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At least 1,315 records · Page 73Linked to original sources
PubMed2003

Update on general health risk of periodontal disease.

OBJECTIVES: To review the potential of periodontal infections to cause nonoral diseases. Therapeutic recommendations are provided to help patients and dental practitioners prevent systemic complications from periodontal infections. FINDINGS: Systemic diseases from oral bacteria are mostly caused by transient bacteraemias, which can occur spontaneously from dental foci of infection, from mastication, brushing, flossing or other daily manipulations, or from dental treatments. Examples of systemic infections that may involve oral microorganisms include infective endocarditis, aspiration pneumonia, HIV-related disseminated candidiasis and cancrum oris, septicaemia associated with cancer chemotherapy and radiotherapy, necrotising faciitis and various other life-threatening infections. Inflamed gingiva constitutes a significant reservoir for herpes viruses, which have the potential to cause serious systemic diseases in immunocompromised patients. Periodontal disease may also aggravate chronic insulin insensitivity and thus interfere with glycaemic control in diabetic patients. Controversy surrounds the involvement of periodontal infections in coronary heart disease. CONCLUSIONS: Cumulative evidence suggests that periodontal disease can be an important cause of morbidity and mortality of various systemic diseases, especially in individuals exhibiting compromised host defence. Maintaining a healthy dentition and periodontium by means of daily oral hygiene practice and regular professional care is the most effective way of preventing systemic diseases from oral infections.

Bacteremia↗
PubMed1999

Do homeopathic nosodes protect against infection? An experimental test.

CONTEXT: For centuries, homeopathic practitioners have claimed that serially agitated dilutions of infectious agents (called "nosodes") are effective in the prevention of infectious disease. However, no rigorous tests of this claim have been performed. OBJECTIVE: To test whether a nosode of Francisella tularensis-infected tissue could protect from subsequent challenge with this pathogen in vivo. DESIGN: Experimental laboratory test. SETTING: A P3 containment laboratory at an infectious disease research facility. PARTICIPANTS: 142 male C3H/HeN specific, pathogen-free mice. INTERVENTION: Six levels of a nosode prepared from tularemia-infected tissue were produced. All exposures were below the lowest level at which a classical vaccination response was expected. The nosode and dilutent control solutions were administered orally (.03 mL, 3 times per week) for 1 month before and after challenge. Animals were challenged with a potentially lethal dose (LD50 or LD75) of F tularensis, then evaluated for time of death and total mortality. MAIN OUTCOME MEASURES: Mortality and time to death. RESULTS: In a series of 15 trials (n = 142), the tularemia nosode consistently produced increased mean times to death. All but 2 of 15 trials showed reduced time to death in the nosode group and decreased mortality compared with controls. Protection rates averaged 22% over controls compared to 100% protection by standard vaccination. CONCLUSIONS: This study found partial protection from a nosode of tularemia in dilutions below those expected to have protective effects, but not as great as those produced by standard vaccination. If homeopathic nosodes can induce protection from infectious agents for which vaccination is currently unavailable, they may provide an interim method of reducing morbidity or mortality from such agents.

Administration, Oral↗
PubMed1976

Urinary infection in boys.A three-year prospective study.

73 boys who presented to their general practitioners over the course of one year with symptoms of urinary-tract infection and were found to have bacteriuria were referred to a three-year prospective study. This included clinical and radiological investigations and monitoring of the preputial flora and midstream-urine culture at monthyl intervals. 22 (30%) of the boys had radiological abnormalities of the urinary tract; 6 had pyelonephritic changes. Only 2 required urinary-tract surgery. Several findings of the study suggest that the natural history of the disease in boys is different from that in girls. Proteus spp.predominated as the infecting organisms. Culture of swabs from the preputial sac, and comparison with matched controls, suggested that the source of infection in boys is the prepuce or urethra rather than the bowel as in girls. Recurrence of infection, in the absence of radiological abnormality, was rare; 51 boys (70%) had no recurrence throughout the follow-up period. There was evidence that recurrence in boys is related to the persistence of gram-negative organisms in the urethra, revealed by low bacterial counts on midstream culture, and it is suggested that in boys urethral infection may be as important as bladder bacteriuria.

Bacteriuria↗
PubMed1993

Travel medicine and general practice: a suitable case for audit?

Travel medicine becomes more important with the continual expansion of international travel and the increased popularity of exotic holiday destinations. In the United Kingdom general practitioners provide the bulk of travel health advice and immunisation and there is growing interest in providing these services. While their armamentarium has been expanded with attractive but expensive new vaccines, the need for health service advice has never been more vital, with the risks of HIV infection and drug resistant malaria. Advantages of a general practice based travel medicine service include maintaining continuity of care for the patient, but a disadvantage might be that the general practitioner sees too few patients to acquire enough skill in the subject. Furthermore, there may be a conflict of interest between time devoted to the "vaccination ritual" and giving health advice. Overall there seems to be a case for both audit and support by the health authorities.

Communicable Disease Control↗
PubMed1993

An outbreak of epidemic polyarthritis (Ross River virus disease) in the Northern Territory during the 1990-1991 wet season.

OBJECTIVE: To describe the epidemiology of a large outbreak of epidemic polyarthritis in the Northern Territory during the wet season of 1990-1991. DESIGN, SETTING AND PARTICIPANTS: Arbovirus cases notified to the Northern Territory Department of Health and Community Services by general practitioners and local laboratories between 1 July 1990 and 30 June 1991. MAIN OUTCOME MEASURES: Date and place of infection, age, sex and symptoms. RESULTS: Doctors in the Northern Territory notified 368 cases; another 14 were infected interstate. The epidemic started in September, peaked in January and tailed off in April. The highest attack rates occurred in the rural areas of Jabiru, Litchfield Shire and Katherine. Those most affected were 30-34 year olds. Children, the elderly and Aboriginal people were under-represented. CONCLUSIONS: Epidemic polyarthritis is a wet season problem in the Northern Territory, affecting the rural towns and districts more than the cities. Pre-planned mosquito control measures (effective water drainage and larval control) limited the extent of the 1990-1991 epidemic in Darwin City and Palmerston. The low attack rate in children reflects asymptomatic and less clinically severe infections. The under-representation of Aboriginal people may be the result of infection occurring earlier in life. A related cross-sectional seroprevalence survey has shown that rural Aboriginal people across all age groups have a significantly higher seropositive rate than urban non-Aboriginal residents.

Adolescent↗
PubMedDate not supplied

Current CDC efforts to prevent and control human immunodeficiency virus infection and AIDS in the United States through information and education.

The human immunodeficiency virus (HIV) is estimated to have infected more than a million people in the United States and millions more in other countries. Even though there is no vaccine or effective treatment, HIV infection can be prevented through behavioral change. As the lead Public Health Service Agency for disease prevention, the Centers for Disease Control (CDC) has designed and implemented information and education activities with the ultimate goal of preventing HIV infection and AIDS in the United States. The target populations include the general public, school- and college-aged populations, persons infected or at increased risk of infection, minorities, and health workers. Because AIDS will be with us for a long time, CDC views educating the public as a long-term undertaking. The agency has initiated an intensive continuing national public information campaign, an informational brochure to be distributed to every U.S. household, a national AIDS information toll-free hotline, and a clearinghouse system that will maintain a comprehensive inventory of AIDS information resources and services. CDC also supports public information and education efforts by State and local health agencies. To reach school- and college-age youth, CDC, in consultation with governmental and national private sector organizations, developed guidelines for effective school health education to assist school health personnel in determining the scope and content of AIDS education. CDC also works with State and local education agencies to help carry out and evaluate educational efforts to prevent the spread of HIV among school- and college-age youth. The populations with the highest priority for AIDS information and education efforts are those who are at increased risk of acquiring or transmitting the AIDS virus because they use illicit intravenous drugs and share needles, engage in anal intercourse, have many sexual partners, practice prostitution, or engage in sex with those who practice these behaviors. Another high-priority population, because they can infect their offspring,is reproductive age women engaging in high-risk behavior and women infected with HIV who become pregnant. CDC programs targeted to these groups include community health education and risk reduction interventions, counseling and testing for HIV infection, AIDS community demonstration projects, perinatal AIDS prevention projects,and programs focused on preventing AIDS in minority populations. CDC is developing a variety of educational approaches for health workers in clinical settings because they are an important channel for providing accurate AIDS information, helping to assess risk, and counseling to actively reduce risk for the patient, sex partners of the patient, friends, and family members of the patient. CDC has conducted research and provided information and training on the use of HIV laboratory tests. CDC has also developed numerous scientific and technical guidelines and recommendations in consultation with practitioners, public health officials, and others and disseminated these through the Morbidity and Mortality Weekly Report. In addition,CDC has provided information about the risk of HIV transmission in the workplace and about methods of prevention. CDC will continue to evaluate these activities and support research in education and related interventions that may be necessary to prevent infection by the HIV virus. By providing educational support for behavior changes that decrease HIV transmission, we can contribute to AIDS prevention in the 1990s.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Identifying and treating plantar warts.

This article aims to help health practitioners to identify plantar warts, and to provide information on available treatments. The efficacy of various treatments is inconclusive. Topical treatments are recommended instead of other often costly and sometimes unsuccessful treatments such as cryotherapy. Improved education and self-management are encouraged to minimise spread of the virus and to ease discomfort.

Antiviral Agents↗
PubMed2001

HIV services for a new generation.

Expanded treatment capabilities, supportive services, and education are available to control the AIDS epidemic as it spreads among new, harder-to-reach populations. Unfortunately, disparities in health status among these groups often prevent them from getting preventive care and treatment. To build awareness among today's at-risk population, health care marketers must address the needs of their target audience. With a well-planned and sensitive approach, they can work with practitioners to bring these services to the people who need them most.

Adolescent↗
PubMed1981

Sexually transmitted diseases in women--something can be done!

Women with sexually transmitted diseases (STDs) are largely asymptomatic, and even in the presence of symptoms are frequently misdiagnosed. The "stigma of VD" perpetuates this problem, such that both patient and physician are too embarrassed to suggest appropriate STD diagnostic tests. Imperatives for the reduction of STDs include increasing federal appropriations for STD control, improving STD training for health professionals, openly advertising condoms, and equipping clinical facilities likely to see women harboring STDs with the means to diagnose and treat. The development of serologic tests and vaccines against gonorrhea, chlamydia and herpes is an additional objective that would benefit women. A multifaceted approach combining the efforts of women's groups, family physicians, gynecologists, nurse practitioners and public health educators will be required to effectively handle the problem of STDs in women.

Advertising↗
PubMedDate not supplied

Balloon-type versus non-balloon-type replacement percutaneous endoscopic gastrostomy: which is better?

Percutaneous endoscopic gastrostomy (PEG) has been an established procedure for nearly 20 years. Caring for patients with a PEG has been incorporated into the practice of nurses in most gastroenterology settings. Several practice-related questions have arisen, particularly in relation to replacement PEGs. In an attempt to obtain relevant information for decisions relating to cost-effectiveness and providing optimum care for PEG replacement, two clinical research questions were studied: (1) is there a difference in patient (stomal) response related to two different replacement PEG tubes, and (2) is there a difference in the duration (life-span) between the two types of replacement tubes? A non-experimental, two-group descriptive study was conducted to answer the two clinical research questions. Two types of replacement PEG tubes were evaluated: a balloon type and a non-balloon type. Stoma response (recording skin and insertion site characteristics) and PEG life span were the measures of interest. Differences in the occurrence of skin and insertion site problems between the two groups were not statistically significant. Differences between the life spans of the two tubes were found to be statistically significant at three time intervals. Findings give information to the practitioner involved in making independent and interdependent practice decisions when planning care for patients with a PEG. Suggestions for additional research and replication are included.

Adult↗
PubMedDate not supplied

[Infection risk and personal protective devices].

The Aa discuss the evidence and recommendations for the use of personal protective equipment by health care practitioners in general care settings; the use of aprons, gowns, gloves, eye protections, face masks is valutated on the basis of an assessment of the risk of transmission of microrganisms to the patient or from the patient to health care practitioners. The primary uses of personal protective equipment are to protect staff and reduce opportunities for transmission of microrganisms in hospitals. A trend to eliminate the unnecessary wearing of aprons, gowns and masks in general care settings has evolved over the past twenty years due to the absence of evidence that they are effective.

Eye Protective Devices↗
PubMed1997

Making the female condom a "reality" for adolescents.

Alarming rates of pregnancy, sexually transmitted diseases, and human immunodeficiency virus infection among adolescents point to the need for expanding contraceptive options for adolescents. The female condom-a female-controlled barrier method that protects both partners from sexually transmitted diseases-marks an important breakthrough in contraceptive technology. This report reviews current research on the efficacy and acceptability of the female condom and considers the feasibility of its use in the adolescent population. Specifically, the authors first consider the factors that affect teenage condom (and other contraceptive) use (efficacy, cost and availability, and acceptability) and then apply the mechanics of the female condom to these issues. Based on this analysis, recommendations for future steps to be taken by researchers, adolescent health practitioners, and the manufacturer of the female condom are presented.

Adolescent↗
PubMed2004

Are there characteristics of infectious diseases that raise special ethical issues?

This paper examines the characteristics of infectious diseases that raise special medical and social ethical issues, and explores ways of integrating both current bioethical and classical public health ethics concerns. Many of the ethical issues raised by infectious diseases are related to these diseases' powerful ability to engender fear in individuals and panic in populations. We address the association of some infectious diseases with high morbidity and mortality rates, the sense that infectious diseases are caused by invasion or attack on humans by foreign micro-organisms, the acute onset and rapid course of many infectious diseases, and, in particular, the communicability of infectious diseases. The individual fear and community panic associated with infectious diseases often leads to rapid, emotionally driven decision making about public health policies needed to protect the community that may be in conflict with current bioethical principles regarding the care of individual patients. The discussion includes recent examples where dialogue between public health practitioners and medical-ethicists has helped resolve ethical issues that require us to consider the infected patient as both a victim with individual needs and rights and as a potential vector of disease that is of concern to the community.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Randomised controlled trial of self management leaflets and booklets for minor illness provided by post.

OBJECTIVE: To assess the effectiveness of providing information by post about managing minor illnesses. DESIGN: Randomised controlled trial. SETTING: Six general practices. PARTICIPANTS: Random sample of 4002 patients from the practice registers. INTERVENTION: Patients were randomised to receive one of three kinds of leaflet or booklet endorsed by their general practitioner: control (surgery access times), booklet, or summary card. MAIN OUTCOME MEASURES: Attendance with the 42 minor illnesses listed in the booklet. Perceived usefulness of leaflets or booklets, confidence in managing illness, and willingness to wait before seeing the doctor. RESULTS: 238 (6%) patients did not receive the intervention as allocated. Of the remaining 3764 patients, 2965 (79%) had notes available for review after one year. Compared with the control group, fewer patients attended commonly with the minor illnesses in the booklet group (>/=2 consultations a year: odds ratio 0.81, 95% confidence interval 0.67 to 0.99) and the summary card group (0.83; 0.72 to 0.96). Among patients who had attended with respiratory tract infections in the past year there was a reduction in those attending in the booklet group (0.81; 0.62 to 1.07) and summary card group (0.67; 0.51 to 0.89) compared with the control group. The incidence of contacts with minor illness fell slightly compared with the previous year in the booklet (incidence ratio 0.97; 0.84 to 1.13) and summary card groups (0.93; 0.80 to 1.07). More patients in the intervention groups felt greater confidence in managing illness (booklet 32%, card 34%, control 12%, P<0.001), but there was no difference in willingness to wait score (all groups mean=32, P=0.67). CONCLUSION: Most patients find information about minor illness provided by post useful, and it helps their confidence in managing illness. Information may reduce the number attending commonly with minor illness, but the effect on overall contacts is likely to be modest. These data suggest that posting detailed information booklets about minor illness to the general population would have a limited effect.

Adult↗
PubMed1999

[Dermatological aspects in prevention and treatment of the diabetic foot syndrome].

Diabetic neuropathy, osteoarthropathy, macro- and microangiopathy and susceptibility to infection are the major factors that contribute to the diabetic foot syndrome. Therefore, these patients benefit from a multidisciplinary treatment by the general practitioner, diabetologist, orthopaedic surgeon and shoemaker, angiologist and vascular surgeon. The role of the dermatologist is to recognize early diabetic foot lesions when the diabetic patient comes for a skin problem on his feet and more specifically to manage dermatologic aspects in diabetic foot patients. These should include recommendations for general skin care, examination and treatment for onychomycosis, patch testing in contact eczema or treatment of other dermatoses, such as plantar psoriasis. Therefore, dermatology has an important impact on the prevention of complications of the diabetic foot syndrome by keeping the skin intact and avoiding potential lesions of entry for bacterial soft tissue infection. The dermatologist must educate the diabetic patient to control his feet daily, to avoid foot-baths with hot water, to use hypoallergenic moisturizers for skin care. "Bathroom surgery" with sharp instruments for nail care or trimming of corns should be discouraged. Diabetics should wear wide, well-fitting shoes without sutures on the inner side. The inside of the shoes should always be checked for foreign bodies or irregular surfaces before they are put on. Diabetics should not walk barefoot. Callosities (calluses, corns) should be shown to the podologist or to the doctor. They are always a sign of increased mechanical stress and therefore, require an adjustment of footwear. Trimming of callosities can only aim at giving symptomatic relief and does not replace an appropriate correction of the mechanical stress. Semi-occlusive synthetic dressings have facilitated the treatment of non-infected chronic wounds. When probing of the bone is positive, however, osteomyelitis has to be assumed and empirical antibiotic therapy started. With the development of catheter-based interventional procedures and of cruro-pedal arterial bypasses the potiential of revascularization in diabetic foot with peripheral arterial occlusive disease has greatly improved. Retrograde intravenous antibiotic therapy under Bier's arterial arrest and the use of G-CSF improve the chance of healing bacterial soft tissue infection in a diabetic foot. In summary, optimization of prevention and treatment of the diabetic foot syndrome should allow for substantial reduction of amputations.

Diabetic Foot↗
PubMed1993

[Consensus therapy of sexually transmissible diseases].

The organization and the management of sexually transmitted diseases shows large differences between general practitioners and specialists and also between specialists in dermato-venereology, obstetrics and urology. Changing insights in epidemiology, growing knowledge in complications, new technology in the diagnosis of sexually transmitted diseases and limited therapeutic possibilities have important implications for the different options in the control of sexually transmitted diseases. By promoting uniformity in strategies for sexually transmitted diseases these consensus guidelines have tried to formulate minimal standards for diagnostic procedures, therapy and follow-up for the most important sexually transmitted diseases.

Chlamydia Infections↗
PubMed2006

International standards for tuberculosis care.

Part of the reason for failing to bring about a more rapid reduction in tuberculosis incidence worldwide is the lack of effective involvement of all practitioners-public and private-in the provision of high quality tuberculosis care. While health-care providers who are part of national tuberculosis programmes have been trained and are expected to have adopted proper diagnosis, treatment, and public-health practices, the same is not likely to be true for non-programme providers. Studies of the performance of the private sector conducted in several different parts of the world suggest that poor quality care is common. The basic principles of care for people with, or suspected of having, tuberculosis are the same worldwide: a diagnosis should be established promptly; standardised treatment regimens should be used with appropriate treatment support and supervision; response to treatment should be monitored; and essential public-health responsibilities must be carried out. Prompt and accurate diagnosis, and effective treatment are essential for good patient care and tuberculosis control. All providers who undertake evaluation and treatment of patients with tuberculosis must recognise that not only are they delivering care to an individual, but they are also assuming an important public-health function. The International Standards for Tuberculosis Care (ISTC) describe a widely endorsed level of care that all practitioners should seek to achieve in managing individuals who have, or are suspected of having, tuberculosis. The document is intended to engage all care providers in delivering high quality care for patients of all ages, including those with smear-positive, smear-negative, and extra-pulmonary tuberculosis, tuberculosis caused by drug-resistant Mycobacterium tuberculosis complex, and tuberculosis combined with HIV infection.

Antitubercular Agents↗
PubMed2000

The human transmissible spongiform encephalopathies (TSEs): implications for dental practitioners.

Transmissible spongiform encephalopathies (TSEs) are rare, fatal degenerative brain diseases which affect humans and certain animals, and are caused by inheritance or acquisition of prions (PrPs). Inherited TSEs include Fatal Familial Insomnia (FFI), Gerstmann-Straussler-Scheinker syndrome (GSS) and other less well clinically characterised disorders, while the human infective TSEs include sporadic, iatrogenic and variant Creutzfeldt-Jakob disease (vCJD). The causative prions are found especially in neural tissues and spinal fluid, and in the case of vCJD, in lymphoreticular tissue. Available epidemiological evidence suggests that normal social or routine clinical contact with affected patients does not present a risk to health care workers, relatives or the community. Isolation of patients is not considered necessary. Nevertheless as the prions are resistant to conventional chemical, irradiation and heat sterilisation methods, highly specific cross-infection control measures are required for the dental management of patients with, or at notable risk, of TSE. The present article reviews current knowledge of the clinical consequences of prion disease and provides information regarding necessary changes to the cross-infection routine when managing patients infected, or at risk of, prion disease.

Animals↗