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At least 1,027 records · Page 57Linked to original sources
PubMed1994

Seroepidemiology of chlamydial infection among a sexually-active population in Barbados.

During a two-year period, sera from 1179 patients with urogenital tract symptoms and from 256 controls were tested for IgG and IgA antibodies to Chlamydia trachomatis, using a commercially prepared indirect immunoperoxidase assay. Of the patient sera, 1051 (89%) were from female patients and 128 (11%) were from males. Specimens were received from patients attending private practitioners (424), government polyclinics (348), the Queen Elizabeth Hospital (206), the Barbados Family Planning Association (117) and various other sources (84). Nine hundred and fifty-nine of specimens (81%) from all patients had IgG titres of 64 or greater, and 441 (37%) had IgA titres of 16 or greater. A lower proportion of male patients (43%) than female patients (61%) had IgG titres of 128 or greater. Among 76 control females attending the antenatal clinic, IgG was detected in 76% and IgA in 16%, while among 75 adult blood donors, IgG was detected in 70% and IgA in 39%. A group comprising 97 asymptomatic children aged 9 months to 13 years, and 8 adolescents aged 14-18 years was also studied. IgG antibodies (titre > or = 64) were detected in 13.4% of children and in 50% of the adolescents. IgA antibodies were detected in only 1% of children and adolescents. Antibodies were not detected in children under the age of 5 years. The detection of antibodies by indirect immunoperoxidase assay in such a high proportion of the population suggests that this method is of little value for diagnosis of infection with Chlamydia trachomatis.

Adolescent↗
PubMed2003

Surveillance of invasive meningococcal disease in Queensland, 2002.

During 2002, 124 cases of invasive meningococcal disease were notified in Queensland. This was similar to the previous year (n = 128). Four (3.2%) of the cases died. Trends by age and serogroup were generally similar to previous years and were consistent with the overall patterns of this disease in Australia. However, an apparent increase in serogroup C, which infected 41 per cent of cases, needs continued monitoring. This report highlights the need for continued surveillance of morbidity and mortality patterns and management of this disease. Ongoing surveillance will monitor the impact of the National Meningococcal C Vaccination Programme, commenced in early 2003. This report also highlights the need for ongoing community education to ensure people seek medical attention early after onset of the illness. This report shows that when general practitioners considered meningococcal disease as a diagnosis, their patients were admitted to hospital sooner than patients in whom this diagnosis was not initially considered. Acknowledging that early disease may present diagnostic difficulties, further awareness raising amongst general practitioners is required to promote early recognition and referral.

Adolescent↗
PubMed2005

Congenital pulmonary tuberculosis associated with maternal cerebral tuberculosis--Florida, 2002.

In 2002, congenital tuberculosis (TB), a rare disease with nonspecific signs and symptoms, was diagnosed in an infant in Florida. If untreated, congenital TB is fatal, which underscores the importance of suspecting congenital TB in newborns and infants who are at risk and who have unexplained febrile illnesses. This report summarizes the investigation of the case in Florida. Health-care practitioners should administer a tuberculin skin test to women who have risks for Mycobacterium tuberculosis infection and treat those who have latent TB infection (LTBI) to prevent maternal and congenital TB disease.

Adult↗
PubMed2005

Impact of an adherence clinic on behavioral outcomes and virologic response in treatment of HIV infection: a prospective, randomized, controlled pilot study.

OBJECTIVE: The aim of this randomized, controlled pilot study was to examine the impact of a pharmacist operated adherence clinic on adherence to highly active antiretroviral therapy (HAART) and viral suppression in patients with HIV over 28 weeks. METHODS: Consecutive eligible patients initiating HAART at an indigent-care clinic were randomized to an adherence clinic or to standard care (information provided by physician or nurse practitioner) for education and monitoring. Group assignment was stratified before randomization according to regimen complexity and potential tolerability. Adherence (electronic monitoring and patient self-report) and viral load (reverse-transcription polymerase chain reaction) were assessed at weeks 4, 16, and 28. RESULTS: Thirty-three randomized patients (adherence clinic, n = 16; standard care, n = 17) comprised the intent-to-treat population. The groups were well-matched for demographics and antiretroviral regimen. The median age was 38.0 years in both groups. Most patients were male (85%), had previously used HAART (78%), and had an AIDS diagnosis (79%). Mean (SD) adherence at weeks 4, 16, and 28 was 86% (27%), 77% (28%), and 74% (31%) in the adherence clinic group versus 73% (32%), 56% (39%), and 51% (41%) in the standard care group (week-16 difference, 21% [90% CI, 1%-42%]; week-28 difference, 23% [90% CI, 1%-44%]). Sixty-nine percent of patients in the adherence clinic group took their medication on schedule versus 42% in the standard care group (P = 0.025); mean decline in adherence from weeks 4 to 28 was 12% in the adherence clinic group (P = 0.15) versus 22% in the standard care group (P = 0.002). HIV-1 RNA levels were <400 copies/mL at weeks 4, 16, and 28 in 63%, 100%, and 94% of the adherence clinic group and 29% (P = NS), 71% (P = 0.04), and 65% (P = NS) of the standard care group. CONCLUSIONS: In this preliminary trial, an adherence clinic model improved adherence to HAART and virologic response over 28 weeks in the patients studied.

Adult↗
PubMed2004

Physician behaviour for antimicrobial prescribing for paediatric upper respiratory tract infections: a survey in general practice in Trinidad, West Indies.

BACKGROUND: Upper respiratory tract infections (URTIs) are among the most frequent reasons for physician office visits in paediatrics. Despite their predominant viral aetiology, URTIs continue to be treated with antimicrobials. We explored general practitioners' (GPs) prescribing behaviour for antimicrobials in children (< or = 16 years) with URTIs in Trinidad, using the guidelines from the Centers for Disease Control and Prevention (CDC) as a reference. METHODS: A cross-sectional study was conducted on 92 consenting GPs from the 109 contacted in Central and East Trinidad, between January to June 2003. Using a pilot-tested questionnaire, GPs identified the 5 most frequent URTIs they see in office and reported on their antimicrobial prescribing practices for these URTIs to trained research students. RESULTS: The 5 most frequent URTIs presenting in children in general practice, are the common cold, pharyngitis, tonsillitis, sinusitis and acute otitis media (AOM) in rank order. GPs prescribe at least 25 different antibiotics for these URTIs with significant associations for amoxicillin, co-amoxiclav, cefaclor, cefuroxime, erythromycin, clarithromycin and azithromycin (p < 0.001). Amoxicillin alone or with clavulanate was the most frequently prescribed antibiotic for all URTIs. Prescribing variations from the CDC recommendations were observed for all URTIs except for AOM (50%), the most common condition for antibiotics. Doctors practicing for >30 years were more likely to prescribe antibiotics for the common cold (p = 0.014). Severity (95.7%) and duration of illness (82.5%) influenced doctors' prescribing and over prescribing in general practice was attributed to parent demands (75%) and concern for secondary bacterial infections (70%). Physicians do not request laboratory investigations primarily because they are unnecessary (86%) and the waiting time for results is too long (51%). CONCLUSIONS: Antibiotics are over prescribed for paediatric URTIs in Trinidad and amoxicillin with co-amoxiclav were preferentially prescribed. Except for AOM, GPs' prescribing varied from the CDC guidelines for drug and duration. Physicians recognise antibiotics are overused and consider parents expecting antibiotics and a concern for secondary bacterial infections are prescribing pressures. Guidelines to manage URTIs, ongoing surveillance programs for antibiotic resistance, public health education on non-antibiotic strategies, and postgraduate education for rational pharmacotherapy in general practice would decrease inappropriate antibiotic use in URTIs.

Journal Article↗
PubMed1995

Outbreak of Salmonella enteritidis phage type 4 infection associated with cheese and onion quiche.

Twelve people developed gastrointestinal symptoms suggestive of food poisoning after a party attended by between 60 and 80 people. The outbreak went unrecognised, however, until general practitioners admitted three patients to hospital, where faecal specimens were examined. An epidemiological investigation identified 12 cases, and a case control study showed a significant association between illness and eating a cheese and onion quiche at the party. Salmonella enteritidis phage type 4 was cultured from three out of seven faecal specimens obtained from cases. Consultants in communicable disease control should continue to encourage general practitioners to investigate and notify suspected cases of food poisoning.

Adult↗
PubMedDate not supplied

Patient management following suprapubic catheterization.

This article considers the issue of suprapubic catheterization and the subsequent care of the client. The conditions and situations where suprapubic catheterization may be used are outlined. A review of the literature on this important subject suggests that there is little research/evidence-based practice to support some current-day practices. The review addresses such issues as what suprapubic catheterization is and how it is carried out. Key issues such as avoidance of infection, the need for dressings and care of the insertion site are discussed. In particular, the gynaecological field is explored to highlight concern about variations and discrepancies in approaches to care of the patient with a suprapubic catheter in situ. Finally, a call is made for practitioners to base their care on research findings or evidence-based practice rather than tradition, ritual or heresy.

Female↗
PubMedDate not supplied

Body adornment: piercings and tattoos.

Body adornment through tattoos and piercings is on the increase, making adverse side effects more common. Practitioners should be prepared to give advice, either before the event, or post-procedure in written and oral forms. The aim of this article is to inform practitioners of the sites and types of piercings, likely adverse side effects and estimated healing times.

Adolescent↗
PubMed1999

The effect of surveillance on surgical wound infection rates.

The clean wound infection rate is the most valuable reflection of surgical care in any hospital. Wound infection rates are seen as indicators of quality in terms of negative outcome measures. A nurse was appointed by Hairmyres and Stonehouse Hospitals NHS Trust for the purpose of surveillance of the clean surgical wound infection rate. The surveillance is based on a previous study in the USA showing that feedback of infection rates to surgeons can lead to a reduction in these rates. The specifications for surveillance were that all clean surgery would be followed up for 30 days post-operatively and that wounds with implants, i.e. vascular grafts, would be followed up for 1 year post-operatively to produce infection rates for the surgeons, wards, theatres and the infection control team. Data collection commenced in October 1995 and so far 1851 clean surgical cases have been followed up for 30 days post-operatively. All patients were monitored until discharge, then at 30 days post-operatively, and the wound scored for signs of infection. Day cases were seen within week 1 and at day 30. General practitioner and district nurse liaison enabled detection of problems at other times. The patients were given a telephone number they could use to report problems after surgery. The results show that this type of surveillance is an effective way of collecting accurate data on wound infection rates. It has enabled the early identification of problem areas in practice. The audit has also been used to facilitate the adoption of evidence-based practice, through recommendations for clean surgery, to reduce the extrinsic risk factors for wound infection. As a result of the surveillance, there has been a significant reduction (P < 0.05) in the clean wound infection rate.

Evidence-Based Medicine↗
PubMed2000

Dutch paratuberculosis programme history, principles and development.

Organised disease control started in the Netherlands in the 18th century with governmental attempts to eradicate cattle plague. At the beginning of the 20th century, the dairy industry and cattle breeding organisations initiated a programme to control infectious diseases by means of a complex system of rewards and penalties. This was also the reason for establishing the Animal Health Service in Friesland in 1919. The history of programmes to control paratuberculosis in sheep, goats, and cattle in various countries is described. The vaccination of young animals seems to be an effective measure in the prevention of clinical paratuberculosis, although changes in management and hygiene practices are also important. A control programme for infectious cattle diseases has a number of phases (a lifecycle) and different components. Two components are essential for success, namely: open and regular communication with farmers, veterinary practitioners, and other people involved and a good registration and identification system for cattle, herds, and veterinary practitioners. The Dutch paratuberculosis programme has 10 herd status levels: 5-10 for non-suspect herds and 1-4 for infected herds or herds of unknown status. The higher the status, the greater the chance that a herd is free of paratuberculosis. An outline is given of the Dutch paratuberculosis programme including its objectives, basic principles for eradication, communication plan, legal action, logistic considerations, and complementary research programme.

Animal Husbandry↗
PubMedDate not supplied

Preventing hepatitis B: focus on women and their families.

BACKGROUND: Infections contracted during infancy or childhood are responsible for 42 percent of case of chronic hepatitis B disease, and in 25 percent or more these infections result in death from hepatoma or cirrhosis during adulthood. Hepatitis B vaccine and immune globulin provide the means of preventing the disease and its sequelae, but their proper use requires clinical strategies for deciding which patients are at risk and which responses are appropriate for family practice. METHODS: A MEDLINE search of the literature pertaining to hepatitis B and its prevention, a review from the Centers for Disease Control (CDC), and critique by both practitioners and members of the CDC Hepatitis Branch led to the development of the clinical guidelines reported in this review. RESULTS AND CONCLUSIONS: Women at high risk for hepatitis B should be screened, including during pregnancy, by testing for hepatitis B core antibody. Those at low risk should be screened by testing for hepatitis B surface antigen. Susceptible high-risk women should be vaccinated; pregnancy is not a contraindication. Administration of hepatitis B immune globulin and vaccine to newborns is 95 percent effective in preventing transmission from a hepatitis B-infected mother. Follow-up vaccination is critical. Prophylaxis of contacts can include hepatitis B immune globulin and vaccination with or without previous testing, depending on age group and risk. Testing for hepatitis B surface antibody to assess development of immunity after vaccination is indicated only for those with ongoing exposure.

Carrier State↗
PubMed2001

Oral health of patients with hepatitis C virus infection: a pilot study.

OBJECTIVES: This study examined the oral health of a cohort of hepatitis C virus (HCV) patients. In particular, the prevalence of lichen planus and xerostomia were determined. Experiences of discrimination against HCV-infected patients by their dentists were also recorded. METHODS: Forty patients infected with HCV, who were not undergoing anti-viral treatment, were examined. Patient information collected included demographic details together with patients' perception of their oral health and access to dental care since being diagnosed with hepatitis C. Both extra-oral and intra-oral examinations were conducted. Teeth present and visible caries were recorded, periodontal condition was measured using a Community Periodontal Index of Treatment Need (CPITN) probe and denture fit and hygiene were assessed where appropriate. The soft tissues were examined and lichen planus diagnosed clinically. Salivary flow rates were estimated by the Salivette system. RESULTS: The oral health of this cohort was poor. Eight patients had clinical evidence of oral lichen planus (OLP), although this was not confirmed histologically. The salivary flow rates were significantly lower (P < 0.001) than in previously reported healthy controls. Of the 15 (37.5%) regular dental attenders, two had encountered problems accessing dental care. CONCLUSIONS: Chronic hepatitis C patients have significant oral health needs. More effective oral health education is required for both HCV-infected patients and their carers, including dental practitioners.

Adult↗
PubMedDate not supplied

Influenza in the intensive care unit.

Influenza remains an important epidemic viral infection. Thousands of deaths occur and billions of dollars are spent each year with influenza-related illnesses. Morbidity and mortality are largely attributed to respiratory complications that may require intensive care unit (ICU) admission. Medical and neonatal ICUs, transplant units, chronic-care wards, and nursing homes are at increased risk for nosocomial outbreaks of influenza, which are characterized by abrupt onset and rapid spread. In this article, the authors review the current concepts, recent advances, and management strategies in influenza-associated pneumonia. Pertinent issues to the critical care practitioner are discussed in detail.

Antiviral Agents↗
PubMed1998

Aspects of care for the hepatitis C positive patient.

BACKGROUND: With almost 200,000 infected Australians, hepatitis C is Australia's commonest life threatening chronic infection. OBJECTIVE: Over 90% of the 11,000 new infections in Australia each year are associated with injecting drug use. Australia does not have a national plan for achieving control of hepatitis C. Treatment at present is expensive, less effective than many other conditions and associated with considerable side effects. DISCUSSION: Most people with chronic hepatitis C infection have a normal life expectancy with good quality of life. The role of general practitioners in prevention and treatment is increasing.

Antiviral Agents↗
PubMed1997

[Extent of the use of systemic anti-infective agents in a rural health area in Asturias. Comparison of the years 1994 and 1995].

OBJECTIVE: To establish how widely used systemic drugs against infection were in 1994 and 1995. To compare the interannual variation and evaluate whether this is consistent with CFyT interventions to improve prescription habits. DESIGN: Comparative before-and-after study without a control group. SETTING: A rural Health Area with 57,536 inhabitants, 24.01% of whom were over 65. PARTICIPANTS: All the general practitioners in the Primary Care public network in this Health Area who prescribed medicines charged to the SNS (National Health Service) in 1994 and 1995. MEASUREMENTS AND MAIN RESULTS: All the prescriptions billed to the SNS were processed. Prevalence of use was measured by the variable N(o)DDD/1,000 inhabitants per day. Annual values and variations were obtained for each medicine, therapeutic groupings and indicators proposed to measure aspects pursued in the interventions. CONCLUSIONS: Through the application of the DDD unit of measurement, broad data bases on medicine consumption can be exploited, and simplified intuitive information about the use of medicines can be obtained. The results of the variations in the indicators linked to the interventions show the efficacy of the interventions.

Adolescent↗
PubMed1996

College health providers' knowledge, attitudes, and management practices of genital HPV infection.

This comparative survey of college health providers explored nurse practitioners' (N = 73) and physicians' (N = 70) knowledge, attitudes, and management practices related to genital human papillomavirus (HPV) infection in females. Both groups had adequate knowledge of basic issues of HPV epidemiology, diagnosis, and treatment. Divergent attitudes and management practices were reported among the providers, with generally low agreement with national STD treatment guidelines published by the Centers for Disease Control and Prevention (CDC). Generally, providers tended to practice a more aggressive management approach on several aspects of HPV infection than recommended by the CDC guidelines. The one major exception reported by the majority of providers was the conservative use of colposcopy for identifying subclinical HPV infection in patients with external genital warts, a finding consistent with CDC guidelines. The availability of colposcopy within a provider's health center was found to be associated with the reported use of colposcopy. Recommendation for future research and implications for college health and advanced nursing practice are addressed.

Adult↗
PubMed2002

Mycoplasma pneumoniae and Chlamydia pneumoniae cause lower respiratory tract disease in paediatric patients.

New studies suggest that Mycoplasma pneumoniae and Chlamydia pneumoniae play a more significant role as causes of lower respiratory tract infections in childhood than was previously thought. In particular, the incidence of infections caused by these pathogens is high in children aged less than 5 years, the infections themselves seem to be a possible cause of wheezing, and may present a more complicated course when not treated with adequate antimicrobial agents. However, despite the increasing pathogenic significance of M. pneumoniae and C. pneumoniae, progress in fighting them is hampered by the lack of rapid and standardized diagnostic methods. This not only makes it practically impossible for practitioners to make a specific microbiological diagnosis, but has also had an adverse effect on treatment trials and has generated some questionable results. Carefully randomized and controlled trials are clearly needed to examine the effectiveness of different antibiotics against M. pneumoniae or C. pneumoniae and the optimal duration of therapy in various patient populations.

4-Quinolones↗
PubMed1992

AIDS and the health care worker--a physician's perspective.

The issue of physician health has been highlighted recently by the public's concern about the possibility of contracting AIDS from an HIV-positive health care practitioner. This article examines some of the applicable standards on physician health issues, recent cases and incidents involving HIV-infected practitioners, the new CDC guidelines for preventing HIV transmission to patients, and the consequences to, and responsibilities of, the HIV-positive physician.

Acquired Immunodeficiency Syndrome↗