Abstract. Internet search engines have become an increasingly popular resource for accessing health-related information. The key words used as well as the number and geographic location of searches can provide trend data, as have recently been made available by Google Trends. We report briefly on exploring this resource using Lyme disease as an example because it has well-described seasonal and geographic patterns. We found that search traffic for the string "Lyme disease" reflected increased likelihood of exposure during spring and summer months; conversely, the string "cough" had higher relative traffic during winter months. The cities and states with the highest amount of search traffic for "Lyme disease" overlapped considerably with those where Lyme is known to be endemic. Despite limitations to over-interpretation, we found Google Trends to approximate certain trends previously identified in the epidemiology of Lyme disease. The generation of this type of data may have valuable future implications in aiding surveillance of a broad range of diseases.

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Background: The human resource shortage in Zambia is placing a heavy burden on the few health care workers available at health facilities. The Zambia Prevention, Care and Treatment Partnership began training and placing community volunteers as lay counsellors in order to complement the efforts of the health care workers in providing HIV counselling and testing services. These volunteers are trained using the standard national counselling and testing curriculum. This study was conducted to review the effectiveness of lay counsellors in addressing staff shortages and the provision of HIV counselling and testing services.

BackgroundLyme disease, the most common vector-borne infection in North America, is increasingly reported. When the characteristic rash, erythema migrans, is not recognized and treated, delayed manifestations of disseminated infection may occur. The accuracy of diagnosis and treatment of early Lyme disease in the community is unknown.MethodsA retrospective, consecutive case series of 165 patients presenting for possible early Lyme disease between August 1, 2002 and August 1, 2007 to a community-based Lyme referral practice in Maryland. All patients had acute symptoms of less than or equal to 12 weeks duration. Patients were categorized according to the Centers for Disease Control and Prevention criteria and data were collected on presenting history, physical findings, laboratory serology, prior diagnoses and prior treatments.ResultsThe majority (61%) of patients in this case series were diagnosed with early Lyme disease. Of those diagnosed with early Lyme disease, 13% did not present with erythema migrans; of those not presenting with a rash, 54% had been previously misdiagnosed. Among those with a rash, the diagnosis of erythema migrans was initially missed in 23% of patients whose rash was subsequently confirmed. Of all patients previously misdiagnosed, 41% had received initial antibiotics likely to be ineffective against Lyme disease.ConclusionFor community physicians practicing in high-risk geographic areas, the diagnosis of Lyme disease remains a challenge. Failure to recognize erythema migrans or alternatively, viral-like presentations without a rash, can lead to missed or delayed diagnosis of Lyme disease, ineffective antibiotic treatment, and the potential for late manifestations.

Aims To examine near vision spectacle retention and use, and changes in self-reported and performance-based near vision, 2 months after the provision of near vision spectacles. Methods We conducted a 2-month follow-up of a population-based cohort of persons in rural Tanzania with near vision impairment who had received spectacles. Previously, residents age ≥40 years were examined for distance and near vision acuity. Those with presbyopia and hyperopia (‘functional presbyopia’) were given near vision spectacles. At baseline, subjects were asked to thread a needle; they were also asked questions on the perception of their near vision, ability to be independent and general health. At 2 months, subjects were again queried. Questions on the perceived affordability of replacement spectacles were also asked. Results Of the 866 people provided with spectacles, 89% were seen at 2 months. Ninety-two per cent were still using the spectacles. Users were more likely to have any education (51.8%) than non-users (28.3%) (p<0.001). Only 31% had successfully threaded a needle at baseline, increasing to 91% at follow-up (p<0.001). Spectacle-users showed a significant improvement in satisfaction with near vision and ability to be independent, but no change in perception of general health, from baseline to follow-up. Men were more likely than women to be able to afford spectacles and to know where to get them. Conclusions Our cohort maintained their spectacles and reported tangible improvements associated with their use. The value of simple reading spectacles for those with near vision impairment suggests that a greater emphasis on near vision is needed in the Vision 2020 agenda.

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A quality of life questionnaire utilizing scaled response codes is created for implementation in a predominantly rural African setting. The authors design a concrete tool using color as a semantic differential as a means to ease semantic shifts and enhance participant comprehension. Although they find a fairly even response distribution and no significant clustering among a sample of questions for which the tool is used, their interviewers report that some groups have more difficulty than others and suggest alternative or complementary approaches. This article describes the authors' experience with the utility of their tool within the parameters of this study.