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PubMed2003

[Alcohol-induced gastrointestinal diseases].

UNLABELLED: Alcohol induced gastrointestinal diseases are common and significant, and may lead to early death. The annual death caused by alcoholic liver disease and pancreatitis in Hungary is up to 8000. Metabolites, mainly acetaldehyde and free radicals are responsible for the injury. Although the alcohol itself is not carcinogenic, some maligancies are more common among alcoholics. AIM AND METHODS: In this review the hepatic and extrahepatic metabolism of alcohol, the epidemiology, pathomechanism, clinical signs of the alcohol induced organ damages and the treatment options are summarized. RESULTS: Type IV alcoholdehydrogenase in the stomach has a role in the first pass metabolism. The liver is the main place of the metabolism. If the amount of alcohol exceeds the metabolising capacity, the toxic substances cause lipidperoxidation, membrane and organ injury. Alcohol metabolism is different in the pancreas, the activity of fatty acid ethanol ester synthase activity is more pronounced. In alcoholics the leukoplakia, oropharingeal carcinoma, oesophagitis, Mallory-Weiss syndrome, liver cirrhosis related oesophageal variceal bleeding, chronic gastritis, liver diseases, pancreatitis, bowel motility disorders, malabsorption and colorectal carcinoma are more frequent. The fatty liver remains reversible for a long. Following steatohepatitis, fibrosis, cirrhosis and liver carcinoma may develop. Despite growing knowledge of the role of endotoxins, cytokines, nutritional, immunological and genetic factors, it is still unknown why the given disease will develop in a patient, and there is no parameter for determining the point of irreversibility of the alterations. The possibilities for medical treatment are limited, since some patients do not cooperate properly, and on the other hand, the drugs and measurements can control only a part of the whole process (antioxidants, anti-inflammatory drugs, monoclonal anti-cytokine antibodies), and are appropriate only for the treatment of complications as ascites, portal hypertension, oesophageal varices, portosystemic encephalopathy, malabsortion, infections, vitamin deficiency. CONCLUSIONS: Therefore the prevention and abstinence are very important. The task of the general practitioner and the role of the cooperation among the patient, the physician, the family and the community are very important.

Alcohol Drinking↗
PubMed2006

Herpes simplex infection--Part II: Management of HSV infections.

Oral and perioral herpes simplex virus infections are commonly seen and managed by the dental practitioner. Many topical and oral antiviral agents are available in Israel. However, only a few regimens are based on solid evidence. The purpose of this study was to review the mode of action of antiviral agents and to present therapeutic regimens supported by randomized control trials.

Antiviral Agents↗
PubMed2006

Can biomedical and traditional health care providers work together? Zambian practitioners' experiences and attitudes towards collaboration in relation to STIs and HIV/AIDS care: a cross-sectional study.

BACKGROUND: The World Health Organization's World health report 2006: Working together for health underscores the importance of human resources for health. The shortage of trained health professionals is among the main obstacles to strengthening low-income countries' health systems and to scaling up HIV/AIDS control efforts. Traditional health practitioners are increasingly depicted as key resources to HIV/AIDS prevention and care. An appropriate and effective response to the HIV/AIDS crisis requires reconsideration of the collaboration between traditional and biomedical health providers (THPs and BHPs). The aim of this paper is to explore biomedical and traditional health practitioners' experiences of and attitudes towards collaboration and to identify obstacles and potential opportunities for them to collaborate regarding care for patients with sexually transmitted infections (STIs) and HIV/AIDS. METHODS: We conducted a cross-sectional study in two Zambian urban sites, using structured questionnaires. We interviewed 152 biomedical health practitioners (BHPs) and 144 traditional health practitioners (THPs) who reported attending to patients with STIs and HIV/AIDS. RESULTS: The study showed a very low level of experience of collaboration, predominated by BHPs training THPs (mostly traditional birth attendants) on issues of safe delivery. Intersectoral contacts addressing STIs and HIV/AIDS care issues were less common. However, both groups of providers overwhelmingly acknowledged the potential role of THPs in the fight against HIV/AIDS. Obstacles to collaboration were identified at the policy level in terms of legislation and logistics. Lack of trust in THPs by individual BHPs was also found to inhibit collaboration. Nevertheless, as many as 40% of BHPs expressed an interest in working more closely with THPs. CONCLUSION: There is indication that practitioners from both sectors seem willing to strengthen collaboration with each other. However, there are missed opportunities. The lack of collaborative framework integrating maternal health with STIs and HIV/AIDS care is at odds with the needed comprehensive approach to HIV/AIDS control. Also, considering the current human resources crisis in Zambia, substantial policy commitment is called for to address the legislative obstacles and the stigma reported by THPs and to provide an adequate distribution of roles between all partners, including traditional health practitioners, in the struggle against HIV/AIDS.

Journal Article↗
PubMed1990

Risk management information for HIV infection.

This article discusses HIV infection in terms of the risk manager's information needs in the health care environment. The malpractice problem, increasing workman's compensation suits, the greater role of the ombudsman, implementation of the National Practitioner Data Bank, and the Joint Commission on Accreditation of Health Care Organizations' (JCAHO) emphasis on clinical excellence are conditions which have given greater importance to the risk manager's position. Included in this article are hedges to retrieve various components of risk management and a select bibliography from AIDSLINE.

Communicable Disease Control↗
PubMed2000

Hepatitis B, C and human immunodeficiency virus infections in multiply-injected kala-azar patients in Delhi.

Sera from 164 patients with parasitologically confirmed kala-azar and 100 patients with non-kala-azar Delhite in 2 Delhi hospitals were tested for anti-human immunodeficiency (anti-HIV) and anti-hepatitis C virus (anti-HCV) antibodies and hepatitis B surface antigens to determine which group is more likely to contract these infections. The mean age of the patients was 32.5 y (+/-6.5 y), (120 M, 44 F). Two patients were from Nepal and the others from the kala-azar endemic state of Bihar, India. As geographical controls, 50 serum samples from sex- and age-matched healthy Bihar residents were also tested for the blood-borne viral infections. All patients had been treated with injectable medicines by 1 or more local physicians before they were referred to the Delhi hospitals. The prevalence of hepatitis B virus (HBV) and HCV infection was significantly different between the 2 patient groups. While 2 kala-azar patients (1.21%) were found to be HIV-1 positive, 54 (32.9%) patients had anti-HCV antibodies detected by ELISA and 51 (31.1%) by RIBA test. The seroprevalence of HCV was only 2% in hospitalized non-kala-azar cases and 4% in the geographical controls (p < 0.001). The seroprevalence of HBV was 13.2% in hospitalized kala-azar cases, but only 1.75% in disease control cases and 1.6% in geographical control cases. The difference in infection rates between cases and controls was significant (p < 0.001). The results indicate that kala-azar patients treated locally in Bihar have a greater chance of contracting blood-borne infections. Interestingly, we found that HCV was more prevalent than HBV. These infections were most likely acquired through the re-use of needles by local medical and paramedical practitioners for administering anti-leishmanial drugs. This trend, if not checked immediately, may have drastic consequences in the horizontal transmission of HIV in Bihar.

Adolescent↗
PubMed2005

Report of working group 1: public health challenges.

There is a need to improve surveillance systems in order to recognise emerging threats, both in the community and in hospitals, in a timely manner. The laboratory arm of surveillance must be complemented by hospital and primary care components. We also need more training at all levels: undergraduate and postgraduate medical training, specialist training, as well as continuing professional development schemes. Core training programmes for infectious disease specialists and medical microbiologists must be established. The contribution of general practitioners, infection specialists, microbiology laboratories, and public health specialists/agencies to response systems should be defined as clearly as possible and should be either empirically based or derived from scenario-guided calamity models. The success of surveillance hinges on sufficient long-term resources and dedicated coordination. The European Centre for Disease Prevention and Control (ECDC) may assume this role. However, structural and administrative constraints of the diverse healthcare systems throughout Europe may represent an impediment to a harmonised response. Also, the funding of the ECDC cannot cover the operational demands. The ECDC may well work as a small coordinating unit; however, without a laboratory-based scientific status, it remains doubtful whether the ECDC will achieve the competence and authority needed for effective leadership in healthcare. The ESCMID, together with other national and international scientific societies, should put emphasis on the fact that infectious diseases have not received the necessary degree of attention from governments in the European region. The ESCMID should strengthen its role in harmonising and supporting the highest standards of training in the infection disciplines.

Communicable Disease Control↗
PubMed1991

Collaborative education regarding prevention of human immunodeficiency virus transmission in healthcare settings--Ghana.

OBJECTIVE: To evaluate the effectiveness of a collaborative and participatory approach to professional training to reduce the risk of human immunodeficiency virus (HIV) transmission. SETTING: Healthcare settings in Ghana. METHODS: Two 5-day workshops were conducted for high-level nurse educators and leaders who could contribute to national policy development. A combination of didactics, skill development sessions, field experiences, and development of draft national guidelines and curriculum were used. Outcomes evaluated were pre-to-post training changes in HIV knowledge and attitudes and changes in practice within selected healthcare settings. One-month follow-up visits (times not specified to participants) were used to evaluate outcomes. RESULTS: At post-test, significantly fewer participants thought HIV was transmitted by saliva, sweat, or tears (chi square, p less than .0001), and significantly fewer reported hesitation to care for an HIV-infected patient because of lack of understanding about mode of transmission or because of lack of supplies, such as gloves (chi square, p less than .01). In field observations, there was an overall 42% improvement in specific infection control practices. CONCLUSIONS: A collaborative and participatory approach to training can result in significant changes in infection control practices, even in settings with limited resources.

Curriculum↗
PubMed1994

Protective wear and instrument sterilisation/disinfection in UK general dental practice.

The 18,000 United Kingdom general dental practitioners registered for National Health Service (NHS) practice were surveyed in July 1991 to assess their current use of protective gloves, eyewear and masks, and instrument sterilisation. Nearly 7,000 (6,588) valid responses were obtained immediately; of these, 70% of practitioners wore gloves routinely for clinical work, but only 14.5% donned new gloves for each patient. About 60% wore protective eyewear routinely or all the time but 12% never wore eye protection, and only 36% of practitioners used masks. Autoclaves or chemical solutions were the most popular methods to disinfect handpieces, but less than half the respondents stated that handpieces were sterilised or disinfected after each patient use. Most respondents (81%) routinely used autoclaves for sterilisation of other instruments. Although the response rate to the questionnaire was low, the results indicate that, despite the risks of, and publicity about, cross-infection, a substantial number of NHS dental practitioners may not adequately disinfect or sterilise their equipment between patients.

Attitude of Health Personnel↗
PubMed1996

The Ambulatory Care Medical Audit Demonstration Project. Research design.

The authors describe the design of and statistical analyses involved in the Ambulatory Care Medical Audit Demonstration Project, which tested feasibility, cost, and effectiveness of cycles that met quality assurance requirements in eight pediatric and eight general medicine group practices at four teaching hospitals and six health centers. The authors used a concurrent crossover design using randomized cycles of quality assurance so that a practice was a control site for one guideline and an experimental site for another. For 12 months before and 18 months during and after quality assurance experimental interventions, the authors measured practitioner conformance to review criteria for patient-care guidelines believed to improve outcomes, including four internal medicine patient-care guidelines (ie, follow-up of low hematocrit, cancer screening for women, follow-up of high serum glucose, and monitoring of patients treated with digoxin) and four pediatric patient-care guidelines (ie, follow-up of positive urine cultures, screening for disease and immunizing infants, management of acute gastroenteritis, and management of acute ear infection). The authors distinguished review criteria whose performance depended on personal efforts of practitioners from those that concerned performance dependent on the practice's system for reporting test results and calling patients to return for care.

Adult↗
PubMedDate not supplied

Psychosocial and educational services for female college students with genital human papillomavirus infection.

CONTEXT: College-age women have a high risk of acquiring human papillomavirus (HPV) infection, which may have substantial psychosocial and physical effects. Young women who become infected need information and support from health care professionals, but little is known about providers' attitudes toward or provision of interventions for helping women cope with HPV. METHODS: A survey of 73 nurse practitioners and 70 physicians in college-based health clinics explored their perceptions of the need for psychosocial and educational interventions and their practices regarding such services for HPV patients. Analysis of variance and chi-square testing were used to examine differences by providers' type and gender. RESULTS: At least 86% of providers agree that HPV infection has a variety of psychosocial effects on young women, but only 54% spend at least 10 minutes providing education and counseling to all of their HPV patients. Roughly 80-90% routinely take a sexual history, explain the potential of HPV recurrence and discuss the risk of cancer with HPV patients; however, fewer than half always offer a variety of other interventions that could help patients cope with the diagnosis and promote preventive behaviors. Female providers are more aware of the psychosocial impact of HPV and the need for support than are male providers. However, nurse practitioners provide counseling and educational interventions more frequently than do physicians, even when gender is controlled for. CONCLUSIONS: College-based health providers need to improve the content of the counseling and education they offer to women with HPV, as well as the consistency with which they deliver those interventions. When they are unable to provide services, they should be able to refer patients elsewhere.

Counseling↗
PubMed1992

Hearing aids: family practitioner referral patterns.

This study aims to determine whether the implementation of a direct referral service in which family practitioners received feedback on the appropriateness of their patient selection had any impact on the referral pattern. Six months after the establishment of such a service to which general practitioners were requested to refer patients who satisfied the Hearing Aid Council and Therapist Technicians and Scientists in Audiology group criteria, 40 consecutive patients were analysed. 40 age matched controls referred concurrently to the routine ENT clinic for hearing aid provision were compared. In the 80 ears seen in each group, the number of perforations infected or otherwise were 2 and 7 respectively (P less than 0.01). Conductive hearing losses were more common in the control group (P less than 0.05). The degree of patient selection was higher than noted in the first 6 months of the service when the prevalence of perforations in the direct sample was 7%. It appears that the practice of selective referral has developed.

Aged↗
PubMed1992

Temazepam misuse in a group of injecting drug users.

It is well recognized that many injecting drug users are poly-drug users. The intravenous use of Temazepam has become popular recently. In response to the ease of misuse, the pharmaceutical industry produced a formulation that would be as 'resistant' as possible to injecting. The preparation is a gel-filled formulation, one proprietary name being Temazepam Gelthix. General Practitioners have been encouraged to prescribe gel-filled capsules to potential drug misusers in order to reduce the harm Temazepam can cause by its misuse. This study of 23 Temazepam injectors shows that the group still find the gel-filled preparation readily injectable. It appears to be more problematic in causing medical complications including superficial thrombophlebitis, abscesses and deep venous thrombosis. Temazepam misuse can cause drug users to become more chaotic. The study group recognize this and suggest there should be stricter control on the supply of Temazepam to drug dependents. General Practitioners, who are the main source of Temazepam prescribing, require additional training in prescribing to drug users.

Adult↗
PubMed2003

Paratuberculosis: eradication, control and diagnostic methods.

At the beginning of the twentieth 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. The history of programmes to control paratuberculosis in sheep, goats, and cattle in various countries is described. The vaccination of young animals (especially goats and sheep) 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 life cycle) 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 principles and different levels of control of paratuberculosis are discussed. The Dutch paratuberculosis programme is divided in two parts: an intensive programme based on test and cull and an extensive programme based on education. The intensive programme has ten herd status levels: 5 to 10 for non?suspect herds and 1 to 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. Diagnostic methods are summarised. Future developments regarding vaccination and control or acceptance of paratuberculosis are discussed.

Animals↗
PubMed1988

Viral gastroenteritis.

As our ability to control many of the common infectious diseases has increased, attention has turned toward the less common or less severe infections. It is clear that worldwide, significant numbers of the cases of gastroenteritis in both adults and children are caused by viruses. Many of these viruses now are quite well understood and their control appears to be on the horizon. Many other etiologic agents are just being identified and will present a challenge to researchers and practitioners alike.

Adult↗
PubMed2003

Rapid detection of adenovirus in throat swab specimens by PCR during respiratory disease outbreaks among military recruits.

We evaluated the performance of a generic PCR test to detect adenoviruses (AdV) in throat swab specimens collected from asymptomatic and ill military recruits with acute respiratory disease. Samples (n = 210) were collected at entry to basic training and at the time of large outbreaks of AdV-associated acute respiratory disease among military recruits at Fort Jackson, South Carolina, from 1997 to 1998. Compared to cell culture, a sensitivity of 99% and a specificity of 98% were noted for the PCR method to detect AdV in throat swabs. Similar results were obtained with or without DNA extraction, suggesting the absence of significant inhibitors for the PCR method in throat swab samples. No AdV was detected by culture or PCR in throat swabs from healthy recruits, suggesting the absence of latency or asymptomatic shedding. Throat swab specimens proved to be adequate, noninvasive samples to rapidly diagnose respiratory disease in young adults. This generic direct PCR proved to be a useful test for the rapid diagnosis of AdV-associated respiratory disease, detecting all serotypes tested to date and furnishing results within 6 h of specimen arrival. The use of this direct, rapid, sensitive, and specific assay would assist health care providers and public health practitioners in the early diagnosis, management, and control of AdV-associated respiratory disease.

Adenoviridae↗
PubMed1988

Characterization of the acute clinical illness associated with human immunodeficiency virus infection.

The clinical and serologic features and immune status of 39 homosexual men who had seroconversion to human immunodeficiency virus positivity were compared with 26 homosexual men who remained seronegative during a six-month period. An acute clinical illness occurred in 92.3% of seroconverted subjects and 40% of controls. The duration of illness was significantly greater in the seroconverters than the controls (10 + 4.4 days). A general practitioner was consulted by 87.2% of the seroconverters because of the illness, including 12.8% who were admitted to hospital, compared with 20% of controls. The most frequently reported symptoms in the seroconversion group were fever (76.9%); lethargy and malaise (66.7%); anorexia, sore throat, and myalgias (56.4% each); headaches and arthralgias (48.7% each); weight loss (46.2%); swollen glands (43.5%); retro-orbital pain (38.5%); and dehydration and nausea (30.8% each). Lymphadenopathy developed in 75% of seroconverters compared with 4% of controls. Changes in T-cell subsets were not found in controls, but the number of T4+ cells and the T4+/T8+ ratio decreased significantly in seroconverters.

Acquired Immunodeficiency Syndrome↗
PubMed1996

A national survey of nurse practitioner chlamydia knowledge and treatment practices of female patients.

Chlamydia is the most prevalent sexually transmitted disease in the United States, with over 4 million new infections presenting each year. The disease presents disproportionate problems for women who are generally asymptomatic; chlamydia is more difficult to diagnose in women than men. Untreated infections in women evolve into serious reproductive tract sequelae, including pelvic inflammatory disease, chronic pain, infertility, ectopic pregnancy, and neonatal complications. The bright side to this epidemic is that these sequelae are preventable. Chlamydia is both treatable and easily cured when it is detected. A national mailed survey of NPs was conducted to ascertain current chlamydia knowledge levels and clinical practices with female patients. Survey findings indicate that NPs are fairly knowledgeable about the infection and NP clinical practices are generally consistent with Centers for Disease Control and Prevention recommendations for chlamydia diagnostics and treatment. However, the survey identified NP deficits in screening and treatment practices for pregnant women. These findings are disturbing given the serious risks associated with failure to promptly diagnose and treat prenatal infections. The survey highlights the need for continuing professional education about chlamydia and other sexually transmitted infections.

Adolescent↗