Country-wide Studies Research Articles

The Demographic, Clinical, Radiographic and Bronchoscopic Evaluation of Anthracosis and Anthracofibrosis Cases

Background: The aim of the study was to evaluate the demographic features, clinical findings, radiological and bronchoscopical findings of patients with bronchial anthracosis. Methods: Among 1541 patients who underwent broncoscopy in our bronchoscopy unit between 2006-2008, 104 patients with anthrocosis were included in this prospective study. The patient’s geographical location, occupation, type of fuel used for cooking in the kitchen and for heating in their house, admission complaints, chest x-ray and thorax computed tomography (CT) findings, bronchoscopic images and the accompanying pathological diagnosis were recorded and evaluated. Results: A total of 104 (6.7%) patients with a mean age of 61.35±13.34 years were included in this study; 49 (47.1%) of which were female, 55 (52.9%) male.The most common complaints were cough, dyspnea and sputum production in 71.2%, 57.7% and 49.0% patients, respectively. In 48 (46.1%) patients history of cigarette smoking was found. While in 31 (38.3%) patients exposure to mineral dust or biomass in their job was observed, 37 (45.7%) patients were housewives. In all of the patients biomass exposure was found because of the fuel used for heating or in kitchens. Regarding geographical location, we found that the majority of the patients (38.5%) were from Black Sea region located in northern Anatolia. While the most common chest x-ray findings were consolidation (51.9%) and fibrosis (18.3%), consolidation (38.5%) and fibrosis (36.5%) were also found to be the leading thorax CT findings. The most common bronchoscopic findings were bilateral anthracosis, stenosis and bronchial torsion 67.3%, 40.4% and 23.1% patients, respectively. Among the anthracosis patients, with bronchoscopy 11 of them were found to have malignancy and 7 of them tuberculosis. Conclusion: Large scale, country-wide studies should be conducted for the determination of epidemiological data of bronchial anthracosis and anthracofibrosis in our country in which a high rate of biomass exposure is found.

Nationwide Epidemiologic Survey of Idiopathic Osteonecrosis of the Femoral Head

BackgroundAlthough numerous studies describe the clinical characteristics of idiopathic osteonecrosis of the femoral head (ONFH) in specific study populations, these have not been confirmed in countrywide studies.Questions/purposesWe therefore determined: (1) the annual number of patients seeking medical care and number of patients newly diagnosed; and (2) the distribution of the age and gender of the patients, potential causative factors, severity of the disease, and operative procedures performed.Patients and MethodsWe conducted a nationwide epidemiologic survey in 2005. The survey included all orthopaedic departments in Japan by stratified random sampling according to the number of beds.ResultsThe number of patients who sought medical care for idiopathic ONFH during 2004 was estimated to be 11,400 (95% confidence interval, 10,100–12,800). We obtained clinical information from 1502 of these patients. The peak in age distribution occurred in the 40s. Potential causative factors were systemic steroid administration (51%) and habitual alcohol use (31%). Hip replacement was the most frequently performed procedure (65%). Among patients with a history of systemic steroid administration, systemic lupus erythematosus was reported most frequently (31%) as the underlying disease. Among patients younger than 40 years, steroid use was the most prominent potential causative factor (60%), and hip replacement frequently was performed (45%). A greater proportion of patients with no history of steroid or alcohol use was observed among patients 65 years or older (41%).ConclusionsIn addition to the disease burden of idiopathic ONFH in Japan, our results confirmed the importance of developing preventive and treatment strategies, especially among the younger population.Level of EvidenceLevel IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Palliative stoma creation: comparison of laparoscopic vs conventional procedures

The creation of a stoma is an established therapeutic concept for the palliation of non-resectable rectal carcinomas and advanced tumours infiltrating the pelvis. In two prospective country-wide multicentre studies, each conducted over a similar period of time, the peri-operative course and postoperative short-term outcomes of laparoscopic vs laparotomy-based stoma construction were compared. A total of 90 patients underwent palliative laparoscopic construction; 550 patients received a stoma via a laparotomy. The intra-operative complication rate was lower after open surgery than after laparoscopic surgery (2.7 vs 5.6%; p = 0.15), although the difference was not significant. With regard to general (30.9 vs 15.6%; p = 0.003) and also specific postoperative complications (13.8 vs 5.6%; p = 0.029), however, a significant advantage of the laparoscopic approach was seen. Furthermore, mortality in the laparoscopic group was also significantly lower (4.4 vs 14.0%; p = 0.011). Palliative stoma done via laparoscopy had significantly better outcomes in terms of postoperative morbidity and mortality in comparison with the open surgical procedure.

An update on Chagas disease (human American trypanosomiasis)

Human American trypanosomiasis or Chagas disease -- named after Carlos Chagas who first described it in 1909 -- exists only on the American continent. It is caused by a parasite, Trypanosoma cruzi, that is transmitted to humans by blood-sucking triatomine bugs, by blood transfusion, and transplacentally. Chagas disease has two, successive phases: acute and chronic. The acute phase lasts 6-8 weeks. After several years of starting the chronic phase, 20%-35% of infected individuals (the percentage varying with geographical area) develop irreversible lesions of the autonomous nervous system in the heart, the oesophagus, the colon and/or the peripheral nervous system. Data on the prevalence and distribution of Chagas disease markedly improved in quality during the 1980s, as a result of demographically representative, cross-sectional studies carried out in countries where no accurate information on these parameters was available. Experts had previously met in Brasilia, in 1979, and devised standard protocols for carrying out country-wide studies not only on the prevalence of human infection with T. cruzi but also on house infestation with the triatomine vectors. Thanks to a co-ordinated programme in the southernmost countries of South America (i.e.the 'Southern Cone'), transmission of T. cruzi by the vectors or blood transfusion has been successfully interrupted in Uruguay (from 1997), Chile (from 1999) and Brazil (from 2005), and the global incidence of new human infection with T. cruzi has decreased by 67%. Similar multi-country control initiatives have been launched in the Andean countries and in Central America, with the goal of interrupting all transmission of T. cruzi to humans by 2010 -- a goal set, in 1998, as a resolution of the World Health Assembly. Recent advances in basic research on T. cruzi include the genetic characterization of populations of the parasite and the sequencing of its genome.

Carbon sequestration in agroforestry systems

Management of trees in agroecosystems such as agroforestry, ethnoforests, and trees outside forests can mitigate green house gas (GHG) emissions under the Kyoto Protocol. Agroforestry systems are a better climate change mitigation option than oceanic, and other terrestrial options because of the secondary environmental benefits such as helping to attain food security and secure land tenure in developing countries, increasing farm income, restoring and maintaining above-ground and below-ground biodiversity, corridors between protected forests, as CH 4 sinks, maintaining watershed hydrology, and soil conservation. Agroforestry also mitigates the demand for wood and reduces pressure on natural forests. Promoting woodcarving industry facilitates long-term locking-up of carbon in carved wood and new sequestration through intensified tree growing. By making use of local knowledge, equity, livelihood security, trade and industry, can be supported. There is need to support development of suitable policies, assisted by robust country-wide scientific studies aimed at better understanding the potential of agroforestry and ethnoforestry for climate change mitigation and human well-being.

Resistance patterns of Plasmodium falciparum malaria to chloroquine in Kampala, Uganda.

Chloroquine is a first line drug for the treatment of uncomplicated Plasmodium falciparum malaria in Uganda. Recently, there have been increasing reports of resistance of Plasmodium falciparum malaria to chloroquine, as well as an increase in malaria morbidity and mortality among adults and children. To assess the current effectiveness (clinical and parasitological response) of chloroquine in the treatment of uncomplicated Plasmodium falciparum malaria, and to define the magnitude of chloroquine resistant Plasmodium falciparum malaria in Kampala. A descriptive cross-sectional study among adults and children. Mulago hospital complex (the national referral and teaching hospital in Kampala, Uganda) between September 1998 and March 1999. Ninety six patients with Plasmodiumfalciparum parasitaemia of 1000 to 100,000/microl of blood were treated with oral chloroquine phosphate, and followed up for 14 days. Sixty three (65.6%) patients showed clinical improvement, 29 (30.2%) deteriorated and four (4.2%) had no change. Adequate parasitological response was seen in 71(74 %), moderate in four (4.2%) and poor in 21(21.8%) patients. Treatment failures were highest among children below five years, with eleven (57.9%) children not responding to chloroquine. Although chloroquine was found to be effective in two thirds of all patients, the high treatment failure, especially seen in children below five years is of concern. This necessitates further countrywide studies, and possibly a need to review the use of chloroquine as single first line drug for the treatment of uncomplicated malaria in Uganda, especially in children below five years of age.

Carbon sequestration in agroforestry systems

Management of trees in agroecosystems such as agroforestry, ethnoforests, and trees outside forests can mitigate green house gas (GHG) emissions under the Kyoto Protocol. Agroforestry systems are a better climate change mitigation option than oceanic, and other terrestrial options because of the secondary environmental benefits such as helping to attain food security and secure land tenure in developing countries, increasing farm income, restoring and maintaining above-ground and below-ground biodiversity, corridors between protected forests, as CH4 sinks, maintaining watershed hydrology, and soil conservation. Agroforestry also mitigates the demand for wood and reduces pressure on natural forests. Promoting woodcarving industry facilitates long-term locking-up of carbon in carved wood and new sequestration through intensified tree growing. By making use of local knowledge, equity, livelihood security, trade and industry, can be supported. There is need to support development of suitable policies, assisted by robust country-wide scientific studies aimed at better understanding the potential of agroforestry and ethnoforestry for climate change mitigation and human well-being.

Risk factors for multiple sclerosis: a case-control study in Israel.

This case-control study was aimed at identifying environmental risk factors for multiple-sclerosis (MS). Ninety-three Israeli-born MS patients identified in country-wide studies and 94 age- and sex-matched controls were interviewed. The questionnaire covered a large span of factors at ages 0, 10 and onset of the disease, with particular emphasis on socioeconomic status (SES) and sanitary conditions (SAN). A significantly larger percentage of patients reported frequent respiratory educational levels than controls. The SES and SAN at age 10 were also systematically higher among patients, but significance was reached only when the frequencies of conditions indicating extremely low values of SES or SAN were compared. It is possible that the protective effect of low SES or SAN on risk of MS can be detected only when living conditions are well below average, as is frequent in developing countries.

The global burden of trachomatous visual impairment: I. Assessing prevalence.

This paper summarizes primary epidemiologic studies of trachomatous blindness to develop age-/sex-/region-specific estimates of the global prevalence of trachomatous blindness and low vision. These studies are first examined for their validity and then employed to derive a 'minimum' prevalence of trachomatous visual impairment. This method yield a global total for 1990 of approximately 640,000 cases of trachomatous blindness, corresponding to a prevalence of 0.12/1,000 (lower and upper bounds, 0.10 to 0.14/1,000). When those with low vision due to trachoma are included, 1.5 million cases of visual impairment are estimated, corresponding to a prevalence of 0.28/1,000 (lower and upper bounds, 0.15 to 0.75/1,000). A second approach, labeled the 'projected' prevalence of trachomatous visual impairment, selects country-wide studies to derive representative regional prevalence values. A global total of 2,899,000 blind ("projected' prevalence of 0.55/1,000 with lower and upper bounds, 0.37 to 0.83/1,000) is estimated for 1990. With trachomatous low vision included, greater than 6.7 million individuals in 1990 have visual impairment from trachoma ("projected' prevalence of 1.28/1,000 with lower and upper bounds, 0.53 to 4.29/1,000). Analysis of the distribution of the global prevalence by age, gender, visual acuity and region provide direction for trachoma research and programme priorities. Attention is drawn to the limited studies and resulting wide variation in the estimates of trachomatous visual impairment prevalence as indicated by the lower and upper bound estimates. It is recommended that this epidemiologic uncertainty be reflected in global and regional estimates of trachomatous visual impairment prevalence in order to draw attention to how little is known and emphasize the need for further surveys. A second paper incorporates these findings in an assessment of the global burden of trachomatous visual impairment.

Children at-risk

In Denmark there have been few case reports on child abuse, but only one epidemiological study conducted in 1969. We have therefore initiated a number of countrywide studies by contacting all pediatric departments, Institutes of Forensic Medicine and the public health officers in Denmark. The present study describes the findings from the city of Copenhagen during 1970-79. Only 27 children, mostly under seven years of age, were registered. Information on pregnancy, delivery, neonatal period and the children's former development provided significant findings. All the registered families belonged to the lowest social class, half of the children had a history of previous abuse, one third of siblings had also previously been abused and one third of the wives were "battered wives". In 2/3 of the cases the father-figure was the perpetrator. The study showed an urgent need for a more coherent policy on child abuse and child welfare, general guidelines on interdisciplinary work, communication, prevention, community work and follow-up. Practical guidelines for involvement with child abuse are proposed and it is recommended to establish child abuse teams in Denmark, also in order to deal with prevention at the pre- and postnatal level. The pediatric departments should get more involved with community and social work in order to deal with child abuse and neglect at an early stage, where the abuse can be prevented.