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Biomedical subjects

S Wall

Publications and source records attributed to S Wall.

At least 91 records · Page 5Linked to original sources
PubMed1995

A one-year community study of under-fives in rural Ethiopia: patterns of morbidity and public health risk factors.

A prospective weekly home surveillance study was undertaken to determine morbidity patterns within the Butajira Rural Health project in central Ethiopia. Overall prevalence of illness was 5.8% in 1216 person-years observed among rural Ethiopian children aged under 5 years. Acute respiratory infections (ARI) (prevalence 2.8%) and acute diarrhoea (2.4%) were the commonest conditions. Episodes of illness were distributed unequally among children, with a mean of 2.34 episodes per child. These included an average of 1.13 episodes of ARI (of which 0.16 had lower respiratory symptoms [ALRI]) and 1.17 episodes of acute diarrhoea. Sanitation factors were the principal risks for gastroenteritis, while living in rural areas predisposed children to ARI. Parental factors such as illiteracy were also linked to morbidity.

Acute Disease↗
PubMed1995

Epidemiology for prevention.

This paper illustrates the basis of, expectations for and evaluation of prevention from an epidemiological perspective. Specifically, the extent to which epidemiologists could and should be involved in designing and evaluating public health interventions is addressed. Changes in the view on disease causation and epidemiology's role for the future of public health are discussed. Examples from cardiovascular epidemiology are used to illustrate the ever more complex, but still incomplete, knowledge on which prevention is based. A few current examples illustrate paradoxes where health information must balance academic discord. Methodological problems in the evaluation of intervention studies often fail to live up to the expectations of prevention. Outcome indicators of preventive projects must be developed and traditional appraisals of effects be supplemented with process analyses using both quantitative and qualitative methods. Social conditions for prevention are discussed and areas for further research are suggested.

Epidemiologic Methods↗
PubMed1995

Facial skin symptoms in visual display terminal (VDT) workers. A case-referent study of personal, psychosocial, building- and VDT-related risk indicators.

BACKGROUND: The Office Illness Project in northern Sweden, comprising both a screening questionnaire study of 4943 office workers and a case-referent study of facial skin symptoms in 163 subjects was recently completed. Previously published results from the survey showed that female gender, asthma/rhinitis, high psychosocial work load, visual display terminal (VDT) and paperwork were related to an increased prevalence of facial skin symptoms. METHODS: The case-referent study presented in this paper used data from the questionnaire supplemented by information from a clinical examination, a survey of psychosocial factors at work, building data and VDT-related factors from inspection and measurements taken at the work site. RESULTS: Psychosocial conditions and exposure to electromagnetic fields or conditions associated with such factors were related to an increased occurrence of skin symptoms. The results also indicated that personal factors such as atopic dermatitis and physical exposure factors influencing indoor air quality, such as paper exposure and cleaning frequency were related to an increased prevalence of symptoms. CONCLUSIONS: The results suggest that skin symptoms reported by VDT users have a multifactorial background.

Administrative Personnel↗
PubMed1995

Lung cancer, smoking and smelter work in a occupational cohort.

BACKGROUND: A cohort of employees at a smelter in Northern Sweden has been updated with the addition of information regarding smoking habits to evaluate the role of smoking in the occurrence of lung cancer in various job categories and employment cohorts. An updated analysis of earlier studies of the interaction between roaster work and smoking is also reported. The cohort members first employed during the period 1928-1979 have been followed up to 1 January 1988. Information regarding smoking habits for 69% of the cohort was gathered in a questionnaire study. RESULTS: The prevalence of daily smoking decreased during the study period and was lower for salaried employees. The figures were, however, comparable with national figures for similar social and occupational strata. Adjustment for smoking did not alter the lung cancer gradient between employment cohorts or between job categories. CONCLUSIONS: The interaction between smoking and roaster work was confirmed and the benefits from ceasing to smoke shown to be greater among the roaster workers.

Adult↗
PubMed1994

The Butajira Rural Health Project in Ethiopia: a nested case-referent (control) study of under-5 mortality and its health and behavioural determinants.

The associations between under-5 mortality and its health and behavioural determinants were investigated in a rural district of Ethiopia, by means of a concurrent case-referent technique nested within a study-base population established in 1987. Three-hundred and six infant and child deaths registered over a period of 1 year, were contrasted with 612 controls, matched for age, sex and study area. Data were collected by trained non-medical workers using a structured questionnaire. Breastfeeding and supplementary feeding came out as strongly protective against under-5 mortality, even when controlling for parental and environmental determinants. Early termination of breastfeeding was demonstrated to have a substantial impact on mortality, particularly on that caused by diarrhoea. Late introduction of supplementary feeding, particularly of protein origin, was also associated with increased under-5 mortality. When the relative impacts of parental, environmental and behavioural determinants are compared, the greater impact of parental factors can be demonstrated, especially among infants.

Age Factors↗
PubMed1994

Diarrhoea among children in rural Somalia. Maternal perceptions, management and mortality.

Diarrhoea was the second most common symptom of disease in a longitudinal study of 431 children under 5 years of age in rural Somalia. Most mothers perceived diarrhoea as a condition in which oral rehydration therapy (ORT) and feeding were logical parts of its management. During 1 year of observation, ORT was used in the household in one-third of the episodes of diarrhoea, mostly by non-farming, young and literate mothers. Infants were treated more often than older children, as were also children in smaller households. In a 3-year demographic surveillance in the same area (1219 person years), the under-5 mortality from diarrhoea in children of literature and illiterate mothers was 43 per 1000 (95% CI 0-84) and 93 per 1000 (95% CI 60-101), respectively. The findings suggest that the use of ORT is associated with a mother's ability to allocate time to health care and her general position in the household.

Adult↗
PubMed1994

Co-operation, participation and conflicts faced in public health--lessons learned from a long-term prevention programme in Sweden.

A comprehensive community-based programme for prevention of cardiovascular diseases (CVD) and diabetes was established in 1985 in a small municipality in northern Sweden. A cross-sectional survey to the general public was performed and semi-structured open-ended interviews were taken of actors at different levels. Notes from official records were also included in the study. The aim was to describe and discuss some factors that promote or constrain community participation in health programmes. The results generally confirmed that the right of definition concerning the health programme mainly remained with the health professionals. Community participation was mainly defined by the actors based on the medical and health planning approach and, thereby, as a means to transform health policy plans into reality by transmitting health knowledge and increasing consciousness among the citizens of the need for changing lifestyles. However, participation as a means of identifying problems and demonstrating power relationships and as elements in promoting local democracy was hardly represented among the actors at all. Overall, the CVD health programme was characterized by consensus between the actors. Despite this, debates and arguments about interpretations, social interests, personal conflicts and ideological constraints were observed. However, a majority of the public wanted the CVD preventive programme to continue.

Adult↗
PubMed1994

The Sick Building Syndrome (SBS) in office workers. A case-referent study of personal, psychosocial and building-related risk indicators.

BACKGROUND: The Office Illness Project in Northern Sweden, comprising both a screening questionnaire study of 4943 office workers and a case-referent study of Sick Building Syndrome (SBS) in 464 subjects was recently completed. Previously published results from the survey showed that female gender asthma/rhinitis, high psychosocial work load, paper and visual display terminal (VDT) work were related to an increased prevalence of SBS symptoms. METHODS: The case-referent study presented in this paper used data from the questionnaire supplemented with information from a clinical examination, a survey of psychosocial factors at work building data from inspection and measurements taken at the work sites. RESULTS: Personal factors such as atopy and photosensitive skin, psychosocial conditions and physical exposure factors influencing indoor air quality (IAQ), such as outdoor air flow rates and the presence of photocopiers were related to an increased prevalence of the reported SBS symptoms. The results were established using multivariate analysis. CONCLUSIONS: The rate response relationship between actually measured ventilation rates and the prevalence of perceived SBS symptoms presents strong evidence for the association between IAQ factors and health.

Adult↗
PubMed1994

Gender and social patterning of health: the Norsjö cardiovascular preventive programme in northern Sweden 1985-1990.

OBJECTIVE: To assess the extent to which the impact of social stratification on cardiovascular disease (CVD) risk factors was different among men and women. DESIGN: Pooled data from six (1985-90) cross-sectional health surveys. SETTING: The intervention area is an inland municipality, Norsjö, in northern Sweden with a population of 5,300 inhabitants. MAIN OUTCOME MEASURES: Smoking, high blood pressure, hypercholesterolaemia, and perceived health status. RESULTS: Almost half of the study population had hypercholesterolaemia (> or = 6.5 mmol/l), 19% of men and 25% of women were smokers, and 30% and 29%, respectively, had hypertension. Age had a strong impact on all outcome measures. Social factors were associated with smoking in women and with hypercholesterolaemia in men. There were no sex differences in perceived good health. The likelihood of self-assessed good health decreased with increasing risk factor load, with the exception of hypercholesterolaemia, in all social strata. CONCLUSION: The present study implies the importance of considering age, gender, and social differences in intervention and evaluation of CVD preventive programmes. The study also demonstrate that self-defined health contains important information on cardiovascular risk profile.

Adult↗
PubMed1994

Exploring the use of NPs and PAs in primary care.

Although nurse practitioners (NPs) and physician assistants (PAs) can meet a majority of primary care needs, the implications for ambulatory health centers are not straightforward. One HMO health center undertook to determine its providers' and patients' views on the role of NPs and PAs in its Internal Medicine Department. The analysis suggests that 28% of visits required the attention of a physician, though physicians actually provided 66% of visits. We conclude that it may be possible to increase the use of NPs and PAs if we can educate members, particularly younger women, about the role of NPs and PAs so as to encourage their preferentially selecting these practitioners for their routine care.

Adult↗
PubMed1993

Famine in Somalia.

Explore the source record for details and available documents.

Cause of Death↗
PubMed1993

Breast cancer screening with mammography: overview of Swedish randomised trials.

Despite encouraging results from screening trials the efficacy of mammography in reducing mortality remains somewhat controversial. Five studies have been done in Sweden. This overview, based on 282,777 women followed for 5-13 years in randomised trials in Malmö, Kopparberg, Ostergötland, Stockholm, and Gothenburg, reveals a 24% (95% confidence interval 13-34%) significant reduction of breast cancer mortality among those invited to mammography screening compared with those not invited. To avoid the potential risk of differential misclassification causes of death were assessed by an independent end-point committee after a blinded review of all fatal breast cancer cases. The mortality reduction was similar, irrespective of the end-point used for evaluation ("breast cancer as underlying cause of death" or "breast cancer present at death"). There was a consistent risk reduction associated with screening in all studies, although the point estimate of the relative risk for all ages varied non-significantly between 0.68 and 0.84. The cumulative breast cancer mortality by time since randomisation was estimated at 1.3 per 1000 within 6 years in the invited group compared with 1.6 in the control group. The corresponding figures after 9 years are 2.6 and 3.3 and after 12 years 3.9 and 5.1. The largest reduction of breast cancer mortality (29%) was observed among women aged 50-69 at randomisation. Among women 40-49 there was a non-significant 13% reduction. In this younger age group cumulative breast cancer mortality was similar in the invited and control group during the first 8 years of follow-up. After 8 years there was a difference in favour of the invited women. There was no evidence of any detrimental effect of screening in terms of breast cancer mortality in any age group. Among women aged 70-74 years screening seems to have had only a marginal impact.

Adult↗
PubMed1993

Phase I trial of a 5-day infusion of L-leucovorin plus daily bolus 5-fluorouracil in patients with advanced gastrointestinal malignancies.

The combination of leucovorin [(6d,l)-5-formyl-tetrahydrofolate] and 5-fluorouracil (5-FU) has increased efficacy compared to 5-FU alone as treatment of advanced colorectal cancer. Leucovorin is metabolized to methylene tetrahydrofolate, which potentiates the antitumor actions of 5-FU by forming a ternary complex of thymidylate synthase, fluorodeoxyuridine and methylene tetrahydrofolate. Only l-leucovorin is metabolized to methylene tetrahydrofolate and forms this ternary complex. However, d-leucovorin may not be inert. d-Leucovorin may impair cellular uptake and metabolism of l-leucovorin, thereby inhibiting the actions of l-leucovorin. Because of this possible limitation to the effectiveness of racemic leucovorin, we have begun to explore the effects of the pure, biologically active isomer, l-leucovorin. In this phase I trial, patients with advanced gastrointestinal malignancies were treated with a 5-day continuous infusion of l-leucovorin and daily intravenous boluses of 5-FU at 370 mg/m2. The dose of l-leucovorin was escalated in groups of three patients at four doses, 200 mg/m2 per day, 400 mg/m2 per day, 700 mg/m2 per day and 1000 mg/m2 per day. Treatment was repeated every 28 days. Seventeen patients with advanced gastrointestinal cancers entered the trial. Sixteen patients were evaluable for toxicity. Toxicity was similar to that expected for leucovorin plus 5-FU. The most common severe toxicities (and the number of patents affected) were: diarrhea (2), mucositis (2), nausea/vomiting (1), and abdominal/rectal pain (2). The maximum tolerated dose of l-leucovorin was 700 mg/m2 per day. Twelve patients were evaluable for response. One complete, one partial and one minor response were observed. All responses occurred among the nine patients with colorectal carcinomas. The combination of l-leucovorin and 5-FU is well tolerated by patients and appears active for treatment of advanced colorectal carcinomas. Additional clinical trials are necessary to determine if l-leucovorin is more effective than d,l-leucovorin for modulating the effectiveness of 5-FU.

Adenocarcinoma↗
PubMed1993

Incidence of HIV-1 infection among adults in the Kagera region of Tanzania.

The results of a population-based follow-up study are presented. The baseline study which started in August 1987, was carried out to determine the prevalence of human immunodeficiency virus (HIV-1) infection in the Kagera region of Tanzania. A multistage cluster sampling technique was adopted in the selection of the study population. In the follow-up survey which started in June 1988, members of the same study population were revisited and studied in order to determine the incidence of HIV-1 infection among those who were HIV seronegative in the initial survey. HIV serology was conducted by using enzyme-linked immunosorbent assay and all positive sera were confirmed by the Western blot technique. A total population of 1316 adults aged 15-54 years was studied, constituting an average follow-up response rate of 69% in the rural areas and of 59% in the urban area. The overall incidence of HIV-1 infection among the adult population sample was 13.7 per 1000 person-years at risk with the highest incidence in the urban zone (47.5 per 1000 person-years at risk) and the lowest incidence in one of the three rural zones (4.9 per 1000 person-years at risk). The age-specific annual incidence was highest in the age group 25-34 years for males and in the age group 15-24 for females. From these results it was estimated that the number of newly infected adults in the region each year is about 8200 with a range between 5400 and 11,000 corresponding to the 95% confidence limits on the overall incidence.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1993

Changing social patterns of risk factors for cardiovascular disease in a Swedish community intervention programme.

Since 1985 a small-scale community-based cardiovascular disease (CVD) preventive programme has been in operation in an inland municipality, Norsjö, in Northern Sweden. The aim of this study was to assess the development of the relationship between social position and CVD risk factors in repeated cross-sectional surveys (1985-1990) among all men and women aged 30, 40, 50 and 60 years in the study area, using an age-stratified random sample from the Northern Sweden MONICA Study of 1986 and 1990 as reference population. These multiple cross-sectional surveys comprised a self-administered questionnaire and a health examination. Of the study population 95% (n = 1499) and 80% of those in the reference area (n = 3208) participated. Subjects were classified with regard to demographic, structural and social characteristics in relation to CVD risk factors and self-reported health status. Time trends in classical risk factor occurrence were assessed in terms of age- and sex- adjusted odds ratios using Mantel-Haenszel procedures. When simultaneously adjusting for several potential confounders we used a logistic regression analysis. Initially, more than half of the study population, both males and females, had and elevated (> or = 6.5 mmol/l) serum cholesterol level. After adjustments had been made for age and social factors it was found that the relative risk of hypercholesterolaemia dropped substantially and significantly among both sexes during the 6 years of CVD intervention in the study area. However, the probability of being a smoker was significantly reduced only in highly educated groups. Among other risk factors no single statistically significant change over time could be found. In the reference area there were no changes over time for the selected CVD risk factors. People in the study area had a less favourable perception of their health than those in the reference area. Social differences were found when perceived good health was measured, especially in variables indicating emotional and social support. When sex, age and social factors had been accounted for there was not clear change over the years in perceived good health.

Adult↗
PubMed1993

Construction and use of integrative vectors to express foreign genes in mycobacteria.

We have constructed a mycobacterial integrative vector by placing two copies of the insertion sequence IS900 flanking a kanamycin-resistance gene into a 'suicide' vector unable to replicate in mycobacteria. The Mycobacterium leprae gene encoding the M. leprae 18 kDa protein was cloned between the two copies of IS900 to provide expression signals. Constructs were introduced into Mycobacterium species smegmatis, vaccae and bovis BCG by electroporation and selection for kanamycin resistance. The expression of the 18 kDa gene was analysed by Western blotting. Integration of the vector into the M. smegmatis chromosome was analysed by Southern blotting. One to five copies of the vector were detected in each transformant. The SIV gag p27 gene and the foot-and-mouth disease virus VP1 140-160 epitope were successfully cloned into the 18 kDa gene and expression in M. smegmatis was obtained.

Amino Acid Sequence↗
PubMed1993

Prevalence of potential respiratory disease bacteria in children in Ethiopia. Antimicrobial susceptibility of the pathogens and use of antibiotics among the children.

Acute respiratory infections are primary causes of morbidity and mortality in children in developing countries. This project was designed to investigate antimicrobial susceptibility of respiratory tract pathogens isolated from children in rural and city areas, and to contribute to the rational choice of antibiotics for respiratory tract infections in children in Ethiopia. Nasopharynx and throat cultures were taken from all children under five years of age in three study areas representing different levels of contact with health care and accessibility to modern drugs, such as antibiotics. In all, 1126 children were cultured. Haemophilus influenzae and Streptococcus pneumoniae were both found in 85-90% of the children, and beta-haemolytic streptococci group A in 12%. The level of antimicrobial resistance was low. None of the 954 strains of H. influenzae were beta-lactamase producers. Pneumococci were susceptible to penicillin. The use of antibiotics was also low; 11 of 1126 children had antibiotics on the day of culture or the day before. The choice of antibiotics was not limited by resistance, and emphasis could be put on low cost, minimizing adverse drug reactions and ecological impact.

Anti-Bacterial Agents↗