Edward A. Mortimer

Reduction in Mortality from Coronary Heart Disease in Men Residing at High Altitude

In New Mexico, where inhabited areas vary from 914 to over 2135 m above sea level, we compared age-adjusted mortality rates for arteriosclerotic heart disease for white men and women for the years 1957-1970 in five sets of counties, grouped by altitude in 305-m (1000-foot) increments. The results show a serial decline in mortality from the lowest to the highest altitude for males but not for females. Mortality rates for males residing in the county groups higher than 1220 m in order of ascending altitude were 98, 90, 86 and 72 per cent of that for the county group below 1220-m altitude (P less than 0.0001). The results do not appear to be explained by artifacts in ascertainment, variations in ethnicity or urbanization. A possible explanation of the trend is that adjustment to residence at high altitude is incomplete and daily activities therefore represent greater exercise than when undertaken at lower altitudes.

Antibody Responses to Bordetella pertussis Antigens and Clinical Correlations in Elderly Community Residents

A serological study to determine the frequency of Bordetella pertussis infection in 100 adults aged >/=65 years was carried out over a 3-year period. Ten serum samples (collected every 4 months) from each subject were examined for IgA and IgG antibodies to the following B. pertussis antigens: pertussis toxin (PT), filamentous hemagglutinin (FHA), pertactin, and fimbriae-2. A >/=2-fold titer increase in ELISA units from one time period to the next was considered serological evidence of infection. The rate of serologically defined infection (i.e., in which there was an increase in titer against any antigen) was 19.7 per 100 person-years. With the use of more specific criteria that indicate definite B. pertussis infection (>/=2-fold increase in titer to PT) and probable B. pertussis infection (>/=2-fold increase in titer to PT or >/=2-fold increase to fimbriae-2), the rates were 3.3 and 8.0 per 100 person-years, respectively. Fifty percent of individuals with definite B. pertussis infections had time-associated symptomatology. Antibody patterns over time suggest that antibody to FHA and perhaps to pertactin is stimulated by infections with other organisms, as well as B. pertussis infections. Our data suggest that symptomatic pertussis occurs in elderly individuals. Consideration should be given to immunization of the elderly with acellular pertussis vaccines.

Importance of the carrier state as a source of Staphylococcus aureus in wound sepsis

The relationship of pre-operative nasal and skin carriage of Staphylococcus aureus to wound colonization and sepsis was studied in 269 patients. Thirty-seven per cent of 96 carriers developed wound colonization as compared to 16 % among non-carriers (a statistically significant difference). The wound sepsis rates were 17 % and 9 % respectively. The combination of nasal and skin carriage was an important factor, since the sepsis rate among skin carriers (most of whom were nasal carriers as well) was 22%. Among carriers, the homologous strain was recovered from the majority of wound colonizations and from all instances of wound sepsis. A carrier strain also was recovered from 52% of the wounds colonized and from 50% of septic wounds in the entire study group. Profuse nasal carriage resulted in a significantly greater number of septic wounds (31%) than sparse carriage (9%). Wound cultures before closure, and skin from the initial incision site only once yielded a patients carrier strain or a strain of Staph. aureus that was later recovered from the wound. The results indicate that measures designed to control the carrier state or to isolate the wound from the external environment should reduce wound sepsis by approximately one half. Excellent technical aid was furnished by Eleanor Ford, R. N., Edith E. Silverman, Adrienne Marus, M. S., and Patricia Welch.

Seeing the same doctor: determinants of satisfaction with specialty care for disabled children.

The effect of continuity of physician on satisfaction with medical care was examined in a sample of 370 families of disabled children receiving care from four specialty clinics of teaching hospitals. Families of children with myelodysplasia, cystic fibrosis (CF), cerebral palsy and multiple physical handicaps were included. A comparison of scores on the eight scales of the Patient Satisfaction Questionnaire across the four clinics revealed marked and consistent differences: patients of cystic fibrosis clinic scored significantly higher than patients of other clinics on most scales. Multiple regression analysis in which source of care (CF clinic versus other clinics), continuity of care, waiting time and patient and family characteristics (income, race, education, level of disability) were used as predictors indicated that continuity of care accounted for a large part of the association between source of care and satisfaction. Further, when continuity of physician and waiting time in the clinic were held constant, patients of the CF clinic were indistinguishable from patients of other clinics in their satisfaction with doctors and with medical care. Further analysis revealed that continuity of care contributed to patient satisfaction not only in a clinic that constitutes a patients principal source of care, but also in a clinic in which only specialized care is given, excluding care for intercurrent illnesses or immunizations.

Transmission of Streptococcal and Staphylococcal Infections

Excerpt In 1955, Colebrook (1), a bacteriologist who had studied infections of burns and wounds during two world wars, reviewed the problem of the transmission and control of hospital-acquired infe...

Production of L Forms of Group A Streptococci in Mice.

Summary Mice, inoculated intraperitoneally with lethal doses of group A streptococci, yielded L forms as well as streptococci from peritoneal exudate and heart blood at death. These L forms propagated readily and were recovered on penicillin-free medium after separation from the streptococci by differential filtration. They were shown to be derived from the original streptococcus, and usually appeared in mice inoculated with streptococci of relatively low virulence.

Ventricular tachycardia in childhood controlled with large doses of procaine amide.

VENTRICULAR tachycardia in childhood presents difficult diagnostic and therapeutic problems. The following case required extraordinary doses of procaine amide for control. Case Report A 14-month-ol...

Acute Respiratory Illness in Older Community Residents

OBJECTIVE: To describe the 3‐year incidence of acute respiratory illness in a population of noninstitutionalized elderly persons.

Use of Chemoprophylaxis to Prevent the Spread of Hemophilus influenzae b in Day-Care Facilities

Should children in day-care facilities receive rifampin chemoprophylaxis after the occurrence of invasive Hemophilus influenzae b disease in a day-care contact? The magnitude of uncertainty regardi...

The Mother as a Source of Neonatal Staphylococci

OBSERVATIONS of the natural history of epidemic staphylococcal disease in newborn nurseries and studies of the transmission of staphylococci to newborn infants have clearly shown that the sources o...