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Biomedical subjects

H Siem

Publications and source records attributed to H Siem.

At least 19 recordsLinked to original sources
PubMed2003

Comparison of four-day and seven-day pantoprazole-based quadruple therapy as a routine treatment for Helicobacter pylori infection.

BACKGROUND: H. pylori eradication is usually performed with three or four drugs for at least seven days. Recently four reports have shown a cure rate of approximately 90% using a four-day quadruple therapy. The objectives of this prospective study were: 1) to evaluate the efficacy of pantoprazole-based quadruple therapy, and 2) to compare the efficacy and tolerability of four-day with seven-day quadruple therapy. METHODS: The study was performed in a single centre. The first 56 consecutive patients with nonulcer dyspepsia or peptic ulcer disease and proven H. pylori infection received seven days of quadruple therapy (pantoprazole, bismuth, tetracycline and metronidazole). At least six weeks after treatment, endoscopy was repeated with six biopsies of the antrum and corpus for histology, urease test and culture. The next 59 consecutive patients followed the same protocol but received four-day quadruple therapy. RESULTS: Using an intention-to-treat analysis, the cure rate in the seven-day treatment group was 54/56 (96.4%, 95% confidence interval (CI) 87.7-99.6%). In the per protocol analysis the cure rate was 53/55 (96.3%, 95% CI 87.5-99.6%). Primary metronidazole resistance was observed in seven patients. All were cured. Using an intention-to-treat analysis, the cure rate in the four-day treatment group was 51/59 (86.4%, 95% CI 75.0-94.0%). In the per protocol analysis the cure rate was 50/58 (86.2%, 95% CI 74.6-93.8%). Primary metronidazole resistance was observed in seven patients, four of whom were cured. In three out of eight patients in whom four-day treatment failed, secondary metronidazole resistance was induced. Both treatment regimens were well tolerated. The difference between cure rates of both regimens did not reach statistical significance (p=0.0585). CONCLUSION: Routine use of both four-day and seven-day pantoprazole-based quadruple anti-H. pylori treatment is effective and well tolerated. The results of both regimens reach the required eradication standard, but results with the seven-day regimen were slightly but not significantly better. Seven-day treatment may be superior, especially in case of metronidazole resistance, and should be preferred.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1997

Migration and health-the international perspective.

Mass movement of people is not a new phenomenon. There are significant differences, however, between contemporary migration and that of yesterday. Modern communication and transportation makes it possible for people and their health problems to travel further and more quickly than ever before. The Plan of Action produced by the 1994 International Conference on Population in Cairo estimates that there are 125 million migrants world-wide. The cause of concern is not only linked to the numbers, but also to the new patterns and categories of migrants that give the strong feeling that the problem is getting out of control. This presents a challenge which urgently asks for response and action on various levels including health and social services. European states started to develop policies that would link immigration to health care policies. "Health for All" strategies, only towards the end of the 1980s, if at all. There are six areas, where health policies and programmes explicitly should take the needs of the immigrants into consideration: (1) communication and understanding, (2) control of infectious diseases, (3) mother and child care, (4) occupational health, (5) violence and (6) health indicators among migrants. To improve the health status of migrant families immigrant receiving countries need to put ethnic policies high on the public health agenda, they need to provide adequate health services to immigrants and there is a crucial need for training and preparing health professionals to understanding perspectives that differ from their own ethnic orientation, and to provide adequate and effective responses.

Communicable Disease Control↗
PubMed1995

No real progress towards equity: health of migrants and ethnic minorities on the eve of the year 2000.

The paper reviews the available evidence on access to health care and two health outcomes, perinatal mortality and accident/disability, for migrant and ethnic minorities in selected receiving industrialized countries. The health of these communities is analyzed using the entitlement approach, which considers health as the product of both the individual's private endowments and the social environment he or she faces. Migrants, especially first and second generations, and ethnic minorities often have reduced entitlements in receiving societies. Not only are they exposed to poor working and living conditions, which are per se determinants of poor health, but they also have reduced access to health care for a number of political, administrative and cultural reasons which are not necessarily present for the native population. The paper argues that the higher rates of perinatal mortality and accidents/disability observed in many migrant groups compared to the native population are linked to their lower entitlements in the receiving societies. Policies aimed at reducing such health gaps need to be accompanied by a more general effort to reduce inequalities and to promote full participation of these groups in the mainstream of society.

Accidents, Occupational↗
PubMed1995

Prevalence of tuberculosis in Vietnamese migrants: the experience of the Orderly Departure Program.

This study aimed to describe the Internal Organization for Migration (IOM) tuberculosis screening and treatment program in Ho-Chi-Minh City (Vietnam); and to review the prevalence of tuberculosis and treatment outcome in a cohort of Vietnamese migrants and refugees prior to their departure. From 1 November 1992 to 1 June 1993, prospective migrants and refugees bound to the United States, Australia, and Canada underwent medical examination by IOM in Ho-Chi-Minh City. Screening for tuberculosis was based on chest x-rays, and the diagnosis was confirmed by smear examination. Smear-positive patients received short-course chemotherapy, directly supervised, with isoniazid, rifampicin, ethambutol, and pyrazinamide. Out of 39,581 persons screened, 322 were smear-positive (641 per 100,000), and started treatment. Follow-up varied from a minimum of 12 months to a maximum of 18 months. At that time, 265 (82%) were cured, while the remaining either continued treatment with first-line drugs (24), started second-line treatment (17), or failed to be cured for various reasons (16). This report confirms the efficacy of short course chemotherapy and directly observed treatment for tuberculosis, in the context of one of the largest screening programs for prospective migrants. Follow-up in receiving countries would help clarify risk factors for both new infection and relapse of tuberculosis.

Adult↗
PubMed1991

[Refugees and migrants].

Today, there are about 14 million refugees worldwide. The United Nations' High Commissioner for Refugees supports them with legal aid, food supplies, housing and preventive health measures, and also tries to find a permanent residence for the refugees. In recent years, there has been increasing awareness about the great number of internally displaced persons in many countries, and of the extent of economic migration. The fear that immigrants may be a threat to the public health, especially as regards import of infectious diseases such as HIV, hepatitis B and tuberculosis, is diminishing. The cultural aspects of health care among immigrants require increased attention, both from the immigrants themselves, and the countries to which they immigrate.

Cross-Cultural Comparison↗
PubMed1984

Factors affecting primary health care utilization.

Using a one-stage random probability sample of households, 5806 people in an area of Norway were interviewed about illness, use of medicines, self-treatment and visits to the doctor in the previous two weeks. Several social and demographic variables that might influence primary health care utilization were divided into five categories: need of medical care; self-care; availability of the doctor; sociodemographic factors; social network factors. Multiple classification analysis was used for the statistical analysis. The greatest influence on the percentage of people seeing the doctor was the need for medical care, the second largest influence was self-care. The availability of the doctor had a different effect according to whether the illness was chronic or non-chronic. Difficulties in reaching the doctor reduced the number of consultations for non-chronic diseases while the opposite was the case for chronic diseases. Among the sociodemographic variables neither level of education nor income had any influence on utilization when other variables were taken into account. Increasing age, however, caused a large increase in the percentage seeing the doctor, except after the age of 85 years when there was a large drop in consultation rate despite increasing illness. Social network factors had little effect on health care utilization.

Acute Disease↗