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Biomedical subjects

W A Alto

Publications and source records attributed to W A Alto.

16 recordsLinked to original sources
PubMed1999

Cutaneous and systemic manifestations of mastocytosis.

Mastocytosis is characterized by an excessive number of apparently normal mast cells in the skin and, occasionally, in other organs. Characteristic skin lesions, called urticaria pigmentosa, are present in most patients, but clinical presentation can vary from a pruritic rash to unexplained collapse and sudden death. These lesions are typically tan to red-brown macules that appear on the trunk and spread symmetrically. Patients with mastocytosis often have a long history of chronic and acute symptoms that were unrecognized as mastocytosis. Skin lesions may or may not accompany systemic mastocytosis. Systemic disease may involve the gastrointestinal tract, the bone marrow or other organs. Even when the disease is considered as a possibility by the physician, the diagnosis can be difficult because of special technical requirements necessary for biopsy and because of the problems with biochemical testing. Drug therapy is initiated to stabilize mast cell membranes, to reduce the severity of the attacks and to block the action of inflammatory mediators. The mainstay of therapy is histamine H1 and H2 blockers and the avoidance of triggering factors.

Biopsy↗
PubMed1996

Primary health care in Melanesia: problems and potentials.

Locally directed, decentralized health services offer opportunities for empowerment by defining priorities based on community-derived policies. These are the components of the Primary Health Care Approach still missing in Melanesia.

Community Health Workers↗
PubMed1995

Prevention in practice.

There are many barriers that must be overcome for health providers to integrate appropriate health screening, health promotion, and disease prevention into their practices. This article delineates these barriers and offers suggestions to put prevention into practice.

Delivery of Health Care↗
PubMed1994

Introduction of an integrated community-based bancroftian filariasis control program into the Mt Bosavi region of the Southern Highlands of Papua New Guinea.

In mid-1987 a baseline microfilarial prevalence survey was conducted among five villages in the Mt Bosavi region of the Southern Highlands Province of Papua New Guinea. Through use of the Nucleopore filtration technique, it was determined that 48% of villagers had detectable microfilaraemia. The highest prevalence was documented in Fogomaiyu, where the microfilaraemia rate was 92%. On the basis of this initial survey and the expressed interest of the community, the Division of Health in the Southern Highlands Province undertook an integrated community-based pilot control program. The project used two principal control methods: (a) drug treatment with low-dose diethylcarbamazine citrate (DEC) distributed to the community weekly and (b) vector control with permethrin-impregnated bednets. Results six months after the intervention indicate that the program was successful in reducing microfilaraemia at Fogomaiyu village from 92% to 6%. The reduction is principally related to the effects of DEC, although the bednets, by limiting vector-person contact, are expected to reduce the incidence of both filariasis and malaria.

Adolescent↗
PubMed1992

Measurement of child mortality in association with a multipurpose birth certificate programme in the Southern Highlands Province of Papua New Guinea.

A simple and inexpensive method for monitoring child mortality in association with birth registration was introduced into the Southern Highlands of Papua New Guinea. Eight thousand two hundred and one newborn infants were registered in 1988, approximately 77% of all children born in that year. The risk of death by age 2 was determined from reports given by the mother on the present status of a previously born child at the time of a recent delivery or during clinic registration of the current birth. This was 91 per 1000 for the province and corresponds to a risk of death by age 1 of 77/1000 by extrapolation using standard lifetables. This method was validated by comparison with a continuing demographic surveillance system covering 30,000 people in the western part of the province. The new birth certificate has been an incentive to increase supervised delivery rates and to generate a register that can be used to increase vaccination coverage.

Birth Certificates↗
PubMed1992

Acute rheumatic fever: an update.

The incidence of acute rheumatic fever is increasing in the United States, but many physicians are now unfamiliar with the diagnosis and treatment of this disease. The revised Jones criteria provide guidance for the diagnosis of rheumatic fever; two major criteria or one major and two minor manifestations are required to make the diagnosis. Salicylates are usually the initial treatment of choice for the arthritis of rheumatic fever. Penicillin remains the recommended prophylactic agent for secondary prevention.

Acute Disease↗
PubMed1991

An alternative to unattended delivery--a training programme for village midwives in Papua New Guinea.

Certain linguistic groups in the Southern Highlands of Papua New Guinea are unique in that there is no cultural role for a traditional birth attendant and, therefore, women deliver alone unattended. A programme to train village women as midwives was begun at Nipa Health Centre im 1981 and later expanded to a province-wide scope in 1986. Thirty-two Angal Heneng village midwives were trained during the period 1981-1989. Women of this language group have traditionally given birth alone. By 1989 the Angal Heneng village midwives had supervised 623 deliveries while 24 of them were still practicing. Well accepted in the community, they attended 11% of all births in 1989. Their efforts contributed to infant and perinatal mortality rates that were lower among the Angal Heneng than those of the neighbouring language group.

Community Health Workers↗
PubMed1990

Arrow wound management in Papua New Guinea.

Arrow injuries sustained during tribal fighting are a common reason for admission to the hospitals of Southern Highlands Province in Papua New Guinea (P.N.G.). The authors, Canadian and American family physicians with an aggregate 12 years' general practice experience in the P.N.G. Highlands, present the findings of a 1-year retrospective study of arrow wound victims admitted to two hospitals. Arrow wound injuries are a consequence of a variety of sociocultural factors that continue to result in their high incidence despite many decades of contact with the outside world. We present the details of the presentation and management of 90 cases including a preponderence of soft-tissue as well as intracranial, thoracic, and abdominal injuries. Illustrative case histories of the more challenging or unusual cases provide insight into the unique opportunity afforded the general practitioner/surgeon in managing a type of injury which has become virtually extinct in North American practice over the last 200 years.

Adolescent↗
PubMed1990

Abdominal pregnancy.

Abdominal pregnancy is an unusual variant of ectopic pregnancy, with an incidence of approximately one in 6,000 term births. Morbidity and mortality for both the fetus and the mother are considerable. A high degree of suspicion is essential for timely diagnosis, which is best confirmed by radiographic and sonographic examinations. Once the diagnosis is established, immediate surgical intervention is usually advisable.

Adult↗
PubMed1989

Hydatid disease: the threat within Papua New Guinea.

Hydatid disease is a problem in those countries where man, grazing animals and dogs live in close association. The adult tapeworm of Echinococcus granulosus causes few, if any, symptoms in the dog and so its presence may be unsuspected. Transmission to man is by ingestion of eggs, which resist desiccation and may be viable for up to one year. Food or water may be directly contaminated or infection acquired by close contact with dogs carrying eggs in their saliva or hair. Though quarantine regulations exist, the introduction of the disease as the tapeworm in dogs or as the hydatid cyst in imported sheep from New Zealand has occurred and its spread is a possibility. The life cycle, clinical manifestations and significance if introduced to rural communities are discussed.

Animals↗
PubMed1989

Measles immunization and its effectiveness in the southern Highlands.

Measles immunization was introduced in the Southern Highlands Province in 1982. Since then immunization coverage of children aged under 1 year has increased from 12% in 1982 to 52% in 1986. The number of reported measles cases has declined, despite an increase in the number of health facilities reporting and an increase in maternal child clinic visits where most sick children are seen. The incidence of measles and the incidence of diarrhoea are compared with the cumulative measles immunizations given. Problems with the Expanded Programme on Immunization (EPI) campaign and means to improve measles vaccine coverage are discussed.

Child, Preschool↗
PubMed1989

Improving immunization coverage, a comparison between traditional MCH teams and MCH teams plus aid post orderlies.

Aid post orderlies in one district of the Southern Highlands Province were trained to give immunizations to children as part of the Expanded Programme on Immunization. The performance of the aid post orderlies (APOs) as immunizers is compared with that of the traditional maternal and child health (MCH) team. Also the results of the combined efforts of the APOs and MCH sisters in this pilot district are compared with those in a control district. The joint APO-MCH effort was more successful than the traditional approach in reaching national immunization targets.

Allied Health Personnel↗
PubMedDate not supplied

Evolution of a successful community bicycle helmet campaign.

BACKGROUND: Bicycling injuries claim more than 900 lives each year in the United States, and the major cause of deaths is head injuries. Bicycle helmets can prevent head and brain injuries, yet helmet use rate remains low. Helmets are expensive, and their cost can be prohibitive. This study asks the question, "If bicycle helmets are made affordable, will they be worn?" METHODS: A multifaceted bicycle helmet campaign was begun in Grand Junction, Colorado, population 76,000, in 1992 and was evaluated after its first 2 years. The educational component involved presentations in local schools and at community functions, physician education, and media promotions. A discount helmet program was established through community donations, which allowed helmets to be sold to low-income families for $5 and to middle- and upper-income families for $15; approximately 2400 helmets were sold. One year later a local retailer sold helmets for $12.99; approximately 4000 helmets were sold. RESULTS: Twenty-three locations were surveyed in 3 consecutive years by observers looking for bicycle riders and the presence or absence of helmets. The base-line overall use rate in 1992 was 9.9 percent, which increased to 20.9 percent in 1993 and to 37.1 percent in 1994. There were increases in helmet use in all age groups. CONCLUSIONS: A community bicycle helmet campaign that combines affordable helmets with appropriate education can effect an increase in helmet use. A major key to a successful program is a local retailer willing to sacrifice profits to promote helmet sales and use.

Accidents, Traffic↗
PubMedDate not supplied

Vaccine storage in the physician's office: a community study.

BACKGROUND: A survey was conducted of 26 physician offices and the County Health Department to determine the quality of vaccine storage. METHODS: All refrigerators were examined for secure electrical supply, firmly shut door, storage of inappropriate items, and expired vaccines. A maximum-minimum thermometer was then placed in the middle of the storage area for 24 hours, and temperatures were recorded. RESULTS: Of the 27 sites, only two had refrigerator temperatures in which both maximum and minimum temperatures fell within the acceptable range of 2 degrees to 8 degrees C. Sixty-three percent fell below minimum, 59 percent were above maximum, and 93 percent fell either below or above or both. Eight of the offices had a designated cold chain monitor, but there was no correlation with appropriate monitoring and storage of vaccines. Nine of the offices had permanent thermometers, but no correlation could be found between these sites and appropriate storage temperatures. CONCLUSIONS: A majority of vaccines in the community have been exposed to conditions that could reduce or destroy their potency. Physicians must educate their personnel in proper storage techniques of vaccines to ensure the potency of these vaccines.

Child↗
PubMedDate not supplied

Improving the immunization coverage of children less than 7 years old in a family practice residency.

BACKGROUND: This prospective cohort study was designed to evaluate the effectiveness of mail and telephone contact with parents as a means to improve the immunization coverage of children less than 7 years old in a family practice residency clinic. METHODS: Immunization records for 519 children enrolled in an outpatient clinic were reviewed and updated. Children whose immunizations were current (55) were excluded, which left 464 children whose immunizations were more than 1 month behind for their age groups. A random sample of one-half of these children (231) were mailed a postcard listing the immunizations that they required to be up to date. The mailing was followed up with telephone contact, when necessary, to prompt compliance. The other one-half of the children were not contacted and served as the control group. Immunizations provided to the two groups were compared 6 months after the initial mailing. RESULTS: Before the initiation of the study, only 10.6 percent of the infants and children in the practice had their immunizations completed or were up to date. There were 124 immunizations given to 49 children in the intervention group compared with 84 immunizations to 33 children in the control (P < 0.047). Thirty-four children were brought up to date in the control group compared with 17 in the intervention cohort (P < 0.011). CONCLUSIONS: Direct mail reminders and telephone contact with parents of children who were behind in their immunizations were effective methods to encourage compliance. The increased number of immunizations received by the children in the intervention group was overshadowed by the poor coverage of the entire practice, a highly mobile and predominantly indigent group. Additional interventions are urgently needed to improve immunization levels in infants and children.

Appointments and Schedules↗