Residues of chlordane in fish in the Gulf of Gdańsk

Concentrations, composition and spatial variations of the residues of the pesticide Chlordane were determined in several species of fish caught in Gulf of Gdańsk. The residues of Chlordane (cis-i trans-chlordane, cis-i trans-nonachlor, oxychlordane, heptachlor, heptachlor epoxide, MC4, MC5, MC6, MC7, U82 and U83) were found in all fish examined, however, the concentrations noted were low, i.e. from 0.40 to 12 ng/g wet weight. Among the Chlordane constituents and metabolites determined trans-naonachlor, cis-chlordane, oxychlordan, heptachlor epoxide, cis-nonachlor, MC5, MC6 and trans-chlordane were dominated, and MC4, MC7, U82 and U83 were minor compounds. No heptachlor residues were found in fish examined. A small concentrations and specific composition of the residues of Chlordane and its metabolites determined in fish from the Gulf of Gdańsk do indicate on a distant sources of pollution with that pesticide--mainly transported and deposited via the atmosphere.     

Variations in occurrences of nutrition-related diseases in Sub-Saharan Africans in stages of transition: what of the future?

In many Sub-Saharan African populations, in particular urban dwellers, there have been marked rises in the prevalences of obesity in women, hypertension, diabetes, and cerebral vascular disease. Yet there have been only slight rises in coronary heart disease. To learn more of the roles of the various influencing factors in the puzzling situations described, some aspects of the past and present occurrences of these diseases are described and discussed, with comparisons being made with corresponding situations in African Americans, as well as in certain white populations. Despite increases in the knowledge of influencing factors, such fail to explain fully the epidemiologic situations described. As to the future, judging from the experiences of other populations, despite continuing indigence, within the next generation significant rises in coronary heart disease in certain African populations seem to be inevitable. However, in many of those populations, in particular those in the South, the extent of changes, apart from those linked with level of socioeconomic state, will be strongly affected by the rising epidemic of human immunodeficiency virus and acquired immunodeficiency syndrome.     

Comparison of in vivo and in vitro tests of resistance in patients treated with chloroquine in Yaoundé, Cameroon

The usefulness of an isotopic in vitro assay in the field was evaluated by comparing its results with the therapeutic response determined by the simplified WHO in vivo test in symptomatic Cameroonian patients treated with chloroquine. Of the 117 enrolled patients, 102 (87%) completed the 14-day follow-up, and 95 isolates obtained from these patients (46 children, 49 adults) yielded an interpretable in vitro test. A total of 57 of 95 patients (60%; 28 children and 29 adults) had an adequate clinical response with negative smears (n = 46) or with an asymptomatic parasitaemia (n = 11) on day 7 and/or day 14. The geometric mean 50% inhibitory concentration of the isolates obtained from these patients was 63.3 nmol/l. Late and early treatment failure was observed in 29 (30.5%) and 9 (9.5%) patients, respectively. The geometric mean 50% inhibitory concentrations of the corresponding isolates were 173 nmol/l and 302 nmol/l. Among the patients responding with late and early treatment failure, five isolates and one isolate, respectively, yielded a discordant result (in vivo resistance and in vitro sensitivity). The sensitivity, specificity, and predictive value of the in vitro test to detect chloroquine-sensitive cases was 67%, 84% and 86%, respectively. There was moderate concordance between the in vitro and in vivo tests (kappa value = 0.48). The in vitro assay agrees relatively well with the therapeutic response and excludes several host factors that influence the results of the in vivo test. However, in view of some discordant results, the in vitro test cannot substitute for in vivo data on therapeutic efficacy. The only reliable definition of "resistance" in malaria parasites is based on clinical and parasitological response in symptomatic patients, and the in vivo test provides the standard method to determine drug sensitivity or resistance as well as to guide national drug policies.     

Manifestatations of violence in adolescents in public schools in the municipality of Jaboatão dos Guararapes

Adolescence is a period in human development characterized by profound biological, psychological and social modifications affecting both adolescents and their entire social and family environment. This stage, which has good character forming opportunities, is also permeated by various risks, including violence. Nowadays, violence is the main cause of death among adolescents and is considered a public health concern. This research sought to investigate manifestations of violence in adolescents from public schools of the municipality of Jaboat?o dos Guararapes. This is a qualitative study, in which the data obtained from a questionnaire was analyzed using the content analysis technique. The results show that the main manifestations of violence involve harm to others. Drug usage was revealed as the main motive behind physical violence. The deployment of more policemen was the strategy most cited and strengthening the family unit was the most commented preventative measure. In conclusion, the importance of further discussion about disguised manifestations of violence is clear as this would contribute to reflections on new prevention proposals and greater visibility of the phenomenon.     

Economic evaluation of Sinfrontal®in the treatment of acute maxillary sinusitis in adults

Background

Sinfrontal®, a complex homeopathic medication, is popular in Germany for the treatment of ear, nose and throat and respiratory tract infections. Unlike many other homeopathic or herbal medications, the efficacy and safety of Sinfrontal® has been demonstrated in a number of clinical studies of patients with sinusitis.

Objective

To assess the cost effectiveness of Sinfrontal® versus placebo in the treatment of adults with acute maxillary sinusitis (AMS) in Germany. A secondary objective was to assess the cost effectiveness of Sinfrontal® versus standard treatment with antibacterials.

Methods

Sinfrontal® was compared with placebo in a cost-utility analysis based on data from a randomized controlled clinical trial over 3 weeks (Sinfrontal® group: n=57; placebo group: n = 56). Trial data were analysed from a societal perspective; resource use was valued with German unit costs for 2005. In a secondary analysis, the longer-term cost utility of Sinfrontal® versus placebo was estimated over a total of 11 weeks based on an 8-week post-treatment observational phase. In addition, the cost effectiveness of Sinfrontal® versus antibacterials was determined based on an indirect comparison of placebo-controlled trials.

Results

Sinfrontal® led to incremental savings of €275 (95% CI 433, 103) per patient compared with placebo over 22 days, essentially due to the markedly reduced absenteeism from work (7.83 vs 12.9 workdays). Incremental utility amounted to 0.0087 QALYs (95% CI 0.0052, 0.0123), or 3.2 quality-adjusted life-days (QALDs). Bootstrapping showed that these findings were significant, with Sinfrontal® being dominant in 99.9% of simulations. The results were robust to a number of sensitivity analyses. In the secondary analysis, Sinfrontal® led to incremental cost savings of €511 and utility gains of 0.015 QALYs or 5.4 QALDs compared with placebo. Compared with antibacterials, Sinfrontal® had a significantly higher cure rate (11% vs 59%; p < 0.001) at similar or lower costs.

Conclusion

The results of this economic evaluation indicate that Sinfrontal® may be a cost-effective treatment for AMS in adults.     

Investigation of Two Outbreaks of Gastroenteritis in Tr?i? in September 2011

Background

An outbreak of gastroenteritis of etiologically unspecified origin and an outbreak of Salmonellosis occurred simultaneously in September 2011 in Tržič. The purpose of the investigation of both outbreaks was to identify the most probable source and the mode of transmission and to implement preventive measures.

Methods

In two retrospective case-control studies, the association between gastroenteritis of etiologically unspecified origin or Salmonellosis and food from a restaurant or drinking tap water were tested by univariate and multivariate analysis. The subject in the first study was a sick person with salmonellosis, and the subject in the second study was a resident that developed diarrhoea and/ or vomiting. Cases were reported by doctors, and controls were selected from healthy persons who responded to the questionnaire.

Results

A person exposed to food from the restaurant had a 24.8 times higher odds ratio (univariate analysis OR 24.8, 95% CI 7.5 to 82.3, p <0.05; multivariate analysis OR 14.7, 95% CI 3.5 – 61.3, p <0.05) for salmonellosis than non-exposed. A resident exposed to tap water from specific water source had a 3.4 times higher odds ratio (univariate analysis of OR 3.4, 95% CI 2.2 to 5.1 is p <0.05, multivariate analysis of RO 2.9, 95% CI 1, 7 to 5.3, p <0.05), for gastroenteritis of unspecific etiology than non-exposed. The dose response relationship was also statistically significant.

Conclusion

Analytical cases - controls studies confirmed a causal relationship between salmonellosis and food from the specific restaurant and the causal relationship between gastroenteritis of etiologically unspecified origin and drinking tap water from specific water source. Salmonella enteritidis may have entered into the restaurant through tap water.     

Outbreak of aseptic meningitis in Djibouti in the aftermath of El Niño

At the end of 1990s, an outbreak of enteroviral meningitis in Djibouti was associated with the cocirculation of multiple serotypes. This uncommon distribution was related to the dissemination of enterically transmitted agents in the aftermath of El Nino events disturbing the Horn of Africa. Both Djiboutians and expatriate residents were infected.     

Incidence of Toxocara ova--especially ova of visceral larva migrans in beach sand of Warnemünde in 1997

Beach sand was examined and analysed in 1997 at several locations in Warnemünde, a North-East German seaside resort, especially for the incidence of the nematode genuo Toxocara. Two of 126 samples contained Toxocara. The author points out measures to decrease the risk of infection.     

Models of Health and Models of Interaction in the Practitioner–Client Relationship in Acupuncture

The doctor–patient relationship has been widely studied in biomedicine. However, little research has focused on similar provider–client relationships in holistic healthcare forms. Based on ethnographic research with acupuncture clients and practitioners, the authors found that participants used specific models of health to understand and develop subsequent models of interaction, and in doing so, provided a clear critique of biomedicine. This article offers a brief overview of major models of healthcare, including biomedical, biopsychosocial, and holistic. The authors present current models of interaction that have been used to understand the biomedical doctor–patient relationship, and discuss the utility of both sets of models as they relate to the ethnographic observations. Although a particular model of health (biomedical or holistic) does not necessitate a particular model of health interaction (paternalism, consumerism, or collaboration), participants' attempts to tie these 2 realms together are important to understanding practitioner–patient relationships in all healthcare situations.     

Is health insurance in Greece in need of reform?

This paper aims to assess the relationship between insurance contributions and health benefits in Greece by using information from sickness funds' accounts. The paper argues that the fragmentation of social health insurance, and the particular ways in which sickness funds' financial services are organized, are a major source of inequity and are grossly inefficient. The survival of these systems in the 1990s cannot be explained except on grounds of inertia and corporate resistance.     

Is there equalisation in socioeconomic differences in the risk of traffic injuries in childhood? A study of three cohorts of Swedish school children

Equalisation of socioeconomic differences in injury risks at school ages is investigated, considering changes in risk inequalities over time for various categories of road users. Three national cohorts of children were followed up after their entry in different compulsory school levels (about 190,000 subjects by cohort). Subjects were attributed a household socioeconomic status in 1990 and their traffic injuries were sought over a five-year period (1990--94) in the national hospital discharge and causes of death registers. Socioeconomic inequality was measured by year and cohort for various RTI (Road Traffic Injury) diagnoses using the Relative Index of Inequality (RII). Whether equalisation arose or not was assessed considering changes in RII scores within the five-year period, measured by Chi-squared test. RII scores were generally high except for bicycle-related injuries among boys from the oldest cohort throughout the follow up. This relative equality in bicycle-injury risk benefited boys from all socioeconomic groups. Also, there was some, though short lasting, equalisation in bicycle-related injury risk for the younger cohort at the end of the first grade of compulsory school. Hence, some but limited support to the concept of equalisation was found, especially among young male bicycle riders. Population-based intervention aimed at improving safety behaviours among bicycle or motor-vehicle users should target not only suspected class-related influences, but even influences from the school, peer group and youth culture. Transitional periods in modes of transportation are a major concern.     

Prevalence of trachoma in preschool and schoolchildren in the city of São Paulo

OBJECTIVE: To assess the prevalence of trachoma among preschool and school children of public schools to give new focus to control programs. METHODS: An epidemiological survey was carried out in S?o Paulo City in 1999. Children between four and 14 years old were selected by a cluster sampling where school shift was the sampling unit. External eye examination was conducted to detect trachoma. RESULTS: A total of 27,091 children were examined and 597 cases of trachoma were found (2.2%; 95% CI: 1.86-2.55). The prevalence ranged from 0.4% to 4.2% in 10 city areas. The trachoma detection rate in the household contacts examined was 8.7%. Follicular trachoma was found in 99% of the cases and intense trachoma in 1.0%. It was observed that 21.8% of the cases were asymptomatic. CONCLUSIONS: Though the trachoma prevalence was low, the occurrence of severe cases points out to the likelihood of cicatricial trachoma cases in the future if they are not adequately treated and controlled. The great difference in the prevalences in different city areas indicates the need for strengthening epidemiological surveillance activities.     

Changes in susceptibility of Aedes aegypti to organophosphates in municipalities in the state of São Paulo, Brazil

Baseline data on susceptibility of Aedes aegypti to organophosphates detected alterations in cities of the state of S. Paulo, Brazil