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Съдържание

 

НОВИНИ

MEDLINE INFORMATION

-     Early Diagnosis of Cervical Cancer / Ранно диагностициране на рак на маточната шийка

-     Stray Dogs and Echinococcosis Incidence / Бездомни кучета и ехинококоза

-     Control of Risk Factors for Stroke / Контролиране на рисковите фактори за инсулт

-     Early Detection of Tuberculosis and Related Diseases/ Ранно диагностициране на туберкулозата и свързани с нея заболявания

 

Новини

 

На 17 ноември в Плевен се проведе еднодневна среща-дискусия по здравни проблеми на Плевен с участието на представители на Здравна фондация “Драйфус” - Ню Йорк, Фондация “Международно сътрудничество в медицината” - Англия, Полското дружество по хигиена, Община Плевен, Районен център по здравеопазване - Плевен, Хигиенно-епидемиологична инспекция - Плевен, Висш медицински институт - Плевен, представители на фармацевтични фирми и неправителствени организации.

Срещата бе ръководена от г-н Цветан Меченски - заместник-кмет на град Плевен и г-н Ленин Грос - финансов директор на Здравна фондация “Драйфус”.

Целта на срещата беше да се направи опит да се очертаят приоритетните здравни проблеми, които могат да намерят решение със съвместните усилия на цялата общност - здравни служители, градски власти, неправителствени организации с прилагането на подхода, използван в програмата на Здравна фондация “Драйфус” в програмата “Решаване на проблеми за по-добро здраве”.

Преди дискусиите бяха представени проекти, разработени в рамките на програмата “Решаване на проблеми за по-добро здраве”: Превенция на наркомании при подрастващите ( доц. Мария Александрова), Контрол на хипертонията и ранна диагностика на глаукома ( д-р Камен Каменов и д-р Милена Средкова), Стандартни протоколи при спешна помощ ( д-р Мая Джунова), Локална скринингова програма за ранно диагностициране на рак на гърдата (доц. Т. Делийски, д-р Георги Байчев, д-р Румен Стоянов).

Общото между представените на срещата проекти и тези представяни на други срещи ( програма “Астма” - Плевен, просветна програма по проблемите на полово-преносимите заболявания - Стара Загора, програма за привличане на нови кръводарители - Ловеч и много други) е в търсене на решение на здравни проблеми, формулирани в проектите. Някои от тях вече са излезли от рамките на първоначалните намерения и са се превърнали в по-мащабни програми.

Но за всички проекти, разработени досега в рамките на програма “Решаване на проблеми за по-добро здраве” досега е характерно едно: разработилите проектите не биха постигнали целите си без подкрепата на колеги, ръководители, местните власти, училищни ръководства, местните медии, неправителствени организации и много други, оценили ефективността на подхода за решаване на здравни проблеми.

Както беше подчертано и от Мадам Шийла Куин (“Международно сътрудничество в медицината” Англия), г-н Ленин Грос (фондация “Драйфус”) и г-н Ян Соботка (Полско дружество по хигиена) по време на дискусиите, ако хората с различни професии и дейности обединят усилията си в търсене на решение на здравните проблеми на местно ниво, има много по-големи изгледи да решат тези проблеми.

Участниците в срещата идентифицираха десет най-важни проблеми на Плевен:

1.Социалнозначими белодробни болести: ХОББ, астма, туберкулоза.

2. Необходимост от по-активно включване на медицински сестри в решаване на здравните проблеми на населението на Плевен и програми за промоция на здравето.

3. Необходимост от опазване здравето на жената: остеопороза, ранна диагностика на рак на гърдата и шийката на матката.

4. Социално-значими съдови заболявания: хипертония, мозъчен инсулт, инфаркт на миокарда.

5. Злоупотреба с наркотици, алкохол и тютюнопушене.

6. Инциденти в детска възраст, влошено детско стоматологично здраве.

7. Недостатъчно грижи за инвалидите и възрастните хора..

8. Глаукома: необходимост от ранна диагностика, профилактика, лечение.

9.Проблеми с организирането на обща практика: липса на опит; комуникация между лекуващ лекар и диагностични звена; информиране на обществеността за предстоящите промени.

10. Необходимост от оздравяване на екологичната среда: замърсяване на въздуха и питейната вода, бездомни кучета, недостатъчна растителност.

 

Проекти по тези проблеми ще бъдат разработени на семинар “Инициатива за по. добро здраве за Плевен”, който ще се проведе в Плевен.

 

От 18 до 20 ноември се проведе нов семинар със студентите от Факултета по здравни грижи на ВМИ - Плевен. Около 40 участници, разпределени в пет групи, идентифицираха здравни проблеми, които биха искали и могли да решат на работното си място. Помощ да формулират проблемите и да намерят работещи решения им оказаха фасилитаторите Мадам Шийла Куин (Англия), г-н Ленин Грос (САЩ), д-р Катаржина Брочек (Полша), г-н Ян Соботка (Полша), г-жа Кристина Марин, г-н Валентин Пулук (Румъния) и доц. Гена Грънчарова, д-р Анжелика Велкова (първа група), д-р Аспарух Георгиев, д-р Явор Иванов (втора група), д-р Камен Каменов (трета група), д-р Милена Средкова (четвърта група), доц. Мария Александрова и г-жа Янка Цветанова (пета група).

Разработени бяха проекти с разнообразна тематика: Здравка Радославова - “Създаване на телефонна линия за консултиране на терминално болни, диспансеризирани в ДОЗ - Велико Търново”, Наташа Митрова - “Приложение на професионално-образователна програма за подобряване на мотивацията на новоприетите студенти в Медицински колеж - Плевен”, д-р Стела Георгиева - “Повишаване на нивото на знанията и интереса на студенти-медици от III курс по дисциплината “Промоция на здравето”, Тинка Пенова -”Образователна програма за изграждане на комуникативни учения при въвеждане на сестринския метод за обгрижване на болните”, Тонка Попова - “Изграждане на умения и навици за работа в център по семейно планиране и репродуктивно здраве у студенти в МК, специалност ‘акушерки’”, д-р Ваня Бенкова - “Създаване на регионално бюро за предлагане на квалифицирана помощ при обгрижване на болни в домашна обстановка с цел избягване на наемане на некомпетентни лица от нуждаещите се”, Мария Таскова - “Обучения на сестрите да поставят сестринска диагноза” , Маргарита Тодорова - “Теоретична и практическа подготовка на студентите, специалност медицински сестри от II курс в МК - Плевен за работа с ЕКГ апарат”, Жана Павловска - “Съкращаване на предоперативния престой на болните, постъпващи за планови операции в гинекологично отделение в ОРБ - Велико Търново”, Албена Константинова - “Обучение на сестрите от интензивен сектор и пулмологично отделение на Диспансер по белодробни болести - гр. Русе за постигане на взаимна заменяемост”, Ваня Петрова -”Медицинска образователна програма за обучение на болни с диабет тип II в района на Втора поликлиника - гр. Плевен за повишаване качеството на живота на болните”, Валентина Йорданова - “Обособяване на сектор “новородени” в гр. Мездра с цел намаляване на броя на новородените, превеждани в по-големи здравни заведения”, Даниела Събева - “Провеждане на обучение по прилагане на сестринска диагноза за старшите медицински сестри и наставниците на студентите от II курс, специалност “медицинска сестра” в МК - Велико Търново с цел подобряване на качеството на грижите за болния и обучението на студентите”, Росица Алексиева - “Провеждане на медицински контрол върху качеството на храната в детска млечна кухня в Белене за постигане на адекватно хранене на 100 деца до 3-годишна възраст”, Петя Тодорова - “Здравно-образователна програма за туберкулозно болни”, Петранка Начева - “Здравно-профилактична програма за усвояване на правилни стоматологични навици у деца от предучилищна възраст”, Цветанка Ангелова - “Изграждане на практически умения и навици за самостоятелна работа при студентите от специалност “медицински сестри от I курс на МК - Плевен”, Теодора Георгиева - “Здравно-просветна програма за профилактика на туберкулозата при болни и техните семейства”, Рени Цекова - “Въвеждане на ускорен метод за откриване на ревматоиден фактор в серум на болни с ревматоиден артрит”, д-р Станислав Витанов - “Програма за повишаване на двигателната активност на студенти с наднормено тегло и/или понижена физическа активност от ВМИ - Плевен, Красимира Дойнова - “Подобряване на сестринските и общите грижи за инсултно болните от гр. Тетевен след изписването им от стационара”, Изабела Георгиева - “Намаляване на кожните наранявания на децата от Дом “Майка и дете” Плевен чрез въвеждане на топлинна обработка на бельото с апарат тип “Каландър””, Надя Александрова - “Организиране на кабинет за функционална диагностика на деца със сърдечно-съдови заболявания към Детски кардиологичен кабинет - ВМИ - Плевен”, Анелия Димитрова - “Ранна профилактика на зъбно-челюстните деформации при деца до 3-годишна възраст в IV педиатричен участък на II поликлиника - Плевен”, Даринка Крачунова - “Организиране на дневен стационар за деца на територията на Детска консултативна поликлиника на ВМИ - Плевен”, Макрета Драганова - “Повишаване на степента на удоволетвореност сред наставници и стажанти от специалността “Здравни грижи” от преддипломния педагогически стаж чрез краткосрочни курсове за наставници”, Росица Димитрова - “Повишаване на мотивацията за у служители на ВМИ - Плевен при провеждането на цялостни профилактични прегледи”, Поля Дамянова - “Здравно-образователна програма за болни с Меланома малигнум”, д-р Мариела Камбурова - “Подобрявяне качеството на преддипломния стаж по управление на здравни грижи чрез периодични тридневни курсове за старшите сестри-наставници”, Диана Иванова - “Провеждане на здравно-образователна програма “Сексуално здраве и болести преносими по полов път” с ученици от 10 класове в училищата в гр. Ловеч”, Димка Аврамова - “Програма за обучение на близките на болни с прекаран мозъчен инсулт за полагане на адекватни грижи в домашна обстановка”, Румяна Христова Коцева - “Обучение Програма за обучение на близките на болни с прекаран мозъчен инсулт за полагане на адекватни грижи в домашна обстановка”.

      

       Предстоящи мероприятия

 

На 3 март в хотел “Балкан” в Плевен ще се се състои семинар за проследяване на работата по проекти, разработени на семинарите “Решаване на проблеми за по-добро здраве” през януари 1998 и ноември 1998 г.

 

От 4 до 6 март в хотел “Балкан” ще се проведе семинар “Инициатива за по-добро здраве за Плевен” от програмата “Инициатива Кейп коуст - Решаване на проблеми за по-добро здраве”, организиран от Здравна фондация “Драйфус” (САЩ), фондация “Сътрудничество в медицината”(Англия), Районен център по здравеопазване - Плевен, община Плевен и клуб “Отворено общество” - Плевен.

      

 

Early Diagnosis of Cervical Cancer / Ранно диаг-ностициране на рак на матоЧната шийка

 

TI:       [Preoccupation women have and should have in watching their health]

TO:     Preocupaciones que las mujeres tienen y deben tener al vigilar su salud.

AU:     Hollis-RS

SO:      Ginecol-Obstet-Mex. 1997 Jun; 65: 243-6

AB:     The American College of Obstetricians and Gynecologists, since its beginning established three main objectives: 1. Education of physicians, 2. Education for patients, 3. To improve health care for women. The time has confirmed that through its programs the following has been reached: 1. Diminution in maternal mortality, 2. Diminution in newborn mortality, 3. Diminution in cervical cancer. The following is recommended: Exercise, adequate diet, evaluation tests, early diagnosis, hormonal therapy when recommended by the physician, for a prolonged, healthier, and more productive life.

 

 

TI:      A clinician’s guide to Pap smear interpretation.

AU:     Mashburn-J; Scharbo-DeHaan-M

AD:     Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Ga., USA.

SO:     Nurse-Pract. 1997 Apr; 22(4): 115-8, 124-7, 130 passim

AB:     Cervical cancer is the seventh most common cause of death from cancer in the United States and the most common cause of cancer in women around the world. In the United States, in 1995 alone, there were 15,800 cases of invasive cervical cancer that resulted in 4,800 deaths. The Papanicolaou (Pap) smear screen has helped in the identification of preinvasive disease, and, in fact, the cure rate for cervical disease is greater than 95% with early diagnosis using this test. This article discusses the risk factors for cervical disease, the essentials of diagnosis, the comparison of Pap smear classification systems, treatment guidelines, referral protocols, and future screening techniques for cervical disease.

 

 

TI:      [Epidemiology of cervical invasive cancer in the Gerona health area in 1980-1989. Cancer registry of Gerona]

TO:     Epidemiologia del cancer invasor de cervix en el area sanitaria de Girona durante el periodo 1980-1989. Registro poblacional de cancer de Gerona.

AU:     Garrido-Victoria-S; Font-Angel-I; Fabregat-Miguel-B; Quemada-Pau-V

AD:     Instituto Catalan de Oncologia de Barcelona.

SO:     Rev-Esp-Salud-Publica. 1997 Jan-Feb; 71(1): 19-26

AB:     BACKGROUND: The goal of the present work is to carry out a descriptive study about the impact of invasive cervical cancer in the area of Gerona, Spain. METHODS: Using data from the population based cancer registry of Gerona for the period 1980-89, several incidence rates were calculated. Incidence trends, demographical distribution and survival according of different variables were analyzed. RESULTS: The average age in which the disease appears was 57 +/- 14 years; the most frequent histological type was the squamous cell carcinoma; 51% of the cases were women born in Cataluna and the remaining percentage corresponds to women from other regions and foreigners. At the moment of diagnosis, el 36% of the cases were local, 34% were regional and 23% disseminated. Crude, standardized and truncated (35-64 years) incidence rates, during 1980 to 1989 were de 8.2, 6.2 and 13.7 cases x 105 women respectively. According to the cumulative rate, 1 in 150 women will have this cancer by age 74. No increase of the trend has been found, however, a significative subincidence has been observed in rural areas. 5-years survival rates is 48.5% and was significantly associated with stage at diagnosis, but age was not. CONCLUSION: From an international viewpoint, Gerona is a low incident area for this tumour and no rising trend has been found. The subincidence in rural areas may suggest a different exposition to risk factors, although certain aspects such as accessibility to health care services, the defining of rural and urban areas and the existence of migrations should be considered. Finally, the lower survival rate with regard to other countries could be attributed to the presence of more advanced stages, which emphasizes the importance that the early diagnosis of this tumour has.

 

 

TI:      Endometrial cancer, cervical cancer, and the adnexal mass.

AU:     Fontaine-P

AD:     Department of Family Practice and Community Health, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA.

SO:     Prim-Care. 1998 Jun; 25(2): 433-57

AB:     Cancers of the endometrium, cervix, and ovaries account for nearly 25,000 annual deaths among women in the United States. In recent years, better understanding of the causes and risk factors associated with gynecologic malignancies has contributed to more effective screening and early diagnosis. Abnormal uterine bleeding, a palpable adnexal mass, or vague abdominal complaints in women older than 40 can be signs of cancer. Regular pelvic examination, combined with appropriate use of the Papanicolaou’s smear, endometrial biopsy, transvaginal sonography, and other tests, is recommended.

 

 

TI:      [Human papillomaviruses and carcinogenesis of the uterine cervix: future prospects in the domain of detection and prevention]

TO:     Papillomavirus humains et carcinogenese du col uterin: perspectives dans les domaines du depistage et de la prevention.

AU:     Orth-G; Croissant-O

AD:     Unite Mixte Institut Pasteur/INSERM U190, Institut Pasteur, Paris.

SO:     Bull-Acad-Natl-Med. 1997 Oct; 181(7): 1365-92; discussion 1392-4

AB:     It is now admitted that certain genotypes of human papillomavirus ( HPV), mainly HPV types 16 and 18, play an etiological role in the origin of the great majority of invasive carcinomas of the uterine cervix and their intraepithelial precursors. Such an evidence has modified our understanding of the natural history of cervical cancer and should result in new approaches for the early diagnosis and prevention of precursor lesions. Sensitive, specific and reliable HPV detection tests have been progressively designed but their use as routine tests requires multicentric studies, involving large series of women, to evaluate their usefulness in the clinical management or the screening of patients and to establish their limits and cost-effectiveness. It is already most likely that the association of HPV detection tests to cervicovaginal cytology would increase the detection rate of high-grade intraepithelial neoplasia and constitute a means for quality control in cytology. The viral origin of most cancers of the uterine cervix paves the way for their prevention by vaccination against the main oncogenic HPV genotypes and provides hope for specific immunotherapy of associated neoplasia.

 

 

TI:      [Screening against cervical cancer. Experiences, attitudes and knowledge of women in the county of Funen]

TO:     Screening mod livmoderhalskraeft. Fynske kvinders erfaringer, holdninger og viden.

AU:     Andreasen-LJ; Holund-B; Jeune-B; Sorensen-B

AD:     Odense Universitetshospital, patologisk institut og gynaekologisk-obstetrisk afdeling.

SO:     Ugeskr-Laeger. 1998 Jan 19; 160(4): 405-9

AB:     Questionnaires on women’s attitudes and knowledge of cervical screening in the County of Funen were mailed to a sample of 1505 attenders aged 23-59 years, stratified on age and residence. A high proportion of attenders (80.4%) answered the questionnaire. Two-thirds of the women had been informed about the screening program before they received the invitation to participate. Generally the women were satisfied with the introduction to the screening program. However, the majority of the attenders were not satisfied with the way they received the result. They wanted the result no later than two weeks after the test was done, and they wanted the result from their GP. Independent of age and education the majority (about 90%) had a good general knowledge (knew that the smear is taken from the cervix; that early diagnosis is important; that cervix cancer can be treated). However the specific knowledge was lower and significantly associated with education (e.g. 43% versus 63% could identify the cervix on a drawing of the uterus among women with respectively low and high levels of school education). Furthermore, the majority were of the opinion that the test should be done more frequently than every three years as recommended by the National Health Board.

 

 

Stray Dogs and Echinococcosis Incidence / Бездомни куЧета и ехинококоза

 

TI:      Public health aspects of cystic echinococcosis in the Arab countries.

AU:     Dar-FK; Alkarmi-T

AD:     Faculty of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates. mbio@medic.uaeu.ac.ae

SO:     Acta-Trop. 1997 Sep 15; 67(1-2): 125-32

AB:     Human cystic echinococcosis (CE) caused by larval Echinococcus granulosus is a zoonosis of major public health importance throughout the region comprising Arab North Africa and the Middle East. Prevalence rates are determined by epizootiological factors related to the size of stray dog population and its worm burden and to the infection rates in the intermediate host reservoir livestock population. Socio-economic development and socio-cultural practices are considered important determinants in the continued transmission of the disease. The reasons why CE remains a significant public health problem in the region are summarized.

 

 

TI:      Coproantigen detection in dogs experimentally and naturally infected with Echinococcus granulosus by a monoclonal antibody-based enzyme-linked immunosorbent assay.

AU:     Malgor-R; Nonaka-N; Basmadjian-I; Sakai-H; Carambula-B; Oku-Y;  Carmona-C; Kamiya-M

AD:     Unidad de Biologia Parasitaria, Facultad de Ciencias, Instituto de Higiene, Universidad de la Republica, Montevideo, Uruguay. ccarmona@chasque.apc.org

SO:     Int-J-Parasitol. 1997 Dec; 27(12): 1605-12

AB:     A sandwich ELISA for the detection of Echinococcus granulosus coproantigen in formalin and heat-treated faecal supernatants of dogs was developed. The assay used affinity-purified polyclonal antibodies obtained from rabbits hyperimmunised with E. granulosus excretory/secretory antigens and biotinylated monoclonal antibody EmA9 produced against adult E. multilocularis somatic extract. The test was sensitive to 7 ng and 2.3 ng of E. granulosus protein and carbohydrate/ml of faecal supernatant, respectively. Thirteen helminth-free dogs were infected with different amounts of E. granulosus protoscoleces and the presence of coproantigen was monitored during the prepatent period until day 35 post-infection, when they were necropsied. Faecal antigen levels started to rise above the normal range between days 10 and 20 post-infection, and typically peaked at the end of the experiment. All the dogs, bearing from 3 to 67,700 worms, showed positive values in the ELISA during the prepatent period. One dog experimentally infected with Taenia hydatigena metacestode and harbouring three worms, tested positive only after the prepatent period at day 52. The test was applied to 98 stray dogs. The ELISA detected all of four dogs naturally infected with E. granulosus, two dogs with patent infections of T. hydatigena and two dogs with no cestode infections, showing a sensitivity of 100% and a specificity of 96%.

 

 

TI:      [Hepatic hydatidosis in Madagascar: a case of autochthonous origin]

TO:     Hydatidose hepatique a Madagascar: a propos d’un cas d’origine autochtone.

AU:     Pecarrere-JL; Anandra-R; Raharisolo-C; Esterre-P; Huerre-M

AD:     Service Chirurgie-Hopital Joseph Ravoahangy Andrianavalona (HJRA), Antananarivo, Madagascar.

SO:     Arch-Inst-Pasteur-Madagascar. 1994; 61(2): 103-4

AB:     Hydatid disease, due to the larval stage of Echinococcus granulosus, is described for the second time at liver level, in Madagascar. Even with a low level of endemic animal disease and an uncontrolled population of stray dogs, the human parasitosis is very rare in Madagascar. It is interesting to note that, since a hundred of years, the epidemiological status of this Zoonosis has not really changed in the great island.

 

 

TI:      Detection of Echinococcus coproantigens in stray dogs of northern Spain.

AU:     Deplazes-P; Jimenez-Palacios-S; Gottstein-B; Skaggs-J; Eckert-J

AD:     Institute of Parasitology, University of Zurich, Switzerland.

SO:     Appl-Parasitol. 1994 Nov; 35(4): 297-301

AB:     An enzyme-linked immunosorbent assay (ELISA) was assessed for its suitability to diagnostically detect Echinococcus coproantigens in fecal samples of dogs infected with E. granulosus. The specificity of the test was determined by investigating fecal samples from 177 Echinococcus-free dogs infected with Taenia spp., 41 dogs with non-taeniid helminths and 24 dogs free of helminth infections. An overall specificity of 97% was determined. The diagnostic sensitivity was in close association to the worm burden of infected individuals: when dogs harboured less than 100 worms, six from 21 samples (29%) were found to be positive in coproantigen ELISA, whereas sensitivity was much higher (23 ELISA-positive from 25 samples = 92%) when dogs had more than 100 worms. Despite the relatively low average sensitivity (63%), the test enabled detection of more than 90% of the biomass of adult Echinococcus present in the respective dog populations. Conclusively, coproantigen detection allows diagnosis of most individual intestinal Echinococcus infections relevant for the egg contamination of the environment and is therefore a valuable tool to determine the relative prevalence of adult stage E. granulosus prevalence in a given endemic area.

 

 

TI:      The development of new foci of echinococcosis in northern Israel: prevalence in domestic animals.

AU:     Furth-M; Hoida-G; Nahmias-J; Greenberg-Z; Barzilay-A; Goldsmith-RS; el-On-J

AD:     Veterinary Services and Animal Health, Ministry of Agriculture, Hadera, Israel.

SO:     J-Helminthol. 1994 Mar; 68(1): 45-7

AB:     In a survey carried out in 1991-1992 in the town of Yirka in Northern Israel, 49 dogs were examined for Echinococcus granulosus infection and abattoir data, based on organs condemned for the presence of parasites, was collected. The presence of E. granulosus by arecoline test was demonstrated in 7 (14.2%) of the dogs examined, but not parasites were found in the intestines of five stray dogs shot in the area. A survey of sheep slaughtered in the local abattoir during a one-month period revealed Echinococcus cysts in 10% of the 255 animals examined. No Echinococcus parasites were detected in 21 dogs examined 3 months after the initiation of praziquantel treatment. Echinococcosis seems to be a very serious public health problem in Israel and a control programme needs to be given a high priority.

 

 

TI:      Epidemiology of hydatidosis and echinococcosis in Theqar Province, southern Iraq.

AU:     Molan-AL

AD:     Department of Biology, College of Science, University of Sanaa, Republic of Yemen.

SO:     Jpn-J-Med-Sci-Biol. 1993 Feb; 46(1): 29-35

AB:     Ninety-six cases of human hydatidosis caused by Echinococcus granulosus were diagnosed from surgical records of hospitals in Theqar Province, Southern Iraq during 1989. The infection rate was higher in female than in male patients (56 versus 40 cases) and increased with their age (maximum, 25.0% in a female group of 31-40 years and 32.5% in a male group of 41-50 years). Many organs such as liver, lungs, peritoneum and spleen were involved, but the liver was most frequently affected. Of 96 patients, 66 (68.8%) showed single organ-involvement and 30 (31.2%) multiple organ-involvement. In 50 stray dogs surveyed for E. granulosus the prevalence was found to be 56.0% with a mean worm burden of 5,300. The light infection (1-200 worms) was found in 10.7% of the infected dogs, the medium (201-1,000 worms) in 21.4% and the heavy (over 1,000 worms) in 67.9%.

 

 

TI:      Survey of echinococcosis in eastern Ethiopia.

AU:     Mersie-A

AD:     Dire Dawa Regional Veterinary Disease Investigation Laboratory, Ethiopia.

SO:     Vet-Parasitol. 1993 Mar; 47(1-2): 161-3

AB:     A total of 171 adult cattle and nine stray dogs were examined for Echinococcus granulosus in eastern Ethiopia. Prevalences of 20.5% and 22% were recorded in cattle and dogs, respectively. Some of the factors involved in the transmission dynamics are discussed.

 

 

TI:      Prevalence of human hydatid disease in northwestern Libya: a cross-sectional ultrasound study.

AU:     Shambesh-MK; Macpherson-CN; Beesley-WN; Gusbi-A; Elsonosi-T

AD:     Department of Biological Sciences, University of Salford, U.K.

SO:     Ann-Trop-Med-Parasitol. 1992 Aug; 86(4): 381-6

AB:     A total of 4103 people were screened in an ultrasound survey of the prevalence of hydatid disease (Echinococcus granulosus) in five areas of northwestern Libya; hydatid cysts were seen in 57 (1.4%), an overall prevalence of approximately 2.0% when adjusted for the likelihood of the occurrence of cysts in other sites in the body. All ultrasound-positive cases were confirmed by dot-blot ELISA. The prevalence of hydatid cysts increased with age, and differed between the sexes except in the five to 14 age group. All diagnosed cases, even those with large cysts, were asymptomatic. This study demonstrates the value of ultrasonography for screening field populations for hydatid disease. The technique was well received locally, facilitating the rapid collection of prevalence data from all ages and both sexes. Libyan people keep guard dogs, but there is little direct human:dog contact. Many people own a single dog, invariably kept outside and often chained up. Stray dogs are common, roaming the countryside to scavenge sheep carcases etc., and such dogs could be the main reservoir of E. granulosus in Libya. Because of the minimal direct human:dog contact, transmission of hydatid disease in Libya is probably indirect by ingestion of eggs from contaminated vegetables or drinking water.

 

 

TI:      The prevalence of Echinococcus granulosus in stray dogs in Iraq.

AU:     Molan-AL; Baban-MR

AD:     Department of Biology, College of Education, University of Salahddin, Arbil, Iraq.

SO:     J-Trop-Med-Hyg. 1992 Apr; 95(2): 146-8

AB:     The present paper records the prevalence of Echinococcus granulosus in stray dogs of Al-Tamim (northern Iraq), Diala (mid Iraq) and Theqar province (southern Iraq), where many people are infected with hydatid disease. Of 150 dogs examined in three provinces in Iraq, 57 (38%) were infected with E. granulosus. The prevalence of the worm was higher in the dogs of Theqar province (56%) than in those of Al-Tamim (20%) and Diala Provinces (38%). Infections were light (1-200 worms) in eight (14%) of the infected dogs, medium (201-1000 worms) in 14 (24.6%) and high (over 1000 worms) in 35 (61.4%). The mean worm burden was 1844 and the maximum number of worms was 15,182 recorded in a male dog from Theqar province. The reasons for such a high rate of infection in the dogs are discussed.

 

Control of Risk Factors for Stroke / Контроли-ране на рисковите фактори за инсулт

 

TI:      Risk factors for cerebrovascular stroke in a cohort of hypertensive patients]

TO:     Factores de risco de acidente vascular cerebral numa coorte de hipertensos.

AU:     Rocha-E; Gouveia-Oliveira-A; Cotter-A; Laranjeiro-A; Sousa-A; Mendes-F; Teixeira H; Galvao-J; Miguel-JM

AD:     Centro de Estudos de Cardiologia Preventiva, INSA, Lisboa.

SO:     Rev-Port-Cardiol. 1997 Jun; 16(6): 543-56, 508

AB:     OBJECTIVES: To identify stroke risk factors in hypertensive patients and the probability of stroke in relation to those risk factors and follow-up. STUDY DESIGN: A cohort study (patients with high blood pressure). MATERIAL AND METHODS: 707 hypertensive patients were studied (Hypertension Register) in what concerns stroke incidence until 1992 (n = 126), considering one case per individual. The following variables were analysed: age, sex, body mass index (Quetelet), systolic and diastolic blood pressure, heart rate, types of hypertension (JNC-IV), left ventricular hypertrophy, changes in ST segment and T wave (Minnesota Code), fundi, angina pectoris, heart failure, central nervous (neurological) disturbances, antihypertensive treatment, smoking, serum potassium, serum sodium, blood urea, creatinine, uric acid, blood sugar, diabetes and cholesterol, in the initial record. Individually, in relation to the control of hypertension, the subjects were classified according to the casual recording of normal blood pressure, the absence of drug treatment, diastolic pressure > 114 mmHg and, at the end of 1992, according to survival, causes of death and follow-up. Stroke risk factors have been identified by multivariate analysis (Cox regression model). The survival probability (without stroke) was defined by Kaplan-Meier method. RESULTS: It was possible to maintain the epidemiological surveillance, from 1975 to 1992, of 598 cases. From those, 109 hypertensive patients were victims of at least one episode of non transient cerebral ischaemia, during their follow-up of 10.5 years. From the characteristics studied, only five were identified at risk factors. The adjusted relative risks and confidence intervals (95% CI) were the following: age: 1.08 (1.06-1.10); diastolic pressure > 114 mmHg: 1.96 (1.32-2.91); neurological disturbances 4.64 (2.99-7.2); diabetes: 2.57 (1.62-4.05) and left ventricular hypertrophy: 1.34 (1.13-1.58). CONCLUSIONS: As far as stroke is concerned: a) Age, diabetes, a casual measurement of diastolic blood pressure > 114 mmHg and left ventricular hypertrophy (electrocardiogram) were the risk factors identified; b) Prevention should include blood pressure and diabetes control, although this disease has shown more risk than a casual measurement of severe hypertension; c) Its occurrence, in this model, has only partly been explained, therefore it has become necessary to deepen the study of the risk profile.

 

 

TI:      Stroke incidence and mortality correlated to stroke risk factors in the WHO MONICA Project. An ecological study of 18 populations.

AU:     Stegmayr-B; Asplund-K; Kuulasmaa-K; Rajakangas-AM; Thorvaldsen-P; Tuomilehto-J

AD:     Department of Medicine, University Hospital, Umea, Sweden.

SO:     Stroke. 1997 Jul; 28(7): 1367-74

AB:     BACKGROUND: The aim of the present study was to determine the extent to which the variation in conventional risk factors contributed to the variation in stroke incidence among these populations. METHODS: Within the WHO MONICA Project, stroke has been recorded in 18 populations in 11 countries. In population surveys, risk factors for cardiovascular diseases have been examined in the age group 35 to 64 years. Over a 3-year period, 12,224 acute strokes were registered in men and women within the same age range. RESULTS: The highest stroke attack rates were found in Novosibirsk in Siberia, Russia, and Finland, with a more than three-fold higher incidence than in Friuli, Italy. The mean diastolic blood pressure among the populations differed by 15 mm Hg between Novosibirsk (highest) and Denmark (lowest). In multiple regression analyses, the presence of conventional cardiovascular risk factors (smoking and elevated blood pressure) explained 21% of the variation in stroke incidence among the population in men and 42% in women. In Finland, in China, and in men in Lithuania, the stroke incidence rates were higher than expected from the population risk factor levels. CONCLUSION: Prevalence of smoking and elevated blood pressure explain a substantial proportion of the variation of stroke attack rates between populations. However, other risk factors for stroke that were not measured in the present study also contribute considerably to interpopulation differences in stroke rates.

 

 

TI:      [Stroke prevention with a high risk strategy of treating hypertension in patients after a transient ischemic attack]

TO:     Schlaganfallpravention mittels einer Hochrisikostrategie der Hypertoniebehandlung bei Patienten nach einer transienten ischamischen Attacke.

AU:     Brainin-M; Dachenhausen-A; Steiner-MM

AD:     Donau-Universitat Krems, Maria Gugging. brainin@ins.at

SO:     Wien-Med-Wochenschr. 1997; 147(2): 34-6

AB:     High-risk strategies represent important preventive measures that focus on individuals with a defined high risk of suffering a chronic disease. They are valuable in addition to measures of prevention within the general population. One example for a high-risk approach for stroke prevention is the treatment of hypertension in individuals that have previously suffered a transient ischemic attack (TIA). Data from the Klosterneuburg Stroke Data Bank and other sources enable an estimate of 2000 TIAs occurring in Austria each year, half of them being hypertensives that are mostly not treated or not sufficiently treated for their hypertension. A high-risk programme that implies forced and effective treatment of hypertension would prevent some 400 strokes or 3% of 16,000 first-ever strokes per year. Costs for preventing one stroke by means of Betablocker agents would amount to ATS 3500 and by ACE-inhibitor agents ATS 11,500, respectively. In addition to general preventive measures, such a programme would have an important impact on stroke incidence and public health.

 

 

TI:      Ischemic stroke after acute myocardial infarction. A population-based study.

AU:     Mooe-T; Eriksson-P; Stegmayr-B

AD:     Department of Internal Medicine, Norrland University Hospital, Umea, Sweden. thomas.mooe@medicin.umu.se

SO:     Stroke. 1997 Apr; 28(4): 762-7

AB:     BACKGROUND AND PURPOSE: Modern treatment may have influenced the risk of stroke after myocardial infarction (MI). The purpose of this study was to examine the incidence of ischemic stroke during the first month after an acute MI in an unselected population, to identify predictors of MI-related stroke, and to investigate the secular trend in MI-related stroke incidence. METHODS: In this case-control study, from a population of approximately 310000 25- to 74-year-old inhabitants, case subjects with a stroke within 1 month after an MI were prospectively recorded in the population-based Northern Sweden MONICA (Monitoring of Trends and Determinants in Cardiovascular Disease) study from 1985 to 1994. The same number of control subjects with an MI but without a stroke were matched for age, sex, and year when MI occurred. RESULTS: One hundred twenty-four case subjects were recorded. Fifty-one percent (63/124) of the strokes occurred within 5 days after onset of MI. The odds ratios (ORs) of an MI-related stroke were for a history of hypertension 1.7 (95% confidence interval [CI], 1.0 to 3.2), previous stroke 2.4 (CI, 1.0 to 6.1), chronic atrial fibrillation 3.0 (CI, 1.1 to 9.2), onset of atrial fibrillation during the hospital stay 3.5 (CI, 1.4 to 10.1), ST-segment elevation 2.4 (CI, 1.4 to 4.6), and anterior infarction 1.5 (CI, 0.9 to 2.6). In a conditional multiple logistic regression model, previous stroke (OR, 2.8; CI, 1.1 to 7.6), chronic atrial fibrillation (OR, 3.8; CI, 1.3 to 11.0), new-onset atrial fibrillation (OR, 4.6; CI, 1.6 to 12.8), and ST-segment elevation (OR, 3.4; CI, 1.6 to 7.4) were independent predictors of stroke. MIs preceding stroke were larger and in 51% were located anteriorly. There was a decrease in the incidence and event rate of MI-related stroke during the study period (P < .01 and P < .05, respectively). CONCLUSIONS: The risk of stroke is highest the first 5 days after MI. Only approximately half of the strokes occurring the first month after an MI are preceded by an anterior MI. The most important predictors of MI-related stroke are atrial fibrillation (chronic or new onset), ST elevation, and a history of a previous stroke. There is a long-term trend toward a lower incidence of MI-related stroke. These findings have important implications concerning both the pathophysiology and prevention of MI-related stroke.

 

 

TI:      Distribution and determinants of cardiovascular events during 20 years of successful antihypertensive treatment.

AU:     Alderman-MH; Cohen-H; Madhavan-S

AD:     Albert Einstein College of Medicine, Department of Epidemiology & Social Medicine, Bronx, New York 10461, USA.

SO:     J-Hypertens. 1998 Jun; 16(6): 761-9

AB:     OBJECTIVE: To define the distribution and determinants of cardiovascular disease events among participants undergoing long-term antihypertensive therapy, and to stratify them into risk groups on the basis of pretreatment clinical profiles. DESIGN: A prospective cohort study of participants in a worksite-based antihypertensive treatment program in New York city (1973-1994). PATIENTS: We studied 8690 systematically treated patients who had at least 6 months of follow-up (average of 5.7 years) and, at entry, had had a systolic blood pressure of > or = 160 mmHg or a diastolic blood pressure of > or = 95 mmHg (after 1992 > or = 140/90 mmHg), or had been being administered antihypertensive medication. MAIN OUTCOME MEASURES: Blood pressure and incidence of morbid and mortal cardiovascular events. RESULTS: Blood pressure control (to 140 +/- 3/87 +/- 7 mmHg) was achieved by the first year and maintained through 18 years of therapy. In nearly 50,000 person-years of follow-up, there were 468 cardiovascular disease events [myocardial infarction including revascularization (282), strokes (93), congestive heart failure (30) and other cardiovascular deaths (63)]. Deaths from cardiovascular disease events accounted for 68% of all deaths. Myocardial infarction was most common throughout, but congestive heart failure incidence surpassed stroke incidence after 10 years. A scheme for risk stratification was constructed after analysis of the independent association of baseline factors and incident cardiovascular events. Upon the basis of ease of ascertainment and their demonstrated associations with occurrence of cardiovascular disease during treatment, we selected five pretreatment factors (history of heart attack, stroke, diabetes, age > or = 55 years and pulse pressure > or = 60 mmHg) to stratify patients into four groups. Those with no risk factor had a low risk (n=2999), those with one had a moderate risk (3042), those with two had a high risk (2237), and those with three or more had a very high risk (412). Overall, the unadjusted rates of incidence of cardiovascular disease events per 1000 person-years for patients in very high and low risk groups differed by factors of six and 14 for men and women, respectively. CONCLUSION: These results demonstrate that long-term control of blood pressure can be achieved in a general population. Nevertheless, cardiovascular disease events still accounted for most morbidity and mortality among these ‘recovered’ hypertensive patients. At entry, on the basis of readily identifiable characteristics, it was possible to stratify patients according to likelihood of subsequent events occurring despite control of blood pressure. This scheme could provide the basis for targeting more aggressive therapy where the potential for further cardioprotection is greatest.

 

 

TI:      Incidence and risk factors for stroke in an occupational cohort: the PROCAM Study. Prospective Cardiovascular Muenster Study.

AU:     Berger-K; Schulte-H; Stogbauer-F; Assmann-G

AD:     Institute of Atherosclerosis Research, University of Muenster, Germany.
bergerk@uni-muenster.de

SO:     Stroke. 1998 Aug; 29(8): 1562-6

AB:     BACKGROUND AND PURPOSE: The purpose of this study was to assess the incidence of stroke and the magnitude of classic stroke risk factors in an occupational cohort of white-collar and blue-collar workers. METHODS: We studied a prospective cohort of 12 866 male employees, aged 30 to 65 years, in 52 companies in northwestern Germany, with an average follow-up of 7.2 years. Participants were free of self-reported stroke, transient ischemic attack, and myocardial infarction at baseline. Physical examination, blood tests, and a face-to-face interview to assess presence of various risk factors were performed at the workplace. Follow-up was done by standardized mailed questionnaire. Main outcome measure was first stroke occurrence. RESULTS: Overall stroke incidence was 42.4 per 100000 person-years, increasing from 10.1 per 100000 person-years in the age category 30 to 39 years to 33.6, 80.6, and 159.2 per 100000 person-years in the age categories 40 to 49, 50 to 59, and 60 years and older, respectively. After adjustment for potential confounders, the relative risks of total stroke associated with systolic blood pressure < or = 120, 121 to 140, and > or = 141 mm Hg were 1.00 (reference), 2.99 (95% confidence interval, 0.85 to 10.49), and 5.56 (1.56 to 19.88). The risks associated with smoking status of never/past, < or = 20 cigarettes per day, and >20 cigarettes per day) were 1.00 (reference), 1.65 (0.62 to 4.42), and 3.56 (1.78 to 7.15), respectively. A history of hypertension at baseline (yes versus no) was independently associated with a relative risk of 2.37 (1.20 to 4.71) for total stroke and a history of diabetes mellitus (yes versus no) with a risk of 2.21 (1.00 to 4.87). A comparison of risk factor levels with a general population study revealed only small differences. CONCLUSIONS: This occupational cohort had a 2-fold lower stroke incidence than that observed in cohorts of the general population. In the absence of a strong healthy-worker effect, moderate differences in behavioral risk factors and a higher treatment rate for hypertension contribute to the explanation of this favorable stroke incidence.

 

 

TI:      Effects of a long-term hypertension control program on stroke incidence and prevalence in a rural community in northeastern Japan.

AU:     Iso-H; Shimamoto-T; Naito-Y; Sato-S; Kitamura-A; Iida-M; Konishi-M; Jacobs-DR Jr; Komachi-Y

AD:     Institute of Community Medicine, University of Tsukuba, Ibaraki-ken, Japan.

SO:     Stroke. 1998 Aug; 29(8): 1510-8

AB:     BACKGROUND AND PURPOSE: Although randomized clinical trials have demonstrated the benefit of antihypertensive treatment in preventing stroke, the effectiveness of community-based programs is largely unknown. We investigated long-term community-based prevention activities. METHODS: In rural northeastern Japan, people aged > or = 30 years numbered 3219 in the full intervention community and 1468 in the minimal intervention community in 1965. Systematic blood pressure screening and health education began in 1963. Stroke was registered through 1987. RESULTS: More than 80% of people aged 40 to 69 years were screened in both communities in the 1960s. One community charged for screening services after 1968, whereas the other community intensified intervention; subsequently, screening rates and the follow-up of hypertensive individuals declined in the minimal intervention community, especially in men. In men, stroke incidence declined more (P < 0.001) in the full intervention (42% in the period 1970 to 1975, 53% in the period 1976 to 1981, and 75% in the period 1982 to 1987) than in the minimal intervention community (5% increase, 20% decrease, and 29% decrease, respectively); in women, the stroke incidence declined about 45% to 65% in both communities. Changes in stroke prevalence paralleled those in stroke incidence. Trends in systolic blood pressure levels tend to explain the differential stroke rates in men. CONCLUSIONS: Delivery of hypertension control services through intensive, free, community-wide screening and health education was effective in prevention of stroke for men in a community.

 

 

TI:      Stroke and cholesterol: ‘enigma variations’?

AU:     Stoy-NS

AD:     St George’s Hospital, London.

SO:     J-R-Coll-Physicians-Lond. 1997 Sep-Oct; 31(5): 521-6

AB:     The relationship of raised serum cholesterol to coronary atherosclerosis, the main pathophysiological substrate for most ischaemic myocardial events, is clear. Strokes have a more complex aetiology. Hypertension and smoking are strong risk factors for stroke, and their elimination is effective in stroke prevention, but cholesterol has been regarded historically as a poor predictor of stroke incidence. The reasons for this are analysed and the relevance of serum cholesterol to stroke prevention discussed.

 

 

TI:      Identification and management of stroke risk in older people: a national survey of current practice in primary care.

AU:     Coppola-WG; Whincup-PH; Walker-M; Ebrahim-S

AD:     Department of Primary Care & Population Sciences, Royal Free Hospital School of Medicine, London, UK.

SO:     J-Hum-Hypertens. 1997 Mar; 11(3): 185-91

AB:     The current practice of stroke prevention was assessed among UK general practitioners (GPs) using a postal questionnaire. A random sample of 583 GPs (response rate 60%) in practice throughout the UK was examined. Main outcomes were the reported practice in the identification of stroke risk, management of hypertension, and use of other interventions (particularly aspirin treatment) to reduce the risk of stroke. Most respondents (451, 77%) reported that they specifically identified patients at high risk of stroke. However, of these only 301 (67%) used more than one major risk factor to do this and less than one-third used either age or pre-existing cardiovascular disease as an indicator. Thresholds for drug treatment of hypertension increased markedly with patient age with only 68%, 23% and 9% of respondents reporting treating elevated systolic, diastolic and isolated systolic pressures respectively, in accord with the British Hypertension Society (BHS) guidelines for patients aged 70-79 years. Thresholds for blood pressure (BP) treatment in older patients did not differ by region but were higher among respondents who had been in general practice for more than 10 years. The value of aspirin in preventing stroke in patients with pre-existing cardiovascular disease was recognized by almost all (560, 96%) respondents. The results suggest that there is scope for increasing the benefits of stroke prevention in primary care, by focusing on the management of patients at high absolute risk, in whom the greatest treatment benefits are likely to be obtained.

 

 

TI:      Health outcomes associated with antihypertensive therapies used as first-line agents. A systematic review and meta-analysis.

AU:     Psaty-BM; Smith-NL; Siscovick-DS; Koepsell-TD; Weiss-NS; Heckbert-SR; Lemai-tre-RN; Wagner-EH; Furberg-CD

AD:     Cardiovascular Health Research Unit, Seattle, WA 98101, USA.

SO:     JAMA. 1997 Mar 5; 277(9): 739-45

AB:     OBJECTIVE: To review the scientific evidence concerning the safety and efficacy of various antihypertensive therapies used as first-line agents and evaluated in terms of major disease end points. DATA SOURCES: MEDLINE searches and previous meta-analyses for 1980 to 1995. DATA SELECTION: We selected long-term studies that assessed major disease end points as an outcome. For the meta-analysis, we chose placebo-controlled randomized trials. For randomized trials using surrogate end points such as blood pressure, we selected the largest studies that evaluated multiple drugs. Where clinical trial evidence was lacking, we relied on information from observational studies. DATA SYNTHESIS: Diuretics and beta-blockers have been evaluated in 18 long-term randomized trials. Compared with placebo, beta-blocker therapy was effective in preventing stroke (relative risk [RR], 0.71; 95% confidence interval [CI], 0.59-0.86) and congestive heart failure (RR, 0.58; 95% CI, 0.40-0.84). The findings were similar for high-dose diuretic therapy (for stroke, RR, 0.49; 95% CI, 0.39-0.62; and for congestive heart failure, RR, 0.17; 95% CI, 0.07-0.41). Low-dose diuretic therapy prevented not only stroke (RR, 0.66; 95% CI, 0.55-0.78) and congestive heart failure (RR, 0.58; 95% CI, 0.44-0.76) but also coronary disease (RR, 0.72; 95% CI, 0.61-0.85) and total mortality (RR, 0.90; 95% CI, 0.81-0.99). Although calcium channel blockers and angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure in hypertensive patients, the clinical trial evidence in terms of health outcomes is meager. For several short-acting dihydropyridine calcium channel blockers, the available evidence suggests the possibility of harm. Whether the long-acting formulations and the nondihydropyridine calcium channel blockers are safe and prevent major cardiovascular events in patients with hypertension remains untested and therefore unknown. CONCLUSION: Until the results of large long-term clinical trials evaluating the effects of calcium channel blockers and ACE inhibitors on cardiovascular disease incidence are completed, the available scientific evidence provides strong support for the current national guidelines, which recommend diuretics and beta-blockers as firstline agents and low-dose therapy for all antihypertensive agents.

 

 

TI:      Risk factors for stroke due to cerebral infarction in young adults.

AU:     You-RX; McNeil-JJ; O’Malley-HM; Davis-SM; Thrift-AG; Donnan-GA

AD:     Department of Neurology, Austin and Repatriation Medical Centre, University of Melbourne, Heidelberg, Vic., Australia.

SO:     Stroke. 1997 Oct; 28(10): 1913-8

AB:     BACKGROUND AND PURPOSE: Stroke in the young is particularly tragic because of the potential for a lifetime of disablement. More than 10% of patients with stroke due to cerebral infarction are aged 55 years or younger. While a number of studies have addressed the issue of stroke mechanism in the young, quantitation of risk factors has rarely been undertaken. Given the importance of risk factor assessment in primary prevention, we aimed to assess this using case-control methodology in a hospital-based series and community-based control subjects. METHODS: A total of 201 consecutive patients with first-onset stroke due to cerebral infarction aged 15 to 55 years (mean, 45.5 years) were accrued from four teaching hospitals during 1985 to 1992 and compared with their age- and sex-matched neighborhood controls. Information concerning potential risk factor exposure status was collected by structured questionnaire at interview. Stroke risks were estimated by calculating the odds ratios with multivariate logistic regression. RESULTS: Significantly increased risk of stroke was found among those with diabetes (odds ratio, 11.6 [95% confidence intervals, 1.2 to 115.2]), hypertension (6.8 [3.3 to 13.9]), heart disease (2.7 [1.1 to 6.4]), current cigarette smoking (2.5 [1.3, 5.0]), and long-term heavy alcohol consumption (> or = 60 g/d) (15.3 [1.0 to 232.0]). However, heavy alcohol ingestion (> or = 60 g) within 24 hours preceding stroke onset was not a risk factor (0.9 [0.3 to 3.4]). CONCLUSIONS: Diabetes, hypertension, heart disease, current smoking, and long-term heavy alcohol consumption are major risk factors for stroke in young adults. Given that the majority of these factors are either correctable or modifiable, prevention strategies may have the potential to reduce the impact of stroke in this age group.

 

 

TI:      Secular trends in stroke mortality in African Americans: the role of urbanization, diabetes and obesity.

AU:     Gillum-RF

AD:     Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, MD 20782, USA.

SO:     Neuroepidemiology. 1997; 16(4): 180-4

AB:     The decline in stroke mortality rates in African Americans has slowed to that seen in the 1960s; rates remain higher than in European Americans. Rates are higher in the southeastern US and in non-metropolitan areas. Adverse trends and patterns in diabetes, obesity, and heart disease prevalence are possible explanations. Unless new, effective prevention programs are introduced in African American communities, stroke mortality rates will decline slowly if at all. The best chance to increase the rate of decline in stroke mortality rates in African Americans may be to redouble efforts to achieve the goals for the year 2000. Community and patient education on improving diet, increasing exercise, further improving detection and control of hypertension, using aspirin in stroke prevention and active control of stroke risk factors in diabetics must be stressed.

 

 

TI:      Fatty acid dietary intake and the risk of ischaemic stroke: a multicentre case-control study. UFA Study Group.

AU:     Ricci-S; Celani-MG; Righetti-E; Caruso-A; De-Medio-G; Trovarelli-G; Romoli-S; Stragliotto-E; Spizzichino-L

AD:     Centro di Coordinamento IST-Italia, Ospedale Silvestrini, Perugia, Italy. istitaly@unipg.it

SO:     J-Neurol. 1997 Jun; 244(6): 360-4

AB:     A low dietary intake of unsaturated fatty acids has been found in male patients with stroke as compared with controls in Italy, and a high consumption of meat has been associated with an increased risk of stroke in Australia. We present a case-control study, comparing the unsaturated and saturated fatty acids content of red cell membranes (which reflects the dietary intake of saturated and unsaturated fats) in 89 patients with ischaemic stroke and 89 controls matched for age and sex. In univariate analysis, besides hypertension, atrial fibrillation, ischaemic changes in ECG and hypercholesterolaemia, stroke patients showed a lower level of oleic acid (P = 0.000), but a higher level of eicosatrienoic acid (P = 0.009). Conditional logistic regression (dependent variable; being a case) showed that the best model included atrial fibrillation, hypertension, oleic acid and eicosatrienoic acids. These results confirm a possible protective role of unsaturated fatty acids against vascular diseases; however, we did not find any difference in the content of omega3 acids, which have been considered in the past to protect against coronary heart disease. We conclude that the preceding diet of patients with ischaemic stroke may be poor in unsaturated fatty acids (namely, oleic acid), and this defect is independent of other vascular risk factors. Only further studies will show whether changes in diet and/or supplement of unsaturated fatty acids might reduce the incidence of ischaemic stroke.

 

 

TI:      Is diastolic hypertension an independent risk factor for stroke in the presence of normal systolic blood pressure in the middle-aged and elderly?

AU:     Nielsen-WB; Lindenstrom-E; Vestbo-J; Jensen-GB

AD:     The Copenhagen City Heart Study, Rigshospitalet, Denmark.

SO:     Am-J-Hypertens. 1997 Jun; 10(6): 634-9

AB:     In a prospective population-based study from the Copenhagen City Heart Study, the role of diastolic blood pressure as an independent risk factor of stroke, in the presence of normal systolic blood pressure, was assessed in 6,545 subjects aged 50 to 80 years. Follow-up was 12 years. Subjects were divided into various blood pressure categories according to both diastolic and systolic blood pressure. The risk of stroke was assessed using a multivariate Cox proportional hazards model, taking into account various cardiovascular risk factors (age, sex, smoking, diabetes mellitus, body mass index, and levels of serum cholesterol). After adjustment for risk factors, only subjects with elevated systolic blood pressure had a significantly increased risk of future stroke. The risk of stroke according to blood pressure categories further reflected increasing levels of pulse pressure, with the highest risk of stroke in subjects with the greatest pulse pressure. We conclude that systolic blood pressure is a better predictor of stroke than is diastolic blood pressure, and question whether diastolic blood pressure, in the presence of normal systolic blood pressure, is an independent risk factor for stroke in the middle-aged and elderly.

 

 

TI:      Science, medicine, and the future. Hypertension.

AU:     Brown-MJ

AD:     Clinical Pharmacology Unit, University of Cambridge, Addenbrooke’s Hospital. mjb14@medschl.cam.ac.uk

SO:     BMJ. 1997 Apr 26; 314(7089): 1258-61

AB:     The abundance of drugs now available for treating hypertension, and evidence that small reductions in blood pressure reverse the associated risk of stroke have shifted clinical concerns away from hypertension. However, we do not understand the cause of hypertension in 95% of patients, fail to achieve a normal blood pressure in 50% of patients, and are unable fully to reverse the cardiac and vascular changes that predate the diagnosis and treatment of hypertension. Consequently, hypertension remains the commonest cause of strokes in Britain and of renal failure in the United States. Essential hypertension is a polygenic disease whose understanding can now be advanced through molecular genetic analyses. Several different syndromes are likely to be recognised; most will be due to interactions between genetic and environmental factors, but there are also likely to be further monogenic syndromes in families with multiple affected members. Recognition of these syndromes will permit accurate genetic prediction of prognosis and optimal treatment and perhaps lead to new and more powerful classes of antihypertensive treatment.

 

 

TI:      A prospective study of body mass index, weight change, and risk of stroke in women.

AU:     Rexrode-KM; Hennekens-CH; Willett-WC; Colditz-GA; Stampfer-MJ; Rich-Edwards-JW; Speizer-FE; Manson-JE

AD:     Division of Preventive Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA. kmrexrode@bics.bwh.harvard.edu

SO:     JAMA. 1997 May 21; 277(19): 1539-45

AB:     OBJECTIVE: To examine the associations of body mass index (BMI) and weight change with risk of stroke in women. SETTING AND DESIGN: Prospective cohort study among US female registered nurses participating in the Nurses’ Health Study. PARTICIPANTS: A total of 116759 women aged 30 to 55 years in 1976 who were free from diagnosed coronary heart disease, stroke, and cancer. MAIN OUTCOME MEASURE: Incidence of ischemic stroke, hemorrhagic stroke (subarachnoid or intraparenchymal hemorrhage), and total stroke. RESULTS: During 16 years of follow-up, 866 total strokes (including 403 ischemic strokes and 269 hemorrhagic strokes) were documented. In multivariate analyses adjusted for age, smoking, postmenopausal hormone use, and menopausal status, women with increased BMI (> or =27 kg/m2) had significantly increased risk of ischemic stroke, with relative risks (RRs) of 1.75 (95% confidence interval [CI], 1.17-2.59) for BMI of 27 to 28.9 kg/m2; 1.90 (95% CI, 1.28-2.82) for BMI of 29 to 31.9 kg/m2; and 2.37 (95% CI, 1.60-3.50) for BMI of 32 kg/m2 or more (P for trend<.001), as compared with those with a BMI of less than 21 kg/m2. For hemorrhagic stroke there was a nonsignificant inverse relation between obesity and hemorrhagic stroke, with the highest risk among women in the leanest BMI category (P for trend=.20). For total stroke the RRs were somewhat attenuated compared with those for ischemic stroke but remained elevated for women with higher BMI (P for trend<.001). In multivariate analyses that also adjusted for BMI at age 18 years, weight gain from age 18 years until 1976 was associated with an RR for ischemic stroke of 1.69 (95% CI, 1.26-2.29) for a gain of 11 to 19.9 kg and 2.52 (95% CI, 1.80-3.52) for a gain of 20 kg or more (P for trend<.001), as compared with women who maintained stable weight (loss or gain <5 kg). Although weight change was not related to risk of hemorrhagic stroke (P for trend=.20), a direct relationship was observed between weight gain and total stroke risk (P for trend<.001). CONCLUSIONS: These prospective data indicate that both obesity and weight gain in women are important risk factors for ischemic and total stroke but not hemorrhagic stroke. The relationship between obesity and total stroke depends on the distribution of stroke subtypes in the population.

 

 

TI:      Serum creatinine concentration and risk of cardiovascular disease: a possible marker for increased risk of stroke.

AU:     Wannamethee-SG; Shaper-AG; Perry-IJ

AD:     Department of Primary Care and Population Sciences, Royal Free Hospital School of Medicine, London, UK.

SO:     Stroke. 1997 Mar; 28(3): 557-63

AB:     BACKGROUND AND PURPOSE: Elevated serum creatinine has been associated with increased mortality in hypertensive persons, the elderly, and patients with myocardial infarction or stroke in whom cardiovascular disease is the major cause of death. We have examined the relationship between serum creatinine concentration and the risk of major ischemic heart disease and stroke events and all-cause mortality in a general population of middle-aged men. METHODS: We present a prospective study of middle-aged men (aged 40 to 59 years) drawn from 24 British towns who have been followed up for an average of 14.75 years. Data on serum creatinine were available for 7690 men in whom there were 287 major stroke events, 967 major ischemic heart disease events, and 1259 deaths from all causes during follow-up. RESULTS: The median serum creatinine concentration was 98 micromol/L (95% range, 76 to 129 micromol/L). Stroke risk was significantly increased at levels above 116 micromol/L (90th percentile) even after adjustment for a wide range of cardiovascular risk factors (relative risk [RR], 1.6; 95% CI, 1.1 to 2.1; > 116 micromol/L versus the rest). Risk of a major ischemic heart disease event was significantly increased at or above 130 micromol/L (97.5 percentile), but this was attenuated after adjustment (RR, 1.2; 95% CI, 0.8 to 1.7; > or = 130 micromol/L versus the rest). There was a weak but significant positive association between diastolic blood pressure and creatinine concentration. However, elevated creatinine concentration (> or = 116 micromol/L) was associated with a significant increase in stroke in both normotensive and hypertensive men. All-cause mortality and overall cardiovascular mortality were significantly increased only above the 97.5 percentile, and no significant association was seen with cancer or other noncardiovascular mortality. CONCLUSIONS: A high serum creatinine concentration within the normal range is a marker for increased risk of cerebrovascular disease in both normotensive and hypertensive subjects. These findings support the evidence indicating that subtle impairment of renal function is a factor for increased risk of stroke and suggest mechanisms in the pathogenesis of stroke that warrant further investigation.

 

 

TI:      Case-control study of stroke and the quality of hypertension control in northwest England.

AU:     Du-X; Cruickshank-K; McNamee-R; Saraee-M; Sourbutts-J; Summers-A; Roberts-N; Walton-E; Holmes-S

AD:     School of Epidemiology and Health Sciences, University of Manchester Medical School.

SO:     BMJ. 1997 Jan 25; 314(7076): 272-6

AB:     OBJECTIVE: To examine the risk of stroke in relation to quality of hypertension control in routine general practice across an entire health district. DESIGN: Population based matched case-control study. SETTING: East Lancashire Health District with a participating population of 388,821 aged < or = 80. SUBJECTS: Cases were patients under 80 with their first stroke identified from a population based stroke register between 1 July 1994 and 30 June 1995. For each case two controls matched with the case for age and sex were selected from the same practice register. Hypertension was defined as systolic blood pressure > or = 160 mm Hg or diastolic blood pressure > or = 95 mm Hg, or both, on at least two occasions within any three month period or any history of treatment with antihypertensive drugs. MAIN OUTCOME MEASURES: Prevalence of hypertension and quality of control of hypertension assessed by using the mean blood pressure recorded before stroke) and odds ratios of stroke (derived from conditional logistic regression). RESULTS: Records of 267 cases and 534 controls were examined; 61% and 42% of these subjects respectively were hypertensive. Compared with non-hypertensive subjects hypertensive patients receiving treatment whose average pre-event systolic blood pressure was controlled to < 140 mm Hg had an adjusted odds ratio for stroke of 1.3 (95% confidence interval 0.6 to 2.7). Those fairly well controlled (140-149 mm Hg), moderately controlled (150-159 mm Hg), or poorly controlled (> or = 160 mm Hg) or untreated had progressively raised odds ratios of 1.6, 2.2, 3.2, and 3.5 respectively. Results for diastolic pressure were similar; both were independent of initial pressures before treatment. Around 21% of strokes were thus attributable to inadequate control with treatment, or 46 first events yearly per 100,000 population aged 40-79. CONCLUSIONS: Risk of stroke was clearly related to quality of control of blood pressure with treatment. In routine practice consistent control of blood pressure to below 150/90 mm Hg seems to be required for optimal stroke prevention.

 

 

TI:      Coffee consumption in hypertensive men in older middle-age and the risk of stroke: the Honolulu Heart Program.

AU:     Hakim-AA; Ross-GW; Curb-JD; Rodriguez-BL; Burchfiel-CM; Sharp-DS; Yano-K; Abbott-RD

AD:     Division of Biostatistics and Epidemiology, University of Virginia School of Medicine,Charlottesville 22908, USA.

SO:     J-Clin-Epidemiol. 1998 Jun; 51(6): 487-94

AB:     OBJECTIVE: To examine the association between coffee consumption and the development of stroke in men at high risk for cardiovascular disease. METHODS: Coffee intake was observed from 1965 to 1968 in a cohort of men enrolled in the Honolulu Heart Program with follow-up for incident stroke over a 25-year period. Subjects were 499 hypertensive men (having systolic or diastolic blood pressures at or above 140 and 90 mm Hg, respectively) in older middle-age (55 to 68 years) when follow-up began. Past and current cigarette smokers were excluded from follow-up. RESULTS: In the course of follow-up, 76 men developed a stroke. After age-adjustment, risk of thromboembolic stroke increased significantly with increases in coffee consumption (P = 0.002). No relationships were observed with hemorrhagic stroke. When adjusted for other factors, the risk of thromboembolic stroke was more than doubled for men who consumed three cups of coffee per day as compared to nondrinkers of coffee (RR = 2.1; 95% CI = 1.2-3.7). CONCLUSIONS: Although in need of further confirmation, consumption of coffee appears to be positively associated with an increased risk of thromboembolic stroke in hypertensive men in older middle-age. Findings suggest that it may be prudent to advise older middle-aged men with hypertension who consume large amounts of coffee to consider reducing their coffee intake.

 

 

TI:      Depressive symptoms and increased risk of stroke mortality over a 29-year period.

AU:     Everson-SA; Roberts-RE; Goldberg-DE; Kaplan-GA

AD:     Human Population Laboratory, Public Health Institute, Berkeley, Calif, USA. severson@umich.edu

SO:     Arch-Intern-Med. 1998 May 25; 158(10): 1133-8

AB:     BACKGROUND: Several lines of evidence indicate that depression is importantly associated with cardiovascular disease end points. However, little is known about the role of depression in stroke mortality. METHODS: This study examined the association between depressive symptoms and stroke mortality in a prospective study of behavioral, social, and psychological factors related to health and mortality in a community sample of 6676 initially stroke-free adults (45.8% male; 79.1% white; mean age at baseline, 43.4 years) from Alameda County, California. Depressive symptoms were assessed by the 18-item Human Population Laboratory Depression Scale. Cox proportional hazards regression models were used to evaluate the impact of depressive symptoms after controlling for age, sex, race, and other confounders. RESULTS: A total of 169 stroke deaths occurred during 29 years of follow-up. Reporting 5 or more depressive symptoms at baseline was associated with increased risk of stroke mortality, after adjusting for age, sex, and race (hazard ratio, 1.66; 95% confidence interval, 1.16-2.39; P<.006). This association remained significant after additional adjustments for education, alcohol consumption, smoking, body mass index, hypertension, and diabetes (hazard ratio, 1.54; 95% confidence interval, 1.06-2.22; P<.02). Time-dependent covariate models, which allowed changes in reported depressive symptoms and risk factor levels during follow-up, revealed the same pattern of associations. CONCLUSIONS: This population-based study provides the strongest epidemiological evidence to date for a significant relationship between depressive symptoms and stroke mortality. These results contribute to the growing literature on the adverse health effects of depression.

 

 

TI:      [Control of blood pressure: a key factor in prevention]

TO:     Blutdruck-Kontrolle: Ein Paradebeispiel der Pravention.

AU:     Suter-PM; Hasler-E; Vetter-W

AD:     Medizinische Poliklinik, Universitatsspital, Zurich.

SO:     Schweiz-Rundsch-Med-Prax. 1998 Jan 28; 87(5): 145-9, 152-6

AB:     An increase in blood pressure represents one of the most common conditions in daily medical practice. Many different factors are regarded as risk factors for a stroke. Hypertension, cardiac diseases, atrial fibrillation, smoking, diabetes mellitus, alcohol consumption and dyslipidemia are central stroke risk factors. The pathophysiological importance of these different risk factors is discussed. Hypertension represents the most prevalent risk factor for stroke in the general population. A decrease in blood pressure leads in general to a reduction of the risk. Besides an optimal pharmacological control of blood pressure miscellaneous non-pharmacological means should be implemented in any patient with high blood pressure. The most important non-pharmacological means of blood pressure control are discussed in the context of stroke risk.

 

 

TI:      Actual blood pressure control: are we doing things right?

AU:     Coca-A

AD:     Department of Internal Medicine, Hospital Clinic, University of Barcelona, Spain.

SO:     J-Hypertens-Suppl. 1998 Jan; 16(1): S45-51

AB:     CORRELATION BETWEEN BLOOD PRESSURE AND RISK OF CARDIOVASCULAR EVENTS: The goal of antihypertensive treatment is to reduce morbidity and mortality from cardiovascular disease associated with high blood pressure values. Epidemiological studies have demonstrated a direct correlation between the risk of stroke or coronary events and blood pressure values, and randomized controlled trials with antihypertensive drugs have shown that an average fall in diastolic blood pressure (DBP) of 5-6 mmHg [or in systolic blood pressure (SBP) of 10 mmHg] reduces the relative risk of cerebrovascular events by 40% and of coronary events by 15%. Thus, it would seem appropriate to achieve the maximum tolerated blood pressure reduction, although there is still no consensus on how far blood pressure should be lowered. PROBLEMS OF BLOOD PRESSURE CONTROL: Because the reduction in the absolute risk for a given level of blood pressure is higher in elderly patients and in those with multiple risk factors, the 1996 World Health Organization report recommends lowering blood pressure to below 140/90 mmHg in elderly patients, and suggests that it might be desirable to achieve blood pressure values of 120-130/80 mmHg in young patients with mild hypertension. Recent surveys in primary care centers in Spain show blood pressure control rates (blood pressure < 140/90 mmHg) ranging from 13 to 26%. These insufficient rates denote the particular difficulty of controlling SBP in an elderly population of patients with essential hypertension mainly treated in monotherapy schedules. The picture is similar in other developed countries. In a sample of 14,000 patients from Western European countries the Cardiomonitor survey showed control rates of 43% for DBP (< 90 mmHg) and 35% for SBP (< 140 mmHg). No more than 24% of treated hypertensive patients achieve the target (blood pressure < 140/90 mmHg) in the USA, and no more than 27% (DBP < 90 mmHg) in New Zealand. Preliminary reports from the Hypertension Optimal Treatment study indicate that in most patients combined therapy is required to achieve target blood pressure. Fixed combinations of synergistic antihypertensive drugs may help to improve both drug compliance and blood pressure control.

 

 

TI:      Public perception of stroke warning signs and knowledge of potential risk factors.

AU:     Pancioli-AM; Broderick-J; Kothari-R; Brott-T; Tuchfarber-A; Miller-R; Khoury-J; Jauch-E

AD:     Department of Emergency Medicine, University of Cincinnati, OH 45267-0769, USA.Arthur.Pancioli@uc.edu

SO:     JAMA. 1998 Apr 22-29; 279(16): 1288-92

AB:     CONTEXT: Decreasing the time from stroke onset to hospital arrival and improving control of stroke risk factors depend on public knowledge of stroke warning signs and risk factors. OBJECTIVE: To assess current public knowledge of stroke warning signs and risk factors. DESIGN: A population-based telephone interview survey using random digit dialing conducted in 1995. SETTING: The Greater Cincinnati, Ohio, metropolitan area, the population of which is similar to that of the United States overall in age, sex, percentage of blacks, and economic status. PARTICIPANTS: Respondents with age, race, and sex that matched the population of patients with acute stroke. MAIN OUTCOME MEASURES: Knowledge of risk factors for stroke and warning signs of stroke as defined by the National Institute of Neurological Disorders and Stroke. RESULTS: Telephone calls were made to 17634 households, which yielded 2642 demographically eligible individuals. Interviews were completed by 1880 respondents (response rate, 71.2%). A total of 1066 respondents (57%) correctly listed at least 1 of the 5 established stroke warning signs, and of all respondents, 1274 (68%) correctly listed at least 1 of the established stroke risk factors. Of the respondents, 469 (57%) of 818 respondents with a history of hypertension listed hypertension, 142 (35%) of 402 respondents who were current smokers listed smoking, and 32 (13%) of 255 respondents with diabetes listed diabetes as a risk factor for stroke. Compared with those younger than 75 years, respondents 75 years or older were less likely to correctly list at least 1 stroke warning sign (60% vs 47%, respectively; P<.001) and were less likely to list at least 1 stroke risk factor (72% vs 56%, respectively; P<.001). CONCLUSION: Considerable education is needed to increase the public’s awareness of the warning signs and risk factors for stroke. Respondents with self-reported risk factors for stroke are largely unaware of their increased risk. The population at greatest risk for stroke, the very elderly, are the least knowledgeable about stroke warning signs and risk factors.

 

 

TI:      Leisure-time physical activity and ischemic stroke risk: the Northern Manhattan Stroke Study.

AU:     Sacco-RL; Gan-R; Boden-Albala-B; Lin-IF; Kargman-DE; Hauser-WA; Shea-S; PaikMC

AD:     Department of Neurology, Sergievsky Center, Columbia University College of Physicians and Surgeons and School of Public Health, New York, NY, USA. RLS1@Columbia.edu

SO:     Stroke. 1998 Feb; 29(2): 380-7

AB:     BACKGROUND AND PURPOSE: Physical activity reduces the risk of premature death and cardiovascular disease, but the relationship to stroke is less well studied. The objective of this study was to investigate the association between leisure-time physical activity and ischemic stroke in an urban, elderly, multiethnic population. METHODS: The Northern Manhattan Stroke Study is a population-based incidence and case-control study. Case subjects had first ischemic stroke, and control subjects were derived through random-digit dialing with 1:2 matching for age, sex, and race/ethnicity. Physical activity was recorded through a standardized in-person interview regarding the frequency and duration of 14 activities over the 2 prior weeks. Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals after adjustment for medical and socioeconomic confounders. RESULTS: Over 30 months, 369 case subjects and 678 control subjects were enrolled. Mean age was 69.9 +/- 12 years; 57% were women, 18% whites, 30% blacks, and 52% Hispanics. Leisure-time physical activity was significantly protective for stroke after adjustment for cardiac disease, peripheral vascular disease, hypertension, diabetes, smoking, alcohol use, obesity, medical reasons for limited activity, education, and season of enrollment (OR = 0.37; 95% confidence interval=0.25 to 0.55). The protective effect of physical activity was detected in both younger and older groups, in men and women, and in whites, blacks, and Hispanics. A dose-response relationship was shown for both intensity (light-moderate activity OR = 0.39; heavy OR = 0.23) and duration (<2 h/wk OR = 0.42; 2 to <5 h/wk OR = 0.35; > or =5 h/wk OR = 0.31) of physical activity. CONCLUSIONS: Leisure-time physical activity was related to a decreased occurrence of ischemic stroke in our elderly, multiethnic, urban subjects. More emphasis on physical activity in stroke prevention campaigns is needed among the elderly.

 

 

TI:      Risk factors for ischemic stroke in a Russian community: a population-based case-control study.

AU:     Feigin-VL; Wiebers-DO; Nikitin-YP; O’Fallon-WM; Whisnant-JP

AD:     Department of Health Sciences Research, Mayo Clinic and Mayo Foundation, Rochester, Minn 55905, USA.

SO:     Stroke. 1998 Jan; 29(1): 34-9

AB:     BACKGROUND AND PURPOSE: This study was conducted to determine the risk factors for ischemic stroke in a defined Russian population. METHODS: Our data are based on a population-based case-control study of 237 patients with first-ever ischemic stroke and 237 age- and sex-matched controls. Logistic regression methods for matched pairs were used to estimate the relative risk for the variables studied. RESULTS: In a multivariate analysis, hypertension, left ventricular hypertrophy on electrocardiography, ischemic heart disease, mitral valve disease, current cigarette smoking, and high body mass index were significant and independent risk factors for ischemic stroke in this Russian community. CONCLUSIONS: The significant risk factors for ischemic stroke in Novosibirsk are similar to those from other populations and cohorts. This study, the first of stroke risk factors in Russia, has implications for clinical practice and the planning of stroke prevention in the population.

 

 

TI:      Ischemic stroke and use of estrogen and estrogen/progestogen as hormone replacement therapy.

AU:     Petitti-DB; Sidney-S; Quesenberry-CP Jr; Bernstein-A

AD:     Kaiser Permanente Medical Care Program, Southern California, USA. diana.b.petitti@kp.org

SO:     Stroke. 1998 Jan; 29(1): 23-8

AB:     BACKGROUND AND PURPOSE: Information about the risk of stroke in current postmenopausal hormone users is limited. METHODS: In this case-control study, women aged 45 to 74 years hospitalized with a fatal or nonfatal stroke in any of 10 Northern California Kaiser Permanente facilities during the period November 1991 to November 1994 were identified as cases. Controls were selected at random from female Health Plan members. Data regarding use of estrogen plus progestogen or estrogen alone were obtained in interviews. RESULTS: The analysis was based on nonproxy responses from 349 cases of ischemic stroke and 349 matched control subjects. After adjustment for confounders, the odds ratio for ischemic stroke in current hormone users was 1.03 (95% confidence interval, 0.65 to 1.65). The odds ratios for ischemic stroke in current hormone users showed no clear trend of increasing or decreasing risk in relation to duration of hormone use. The odds ratio for ischemic stroke in past hormone users was 0.84 (95% confidence interval, 0.54 to 1.32). CONCLUSIONS: In this study postmenopausal hormone use was not associated with an increase or decrease in the risk of ischemic stroke, a finding that is consistent with the body of literature on this topic.

 

 

TI:      Strokes in the elderly: prevalence, risk factors & the strategies for prevention.

AU:     Dalal-PM

AD:     Department of Neuroscience, Medical Research Centre Lilavati Hospital, Mumbai.

SO:     Indian-J-Med-Res. 1997 Oct; 106: 325-32

AB:     Current demographic trends suggest that the Indian population will survive through the peak years of occurrence of stroke (age 55-65 yr) and stroke-survivors in the elderly with varying degree of residual disability, will be a major medical problem. The available data from community surveys from different regions of India for ‘hemiplegia’ presumed to be of vascular origin indicate a crude prevalence rate in the range of 200 per 100,000 persons. Thus, the anticipated costs of rehabilitation of stroke-victims will pose enormous socio-economic burden on our meagre health-care resources, similar to what is now faced by industrialised nations in the West. Therefore, prevention of strokes at any age should be our main strategy in national health planning. Among all risk factors for strokes, hypertension is one of the most important and treatable factor. Community screening surveys, by well defined WHO protocol, have shown that nearly 15 per cent of the urban population is ‘hypertensive’ (160/95 mm Hg or more). Though high blood pressure has the highest attributable risk for stroke, there are many reasons such as patient’s compliance in taking medicines and poor follow up in clinical practice that may lead to failure in reducing stroke mortality. In subjects who have transient ischaemic attacks (TIAs), regular use of antiplatelet agents like aspirin in prevention of stroke is well established. It is also mandatory to prohibit tobacco use and adjust dietary habits to control body weight, and associated conditions like diabetes mellitus etc., should be treated. It is advisable to initiate community screening surveys on well defined populations for early detection of hypertension and TIAs. Primary health care centres should be the base-stations for these surveys because data gathered from urban hospitals will not truly reflect the crude prevalence rates for the community to design practical prevention programmes.

 

 

TI:      Predictive value of home blood pressure measurement in relation to stroke morbidity: a population-based pilot study in Ohasama, Japan.

AU:     Sakuma-M; Imai-Y; Tsuji-I; Nagai-K; Ohkubo-T; Watanabe-N; Sakuma-H; Satoh-H; Hisamichi-S

AD:     Department of Environmental Health Sciences, Tohoku University School of Medicine, Sendai, Japan.

SO:     Hypertens-Res. 1997 Sep; 20(3): 167-74

AB:     We investigated the utility of home blood pressure measurements for determining the risk of stroke. We also analyzed the relationship between home blood pressure and the incidence of stroke. Home blood pressure and screening blood pressure measurements were obtained from 1,789 residents (aged 40 yr or older) of a rural Japanese community. Blood pressure was measured at home with a semiautomatic device. A mean (+/-SD) of 23.0 +/- 7.5 measurements were made for each subject. Subjects without a history of stroke and who were not receiving medication for hypertension (n = 1,256) were prospectively followed up for 4.4 +/- 2.1 yr. Subjects were subdivided into quintiles according to their baseline blood pressure. The association between the baseline blood pressure and the incidence of the first-ever stroke was examined with the Cox proportional hazards regression model, adjusted for age and sex. The lowest risk of stroke morbidity occurred in the subjects in the third quintile for home systolic blood pressure (117-123 mmHg) and in those in the second quintile for home diastolic blood pressure (66-70 mmHg). The subjects in the fifth quintiles for home systolic (> or = 133 mmHg) and diastolic blood pressure (> or = 81 mmHg) had a significantly increased risk of stroke morbidity. The subjects in the first and the second quintiles for home systolic blood pressure and those in the first quintile for home diastolic blood pressure tended to have an increased risk as compared with subjects in the lowest risk groups, although this increase was not statistically significant, indicating two possibilities: a trend toward a J-shaped relationship or no-decrease in risk of the first-ever stroke in subjects with home blood pressure level less than 123/70 mmHg. This relationship was not observed for screening blood pressure. We conclude that home blood pressure measurements can provide additional prognostic information to that obtained from blood pressure measurement in a medical environment.

 

 

Early Detection of Tuberculosis and Related Diseases / Ранно диагностициране на туберкулозата и свързани с неЯ заболЯваниЯ

 

TI:      Early detection of Mycobacterium tuberculosis in BACTEC cultures by li-gase chain reaction.

AU:     Tortoli-E; Lavinia-F; Simonetti-MT

AD:     Laboratorio di Microbiologia e Virologia, Ospedale di Careggi, 50139 Florence,Italy. tortoli@dada.it

SO:     J-Clin-Microbiol. 1998 Sep; 36(9): 2791-2

AB:     The LCx Mycobacterium tuberculosis ligase chain reaction system (Abbott Diagnostic Division, Abbott Park, Ill.) was used to detect M. tuberculosis in 150 consecutive BACTEC vials on the day on which a positive growth index (GI) was recorded. By LCx, M. tuberculosis DNA was detected in BACTEC vials on average 2.6 days before the presence of acid-fast bacilli could be confirmed by microscopic examination. A total of 106 of 108 M. tuberculosis isolates were detected without centrifugation from bottles presenting very low GIs (average, 70; median, 33). No false-positive result was obtained from nontuberculous mycobacteria or from isolates with contaminants.

 

 

TI:      Tuberculous meningitis in adults: an eleven-year review.

AU:     Hosoglu-S; Ayaz-C; Geyik-MF; Kokoglu-OF; Ceviz-A

AD:     Department of Infectious Diseases, Faculty of Medicine, Dicle University, Diyarbakir, Turkey.

SO:     Int-J-Tuberc-Lung-Dis. 1998 Jul; 2(7): 553-7

AB:     OBJECTIVE: To assess the presentation, diagnosis and outcome of patients with tuberculous meningitis (TBM). DESIGN: The medical records of adults with TBM who were treated at Dicle University Hospital between January 1985 and October 1996 were reviewed. RESULTS: In total, 101 patients were identified and stratified

according to the stage of disease at presentation. The mean duration of the symptoms of TBM before admission was 12 days. The majority of patients had headaches (96.0%), fever (91.1%), nuchal rigidity (91.1%), vomiting (81.2%), meningism (79.2%) and abnormal mental state (72.3%). The mean cerebrospinal fluid (CSF) leukocyte count was 0.38 x 10(9)/L, protein 1410 mg/L, glucose 2.0 mmol/L and CSF/blood glucose ratio 27%. Cranial computerized tomography (CT) scans were performed during the course of TBM in 64 patients. The results were normal in 6.3%, and abnormal in 93.7% of the cases; the most frequent abnormality found on CT was hydrocephalus (45.3%). Forty-four patients (43.5%) died. Minor neurological sequelae developed in 11 patients (10.9%), major sequelae in 10 (9.9%), and 31 patients (30.7%) completely recovered. There was no follow-up for five patients (5.0%). Five factors were important in predicting fatal outcome: stage III at presentation, low glucose levels, low CSF/blood glucose ratio, high protein levels, and CT scanning abnormality. CONCLUSION: TBM is a very critical disease in terms of fatal outcome and permanent sequelae: 43.5% of the patients died and only 30.7% experienced complete recovery. Early treatment may reduce fatal outcome and morbidity.

 

 

TI:      Role of antigen specific circulating immune complexes in diagnosis of tuber-culosis.

AU:     Gupta-I; Jain-A; Singh-NB; Chaturvedi-V; Agarwal-SK

AD:     Post Graduate Department of Microbiology, King George’s Medical College, Lucknow, India.

SO:     Int-J-Tuberc-Lung-Dis. 1998 Jun; 2(6): 456-61

AB:     SETTING: Tuberculosis is a public health problem worldwide. Early accurate diagnosis in patients with active disease is essential to reduce morbidity and mortality. Conventional methods for detection of Mycobacterium tuberculosis have given disappointing results. OBJECTIVE: To evaluate the utility of detection of M. tuberculosis antigen in circulating immune complexes (CIC) for the diagnosis of tuberculosis. METHOD: Eighty-four clinically diagnosed cases of mainly extra-pulmonary tuberculosis, 85 patients with diseases other than tuberculosis and 30 healthy controls, were evaluated for the presence of antigen of M. tuberculosis in CIC in serum using sandwich enzyme linked immunosorbent assay (ELISA). RESULTS: In total, 22 out of 84 cases were positive for culture on Lowenstein Jensen medium; 76.5% (n = 65) of the clinically diagnosed patients (including 20 culture-positive cases) were found to be positive by ELISA. The difference in mean absorbance values of ELISA in cases of tuberculosis was significantly higher than in controls. The sensitivity of ELISA was 90.9% and the specificity was 93.04%. CONCLUSION: Detection of M. tuberculosis antigen in CIC by ELISA has potential as a useful diagnostic tool for the rapid diagnosis of tuberculosis, especially extra-pulmonary forms where results of conventional methods of diagnosis are disappointing.

 

 

TI:      Tuberculosis in children and adolescents: California, 1985 to 1995.

AU:     Lobato-MN; Cummings-K; Will-D; Royce-S

AD:     University of California, Department of Pediatrics, San Francisco, USA.

SO:     Pediatr-Infect-Dis-J. 1998 May; 17(5): 407-11

AB:     OBJECTIVES: To describe the epidemiology and clinical characteristics of tuberculosis (TB) among children and adolescents and to define children at risk for TB. SETTING: 4607 children 0 to 14 years of age and 1615 adolescents 15 to 19 years of age reported with TB in California. METHODS: We analyzed surveillance data reported to the California Department of Health Services TB Control Branch from 1985 through 1995. RESULTS: TB cases increased 22% among children 0 to 4 years of age and 66% among children 5 to 14 from 1985 through 1995. Case rates were highest among children 0 to 4 years of age (13/ 100000 children), but declined from 1993 to 1995, except for black children 0 to 4 years of age. Minority children 0 to 14 years of age had case rates 6- to 34-fold higher than did white children. Pulmonary TB was the most common site of disease in all age groups (71 to 82%). TB meningitis was most common in children 0 to 4 years of age (5%). Most children (64%) did not have cultures done; however, among culture-proved cases isoniazid-resistant Mycobacterium tuberculosis was isolated in 7%. Adolescents were more likely to have cavitary pulmonary disease (24%), to be foreign-born (78%) or homeless (4%) and to have an isoniazid-resistant strain isolated (13%) than were children 0 to 14 years of age (P < 0.05). CONCLUSIONS: TB in children and adolescents increased substantially in the mid-1980s and early 1990s. Pediatric TB remains a serious health problem, especially among minority children and adolescents. Our findings indicate that TB control programs need improved strategies to prevent infection and detect disease in this population.

 

 

TI:      Tuberculosis mortality in notified cases from 1989-1995 in Birmingham.

AU:     Bakhshi-SS; Hawker-J; Ali-S

AD:     Birmingham Health Authority, Edgbaston.

SO:     Public-Health. 1998 May; 112(3): 165-8

AB:     This is a retrospective descriptive study examining medical records of notified cases of tuberculosis in Birmingham, UK, who died before completion of treatment, plus notified cases identified at postmortem. During the study period, 1989-1995, there were a total of 2088 notifications of tuberculosis of which 75 (3.6%) died. This case-fatality rate is lower than that reported from earlier studies, a finding which may be due to improved ascertainment, earlier diagnosis and improved treatment in recent years. Forty-five deaths (60%) were in males and 30 (40%) in females. The median age at death was 66 y. Forty-five deaths (60%) were among the white ethnic group, 21 (28%) among persons of Indian sub-continent origin, 4 (5.3%) among Black Caribbeans and 5 (6.6%) among the other ethnic groups. Case-fatality rates were significantly higher (P < 0.01) in caucasians (9.4%) than in Asians (1.5%) and only half of this difference was explained by the age of those affected. Twenty-two (29%) cases were confirmed by a positive sputum smear and a further 23 (31%) by a positive sputum culture. Eighteen (24%) cases also had histological confirmation. Twelve (16%) cases were identified on autopsy. The case fatality rate in respiratory disease was significantly higher (RR = 1.19, P > 0.05) than in non-respiratory disease. As delay in diagnosis is likely to be the main contributing factor leading to death, a high index of suspicion of tuberculosis is needed when investigating elderly patients with general chronic illness, especially if there are prolonged respiratory symptoms. Early diagnosis will reduce mortality as the disease rapidly responds to treatment.

 

 

TI:      Tuberculosis and pregnancy—a provincial study (1990-1996).

AU:     Doveren-RF; Block-R

AD:     Department of Tuberculosis Control, GGD Zeeland, Goes, Netherlands.

SO:     Neth-J-Med. 1998 Mar; 52(3): 100-6

AB:     BACKGROUND: Several studies suggest that physiological changes in pregnancy mimic early symptoms of tuberculosis. If true, this could influence the diagnostic delay of the disease and the outcome of pregnancy. METHODS: From the register of the Public Health Centre, all female patients with culture-proven tuberculosis aged between 22 and 35 years in the Province of Zeeland in the period 1990-1996 have been identified. Data on symptoms, delay, therapy and outcome of the pregnancy have been collected. Risk factors for an early diagnosis have been identified. RESULTS: In nearly one-third of the patients with tuberculosis (n = 14), it has been possible to make a presumptive diagnosis on the basis of a chest X-ray only. Patients with tuberculosis associated with pregnancy are more likely than their non-pregnant counterparts to have non-specific symptoms which are, at most, moderate (p = 0.002). Diagnosis has also been hampered by non-cavernous, smear-negative presentation of the disease. In addition, women with pulmonary tuberculosis associated with pregnancy are more likely to postpone having a chest X-ray taken (p = 0.02), which contributes to the delay. CONCLUSION: As the clinical features of tuberculosis in pregnancy are moderate, a high index of clinical suspicion is necessary. Nevertheless, the favourable outcome suggests that (if all risk factors are taken into account) lung tuberculosis in pregnant women in The Netherlands can be discovered sufficiently early within the limits of the current screening programme to prevent harm to mother or child.

 

 

TI:      Few opportunities found for tuberculosis prevention among the urban poor.

AU:     Bock-NN; McGowan-JE Jr; Blumberg-HM

AD:     Department of Medicine, Emory University School of Medicine and Grady Memorial Hospital, Atlanta, Georgia 30303, USA.

SO:     Int-J-Tuberc-Lung-Dis. 1998 Feb; 2(2): 124-9

AB:     SETTING: Grady Memorial Hospital, a public hospital in Atlanta, Georgia, a city with high rates of tuberculosis. OBJECTIVE: To identify specific points of contact with the public health system where high risk individuals could receive tuberculin testing and isoniazid preventive therapy. DESIGN: Patient interviews and medical chart reviews of tuberculosis patients diagnosed in hospital between October 1993 and December 1994. RESULTS: In total 151 tuberculosis patients participated: 80% were male, 89% African American, the mean age was 40; 50% were HIV co-infected. Three fourths reported no regular source of medical care. The only potential public health sites at least one third of the patients had encountered in the five years prior to tuberculosis diagnosis were correctional institutions (44%) and public hospital in-patient wards (37%). Duration of incarceration was six months or more in only 13% of patients. Of 108 (71%) patients who had identified substance abuse problems, only 25% had been in treatment programs. CONCLUSION: We conclude that most tuberculosis cases in this community occurred in persons with poor access to health care and few opportunities for public health intervention. Tuberculosis prevention for this high risk population can best be accomplished by focusing efforts on early case identification, completion of therapy and contact investigations.

 

 

TI:      Noncompliance with directly observed therapy for tuberculosis. Epidemiology and effect on the outcome of treatment.

AU:     Burman-WJ; Cohn-DL; Rietmeijer-CA; Judson-FN; Sbarbaro-JA; Reves-RR

AD:     Department of Public Health, Danver Health and Hospitals, CO 80204, USA.

SO:     Chest. 1997 May; 111(5): 1168-73

AB:     STUDY OBJECTIVES: To describe the epidemiology and clinical consequences of noncompliance with directly observed therapy (DOT) for treatment of tuberculosis. DESIGN: Retrospective review. SETTING: An urban tuberculosis control program that emphasizes DOT. PATIENTS: All patients treated with outpatient DOT from 1984 to 1994. MEASUREMENTS AND RESULTS: We defined noncompliance as follows: (1) missing > or = 2 consecutive weeks of DOT; (2) prolongation of treatment > 30 days due to sporadic missed doses; or (3) incarceration for presenting a threat to public health. Poor outcomes of therapy were defined as a microbiologic or clinical failure of initial therapy, relapse, or death due to tuberculosis. Fifty-two of 294 patients (18%) who received outpatient DOT fulfilled one or more criteria for noncompliance. Using multivariate logistic regression, risk factors for noncompliance were alcohol abuse (odds ratio, 3.0; 95% confidence interval, 1.2 to 7.5; p = 0.02) and homelessness (odds ratio, 3.2; 95% confidence interval, 1.5 to 7.2; p = 0.004). Noncompliant patients had poor outcomes from the initial course of therapy more often than compliant patients: 17 of 52 (32.7%) vs 8 of 242 (3.3%); relative risk was 9.9; 95% confidence interval was 4.5 to 21.7 (p < 0.001). CONCLUSIONS: In an urban tuberculosis control program, noncompliance with DOT was common and was closely associated with alcoholism and homelessness. Noncompliance was associated with a 10-fold increase in the occurrence of poor outcomes from treatment and accounted for most treatment failures. Innovative programs are needed to deal with alcoholism and homelessness in patients with tuberculosis.

 

 

TI:      Two-year follow-up of directly-observed intermittent regimens for smear-positive pulmonary tuberculosis in China.

AU:     Cao-JP; Zhang-LY; Zhu-JQ; Chin-DP

AD:     The Anti-Tuberculosis Institute of Hebei Province, People’s Republic of China.

SO:     Int-J-Tuberc-Lung-Dis. 1998 May; 2(5): 360-4

AB:     SETTING: The tuberculosis component of the Infectious and Endemic Disease Control Project in the People’s Republic of China is the largest single tuberculosis control project in the world using directly-observed therapy and standardized intermittent regimens. OBJECTIVE: To determine the two-year relapse and mortality rates following completion of treatment. DESIGN: A prospective cohort study of 649 cases cured in this project. The 306 new and 343 retreatment cases were treated under field conditions with 2H3R3Z3S3/4H3R3 and 2H3R3Z3E3S3/6H3R3E3, respectively. Following treatment completion, two sputum samples were collected every six months for two years and examined for acid-fast bacilli. Causes of death were identified. RESULTS: The two-year relapse rates for new and retreatment cases were 3.3% and 5.6%, respectively. Retreatment cases with delayed sputum conversion had a greater risk for subsequent relapse. The two-year mortality rate for new and retreatment cases was 3.3% and 8.5%, respectively. The higher mortality rate in retreatment cases was not attributable to relapse of disease, but rather to non-infectious sequelae of tuberculosis. CONCLUSION: The use of directly-observed intermittent regimens is effective in permanently removing infectious tuberculosis cases from the community.

 

 

TI:      The tuberculosis epidemic. Scientific challenges and opportunities.

AU:     Ginsberg-AM

AD:     Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, USA. ag73i@nih.gov

SO:     Public-Health-Rep. 1998 Mar-Apr; 113(2): 128-36

AB:     One in every three people on Earth is believed to be infected with Mycobacterium tuberculosis, leading to seven to eight million cases of active tuberculosis (TB) per year and approximately three million deaths annually. this epidemic, like those of most infectious diseases, creates scientific challenges and opportunities as it raises the demand for public health solutions. The currently available weapons for fighting TB are inadequate. The ultimate goal of biomedical TB research is to lessen the public health burden of this disease by developing improved diagnostic, therapeutic, and intervention strategies. Achieving this goal requires a base of knowledge about the biology of M. tuberculosis and related mycobacteria, their interactions with human and animal hosts, and the nature of an effective host-protective immune response. TB researchers are applying this accumulating base of knowledge to developing rapid, easy-to-use diagnostic assays appropriate for low-as well as high-income countries, improving the current complicated therapeutic regimen, identifying potential new drugs to combat multidrug-resistant TB, and creating more effective vaccines.

 

 

TI:      Treatment of pulmonary tuberculosis.

AU:     van-Loenhout-Rooyackers-JH; Veen-J

AD:     GGD Regio Nijmegen, Netherlands.

SO:     Neth-J-Med. 1998 Jul; 53(1): 7-14

AB:     Recently the duration of treatment for pulmonary tuberculosis in The Netherlands was shortened from nine to six months. A six months regimen containing isoniazid (H), rifampicin (R) and pyrazinamid (Z) daily for two months, followed by H and R daily for another four months (2HRZ/2HR) has been proven effective for the treatment of pulmonary tuberculosis, provided the cause is a fully susceptible strain of M. tuberculosis. Worldwide there is an increase in drug-resistant tuberculosis. Since at the start of treatment susceptibility tests often are not available, a fourth drug must be added in the intensive phase. Ethambutol is the drug preferred. This means that one always starts with 4 drugs unless the patient is a contact of an index-case with proven susceptibility and one is sure that he will be compliant or the patient is infected in the past before 1940, he received never tuberculostatic drugs and one is sure that there is no exogenous reinfection. If the patient has been treated previously and anti-tuberculosis drug resistance is likely, treatment regimens should contain at least two drugs with which he has not been treated before, while a fifth drug routinely must be added in the intensive phase. Amikacin is preferred, since there is no cross-resistance to streptomycin. Consensus on the duration of treatment for extra-pulmonary tuberculosis has not yet been reached, but basically the principles for treatment are the same. This is also true for HIV infected tuberculosis patients. In some serious clinical situations (meningitis, miliary, spine tb) duration of treatment still is 9-12 months. Early involvement of the public health nurse of the municipal health department (GGD) is necessary to ensure patient compliance and treatment supervision.

 

 

TI:      Costs of implementing a tuberculosis control plan: a complete education module that uses a train-the-trainer concept.

AU:     Trovillion-E; Murphy-D; Mayfield-J; Dorris-J; Traynor-P; Fraser-V

AD:     Quality Management Department, Barnes-Jewish Hospital at Washington University Medical Center, BJC Health System, St. Louis, MO, USA.

SO:     Am-J-Infect-Control. 1998 Jun; 26(3): 258-62

AB:     BACKGROUND: Tuberculosis once was thought to be nearly eradicated, but there was a 14% increase in cases of tuberculosis between 1985 and 1993, although decreases were observed in both 1994 and 1995. To reduce spread of this disease, health care workers must be familiar with tuberculosis, its signs, symptoms, and modes of transmission. In October 1994 the Centers for Disease Control and Prevention issued “Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health Care Facilities.” The combination of persistently high tuberculosis case rates, the development of multidrug-resistant tuberculosis, the new Centers for Disease Control and Prevention recommendations, and Occupational Safety and Health Administration enforcement has mandated large-scale training in health care facilities. METHODS: A tuberculosis control plan was developed and the train-the-trainer concept was selected after review of the hospital’s tuberculosis risk assessment, staff members requiring training, and available teaching staff. The training program that was developed included tuberculosis pathology and transmission, national and local epidemiology, placement and evaluation of skin tests, and an algorithm to assist in determining when isolation is indicated. RESULTS: One hundred forty-six trainers were trained in 4 days. During the next quarter, 66% (1989/3000) of staff members requiring instruction were trained. The total cost involved in development and training was approximately $26,000 and involved 1600 person-hours. CONCLUSION: Tuberculosis training should be directed toward high-risk areas, including intensive care units, emergency departments, and acute medicine wards. Large-scale training is time-consuming and expensive. Evaluation remains difficult. To facilitate compliance, pretest and posttest results should be provided, linked to Occupational Safety and Health Administration compliance and quality indicators for the hospital.

 

 

TI:      An outbreak of multi-drug-resistant tuberculosis in a London teaching hospital.

AU:     Breathnach-AS; de-Ruiter-A; Holdsworth-GM; Bateman-NT; O’Sullivan-DG; Rees-PJ; Snashall-D; Milburn-HJ; Peters-BS; Watson-J; Drobniewski-FA; French-GL

AD:     Department of Microbiology, St Thomas’s Hospital, London, UK.

SO:     J-Hosp-Infect. 1998 Jun; 39(2): 111-7

AB:     We describe the epidemiology and control of a hospital outbreak of multi-drug-resistant tuberculosis (MDR-TB). A human immu-nodeficiency virus (HIV)-negative patient with drug-sensitive tuberculosis developed MDR-TB during a period of unsupervised therapy. She was admitted to an isolation room in a ward with HIV-positive patients, but the room, unbeknown to hospital staff, was at positive-pressure relative to the main ward. Seven HIV-positive contacts developed MDR-TB. The diagnosis in the second patient was delayed, partly because acid-fast bacilli in his sputum were assumed to be Mycobacterium avium-intracellulare. All the available Mycobacterium tuberculosis isolates were indistinguishable by molecular typing. Nearly 1400 staff and patient contacts were offered screening, but the screening programme detected only one of the cases. Despite therapy, the index patient and two of the contacts died. HIV-positive patients are more likely than others to develop tuberculosis after exposure, and the disease may progress more rapidly. In these patients the possibility that acid-fast bacilli may represent M. tuberculosis must always be considered. Patients with tuberculosis (suspected or proven) should not be nursed in the same wards as immunosuppressed patients, and should be isolated. MDR-TB cases must be isolated in negative-pressure rooms. Hospital side-rooms may be positive-pressure as a fire safety measure; infection control teams must be aware of the airflows in all isolation rooms, and must be consulted during the design of hospital buildings. Good communication between infection control teams and clinicians is important, and all medical and nursing staff must be aware of the principles of management of patients with proven or suspected tuberculosis and MDR-TB.

 

 

TI:      BCG and prospects for new vaccines against tuberculosis.

AU:     Ortona-L; De-Luca-A

AD:     Istituto di Clinica delle Malattie Infettive, Universita Cattolica del S. Cuore, Policlinico A. Gemelli, Roma, Italy.

SO:     Rays. 1998 Jan-Mar; 23(1): 225-30

AB:     Seventy-five years have elapsed since its introduction and a renewed interest has arisen in the vaccination with bacillus Calmette-Guerin (BCG) for the prevention of tuberculosis. This interest has been motivated by the increase in tuberculosis, especially in multidrug-resistant tuberculosis. The efficacy of BCG has been questioned for decades, however, new epidemiological studies have shown a protective effect in some populations and categories at risk. Protection is more evident in the populations with a high incidence of the disease, especially against disseminated and invasive disease. The use of this vaccination is advised for specific populations based on the risk of infection and disease. However, BCG has a limited benefit. New agents produced with methods of molecular biology are supplying encouraging results in the animal model.

 

 

TI:      Epidemiology of multidrug-resistant tuberculosis.

AU:     Ortona-L; De-Luca-A

AD:     Istituto di Clinica delle Malattie Infettive, Universita Cattolica del S. Cuore, Policlinico A. Gemelli, Roma, Italy.

SO:     Rays. 1998 Jan-Mar; 23(1): 15-8

AB:     Since the nineties, the increasing incidence of tuberculosis was accompanied by numerous epidemic foci of multidrug-resistant strains of Mycobacterium tuberculosis, especially of nosocomial transmission. In the United States and other countries there was an increase in both primary and acquired drug-resistant tuberculosis. HIV infection and the poor social and health care facilities of different population groups, the lack of compliance with therapy and the reduction of programs of nosocomial and extranosocomial surveillance and control of tuberculosis are all concomitant causes of the increase in multi-drug resistant cases. The improvement in surveillance and treatment closely monitored therapies and nosocomial control by specific regulations, when applied, have contributed to the decrease in the rate of drug-resistant forms.

 

 

TI:      Surveillance of tuberculosis treatment prescription in Italy. The Varese TB Study Group.

AU:     Migliori-GB; Spanevello-A; Ambrosetti-M; Neri-M

AD:     Division of Pneumology, Fondazione S. Maugeri, Clinica del Lavoro e della Riabilitazione, Care and Research Institute, Tradate, Italy.

SO:     Monaldi-Arch-Chest-Dis. 1998 Feb; 53(1): 37-42

AB:     In industrialized countries, data on antituberculosis treatment are scanty. The aim of this study was to describe the tuberculosis (TB) treatment programme from diagnosis to drug intake in a model area of northern Italy, evaluating: 1) antiTB regimens prescribed and their adequacy; 2) dosage of drugs; 3) side-effects; and 4) drug resistance. Individual data on new TB cases from all the existing health facilities of the area were collected by means or a prospective surveillance system based on the systematic review of original clinical forms. Regimens were classified as adequate, potentially adequate and inadequate, based on published recommendations. Data on drug dosage, side effects and drug resistance were analysed. Out of 109 TB cases with regimen recorded on clinical records, 20.2% included more than four major drugs, 63.3% three drugs and 16.5% two drugs. The regimens were classified as 1.8% adequate, 85% potentially inadequate and 12.8% inadequate. The dosages prescribed (mean +/- SD in mg.kg body weight-1.day-1) were: isoniazid: 6.8 +/- 2.7: rifampicin: 10.2 +/- 2.5; ethambutol: 21.3 +/- 4.5; streptomycin: 17.4 +/- 4.0: and pyrazinamide: 15.2. Twelve per cent of cases required treatment modification due to side-effects. Resistance to one single drug was found in 9% of cases, but no case with multidrug-resistant TB. The description of the treatment programme revealed that: 1) the majority of regimens are potentially adequate; 2) they are at a proper dosage; 3) the side-effects are in agreement with the literature; and 4) drug-resistance rates are low.

 

 

TI:      Initial drug regimens for the treatment of tuberculosis: evaluation of physician prescribing practices in New Jersey, 1994 to 1995.

AU:     Liu-Z; Shilkret-KL; Finelli-L

AD:     The New Jersey Department of Health and Senior Services, Trenton 08625-0369, USA.

SO:     Chest. 1998 Jun; 113(6): 1446-51

AB:     STUDY OBJECTIVE: To evaluate physician prescribing practices for the initial therapy for tuberculosis (TB) according to the recommendations of the Centers for Disease Control and Prevention (CDC) and American Thoracic Society (ATS). DESIGN: Cross-sectional study. SETTING: Statewide TB surveillance system in New Jersey, 1994 to 1995. PATIENTS: We studied 1,230 culture-positive TB patients who were alive at diagnosis and whose isolates were tested for isoniazid susceptibility. RESULTS: Almost all TB patients (98%) were reported from counties with an isoniazid-resistant proportion of 4% or more, which is the minimum level for implementation of an initial four-drug regimen recommended by CDC/ATS. Overall, 36% of the 1,230 patients were not initially treated with four or more drugs. Multivariate analyses found that non-Hispanic white patients were more likely to be treated with fewer than four drugs than were non-Hispanic black patients. Private practitioners and physicians at chest clinics were about five times more likely to prescribe fewer than four drugs initially than were physicians at the hospital where a national TB center is located. CONCLUSION: A substantial proportion of physicians did not initially treat their TB patients according to the CDC/ATS recommendations. The results suggest that New Jersey physicians should be better informed about the recom-mendation and the high level of drug resistance in the communities they serve to assure that TB patients receive appropriate initial therapy.

 

 

TI:      Origin and management of primary and acquired drug-resistant tuberculosis in The Netherlands: the truth behind the rates.

AU:     Lambregts-van-Weezenbeek-CS; Jansen-HM; Veen-J; Nagelkerke-NJ; Sebek-MM; van-Soolingen-D

AD:     Royal Netherlands Tuberculosis Association (KNCV), The Hague, The Netherlands.

SO:     Int-J-Tuberc-Lung-Dis. 1998 Apr; 2(4): 296-302

AB:     SETTING: The Netherlands, May 1994 to May 1996. OBJECTIVE: 1) To estimate to what extent drug-resistant tuberculosis was acquired or recently transmitted in The Netherlands, 2) to assess the relevance of drug resistance data as routinely collected, and 3) to describe case management. DESIGN: Prospective descriptive study. Patients diagnosed with drug-resistant tuberculosis were interviewed. Information on patient management and contact tracing was collected. IS6110 restriction fragment length polymorphism (RFLP) patterns of all strains were compared with those of the National RFLP library and clusters were analyzed. RESULTS: In total 193 cases were included in the study. Acquired drug resistance (ADR) was rare. Dutch ADR patients reported receiving treatment a long time previously (mean age 58, mean treatment interval 23 years). Most foreign ADR patients had been treated recently in their country of origin. Of 151 primary drug-resistant (PDR) cases, 129 (85%) were foreign-born, of whom few (8%-19%) had been infected in The Netherlands. Few Dutch PDR cases had been infected recently (mean age 49 years). Rifampicin resistance was more frequently observed in foreign ADR cases than in foreign PDR cases (28% vs 5%; P < 0.001). One third of cases had not been treated according to treatment guidelines. CONCLUSION: Only a small proportion of drug-resistant cases resulted from recent infection or treatment in The Netherlands. General rates of ADR and PDR do not reflect current Dutch programme performance. For programme monitoring, ADR/PDR rates and their trends must be reported and evaluated in Dutch and foreign patients separately.

 

 

TI:      Nationwide surveillance of drug-resistant tuberculosis in The Netherlands: rates, risk factors and treatment outcome.

AU:     Lambregts-van-Weezenbeek-CS; Jansen-HM; Nagelkerke-NJ; van-Klingeren-B; Veen-J

AD:     Royal Netherlands Tuberculosis Association (KNCV), The Hague, The Netherlands.

SO:     Int-J-Tuberc-Lung-Dis. 1998 Apr; 2(4): 288-95

AB:     SETTING: The Netherlands, 1993 and 1994. OBJECTIVE: To determine 1) rates of drug resistance in relation to nationality and country of birth, 2) risk factors for drug resistance, 3) treatment outcome of drug-resistant cases, and 4) rates of primary and acquired drug resistance. DESIGN: Retrospective study of all cases notified with bacillary tuberculosis in The Netherlands in 1993 and 1994. RESULTS: Drug resistance to one or more drugs was reported in 268 (14.6%) of all 1836 cases, of whom 203 (76%) were foreign born. In Dutch patients rates of isoniazid (H) (2.9%) and streptomycin resistance (3.6%) were lower than in foreign patients (8.6% and 10.6% respectively, P < 0.001). Multidrug (H and rifampicin [R]) resistance was reported in 0.5% of Dutch-born and 1.4% of foreign cases (P = 0.055). Rates of acquired resistance to H (11.4%) and HR (5.7%) were higher than rates of primary resistance to these drugs (5.2% and 0.7% respectively, P < 0.05), but the number of retreatment cases was low (6.8% of all cases). Drug resistance was associated with immigration but not with drug use, homelessness or human immunodeficiency virus (HIV) co-infection. One fifth (20%) of drug-resistant cases was diagnosed by active case finding. Treatment outcome in sensitive and resistant cases was compared. CONCLUSION: These findings suggest that drug resistance is imported, but it is unclear to what extent drug resistance among foreigners has been transmitted or created in The Netherlands. Drug resistance data should be monitored in Dutch and foreign patients separately.

 

 

TI:      Risk factors for the spread of antibiotic-resistant bacteria.

AU:     Rao-GG

AD:     Department of Microbiology, University Hospital, Lewisham, London, England.

SO:     Drugs. 1998 Mar; 55(3): 323-30

AB:     The emergence of antibiotic resistance is primarily due to excessive and often unnecessary use of antibiotics in humans and animals. Risk factors for the spread of resistant bacteria in hospitals and the community can be summarised as over-crowding, lapses in hygiene or poor infection control practices. Increasing antibiotic resistance in bacteria has been exacerbated by the slow pace in developing newer antibiotics. Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and multiresistant Gram-negative bacteria are spread primarily by direct or indirect person-to-person contact. Independent risk factors for MRSA include the use of broad spectrum antibiotics, the presence of decubitus ulcers and prosthetic devices while those for VRE include prolonged hospitalisation and treatment with glycopeptides or broad spectrum antibiotics. For the spread of resistant Gram-negative bacteria risk factors include urinary catheterisation, excessive use of antibiotics and contamination of humidifiers and nebulisers. The spread of penicillin-resistant pneumococci (PRP) and drug-resistant and multidrug-resistant tuberculosis (MDRTb) is due to airborne transmission. Risk factors for the spread of PRP include overcrowding, tracheostomies and excessive use of penicillins for viral respiratory infections; for MDRTb they include poor compliance, convergence of immunosuppressed patients, delayed diagnosis or treatment, and poor or inadequate ventilation and isolation facilities. Recent developments in the genomic mapping of many bacteria and advances in combinatorial chemistry promise to usher in a new era of antibiotic development. While this may result in our regaining some of the ground lost to resistant bacteria, there will still be a continuing need to minimise the spread of antibiotic resistance through the rational use of antibiotic agents and stringent infection control practice

 

 

TI:      Time to detection of Mycobacterium tuberculosis in sputum culture correlates with outcome in patients receiving treatment for pulmonary tuberculosis.

AU:     Epstein-MD; Schluger-NW; Davidow-AL; Bonk-S; Rom-WN; Hanna-B

AD:     Department of Medicine, Bellevue Chest Service, NYU Medical Center, New York, NY 10016, USA.

SO:     Chest. 1998 Feb; 113(2): 379-86

AB:     STUDY OBJECTIVE: The purpose of this study was to determine whether the time to detection (TTD) of Mycobacterium tuberculosis in sputum culture correlates with the response to antituberculous treatment in patients with pulmonary tuberculosis. STUDY DESIGN: Twenty-six consecutive patients were studied who had active pulmonary tuberculosis and sufficient sputum cultures and clinical follow-up to allow adequate assessment. RESULTS: Following initiation of antituberculous therapy, 13 patients (group 1, responders) had a complete response to treatment, and the TTD of M tuberculosis using the mycobacterial growth indicator tube increased steadily. The remaining 13 patients (group 2, nonresponders) had persistent evidence of active disease and demonstrated little or no increase in the TTD with treatment unless an additional therapeutic intervention was implemented (surgery, improved compliance with medications, or a change in medications). The presence of HIV infection, intravenous drug use, multidrug resistance, treatment with second-line therapy, extensive radiographic involvement, and cavitary disease were associated with a delayed increase in the TTD. CONCLUSIONS: The TTD was superior to clinical, radiographic, or conventional bacteriologic evaluation in determining treatment outcome. The TTD closely correlates with the overall response to treatment for pulmonary tuberculosis and may represent a useful adjunct to predict outcome in these patients.

 

 

TI:      Costs of implementing a tuberculosis control plan: a complete education module that uses a train-the-trainer concept.

AU:     Trovillion-E; Murphy-D; Mayfield-J; Dorris-J; Traynor-P; Fraser-V

AD:     Quality Management Department, Barnes-Jewish Hospital at Washington University Medical Center, BJC Health System, St. Louis, MO, USA.

SO:     Am-J-Infect-Control. 1998 Jun; 26(3): 258-62

AB:     BACKGROUND: Tuberculosis once was thought to be nearly eradicated, but there was a 14% increase in cases of tuberculosis between 1985 and 1993, although decreases were observed in both 1994 and 1995. To reduce spread of this disease, health care workers must be familiar with tuberculosis, its signs, symptoms, and modes of transmission. In October 1994 the Centers for Disease Control and Prevention issued “Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health Care Facilities.” The combination of persistently high tuberculosis case rates, the development of multidrug-resistant tuberculosis, the new Centers for Disease Control and Prevention recommendations, and Occupational Safety and Health Administration enforcement has mandated large-scale training in health care facilities. METHODS: A tuberculosis control plan was developed and the train-the-trainer concept was selected after review of the hospital’s tuberculosis risk assessment, staff members requiring training, and available teaching staff. The training program that was developed included tuberculosis pathology and transmission, national and local epidemiology, placement and evaluation of skin tests, and an algorithm to assist in determining when isolation is indicated. RESULTS: One hundred forty-six trainers were trained in 4 days. During the next quarter, 66% (1989/3000) of staff members requiring instruction were trained. The total cost involved in development and training was approximately $26,000 and involved 1600 person-hours. CONCLUSION: Tuberculosis training should be directed toward high-risk areas, including intensive care units, emergency departments, and acute medicine wards. Large-scale training is time-consuming and expensive. Evaluation remains difficult. To facilitate compliance, pretest and posttest results should be provided, linked to Occupational Safety and Health Administration compliance and quality indicators for the hospital.

 

 

TI:      An outbreak of multi-drug-resistant tuberculosis in a London teaching hospital.

AU:     Breathnach-AS; de-Ruiter-A; Holdsworth-GM; Bateman-NT; O’Sullivan-DG; Rees-PJ; Snashall-D; Milburn-HJ; Peters-BS; Watson-J; Drobniewski-FA; French-GL

AD:     Department of Microbiology, St Thomas’s Hospital, London, UK.

SO:     J-Hosp-Infect. 1998 Jun; 39(2): 111-7

AB:     We describe the epidemiology and control of a hospital outbreak of multi-drug-resistant tuberculosis (MDR-TB). A human immunode-ficiency virus (HIV)-negative patient with drug-sensitive tuberculosis developed MDR-TB during a period of unsupervised therapy. She was admitted to an isolation room in a ward with HIV-positive patients, but the room, unbeknown to hospital staff, was at positive-pressure relative to the main ward. Seven HIV-positive contacts developed MDR-TB. The diagnosis in the second patient was delayed, partly because acid-fast bacilli in his sputum were assumed to be Mycobacterium avium-intracellulare. All the available Mycobacterium tuberculosis isolates were indistinguishable by molecular typing. Nearly 1400 staff and patient contacts were offered screening, but the screening programme detected only one of the cases. Despite therapy, the index patient and two of the contacts died. HIV-positive patients are more likely than others to develop tuberculosis after exposure, and the disease may progress more rapidly. In these patients the possibility that acid-fast bacilli may represent M. tuberculosis must always be considered. Patients with tuberculosis (suspected or proven) should not be nursed in the same wards as immunosuppressed patients, and should be isolated. MDR-TB cases must be isolated in negative-pressure rooms. Hospital side-rooms may be positive-pressure as a fire safety measure; infection control teams must be aware of the airflows in all isolation rooms, and must be consulted during the design of hospital buildings. Good communication between infection control teams and clinicians is important, and all medical and nursing staff must be aware of the principles of management of patients with proven or suspected tuberculosis and MDR-TB.

 

 

TI:      BCG and prospects for new vaccines against tuberculosis.

AU:     Ortona-L; De-Luca-A

AD:     Istituto di Clinica delle Malattie Infettive, Universita Cattolica del S. Cuore, Policlinico A. Gemelli, Roma, Italy.

SO:     Rays. 1998 Jan-Mar; 23(1): 225-30

AB:     Seventy-five years have elapsed since its introduction and a renewed interest has arisen in the vaccination with bacillus Calmette-Guerin (BCG) for the prevention of tuberculosis. This interest has been motivated by the increase in tuberculosis, especially in multidrug-resistant tuberculosis. The efficacy of BCG has been questioned for decades, however, new epidemiological studies have shown a protective effect in some populations and categories at risk. Protection is more evident in the populations with a high incidence of the disease, especially against disseminated and invasive disease. The use of this vaccination is advised for specific populations based on the risk of infection and disease. However, BCG has a limited benefit. New agents produced with methods of molecular biology are supplying encouraging results in the animal model.

 

 

TI:      Epidemiology of multidrug-resistant tuberculosis.

AU:     Ortona-L; De-Luca-A

AD:     Istituto di Clinica delle Malattie Infettive, Universita Cattolica del S. Cuore, Policlinico A. Gemelli, Roma, Italy.

SO:     Rays. 1998 Jan-Mar; 23(1): 15-8

AB:     Since the nineties, the increasing incidence of tuberculosis was accompanied by numerous epidemic foci of multidrug-resistant strains of Mycobacterium tuberculosis, especially of nosocomial transmission. In the United States and other countries there was an increase in both primary and acquired drug-resistant tuberculosis. HIV infection and the poor social and health care facilities of different population groups, the lack of compliance with therapy and the reduction of programs of nosocomial and extranosocomial surveillance and control of tuberculosis are all concomitant causes of the increase in multi-drug resistant cases. The improvement in surveillance and treatment closely monitored therapies and nosocomial control by specific regulations, when applied, have contributed to the decrease in the rate of drug-resistant forms.

 

 

TI:      Initial drug regimens for the treatment of tuberculosis: evaluation of physician prescribing practices in New Jersey, 1994 to 1995.

AU:     Liu-Z; Shilkret-KL; Finelli-L

AD:     The New Jersey Department of Health and Senior Services, Trenton 08625-0369, USA.

SO:     Chest. 1998 Jun; 113(6): 1446-51

AB:     STUDY OBJECTIVE: To evaluate physician prescribing practices for the initial therapy for tuberculosis (TB) according to the recommendations of the Centers for Disease Control and Prevention (CDC) and American Thoracic Society (ATS). DESIGN: Cross-sectional study. SETTING: Statewide TB surveillance system in New Jersey, 1994 to 1995. PATIENTS: We studied 1,230 culture-positive TB patients who were alive at diagnosis and whose isolates were tested for isoniazid susceptibility. RESULTS: Almost all TB patients (98%) were reported from counties with an isoniazid-resistant proportion of 4% or more, which is the minimum level for implementation of an initial four-drug regimen recommended by CDC/ATS. Overall, 36% of the 1,230 patients were not initially treated with four or more drugs. Multivariate analyses found that non-Hispanic white patients were more likely to be treated with fewer than four drugs than were non-Hispanic black patients. Private practitioners and physicians at chest clinics were about five times more likely to prescribe fewer than four drugs initially than were physicians at the hospital where a national TB center is located. CONCLUSION: A substantial proportion of physicians did not initially treat their TB patients according to the CDC/ATS recommendations. The results suggest that New Jersey physicians should be better informed about the recom-mendation and the high level of drug resistance in the communities they serve to assure that TB patients receive appropriate initial therapy.

 

 

TI:      Origin and management of primary and acquired drug-resistant tuberculosis in The Netherlands: the truth behind the rates.

AU:     Lambregts-van-Weezenbeek-CS; Jansen-HM; Veen-J; Nagelkerke-NJ; Sebek-MM; van-Soolingen-D

AD:     Royal Netherlands Tuberculosis Association (KNCV), The Hague, The Netherlands.

SO:     Int-J-Tuberc-Lung-Dis. 1998 Apr; 2(4): 296-302

AB:     SETTING: The Netherlands, May 1994 to May 1996. OBJECTIVE: 1) To estimate to what extent drug-resistant tuberculosis was acquired or recently transmitted in The Netherlands, 2) to assess the relevance of drug resistance data as routinely collected, and 3) to describe case management. DESIGN: Prospective descriptive study. Patients diagnosed with drug-resistant tuberculosis were interviewed. Information on patient management and contact tracing was collected. IS6110 restriction fragment length polymorphism (RFLP) patterns of all strains were compared with those of the National RFLP library and clusters were analyzed. RESULTS: In total 193 cases were included in the study. Acquired drug resistance (ADR) was rare. Dutch ADR patients reported receiving treatment a long time previously (mean age 58, mean treatment interval 23 years). Most foreign ADR patients had been treated recently in their country of origin. Of 151 primary drug-resistant (PDR) cases, 129 (85%) were foreign-born, of whom few (8%-19%) had been infected in The Netherlands. Few Dutch PDR cases had been infected recently (mean age 49 years). Rifampicin resistance was more frequently observed in foreign ADR cases than in foreign PDR cases (28% vs 5%; P < 0.001). One third of cases had not been treated according to treatment guidelines. CONCLUSION: Only a small proportion of drug-resistant cases resulted from recent infection or treatment in The Netherlands. General rates of ADR and PDR do not reflect current Dutch programme performance. For programme monitoring, ADR/PDR rates and their trends must be reported and evaluated in Dutch and foreign patients separately.

 

 

ФормулЯр

Драги читатели,

 

Надяваме се, че настоящото издание ви е било полезно. В случай, че някой от вашите приятели се интересува от него, може да си го поръча, попълвайки следния формуляр:

 

1. Бих искал/а да получа пълния текст на следните статии:

     а/ .......................................................................................................................................................................

     б/ .......................................................................................................................................................................

     в/ .......................................................................................................................................................................

 

2. Коментари.

     а/ препоръки

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     б/ в следващи броеве бих искал да се публикуват материали по следните здравни проблеми:

..........................................................................................................................................................................

..........................................................................................................................................................................

     в/ бих искал/а да публикувам в този бюлетин следните материали:

     /приложете ги отделно/

     3. Адрес, на който искате да получите посочените от Вас материали:

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     ул. “Св. Климент Охридски” N 1

     Медицинска библиотека

     5800 Плевен

     Програма “Комуникации за по-добро здраве”

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Въпросник

 

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                                 Дата на попълване: 

 

А/ Лични данни

Вашето име: ..........................................................................................................................................................................

 

Специалност: ..........................................................................................................................................................................

 

Къде сте я придобили

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Кога сте завършили

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Месторабота в момента

Придобита специалност /каква, кога/.

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Б/ Основни здравни проблеми в региона Ви

 Кои здравни проблеми/заболявания/ са най-сериозните и/или най често срещаните във Вашия район? Молим да бъдете конкретни!

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1. Отбележете, като ги степенувате от 1 до 7, Вашите източници на здравна информация:

Библиотека             Колеги         Монографии/учебници  Списания
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Други /по възможност избройте/

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2. Има ли пълен комплект от основните учебници по медицина във Вашата болница/на работното Ви място?                        Да         Не /Подчертайте верния отговор/

Ако отговорът е “Да”, повечето от заглавията след 1987 год. ли са публикувани?

                                        Да         Не

3. Имате ли свободен достъп до тази литература?   

                                        Да         Не

4. Имате ли собствени медицински учебници?

                                        Да         Не

Ако отговорът е “Да”, кои от тях са Ви най-полезни? Кога са издадени?

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5. Получават ли се редовно медицински списания на местоработата Ви?

                                        Да         Не

 

Ако отговорът е “Да”, кои от тях са Ви най-полезни?

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.................………………………………………………………………………………………………….…

 

6. Вие самите абонирани ли сте за някакво медицинско списание?

                                        Да         Не

Ако отговорът е “Да”, избройте ги.

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7. Имате ли собствен каталог от заглавия по актуална медицинска информация?

                                        Да         Не

Ако отговорът е “Да”, опишете го накратко / т.е. монографии, копия от статии, изрезки от вестници, списания, лични бележки и др./

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8. Получавате ли лично и редовно безплатни материали от СЗО или други здравни организации?

                                        Да         Не 

Получават ли се редовно такива материали във Вашата болница или работното Ви място?     

                                        Да         Не

Ако отговорът е “Да”, опишете ги накратко.

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9.Осигурен ли Ви е ли достъп до

а/ телефон                     Да         Не

б/ факс                                  Да         Не

в/ електронна поща                    Да         Не

г/ интернет                           Да         Не

 

10. Ползвате ли услугите на медицинска библиотека?

                                        Да         Не 

11. Кои услуги от библиотеката ползвате?

 

Заемате книги                      Да         Не

Заемате книги по пощата          Да         Не

Посещавате библиотеката         Да         Не

Поръчвате библиографска справка Да         Не

Поръчвате копия от нужните

Ви статии                      Да         Не

12. Кои от изброените по-горе услуги бихте ползвали най-често?

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13.Посочете кои от Вашите професионални занимания изискват периодична информация. Избройте тези занимания накратко - грижи за пациента, обучение на студенти, научна работа, следдипломна квалификация, други.

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14. Ще имате ли полза, ако Ви се предоставят копия от статии, третиращи заболявания, които са сериозен проблем за Вашия район/регион?

                                        Да         Не

15 Ще имате ли полза, ако Ви се предоставят копия от статии от Ваши колеги, третиращи заболявания, които са сериозен проблем за Вашия район/регион?

                                        Да         Не

Ако отговорът е “Да”, по кои проблеми бихте искали да са те?

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16. Моля добавете своите коментари по въпроси, които считате за важни по отношение на разпространението и достъпа до интересуваща Ви здравна информация, както и своите предложения по осигуряването й.

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Благодарим Ви. Отговорите изпращайте на адрес:.

 

Висш медицински институт - Плевен

ул. “Св. Климент Охридски” N 1

Медицинска библиотека

5800 Плевен

Програма “Комуникации за по-добро здраве”