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[A questionnaire study in the county of Stockholm on transmission control of chlamydia infections. Too many physicians neglect the contact tracing].

Since 1989 the reporting of chlamydia infections is regulated by the Contagious Diseases Act, which stipulates that a physician who detects chlamydia is obliged to trace the patient's sexual partner(s). Up to 1994 the annual decrease in the number of chlamydia cases was 20 percent, which did not meet the goal stipulated by the County Council. A questionnaire study was carried out concerning diagnosis, treatment and public health intervention in chlamydia patients seen by general and private practitioners. While the clinical management was seen to adhere to the recommendations of the National Board of Health, adequate tracing of sexual contacts was not carried out in 20-45 per cent of the cases. In a major urban area, such as the County of Stockholm, referral of all chlamydia cases to specialist clinics could possibly improve not only the care of the patients but also the success rate in reaching their sex partners.

Adolescent↗

Role of disinfectants in infection control.

The ADA Council on Dental Therapeutics recognizes many commercial products as effective for use in dentistry as disinfectants or sterilants. Some of the products act only as disinfectants and do not sterilize; some have an odor that is unpleasant; others stain or bleach surfaces; and some of the formulations are corrosive to metallic surfaces. Therefore, it is essential that, before purchasing a chemical sterilant/disinfectant or a surface disinfectant for routine use, the practitioner, dental hygienist, and assistant obtain as much detailed information as possible. With sufficient information, subsequent decisions may be used on appropriate efficacy criteria, and the potential for product misuse may be reduced.

Communicable Disease Control↗

Secretory otitis media--a retrospective general practice survey.

The general practice records of 68 children with secretory otitis media (SOM) were studied. A control group was matched one-for-one on the basis of sex, year of birth and general practice list. The SOM group had twice the incidence of recorded atopy, twice the incidence of recorded previous upper respiratory tract infections (URTI), and three times the incidence of recorded attacks of acute otitis media (AOM) compared with the control group. The recorded antibiotic treatment of URTI and AOM in the two groups was similar. Antihistamines and decongestants were seldom recorded in the treatment of AOM. The higher incidence of atopy found in the children with SOM prompts the suggestion that antihistamines and decongestants used by general practitioners in the routine treatment of AOM and URTI might help prevent the development of SOM. A prospective double-blind trial along these lines seems desirable.

Acute Disease↗

Oropouche virus: viral evolution, epidemiological trends, and challenges for control.

PURPOSE OF REVIEW: In recent years, OROV has emerged as a significant public health threat beyond the Amazon region. Here we review current epidemiological, virological, clinical and ecological knowledge of OROV to inform health practitioners, public health authorities and the scientific community and to facilitate the development of effective control strategies for OROV. RECENT FINDINGS: We describe the epidemiological, virological, ecological and clinical characteristics of OROV, focusing on lessons from the recent expansion, and highlighting needs for control and management of this emerging arbovirus. SUMMARY: This review aims to inform health practitioners, public health authorities and the scientific community of the recent reemergence and expansion of OROV beyond the Amazon Basin. The ecology, epidemiology, virology of OROV and clinical presentations of OROV infection are discussed, and knowledge gaps are identified.

Humans↗

Management of aspiration and swallowing incidents: a review of the literature and report of case.

This article has reviewed aspiration and swallowing incidents in a dental environment with particular emphasis on the young child and the medically, physically and mentally handicapped patient. A thorough review of prevention, signs and symptoms, management and documentation of these incidents has been presented. This review was presented to reaffirm the potential of these incidents and strives to educate the practitioner who treats these special populations. The case report applies reported guidelines for noting signs and symptoms, management and documentation. This case report also affirms the need to check all dental instruments before their use, as a safeguard against possible failure. Current policy for infection control maintains strict guidelines for asepsis. With the increasing use of steam autoclaving and cleansing products, an increased rate of failure may be seen in some instruments. Manufacturers should be contacted for instrument care and sterilization recommendations, as well as projected longevity of the instrument, if their sterilization procedures are followed. The economic implications of replacing instruments because of the protocol for maintaining asepsis will undoubtedly contribute to the rising cost of care. Prevention has been the goal of dentistry for decades and dental emergencies are not excluded. Preparation for such incidents will prevent many incidents and allow for proper patient management should they occur.

Adolescent↗

[1990 epidemiology of AIDS and risk of transmission to the dentist].

All epidemiological inquiries and all studies on VIH transmissibility allow to precise transmission risks among different population groups. For the dental practitioner, as for the other medical and paramedical staffs, these risks are weak. VIH is certainly one of the less contaminant agent, in term of nosocomial infection.

Acquired Immunodeficiency Syndrome↗

Treatment of ocular bacterial infections: an update.

BACKGROUND: Because of increased bacterial resistance and the addition of new antimicrobial medications, the current and appropriate treatment of ocular bacterial infections is an important issue for eye care practitioners. METHODS: The literature on the antimicrobial treatment of ocular bacterial infections is reviewed to provide the practicing optometrist with an overview of the issues and medications involved in therapy. RESULTS: New topical, oral, and parenteral antibiotic medications continuously become available to eye care practitioners. Clinicians must routinely reassess the conventional antimicrobial therapy in light of the drugs available for the treatment of bacterial eye infections. The clinician must be familiar with distinct protocols and medications for the management of different ocular bacterial infections. CONCLUSIONS: Knowledge of the results of controlled antimicrobial studies and a review of standard practices in managing bacterial eye disease can provide the necessary background to help the eye care clinician make appropriate antimicrobial therapeutic decisions in patient care.

Anti-Bacterial Agents↗

Pneumococcal vaccine.

Pneumococcal infection is a major health problem in both developed and developing countries. Adult patients with a range of chronic illnesses are at increased risk of both morbidity and mortality from this condition. The currently available 23 valent vaccine is generally not effective in children under 2 years of age or adults with significant immunosuppression. However, case control and cohort studies have established the vaccine's effectiveness in patients with a number of chronic illnesses as well as those undergoing splenectomy. The vaccine is safe and should be more widely used by practitioners with patients who meet the current NHMRC guidelines.

Adolescent↗

Randomised, double blind, placebo controlled trial of penicillin V and amoxycillin in treatment of acute sinus infections in adults.

OBJECTIVES: To compare the effectiveness of penicillin V and amoxycillin with placebo in treatment of adult patients with acute sinusitis. DESIGN: Randomised, double blind, placebo controlled trial. SETTING: Norwegian general practice. SUBJECTS: 130 adult patients with a clinical diagnosis of acute sinusitis confirmed by computed tomography. MAIN OUTCOME MEASURES: Subjective status after three and 10 days of treatment, difference in clinical severity score between day 0 and day 10 as evaluated by the general practitioner, difference in score from computed tomography on day 0 and day 10, and duration of sinusitis. RESULTS: Amoxycillin and penicillin V led to significantly faster and better recovery than placebo. By day 10, 71 patients receiving antibiotic treatment- (86%) considered themselves to be recovered or much better compared with 25 (57%) receiving placebo. The mean (95% confidence interval) reductions in clinical severity scores by day 10 were 5.4 (5.0 to 5.8) for penicillin V, 5.5 (4.9 to 6.0 for amoxycillin, and 3.4 (2.8 to 4.0) for placebo. For the antibiotic groups combined the number of patients with the greatest degree of improvement on computed tomography (scale 0-16)-that is, score 5-16 on day 10-was 31/83 (37%) compared with 10/44 (23%) receiving placebo. The median duration of the sinusitis was nine days in the amoxycillin group, 11 days in the penicillin V group, and 17 days in the placebo group. CONCLUSION: Penicillin V and amoxycillin are significantly more effective than placebo in the treatment of acute sinusitis.

Acute Disease↗

Management of protease inhibitor-associated diarrhea.

Diarrhea is a common and often inadequately treated complication in patients with human immunodeficiency virus infection. Diarrhea has a significant impact on quality of life (QOL) and can contribute to malnutrition, weight loss, immunosuppression, and mortality. In addition, diarrhea may have a significant impact on compliance with antiretroviral therapy; however, this impact has not been adequately assessed. Medications, including protease inhibitors (PIs), are recognized as a common cause of diarrhea. Treatment of PI-associated diarrhea is largely nonspecific; most of the available literature is published only in abstract form and is based primarily on retrospective and survey data. Agents for which some efficacy has been shown for treatment of PI-associated diarrhea include oat bran, psyllium, loperamide, calcium carbonate, SP-303, and pancrelipase. Practitioners and patients need to work together to determine which treatment modality is appropriate based on efficacy, cost, and lifestyle. Management of diarrhea is crucial to improving QOL, controlling weight loss, and enhancing overall efficacy of antiretroviral therapy.

Antidiarrheals↗

Revised guidelines for prevention of early-onset group B streptococcal (GBS) infection. American Academy of Pediatrics Committee on Infectious Diseases and Committee on Fetus and Newborn.

In 1992, the Committee on Infectious Diseases and Committee on Fetus and Newborn of the American Academy of Pediatrics provided guidelines for prevention of early-onset group B streptococcal (GBS) disease through intrapartum chemoprophylaxis of selected maternal GBS carriers. The guidelines were based on demonstrated efficacy in randomized, controlled clinical trials and selected only women with GBS colonization who had an obstetric risk factor. The guidelines were controversial and their implementation incomplete. Since 1992, additional data have become available, and experience with the guidelines has been gained in numerous medical centers. Recently, consensus guidelines were developed by obstetricians, pediatricians, family practitioners, and public health authorities and published by the Centers for Disease Control and Prevention. These recommendations are supported by the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics. This statement reviews the selection of pregnant women for chemoprophylaxis and provides an algorithm for management of their newborns.

Algorithms↗

Preventing perioperative transmission of infection: a survey of anesthesiology practice.

Given the societal and economic impact of perioperative infection, it is essential that anesthesiologists and other operating room personnel use appropriate precautions to reduce the potential for transmission of infectious agents to the patients under their care. This study, therefore, was designed to evaluate the degree to which anesthesiologists utilize appropriate hygienic techniques for the prevention of infection in the perioperative period. A total of 1149 questionnaires were mailed to anesthesiologists randomly selected from the membership of the American Society of Anesthesiologists (ASA). Of these, 493 (44%) were completed and returned. Forty-nine percent and 75.3% of respondents always used gloves and masks, respectively, in their everyday practice. Only 58% of respondents stated that they always washed their hands after every patient contact and 85% reported that they always used aseptic technique for placing indwelling catheters. Knowledge of universal precautions for prevention of occupational transmission of infection was associated with good hygienic practice. Twenty percent of the respondents reported frequently or always reusing syringes for more than one patient and 34.4% reported never or rarely disinfecting the septum of multidose vials prior to use. The practice of reusing syringes was significantly greater among private than university practitioners (P < 0.01). On a scale of 0-10 (10 = high) anesthesiologists rated their potential for transmitting or contributing to patient potential for transmitting or contributing to patient infection as 4.7 +/- 0.12 (mean +/- SE). Results of this study suggest that, whereas most responding anesthesiologists exhibit appropriate infection control behaviors, there are several potentially hazardous practices that continue.

Anesthesiology↗

Drug-exposed infants at home: strategies and supports.

This longitudinal, descriptive study gathered information on drug-exposed infants at home and identified effective public health nurse interventions for them and their caregivers. These infants exhibit symptoms that may well interfere with their ability to give clear cues as part of the infant-caregiver interactive system. This may amplify or perpetuate the effects of the drugs and low birth weight. Fifteen infants with a positive toxicology screen were compared to controls at birth and followed for up to 12 months of age through home visits by a public health nurse practitioner. The drug-exposed infants were significantly smaller at birth, and their most common initial problems were the need for nonnutritive sucking, excessive extensor tone, infections, and irritability. The mean weight, length, and head circumference went from the 10th to the 25th percentile at birth to the 25th to 50th percentile at 12 months. The support system and organization of the home predicted the family's ability to sustain caregiving for these infants. Effective strategies to care for these infants included recognizing states and cues, swaddling, use of pacifier, waking to eat, and smaller feedings. The role of the public health nurse was crucial for conducting early assessment, implementing strategies, and facilitating a therapeutic relationship.

Birth Weight↗

Goat-associated Q fever: a new disease in Newfoundland.

In the spring of 1999 in rural Newfoundland, abortions in goats were associated with illness in goat workers. An epidemiologic investigation and a serologic survey were conducted in April 1999 to determine the number of infections, nature of illness, and risk factors for infection. Thirty-seven percent of the outbreak cohort had antibody titers to phase II Coxiella burnetii antigen >1:64, suggesting recent infection. The predominant clinical manifestation of Q fever was an acute febrile illness. Independent risk factors for infection included contact with goat placenta, smoking tobacco, and eating cheese made from pasteurized goat milk. This outbreak raises questions about management of such outbreaks, interprovincial sale and movement of domestic ungulates, and the need for discussion between public health practitioners and the dairy industry on control of this highly infectious organism.

Adult↗

How much variation in clinical activity is there between general practitioners? A multi-level analysis of decision-making in primary care.

OBJECTIVES: There is considerable policy interest in medical practice variation (MPV). Although the extent of MPV has been quantified for secondary care, this has not been investigated adequately in general practice. Technical obstacles to such analyses have been presented by the reliance on ecological small area variation (SAV) data, the binary nature of many clinical outcomes in primary care and by diagnostic variability. The study seeks to quantify the extent of variation in clinical activity between general practitioners by addressing these problems. METHODS: A survey of nearly 10 000 encounters drawn from a representative sample of general practitioners in the Waikato region of New Zealand was carried out in the period 1991-1992. Participating doctors recorded all details of clinical activity for a sample of encounters. Measures used in this analysis are the issuing of a prescription, the ordering of a laboratory test or radiology examination, and the recommendation of a future follow-up office visit at a specified date. An innovative statistical technique is adopted to assess the allocation of variance for binary outcomes within a multi-level analysis of decision-making. RESULTS: As expected, there was considerable variability between doctors in levels of prescribing, ordering of investigations and requests for follow up. These differences persisted after controlling for case-mix and patient and practitioner attributes. However, analysis of the components of variance suggested that less than 10% of remaining variability occurred at the practitioner level for any of the measures of clinical activity. Further analysis of a single diagnostic group--upper respiratory tract infection--marginally increased the practitioner contribution. CONCLUSIONS: The amount of variability in clinical activity that can definitively be linked to the practitioner in primary care is similar to that recorded in studies of the secondary sector. With primary care doctors increasingly being grouped into larger professional organisations, we can expect application of multi-level techniques to the analysis of clinical activity in primary care at different levels of organisational complexity.

Analysis of Variance↗

Australia's notifiable diseases status, 2000. Annual report of the National Notifiable Diseases Surveillance System.

In 2000, there were 89,740 notifications of communicable diseases in Australia collected by the National Notifiable Diseases Surveillance System (NNDSS). The number of notifications in 2000 was an increase of 5.9 per cent over those reported in 1999 (84,743) and the largest reporting year since the NNDSS commenced in 1991. Notifications in 2000 consisted of 28,341 bloodborne infections (32% of total), 24,319 sexually transmitted infections (27%), 21,303 gastrointestinal infections (24%), 6,617 vaccine preventable infections (7%), 6,069 vectorborne infections (7%), 2,121 other bacterial infections (legionellosis, meningococcal infection, leprosy and tuberculosis) (2%), 969 zoonotic infections (1%) and only one case of a quarantinable infection. Steep declines in some childhood vaccine preventable diseases such as Haemophilus influenzae type b, measles, mumps and rubella, continued in 2000. In contrast, notifications of pertussis and legionellosis increased sharply in the year. Notifications of bloodborne viral diseases (particularly hepatitis B and hepatitis C) and some sexually transmitted infections such as chlamydia, continue to increase in Australia. This report also summarises data on communicable diseases from other surveillance systems including the Laboratory Virology and Serology Surveillance Scheme (LabVISE) and sentinel general practitioner schemes. In addition this report comments on other important developments in communicable disease control in Australia in 2000.

Australia↗

Local transmission of Plasmodium vivax malaria in Singapore.

A localised outbreak involving 19 cases and two carriers of vivax malaria was reported at Dairy Farm from May to June 1996. Epidemiological investigations showed that the outbreak was caused by the introduction of two foreign workers with imported relapsing vivax malaria into this malaria-receptive area. Transmission of infection occurred amongst 17 other foreign workers residing in the locality and two local residents staying at a condominium nearby. The outbreak was rapidly brought under control through active case finding, isolation and treatment of infected persons, epidemic vector control measures, and improved drainage to prevent Anopheles maculatus breeding. Were it not for the very thorough epidemiological investigations in this episode, foreign workers and local residents with a recent travel history would have been misclassified as imported and the outbreak missed. Medical practitioners should always consider the possibility of malaria in a foreign worker presenting with fever and notify the case as soon as the disease is suspected.

Animals↗

Infection control knowledge, practice, and attitudes of Mississippi dental hygienists.

PURPOSE: The purpose of this study was to assess Mississippi dental hygienists' knowledge and use of infection control techniques, attitudes pertaining to universal precautions and the risk of clinician/patient cross-infection, and attitudes toward treatment of patients with infectious diseases. METHODS: A 41-item questionnaire was mailed to all 508 licensed dental hygienists in Mississippi. Inactive, retired, and out-of-state hygienists (n = 59) were deleted from this study. The data were tested for significant associations using Chi-square. RESULTS: After adjusting for the 59 unusable returns, the response rate for analysis was 58% (n = 297). Dental hygienists reported using infection control techniques including sterilization or disposal of common items such as prophylaxis angles, suction tips, and air/water syringe tips. Although 98% of the respondents believed that barrier techniques were effective, some believed patients infected with HIV/AIDS (43%), hepatitis B (31%), or tuberculosis (40%) are best treated in public clinics rather than in private settings and that these clients pose a threat to dental hygiene practitioners. Further, a majority of the respondents believed that all oral healthcare workers and patients should be tested for HIV/AIDS. CONCLUSIONS: The incongruity between perceived knowledge, reported practice, and attitudes suggests the need for continuing education courses designed to allow dental hygienists to explore the affective domain regarding the care of patients with infectious diseases. In addition, courses on working with patients with HIV/AIDS should be offered in smaller cities for greater accessibility.

Adult↗