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 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A number of newly-developed vaccines are available nowadays, whilst others, which are well-established, have been improved. The collection of epidemiological data, however, is equally important in assessing and providing insight into prophylactic measures. The beneficial effects and risks of vaccination may be calculated by special formulae. Changes in the effect of vaccines can be detected by constant reevaluation of the epidemiological situation by means of these formulae. Another possibility lies in the calculation of the borderline number of complications of a certain disease when the risks of the sequelae of the disease or of the vaccination are about equal. Examples of valuable and recommendable vaccinations are vaccination against measles, poliomyelitis, tetanus and tick-borne encephalitis. A follow-up of the case mortality of whooping-cough in Austria over the past 15 years and a consideration of the fatal complications of vacinnation, as quoted by Ehrengut, reveals that the risks of the disease balanced the risks of vaccination with usual vaccines, already in 1971 (1976 with WHO data). A beneficial effect of BCG vaccination is still present, but the influence on mortality figures is very slight only. However, the benefit of BCG may lie in the prevention of deaths from leukaemia observed by some authors. Paraspecific effects of some vaccinations are mentioned. Finally, cost-benefit calculations for Austria are presented in the case of vaccination against measles and mumps, which appear to be highly recommendable, not only from the medical, but also the economic point of view.
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PMID:[Modern trends in vaccination policy: evaluation of benefits, risks and cost (author's transl)]. 10 58

This paper is a description of a vaccination programme against the most frequent communicable diseases among children: measles, tuberculosis, diphtheria, tetanus, whooping-cough and poliomyelitis. The programme is to be carried out in three different climate zones (town, forest and savanna) and over a period of six years. The project is supported by US-AID and UNICEF.
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PMID:[A broad program of vaccination in the Ivory Coast]. 22 14

The vaccination status was investigated in 1482 patients between the ages of 1 and 14 years admitted to hospital with scarlet fever. Most of the patients were vaccinated against tuberculosis (97.7%), diphtheria, tetanus and whooping-cough (95.3%) and poliomyelitis (94.1%), relatively few against measles (21.1%) and very few indeed against mumps (0.7%) and tick-borne encephalitis (1.9%). The booster vaccination against tetanus and diphtheria had been omitted in more than 40%. Although the beneficial results of vaccination against tuberculosis, diphtheria-pertussis-tetanus and poliomyelitis remained more or less the same, the tendency towards vaccination did not spread as might have been anticipated. On the contrary, the extent of vaccination decreased, especially during the past years. In the same way the tendency towards vaccination against measles showed a sudden slowing down after a period of rapid increase. This implies that vaccination of children does not tend towards perfection. The vaccination rates differ widely between foreign children living in Vienna and natives. Although the foreigners show a similar vaccination distribution pattern as the natives, the numbers of unvaccinated children are much higher.
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PMID:[Vaccination status of children in the Vienna area (author's transl)]. 74 51

Post-polio patients sometimes complain about the occurrence of breathing difficulties decades after the polio infection. We have examined 40 post-polio patients who have had respiratory or non-respiratory poliomyelitis for at least 30 years in an attempt to elucidate whether hypoventilation is common and to what extent certain symptoms and simple lung function tests are related to hypoventilation or incipient hypoventilation. We measured arterial blood gases, vital capacity (VC), maximal expiratory and inspiratory pressures (MEP, MIP) and CO2 rebreathing response. Symptoms were assessed by a yes/no questionnaire. Six patients required respiratory assistance at the onset of the disease. At present, two require nocturnal assisted ventilation. Two patients showed manifest hypoventilation; one of which required night-time ventilator, whereas the other patient had not required ventilatory assistance even at the onset of the disease. Significant correlation (p less than 0.05) was found between arterial carbon dioxide tension (a-PCO2) and VC, MEP and ventilation increase during CO2 rebreathing. A significantly higher a-PCO2 was found among those who required respiratory assistance at the onset of the disease, who admitted headache and who felt the cough ineffective. Low VC and low ventilatory increase during CO2 rebreathing and the presence of headache explained 45% of the variation in a-PCO2 in a multiple regression analysis. We conclude that manifest hypoventilation is rare in this unselected material of post-polio patients and that a vital capacity below 45-50% of predicted normal and the presence of frequent headaches indicate an increased risk to develop hypoventilation.
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PMID:Post-polio lung function. 160 61

Twenty patients with a remote history of poliomyelitis and recent or progressive dysphagia were evaluated with cinefluorography. Radiographic abnormalities were present in the pharynx in varying degrees in all but one of the patients. Findings included atrophy of the prevertebral soft tissues, unilateral or bilateral weakness of the tongue or soft palate, paresis or paralysis of the pharyngeal constrictor muscle, incomplete or absent epiglottic tilt, poor laryngeal elevation, poor laryngeal closure with laryngeal penetration, aspiration (often without a cough), and luminal narrowing at the cricopharyngeal level. Other structural lesions included a Zenker diverticulum in one patient, bilateral pharyngeal pouches in five, and a unilateral pouch in one. Additional structural lesions contributing to dysphagia were found in two other patients, including a focal stricture in the cervical esophagus in one patient and two stenotic rings in the distal esophagus in another. In four patients (one of whom had the Zenker diverticulum), the inferior constrictor muscle contracted forcibly above a prominent cricopharyngeus muscle, perhaps contributing to the formation of the diverticulum. It is important to examine postpolio patients with dysphagia carefully with dynamic imaging to assess the severity of decompensation and to detect other lesions that may be treatable. The information derived can be used to guide management.
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PMID:Swallowing dysfunction in the postpolio syndrome: a cinefluorographic study. 172 82

Research programs in developing countries show no priorities. The World Health Organization (WHO) has promoted primary health care (PHC) and the experience of the developed countries and the developing countries is the same namely that the health improvement was due to a reduction of deaths from infectious diseases. The direct reasons for this are: 1) increased resistance; and 2) reduced exposure. Indirect influences include fertility control and advances in primary and secondary education. Economic prosperity is not always essential. Equity of access to the health determinants was important, as was the social and political will to bring about health improvements. Food is a major influence on health. People must have enough to eat. Many countries do not have enough food. Supplies are insufficient to provide everyone with an adequate diet. Several countries which do produce enough food for their populations cannot meet unstable world prices. The food available is often unevenly distributed, between countries and within them. In 1987, 50% of the children of the world were protected against tetanus, poliomyelitis, whopping cough, diphtheria, tuberculosis, and measles; 10 years earlier, it had been 5%. By the year 2000, poliomyelitis should be eradicated; deaths from neonatal tetanus should disappear, and measles mortality should be reduced by 95%. Diarrhea is serious in children. Attempts are being made to treat it with oral rehydration therapy (ORT). It is also necessary to prevent transmission of germs that cause diarrhea. In Africa, before 1950, the population growth rate was over 1% per year. Today is it 3%, on average. Many epidemic plagues have lost their demographic import. UN estimates show that world population, now 5 billion, will be 6 billion by 2000, 8 billion by 2025, and 10 billion when it stabilized in 2100. A consequence of demographic trends is the movement of people, not only from 1 country to another, but from rural to urban areas within a country. The setting of population goals is a sensitive issue.
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PMID:The road to health. 263 16

177 children between 1 and 3 years (74 well-nourished, 55 suspected of protein/calorie deficiency, 48 under nourished) were vaccinated (tuberculosis, diphtheria, tetanus, whooping-cough, polio); one month after the third dose of DTWC polio, we proceeded to apply the Merieux multitest and to check for intradermal reaction to the tuberculin: This study has shown that the Merieux multitest gives results comparable to the classical intradermal method with tuberculin. The multitest makes it possible to explore simultaneously seven different antigens under perfectly comparable conditions from the standpoint of precision and standardization (diphtheria, tetanus, tuberculin, Streptococcus, Proteus, Trichophyton and Candida). This exploration has shown that there is no significant difference in terms of the nutritional condition of the children. Well-nourished children, under-nourished children and children suspected of a deficiency react in the same manner to antigenic attractions whether vaccinal or spontaneous. This study would seem to suggest, therefore, that the nutritional conditions of a child need not to be taken into account when administering a vaccine.
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PMID:[Immune response as a function of the nutritional status in young children 1 to 3 years of age in the south of Ivory Coast]. 299 58

Findings on three postpolio sequelae patients referred for swallowing evaluations are presented. The first patient, a 67-year-old man more than 60 years post onset of polio, complained of frequent coughing and the sensation of foods becoming stuck in his throat during meals. Videofluoroscopic swallowing exam revealed reduced pharyngeal peristalsis and liquid pooling in the pyriform sinus. The second patient, a 59-year-old woman, was more than 30 years post onset of polio and was referred because of progressive dysphagia and hoarseness in the past three years. Videofluoroscopy revealed reduced strength of the oral musculature and reduced pharyngeal peristalsis with pooling of liquids in the pyriform sinus. The last patient, a 50-year-old woman more than 40 years post onset of polio, reported having difficulty with foods sticking in her throat. Swallowing exam revealed a delayed swallowing reflex and reduced pharyngeal peristalsis. Although none of the patients was observed to aspirate, all were considered to be at risk because of the gradual build-up of foods in the pharynx. Noninvasive management procedures and the importance of stress testing the swallowing mechanisms of such patients are discussed. Longitudinal follow-up with these individuals is recommended.
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PMID:Dysphagia in postpolio sequelae: report of three cases. 340 36

One hundred and seventy-eight mothers who had recently been delivered were interviewed before discharge from hospital to ascertain their initial intentions about vaccination of their children. Nine months later the behaviour of 154 mothers was checked from health service records; 24 were lost to follow-up.One hundred and forty-one (92 per cent) of the infants had received at least one dose of vaccine against polio, diphtheria and tetanus. Eighty-five infants (63 per cent of 135) had received at least one dose of vaccine against whooping-cough; 19 mothers had been advised against the vaccine. Failure to have their children vaccinated against whooping-cough correlated with the mothers' initial intentions, although a high proportion of mothers who were initially against the vaccine had started vaccination by the time their child was nine months old. Mothers attending general practitioners were more likely to have their infants vaccinated against whooping-cough than those attending community health clinics, and this difference was not explained by the social characteristics of the mothers nor by more positive early intentions among the mothers who attended general practitioners.
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PMID:Mothers' intentions and the immunization of their infants. 688 91

Between 1975 and 1983 health care expenditures in Ghana dropped to a low point as a consequence of the structural readjustment program instituted by the World Bank. During 1975-76 only 15% of available funds were spent on primary health care (PHC), which was officially introduced in the late 1970s. PHC made up 20-25% of the health care expenditures by 1991 with about 25% of health personnel engaged in PHC. 2/3 of health care delivery covered urban areas when 60% of the population lived in the countryside. The district of Ejisu-Juaben in the Ashanti region had high morbidity. Tetanus, polio, whooping-cough, and diphtheria had been brought under control, but measles, diarrhea, and malnutrition were still widespread among children under 5 years old. Malaria, bilharzia, intestinal parasites, respiratory infections, hepatitis, anemia, hypertension, and vitamin A deficiency were also grave problems. AIDS was on the rise. Child mortality amounted to 130/1000 live births and maternal mortality to 1400/100,000 cases. The medical structure of the district comprises 10 health posts (6 governmental and 4 mission). Only 72 villages and 120,000 people are cared for. Each post has a mobile team. In 1993 a new community-based health care program began funded by Save the Children Netherlands. In 60 villages a village health committee existed but they were substandard. They were either reactivated or new committees were set up. Training activities were also started in prenatal care, delivery, care of malnutrition and diarrhea, hygiene, and sanitation. Two years later safe motherhood indicators had improved; postnatal care increased from 16% to 49%; medical deliveries increased from 27% to 37%; the share of families with contraceptive acceptance increased from 7% to 21%; and tetanus vaccination among mothers was estimated to have increased from 27% to 86%.
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PMID:[Primary health care in Ghana: no pay no cure?]. 750 Oct 68


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