From <@uga.cc.uga.edu:owner-mednews@ASUACAD.BITNET> Tue Jun 6 11:29:32 1995 with BSMTP id 5403; Tue, 06 Jun 95 11:20:19 EDT UGA.CC.UGA.EDU (LMail V1.2a/1.8a) with BSMTP id 3931; Tue, 6 Jun 1995 10:30:18 -0400 HICNet Medical News Digest Tue, 06 Jun 1995 Volume 08 : Issue 23 Today's Topics: [MMWR] Outbreak of Ebola Viral Hemorrhagic Fever -- Zaire, 1995 Essential Fatty Acid May Protect Against Stroke Home Exercise Helps Older Adults Protect their Hearts Primary Care Conference +------------------------------------------------+ ! ! ! Health Info-Com Network ! ! Medical Newsletter ! +------------------------------------------------+ Editor: David Dodell, D.M.D. 10250 North 92nd Street, Suite 210, Scottsdale, Arizona 85258-4599 USA Telephone +1 (602) 860-1121 FAX +1 (602) 451-1165 Internet: mednews@stat.com Bitnet: ATW1H@ASUACAD Mosaic WWW *Asia/Pacific: http://biomed.nus.sg/MEDNEWS/welcome.html *Americas: http://lab.xrt.upenn.edu:2000/hicn (good till June 1995) *Europe: http://www.dmu.ac.uk/ln/MEDNEWS/ Compilation Copyright 1995 by David Dodell, D.M.D. All rights Reserved. License is hereby granted to republish on electronic media for which no fees are charged, so long as the text of this copyright notice and license are attached intact to any and all republished portion or portions. The Health Info-Com Network Newsletter is distributed biweekly. Articles on a medical nature are welcomed. If you have an article, please contact the editor for information on how to submit it. If you are interested in joining the automated distribution system, please contact the editor. Associate Editors: E. Loren Buhle, Jr. Ph.D. Dept. of Radiation Oncology, Univ of Pennsylvania Tom Whalen, M.D., Robert Wood Johnson Medical School at Camden Douglas B. Hanson, Ph.D., Forsyth Dental Center, Boston, MA Lawrence Lee Miller, B.S. Biological Sciences, UCI Dr K C Lun, National University Hospital, Singapore W. Scott Erdley, MS, RN, SUNY@UB School of Nursing Jack E. Cross, B.S Health Care Admin, 882 Medical Trng Grp, USAF Albert Shar, Ph.D. CIO, Associate Prof, Univ of Penn School of Medicine Stephen Cristol, M.D. MPH, Dept of Ophthalmology, Emory Univ, Atlanta, GA Subscription Requests = mednews@stat.com anonymous ftp = vm1.nodak.edu; directory HICNEWS FAX Delivery = Contact Editor for information ---------------------------------------------------------------------- To: hicnews 1995 Outbreak of Ebola Viral Hemorrhagic Fever -- Zaire, 1995 On May 6, 1995, CDC was notified by health authorities and the U.S. Embassy in Zaire of an outbreak of viral hemorrhagic fever (VHF)-like illness in Kikwit, Zaire (1995 population: 400,000), a city located 240 miles east of Kinshasa. The World Health Organization and CDC were invited by the Government of Zaire to participate in an investigation of the outbreak. This report summarizes preliminary findings from this ongoing investigation. On April 4, a hospital laboratory technician in Kikwit had onset of fever and bloody diarrhea. On April 10 and 11, he underwent surgery for a suspected perforated bowel. Beginning April 14, medical personnel employed in the hospital to which he had been admitted in Kikwit developed similar symptoms. One of the ill persons was transferred to a hospital in Mosango (75 miles west of Kikwit). On approximately April 20, persons in Mosango who had provided care for this patient had onset of similar symptoms. On May 9, blood samples from 14 acutely ill persons arrived at CDC and were processed in the biosafety level 4 laboratory; analyses included testing for Ebola antigen and Ebola antibody by enzyme-linked immunosorbent assay, and reverse transcription-polymerase chain reaction (RT-PCR) for viral RNA. Samples from all 14 persons were positive by at least one of these tests; 11 were positive for Ebola antigen, two were positive for antibodies, and 12 were positive by RT-PCR. Further sequencing of the virus glycoprotein gene revealed that the virus is closely related to the Ebola virus isolated during an outbreak of VHF in Zaire in 1976 (1). As of May 17, the investigation has identified 93 suspected cases of VHF in Zaire, of which 86 (92%) have been fatal. Public health investigators are now actively seeking cases and contacts in Kikwit and the surrounding area. In addition, active surveillance for possible cases of VHF has been implemented at 13 clinics in Kikwit and 15 remote sites within a 150-mile radius of Kikwit. Educational and quarantine measures have been implemented to prevent further spread of disease. Reported by: M Musong, MD, Minister of Health, Kinshasa, T Muyembe, MD, Univ of Kinshasa; Dr. Kibasa, MD, Kikwit General Hospital, Kikwit, Zaire. World Health Organization, Geneva. Div of Viral and Rickettsial Diseases, and Div of Quarantine, National Center for Infectious Diseases; International Health Program Office, CDC. Editorial Note: Ebola virus and Marburg virus are the two known members of the filovirus family. Ebola viruses were first isolated from humans during concurrent outbreaks of VHF in northern Zaire (1) and southern Sudan (2) in 1976. An earlier outbreak of VHF caused by Marburg virus occurred in Marburg, Germany, in 1967 when laboratory workers were exposed to infected tissue from monkeys imported from Uganda (3). Two subtypes of Ebola virus--Ebola-Sudan and Ebola-Zaire--previously have been associated with disease in humans (4). In 1994, a single case of infection from a newly described Ebola virus occurred in a person in Cote d'Ivoire. In 1989, an outbreak among monkeys imported into the United States from the Philippines was caused by another Ebola virus (5) but was not associated with human disease. Initial clinical manifestations of Ebola hemorrhagic fever include fever, headache, chills, myalgia, and malaise; subsequent manifestations include severe abdominal pain, vomiting, and diarrhea. Maculopapular rash may occur in some patients within 5-7 days of onset. Hemorrhagic manifestations with presumptive disseminated intravascular coagulation usually occur in fatal cases. In reported outbreaks, 50%-90% of cases have been fatal (1-3,6). The natural reservoirs for these viruses are not known. Although nonhuman primates were involved in the 1967 Marburg outbreak, the 1989 U.S. outbreak, and the 1994 Cote d'Ivoire case, their role as virus reservoirs is unknown. Transmission of the virus to secondary cases occurs through close personal contact with infectious blood or other body fluids or tissue. In previous outbreaks, secondary cases occurred among persons who provided medical care for patients; secondary cases also occurred among patients exposed to reused needles (2). Although aerosol spread has not been documented among humans, this mode of transmission has been demonstrated among nonhuman primates. Based on this information, the high fatality rate, and lack of specific treatment or a vaccine, work with this virus in the laboratory setting requires biosafety level 4 containment (3,7). CDC has established a hotline for public inquiries about Ebola virus infection and prevention ([800] 900-0681). CDC and the State Department have issued travel advisories for persons considering travel to Zaire. Information about travel advisories to Zaire and for air passengers returning from Zaire can be obtained from the CDC International Travelers' Hotline, (404) 332-4559. References 1. World Health Organization. Ebola haemorrhagic fever in Zaire, 1976: report of an international commission. Bull WHO 1978;56:271-93. 2. Baron RC, McCormick JB, Zubeir OA. Ebola virus disease in southern Sudan: hospital dissemination and intrafamilial spread. Bull World Health Organ 1981;61:997-1003. 3. Peters CJ, Sanchez A, Rollin PE, Ksiazek TG, Murphy FA. Filoviridae: Marburg and Ebola viruses. In: Fields BN, Knipe DM, Howley PM, eds. Field's virology. 3rd ed. New York: Raven Press, Ltd, 1996 (in press). 4. McCormick JB, Bauer SP, Elliott LH, Webb PA, Johnson KM. Biologic differences between strains of Ebola virus from Zaire and Sudan. J Infect Dis 1983;147:264-7. 5. Jarling PB, Geisbert TW, Dalgard DW, et al. Preliminary report: isolation of Ebola virus from monkeys imported to USA. Lancet 1990;335:502-5. 6. CDC. Management of patients with suspected viral hemorrhagic fever. MMWR 1988;37(no. S-3). 7. Peters CJ, Sanchez A, Feldmann H, Rollin PE, Nichol S, Ksiazek TG. Filoviruses as emerging pathogens. Seminars in Virology 1994;5:147-54. ------------------------------ To: hicnews American Heart Association National Center For more information, annw@amhrt.org AHA journal report: Essential fatty acid, alpha-linolenic, may protect against stroke May 2, 1995 NR 95-4279 (Stroke/Simon)** DALLAS, May 2 -- To reduce the risk of stroke, you may want to include a few walnuts or a modest amount of soybean or canola oil in your diet, say California researchers. These foods contain a "good fat" called alpha-linolenic acid, which a new study suggests may help lower the risk of stroke. "There is potentially some benefit in reducing the risk of stroke if these oils are used in the diet," says Joel Simon, M.D., M.P.H. The lead author of the report in the May issue of the American Heart Association's scientific journal Stroke, he is assistant professor of medicine and epidemiology and biostatistics at the University of California, San Francisco. Fatty acids are the building blocks of fats and oils. A small amount of alpha-linolenic acid, a polyunsaturated fatty acid, is "essential" in the human diet because the body cannot produce it from other fats. "Our findings suggest that higher serum levels of the essential fatty acid alpha-linolenic acid are independently associated with a lower risk of stroke in middle-aged men at high risk for cardiovascular disease," conclude the scientists. The UCSF study included 96 men who had had a stroke and 96 healthy men serving as controls. Intake of stearic acid (found mainly in animal products and chocolate) and alpha-linolenic acid (found in vegetable oils) were determined by measuring their concentrations in the blood. Most studies determine fatty acid dietary intake with questionnaires, but this can be imprecise. "Instead, we looked at the serum level, which better reflects dietary intake," points out Simon. The subjects were part of the the Multiple Risk Factor Intervention Trial (MRFIT), a study looking at the effects of smoking cessation and lowering cholesterol levels and blood pressure in men at high risk for coronary heart disease. The UCSF study found that men who had high blood pressure and smoked had increased stroke risk. But researchers were surprised to find a "provocative" effect from intake of alpha-linolenic acid. For every 0.13 percent increase in alpha-linolenic acid in the blood, the risk of stroke dropped 37 percent. On the other hand, an increase in stearic acid levels was associated with an increased risk of stroke. Researchers measured 16 fatty acids in all. The specific effect of alpha-linolenic acid is not understood. But a family of fatty acids derived from it -- the omega-3 fatty acids -- is known to have beneficial effects on the clotting system. Thrombotic stroke occurs from clots forming or becoming lodged in the arteries that feed blood to the brain. Alpha-linolenic acid -- as well as other omega-3 fatty acids -- may help reduce the chances of clots forming and a stroke occurring, suggest the UCSF researchers. The main dietary sources of alpha-linolenic acid are canola, soybean and walnut oils. Other members of the omega-3 fatty acid family are obtained through the consumption of seafood. These fatty acids have been shown to reduce blood clotting through their effects on platelets, disk-shaped blood particles that form clots. Because the study included only middle-aged men, Simon says the results may not be generalizeable to women or to other age groups. And regardless of the findings, the mainstay of stroke prevention still holds: eating a variety of vegetables and fruits, keeping blood pressure low and not smoking. The AHA cautions that people should not focus on single nutrients in planning what they eat and that balance is the key to health. Also this study was describing what these men were eating as they entered the study. This type of research does not carry as much weight as an investigation in which dietary changes are made and studied. Authors of the UCSF study are Josephine Fong, M.S.; John Bernett Jr., Ph.D.; and Warren Browner, M.D., M.P.H. ### . --- Internet: david@mailhost.smhsi.com Telephone: +1-602-860-1121 FAX: +1-602-451-1165 ------------------------------ To: hicnews American Heart Association National Center For more information, annw@amhrt.org Moderate home exercise helps older adults protect their hearts May 14, 1995 NR 95-4284 (Circ/Exercise)* DALLAS, May 15 -- Home-based, moderate-intensity exercise sessions at least twice weekly may help older adults reap the cardiovascular benefits of physical activity, say researchers at Stanford University School of Medicine in Palo Alto, Calif. And frequency of activity seems to be more cardioprotective than exercise intensity, the scientists add. "Identifying strategies for facilitating sustained exercise participation at a level sufficient to provide these health benefits remains a major public health challenge," the scientists write in their report, published in the May 15 issue of the American Heart Association journal Circulation. But changing the intensity and environment of exercise have been found to influence participation rates, they add. Moderate activity carried out for less than a year can increase blood levels of high-density-lipoprotein cholesterol (HDL, the "good" cholesterol) of young adult women. But little data is available to indicate the time frame, frequency and intensity of activity required to achieve similar results in older women and men. Abby C. King, Ph.D., assistant professor of medicine and health research & policy, and her colleagues followed 269 sedentary adults (149 men and 120 post-menopausal women) who were 50 to 65 years old at the beginning of the study during a two- year exercise program. All participants were free of cardiovascular disease and had not participated in regular physical activity during the preceding six months. Study subjects were randomly assigned to one of four groups: high-intensity, group-based exercise training; high-intensity, home-based exercise training; lower-intensity, home-based exercise training; and a one-year delayed-treatment control group that participated in an exercise training program during the second year. Group-based exercise training consisted of three 60-minute sessions per week in which the major endurance activity was walking/jogging, with some use of stationary bicycles and treadmills. During the first six weeks, study subjects increased exercise intensity to 73-88 percent of peak heart rate. Individuals in the high-intensity, home-based program followed similar exercise prescriptions. They kept activity logs and regularly communicated with staff members. During the second year they received monthly self-assessment and informational materials related to relapse prevention. Members of the lower-intensity, home-based program exercised at 60-73 percent of peak heart rate for five 30-minute sessions per week. During the second year they also received monthly information packets. Those in the control group entered the physical activity program of their choice during the second year. Even though patient adherence decreased during the second year in the lower-intensity home-based program to an average of 2.4 sessions per week, HDL increases above those obtained at the beginning of the study were markedly pronounced compared to the other regimens, the scientists report. After analyzing the influence of exercise frequency on HDL levels, the investigators found that subjects who achieved a minimum of two exercise sessions per week experienced similar increases in HDL regardless of the level of intensity. "The similar pattern of differences shown across the three training regimens support the concept that frequency of exercise participation across an extended time period rather than its intensity may be important in influencing HDL cholesterol levels in this age group," the scientists write. Furthermore, 51.7 percent of men and women in the home-based lower-intensity program showed HDL increases of at least five milligrams per deciliter. Only about a third of the participants in the other exercise programs had similar increases. The suggestion that a longer time frame and reasonable frequency of ongoing exercise participation may be required to achieve HDL cholesterol increases in older adults underscores the importance of physical activity regimens that are convenient and enjoyable enough to be adequately sustained over time, King and her colleagues say. But the researchers point out that "the community being studied was largely white and well educated. Investigations in different populations are necessary to better determine the generalizability of these results." King's colleagues in this study were: William L. Haskell, Ph.D.; Deborah R. Young, Ph.D.; Roberta K. Oka, D.N.Sc.; and Marcia L. Stefanick, Ph.D. --- Internet: david@mailhost.smhsi.com Telephone: +1-602-860-1121 FAX: +1-602-451-1165 ·_ ------------------------------ To: hicnews The Primary Care Conference & Exhibition (PCCE) will be held on June 23-25 at the Pennsylvania Convention Center, Philadelphia. This is the first conference held exclusively for the primary care team. All members of this team (both physicians and nonphysician health care professionals) are invited to attend. Speakers will include former US Surgeon General, C. Everett Koop, MD, ScD; Dr. Vivian W. Pinn, Associate Director of the National Institutes of Health (NIH) for Research on Women's Health; and Dr. Samuel O. Their, President of Massachusetts General Hospital and Professor of Medicine at Harvard Medical School. Dr. Thier's keynote lecture will be "Challenges Facing Primary Care Practitioners in the '90s". Reorganization of health care, driven by economic pressures is accelerating the growth of managed care and the move to capitation. These forces are changing the incentives for those delivering care to favor vertically integrated health systems coordinated by primary care physicians (PCPs). PCPs were, until recently, below specialists in the hierarchy and rewards of medical care. Those PCPs must now assume a leadership role in health care delivery that requires a sense of the responsibility of the profession for education and research as well as for excellent care. The diplomacy and vision with which PCPs assume their new role may well determine the configuration of U.S. medicine for the next several decades. There will be numerous presentations, exhibits, plenary sessions, and clinical workshops to attend while you visit the PCCE. In addition, there are breakfast and luncheon "Meet the Professor" sessions that allow a small, informal group of attendees to meet with Conference faculty. There are also several exciting programs available to entertain your family with the sights of Philadelphia while you are attending the sessions. More information is available at http://www.ep.cursci.com/~pcce/contents.html The following table of contents will give you a glimpse of what to expect at the PCCE. The Primary Care Conference & Exhibition (PCCE) I. Invitation from Sherwood L. Gorbach, MD Chairman of the Executive Advisory Board Invitation from the PCCE Executive Committee II. PCCE Benefits and Highlights Conference Program Objectives and Accreditation PCCE SCHEDULE AT A GLANCE: Friday, June 23, 1995 Saturday, June 24, 1995 Sunday, June 25, 1995 Special presentation by C. Everett Koop, MD, ScD Keynote Lecturer biographies of Vivian W. Pinn, MD and Samuel O. Thier, MD III. Conference Program Overview/Content Special Presentation by C. Everett Koop, MD, ScD Keynote Lecture Content PCCE Plenary Sessions PCCE Clinical Workshops PCCE "Meet the Professor" Sessions IV. PCCE Exhibition Information PCCE Call for Posters V. Travel and Hotel Information VI. Philadelphia Sightseeing Map General Information and History VII. PCCE Family Programs Family Program Registration Form VIII. Create your own PCCE Schedule IX. PCCE Registration Information PCCE Registration Form Useful Information About the PCCE X. PCCE Faculty Index ------------------------------ End of HICNet Medical News Digest V08 Issue #23 *********************************************** --- Editor, HICNet Medical Newsletter Internet: david@stat.com FAX: +1 (602) 451-6135