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PubMed2002

Risk of infection with Leishmania spp. in the canine population in the Netherlands.

The dog is the main reservoir of Leishmania infantum, the causative agent of visceral leishmaniasis (VL) in humans in Southern Europe. In order to identify the risk of dogs from a Leishmania non-endemic area traveling to a Leishmania-endemic area becoming infected and the risk of transmitting infection to humans in non-endemic areas an investigation was performed, in which the results of a questionnaire were combined with the results of a serologic survey. The questionnaire was sent to 1478 at random chosen families in the Netherlands. Of the 59.0% responders 28.0% had one or more dogs and 4.8% of these dogs had visited Southern Europe during the summer period of that year. On a total population of 1,200,000 dogs in the Netherlands, this means that each year some 58,000 dogs are at risk of being exposed to a Leishmania infection in Southern Europe. During the period 1990-1992 blood was collected for serology in 1911 dogs presented to the Utrecht University Clinic because of clinical problems not related to leishmaniasis, of which 434 had been in Southern Europe in the foregoing years. None was serologically positive. From these data it can be deduced that the highest chance to obtain leishmaniasis during a vacation in Southern Europe is mathematically less than 1/434 or less than 0.23%. Serology was also performed during the period 1989-1993 in 597 dogs that had been in Southern Europe and were suspected of leishmaniasis. Titers were positive in 145 of these samples. Sixty-four of these dogs were born in the Mediterranean and had been imported into the Netherlands. Excluding these imported dogs, it was calculated that at least 0.027% of the 58,000 dogs yearly taken to Southern Europe during holidays become infected with Leishmania. In order to establish the risk of disease transmission for people in close contact with an infected dog, serum samples of owners and house mates of 37 dogs with leishmaniasis were tested. All 112 sera tested negative. It was concluded that the risk to get leishmaniasis was between 0.027% and 0.23% for the dog when taken to Southern Europe during vacation, and that the risk for owners in non-endemic areas to get leishmaniasis from an infected dog is minimal.

Agglutination Tests↗
PubMed1991

Burnout syndrome in the practice of oncology: results of a random survey of 1,000 oncologists.

Burnout, the end result of stress, can occur in any profession. We set out to determine the extent of burnout among a representative group of American oncologists. A questionnaire with 12 specific points was designed and prepared by the authors. It was mailed to 1,000 randomly selected physician subscribers to the Journal of Clinical Oncology. Five hundred ninety-eight completed surveys (60%) were returned before the cut-off date and included in the analysis. Overall, 56% of the respondents reported experiencing burnout in their professional life. No significance was found between the incidence of burnout and specialty within oncology, year medical training ended, or practice location. Significance was found, however, between type of practice and the incidence of burnout; institution- or university-based oncologists reported a lower incidence of burnout (47%) versus all other types of practice (66% burnout rate for oncology plus internal medicine, 63% for private adult oncology only, 39% for pediatric oncologists [there were too few pediatric oncologists for this rate to be significant], and 64% for others; P = .0003). Frustration or a sense of failure was the most frequently chosen (56%) description of burnout, and insufficient personal and/or vacation time was the most frequent reason (57%) chosen to explain the existence of burnout. To alleviate burnout, the majority (69%) of respondents indicated the need for more vacation or personal time. Administering palliative or terminal care, reimbursement issues, and a heavy work load were identified as contributing factors to burnout. Given the high response to the questionnaire and a 56% incidence of burnout in the surveyed population, it is concluded that further research on this issue is required.

Burnout, Professional↗
PubMed1979

Pulmonary and gastrointestinal exposure to cadmium oxide dust in a battery factory.

The elimination of cadmium in feces was studied in a group of 15 male workers exposed to cadmium oxide dust in a nickel-cadmium battery factory. The elimination of cadmium in feces was on the average 619 and 268 microgram/day in seven smokers and eight nonsmokers, respectively. The corresponding ranges were 97-2577 and 31-1102 microgram/day. The cadmium concentrations in blood were significantly higher in smokers than in nonsmokers, both before and after one month of vacation. Among the smokers there was a significant decrease in the cadmium concentrations during the vacation period, but not among the nonsmokers. It was estimated that cadmium naturally occurring in food and cigarettes, cadmium excreted from the gastrointestinal tract, and cadmium transported from the lungs by mucocillary clearance to the gastrointestinal tract only could explain up to 100 microgram of the cadmium in the feces. Since even among some nonsmokers much higher values for fecal cadmium were recorded, this was interpreted as being the result of ingestion of cadmium from contaminated hands and other body surfaces. Among the smokers, direct oral contact with contaminated cigarettes or pipes is an additional factor; the smokers also inhale cadmium in the tobacco smoke from contaminated cigarettes. Part of that cadmium is transferred to the gastrointestinal tract by mucociliary clearance and also adds to the fecal cadmium.

Adult↗
PubMed1993

Effect of intermittent exposure to sunlight on melanoma risk among indoor workers and sun-sensitive individuals.

Intermittent exposure to sunlight is considered to be an important risk factor for melanoma, but the associations reported in most case-control studies are surprisingly weak. The aim of this study was to evaluate whether the incorporation of a subject's background exposure to the sun and pigmentation characteristics (which are assumed to influence a person's susceptibility to sunlight exposure) could produce stronger associations between sunlight exposure and the risk for melanoma. A population-based case-control study was performed in the mid-eastern part of the Netherlands. The study group comprised 141 patients with a histologically verified melanoma and 183 controls with other malignancies who were registered by the same cancer registry. Patients with a lentigo maligna melanoma or an acrolentiginous melanoma were excluded. Information was collected by interviews and physical examination. We categorized subjects as indoor or outdoor workers on the basis of occupational exposure to the sun. Pigmentation characteristics, which are known to be risk indicators for cutaneous melanoma, were summarized as one sun sensitivity score. We used this score to distinguish between sun-sensitive and sun-resistant persons. The odds ratios associated with sunbathing, vacations spent in sunny countries, and sunburns were higher among the indoor workers than among the outdoor workers. After stratification by the sun sensitivity score, the effect of sunbathing, participating in water sports (swimming excluded), vacations to sunny countries, and a history of sunburn was largest for the sun-sensitive persons. The data show a general trend toward higher relative risks among indoor workers and sun-sensitive individuals. The results of this study support the intermittent sunlight hypothesis.

Adolescent↗
PubMed2003

High-altitude pulmonary edema at moderate altitude (< 2,400 m; 7,870 feet): a series of 52 patients.

STUDY OBJECTIVES: To describe a group of patients who acquired pulmonary edema at a moderate altitude of 1,400 to 2,400 m. DESIGN: Observational, retrospective chart review (1992-2000) of a series of 52 consecutive patients admitted for high-altitude pulmonary edema (HAPE) that occurred at 1,400 to 2,400 m. SETTING: Emergency department of a community hospital in the French Alps (altitude, 500 m). PATIENTS: Vacationing skiers who met criteria for altitude-related pulmonary edema, and in whom other causes (infectious, cardiogenic, neurogenic, and toxic) were excluded. MEASUREMENTS AND RESULTS: All patients presented with signs of pulmonary edema. Diagnoses of infectious, cardiogenic, neurogenic, or toxic edema were ruled out in each patient. All patients were hypoxemic and had radiographic signs of pulmonary edema. Virtually all patients (96%) had dyspnea, and most (77%) had moist rales. All patients were treated with supplemental oxygen (3 to 12 L/min), bed rest, moderate fluid restriction, and continuous positive airway pressure. All recovered fully and were discharged after 4 +/- 2 days (mean +/- SD). CONCLUSION: This study suggests that HAPE at moderate altitudes is more frequent than usually reported. Patients are likely to be young, vacationing men, with no history of prior disease. The disease has a favorable prognosis, and requires simple treatment and a short hospital stay.

Adolescent↗
PubMed1983

Sexual experience, androgens and female choice of a mate in laboratory rats.

Sexual experience produces long-lasting changes in both the behaviour and reproductive system of a male rat. The response of the female rat to an area that had recently housed a previously mated male was investigated in three experiments. In experiments 1 and 2 females preferentially urine marked in an area vacated by a sexually experienced (SE) male relative to areas vacated by a sexually inexperienced (SI) or castrated (C) male. The density of female marks were ranked SE greater than SI greater than C greater than empty area. In experiment 3 female preference of an SE male with varied and multiple mating experiences was magnified when compared with an SI male. There was the suggestion that the multiple SE male was even preferred to a male with only a single mating experience. A fourth experiment demonstrated an acute increase in circulating testosterone in multiple SE males exposed to oestrous or non-oestrous females, and the increase was observable for up to 7 days after exposure to an oestrous female. The conclusion is that chronic changes in androgen-dependent urinary by-products released by the SE male mediate the discrimination and choice of a mate by the female rat.

Animals↗
PubMed2004

[Biomedical impact of traveling for Chilean elderly].

BACKGROUND: In Chile there is a program named "Vacations for Elderly during Low Season". AIM: To characterize participants of this program and to measure the impact of traveling in their health and wellbeing. MATERIAL AND METHODS: Two anonymous and voluntary questionnaires were applied to 4200 participants, before and after a ten days vacation package. RESULTS: Before traveling, questionnaires were answered by 802 subjects, and after traveling by 4057 (69% women, 22% older than 75 years old, 15.8% living alone). The presence and maintaining of good health were most appreciated at this age and 59% classified their health as good or excellent. Twenty five percent referred sensory problems (seeing or hearing), 12% reported urinary incontinence and 21% presented falls in the last three months; depression screening (GDS-5) was positive in 16%. Chronic disease prevalence was similar to the general Chilean elderly population. After traveling they reported significant improvements in the items sociability, wellbeing, mood, appetite, insomnia and ostheoarthritic pain. CONCLUSIONS: Elderly who traveled were mainly women, who thought that maintaining good health is the most precious value. After traveling they improved significantly different aspects of wellbeing. Promotion of this kind of recreation programs is an important tool for integration and enhancement of quality of life in elderly subjects in our country.

Aged↗
PubMed1998

An interstate outbreak of tick-borne relapsing fever among vacationers at a Rocky Mountain cabin.

In July 1995, an outbreak of acute febrile illness affected 11 (48%) of 23 family members from Nebraska and Kansas who had vacationed at a Colorado cabin in June. Similar symptoms were identified among five (17%) of 30 additional persons from Nebraska, Kansas, Florida, and Texas who had vacationed at the same cabin. Symptoms suggested tick-borne relapsing fever (TBRF). Although no spirochetes were detected in available blood smears from five case-patients, Borrelia hermsii was cultured from the blood of one case-patient and two chipmunks trapped near the cabin. Case-patients were more likely than non-ill cabin visitors to have slept on the floor (odds ratio [OR] = 28.0, 95% confidence interval [CI] = 3.0-258) or in the top bunk bed (OR = 5.2, 95% CI = 1.1-25.1). Tick-borne relapsing fever should considered in the differential diagnosis of fever in patients who have stayed overnight in mountain cabins in the western United States.

Adolescent↗
PubMed1991

Parental leave policies for faculty in U.S. medical schools.

OBJECTIVE: To assess medical school policies for maternity and other parental leaves as well as related opportunities for part-time employment, flexibility in tenure systems, and the availability of child care centers. DESIGN: Cross-sectional survey of all 127 U.S. medical schools based on telephone interviews and review of faculty handbooks. MEASUREMENTS AND MAIN RESULTS: Ninety-three percent of medical schools responded. Twenty-two percent of medical schools have no written guidelines for maternity leave, 45% categorize maternity leave as a form of sick or disability leave, and only 34% have developed specific policies. Most schools (61%) require that maternity leave be taken from allotted sick days or from vacation days (or from both) for women to obtain salary support. The time available from sick and vacation leave averages 6.8 weeks. Although 72% of schools make allowances in the tenure probationary period for extended leaves of absence, few have developed specific provisions for childbearing or childrearing. Finally, 18% of medical schools have child care facilities. CONCLUSIONS: Considerable work is needed to develop adequate support for faculty members who are parents. Recommendations include developing specific parental leave policies and flexible tenure systems and providing adequate child care facilities.

Absenteeism↗
PubMedDate not supplied

Are you in the big picture?

Carol Smith, an endoscopy nurse, is spending her two-week vacation as the camp nurse at the Boy Scouts Camporee. Staff from the Food and Nutrition Department volunteer to cook and serve meals at the Salvation Army soup kitchen. Linda Ward of the Distribution and Processing Department spends her vacation at Camp Quality, just one of many volunteers who brighten the faces of children who have cancer.

Community-Institutional Relations↗
PubMed1999

[Surveillance of nosocomial infections in a cardiology hospital].

OBJECTIVE: To describe a nosocomial infection surveillance in a cardiology and thoracic diseases hospital in Northern Mexico during its initial months of activity. MATERIAL AND METHODS: Retrospective report of nosocomial infection surveillance performed by the infection control team with patient visits, clinical records, microbiology reports, and direct information obtained by health personnel. General and specific infection rates were analyzed by the chi 2 test and the Student t test. RESULTS: General infection rate was 4.99 during the 17 month period. Monthly infection rates changed significantly during infection control team vacations. By site of infection, surgical wound infection were the most common (1.14), followed by urinary tract infections (1.08), and bacteremia (0.72). However, when we grouped bacteremias and other catheter related infections, this intravascular access related infections were the most frequent (1.73). Gram positive organisms were most commonly isolated in nosocomial infections, except in pneumonias (gram negative organism) and urinary tract infections (Candida spp.). Mortality related to nosocomial infection was high (21.7%), and at least one third of those deaths was directly related to the infection. In hospital stay and cost were also increase with nosocomial infections. CONCLUSIONS: Nosocomial infection is common in interventional cardiology hospitals, producing high mortality and rising costs and length of stay. We need a more effective nosocomial infections surveillance system to eliminate changes in monthly case detection produced by the infection control team vacations, since this under-registry could result in lost of control of nosocomial infections and epidemic outbreak emergence.

Adult↗
PubMed1999

[The efficacy of methods for the differentiated health rehabilitation of miners in risk groups for disease development].

Of the miners in poor health, groups have been identified at high risk for development of respiratory, cardiovascular, and neural pathologies (n = 30). Treatment and prophylactic complexes were differentiated and implemented in the miners while on vacation in a sanatorium-preventorium setting. Efficacies are shown of differentiated methods for promotion of the health of those miners having been assigned to different groups at risk for development of pathologies of the respiratory organs, the cardiovascular, and the nervous system while on tariff vacation. The promotion-of-health courses have led to normalization of the immune and biochemical statuses in 68 percent of miners secondary to activation of chief links of cell-mediated, humoral immunity, factors of nonspecific bodily resistance and parameters for fat metabolism.

Cardiac Rehabilitation↗
PubMed2001

Do residents in a northern program have better quality lives than their counterparts in a city?

OBJECTIVE: To determine whether McMaster University's family medicine residents training in the Family Medicine North (FMN) program have better quality lives than those based in Hamilton, Ont (urban). DESIGN: Residents at both sites were simultaneously given the Quality of Life Questionnaire, a standardized measurement tool. They were asked to complete the questionnaire anonymously and to provide demographic data. SETTING: Family practice residencies in Ontario. PARTICIPANTS: McMaster University's family medicine residents. Of 66 residents living in Hamilton, 36 completed the questionnaire; five respondents were ineligible. Of 25 residents living in Thunder Bay, Ont, 24 completed the questionnaire; none were ineligible. MAIN OUTCOME MEASURES: Total quality-of-life score. Score was divided into five major domains, each with several subdomains: general well-being (material, physical, and personal growth), interpersonal relations (marital, parent-child, extended family, and extramarital), organizational activity (altruistic and political behaviour), occupational activity (job characteristics, occupational relations, and job satisfiers), and leisure and recreational activity (creative/esthetic behaviour, sports activity, vacation behaviour). RESULTS: The FMN residents scored significantly higher than the Hamilton-based residents on overall quality of life (124.7 vs 112.5, P < .05) and tended to score higher in the five major domains. The trend reached statistical significance in general well-being and occupational activity; it was also apparent in various subdomains, with statistically significant differences in material well-being, marital relations, job characteristics, job satisfiers, and vacation behaviour. CONCLUSION: Family Medicine North residents enjoy better quality of life than their urban counterparts based on responses to a standardized questionnaire.

Adult↗
PubMed2001

Childhood tuberculosis in the State of Qatar: the effect of a limited expatriate screening programme on the incidence of tuberculosis.

OBJECTIVE: To determine incidence rates and the effectiveness of the expatriate screening programme on paediatric tuberculosis (TB) in the State of Qatar. METHOD: A state-wide, population-based, retrospective analysis of all cases of tuberculosis among children 0-14 years of age reported to the TB Unit of the Division of Public Health during 1983-1996. RESULTS: One hundred and forty-four children with tuberculous disease were identified, with a steadily declining incidence rate (rate of notification) from 11/100000 children (0-14 years) population in 1983 to 7/100000 in 1996. This decrease in the childhood TB case notification rate correlated with foreign-born children, older children and the implementation of expatriate screening in 1986. Diagnosis in 56% of children was made abroad or within 3 months of arrival from vacation and 30% within one year of arrival. Comparison of the three age groups (<5, 5-9 and 10-14 years) showed no significant difference with regard to nationality, sex, type of TB, radiological findings and screening. However older children were more likely to be symptomatic (P < 0.0001) and to have positive tuberculin skin test (TST) reactivity (P = 0.012), culture (P < 0.0001), and gastric aspirates (P = 0.018). CONCLUSION: Although there was a 36% decrease in paediatric TB incidence after the implementation of expatriate screening in 1986, Qatar has a high rate of paediatric tuberculosis. The policy of BCG vaccination at birth should be continued, and screening children at school entry and on return from vacation would be useful for further case identification.

Adolescent↗
PubMed2002

[Health hazards for immigrants when travelling to their home countries].

Vacations in the home country are important and positive events in the lives of immigrants, events that allow them to maintain contact with their culture, relatives and friends. However, vacations also carry certain health risks, though these risks can to some degree be prevented. Infectious disease is the greatest risk. Some children and adolescents also run the risk of female genital mutilation, forced marriage, and the risk og being left behind in the home country against their will. Among the notifiable diseases registered with the Norwegian Surveillance System for Communicable Diseases (MSIS), five stand out as having a higher incidence in people of foreign background than in people of Norwegian origin: malaria, hepatitis A, shigella infection, typhoid and paratyphoid fever. This higher incidence is partly the result of less use of pre-travel vaccines and malaria prophylaxis. Immigrants as a group are exposed to varied risks and should be given high priority in relation to vaccines and malaria prophylaxis for travel abroad. High priority should also be given to preventive health measures designed to reduce the risk of female genital mutilation and other violations against children and young people on visit to their country of origin.

Adolescent↗
PubMed2002

[Use of a health insurance company database for study of theoretical exposure to hypolipidemic agents].

OBJECTIVE: The objective of the investigation was to analyze theoretical exposures to hypolipidaemics in patients treated chronically with these drugs, using the database of the health insurance company. INVESTIGATED GROUP: From the database (with information on age, sex of the insured person, the number of packages and the type of hypolipidemic and year of issue of the prescription) of subjects insured at the Employees Health Insurance Skoda Mladá Boleslav comprising some 100,000 insured subjects in 1994-2000. Patients with long-term (more than one year) hypolipidaemic treatment were selected in years from 1995 to 1999. The group increased every year. In 1995 it comprised 668 cases in 1999, 2396 subjects. METHOD: The consumption of hypolipidaemics was expressed in defined daily doses (DDD). The authors investigated the ratio of chronically treated patients and the proportion of the following groups of patients according to their annual consumption in 1995-1999: group of of drug "vacation" (0 DDD) and the group with a low (< 121.7 DDD), medium (< 243.3 & > 121.7 DDD) and optimal (> 243.3 DDD) consumption of hypolipidaemics and their relationship to sex and age. For statistical ealuation software SPSS 10.1 was used. RESULTS: In the course of the investigation among the insured subjects the statin consumption increased 76 times and the consumption of fibrates 5 times. The ratio of consumption of resin derivatives and of nicotinic acid was negligible. The size of the group of subjects treated with hypolipidaemics for longer than one year increased from 0.8% in 1995 to 2.2% of the database. The average age increased from 55 to 59 years. The ratio of seniors (> or = 65 years) increased in the course of the investigation and reached 33% in 1999 of all members of the investigated group. The mean annual consumption of hypolipidaemics increased significantly as compared with 1995 and the interannual increase as compared with the previous year was statistically significant in 1997 and 1999. In 1999 it was 237 DDD/per consumer. A lower consumption was recorded in women and in seniors. Drug "vacations" were recorded in 6% of the insured subjects of the group and the frequency did not change significantly in the course of the investigation and no relationship with age and sex was found. A low exposure according to DDD was found in 20%, medium exposure in about 40% and optimal exposure in only one third of the subjects of the investigated group. CONCLUSION: The authors developed a method which makes it possible, when individual data of the health insurance company are available, to investigate the theoretical exposure to hypolipidaemics in insured subjects treated on a long-term basis with these drugs. The authors provided evidence that analysis of the database of the health insurance company can provide certain signals for further pharmacoepidemiological research and for application in a defined medical discipline. Some of the insured subjects are exposed to smaller doses than theoretically assumed. It is necessary to extend the investigation so that the results will better reflect the population of patients and prescribing physicians. Complete evaluation of cases with a low exposure from the aspect of morbidity and drug compliance will be also essential.

Aged↗
PubMed2003

Test your knowledge. Patient with a skin rash.

A fit and healthy 22 year old of Asian ancestry, living in New Zealand with no previous history of asthma or dermatitis, visited the Gold Coast, Queensland, for a vacation. Having been cautioned about the intensity of the Australian sun, he arrived armed with a hat and new SPF130 sunscreen that he had obtained from Japan. On the third day of his vacation he noticed the appearance of many erythematous papules and some vesicles on the dorsum of the forearm, arm and the 'v' of the neck. His face was spared. On the fourth day, the papules coalesced to form swollen, warm, very pruritic, erythematous plaques (Figure 1). The patient commenced taking loratadine 10 mg per day, but did not improve after seven days of treatment.

Adult↗
PubMed2005

[Dermatologic problems arising during foreign travel].

The skin is a highly exposed organ during vacation times, especially during travel to countries with subtropical and tropical climates. Prolonged stay in these countries significantly increases the risk of contracting rarely seen dermatoses such as leishmaniasis, larva migrans and myiasis. The bites of various flies may provoke itching and excoriations that may be infected with Staphylococcus aureus and/or hemolytic streptococci, resulting in impetigo, furunculosis or erysipelas. Elderly persons spending weeks in the tropical sun may develop drug-induced phototoxic or photoallergic rash due to concomitant medication for cardiovascular or rheumatic diseases. Acute sunburn is considered a short-lasting problem, but in children it increases the risk of malignant melanoma in later years. Also of concern is chronic UV exposure, which increases the risk of premalignant and malignant skin tumors. Finally, mucocutaneous manifestations arising weeks and months after returning from vacation should raise suspicions of sexually transmitted syphilis and HIV.

Adult↗