Search PubMed⌕ Search

Biomedical subjects

D Enarson

Publications and source records attributed to D Enarson.

At least 19 recordsLinked to original sources
PubMed2005

The prevalence of symptoms associated with pulmonary tuberculosis in randomly selected children from a high burden community.

BACKGROUND: Diagnosis of childhood tuberculosis is problematic and symptom based diagnostic approaches are often promoted in high burden settings. This study aimed (i) to document the prevalence of symptoms associated with tuberculosis among randomly selected children living in a high burden community, and (ii) to compare the prevalence of these symptoms in children without tuberculosis to those in children with newly diagnosed tuberculosis. METHODS: A cross sectional, community based survey was performed on a 15% random sample of residential addresses. A symptom based questionnaire and tuberculin skin test (TST) were completed in all children. Chest radiographs were performed according to South African National Tuberculosis Control Program guidelines. RESULTS: Results were available in 1415 children of whom 451 (31.9%) were TST positive. Tuberculosis was diagnosed in 18 (1.3%) children. Of the 1397 children without tuberculosis, 253 (26.4%) reported a cough during the preceding 3 months. Comparison of individual symptoms (cough, dyspnoea, chest pain, haemoptysis, anorexia, weight loss, fatigue, fever, night sweats) in children with and without tuberculosis revealed that only weight loss differed significantly (OR = 4.5, 95% CI 1.5 to 12.3), while the combination of cough and weight loss was most significant (OR = 5.4, 95% CI 1.7 to 16.9). Children with newly diagnosed tuberculosis reported no symptoms in 50% of cases. CONCLUSION: Children from this high burden community frequently reported symptoms associated with tuberculosis. These symptoms had limited value to differentiate children diagnosed with tuberculosis from those without tuberculosis. Improved case definitions and symptom characterisation are required when evaluating the diagnostic value of symptoms.

Adolescent↗
PubMed2002

Relation of grading of sputum smears with clinical features of tuberculosis patients in routine practice in Sudan.

SETTING: Health services in Khartoum, Red Sea, Gadarif, Kassala, Bahr el Jebel, Gezira and North Kordofan States of Sudan. OBJECTIVE: To investigate the association of presenting symptoms and clinical history with grade of sputum smear positivity in tuberculosis patients. METHODS: The 5338 tuberculosis suspects aged 15 to 49 years who consulted between March 1998 and March 1999 underwent sputum smear microscopy, with smears graded by a standardised method. Patients who gave consent had a structured interview concerning the nature and duration of their symptoms and whether they had a sick relative at home. Statistical analysis determined the association of symptoms and home characteristics with the results of smear examination. RESULTS: A total of 514 suspects (9.6%) demonstrated acid-fast bacilli: 45 (8.8%) grade +1, 167 (32.5%) grade +2 and 302 (58.8%) grade +3. Most of the patients had a duration of symptoms of 6-9 weeks, while 100 had symptoms of more than one year's duration, many (n = 47) with other chronic respiratory diseases. Multiple chest symptoms were positively, and duration of symptoms negatively associated with grade of positivity (P = 0.018 and 0.028, respectively). A high grade of smear positivity (+3) and the longest duration of symptoms, among those reporting symptoms of less than one year's duration, were significant predictors of the presence of a sick household member (OR = 1.99, 95%CI 1.12-3.55; OR = 1.004, 95%CI 1.000-1.008). CONCLUSION: This study demonstrates a relation between the grade of smear positivity and the clinical features of tuberculosis patients.

Age Distribution↗
PubMed2001

Chronic respiratory diseases in developing countries: the burden and strategies for prevention and management.

In developing countries, chronic respiratory diseases represent a challenge to public health because of their frequency, severity, projected trends, and economic impact. Health care planners, for example, are faced with a dramatic increase in tobacco use and must establish priorities for the allocation of limited resources. Nevertheless, smoking prevention and standardized management programmes for asthma and chronic obstructive pulmonary disease should be implemented in developing countries whenever possible. International measures will be required to reverse tobacco smoking trends, and international agencies could define essential drugs and equipment and encourage the use of generic drugs, particularly for corticosteroids inhaled at high dosages. For such programmes to be effective, producers of high-quality generics will need to be identified, and the medications added to national lists of essential drugs and included in procurement procedures. Other recommendations for alleviating the burden of chronic respiratory diseases in developing countries are: adapting guidelines to local contexts and ensuring their distribution; upgrading equipment at district level; purchasing high-quality drugs at low prices; routine training and supervision of health services personnel; and regular monitoring of performance. Social mobilization by professional societies, nongovernmental organizations, and the mass media will also increase government commitment to tobacco control and standardized case management.

Anti-Asthmatic Agents↗
PubMed1997

[The epidemiology of tuberculosis and of the resistance to antitubercular agents].

Tuberculosis is once more a subject of world wide preoccupation; since 1985 a disturbing recrudescence of this disease has been noted in numerous countries related to population growth and the worsening of poverty in those countries without natural resources, and disadvantaged groups living on the margins of society in rich countries, along with the occurrence of an epidemic of HIV (VIH). In numerous developed countries where tuberculosis no longer represents a public health problem, the care services have little by little been closed or re-orientated and the principles of treatment of tuberculosis have been forgotten. The direct consequence of this has often been inadequate treatment and its corollary: the emergence of strains multiresistant to Isoniazid and Rifampicin. If the current epidemiological tendencies are confirmed and no supplementary action is taken, the WHO (OMS) has estimated that during the ten years between 1990 and the millennium there will be 88 million new cases of tuberculosis and 30 million people will die of tuberculosis. However the tendencies can be reversed and tuberculosis could still be eliminated. The struggle against tuberculosis is a world wide emergency and the hope of controlling the situation before an increase in multiresistant strains which would render the trend irreversible, rests on a general application of correct and coherent national programmes. Such a programme as the UICTMR model had already been carried out as has the proof of their efficacy.

AIDS-Related Opportunistic Infections↗
PubMed1989

Tuberculosis in British Columbia among immigrants from five Asian countries, 1982-85.

The influence of immigration from six selected Asian countries--Japan, Korea, Philippines, India, China and Hong Kong--on the incidence of tuberculosis in British Columbia has been examined. During the period 1982-1985 the average annual incidence of bacillary tuberculosis in these immigrants was more than six times as great as the overall British Columbia rate and contributed a quarter of the cases of active bacillary tuberculosis in this province whereas the immigrants from these countries represented only 3.7% of the total population. The clinical patterns of active tuberculosis by birthplace were analysed. A high proportion of cases of lymphadenitis was seen among all immigrants from Asia, particularly those from the Philippines. Both primary and secondary drug resistance was substantially higher than in Canadian-born patients. The frequency of primary drug resistance was higher among patients aged less than 40 years than those aged 40 or more.

British Columbia↗
PubMed1986

Trace metals in scalp hair of children and adults in three Alberta Indian villages.

This study examined trace metal levels in scalp hair taken from 122 children and 27 adult residents of three small northern Alberta (Canada) Indian villages, one of which is situated close to the world's first tar sands oil extraction plants. The three communities studied were: Fort McKay (the exposed village), Fort Chipewyan (also in the tar sands ecosystem but distant from the plants), and Garden River (not in the tar sands ecosystem). Inductively coupled argon plasma emission spectroscopy was used to determine hair sample metal content. Nineteen metals were included in data analysis. Children from Fort McKay had the highest average hair lead, cadmium and nickel levels. Chromium levels were approximately equal in hair from Fort McKay and Garden River children, and significantly elevated above levels found in the hair of Fort Chipewyan children. Children from Garden River showed highest hair levels of eight metals: vanadium, aluminum, iron, manganese, barium, zinc, magnesium and calcium. Fort Chipewyan children had the highest hair levels of copper, but the lowest levels of all other metals. Among adults, hair lead, nickel and cadmium levels were highest in Fort McKay residents, while phosphorous and vanadium were highest in hair from Garden River residents. Bioaccumulation of lead, cadmium, nickel and chromium in hair from Fort McKay residents may be related to exposure to extraction plant pollution. Plant stack emissions are known to contain appreciable amounts of lead, nickel and chromium. Spills into the Athabasca River, until recently the source of Fort McKay drinking water, have been reported from plant wastewater holding ponds, known to contain elevated levels of lead, nickel and cadmium. An increased number of significant metal-metal correlations in hair metal levels for Fort McKay children suggests a richer source of multiple metal exposure, relative to children in the other two communities.

Adolescent↗
PubMed1985

Grain dust and respiratory health.

Exposure to grain dust gives rise to many respiratory problems. Since the growing, transporting and processing of grain are major Canadian industries, the number of individuals who might be affected by such exposure is sizeable. This paper describes clinical syndromes related to grain dust exposure, together with predisposing host factors, in an attempt to determine what levels of exposure are "safe" for workers and what areas still require extensive research.

Airway Resistance↗
PubMed1985

Does a family history of allergy predict immediate skin test reactivity?

The value of a family history of allergy in predicting atopy was assessed in men employed in lumber mills, grain handling and railway industries in British Columbia. Detailed family and personal histories of allergy were available for 1434 men, 1426 of whom underwent prick skin testing with two common environmental allergens and one control solution. Those with a family history of allergy had 2.06 times the odds of immediate skin test reactivity as those without a family history and 1.65 (p less than 0.01) times the odds after adjustment for personal history and age. The odds of skin test reactivity in workers with a personal history of allergy were 4.76 times those of workers without such a history and 4.34 after adjustment for family history and age. Almost half (47%) of the workers with both a family and a personal history of allergy had positive results of skin testing, compared with only 10% of the workers without either history. It was therefore concluded that a family history of allergy is an independent predictor of atopy.

Adolescent↗
PubMed1985

Respiratory abnormalities among workers in an iron and steel foundry.

A study of the health of 78 workers in an iron and steel foundry in Vancouver, British Columbia, was carried out and the results compared with those found in 372 railway repair yard workers who were not significantly exposed to air contaminants at work. The foundry workers were exposed to PepSet, which consists of diphenyl methane diisocyanate (MDI) and phenol formaldehyde and their decomposition products as well as to silica containing particulates. A questionnaire was administered by trained interviewers, and chest radiography, allergy skin tests, pulmonary function tests, and methacholine inhalation tests were carried out as well as measurement levels of dust and MDI. Compared with the controls, the foundry workers had more respiratory symptoms and a significantly lower mean FEV1 and FEF25-75% after adjustments had been made for differences in age, height, and smoking habit. Three workers (4.8%) had radiographic evidence of pneumoconiosis and 12 (18.2%) had asthma defined as presence of bronchial hyperreactivity, cough, and additional respiratory symptoms such as wheeze, chest tightness, or breathlessness. Sensitisation to MDI is probably the cause of asthma in these workers.

Adult↗
PubMed1985

Lymphocyte subpopulations in allergic granulomatosis and angiitis (Churg-Strauss syndrome).

We report a case of allergic granulomatosis and angiitis (Churg-Strauss syndrome) in which immunologic parameters, including lymphocyte subpopulations, were determined in the acute phase of the disease and during remission. Hyperimmunoglobulinemia E and immune complexes were present. A low proportion of suppressor/cytotoxic (T8+) lymphocytes and a high helper/suppressor ratio were seen throughout the course of the disease, although immunoglobulin levels and circulating immune complex levels decreased with therapy. We hypothesize that the deficiency of suppressor cells may play a role in the pathogenesis of this syndrome.

Aged↗
PubMed1984

Lymphocyte subpopulations in patients with allergic rhinitis.

The lymphocyte subpopulations were classified using monoclonal antibodies specific for B lymphocytes (B1 antibodies), T lymphocytes (T11 and OKT3 antibodies), helper/inducer T cells (T4 antibodies) and suppressor/cytotoxic T cells (T8 antibodies). Three groups of subjects were studied: 20 normal controls, 29 patients with allergic rhinitis and a subgroup of nine patients who had received immunotherapy. The proportion of B lymphocytes, total T cells and T4 positive (helper/inducer) cells were not significantly different between the groups, but allergic patients were found to have a decreased proportion of suppressor T8 positive (suppressor/cytotoxic) cells and hence a high helper/suppressor cell ratio. These abnormal parameters were found to be normal in the group of allergic patients who had received immunotherapy. These results imply that a suppressor cell deficiency may be an underlying mechanism of allergic disease, and that immunotherapy could correct the suppressor cell deficiency.

Adult↗
PubMed1984

Symptoms, pulmonary function, and bronchial hyperreactivity in western red cedar workers compared with those in office workers.

An epidemiologic health study was carried out on 652 cedar mill workers and a control group of 440 male office workers not exposed to air contaminants. Participants completed a medical-occupational questionnaire with trained interviewers, had allergy skin tests, performed spirometry, and had bronchial reactivity assessed by methacholine inhalation testing. After adjusting for differences in age, race, and smoking, cedar workers were found to have significantly higher prevalences of cough, phlegm, and dyspnea than did office workers. Symptoms of asthma and work-related asthma, but not persistent wheeze or doctor-diagnosed asthma, were reported in a significantly higher proportion of cedar workers than of office workers. Cedar workers also had significantly lower lung function test results than did office workers after controlling for height, age, race, and smoking. Bronchial hyperreactivity, defined by a methacholine PC20 less than 8 mg/ml, was more prevalent among cedar workers than among office workers, with the increase being limited to the nonatopic subgroup of workers. The prevalence of bronchial hyperreactivity increased with duration of employment among cedar workers but not among office workers. We conclude that exposure to western red cedar dust is harmful to the respiratory health of the workers, causing asthma and other respiratory symptoms, bronchial hyperreactivity, and lower levels of lung function.

Adult↗
PubMed1984

Host factors affecting longitudinal decline in lung spirometry among grain elevator workers.

The host factors affecting the longitudinal decline in lung function among 267 white male grain elevator workers who were still working in the industry and did not change their smoking habits over a period of six years were studied. Spirometric measures declined more rapidly in older grain handlers as compared with younger workers. Smokers had slightly greater decline in spirometry compared to nonsmokers, but the differences failed to reach the level of statistical significance. Acute changes in lung function over the course of one work week during the initial study were also positively correlated with subsequent decline in lung function, as was bronchial hyperreactivity determined during the follow-up study. Positive immediate skin reactivity to common allergens, presence and absence of respiratory symptoms, and initial lung function did not appear to influence the subsequent decline in lung function in this group.

Adult↗
PubMed1983

Epidemiologic health study of workers in an aluminum smelter in British Columbia. Effects on the respiratory system.

A health survey was carried out on all white males in an aluminum smelter in British Columbia. The survey consisted of a medical-occupational questionnaire, spirometry, chest radiography, and environmental monitoring. We have compared the results of a respiratory survey in 713 workers in the office and casting department with no significant exposure to air contaminants (control workers) with those of 797 potroom workers: 495 who spent more than 50% of their working time in the potroom (high exposure) and 302 workers who spent less than 50% of their working time in the potroom (medium exposure). Potroom workers (high) had a significantly greater prevalence of cough and wheeze than did those in the control group, and they had significantly lower mean forced expiratory volume in one second and maximal midexpiratory flow rate than did those in the control group after adjustment had been made for differences in age, height, and smoking habits. Potroom workers (medium) had a slightly greater prevalence of respiratory symptoms and lower lung function than did workers in the control group, but the differences were not significant. We were unable to demonstrate potroom asthma. The levels of total fluoride, gaseous fluoride, particulate fluoride, sulphur dioxide, and total particulates found in the potroom at the time of the study were below the currently accepted threshold limit values, but the levels of benzo-alpha-pyrene were high.

Adult↗