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[Safety and health protection of professional divers in the context of the European Diver Technology Committee (EDTC): technical training and diver competence, role of the "examining" physician].

It is necessary to standardize some parameters for occupational health and safety of their professional diver: risk assessment of work duty, appropriate training program and sanitary surveillance. European Diver Technology Committee (EDCT) gathers the member State's experience about safety procedures, professionals and sanitay surveillance. EDTC criterions to whom it is possible to refer in Italy waiting specific regulations are reported.

Diving↗

Strategies for training standardized patient instructors for a competency exam.

The Common Achievement Test (CAT) in Japan, which will be implemented in 2005, involves a medical interview that is the core task to be completed by students during an Objective Structured Clinical Examination (OSCE). Standardized/Simulated Patient instructors (SPs), posing as patients in medical interviews, are trained in standard fashion in terms of expression of symptoms as well as the emotional affect of actual patients. Institution of appropriate training programs for SP instructors in the CAT is also necessary. We trained seven individuals to function as standardized patients (in-school SPs) during a three-day SP training program described in this article. Following completion of the OSCE, we conducted a comparison study among evaluations completed by the evaluators and two types of SP instructors. We observed high correlation, according to Spearman significance testing, between scores of evaluators and those of both newly trained in-school SPs and veteran SPs who had more than five years of experience. Correlation coefficients between the veteran SPs (r=0.77) and the in-school SPs (r=0.73) were nearly identical. These results suggest that our training program for SP instructors is an effective protocol, particularly with respect to reliability and efficiency.

Clinical Competence↗

Iodine status in pregnant women living in Melbourne differs by ethnic group.

The iodine status of pregnant women from different ethnic groups in an Australian population was determined by measuring urinary iodine concentration (UIC) from stored spot urine samples. Study subjects were selected from pregnant women participating in a Down Syndrome screening study at Monash Medical Centre in Melbourne, Australia. In total, 263 Vietnamese, 262 Indian/Sri Lankan (ISL) and 277 Caucasian women were included. The median UIC of Caucasian women (52 microg/L) was significantly lower than that of both Vietnamese women (58 microg/L, P <0.01) and ISL women (61 microg/L, P = 0.03). The proportion of women who had a UIC below 50 microg/L was 48.4% of the Caucasian women, 38.4% of the Vietnamese women and 40.8% of the ISL women. These data are consistent with mild iodine deficiency for each of the groups of pregnant women. The evidence for mild iodine deficiency in these groups of pregnant women is consistent with recent Australian studies in pregnant and non-pregnant individuals. The association of ethnicity with iodine status is most likely due to differences in dietary behaviours. Understanding the factors that influence iodine nutrition in a multiethnic population will be important for identifying the most useful approaches to improving iodine status, evaluating different strategies and the development of appropriate monitoring programs. Action to improve iodine status in the Australian population should include consideration of ethnic differences in diet.

Australia↗

Factors associated with the household contact screening adherence of tuberculosis patients.

A cross-sectional study was conducted to explore factors associated with the adherence of tuberculosis patients in bringing their household contacts to a TB clinic in Bangkok, Thailand. During the study period, May to December 2003, 325 sputum-smear-positive tuberculosis patients were recruited into the study. Of the 325 eligible tuberculosis patients, 169 (52.00%, 95% Cl = 47.00-57.00) brought their household contacts to the TB clinic. Psychosocial and cues to action factors were examined as indicators of the household contact screening adherence of tuberculosis patients. The results reveal that the household contact screening adherence of tuberculosis patients was significantly associated with a higher perceived susceptibility (Adjusted OR = 2.90, 95% Cl = 1.18-7.16), lower perceived barriers (Adjusted OR = 4.60, 95% CI = 1.99-10.60), a higher intention to bring the contacts to the TB clinic (Adjusted OR = 3.35, 95% Cl = 1.44-7.76), and a short distance from home to the TB clinic (Adjusted OR = 11.47, 95% Cl = 4.57-28.79). The results from this study provide information for TB clinic staff for developing an appropriate intervention program. Through effective intervention and active policy enforcement, a higher percentage of household contact screening adherences can be achieved.

Adolescent↗

Management of alcoholism in the primary care setting.

Primary care physicians can play an important role in managing alcoholic patients. Identifying and treating alcoholism early, before it has interfered with patients' relationships and work, may increase the likelihood of prolonged recovery. Simple office interventions can help motivate patients to abstain and seek treatment. People who abuse alcohol and are unwilling to abstain can benefit from a recommendation to reduce their intake of alcohol. For alcohol-dependent patients who decide to stop drinking, primary care physicians often can manage withdrawal on an outpatient basis. Selecting an appropriate treatment program for each alcoholic patient is important, and referral to a specialist to assist in matching patients to treatments is often necessary. Primary care physicians also can help prevent relapse. Although disulfiram is of limited value, primary care physicians can support recovery by identifying coexistent psychosocial problems, helping patients to restructure their lives, and ensuring continuity of care.

Alcohol Drinking↗

[Genetic control of embryo lethality in crosses between common wheat and rye].

The phenotypic manifestation and genetic control of embryo lethality observed in crosses between common wheat and rye were studied. It was found that crosses between common wheat and inbred self-fertile rye lines L2 and 535 gave rise to ungerminating grains, in which the development and differentiation of the hybrid embryo are arrested. Study of the degree of embryo development in the hybrid grains obtained by crossing common wheat varieties with inbred rye lines L2 and 535 showed that genotypes of the parents affected the ratio between undifferentiated embryos of various sizes. Analysis of this trait was performed by test crosses according to a novel pedigree program with the use of interlinear hybrids and a set of fourth-generation hybrid recombinant inbred lines. Rye line L2 was shown to bear the Eml (Embryo lethality) gene, which terminates the development of the hybrid embryo in amphihaploids. The suggestion of complementary interaction between wheat and rye genes during formation of a "n ew" character in wheat-rye F1 hybrids is discussed. A method of detecting an allele not complementary to the rye Eml allele in wheat is proposed. The proposed test program allows appropriate study of the system of wheat and rye genes involved in complementary interaction in the genotype of a distant hybrid.

Crops, Agricultural↗

Income inequalities in oral health among older adults in four Ontario communities.

We used data from telephone interviews, personal interviews and clinical examinations to assess income inequalities in oral health among older adults living in four Ontario communities. Lower income groups had significantly higher rates of edentulism than upper income groups. In dentate subjects aged 50 to 64 years, significant associations were observed between income and 9 of 10 clinical, functional and subjective oral health indicators. Among those aged 65 years and over, associations were found for only 5 of these indicators. The data suggested that the association between income and clinical and functional measures of oral health was stronger among those aged 50 to 64 years, while the association between income and subjective indicators was stronger among those aged 65 years and over. No association was noted between income and oral health status among edentulous subjects. These observations are difficult to explain because of the cross-sectional nature of the study and the complexity of the processes which may lead to social inequalities in health. Nevertheless, the data do suggest the need for the targeting of oral health promotion programs and appropriate dental services at disadvantaged groups.

Age Factors↗

[Molecular epidemiology of cystic fibrosis in Tunisia].

Cystic fibrosis is the most frequent autosomal recessive genetic disease in North European population. This pathology seems to not be rare in Tunisia. On another hand, development of molecular biology techniques has largely contributed to implement the study of the different mutations in the CFTR gene where over 1,300 mutations were reported. Herein, we describe the strategy used to detect molecular defects responsible of cystic fibrosis on 390 children (383 families) in Tunisian population. Several techniques were performed for genotype diagnosis: DNA extraction was from peripheral blood. Polymerase chain reaction (PCR) and polyacylamide gel electrophoresis, and reverse dot blot procedures were used to detect known point mutations. Denaturant gradient gel electrophoresis (DGGE) were used in a next step searching for the unknown point mutations that are later identified by automated sequencing on ABIprism 310. This strategy allowed us to detect 17 different mutations located on the different exons of the CFTR gene. The most frequent was the F508del (50.74%) followed by three other mutations (G542X, W1282X and N1303K) known to be common in the Mediterranean area. For mutations (T665S, 2766 del8, F1166C, L1043R) were exclusively found, up to now, in the Tunisian population. Our results permitted to establish cystic fibrosis mutations and their distribution in Tunisia and to implement an appropriate prevention program of these diseases through the genetic council and prenatal diagnosis.

Child↗

Context specific learning opportunities--adapting training to discrete areas.

BACKGROUND: Australian general practice training was regionalised in 2002 to better meet the specific health care needs of local communities. As a result, 22 unique regions were established, each containing a variety of training practices and learning contexts. The core learning opportunities in distinct learning contexts have not been well explored. METHODS: The research group identified criteria for delineating learning contexts and applied them to the training practices in the Northern Territory. Using focus groups of general practice registrars, we identified the learning opportunities available in each context. RESULTS: Context criteria were identified as: model of health service organisation and delivery; rurality; and community demography. Four distinct contexts were identified: mainstream general practice; regional hospital; Aboriginal Medical Service (AMS); and Aboriginal community clinic. Each learning context demonstrated both strengths and deficiencies, and also provided unique learning opportunities. DISCUSSION: Benefits in defining the learning contexts and opportunities within a general practice training region apply to registrars, trainers, providers, policy makers and standard setters. Context definition provides a valuable tool for more targeted and effective training, contributes to curriculum development and facilitates a more responsive and appropriate education program. We encourage adaptation of this model to other regions.

Family Practice↗

[Diffuse large B-cell lymphoma with strongly positive MIB-1 stain and clinical features resembling Burkitt lymphoma].

A 62-year-old woman was admitted to our hospital because of gastric mucosal bleeding. Gastroendoscopy revealed a gastric tumor which was diagnosed from the biopsied specimen as diffuse large B-cell lymphoma (DLBCL). Lymphoma cells had infiltrated the bone marrow showed morphological features resembling Burkitt lymphoma (BL). Nearly 100% of the cells in the bone marrow were positive for MIB-1 immunostaining. The chromosomal study was normal. Surface marker analysis disclosed that the cells were positive for CD10, CD19, CD20 and CD25. As lymphoma cells had infiltrated the central nervous system, combined chemotherapy was performed accompanied with intrathecal administration of anticancer drugs. Although transient improvement was observed, the patient died of the advanced disease three months after admission. As we have shown here, there are some cases of DLBCL with immunohistochemical features resembling BL. Further consideration about the appropriate chemotherapy program for this type of disease might be necessary.

Antineoplastic Combined Chemotherapy Protocols↗

[Serotype profile and antibiotyping of Streptococcus pneumoniae strains isolated from nasal carriage in pediatric patients].

The aim of this study was to determine the serotype profile and antibiotyping of Streptococcus pneumoniae from nasal isolates in children. Nasopharyngeal swab samples obtained from 125 children were cultivated and screened for the presence of S. pneumoniae. Strains were identified according to standard microbiological methods. The isolates were serotyped by the Quellung reaction and resistance patterns were determined by the microdilution method according to NCCLS guidelines. Results indicate an overall pneumococcal carriage rate of 24% (n = 30). The most commonly isolated serotypes were 23F (20%), 6B (20%) and 14 (13%). 73% of isolates were resistant at least to one of the tested antibiotics. 47% of the strains were consistently resistant to penicillin and the serotypes 6B and 23F were frequently associated with this marker. 60% of the strains were resistant to doxycycline, 37% to trimethoprim/sulfamethoxazole and clindamycin, 30% to erythromycin, 23% to cloramphenicol, 7% to ceftriaxone and 3% to cefepime. All strains were sensible to ofloxacin, rifampin and vancomycin. The most common combined resistance patterns were PNC-ERI-TMP/SMX-DOX-CLO-CLI (16.59%) and PNC-DOX (13.27%). The results obtained in this study will allow to orient the empiric therapy for pneumococcal infections and a rational use of antibiotics in clinical practice, as well as the application of an appropriate vaccination program specially adapted to the serotypes more frequently found in children.

Carrier State↗

[DNAStat, version 1.0--a software package for processing a genetic profile database and for biostatistical calculations].

The application of DNA studies to the administration of justice has led to the necessity of developing appropriate computer programs. Such programs must address two critical problems, i.e. the broadly understood data processing and archivization, and biostatistical calculations. This paper discusses DNAStat 1.0, a program that enables its user to 1) create and process an individual database; 2) analyze biological evidence by calculating the unconditional f and conditional p(X/X) profile frequency, with the possibility of taking into account the inbreeding (coancestry) coefficient, as well as setting the minimum allele frequency; 3) analyze paternity cases by calculating the paternity index PI and probability of paternity W for full and motherless trios, with the possibility of taking into account the silent allele frequency and prior probability.

DNA Fingerprinting↗

The prevalence of lower genital tract infections among ante-natal care (ANC) clinic patients in two central hospitals, Vientiane, Lao People's Democratic Republic.

This study of lower genital tract infections in pregnant women attending antenatal clinics in Vientiane, Lao PDR is a response to the reported rapid increase in the number of HIV infections in neighboring countries, and is a recognition of the important role of reproductive tract infections in facilitating HIV transmission. This cross-sectional study determines the prevalence of lower genital tract infections among 500 antenatal attendees (gestational age < or = 20 weeks) attending two hospitals serving urban areas in Vientiane, between September 2001 and March 2002. Most participants were housewives (64.4%) and government workers (16.0%). Their husbands were mainly government officers (31.4%), laborers or farmers (30.2%), and businessmen (12.4%). Sixty-four percent reported a past history of "any vaginal complaints" with 44.2% having sought treatment. Candida spp had the highest prevalence of all infections (27.0%), followed by bacterial vaginosis (14.4% by Amsel's criteria and 22.0% by Nugent's score), C. trachomatis (10.2% by nucleic acid hybridization and 9.6% by PCR), T. vaginalis (1.8%), and N. gonorrhoeae (0.8%), but no syphilis serological markers. Taken in conjunction with other surveillance data from the same period, this study indicates an opportunity to prevent epidemic spread into the community of both sexually transmitted disease and HIV by appropriate preventative programed activities, including treatment services targeted at higher risk community groups.

Adolescent↗

Cervical cancer screening in India: strategies revisited.

With the change in the life styles and demographic profiles of developing countries, noncommunicable diseases are emerging to be important health problems that demand appropriate control program before they assume epidemic proportion. One of these is the problem of cancer. In India, cervical cancer is a significant problem in terms of incidence, mortality and morbidity. Cervical cancer is a disease that can be prevented through both primary prevention and early detection using screening techniques. Several screening modalities are now available for early detection of cervical cancer and its precursor lesions. They all differ with regard to their test characteristics, feasibility and economic considerations. This communication reviews different aspects of these screening modalities and provides different options considering mass application.

Developing Countries↗

Osteoporosis prevention: a reasoned examination of food habits and physical activities in a schoolchildren population in central Italy.

OBJECTIVE: The dietary intake of calcium is fundamental for prevention of osteoporosis, especially in the first three decade of age to gain a valid peak bone mass; moreover physical activity is important for the same reason. The objective of our research is to examine the food habits and the way to practice sport in a homogenous population of schoolchildren. MATERIALS AND METHODS: Data were collected by an original questionnaire in 500 schoolchildren (238 males, 262 females, 9-12 yrs) living in the centre of Italy. RESULTS: Data show that the calcium intake decreases while the age increases. According to the recommended daily calcium dose, the percentages of insufficient calcium intake were 21% in the 6 years old group, 35% in the 7 to 10 years old group and 52.5% in the 11 to 14 years old group. Milk and dairy products cover 57% of the calcium needs (17% and 40% respectively), water covers 24% and the other foodstuffs 19%; moreover most children (43.5%) practice non competitive sports with a preference (58.3%) for no-weightbearing sports (mainly cycling) over weightbearing sports (mainly football). CONCLUSIONS. This survey suggests that a high percentage of young people do not take the recommended daily dose of calcium (especially interesting that becoming older with consequent lower parental control over the diet, the higher the incidence of poor calcium intake increases), then it would be recommendable to establish a national health program promoting appropriate physical exercise plus a correct calcium intake as early as the primary school.

Adolescent↗

Teaching palliative care in general practice: a survey of educational needs and preferences.

We surveyed general practitioners in the Bath District Health Authority to determine their educational needs in palliative care and their preferred methods of learning, in order to develop an appropriate education program. The survey confirmed our ideas as to the content of the program. There was support for our hypothesis that the majority would favor didactic approaches and would feel generally uncomfortable with experiential methods. The issue of professionals' needs in stressful situations proved to be a surprisingly strong one.

Curriculum↗

[Real time collection of pain profile in treatment with ibuprofen].

In an open three-center pilot study, 17 patients suffering from chronic persistent pain syndrome, due to osteoarthritis of the hip and knee or spondylarthrosis, were treated orally with 1800-2400 mg Ibuprofen per day for 3 weeks. The chronic pain syndrome and joint status were assessed by the physician at the beginning, and after 7, 14 and 21 days. Self-assessments were made by the patients six times daily during the full study period by means of battery-driven electronic diaries (E.D.). The data entered by the patients were stored in the E.D. and after online transfer, processed and evaluated in a PC using appropriate software programs. E.D. were returned by 16 of 17 patients for evaluation. The technical functioning of the instrument was perfect; its use was accepted by patients and physicians. The closely-meshed real-time recording of pain course and other subjective data, such as adverse events or medication, etc., enables the physician to calculate more exactly and reliably improvement rates, as well as to carry out prognostic trend analyses and individual benefit-risk-ratio estimates. By comparing different kinds of data, each entered at the same time, plausibility checks are possible. The procedure presented here is considered to be a new valuable tool for reviewing subjective data from clinical drug trials.

Adult↗