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PubMed2002

Prevalence of byssinosis and respiratory symptoms among cotton mill workers.

BACKGROUND: While the prevalence of byssinosis is decreasing in industrialized countries and persists at high levels in developing countries, this prevalence is remaining constant in Turkey. OBJECTIVE: In order to determine the effects of past cotton dust exposure on the respiratory tract, a total of 223 persons working in a cotton mill were included in this study. METHODS: A questionnaire was used to inquire about respiratory symptoms. Participants underwent several spirometric measurements, which were performed on the 1st, 3rd and 5th day of the working week. Cotton dust measurements were performed in different divisions of the factory. RESULTS: The most common respiratory symptom was chest tightness (20.3%). The prevalence of byssinosis was 14.2% in cotton-processing workers. Among these cases, 28.6% had symptoms on the 1st day of the week, and 71.4% had symptoms on all days of the week. An acute effect was seen in 53.6% of the workers with byssinosis. Mean respirable dust levels were between 0.095 and 0.413 mg/m(3). CONCLUSIONS: In spite of technological improvements, respirable dust concentrations are still above the permissible limits, and thus the risk of byssinosis remains. Workers in the cotton industry where obsolete technology is used and standardized protection measures are not applied should be followed for byssinosis.

Adult↗
PubMed2002

Hepatocellular carcinoma in a low-incidence region. Surgical perspectives.

BACKGROUND/AIMS: To study the characteristics and outcome of patients with hepatocellular carcinoma in a low-incidence region. METHODS: 98 patients with hepatocellular carcinoma who had been referred to the Surgical Department, National Hospital, Oslo, between 1981 and 1999 were studied retrospectively. Tumour size, prevalence of cirrhosis, serum alpha-fetoprotein concentration, rate of resection, type of resection and survival were analysed. RESULTS: 19% (19/98) of the patients had cirrhosis of varying aetiology. Median tumour size was 10 cm. alpha-Fetoprotein was normal in 46% of the patients. Hepatic resection was performed in 30 (31%) patients and 77% of the resections were major (more than 2 segments). Abdominal exploration was done in 33 patients and liver transplantation in 6 patients. No surgical intervention was made in 31 patients. Five-year actuarial survival in resected patients was 24%. Median survival of non-resected patients was 3.3 months. CONCLUSION: The patient characteristics in this study differ from patient cohorts with hepatocellular carcinoma in other geographical areas. The main differences are large tumour size, low prevalence of the disease, and diverse aetiology of cirrhosis.

Adolescent↗
PubMedDate not supplied

Is low-back pain prevalent among Kuwaiti children and adolescents? A governorate-based study.

OBJECTIVE: To measure the magnitude of the problem of low-back pain among 10- to 18-year-old Kuwaiti schoolchildren in Hawalli Governorate. SUBJECTS AND METHODS: A cross-sectional multistage stratified random sample of 400 schoolchildren (199 males and 201 females) of ages 10-18 years were selected from two junior and two high schools in Hawalli Governorate, Kuwait. Data on age, gender and characteristics of low-back pain such as duration, location and frequency were collected through personal interviews using a questionnaire. Low-back pain was defined as pain in the back from the 12th rib to the buttock area. RESULTS: According to our definition, reported lifetime prevalence of low-back pain was found to be 57.8% (50.8% in male and 64.7% in female students), while the point prevalence was 35% (20.6% in male and 39.3% in female students). More female students reported low-back pain than male students, and the prevalence of low-back pain was found to increase with age in both sexes. The age of onset of low-back pain was 14 years in males and 13 years in females. The majority of students (92.1% in males, 84.6% in females) reported pain in the low back. Almost 46% of students related their low-back pain to accidents. A significantly higher proportion of male students (58.4%, compared to females 36.2%) reported low-back pain caused by accident or with duration of recovery less than a week (21.8% for males as compared to 16.2% for female students). Female students reported more recurrent or continual low-back pain. CONCLUSION: Low-back pain is common among Kuwaiti students in Hawalli Governorate. Prevalence of low-back pain increased with age in both sexes. Female students reported more frequent low-back pain than male students.

Adolescent↗
PubMed2005

Psychophysiological reactivity under mental stress in atopic dermatitis.

BACKGROUND: An association of mental stress with atopic dermatitis is widely accepted. However, no long-term evaluation of psychophysiological reactivity over the course of disease has yet been performed. OBJECTIVE: We examined whether atopic dermatitis patients have an increased psychophysiological reactivity compared to healthy controls and in between acute and disease-free phases, and whether they differ in psychological state and trait variables. METHODS: Fifteen patients with atopic dermatitis underwent a stress test during acute exacerbation and after symptom improvement and were compared to matched controls. RESULTS: Psychophysiological responses to stress were not stronger in the patient group than in the controls. Nevertheless, the patients had a higher heart rate and lower vagal activity throughout the resting and stress phases at both examination times. The patients showed significantly higher anxiety, depression and emotional excitability, and self-ratings of inactivity clearly distinguished acute phases from remission. CONCLUSION: There is an increased vegetative excitability level in patients with atopic dermatitis, which cannot be attributed solely to increased disease activity.

Adolescent↗
PubMed2002

Incidence and short-term outcome of cerebral infarction in young adults in western Norway.

BACKGROUND AND PURPOSE: We sought to determine the incidence and short-term outcome of people aged 15 to 49 years with first-ever cerebral infarction in 1988-1997 in Hordaland County, Norway. METHODS: Cases were found from computer search of hospital registries and detailed review of patient records. Stroke subtype was classified according to the major intracranial artery affected. Short-term outcome was evaluated by the modified Rankin Scale (mRS). RESULTS: A total of 96 women and 136 men met the inclusion criteria. The average annual incidence was 11.4/100 000. Women outnumbered men among those aged <30 years (P=0.059); men predominated among those aged > or =30 years (P=0.004). A total of 148 patients had anterior circulation infarction (64%), and 84 had posterior circulation infarction (36%) (P<0.001). Patients with posterior circulation infarction had better mRS score at discharge (P=0.005). Eighty percent had favorable outcome (mRS score < or =2). The 30-day case fatality rate was 3.4%. The recurrence rate in hospital was 2.2%. CONCLUSIONS: The incidence was in the lower range compared with other reports from western Europe. Although men predominated, there was a strong trend toward more women among patients aged <30 years. Short-term outcome was generally good. Patients with posterior circulation infarction had significantly better short-term outcome.

Adolescent↗
PubMed2006

Genome scan of Han Chinese schizophrenia families from Taiwan: confirmation of linkage to 10q22.3.

OBJECTIVE: Genome-wide linkage analyses of schizophrenia have identified several regions that may harbor schizophrenia susceptibility genes, but given the complex etiology of the disorder, it is unlikely that all susceptibility regions have been detected. To address this issue, the authors ascertained 606 Han Chinese families comprising 1,234 affected members. METHOD: Probands with schizophrenia were recruited from six data collection field research centers in Taiwan. Each proband underwent a diagnostic screen with supplemental medical records and a semistructured interview. Following this screen, the authors administered the Mandarin Chinese version of the Diagnostic Interview for Genetic Studies. Best-estimate final diagnoses were made by two board-certified psychiatrists. The genotyping was conducted by the Center for Inherited Disease Research, with 386 markers spaced at an average of 9-centimorgan (cM) intervals. Empirical simulations were generated to determine genome-wide significance. RESULTS: The authors found five regions with nonparametric linkage z scores 2.0 or greater. These were the following: 2.08 was reached for D1S551 (113.7) cM at 1p31.1 and 2.31 for D2S410 (125.2 cM) at 2q14.1; 2.00 was reached for D4S2361 (93.5 cM) at 4q21.23, and 2.07 for D15S1012 (36 cM) at 15q14, the largest nonparametric linkage z score was 2.88 for D10S2327 (100.92 cM) at 10q22.3. CONCLUSIONS: Our 10q22.3 finding at 100.9 cM is consistent with a previously reported nonparametric linkage score of 4.27 at 107.2 cM on chromosome 10, although it did not attain genome-wide significance in this study.

Asian People↗
PubMed2003

Effects of age, sex, and disorder on voice range profile characteristics of 230 children.

In this study, the effect of age, sex, and disorder on the vocal performance of 230 children 6 to 11 years of age was investigated by means of the voice range profile (VRP). Ninety-four control children and 136 children with disorders were studied. The VRPs were quantitatively described by frequency and intensity characteristics, as well as by morphological characteristics. Significant differences between healthy children and children with disorders were found. Age has a different effect in girls than in boys regarding vocal performance. Most of the characteristics for the healthy girls change gradually over the period from 6 to 11 years. For the healthy boys, however, two age groups can be identified: one below and one above 8 years of age. It is hypothesized that the androgen dehydroepiandrosterone (DHEA) and its sulfate may play a role in this phenomenon.

Age Distribution↗
PubMed2000

Parental attitudes toward BB and pellet guns.

As well as describing our pediatric BB and pellet gun injuries and the circumstances surrounding these injuries, we also evaluated parental perceptions of the dangers of BB and pellet guns. A convenience sample of three groups of parents and their children presenting to a Midwest, urban, children's hospital emergency department was prospectively enrolled. The three groups of parents included the injured group, which consisted of the parents whose children had been injured by BB or pellet guns; the gun group, which consisted of the parents who allowed their children to possess BB or pellet guns but had not sustained injury from these guns; and the no gun group, which consisted of the parents who did not allow their children to have these guns. All parents completed a survey concerning their attitudes toward BB and pellet guns. Twenty-eight parents completed questionnaires in each of the three groups. Most BB and pellet gun injuries occurred in adolescent males at home without adult supervision and were inflicted by a friend or by themselves. The injured group and the no gun group viewed BB and pellet guns as significantly more dangerous than the gun group. Parents who allow their children to have BB or pellet guns appear to misperceive their potential for injury by allowing their children to use these guns in an unsafe manner. Clinicians must educate parents about the significant potential for injury of nonpowdered guns.

Adolescent↗
PubMed2001

Trends in age band-specific suicide rates among elderly people in England and Wales.

BACKGROUND: The elderly suicide rate in recent years in England and Wales has been declining for both sexes. METHOD: Data on the various suicide variables were ascertained from the annually published mortality data for years 1985 to 1998. Trends in the age band-specific elderly suicide rates in recent years were examined using this data. RESULTS: The main findings of this study were: (i) there was a decline in the 'pure' and 'combined' suicide rates, for both sexes, for the four five-year age bands between 65 and 85 years, but not for the older age groups; and (ii) for all age bands, male suicide rates were higher than female suicide rates. CONCLUSIONS: The challenge now is to facilitate decline in suicide rates in the very old given that demographic changes imply more people in that age group and absence of current evidence of decline in the very old age bands.

Age Distribution↗
PubMed2004

Functional recovery and exercise behavior in men and women 5 to 6 years following coronary artery bypass graft (CABG) surgery.

Improvement following coronary artery bypass graft (CABG) surgery has been reported to be less in women than men. Relationships between exercise behavior and functional status of men and women 5 to 6 years after CABG have not been examined in a representative patient sample. This study compared the 5- to 6-year recovery in a cohort of 184 patients at the Minnesota site of the Post CABG Biobehavioral Study. Data were collected by telephone interview and self-administered questionnaires. Results showed that women had lower physical ( p </=.004) and social ( p=.001) functioning scores; men were more likely to participate in regular exercise ( p =.01). Exercisers had higher functional status scores. ANCOVA demonstrated that differences in measures of functional status by exercise category were maintained even after controlling for age, sex, and symptom severity ( p </=.01). In conclusion, individuals who exercised had more positive functional outcomes 5 to 6 years post-CABG.

Activities of Daily Living↗
PubMed1997

Outcome after stroke rehabilitation in Hong Kong.

OBJECTIVE: To determine the outcome of patients discharged to the community after stroke rehabilitation. METHODS: One hundred and eighty-five consecutive patients discharged after stroke rehabilitation were enrolled for follow-up 12 months after discharge from a hospital in Hong Kong. A telephone interview to determine disability and place of residence was conducted. Disability was assessed by the Barthel Index and ratings of activities of daily living and mobility on a 4-point scale. RESULTS: One hundred and thirty-one patients or their carers were contacted (70.1%). This comprised 19 patients (10.3%) who died and 112 patients or their carers (60.5%) who were interviewed. Fifty-four patients (29.2%) were lost to follow-up. Comparison of the patients contacted and those lost to follow-up did not detect membership bias. Median Barthel Index of the surviving patients who were contacted rose from 90.0 (interquartile range 78.75-100.0) at discharge to 100.0 (interquartile range 85.0-100.0) at 12 months. Ratings of activities of daily living and mobility were maintained, with significant improvement in toileting. After rehabilitation 77.3% of the patients were discharged home and there was no significant change in residence at 12 months. Elderly patients (> or = 70 years old) had higher rates of institutionalization after hospital discharge and more disability although they achieved similar gains in Barthel Index and had similar lengths of hospital stay compared to younger patients. CONCLUSIONS: These results suggest that stroke patients were able to maintain their gains achieved during inpatient rehabilitation up to one year after discharge from hospital.

Activities of Daily Living↗
PubMed2004

Bloodless intensive care: a case series and review of Jehovah's Witnesses in ICU.

The objective of this study was to assess the outcome of Jehovah's Witness (JW) patients admitted to a major Australasian ICU and to review the literature regarding the management of critically ill Jehovah's Witness patients. All Jehovah's Witness patients admitted to the ICU between January 1999 and September 2003 were identified from a prospective database. Their ICU mortality, APACHE II scores, APACHE II risk of death and ICU length of stay were compared to the general ICU population. Twenty-one (0.24%) out of 8869 patients (excluding re-admissions) admitted to the ICU over this period were Jehovah's Witness patients. Their mean APACHE II score was 14.1 (+/- 7.0), the mean APACHE II risk of death was 21.2% (+/- 16.6), and the mean nadir haemoglobin (Hb) was 80.2 g/l (+/- 36.4). Four out of 21 Jehovah's Witness patients died in ICU compared to 782 out of 8848 non- Jehovah's Witness patients (19.0% vs 8.8%, P = 0.10, chi square). The median ICU length of stay in both groups was two days (P = 0.64, Wilcoxon rank sum). The lowest Hb recorded in a survivor was 23 g/l. Jehovah's Witness patients appear to be an uncommon patient population in a major Australasian ICU but are not over-represented when compared with their prevalence in the community. Despite similar severity of illness scores and predicted mortality to those in the general ICU population, there was a trend towards higher mortality in Jehovah's Witness patients.

APACHE↗
PubMed1998

Relationship between etiology and phenomenologic profile in delirium.

This study describes the symptom profile of 46 patients with delirium seen as consecutive referrals to a consultation-liaison psychiatry service. The relationship between symptoms rated on the Delirium Rating Scale (DRS) and delirium subtypes defined according to three putative etiologic groups are described. The relationship between etiologic groups and motoric subtype of the delirium episode is also described. Drug-related cases had the highest total DRS score and higher scores than the anticholinergic group for perceptual changes, delusions, psychomotor disturbance, and mood lability. Drug-related cases had higher scores than both the anticholinergic and infectious/electrolyte group for changes in sleep-wake cycle and fluctuation of symptoms. Those from the anticholinergic etiologic group were more likely to fit the hypoactive motoric subtype. Although our findings are tentative, etiologic categories may present with different symptom profiles, which may be associated with differing treatment responsiveness and course.

Adult↗
PubMed1999

Association of lifestyle parameters with the prevention of hypertension in elderly Japanese men and women: a four-year follow-up of normotensive subjects.

To study the association of lifestyle parameters with the future risk of hypertension in normotensive subjects, a baseline questionnaire and a four-year follow-up were performed in 445 normotensive Japanese at 35 to 89 years of age. In 60 to 69 year old subjects, the changes of blood pressure during four years were negatively correlated with the amount of boiled rice intake in men and with Japanese tea intake in women. Multiple logistic regression analysis revealed that miso-soup intake at two bowls per day or over was protective against hypertension during follow-up (p < 0.05). These results indicate that food intake is important in the prevention of hypertension in the elderly.

Adult↗
PubMed2003

P300 (latency) event-related potential: an accurate predictor of memory impairment.

To determine if P300 latency changes precede and correlate with memory and mental status, patients (N=1506 aged 20-100 years) who received medical and psychiatric diagnoses (from 1997 to 2002), were assessed for P300 (N=1496), WMS-III (N=694), and MMSE (N=456). Patient and control groups included, a) normal WMS-III on all 4 subscales (N=36), b) normal WMS-III and MMSE (N=189) with subjective memory/mental status complaints, and c) medical patients with normal WMS-III and no memory complaints (N=205), and d) P300 control group without medical, psychiatric or memory problems for ROC. Patients with impaired/borderline memory had a prolonged P300 latency (P<0.02) compared to age matched non-impaired controls; in patients with normal WMS-III/MMSE, with subjective mild memory/mental status impairment, P300 latency was prolonged compared to controls (P=0.0004). The P300 latency increased by 0.72ms per year (P=7.9x10(-65)) and voltage decreased by 0.03dV per year (P=6.7x10(-10)), and both parameters were linearly correlated with the age of the subjects. Male subjects had an average voltage of 6.1dV and female 6.8dV (P=0.00009). Statistically, prolonged latency began at age range 41-50 (P=0.0002); reduced P300 voltage began at age range 51-60 (P=0.003). WMS-III memory decline for all measures began in females at age range 61-70 (P value at least=0.02) and for males at age range 61-80 (P=0.02). Prolonged P300 latency (P<0.0001) and memory impairment (at least <0.02) were greater for females than males. MMSE memory decline, male and female, began at age range 81-90 (P value of at least 0.00007). In our logistic regression model P300 latency was more predictive of WMS-III impairment than MMSE > 24. In patients whose WMS-III score is impaired < or = 69, or borderline < or = 79 (P at least=0.004), a P300 latency more prolonged than the norm (> or = 300 + 30 + Age) identifies these patients, whereas a MMSE > 24 failed. With the ROC curve, we confirmed that P300 latency could accurately identify borderline/impaired memory.

Adolescent↗
PubMedDate not supplied

Invasive aspergillosis in critically ill patients: analysis of risk factors for acquisition and mortality.

OBJECTIVE: To investigate outcome in patients who develop invasive aspergillosis in the ICU, and to evaluate whether specific risk factors for the acquisition of invasive aspergillosis are associated with mortality. DESIGN: Retrospective cohort study (07/1997-12/1999) with screening of 8988 admissions. SETTING: 54-bed ICU of the 1060-bed Ghent University Hospital. PATIENTS: 38 ICU patients with invasive aspergillosis. Invasive aspergillosis was defined as proven by positive histology and tissue culture and as probable by a combination of clinical suspicion as well as microbiological and radiological data. Seventeen patients had risk factors (neutropenia, haematological malignancy, immunosuppressive therapy). In the other 21 apparently immunocompetent patients, invasive aspergillosis was a complication following ARDS, COPD, pneumonia, acute liver failure, burns, severe bacterial infection and malnutrition. MEASUREMENTS: Population characteristics and outcome were compared for patients with and without risk factors for the acquisition of invasive aspergillosis. RESULTS: Patients with risk factors had higher APACHE II scores. No difference was found between patients with and without risk factors in in-hospital mortality (82% vs. 71%; p=0.431). In patients with specific risk factors, the observed mortality was not different from the mortality as expected on basis of the APACHE II (p=0.940). In patients without risk factors the observed mortality exceeded the expected mortality (p<0.001). CONCLUSION: The incidence of invasive aspergillosis in this series is 4/1000 admissions. No difference in mortality was found between patients with and without risk factors for the acquisition of invasive aspergillosis. Yet, the prognosis of the patients without risk factors seems to alter more seriously by the development of this infection.

APACHE↗
PubMed2004

Tuberculosis in HIV-infected persons in the context of wide availability of highly active antiretroviral therapy.

Highly active antiretroviral therapy (HAART) greatly reduces the risk of developing tuberculosis for HIV-infected persons. Nonetheless, HIV-associated tuberculosis continues to occur in countries where HAART is widely used. To identify the characteristics of HIV-infected persons who develop tuberculosis in the context of the availability of HAART, the current authors analysed data taken from 271 patients diagnosed, in Italy, during 1999-2000. These patients represent 0.7% of the 40,413 HIV-infected patients cared for in the clinical units participating in this current study. From the data it was observed that 20 patients (7.4%) had a previous episode of tuberculosis whose treatment was not completed. Eighty-one patients (29.9%) were diagnosed with HIV at tuberculosis diagnosis, 108 (39.8%) were aware of their HIV status but were not on antiretroviral treatment and 82 (30.3%) were on antiretroviral treatment. Patients on antiretroviral treatment were significantly less immunosuppressed than patients with HIV diagnosed concurrently with tuberculosis, or other patients not on antiretrovirals (median CD4 lymphocytes count: 220 cells x mm(-3) versus 100 cells x mm(-3), and 109 cells x mm(-3), respectively). No significant differences in clinical presentation of tuberculosis according to antiretroviral therapy status were recorded. Failure of tuberculosis control interventions (e.g. noncompletion of treatment) and of HIV care (delayed diagnosis of HIV infection and suboptimal uptake of therapy) may contribute to continuing occurrence of HIV-associated tuberculosis in a country where highly active antiretroviral therapy is largely available. However, a significant proportion of cases occur in patients who are on antiretroviral treatment.

AIDS-Related Opportunistic Infections↗
PubMed2005

Effects of exacerbations and seasonality on exhaled nitric oxide in COPD.

Exhaled nitric oxide (eNO) appears to be associated with airway inflammation seen in chronic obstructive pulmonary disease (COPD). The present authors studied the effects of exacerbation, season, temperature and pollution on eNO. eNO was measured seasonally and at exacerbations in 79 outpatients suffering from COPD (mean forced expiratory volume in one second=42%). The effects of exacerbation symptoms, physiological and environmental parameters were analysed. Stable eNO levels were correlated positively with arterial oxygen tension. Median levels were found to be lower in smokers (5.3 ppb) than in ex- or nonsmokers (6.8 ppb). Levels were higher during October to December (6.9 ppb) than in April to June (4.6 ppb). Levels were also higher during 68 exacerbations in 38 patients (7.4 ppb) than in stable conditions (5.4 ppb), independent of the effects of smoking. The rise in eNO was greater in exacerbations that were associated with colds, a sore throat or dyspnoea combined with a cold. In conclusion, exhaled nitric oxide levels were higher in colder weather and in the autumn, perhaps related to the increased prevalence of viral infection at this time of year. The levels were lower in more severe chronic obstructive pulmonary disease. Exhaled nitric oxide levels were raised at the onset of exacerbation, particularly in the presence of a cold.

Age Distribution↗