Centres In Different Parts Research Articles

Establishing an integrated trauma system in iran: the time of translating information into action.

Trauma is one of the most important challenges for the health system in the world. In Iran, according to a study in 2003, injuries accounted for 28% of years of life lost (1) and road traffic accidents were the first cause of disability adjusted life years among males (2). In addition to morbidity and mortality, trauma also imposes direct and indirect economic and social costs to the community. These impacts of trauma have made many countries to pay special attention to issues related to injury, including incidence and causes of trauma; at risk population; and methods of prevention, treatment, and rehabilitation. Based on Model trauma system policy that has been developed by World Health Organization (WHO), every country should have minimum standards for care of the injured, including prehospital care, facility-based trauma care (hospitals and clinics that provide care to the injured), training (e.g. continuing education courses), quality improvement programs (assuring the actual provision of quality essential services), team approach and organization of initial resuscitation (improving the prompt delivery of essential care), facility inspection (assuring and improving the provision of care at its facilities), broader system considerations (promoting broader improvements in the health care system, including nontrauma care, such as surgical and other emergencies), and finally the surveillance (including a good registry and adequate, reliable, and timely information on injuries) (3). Almost all of these components are present in our country and, in addition, free services are provided to the victims of traffic injuries. However, sometimes these are not well- organized. For example, Emergency Medical Services (EMS) (which works under the supervision of the Ministry of Health) is mainly responsible for prehospital care, but has overlapping functions with Red Crescent stations (which work under the supervision of Red Crescent Organization). Since there are no formally designated trauma centers, EMS personnel (after consultation with physicians in their regional central office) usually transfer the trauma victim to the nearest hospital (2). Perhaps one of the most important parts of this chain is injury surveillance. In developed countries, trauma registry systems are well-defined and well-structured. They start at the regional level and then extend to the national level. An injury surveillance system is needed to assess specific requirements for injury prevention programs and policies and also to monitor the effectiveness of the system (4). Having a good data registry provides the ability of analysis, interpretation, and dissemination of data on injury-related events. Identifying at risk populations, determining programmatic priorities, supporting prevention activities, and evaluating interventional efforts are the other advantages of a surveillance system (5). Active research trauma centers in different parts of the country, launching a scientific and educational trauma core, regular meeting to design a comprehensive trauma care system, and holding the first national congress on trauma will hopefully result in the establishment of integrated trauma system in Iran.

Stratification of NWP Forecasts for Medium-Range Ensemble Streamflow Forecasting

AbstractImproving river flow forecasts for longer lead times by incorporating numerical weather predictions (NWP) into streamflow forecasting systems has attracted hydrologists in recent years. The process turns considerably complex and resource hungry when ensembles of NWP forecasts instead of any single NWP output are used to feed the flow forecasting models in order to capture the uncertainties in hydrological forecasting. This paper presents, for the first time, a comparison of three statistical stratification techniques for simplifying the input precipitation ensemble forecasts driving a river flow forecasting system. A data-driven flow forecasting model developed for the Waikato River in New Zealand using genetic expression programming (GEP) was forced by the 10-days-ahead ensemble precipitation forecasts issued by three meteorological .centers in different parts of the world including the United Kingdom, Canada, and China. The three precipitation ensembles, comprising 51, 21, and 15 members respect...

0332 Stress as Human Element at Work: A Survey of Filipino Seafarers

ObjectivesSeafaring entails working on board ships for a long period of time away from home. This results into various psychological experiences by the world’s 1.2 million seafarers working on international...

Bone Mineral Metabolism and Subsequent Hospitalization With Poor Quality of Life in Dialysis Patients

Background:Significant impairment in health-related quality of life (HRQOL) among dialysis patients could be partly explained by some co-morbid disorders, such as chronic kidney disease-mineral and bone disorder (CKD-MBD). Also disturbance in calcium and phosphorus metabolism would increase mortality and morbidity. Therefore, further efforts to treat these abnormalities may improve the survival.Objectives:We designed a large multicenter population-based study in Iran to describe and assess the relation between HRQOL, hospitalization, and bone metabolism markers.Patients and Methods:We enrolled a total of 5820 dialysis patients from 132 dialysis centers in different parts of the country whom were volunteers to cooperate between October 2010 and August 2011. The Iranian adapted version of the Kidney disease quality of life-short form (KDQOL-SFTM) version 1.3 questionnaire was used to assess the health related quality of life. The clinical and demographic characteristics were gathered from patients’ data files.Results:The mean (SD) age of patients was 54.88 (16.36) years, and the range was 2 to 99 years. Of all patients, 43.1% were female. The scores of kidney disease component summary (KDCS), physical component summary, mental component summary, and total quality of life were significantly higher in the lower quartile of corrected serum calcium and higher quartile of serum parathyroid hormone (PTH) levels (P < 0.05). In a regression analysis of multilevel data, while corrected serum calcium level was associated with total KDCS and short form health survey (SF-36) scores after adjusting for other variables, hospitalization was directly correlated with serum phosphorus level and had reverse correlation with dialysis duration and quality of life.Conclusions:In the current study, quality of life was correlated with serum calcium level, calcium-phosphate product, and serum PTH level, while hospitalization was correlated only with serum phosphorus level. However, quality of life was inversely correlated with hospitalization.

Cut Throat Injuries—A Retrospective Study at a Tertiary Referral Hospital

Objective: To analyze the socio demographic pattern, sex and age ratio, common causes, the most common site and extent of the injury in the patients with cut throat injury at our hospital. To compare the same with previous similar studies conducted at other centers in different parts of the world. Setting: Department of ENT, Government Rajaji Hospital, Madurai, India from January 2013 to June 2014. Methods: A total of 51 cases of cut throat injury were included in the study. Separate proforma was prepared to collect the patients’ data. Structured questionnaire was offered. Results: 51 cases of cut throat injury patients were included in the study. Age varied from 4 years to 80 years. Out of 51 cases, there were 43 males, 7 females and one male child. Male to female ratio was 6.2:1. All the patients were belonging to lower socioeconomic status (Kuppusamy class 5). Amongst them 26 cases (50.98%) were due to homicidal attack; 13 cases (25.49%) due to suicidal attempt; 7 cases (13.72%) due to road traffic accident; 4 cases (7.84%) due to bull gore injury; 1 case (1.96%) due to accidental fall. Emergency tracheostomy was done in 16 cases (33.33%). An average hospital stay for most of the patients was less than 3 weeks. 2 victims (3.92%) died due to haemorhage, aspiration pnuemonia and septicemia. Conclusions: Our study found that the majority of the victims were males of age between 20 years to 40 years from poor socioeconomic status. Social commitment and political motivation, decrease in the poverty, individual awareness, increase in economic growth, and literacy rate will prevent the cut throat injuries. Early and improved management will reduce the mortality and morbidity.

Randomized control trial to test a computerized psychosocial cancer assessment and referral program: Methods and research design

The National Cancer Coalition Network, National Cancer Institute, and American College of Surgeons all emphasize the need for oncology providers to identify, address, and monitor psychosocial needs of their patients. The Mental Health Assessment and Dynamic Referral for Oncology (MHADRO) is a patient-driven, computerized, psychosocial assessment that identifies, addresses, and monitors physical, psychological, and social issues faced by oncology patients. This paper presents the methodology of a randomized controlled trial (RCT) that tested the impact of the MHADRO on patient outcomes at 2, 6, and 12months. Patient outcomes including overall psychological distress, depression, anxiety, functional disability, and use of psychosocial resources will be presented in future publications after all follow-up data is gathered. Eight hundred and thirty six cancer patients with heterogeneous diagnoses, across three comprehensive cancer centers in different parts of the United States, were randomized to the MHADRO (intervention) or an assessment-only control group. Patients in the intervention group were provided detailed, personalized reports and, when needed, referrals to mental health services; their oncology provider received detailed reports designed to foster clinical decision making. Those patients who demonstrated high levels of psychosocial problems were given the option to authorize that a copy of their report be sent electronically to a “best match” mental health professional. Demographic and patient cancer-related data as well as comparisons between patients who were enrolled and those who declined enrollment are presented. Challenges encountered during the RCT and strategies used to address them are discussed.

Age at Diagnosis and Breast Cancer Survival in Iran

Background. Tumour characteristics are the most important prognostic factors in breast cancer. Patient-related factors such as young age at diagnosis, obesity, and smoking behaviour may also modify disease outcome. Due to the absence of a unique definition for “young age breast cancer” and the resulting variation in disease management, findings on the association between young age and prognosis of breast cancer are controversial. Methods. This study included 1500 patients with a primary diagnosis of breast cancer in six Iranian hospitals from 5 provinces. We modelled the relative excess risk (RER) of breast cancer death to age at diagnosis and tumour characteristics. Results. Excess risks of death were observed for stage IV disease and poorly differentiated tumours: RER of 4.3 (95% CI: 1.05–17.65) and 3.4 (95% CI: 1.17–9.87), respectively. “Older” patients, particularly those aged 50 and over, presented more often with advanced and poorly differentiated tumours (P = 0.001). After adjustment for stage, histological grade, Her-2 expression, estrogen and progesterone receptors, and place of residency, breast cancer mortality was not significantly different across age groups. Conclusion. We conclude that there is no prognostic effect of age at diagnosis of breast cancer among breast cancer patients treated at cancer centres in different parts of Iran; young and relatively old women have similar risks of dying from breast cancer.

Factors contributing to non-compliance among diabetics attending primary health centers in the Al Hasa district of Saudi Arabia

Purpose:The purpose of the study was to measure the rate of non-compliance and the factors contributing to non-compliance among the diabetic patients in the Al Hasa region of Saudi Arabia.Materials and Methods:A cross-sectional survey was conducted in the Al Hasa region during the period of June 2010 to June 2011. Random sampling was carried out for the selection of 535 diabetic patients from three chronic disease centers in different parts of Al Hasa. The data were collected by means of interviewing questionnaires and file records. Any patient who had been prescribed optimum treatment and was properly advised on diet and exercise for his / her diabetes, but did not follow the medical advice, with Hb1AC of more than 7% at the time of interview, was considered as non-compliant.Results:The overall prevalence of therapeutic non-compliance of the participants was 67.9% (n = 318, 95% CI 63.59 – 72.02%). The non-compliance of males (69.34%) was higher than females (65.45%, P = .003). The non-compliance among the urban participants was significantly higher than (71.04 vs. 60.15%, P = .023) in the rural participants. There was a statistically significant difference in the prevalence rate of non-compliance among the participants with different levels of education. Factors found to be significantly associated with non-compliance on bi-variate analysis were: female gender (OR = 1.90, CI =1.32-4.57),level of education (Illiteracy) (OR = 5.27, CI = 4.63 – 7.19), urban population (OR =5.22, CI= 3.65 – 8.22), irregularity of the follow-up (OR = 8.41, CI = 4.90 – 11.92), non-adherence to drug prescription (OR = 4.55 , CI = 3.54 – 5.56), non-adherence to exercise regimen (OR = 5.55, CI = 4.2 6 – 6.), insulin (OR = 1.29, CI = .71 – 1.87), and insulin with oral Metformin (OR = 1.20, CI = .65 – 1.75).Conclusion:The findings indicate that there is a high rate of non-compliance among the diabetes patients in the Al Hasa region of Saudi Arabia and there is a definite need for improvement in the healthcare system, health education, and training of diabetic patients.

Recruiter-patients as ambiguous symbols of health: bionetworking and stem cell therapy in India

Healthcare service providing centers in India offer contentious stem cell-based therapies to patients for an array of medical conditions. Among strategies these centers adopt to recruit new patients from local, regional and global spheres, the most prominent is the use of “recruiter-patients.” Recruiter-patients are a group of patients who either have already received or are in the process of receiving the therapy and, importantly, are used by service providers as mediums or tools to attract desperate yet novice therapy seeking patients to the ambit of the stem cell therapy enterprise. This article is based on a multi-sited ethnographic study at stem cell-based therapy providing centers in different parts of India between July 2008 and June 2009. Using the concepts of “bionetworking” and “ambiguous symbols,” this article explores how recruiter-patients are used by service providers as tools for the recruitment of new patients and why they are effective.

Growth and Development of Male External Genitalia

To provide estimates of normal variations in penile measurements and testicular volumes, and to establish reference ranges for clinical use. Cross-sectional, population-based study. Schools, kindergartens, and child care centers in different parts of Bulgaria. A population of 6200 clinically healthy white males aged 0 to 19 years. The study physician chose schools, kindergartens, and child care centers randomly and examined children at random until he reached the required number. Each of the 20 age groups (age range, 0-19 years) had an equal number of males (ie, 310). The mean (SD) values and fifth, 50th, and 95th percentiles of height (Siber Hegner anthropometer), weight (beam balance), testicular volume (Prader orchidometer), penile length (rigid tape), and penile circumference (measuring tape) from birth to 19 years of age. Testes did not show any increase in size until the onset of puberty at age 11 years, whereas penile growth was gradual after birth. However, both penile and testicular development demonstrated peak growth from 12 to 16 years of age, which coincided with the maximal male pubertal growth spurt. Data indicate an earlier pubertal development for this study population than that for a similar population several decades ago. Significant differences between urban and rural populations regarding penile length were also noticed. Our study provides the contemporary reference range values for height, weight, testicular volume, and penile length and circumference of males aged 0 to 19 years. Our data show that, even by the end of 20th century, there is still some acceleration of male pubertal development. For the first time are reported somatic differences in genitalia within a population between urban and rural representatives.

Pattern of acute food, drug, and chemical poisoning in Sari City, Northern Iran

This descriptive and retrospective study was conducted at the poisoning ward of Imam teaching hospital, Sari, Iran, with the aim of evaluating the pattern of poisoning. Hence, the medical profiles of 2057 patients, who were admitted, were carefully reviewed during the period from April 2006 to March 2008 for 2 years. During this period, 2057 cases, 53.9% female and 46.1% male, were admitted with the indication of acute poisoning. The greatest proportion of poisoning occurred between the ages of 18 and 29 years, with suicidal intentions. Most cases of poisoning were intentional (85%). The most common agents involved in acute poisoning were drugs (77.7%), especially sedatives/hypnotics such as benzodiazepines, followed by opioid analgesics. Organophosphate and carbamate insecticides were the third major agent that induced poisoning. Twenty-seven patients (1.3%) who were mostly females and young adults died. Death mostly occurred due to organophosphate and carbamate insecticides (19 cases) poisoning, followed by sedatives/hypnotics like benzodiazepines (3 cases). High prevalence of intentional overdose and mortality among young adults requires considerable attention and further studies to find out the underlying causes. In addition, strict rules must be followed regarding the sale of central nervous system drugs and pesticides, particularly organophosphate and carbamate insecticides. Establishing poison information centers in different parts of the country, preparing national treatment guidelines, training healthcare providers, and ensuring easy availability of the antidotes are also recommended.

Epilepsy surgery in India

This review traces the evolution of epilepsy surgery in India from the beginning to the present state. During the last one and half decades, surgical treatment of epilepsies has made resurgence in this country and at present a few centers have very active and sustained epilepsy surgery programs. Within a 14-year period, the R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Trivandrum, has undertaken over 1000 epilepsy surgeries. However, in the whole country, annually, not more than 200 epilepsy surgeries are currently being performed. This number is a miniscule when compared to the number of potential surgical candidates among the vast population of India. The enormous surgical treatment gap can only be minimized by developing many more epilepsy surgery centers in different parts of our country.

Pioneers in Hand Surgery.

ErikMobergwas, tosaythe least, aunique person and aoneof a kind personality with a multifold of skills. Hiscontributions in the field of hand surgery are well documentedand well known. Less known are maybe his other skills thatrange from archeology and ancient cultures to being a devotedsailor and collector of butterflies. His never-ending curiosityandwillingnesstolearnandrelearninthebroadestaspectoflifeareassetsthatneedtobeemphasizedandhopefullyfollowedbyyounger colleagues. Erik was a true academic and a role modelfor people striving for perfection regardless of topic. He joineddiscussions, often with strong opinions, but with a good moodandopenmind.Hedeliverednumerousmemorablelecturesthatalways took the audience further than expected by provokingthe listener to become active and thoughtful. He was not afraidof challenging the so-called state -of –the-art and he keptstressing that state -of –the-art is a dynamic process that we areall involved in. In other words, the interaction between expertson a regular basis was fundamental for development. In thisintensive process of communication, Erik stressed the need forcollecting information not only from experts but also frompatients and laymen because they may present, directly orindirectly, the key to a major scientific break-through.If one picked a special topic that magnetized Erik Mobergit would no doubt be phenomenon and significance of skinsensation. In his clinical accomplishments sensation certainlyplayed an instrumental role. The following citation representsErik’s interest bordering obsession of sensation as well as hisfirm opinions about how to assess sensation. Or maybe morecorrectly what techniques not to use for evaluating sensation:‘‘It must be emphasized that sensibility is, in my opinion andaccording to my experience, the basis for reconstructivework... for reconstructive surgery, ‘‘feeling’’ is a totallyuseless term, as it covers far too much and distinguisheshardly anything...for examination of useful sensibility inreconstructive hand surgery of all the tests evaluated by theauthors,theonlyonewhichwasfoundtobesignificantisthetwo-pointdiscriminationtestnowperformedwithapaperclip.All other tests of sensory function, in my opinion, should inthis work be abandoned, including cotton wool and paperstrip, pinprick, ordinary tuning fork, the difference betweensharp and blunt, figurewriting, thewrinkling skin test and thetwo-point discrimination test performed with sharp pointedcompass. They are not only useless, they are evenmisleading’’ [7].Erik Moberg graduated from the Faculty of Medicine,UniversityofLundin1932andhisfirstappointmentasadoctorwas in Persia (1932–33) where he met a Swedish nurse, Marta,whomhemarriedin1934.Hedefendedathesisinexperimentalpathology at University of Lund 1936 and began training inorthopaedicsurgery,movedtoGoteborgandtheDepartmentofSurgery at Sahlgrenska Hospital where -in 1942- he became asenior staff member.In 1944, he began to treat hand injuries inspired byDr Bunnell’s principles (Surgery of the Hand, 1944). Heorganizedaseparatewardfortreatmentoffracturesduetotheirwound infections and abscesses. In 1949 he had the first handsurgery ward in Scandinavia fully organized and established atthe Sahlgrenska Hospital.In 1947, Erik spent several months with Dr Sterling Bunnellin the U.S where he observed the post-war treatments at handsurgical centers. Back in Sweden he started the first handsurgical ward in Scandinavia in Goteborg.Erik was always very interested in teaching and especiallyhis new concept of treating hand injuries. He wrote a bookEmergency Surgery of the Hand in 1948, which has beentranslated into many languages and published in severaleditions over the years. Erik Moberg introduced hand surgeryofficially in Sweden in 1948.In 1951, he formed the Nordic Hand Club (now theScandinavian Society for Surgery of the Hand, SSSH). He wasinspired by the American Society for Surgery of the Handwhich was started by Bunnell in 1946. In the early 1970´s the‘‘Moberglecture’’wasfoundedatthesemeetings.In1956,ErikMoberg was given a personal professorship in ExtremitySurgery and in 1958 in Hand Surgery. Erik trained severalsurgeons, and five of them became full time hand surgeons andthemselves established centers in different parts of Sweden.In 1958, Erik attended a meeting of the Second Hand Cluband became one of the first Corresponding Members. This clubeven toured in Scandinavia and was accompanied by manyothers from Europe and the USA in 1961. This was the firstinternationalmeeting andwasorganizedbyErik.Thiswas alsothe foundation for meetings with a high level of scientificpapers. Arthur Barsky, President of the American Society, was

Pain drawings and concepts of pain among patients with “half-body” complaints

Objective To explore main features of pain drawings and concepts about illness in patients seeking help for “half-body” complaints at two primary health care centres in different parts of Sweden. Methods A qualitative study of pain-drawings and tape-recorded semi-structured interviews analysed by qualitative methods in 20 patients (4 men, 16 women, aged 37–68 years) from five health centers. Three of them were native Swedes and 17 were foreign-born. Results All complained of pain in a left (three-fourth) or right (one-fourth) body-half, mainly in front. Some had general pain with a “worse side”. Many said they had pain only on the ”edges“ and outlined the margins on the side of pain, but excluded the ”face”. Posterior drawings often received a line in the middle dividing the body in lateral halves. Pain was referred to as a “growing” thing – (“It”) – that could spread (“jump”) to the other side, grow and eventually paralyse them. “It” was believed as caused by body imbalance, natural factors or supernatural forces. Conclusion “Half-body” pain was an expression that in main was used by middle-aged patients to denote an initially superficial and frontal one-sided pain that could spread and become dangerous to their health. Practice implications Patients with half-body complaints should be taken seriously and met with respect by doctors and other health care personnel, particularly in cross-cultural consultations.

Polymorphous light eruption, chronic actinic dermatitis, solar urticaria and porphyria cutanea tarda

Photodermatoses can be divided into four general categories: immunologically mediated photodermatoses, drug- and chemical-induced photosensitivity, DNA repaired deficient photodermatoses and photoaggravated dermatoses. In this review, selected photodermomatoses will be discussed: polymorphous light eruption, chronic actinic dermatitis, solar urticaria and porphyria cutanea tarda. The frequency of photodermatoses has been reported from studies assessing patients in photodermatology referral centers in different parts of the world. All studies consistently showed that polymorphous light eruption is the most common primary photodermatosis, ranging in frequency from 23 to 65% of the patients referred to those centers for evaluation. Other commonly seen primary photodermatoses include solar urticaria and chronic actinic dermatitis. In studies reported from Singapore and Melbourne, Australia, photoaggravation of skin diseases was also seen commonly, probably owing to the high level of sun exposure experienced b...

Evaluating the AIH Scoring System

Evaluating the AIH Scoring System

First‐line eradication therapy for Helicobacter pylori in primary health care based on antibiotic resistance: results of three eradication regimens

To determine the efficacy of three Helicobacter pylori eradication regimens and factors affecting the eradication results in Finland. A total of 342 H. pylori-positive adult patients from primary health care referred for gastroscopy at 23 centres in different parts of Finland were randomized to receive either (i) lansoprazole 30 mg b.d., amoxicillin 1 g b.d. and metronidazole 400 mg t.d.s. (LAM), (ii) lansoprazole 30 mg b.d., amoxicillin 1 g b.d. and clarithromycin 500 mg b.d. (LAC), or (iii) ranitidine bismuth citrate 400 mg b.d., metronidazole 400 mg t.d.s. and tetracycline 500 mg q.d.s. (RMT). A (13)C-urea breath test was performed 4 weeks after therapy. The eradication result could be assessed in 329 cases. Intention-to-treat cure rates of LAM, LAC, and RMT were 78, 91 and 81%. The difference was significant between LAM and LAC (P = 0.01) and between LAC and RMT (P = 0.04). The eradication rates in cases with metronidazole-susceptible vs. -resistant isolates were for LAM 93% vs. 53% (P = 0.00001), for LAC 95% vs. 84%, and for RMT 91% vs. 67% (P = 0.002). Previous antibiotic use, smoking, and coffee drinking reduced the efficacy of therapy. In unselected patients in primary health care, LAC was the most effective first-line eradication.

EuropASI: A standard in de Sleutel, Belgium

Aims. The introduction of the EuropASI (European version of the Addiction Severity Index) as a standard intake instrument was inspired by four different viewpoints—clinical, registration, research and management—and aimed at implementation in these four areas.Setting. De Sleutel includes five ambulatory centres and four residential centres in different parts of Flanders in Belgium. In 1998, the EuropASI interview was introduced in de Sleutel as a diagnostic standard admission for residential as well as ambulatory drug‐treatment settings. Today there is a database of about 2500 EuropASIs of unique clients.Findings and conclusion. Clinically, the introduction of the EuropASI gave a basic guideline for clinical workers to act, measure and orient the client after his first treatment demand. It provided a uniform procedure that guarantees a well‐balanced focus for all life areas traditionally linked with addiction problems. It also became a useful instrument for structuring the clinical team meetings and led to better planning and treatment. The EuropASI could deliver the minimal data set needed for regional, national and European epidemiological data. The extra time spent in making up special data sets for monitoring or registers could be saved. Uniformity in the way data are gathered could guarantee a better quality of the data for registration, and redundancy eliminated. Instead the basics are set for a treatment‐supporting documentation system. The research concentrated around a more scientifically founded understanding of addiction problems, more specificity in client profiles, an ability to compare groups, research in matching treatment to client profiles, and more insight in to necessary knowledge and skills for the clinical teams. From a management perspective, the introduction of a European standard for basic assessment of our clients could start the process of total quality management, in providing an accepted basis in documenting the core business of the treatment centres.

Primary Helicobacter pylori resistance to metronidazole and clarithromycin in the Finnish population.

To systematically determine Helicobacter pylori primary antimicrobial resistance in Finland and the associated demographic and clinical features. A total of 342 adult patients referred for gastroscopy at 23 centres in different parts of Finland and positive for the rapid biopsy urease test were recruited. Clinical and demographic data were collected via a structured questionnaire. Patients with positive H. pylori culture and successful antibiotic sensitivity determination by the E-test method (n = 292) were included in the present analysis. The study population consisted of 134 men and 158 women, mean age 56 years (95% CI, 55-58 years). Resistance to metronidazole was 38% (110 of 292) and to clarithromycin 2% (seven of 292). Resistance to metronidazole was higher in women than in men (48% vs. 25%, P < 0.001). Previous use of antibiotics for gynaecological infections predicted metronidazole resistance (P = 0.01), and previous use of antibiotics for respiratory (P = 0.02) and dental infections (P = 0.02) the clarithromycin resistance. We observed no major geographical variations in metronidazole resistance. The primary metronidazole resistance of H. pylori was 38% and was common in women previously treated for gynaecological infections. Primary clarithromycin resistance was uncommon (2%) and may associate with previous dental and respiratory infections.

Risk of exposure to hepatitis A virus among day-care workers in Israel: implications for preventive measures.

Hepatitis A is an important infectious disease in Israel. The high incidence of hepatitis A, the declining prevalence of antibodies against hepatitis A virus throughout the past decade, and the availability of an active immunization for hepatitis A have engendered the identification of occupations in which workers are at increased risk of acquiring the disease. A prevalence study for hepatitis A antibodies was conducted during the first half of 1998 in a random sample of 37 day-care centers in different parts of Israel. A short interview was conducted, and serum samples were then collected from each worker. The control group comprised a sample of factory workers, blood donors, and women in maternity wards. Ninety percent (402 of 446) of the day-care workers had antibodies to hepatitis A. In a logistic-regression analysis, seropositivity was associated with increased age, minimal education, and lack of military service. When the authors compared a subsample of workers aged 18-40 yr with the control group, seropositivity was associated with the following: birth in Israel, duration of residence in Israel, very minimal education, military service, and employment in a day-care center. These results, together with earlier reports, indicate that day-care workers are at high risk of occupational exposure to hepatitis A. These results may imply that seronegative workers have a 2-fold chance of acquiring hepatitis A. Appropriate preventive measures should be considered, and active immunization of susceptible workers should be undertaken.