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[Joint effort to improve quality in a Brazilian pediatric public hospital through cross-infection control]

OBJECTIVES: To examine the role of the laboratory in nosocomial infection control from January 1993 to December 1996 in Centro Geral de Pediatria of Hospital Foundation of Minas Gerais state. METHODS: Follow -up of 101,139 patient-days (11,147 discharges + deaths + transfers) in the wards and intensive care unit by using the National Nosocomial Infection Surveillance (NNIS) system proposed by the Centers for Disease Control and Prevention (CDC- Atlanta). Prospective surveillance of nosocomial infections at all sites was performed according to the hospital - wide (since 1992) and intensive care unit (since 1996) NNIS components. The CDC definitions since 1988 and Brazilian Ministry of Health regulation number 930 since 1992 were used to diagnose the nosocomial infections. RESULTS: The five most frequent nosocomial pathogens (from a total of 139 isolates) were Klebsiella sp = 24.5%; S. aureus = 18%; P. aeruginosa = 13.7%; E. coli = 12.9%; S. epidermidis = 12.2%. The percentage of identification of pathogens isolated from nosocomial infection sites has increased from 6.2% in 1993 to 13.3% in 1995 and 28.2% in 1996 (p< 0.001) and so has the attempt to isolate the pathogens: 7.5% in 1993, 16.1% in 1995, 33.8% in 1996 (p< 0.001). The time interval taken for lab results (from specimen collected to microbiology result) has decreased from the average of ten days in 1993 to six days in 1996 (p = 0.001). CONCLUSIONS: The continuing education and improved communication among infection control personnel, pediatricians, surgeons and members of the laboratory have proven to play a key role in the epidemiology of nosocomial infections by defining their etiologies in the Centro Geral de Pediatria. A task force to determine the microbiology has been achieved by the understanding of all clinicians that it is important to treat their patients specifically. The NNIS method applied to Brazilian hospitals has shown its impact on the microbiology lab role in nosocomial infection control as well.

Journal Article↗

PubMed2026

A Meta-analysis of the intervention effects of ball sports on children with autism Spectrum disorder.

PURPOSE: To evaluate the overall efficacy of ball sports interventions for children with autism spectrum disorder (ASD) and to explore potential moderators that may influence intervention outcomes. METHODS: Randomized controlled trials were retrieved from nine databases (e.g., CNKI, PubMed) from 2000 to April 2025. Meta-analysis was conducted using RevMan 5.4 and Stata 18.0, with subgroup analyses by age, duration, frequency, session length, and ball sport type. RESULTS: A total of 14 randomized controlled trials involving 406 children were ultimately included. Meta-analysis results indicated that ball sports had a significant overall intervention effect on children with ASD (SMD = -1.12, 95% CI: -1.56, -0.68, P < 0.05), with significant improvements observed in social skills (SMD = -0.55), verbal communication (SMD = -0.85), and behavioral problems (SMD = -1.10). Subgroup analysis indicated that interventions involving mini-basketball or other ball sports with simple rules-conducted over a 12-week period, 3-5 times per week, for 30-60 min per session-yielded better outcomes, with children aged 3-6 years showing more consistent benefits. CONCLUSION: Ball-based interventions effectively alleviate core ASD symptoms. Structured moderate-intensity programs are recommended as adjunct therapies. Future studies should standardize protocols and examine long-term benefits.

Humans↗

PubMed2006

Life cycle assessment of second generation (2G) and third generation (3G) mobile phone networks.

The environmental performance of presently operated GSM and UMTS networks was analysed concentrating on the environmental effects of the End-of-Life (EOL) phase using the Life Cycle Assessment (LCA) method. The study was performed based on comprehensive life cycle inventory and life cycle modelling. The environmental effects were quantified using the IMPACT2002+ method. Based on technological forecasts, the environmental effects of forthcoming mobile telephone networks were approximated. The results indicate that a parallel operation of GSM and UMTS networks is environmentally detrimental and the transition phase should be kept as short as possible. The use phase (i.e. the operation) of the radio network components account for a large fraction of the total environmental impact. In particular, there is a need to lower the energy consumption of those network components. Seen in relation to each other, UMTS networks provide an environmentally more efficient mobile communication technology than GSM networks. In assessing the EOL phase, recycling the electronic scrap of mobile phone networks was shown to have clear environmental benefits. Under the present conditions, material recycling could help lower the environmental impact of the production phase by up to 50%.

Cell Phone↗

PubMed2004

Are effects of depression management training for General Practitioners on patient outcomes mediated by improvements in the process of care?

BACKGROUND: Depression treatment by General Practitioners (GPs) and patient outcomes improved significantly after a comprehensive 20-h training program of GPs. This study examines whether the effects on patient outcomes are caused by the improvements in the process of care. METHODS: Seventeen GPs participated in the training program. A pre-test-post-test design was used. A total of 174 patients (85 pre-test, 89 post-test) aged 18-65 met ICD-10 criteria for recent onset major depression. The main indicator of mediation was a drop in training effect size (eta2) on patient outcome after adjustment for individual and combined process of care variables. We evaluated depression-specific (recognition, accurate diagnosis, prescription of antidepressant, adequate antidepressant treatment) and a non-specific process of care variable (communicative skillfulness of the GP) as well as the combination of adequate antidepressant treatment and communicative skillfulness. Patient outcomes were assessed at 3 months and consisted of change in severity of symptomatology, level of daily functioning and activity limitation days from baseline. RESULTS: Depression-specific interventions mediated up to one third of the observed improvement in patient outcome. 'Adequate dosage and duration of an antidepressant' explained 36% of the training effect on patient outcome (eta2 from 0.044 to 0.028). 'Communicative skillfulness of the GP' only was a weak mediator (18% explained; eta2 from 0.044 to 0.036). However, the combination of both, that is adequate antidepressant treatment by a communicative skillful GP, proved to be the strongest mediator of the observed training effect on patient outcomes (59% explained; eta2 from 0.044 to 0.018). LIMITATIONS: The training effects on patient outcomes in this sample were small. Hence, the scope for mediation was limited. CONCLUSION: GP communication skills are important to enhance depression-specific interventions in bringing about improvements in patient outcomes and should be addressed in GP training programs for the treatment of depression.

Adolescent↗

PubMed2001

Patients' experiences of receiving telephone advice from a GP co-operative.

BACKGROUND: The use of the telephone to deliver health care advice has increased considerably in recent years. Little research has been carried out to explore the experience of patients who receive such advice and its acceptability. OBJECTIVES: The aim of this study is to describe the expectations of patients, or third party callers, who had contacted a GP out-of-hours co-operative and their satisfaction with telephone advice received. METHODS: Semi-structured interviews were conducted by telephone 7-10 days after contact with one inner city GP co-operative. RESULTS: A total of 47 telephone consultations were followed up with an interview. Of these, 23 (48.9%) callers had expected to be offered a home visit when they called. Reasons for wanting a home visit were either to do with the nature of the condition and its perceived severity, problems in being able to attend the primary care centre and the risks of travel, or because of problems in communicating over the telephone. Satisfaction with telephone consultations centred mostly on the doctor being able to provide reassurance and give adequate time to allay concerns. The most common reasons given for dissatisfaction were the caller feeling that the doctor could not make a correct diagnosis without having seen the patient, or the caller being made to feel that they were wasting the doctor's time. Many patients were anxious about their ability to describe symptoms over the telephone, or understand and follow the advice that they received. CONCLUSIONS: There appears to be a need for patients to be better informed about the service they can expect to receive from GP co-operatives. Recent developments such as NHS Direct may have an influence on the telephone consultation rate to GP co-operatives.

Adolescent↗

PubMed2001

A prospective study of quality of life in head and neck cancer patients. Part I: at diagnosis.

PURPOSE: A Swedish and Norwegian study was designed to examine health-related quality of life (HQL) in patients with head and neck cancer (head and neck) at diagnosis and during treatment and rehabilitation. The overall aim was to examine the impact on HQL at diagnosis depending on tumor location, stage, sex, and age (part I) and to describe HQL longitudinally and determine for which patients and during which period HQL deteriorated most (part II). This article presents the results at diagnosis. METHOD: Patients with head and neck cancer at five hospitals in Sweden and Norway were consecutively requested to participate. They were asked to answer the EORTC QLQ-C30 and QLQ-H&N35 (the European Organization for Research and Treatment of Cancer, Core 30 questionnaire and head and neck cancer module) repeatedly during 1 year. A total of 357 patients (mean age, 63 y; 72% males) were included. RESULTS: Patients with different tumor locations all had their special problems at diagnosis, for example, those with tumors in the larynx with communication, those with oral tumors with pain, and those with pharyngeal tumors with nutrition and pain. The patients with hypopharyngeal cancer reported the worst HQL. Stage appeared to have the strongest impact on HQL. Patients with a more advanced tumor stage reported significantly worse HQL scores for 24 of 32 variables reflecting functioning or problems. The females scored worse than the males for some areas, in particular, emotional functioning. The older patients scored significantly better for emotional and social functioning than patients <65 years but worse for physical functioning and various symptoms. The traditional way of grouping the tumor locations into oral, pharyngeal, laryngeal, and "other" tumors (salivary gland, sinus and nose, and unknown primary) was tested from a HQL point of view and found to be consistent. CONCLUSIONS: The chosen questionnaires differentiated between different sites of head and neck cancer at diagnosis. Tumor stage had the most powerful impact on HQL score.

Aged↗

PubMed2004

Trends in urology graduate medical education: a brief update from the Urology Residency Review Committee.

PURPOSE: This communication clarifies recent trends with regard to the number and configuration of urology training programs, and more precisely describes recent variations in the number of urology residents in training. MATERIALS AND METHODS: We reviewed and analyzed longitudinal data from the Accreditation Council for Graduate Medical Education regarding the number of urology resident positions as well as the number and format of urology training programs in the United States. Several publications related to general and urological graduate medical education were also reviewed. RESULTS: In response to various accreditation and demographic forces the total number of urology residency training programs has decreased by more than 20% since 1982. Coincident with this decrease was a transition in urology resident education away from smaller preceptor based programs and toward the current model of larger, broad based training programs anchored by academic medical centers. The educational format of most residency programs has also evolved, such that in 2003 all except 1 accredited program required 4 years of education in the clinical and basic urological sciences. For most programs this shift coincided with a decrease in the duration of pre-urological general surgical training. The number of first year urology residents decreased progressively between 1994 and 1998 before stabilizing at the current level of approximately 250 first year positions. In 2003 the total number of urologists in training was actually higher than it had been for most of the last decade. CONCLUSIONS: We describe recent trends in urological graduate medical education. The observations reported suggest that our specialty has maintained its focus on training a consistent number of high quality urological surgeons.

Education, Medical, Graduate↗

PubMed2005

Enhancing primary health care services for adults with intellectual disabilities.

BACKGROUND: Primary health care teams have an important part to play in addressing the health inequalities and high levels of unmet health needs experienced by people with intellectual disabilities (ID). Practice nurses have an expanding role within primary health care teams. However, no previous studies have measured their attitudes, knowledge, training needs, and self-efficacy in their work with people with ID. METHODS: All practice nurses working in a defined area were identified. A purpose-designed questionnaire to measure nurse attitudes, knowledge, training needs and self-efficacy was developed and piloted. All practice nurses were then invited to participate. Data from completed questionnaires were entered onto PC and analysed. RESULTS: Of a total of 292 practice nurses 201 (69%) participated. Whilst 89% (n=179) of participants reported having infrequent contact, 25% (n=50) reported a growing workload with people with ID. Only 8% (n=16) had ever received any training in communicating with people with ID. A knowledge gap regarding the health needs of people with ID was identified. Eighty-six per cent reported having experienced specific difficulties during previous appointments, and only 23% thought they had sufficient case note information at appointments, but 68% did not modify the duration of their appointments with people with ID. Conversely, responses demonstrated that practice nurses have a high level of experience and qualification in general nursing, have positive attitudes to working with people with ID, and high self-efficacy scores were identified for work with people with ID. The practice nurses viewed ID to be a high priority area for future training. CONCLUSIONS: Primary health care teams have a key role in tackling the unmet health needs of people with ID. Whilst this project has identified factors that may impact on the accessibility of services, it has also identified practice nurses as having positive attitudes and high self-efficacy scores in their work with people with ID. This indicates that they should be targeted for specific training in this area, which may make an important contribution in enhancing future accessibility of primary health care services for people with ID.

Adult↗

PubMed2004

Patient experiences and attitudes about access to a patient electronic health care record and linked web messaging.

OBJECTIVE: Patient access to their electronic health care record (EHR) and Web-based communication between patients and providers can potentially improve the quality of health care, but little is known about patients' attitudes toward this combined electronic access. The objective of our study was to evaluate patients' values and perceptions regarding Web-based communication with their primary care providers in the context of access to their electronic health care record. METHODS: We conducted an online survey of 4,282 members of the Geisinger Health System who are registered users of an application (MyChart) that allows patients to communicate electronically with their providers and view selected portions of their EHR. To supplement the survey, we also conducted focus groups with 25 patients who were using the system and conducted one-on-one interviews with ten primary care clinicians. We collected and analyzed data on user satisfaction, ease of use, communication preferences, and the completeness and accuracy of the patient EHR. RESULTS: A total of 4,282 registered patient EHR users were invited to participate in the survey; 1,421 users (33%) completed the survey, 60% of them female. The age distribution of users was as follows: 18 to 30 (5%), 31 to 45 (24%), 46 to 64 (54%), 65 and older (16%). Using a continuous scale from 1 to 100, the majority of users indicated that the system was easy to use (mean scores ranged from 78 to 85) and that their medical record information was complete, accurate, and understandable (mean scores ranged from 65 to 85). Only a minority of users was concerned about the confidentiality of their information or about seeing abnormal test results after receiving only an explanatory electronic message from their provider. Patients preferred e-mail communication for some interactions (e.g., requesting prescription renewals, obtaining general medical information), whereas they preferred in-person communication for others (e.g., getting treatment instructions). Telephone or written communication was never their preferred communication channel. In contrast, physicians were more likely to prefer telephone communication and less likely to prefer e-mail communication. CONCLUSION: Patients' attitudes about the use of Web messaging and online access to their EHR were mostly positive. Patients were satisfied that their medical information was complete and accurate. A minority of patients was mildly concerned about the confidentiality and privacy of their information and about learning of abnormal test results electronically. Clinicians were less positive about using electronic communication than their patients. Patients and clinicians differed substantially regarding their preferred means of communication for different types of interactions.

Attitude to Computers↗

PubMed1998

Why do some patients not cash their prescriptions?

BACKGROUND: A small number of studies have used different methodologies to measure primary non-compliance, but they have not established the reasons for patients not cashing their prescriptions. It has been suggested that the number of uncashed prescriptions is a measure of the quality of doctor-patient communication, but this hypothesis remains untested. AIM: To establish the feasibility of obtaining data on a sensitive subject from patients by interview and to seek patients' reasons for not cashing prescriptions using qualitative data. METHOD: Questionnaire administered to 1000 consecutive patients attending surgery, followed by interview with those patients who indicated that they had not cashed the index prescription. RESULTS: The response rate was 93.5%. Twenty-two patients were included in the study. There was wide variation in the number of uncashed prescriptions issued by each doctor (1-13). A total of nine out of 22 patients reported that their medication was cheaper over the counter and obtained it in this way; 13 out of 22 did not obtain their medication. Five patients indicated that cost was a factor in not obtaining their medication. Other factors included the doctor's permission not to cash the prescription, poor understanding of the illness, and the wish to maintain control. CONCLUSION: It is feasible to ask patients about aspects of their behaviour that may indicate, or cause, difficulties in the doctor-patient relationship. Prescribing behaviour varies widely between doctors and, although cost is a factor in determining whether a prescription will be cashed, other variables, such as the patient's desire to maintain control over the illness, may be more important.

Adolescent↗

PubMed2002

Loewenstein communication scale for the minimally responsive patient.

PRIMARY OBJECTIVE: Any sign of communicative ability in patients in vegetative state can provide information about regain of consciousness and conservation of cognitive abilities. The aim of this study was to test the reliability and validity of an instrument designed to measure the degree of communication in minimally responsive patients. MATERIALS: The Loewenstein Communication Scale (LCS) measures five hierarchical functions - mobility, respiration, visual responsiveness, auditory comprehension and linguistic skills (verbal or alternative) - which are divided into five parameters and rated in developmental order on a 5-point scale by level of difficulty. Scores for each function are summed to obtain a quantitative communication profile. METHODS: Forty-two adult patients in vegetative state, as a result of acquired brain injury, were examined with the proposed LCS for the minimally responsive patients by two speech and language clinicians at admission to the Intensive Care Unit (ICU) for brain injured patients and, thereafter, at least once weekly. At the end of the ICU stay, 27 patients who showed signs of recovery and were referred for continued rehabilitation were compared to a group of 15 patients who were not referred for continued rehabilitation, for functional and general LCS scores. The predictive power of the LCS in differentiating between these groups was tested. RESULTS: The LCS was found to have very good reliability with good inter-rater agreement. Patients who eventually continued rehabilitation had significantly higher total scores as well as in the motor, visual and auditory sub-scales. Logistic regression results indicated that these parameters successfully differentiated between the two groups of patients, even after adjusting for age and for scores on the Glasgow Coma Scale. CONCLUSION: The LCS for the minimally responsive patients proved to be reliable and predictive of rehabilitation progress of minimally responsive patients. It may be useful for the interdisciplinary rehabilitation team in planning early individually targeted therapeutic programmes.

Adolescent↗

PubMed2003

Reducing psychiatric stigma and discrimination--evaluating an educational intervention with the police force in England.

BACKGROUND: Across the world there are programmes challenging negative stereotypes of people with mental health problems and associated discriminatory behaviours, but the evidence base describing what works in practice is still underdeveloped. This paper evaluates the effectiveness of a mental health training intervention with the police force in England. METHOD: A total of 109 police officers attended training workshops and completed pre- and post-questionnaires detailing knowledge, attitudes and behavioural interventions. RESULTS: Mean attitude scores fell from 2.4 at baseline to 2.3 at follow-up (p < 0.0001) using a 5-point Likert scale. Five key message statements were assessed - 70 % of cases successfully reported more messages at follow-up as compared to baseline; however, the stereotype linking people with mental health problems with violent behaviour overall was not successfully challenged. Positive impacts on police work, particularly improvements in communication between officers and subjects, were reported by a third of cases. CONCLUSIONS: Short educational interventions can produce changes in participants' reported attitudes towards people with mental health problems, and can leave police officers feeling more informed and more confident to support people in mental distress.

Attitude to Health↗

PubMed2005

Lifestyle-related risks: are trends in Europe converging?

OBJECTIVES: What has become of lifestyle differences in a united Europe, where member states become more and more similar on aspects such as welfare systems and population dynamics? In this paper, we try to answer the question whether the gap in lifestyle-related risk factors in Europe has narrowed over the past 30-40 years. METHODS: Smoking, alcohol consumption, physical activity, obesity and food consumption all have an impact on cancer, cardiovascular disease and other non-communicable diseases. Databases of Eurostat, OECD (Organisation for Economic Co-operation and Development) and the World Health Organisation were screened for data on lifestyle-related risk factors in the European Union, and a literature search was performed for studies that collected international comparable data about the selected factors. RESULTS: The gap in European lifestyle has narrowed over the past 30-40 years for smoking (women), alcohol consumption and total fat intake. For fruit and vegetable consumption, convergence is not occurring. For some risk factors, such as smoking and obesity, intranational differences surpass the international differences. CONCLUSIONS: The results support the notion of convergent lifestyles among Europeans over time. We also found that there is a serious lack of reliable data on lifestyle-related risk factors that are suitable for international comparison. It is essential to invest in reliable and internationally comparable data, obtained according to best evidence, to get more insight into real differences regarding risk factors in Europe. The European Public Health programme may be an opportunity to realize these goals.

Age Factors↗

PubMed2002

Lead(II) as a probe for investigating RNA structure in vivo.

In this communication, we describe a simple and reliable method for RNA structure determination in vivo, using the divalent ion, lead(II), as a structural probe. Lead(II) is known to cleave RNA within single-stranded regions, loops, and bulges, whereas cleavages in double-stranded regions are weaker or absent. Because the ion easily entered bacterial cells, Escherichia coli cultures were treated by addition of 50-100 mM lead(II) acetate for 3-7 min, resulting in partial cleavage of RNA in vivo. Cleavage positions were mapped by reverse transcription analysis of total extracted RNA. Three RNAs were analyzed: tmRNA, CopT (the target of the antisense RNA CopA), and the leader region of the ompF mRNA. All three RNAs had previously been analyzed in vitro, and secondary structure models were available. The results presented here show that lead(II) cleavages in vivo yield detailed structural information for these RNAs, which was in good agreement with the models proposed based on in vitro work. These data illustrate the potential of lead(II) as a sequence-independent RNA structure probe for use in living cells.

Base Sequence↗

PubMed2003

Preparing graduates for the first year of residency: are medical schools meeting the need?

PURPOSE: Changes in graduate medical education associated with full implementation of the Balanced Budget Act of 1997 have required medical schools to review and revise their curricula. As limited funding increases pressures to streamline training, residencies will potentially expect an entry level of skill and competence that is greater than that which schools are currently providing. To determine whether medical school curricular requirements correlate with residency needs, this multidisciplinary pilot study investigated expectations and prerequisites for postgraduate specialty training. METHOD: A questionnaire about 100 skills and competencies expected of new first-year residents was sent to 50 U.S. residency directors from surgery, internal medicine, family medicine, pediatrics, and obstetrics-gynecology programs. Each director was asked to state expectations of a first-year resident's competence in each skill at entry to residency and after three months of training. Skills deemed most appropriately acquired in residency were also identified. Competencies included diagnosis, management, triage, interpretation of data, informatics and technology, record keeping, interpersonal communications, and manual skills. RESULTS: A total of 39 residency directors responded, including seven surgery, nine medicine, seven family medicine, eight pediatrics, and eight obstetrics-gynecology. In addition to physical examination skills, 13 competencies achieved more than 70% agreement as being entry-level skills. There was wide variability as to the relative importance of the remaining skills, with residency directors expecting to devote significant resources and time in early training to ensure competence. CONCLUSIONS: Medical schools should consider the expectations of their students' future residency directors when developing new curricula. Assuring students' competencies through focused curricular change should save both time and resources during residency.

Academic Medical Centers↗

PubMed2007

Validity and reliability of patient satisfaction questionnaires in a dental school in Japan.

PURPOSE: The purpose of this study was to construct questionnaires for the dental school setting from freely given patient answers with the aid of text mining, and to confirm the structure, reliability and validity of the questionnaires. METHODS: Using these questionnaires, we carried out a survey of the satisfaction of patients treated at the Dental Hospital of the Tsurumi University School of Dental Medicine. A total of 3394 patients participated in the study. To confirm the reliability of inter-item correlations and construct validity, factor analysis was carried out, and items belonging to each factor and Cronbach's alpha coefficients were calculated. RESULTS: Four factors were extracted and 64.0% of the variance was explained by these four factors. All correlation coefficients were >0.85. These four factors were: 'Treatment', 'Communication', 'Facilities' and 'Appearances'. From structural equation modelling, we determined that overall satisfaction was >0.75 and was statistically significant. CONCLUSION: The questionnaires used in this study are useful for measuring patient satisfaction in the dental school hospital setting.

Adolescent↗

PubMed2001

Tuberculosis at the end of the 20th century in England and Wales: results of a national survey in 1998.

BACKGROUND: A national survey of tuberculosis was conducted in England and Wales in 1998 to obtain detailed information on the occurrence of the disease and recent trends. This survey also piloted the methodology for enhanced tuberculosis surveillance in England and Wales and investigated the prevalence of HIV infection in adults with tuberculosis. METHODS: Clinical and demographic data for all cases diagnosed during 1998 were obtained, together with microbiological data where available. Annual incidence rates in the population were estimated by age, sex, ethnic group, and geographical region using denominators from the 1998 Labour Force Survey. Incidence rates in different subgroups of the population were compared with the rates observed in previous surveys. The tuberculosis survey database for 1998 was matched against the Communicable Disease Surveillance Centre HIV/AIDS database to estimate the prevalence of HIV co-infection in adult patients with tuberculosis. RESULTS: A total of 5658 patients with tuberculosis were included in the survey in England and Wales (94% of all formally notified cases during the same period), giving an annual rate of 10.93 per 100 000 population (95% CI 10.87 to 10.99). This represented an increase of 11% in the number of cases since the survey in 1993 and 21% since 1988. In many regions case numbers have remained little changed since 1988, but in London an increase of 71% was observed. The number of children with tuberculosis has decreased by 10% since 1993. Annual rates of tuberculosis per 100 000 population have continued to decline among the white population (4.38) and those from the Indian subcontinent, although the rate for the latter has remained high at 121 per 100 000. Annual rates per 100 000 have increased in all other ethnic groups, especially among those of black African (210) and Chinese (77.3) origin. Over 50% of all patients were born outside the UK. Recent entrants to the UK had higher rates of the disease than those who had been in the country for more than 5 years or who had been born in the UK. An estimated 3.3% of all adults with tuberculosis were co-infected with HIV. CONCLUSIONS: The epidemiology of tuberculosis continues to change in England and Wales and the annual number of cases is rising. More than one third of cases now occur in young adults and rates are particularly high in those recently arrived from high prevalence areas of the world. The geographical distribution is uneven with urban centres having the highest rates. The increase in the number of cases in London is particularly large. Tuberculosis in patients co-infected with HIV makes a small but important contribution to the overall increase, particularly in London. To be most effective and to make the most efficient use of resources, tuberculosis prevention and control measures must be based on accurate and timely information on the occurrence of disease. A new system of continuous enhanced tuberculosis surveillance was introduced in 1999, based on the methodology developed in this national survey.

AIDS-Related Opportunistic Infections↗

PubMed2006

Early-life psychological stress exacerbates adult mouse asthma via the hypothalamus-pituitary-adrenal axis.

RATIONALE: Despite accumulating evidence that psychological stress has a short-lasting detrimental effect on asthma, little is known about the way stress in childhood predisposes to adult asthma. OBJECTIVES: Using a communication box, we investigated the long-lasting effect of early psychological and physical stress on adult asthma in mice. METHODS: Male BALB/c mice were exposed to either psychological stress or physical stress three times (every other day) during their fourth week of life. The mice were sensitized to ovalbumin at 8 and 10 weeks, and an ovalbumin airway challenge was conducted at the age of 11 weeks. RESULTS: Twenty-four hours after ovalbumin challenge, both psychological and physical stress-exposed mice exhibited a significant acceleration in the number of total mononuclear cells and eosinophils and airway hyperresponsiveness compared with control mice. No differences in serum anti-OVA-specific immunoglobulin E levels were found between stress-exposed and control animals after antigen sensitization. In the psychological stress group, but not in the physical stress group, an elevation of the serum corticosterone levels during ovalbumin challenge was significantly attenuated in comparison with the control group. Moreover, pretreatment with RU-486, a glucocorticoid receptor antagonist, before ovalbumin challenge completely inhibited a psychological stress-induced exacerbation of asthma. However, pretreatment with GR-82334, a neurokinin-1 receptor antagonist, failed to affect physical stress-induced augmentation of airway inflammation. CONCLUSION: Early psychological and physical stresses aggravated adult asthma via hyporesponsiveness of the hypothalamic-pituitary-adrenal axis during antigen challenge and via a pathway(s) distinct from the hypothalamic-pituitary-adrenal axis or neurokinin-1 receptors.

Animals↗