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J Rural Health 2002 18: 521-535.
Chronic disease and injury in an agricultural county: The Keokuk County Rural Health Cohort Study.
Merchant JA, Stromquist AM, Kelly KM, Zwerling C, Reynolds SJ, Burmeister LF.
College of Public Health, The University of Iowa, Iowa City 52242, USA.
The Keokuk County Rural Health Study (KCRHS) was designed as a 20-year, prospective cohort study focusing on chronic disease and injury in an agricultural southeastern Iowa county. The goals of the KCRHS are to prospectively describe, measure, and analyze prevalent rural and agriculturally related adverse health outcomes and their respective risk factors and to provide the basis for future community-based intervention programs to reduce disease and injury incidence. Methods of data collection included in-person interviews, medical screenings, and environmental assessments of homes and farms. All households studied were rural; comparisons were made among farm, rural nonfarm, and town households, between men and women, and between smokers and nonsmokers. The present paper reports selected adult baseline data from Round 1 of this study. Residents of farm households were somewhat younger and better educated than residents of rural nonfarm and town households; smoked less; were more likely to have ridden an all-terrain vehicle; and were more likely to report firearms in the home. Eighty-nine percent of the men and 66% of the women engaged in farming or did so in the past. Men more often reported hearing loss, were more often overweight and obese, more often reported an injury, less often reported asthma, and less often saw a medical practitioner. Women reported poorer emotional health and higher rates of depression symptoms. The KCRHS has identified several modifiable health outcomes and risk factors as candidates for further analysis and targets for community-based prevention and intervention programs.
Diabetes Care 2002; 25: 2224-2229
Adherence to american diabetes association standards of care by rural health care providers.
Coon P, Zulkowski K.
Deaconess Billings Clinic, Center on Aging, Billings, Montana.
OBJECTIVE-To determine whether rural health care providers are compliant with American Diabetes Association (ADA) clinical practice guidelines for glycemic, blood pressure, lipid management, and preventative services. RESEARCH DESIGN AND METHODS-This study was performed using a retrospective chart review of 399 patients 45 years of age and older, with a definitive diagnosis of diabetes seen for primary diabetes care at four rural health facilities in Montana between 1 January 1999 and 1 August 2000. RESULTS-Glycemic testing was adequate (85%), and glycemic control (HbA(1c) 7.43 +/- 1.7%) was above the national average. Comorbid conditions of hypertension and dyslipidemia were not as well managed. Mean systolic blood pressure (SBP) was 139 +/- 18.8 mmHg and LDL was 119 +/- 33 mg/dl. Of 399 patients, 11 were considered as needing no additional treatment based on ADA guidelines of an HbA(1c) level <7%, a BP <130/85 mmHg, and a LDL level <100 mg/dl. Monofilament testing and dilated eye examinations were poorly documented, as were immunizations. There were few referrals for diabetic education. CONCLUSIONS-Rural health care practitioners are not adequately following the ADA standards for comprehensive management of their patients with diabetes. Glycemic testing is being ordered, but HbA(1c) values indicate that patients do not have their diabetes under optimal control. The comorbid conditions of hypertension and dyslipidemia are not optimally managed according to the ADA guidelines.
J Med Microbiol 2002; 51: 1117-1127
Improved molecular identification of Thermoactinomyces spp. associated with mushroom worker's lung by 16S rDNA sequence typing.
Xu J, Rao JR, Millar BC, Elborn JS, Evans J, Barr JG, Moore JE.
Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Belfast BT9 7AD, Applied Plant Science Division, Department of Agriculture and Rural Development, Newforge Lane, Belfast BT9 5PX, Department of Respiratory Medicine, Belfast City Hospital, Belfast BT9 7AD, Department of Respiratory Medicine, Queen's University of Belfast, School of Medicine, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA and Regional Mycology Reference Laboratory, Department of Microbiology, The Royal Group of Hospitals, Kelvin Building, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA.
Mushroom worker's lung (MWL) is a hypersensitivity pneumonitis or allergic alveolitis caused by a type III IgG-mediated immunopathogenic inflammatory reaction in the host due to the inhalation of several thermophilic organisms, including Thermoactinomyces spp. It is difficult to distinguish phenotypically the eight species of this genus; therefore, this study sought to develop an improved molecular means of identifying Thermoactinomyces spp. associated with MWL by partial 16S rDNA PCR amplification and direct sequencing. Hypervariable regions within the 16S rRNA gene, which could be employed as signature sequences of the eight individual species, were identified and employed with highly conserved flanking primers to allow initial PCR amplification, before direct DNA sequencing of the 16S rDNA amplicons. A novel 24-mer 16S rDNA oligonucleotide upstream primer was designed from in silico alignments of all Thermoactinomyces spp. and was employed in combination with downstream (reverse) 16S rDNA primers. This permitted the successful identification of all four isolates associated with mushroom workers' lung. The method may be useful in the identification of Thermoactinomyces spp. associated with allergic alveolitis or pneumonitis associated with occupational exposure in agricultural and horticultural environments.
Eval Rev 2002; 26: 645-655
The effect of active parental consent on the ability to generalize the results of an alcohol, tobacco, and other drug prevention trial to rural adolescents.
Henry KL, Smith EA, Hopkins AM.
Social Science Research Institute, Pennsylvania State University, USA.
The authors report the effect of active parental consent on sample bias among rural seventh graders participating in a drug abuse prevention trial. Students obtaining active consent from their parents to complete the survey were of higher academic standing, missed fewer days of school, and were less likely to participate in the special education program at their school as compared to students who did not return a parental consent form. However, students with consent were not significantly different from students whose parents actively declined. The sample obtained under active parental consent represents students less at risk for problem behaviors than would have been obtained under passive consent procedures.
Med J Aust 2002; 177:633-637
Mission in Afghanistan.
Simpson RA.
Oatlands Medical Practice, 13 Church St, Oatlands, Tas 7120, Australia. oatlands.surgery@tassie.net.au
A rural GP reports on his seven months spent in remote Baharak, working with Medecins Sans Frontieres.
Toxicon 2000; 41:19-22
Snakebite envenomation in Costa Rica: a revision of incidence in the decade 1990-2000.
Sasa M, Vazquez S.
Instituto Clodomiro Picado, Universidad de Costa Rica, San Jose, Costa Rica
We reviewed snakebite records from the Costa Rican health system from the year 1990-2000. During this decade, a total of 5550 snakebite cases occurred in the country. While the average number of snakebites per year was relatively constant at 504 cases, the annual incidence per 100,000 people decreased. This reduction is mainly due to high population growth in Costa Rica, which increased 35% during the study period. The most affected population lives in rural areas characterized by high precipitation, and mainly includes young agricultural workers. The lancehead Bothrops asper is considered the most important species affecting humans.
Food Nutr Bull 2002; 23: 274-279
Measurement of energy cost of selected household and farm activities performed by rural women.
Bains K, Kaur B, Mann SK.
Department of Food and Nutrition, College of Home Science, Punjab Agricultural University, Ludhiana, Punjab, India.
A nutritional study was carried out on 30 rural, low-income women, aged 25 to 35 years, in the village of Dhandra, Ludhiana District, Punjab, India, to measure the energy cost of selected household and farm activities. The mean weight, mid-upper-arm circumference, and triceps skinfold thickness were below the reference standards. A negative energy balance among the subjects indicated their poor energy status. The energy costs of selected household and farm activities were assessed by the Caltrac personal activity computer. The energy costs of household activities--making dough, making chapatis, grinding masala, hand pumping, washing utensils, sweeping, mopping, washing the floor, mud pasting, and washing clothes--were 0.0306, 0.0281, 0.0595, 0.0337, 0.0266, 0.0424, 0.0530, 0.0331, 0.0634, and 0.0453 kcal/kg/min, respectively. The energy costs of farm activities--collecting fodder, chaffing fodder, milking, making dung cakes, picking sag, harvesting wheat, bundling wheat, picking paddy, brooming paddy, and separating paddy--were 0.0472, 0.0372, 0.0530, 0.0270, 0.0337, 0.0623, 0.0374, 0.0411, 0.0370, and 0.0744 kcal/kg/min, respectively. All selected activities were categorized as light, except for grinding masala, mopping, mud pasting, harvesting wheat, separating paddy, and milking, which were categorized as moderate on the basis of Food and Agriculture Organization (FAO) physical activity ratios. The Caltrac gave lower values for the energy costs of most of the activities. Although it is simpler and less costly, the Caltrec must be calibrated against methods of measuring oxygen consumption for similar activities.
Can J Neurol Sci 2002; 29: 83-87.
Nipah encephalitis outbreak in Malaysia, clinical features in patients from Seremban.
Chong HT, Kunjapan SR, Thayaparan T, Tong J, Petharunam V, Jusoh MR, Tan CT.
Department of Medicine, Seremban Hospital, Malaysia.
BACKGROUND: An outbreak of viral encephalitis occurred among pig industry workers in Malaysia in September 1998 to April 1999. The encephalitis was attributed to a new paramyxovirus, Nipah virus. This is a description of the clinical features of 103 patients treated in the Seremban Hospital with characterization of the prognostic factors. METHODS: Clinical case records and laboratory investigations were reviewed. The case definition was: patients from the outbreak area, direct contact or in close proximity with pigs, clinical or CSF features of encephalitis. RESULTS: The mean age was 38 years, 89% were male, 58% were ethnic Chinese, 78% were pig farm owners or hired workers. The mean incubation period was 10 days. The patients typically presented with nonspecific systemic symptoms of fever, headache, myalgia and sore throat. Seizures and focal neurological signs were seen in 16% and 5% respectively. In the more severe cases, this was followed by drowsiness and deteriorating consciousness requiring ventilation in 61%. Autonomic disturbances and myoclonic jerks were common features. The mortality was high at 41%. Systolic hypertension, tachycardia and high fever were associated with poor outcome. On the other hand, 40% recovered fully. As for the other 19%, the residual neurological signs were mostly mild. CONCLUSION: Nipah virus caused an encephalitis illness with short incubation period and high mortality. The prognosis for the survivors was good.