the initial and follow-up MR findings in a patient with subacute combined degeneration of the spinal cord, a complication of vitamin B12 deficiency, and a rare cause of demyelination of the dorsal and lateral columns of the spinal cord. Initial study showed high intensity in the dorsal columns of the cervical and thoracic spinal cord on T2-weighted image. Five months after treatment, the abnormal signal intensity was noted to have decreased.

A successful measles campaign as a model for achieving high uptakes of MMR.

The introduction of MMR makes it imperative to improve and maintain high vaccine uptakes. Here we describe an increase in measles uptake following two short campaigns at a year's interval, run by geographically attached health visitors in inner London. The computer controlled immunisation system was used to organise and evaluate the campaigns. They were directed at two groups of children; those due vaccination (eligible prompt participants) and those who had failed to attend previously (eligible late participants). Results are given as cumulative percent uptake for the 1984, 1985 and 1986 birth cohorts. The campaign resulted in an increased vaccine uptake, from 78% to 87%, and contributed to earlier vaccination; these effects were sustained. The reasons for the success are discussed, as similar campaigns could be used to achieve high uptakes of MMR.