Harold B. Houser

A Pilot Community'Based Screening Program for Gestational Diabetes

A pilot community-based screening program for gestational diabetes has been in operation in Cleveland, Ohio, since April 1, 1977. A socioeconomic and racially heterogeneous group of pregnant women are being routinely tested at approximately 24–28 wk of gestation by a capillary whole blood glucose determination, 2-h after a 75-g oral challenge. The results of the first 2225 screenings are analyzed in terms of the variables of maternal race, age, and stage of gestation. The overall incidence of positive screenings (≥ 120 mg/dl) is shown to be 11.5%, with significantly more positive tests among the whites than the nonwhites. Follow-up oral glucose tolerance testing results in an overall detection rate for abnormal carbohydrate metabolism of 3.1%. The data suggest that a 2-h screening procedure is more efficient than a 1-h procedure in that fewer confirmatory glucose tolerance tests need to be performed in order to yield this rate of detection. It may soon be feasible to introduce such a program on a wider community basis in concert with regionalized perinatal care.

Long-term changes in gross body composition of paraplegic and quadriplegic patients

1. The body composition of groups of 14 paraplegic and six quadriplegic patients were compared with those of groups of other chronically ill patients, judged clinically to be either ‘Weil-nourished’ or “poorly-nourished’.The spinal-cord injured patients had values of sodium space (expressed relative to body weight or lean body mass) similar to those of the poorly-nourished group, while in nine other parameters of body composition they resembled a well-nourished group of patients. The increased sodium space in the spinal-cord injured patients is consistent with erosion of their lean body mass. 2. The changes in body composition of three quadriplegic and four paraplegic patients were followed for varying lengths of time up to 51 months. Although many of the changes were significant in individual cases, there was no consistent trend in body composition. Both gains and losses of weight were observed, the largest factor in these being changes in body fat. Ten paraplegics showed a tendency to decrease their sodium space after 12 weeks of controlled dietary intake with significant changes in three cases.

Morbidity in schistosomiasis japonica in relation to intensity of infection. A study of two rural brigades in Anhui Province, China

Schistosomiasis japonica remains endemic in several provinces south of the Yangtze River in China because of relatively sparse populations of human beings and dense populations of snails. We studied two brigades in a rural commune in Gui-chi County, Anhui Province, to determine the prevalence, intensity, and morbidity associated with this infection before concerted control efforts were instituted. Quantitative fecal examinations, histories, and physical examinations relevant to schistosomiasis japonica were performed in 96 per cent of the available population 2 to 65 years of age. The prevalence was 26.3 per cent in Brigade A (778 persons) and 14.4 per cent in Brigade B (1532 persons). Clinical symptoms and signs were compared among uninfected persons and persons at three levels of infection as determined by fecal egg output. Some increased weakness was seen only at the heaviest levels of infection; abdominal pain was not an important symptom. Hepatomegaly was somewhat more frequent in moderate and heavy infections, but splenomegaly was rare and unrelated to intensity of infection. Neither stool consistency nor occult blood was related to the presence or intensity of infection. Approximately 50 per cent of the population had been treated for schistosomiasis japonica, 25 per cent repeatedly.

Effect of oxytetracycline therapy of streptococcal sore throat on the incidence of acute rheumatic fever.

Excerpt Although penicillin, Chlortetracycline, Oxytetracycline and erythromycin have been shown to be effective in alleviating the symptoms of acute streptococcal disease, only penicillin and Chlo...

Economic aspects of multiple sclerosis—I: A method for classification of income of families of different sizes and compositions and its application in a longitudinal study of multiple sclerosis☆

Abstract A method has been described for classification of family income based on the City Workers Family Budget, the Consumer Price Index, and a scale of equivalent income. The classification permits families of different size and composition to be categorized on a percentage scale which has 99–120 per cent defined as a modest but adequate income to satisfy prevailing standards of what is necessary for health, efficiency, the nurture of children and for participation in social and community activities. The method was developed in order to study the income variable in a longitudinal study of persons with multiple sclerosis. It permits comparison of incomes between families in the study, and within the same family from year to year.

An evaluation of the variability in measurement of some body composition parameters.

Summary The variability in observation of some parameters of gross body composition was assessed by paired observations one week apart in 26 chronically ill subjects. The results of this study permit statistical evaluation of the significance of changes in these parameters observed in other subjects, using the same experimental techniques.

BODY COMPOSITION OF “WELL NOURISHED” COMPARED TO “POORLY NOURISHED” CHRONICALLY ILL PERSONS*

In order to assess the variable of nutritional state in relation to the presence of or progress of chronic illness, nutritional state must be defined objectively. Objective definition implies measurement that is valid, reliable, reproducible, and subject to estimations of intrinsic technical or observer variation. Furthermore, the definition must be related to the problem at hand. Nutritional state may be considered “good or “poor” or relative to these extremes. If the frame of reference is a chronic illness, “good nutritional state would prevent, cure, or delay the progress of disease; the reverse would be true of a Measurement of nutritional state to meet the criteria for objective assessment mentioned above would depend on physical or biochemical techniques. Validation of these techniques depends on an independent definition of nutritional state. In addition, the independent definition should permit a dichotomy of nutritional state into ”good” and “poor” with all questionable decisions as to nutritional state discarded. If the measures selected discriminate between good and poor they may be useful in those instances where the criteria for the independent judgment cannot be applied with accuracy. This is particularly true when a decision must be made between two individuals as to which is better nutritionally than the other. In the study of the role of nutrition in chronic illness it is not always enough to establish that means for a particular value are different in two groups of people. Frequently, one must study small numbers of patients, pairs of patients, or two points in time in the same patient. In these instances placement on a scale of relative goodness of nutritional status is desirable. We have investigated the possibilities of using gross body composition as a measure of nutritional state that would satisfy the foregoing considerations for an objetcive measure. For an independent evaluation of nutritional state we selected “clinical” judgment. This was done in the full knowledge that this was a precarious choice on which to classify individuals. For one thing, it is almost impossible to define without bringing into the judgment the very factors that we would be assessing by body composition studies. However, in the absence of a good way of defining nutritional state from the standpoint of good or poor we felt we could achieve the dichotomy by selecting patients who, by clinical judgment, were in much poorer nutritional state than were those patients with the same disease, and within five years of the same age, selected as good. Poor nutri-

Comparative effects of 3-hydroxy-2-phenylcinchoninic acid (HPC) and aspirin on the acute course of rheumatic fever and the occurrence of rheumatic valvular disease.

Abstract The comparative effects of treatment with 3-hydroxy-2-phenylcinchoninic acid (HPC) and aspirin were observed in a study of sixty-eight patients with acute rheumatic fever. One-half, or thirty-four, of the patients received HPC; the remaining one-half were treated with aspirin. Aspirin exerted a more favorable effect upon arthritis, fever, and erythrocyte sedimentation rate than did HPC. There was no difference between the two treated groups in the course of acute carditis or in the incidence of significant murmurs fourteen to seventeen months after treatment was started. The duration of the acute illness appeared to be equal in the two groups. In the dosages employed in this study, aspirin appears to be preferable to HPC in the treatment of acute rheumatic fever.

Correcting the historical record: diagnosis and management of group A streptococcal pharyngitis.

In summary, studies have demonstrated that P. carinii may not only antibiotic therapy actually examined in controlled studies and shown to prevent rheumatic fever is penicillin. Chlortetracycline have been sufficiently considered for patients whose common feature is immunosuppression due to a variety of reasons, including [2] and oxytetracycline [3] were evaluated in clinical trials of sufficient size to determine their effectiveness in preventing rheutherapy for malignancy and organ transplantation. Although the prevalence of PCP among HIV-1–positive individuals has rematic fever. A significant reduction in the number of cases of rheumatic fever was demonstrated with chlortetracycline treatceived more attention, it is clear that heightened awareness of the possibility of PCP in any significantly immunosuppressed patient ment, while the reduction with oxytetracycline treatment was borderline (P Å .07). would be prudent. Without question, further research will be essential to provide more in-depth fundamental information about the Perhaps the authors meant to say that of currently recommended antibiotics, penicillin is the only one that has been evaluated in nature of this intriguing opportunist. clinical trials. The criterion for choosing other antibiotics is a high rate of eradication of the infecting organism. My colleagues and Linda L. Williford Pifer I observed in our paper on chlortetracycline that eradication of the Department of Clinical Laboratory Sciences, The University of Tennessee, Memphis, the Health Science Center, Memphis, Tennessee infecting organism is necessary to prevent subsequent episodes of rheumatic fever.

Serum proteins and blood vitamins in anemia of the chronically ill: Possible role of protein undernutrition☆

Abstract Chronic anemia not associated with malignancy, infection, uremia, arthritis or liver disease occurs frequently in hospitalized chronically ill patients. Evidence is presented that the anemia is not due to deficiency of iron, folic acid, vitamin B 12 or pyridoxine. It is associated with underweight, with decreased serum albumin, and with increased alpha I and gamma serum globulin. With supporting evidence from animal studies done by others, it is proposed that the anemia is due to prolonged protein calorie undernutrition.