Risk Population Groups Research Articles

Hepatitis C in Lithuania: incidence, prevalence, risk factors and viral genotypes

Background: The epidemiology of hepatitis C virus (HCV) infection has been studied in many countries. However, little is known about HCV infection in Lithuania, a Baltic country, that was part of the former Soviet Union. Objectives: The aim of this study was to determine and evaluate the etiology of acute viral hepatitis, the risk factors for acquiring HCV in comparison to hepatitis B virus (HBV), seroprevalence of anti-HCV among blood donors and risk groups of the population in Lithuania. The distribution of HCV genotypes from Lithuanian first-time blood donors was also assessed. Study design: Sera taken from clinical viral hepatitis patients, blood donors, risk groups of population were investigated serologically. Patients with acute viral hepatitis were interviewed to determine their risk factors for HCV and HBV. HCV genotyping was done by PCR using type specific primers. Results: Acute hepatitis C accounted for 5.0–8.5% of reported viral hepatitis cases in adults in Vilnius. Of the acute hepatitis C cases, 37.0% was associated with blood transfusions before the implementation of screening of blood donors for anti-HCV and only 15.4% ( 2 13 ) after the screening was started. Anti-HCV was found in 2.2% of first-time blood donors, in 7.9% of commercial blood donors, in 13.9% of commercial blood plasma donors, in 48.3% of hemodialysis patients, in 29.4% of prisoners, in 9.4% of elderly nursing home residents, and in 7.9% of hemodialysis staff. The following distribution in genotypes were found: genotype 1b (54.3%), 3a (23.9%), 2a (10.9%) 2b (4.3%), 1a (0%), and double infection (6.5%). Conclusions: Lithuania is a country with a considerable hepatitis C problem.

Removing risk from safe motherhood

It is necessary to differentiate between complications of pregnancy and population risk groups for those complications. The latter have limited use as most complications occur in the low risk groups. Complications of pregnancy need to be treated in health facilities that can provide blood transfusions, cesarean section, removal of placenta and induction of labor. A plan must exist for each pregnant woman to be moved to such a facility, since it is not possible to predict who will have the complication. Early detection and effective treatment of complications and family planning services to prevent unwanted pregnancies is the way to lower maternal mortality.

Hepatitis B vaccination: universal vaccination of newborn babies and children at 12 years of age versus high risk groups. A comparison in the field

From 1983 to 1993 two anti-hepatitis B vaccinal strategies were adopted in two small towns of Southern Italy at high incidence for HBV infections: Afragola (prevalence of HBsAg carriers of 13.4%) and Frattamaggiore (prevalence of HBsAg carriers of 12.9%). In Afragola, the universal vaccination of infants in their first year of life and adolescents at 12 years of age was carried out, while in Frattamaggiore the selective vaccination of high risk groups of population was introduced. During this study, the changes in the HBV infection endemicity in both towns has been tested by monitoring the incidence of new cases of viral hepatitis B and by the prevalence study of HBsAg carriers prior to and 10 years after the beginning of the immunization programme (1978–1993).The results suggest that universal vaccination of infants in the first year of life and adolescents at 12 years of age has a greater efficiency on the improvement on the endemic status of the infection in the general population in comparison with selective vaccination, when the incidence of new cases of disease and the prevalence of number of HBsAg and anti-HBc carriers in the two populations are considered.

Preventive strategies for alcohol‐related problems

Preventive strategies for alcohol-related problems need to be in keeping with their socio-political context. Prohibition is inappropriate except where it has widespread support within the culture. Preventive strategies focus on the population and/or high risk groups and behaviours. Primary prevention can be achieved by control policies, education and provision of alternatives. Fiscal measures are of proven value. Legislative approaches influence availability and context of drinking, such as drinking and driving. Advertising control, server training and server liability are further approaches. Encouraging the provision of alternative beverages and promoting alcohol-free environments is a further approach which should be seen as part of an integrated community response. Secondary prevention linked with early recognition of hazardous drinking at primary level is of known efficacy and would form part of a coordinated strategy.

Mercury and methylmercury in population risk groups on the Atlantic coast of Southern Spain

The presence of methylmercury and total mercury in the hair of high risk groups residing in the highly industralized South Atlantic coastal area of Spain were studied. In fishermen, total mercury and methylmercury content showed slight non-statistically significant differences among groups from two different coastal areas (geometric means: 10.41 and 8.36 μg/g for total mercury; 8.28 and 6.72 μg/g methylmercury). Mercury content in both groups differed significantly from controls (geometric mean 2.5 μg/g total mercury, 4.50 μg/g for methylmercury; p<0.05). In pregnant women, statistically significant differences were found in the three groups (two coastal areas and controls). Geometric means were 2.40, 5.94, and 0.94 μg/g for total mercury and 1.93, 4.78, and 0.82 μg/g for methylmercury. Results were compared with those obtained in other European countries in the Mediterranean area. Simultaneously, the same compounds were analyzed in fish and molluscs from those most consumed by people in the above-mentioned groups. The following results were obtained: sword fish, 1.57±1.27 μg/g and 1.20±0.94 μg/g for total mercury and methylmercury respectively; Scrobicularia plana, 0.07±0.052 and 0.053±0.039 μg/g; Tapes decussatus, 0.046±0.20 and 0.039±0.018 μg/g.

Response to anti-hepatitis B recombinant vaccine in high risk population groups, including hepatitis B+D virus coinfection and in immunodeficient or hyperexposed groups

Response to anti-hepatitis B recombinant vaccine in high risk population groups, including hepatitis B+D virus coinfection and in immunodeficient or hyperexposed groups

Isolation of Salmonella enteritidis from cook-chill food distributed to hospital patients

Cook-chill systems are increasingly being used in the UK as a convenient means of catering for hospitalized patients. When such a system is operational, it is recommended that sampling of food be performed prior to regeneration. At our hospital we have established a food hygiene laboratory to achieve this. On routine sampling of nut roast prepared by the cook-chill method, Salmonella enteritidis was isolated. It was subsequently established that raw egg had been used in the preparation of the food which had been fried. Our investigation thus exposed potentially dangerous practices in the production line and highlights the need for constant vigilance where the system is used to provide food for a relatively high risk population group.

Hepatitis B infection of children in a mixed-race community in western New South Wales.

A seroprevalence survey of markers of hepatitis B virus (HBV) infection in children aged 0-16 years was conducted in a mixed-race township in western New South Wales. A total of 408 children were screened representing 95% of the total 0-16-year-old population. Of the Aboriginal subjects, 69% had seromarkers which indicated previous infection with HBV and 14% were hepatitis B surface antigen (HBsAg) seropositive. In the non-Aboriginal subjects the prevalence of seromarkers was 10% with no subjects HBsAg positive. The township provided an ideal setting for studying possible crossinfection from children in a high risk (Aboriginal) population group to children in a low-risk (non-Aboriginal) group. The ratio of children in the high-risk group for HBV infection to those in the low-risk group was approximately 2.7:1. Although HBsAg was highly endemic in the Aboriginal population, the data indicate that little crossinfection has occurred. We conclude that in this and similar mixed-race communities action should be taken to accelerate vaccination programmes aimed at reducing HBV infection among neonates and children in the high-risk groups. This will provide an immediate overall reduction of potential risk to both high-risk and low-risk groups while the issue of universal vaccination is considered further.

Food Patterns and Health Problems: Central Europe

Central Europe comprises a heterogeneous group of some 120 million persons from 11 countries which differ greatly in food availability and preferences. The region has undergone dramatic changes in food consumption patterns and in the patterns of nutritionally related diseases. The changes in the political situation in central Europe have provided a unique natural experiment which allows the study of the effects of different eating behaviors on health within a genetically homogeneous population and an analysis of the time frame in which effects can be seen at the national level. This is in particular the case for the FRG and the GDR. Epidemics of nutritionally related disease have arisen, including cardiovascular disease, cancers of the colon and breast and obesity. These occur at very different rates in neighboring countries. Furthermore, unknown factors, probably including food-hygienic factors and methods of storage and preparation, have resulted in drastic reductions in the rates of stomach cancers in all countries. These have only recently been detected, as no systematic nutritional surveillance systems are currently in effect in Europe. Due to the chronic nature of the diseases in question, we are noticing too little, too late. Food patterns provide a realistic and sensitive predictor of disease incidence. They are timely enough to detect changes before they are reflected in a diminished health status of the population or specific risk groups. Details on the patterns of intake and secular trends, as far as they are available for individual countries, reveal that eating behavior is quite labile and subject to dramatic changes within decades. The current information status does not allow a closer examination of specific population groups, such as the behavior of children or the elderly, the intakes of pregnant or breast-feeding women, or the eating behavior of men at high risk of heart disease. The foundations of a European nutrition surveillance system need to be laid, to make possible the timely detection of high-risk-related changes in food consumption, unfavorable trends and early signs of nutritionally related epidemics. The regular, standardized assessment of eating patterns will be an important building stone in such a system.

Mass screening models for contagious diseases with no latent period.

In this paper, a simplified model describing the stochastic process underlying the etiology of contagious and noncontagious diseases with mass screening is developed. Typical examples might include screening of tuberculosis in urban ghetto areas, venereal diseases in the sexually active, or AIDS in high risk population groups. The model is addressed to diseases which have zero or negligible latent periods. In the model, it is assumed that the reliabilities of the screening tests are constant, and independent of how long the population unit has the disease. Both tests with perfect and imperfect reliabilities are considered. It is shown that most of the results of a 1978 study by W.P. Pierskalla and J.A. Voelker for noncontagious diseases can be generalized for contagious diseases. A mathematical program for computing the optimal test choice and screening periods is presented. It is shown that the optimal screening schedule is equally spaced for tests with perfect reliability. Other properties relating to the managerial problems of screening frequencies, test selection, and resource allocation are also presented.

Lack of effect of nicardipine and diltiazem on glucose- and arginine-induced insulin release in obese subjects.

The metabolic effects of calcium channels blockers have already been studied both in normal and diabetic humans and results were quite controversial, depending on the drug used, the dose administered, and the type of patient. Little information exists on the use of Ca2+ antagonists in obese people, even if these persons are a population risk group for developing diseases in which these drugs may be requested for treatment. Thus, we evaluated, in obese humans, the metabolic effects of two Ca2+ antagonist drugs recently made commercially available to treat diseases such as hypertension and ischemic heart disease: nicardipine and diltiazem. Sixteen obese subjects were submitted to an intravenous glucose tolerance test (0.33 g/kg) (IVGTT) and an arginine test tolerance (30 g in 30 minutes) (ATT) before and after a week of oral treatment with nicardipine (60 mg/day) or diltiazem (360 mg/day). Plasma values of glucose, insulin, and C-peptide during IVGTT, and of glucose, insulin and glucagon during ATT did not show any modification during treatment with either drug. Thus the Ca2+ antagonists, nicardipine and diltiazem, at therapeutic doses in obese subjects do not significantly affect glucose tolerance or insulin and glucagon release.

Education for Life during the AIDS Pandemic

6 gay men who recognized the medical psychological social legal and economic consequences of the epidemic in New York City founded the Gay Mens Health Crisis (GMHC) in 1981. It now serves >2000 persons with or related complex who belong to 1 or more high risk population groups e.g. intravenous (IV) drug users but the majority of clients are gay or bisexual men. GMHC provides individual and group counseling recreation financial advocacy and legal and ombudsman services. It also distributes comprehensive and scientifically accurate information to educate high risk groups health care providers and the general public so as to prevent the spread of the virus (HIV) and to destroy the barriers set up by misinformation and fear. For example HIV is not transmitted by casual contact e.g. kissing hugging and shaking hands. The most effective ways of reducing transmission of HIV include avoiding infected blood semen and vaginal fluid exchanges or not sharing contaminated needles syringes and other IV drug items. 2 safe sex practices consist of using intact latex condoms during vaginal oral and anal sex and preferably the man should ejaculate outside these cavities. GMHC disseminates this information via existing networks that extend to every neighborhood and ethnic community in the city e.g. libraries. Medical Answers about AIDS and Legal Answers to AIDS are 2 of 35 GMHC publications that address the variety of issues affecting the community. GMHC also publishes information in Spanish and chinese. GMHCs Hotline provides yet another means of disseminating information. Other services include the Professional Education Program a cable television program and the Prevention Program.

Mammography is an objective diagnostic method.

Six hundred mammograms from 307 consecutive symptomatic patients with a firm retrospective diagnosis were evaluated blindly and independently by two observers. Each observer identified 43 of 47 tumors (91 per cent) with predictive values of 0.63 and 0.68, respectively, for the positive statement, and 0.98 for the negative statement. The overall interobserver agreement with respect to malignancy was 94 per cent (Kappa 0.84) and concerning the diagnosis of simple cysts 91 per cent (Kappa 0.60). The frequency of subclinical cancer demonstrated by mammography in this material was higher than the prevalence of mammary carcinoma found by screening of risk group populations. Thus, mammography remains an objective and reproducible diagnostic method with distinct complementary value to clinical examination. By utilizing certain mammographic criteria for benign lesions it may be possible to reduce the number of biopsies presently performed on the basis of unspecific palpatory findings.

ISOSPORA BELLI DIARRHEAL INFECTION IN HOMOSEXUAL MEN

Unsporulated Isospora belli oocysts were detected in the stool specimens of three homosexual men. The oocysts were ellipsoidal measuring 23-33 X 12-15 micron. It is acid fast with modified cold kinyoun stain (MCK) and reveals orange fluorescence with the Truant's stain. Sheather's sucrose flotation method is effective in concentrating Isospora oocyst as with other coccidial oocysts. One specimen showed many Charcot-Leyden crystals. All three patients responded to treatment. Isosporiosis is rare in this country and is endemic in the tropics and subtropics. Although one case acquired the infection after returning from an endemic area, the other two cases had no travel history. This raised the suspicion that this, like other parasitic infections (amebiasis, giardiasis, cryptosporidiosis) may be sexually transmitted. Such exotic parasitic infections in homosexual men during the outbreak of the acquired immunodeficiency syndrome adds another unusual infectious agent to the differential diagnosis of diarrheal disease in this high risk group of population.

Memorial hospital registry of population groups at high risk for cancer of the large intestine: Age of onset of neoplasms

An early age of onset, and tendency to develop multiple neoplasms, are characteristic of population groups having hereditary predisposition to a variety of cancers including those of the large intestine. Familial aggregates having inherited adenomatosis of the colon and rectum (familial polyposis), and those who are strongly colon cancer prone without polyposis, illustrate population groups in which early age of onset of neoplasia is characteristic. These and other high risk groups have been entered into a new Memorial Hospital Registry. Additional phenotypic abnormalities in high risk population groups have recently been found to occur at early ages. These are being measured to improve the characterization of subjects requiring improved surveillance, and to study modes of intervention that attempt to inhibit the development of malignancy.