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This study examined the effects of four sets of factors on use of curative health services among rural women living in Gujarat, India. The sets of factors analyzed were as follows: (1) the demographic characteristics of the women; (2) the characteristics of the household in which they lived; (3) the characteristics of the environment in which they lived; and (4) the price and convenience of care. The study focused on rural married women aged 17-45 who had at least one child. Nested multiple logistic regressions were computed on cross-sectional data to assess the simultaneous influences of the independent variables on (1) reports of episodes of illness (2) use of curative services among rural women who reported an illness and (3) use of a specific service. Four types of service were examined as outcomes of interest, namely, private doctors, Aga Khan Health Services centres, government health centres, and traditional healers. Other things being equal, women's education, income, family structure and kinship affiliation were significant predictors of use of service. Women seemed to be more sensitive to travel time to the health service and its associated costs (purdah restrictions, transportation and time costs) than to the direct costs of service. Factors such as women's occupation and sanitation facilities, while associated with use of service in the expected direction, were not significant predictors of use of service. Implications for health planning are offered, including initiatives to implement health promotion and disease prevention programs in addition to increasing access to the existing health services. Avenues for future studies are suggested, particularly in regard to decision-making processes affecting the health-seeking behavior of rural women. It is recommended that such policies and studies should consider the cultural environment in addition to the existing pluralistic health system.

During 1971-77 the incidence of bacterial meningitis among Alaskan Eskimos was 84.4 cases per 100 000 population per year, which is more than 10 times that for most other U.S. populations. Haemophilus influenzae (HI) accounted for 68% of meningitis cases. The average annual incidence of HI disease per 100 000 children below 5 years of age was 409 for patients with meningitis only and 491 for patients with all systemic HI disease. Children with HI meningitis in Alaska tended to be younger than those in other U.S. populations, 98% of the children affected being less than 18 months of age. The risk for all HI disease was 2.4% during the first year of life. The spectrum of HI disease in Alaska differs from that in other populations in that no patient had epiglottitis and 5% of children had recurrent HI disease. Alaskan newborns and children over 4 years old had HI anticapsular antibody titres that were nearly thrice those for children of similar ages in other U.S. populations (p less than 0.005). The pharyngeal carriage of HI type b (5%) and the rectal carriage of Escherichia coli K100 (2%), an organism with a capsule antigenically similar to HI type b, did not differ from those in other populations. The high incidence of disease almost exclusively in the very young and the early development of antibody in this population suggest that the high rate of disease is due to early exposure to HI type b rather than to an unusual susceptibility to HI type b.

An illness characterized by high fever and pneumonia struck 2.9% of a group of the Independent Order of Odd Fellows attending a convention held in Philadelphia, in September, 1974. The convention headquarters was the hotel where the American Legion met in July, 1976. The epidemiological, clinical, and laboratory characteristics of the illness were nearly identical to those of the disease in American legionnaires in 1976. Illness was significantly associated with attendance at one convention activity held on Monday morning, Sept. 16, 1974, in the grand ballroom of the hotel. A serological survey in February and March, 1977, showed that people who had attended the convention and became ill were more likely to have raised indirect fluorescent antibody titres than persons who had attended and remained well. The illness seen in Odd Fellows members in September, 1974, was caused by the legionnaire's disease organism.

Erythromycin and rifampicin (rifampin) were able to prevent death of guineapigs given intraperitoneal injections of the agent causing legionnaires' disease. Penicillin, chloramphenicol, tetracycline, and gentamicin showed no significant effect. On the basis of clinical experience and experimental observations, erythromycin is recommended for patients suspected to have legionnaires' disease. Combined therapy with erythromycin and rifampicin may be justified in patients with confirmed legionnaires' disease who are not responding to erythromycin alone or as part of a controlled antibiotic trial among suspected cases during an outbreak of legionnaires' disease.

A group of related bacteria designated atypical Legionella-like organisms (ALLO) has been identified. ALLO, like L. pneumophila, are fastidious gram-negative rods that grow well on charcoal yeast extract (CYE) agar and produce ground glass colonies and browning of modified yeast extract agar. Unlike L. pneumophila, ALLO do not grow well on Feeley-Gorman (FG) agar, and on CYE agar they fluoresce under longwave ultraviolet light. ALLO and L. pneumophila have a similar predominance of branched-chain forms among total cellular fatty acids but have distinctive fatty-acid profiles. 2 patients with culture-verified ALLO pneumonia and 10 with pneumonia of uncertain aetiology who seroconverted to ALLO offer evidence that ALLO may be a cause of community-acquired pneumonia. Like L. pneumophila, ALLO appear to be water-associated; both persons with culture-verified ALLO infection were exposed to fresh water or its contents before becoming ill, and two strains of ALLO were isolated from water or wet environments.