Interferon-gamma production in peripheral lymphocytes of patients with tinea pedis: comparison of patients with and without tinea unguium.

The precise mechanism of the host defense that protects the nail from dermatophyte invasion is not known. Recent immunological findings in dermatophytosis suggest the hypothesis that the T helper 1 (Th1) response may play a role in protecting the nail from dermatophyte invasion. Our present study focused on interferon-gamma (IFN-gamma) release in patients with tinea pedis with or without tinea unguium, and pathogenesis of tinea unguium is discussed in relation to the association with a possible deficiency of Th1 response in the host defense mechanism. The production of IFN-gamma by peripheral blood mononuclear cells from the patients with tinea unguium in response to stimulation with trichophytin was not impaired in contrast to that from the patients without tinea unguium. Comparable lymphocyte proliferation to trichophytin was observed in both groups. Normal healthy persons with no clinical evidence of tinea could be divided into two groups based on lymphocyte proliferation and IFN-gamma production in response to trichophytin: high responder and low responder, with high responders being correlated with a clinical history of previous tinea pedis. In this study, a lack of a Th1 response to dermatophyte antigen was not shown in patients with tinea unguium by measuring the release of IFN-gamma, which plays a role in the effector phase of the delayed-type hypersensitivity reaction. A deficiency in the Th1 response to dermatophyte antigen, therefore, does not appear to play an important role in the establishment of tinea unguium.     

Prevalence and risk factors of subjective sleepiness in the general adult population

STUDY OBJECTIVES: The aim of this study was to investigate the prevalence and risk factors of self-reported excessive daytime sleepiness (EDS) in Norway. DESIGN: The Epworth Sleepiness Scale was administered by a telephone interview to a random sample of 2301 adult inhabitants of Norway. Questions of demography, symptoms of sleep disorders, and depression were included. SETTING: Norway. PARTICIPANTS: Two thousand three hundred one subjects, 18 years and older. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: The mean score of the Epworth Sleepiness Scale was 6.95 (SD = 3.8), and 17.7% had a score (> 10), indicating EDS. Univariate logistic regression analyses showed that being a man; living in southern Norway; working nights; being young; having symptoms of cataplexy, restless legs, or periodic limb movement in sleep; having breathing pauses in sleep; and having symptoms of depression were significantly related to EDS. Of these 9 predictors, only symptoms of restless legs did not maintain the significant relationship with EDS when a multiple logistic regression analysis was performed. CONCLUSIONS: The prevalence of EDS was high in this adult Norwegian population sample. EDS seems to be related to several symptoms of sleep disorders.     

Prevalence and patient's consciousness of tinea pedis and onychomycosis]

Epidemiological studies on tinea pedis and onychomycosis have been performed across Europe and East Asia. The prevalence of these conditions was 20%, respectively, and it increased with advancing age, more men than women had fungal infection of the feet. The prevalent predisposing factors were sports participation, average temperature, and family history of tinea pedis. The predisposing diseases were hypercholesterolemia, cardiovascular disease, diabetes mellitus, and osteoarticular disease. We conducted an epidemiological investigation to determine the prevalence and circumstances of untreated and unsuspected tinea pedis and onychomycosis. The results showed that the prevalence of occult athlete's foot was 25%, and that 59% of those cases were complicated by tinea unguium. The characteristics of patients with occult athlete's foot included a higher proportion of men and a tendency toward a low clinical score together with a high severity score. In the patient background, a strong correlation was observed between a positive KOH test result and characteristics such as past history of tinea pedis and/or onychomycosis, age, disposition of toes, and predisposing disease, as well as the type of shoes worn daily. We suspected that a patient's local and systemic conditions affected each other, creating good conditions for tinea pedis and onychomycosis so that the prevalence has increased. More understanding of occult athlete's foot will lead to prevention and improvement in treatment and diagnosis.     

Observation of tinea unguium by neutral red staining]

To evaluate the viability of dermatophytes in tinea unguium, we applied neutral red staining (NRS) for nail powder obtained from direct microscopic examination (DME) of positive tinea unguium patients. The nail powder from tinea unguium patients by grinder was applied following three sets of examinations, NRS, DME, and culture on Mycosel medium. The positive rates of nail powder obtained from 50 tinea unguium patients were 35 (70%), 37 (74%) and 2 (4%), respectively. Correlation of three sets of examinations were as follows: twenty-five patients were NRS positive, DME positive and culture negative, 10 patients were NRS negative, DME positive and culture negative, and 8 patients were NRS positive, DME negative and culture negative. These findings suggest that application of NRS for nail powder from tinea unguium patients is a practical method for evaluation of the viability of fungal elements.     

Socio-economic risk factors for incident restless legs syndrome in the general population

Few and controversial data exist about the relationship between socio‐economic status and restless legs syndrome, and prospective analyses are lacking. We aimed to explore the associations between socio‐economic factors and incident restless legs syndrome in the general population. Two prospective population‐based cohort studies were conducted: the Dortmund Health Study with a mean follow‐up of 2.2 years; and the Study of Health in Pomerania with a mean follow‐up of 5.2 years. The studies included 1312 subjects and 4308 subjects, respectively. Restless legs syndrome was assessed twice according to the standard minimal criteria. The modified Winkler Index of social class, education, job status, partnership and income were assessed by interviews at baseline. The risk of restless legs syndrome associated with each socio‐economic factor was estimated by multivariable logistic regression adjusted for behavioural factors and co‐morbidities. Female gender, being retired and unemployment were independent risk factors of incident restless legs syndrome in both studies. Low level of education and income were independently associated with incident restless legs syndrome only in the Dortmund Health Study, but not in the other study. Migrational background and shiftwork were further independent risk factors of restless legs syndrome that were only assessed in the Dortmund Health Study. People with less favourable socio‐economic situation are at an increased risk of developing restless legs syndrome. Behavioural variables and co‐morbidities did not explain this association, thus further studies are required to reveal the mechanism behind the proposed relationship.     

Prevalence of specific antibody to hepatitis E virus in the general population of the community of Madrid, Spain

Hepatitis E virus (HEV) is an infectious agent causing hepatitis among humans. Although hepatitis E has been reported from many European countries, its incidence in Europe is largely unknown, and the prevalence of the HEV infection is also unknown for most countries of the region. Antibody to HEV (anti-HEV) was tested on 2,305 serum samples from the general population of the Community of Madrid (Spain) collected in the year 2008 among people aged 2-60 years. Total anti-HEV was tested by enzyme-immunoassay (EIA), and reactive samples were retested separately for anti-HEV IgG and IgM by recombinant immunoblot test (RIBT). Fifty samples (2.17%) displayed reactivity for total anti-HEV after EIA testing, and anti-HEV IgG was confirmed by RIBT in 25 (1.08%). The frequency of RIBT-confirmed anti-HEV ranged from 0.97% among the youngest to 3.61% among the oldest, and displayed a statistically significant trend to increasing with age. The rate of RIBT confirmation was also significantly higher among the individuals aged above 20 years old than among those younger of 21 years. HEV infection would be less frequent in the Community of Madrid than in Catalonia or the United Kingdom, and contact with HEV would be very uncommon among children and adolescents of the region. Confirmation of EIA-reactive samples by RIBT reduced the final numbers of anti-HEV testing as much as 50%, and some findings of this study suggest that such testing protocol would reflect better the real prevalence of anti-HEV in settings of low endemicity than the single testing by EIA.     

Prevalence and correlates of illness worry in the general population

The prevalence and correlates of illness worry in the general population were investigated in a representative sample. The authors screened residents of the United States by telephone, and more detailed interviews were conducted with 123 respondents who reported at least 1 month of worry about serious illness in the past 12 months and an equal number of randomly selected persons without such worry. Data on demographic characteristics, medical and psychiatric conditions, functional impairment, and health care utilization were collected. At least 1 month of worry was endorsed by 13.1% of the screened population. Correlates of worry included a cluster of psychiatric conditions (major depressive episode, panic attacks, and generalized anxiety disorder) and three clusters of physical conditions (heart disease, cancer, and other diseases). Worry about serious illness was associated with functional impairment and health care utilization.     

Prevalence of three bulimia syndromes in the general population

Prevalence of bulimia was estimated from a cross-sectional general population survey of 1498 adults, using the Diagnostic Interview Schedule (DIS) administered by trained lay interviewers. Lifetime prevalence of the DSM-III syndrome in adults aged 18-64 was 1.0% and this was concentrated in young women: in women aged 18-44 lifetime prevalence was 2.6%, and 1.0% currently had the disorder. Based on clinicians' reinterviews of random respondents and identified and marginal cases, the prevalence of current disorder using criteria for draft DSM-III-R bulimia was 0.5%, for DSM-III it was 0.2%, and for Russell's Criteria bulimia nervosa 0.0%. A strong cohort effect was found, with higher lifetime prevalence among younger women, which is consistent with a growing incidence of the disorder among young women in recent years. Although elements of the syndromes were so common as to suggest that dysfunctional attitudes to eating and disturbed behaviour surrounding eating are widespread, there was little evidence of the bulimia syndrome having become an epidemic on the scale suggested by early reports.     

Prevalence of obstructive sleep apnea symptoms and risk factors in an Armenian population sample

Aim

Obstructive sleep apnea (OSA) is a common medical condition with significant adverse consequences. OSA awareness among the general population and physicians in Armenia is quite low. This study aimed to estimate the prevalence of OSA symptoms and risk factors in Armenia, which has not been investigated so far.

Patients and methods

This was a cross-sectional study of 1,500 randomly selected adults from the capital city and regions of the country. The instrument used to assess the risk of OSA was the Berlin questionnaire.

Results

Of the 1,500 respondents, 44% (49% of men and 37% of women) were identified as being at high risk of OSA. In both genders the risk of OSA increased with age achieving the maximum level of 60% at the age of 50?C69?years and declining to 45% after the age of 70?years. Before the age of 50?years, men were at higher risk of OSA than women (42% vs. 19%, p?<?0.001). After 50 the risk of having OSA was almost the same in men and women (57% vs. 56%).

Conclusion

Almost every second Armenian male and every third female citizen could benefit from evaluation for OSA.     

Prevalence and risk factors for viral hepatitis in the Kosovarian population: implications for health policy

The prevalence of hepatitis infection among the Kosovarian population is largely unknown. The aim of the study was to evaluate the prevalence and risk factors of hepatitis A, B, C, and D (HAV, HBV, HCV, HDV) infection among the general population and in a group of health care workers in the Kosovo region. Overall, 1,287 participants were recruited, 460 males (36%) and 827 females (64%). Health care workers accounted for 253 individuals (20%), 301 were blood donor candidates (23%), 334 were pregnant women (26%), and 399 (31%) were subjects who had been examined in two clinics for routine laboratory testing. The prevalence of total anti-HAV was 88.6% (95% CI: 86.69-90.25). Prevalence of anti-HAV among children up to 10 years was 40.5% (95% CI: 29.6-53.15), reaching 70% (95% CI: 62.25-77.10) in the 11-20 age group. Age, living in rural areas and unemployment were factors associated with higher risk of HAV infection. HBsAg was detected in 2.4% (95% CI: 1.57-3.38%) of the study sample, with a significant age trend (P-value:0.0110). Positivity for total anti-HBc was detected in 18.4% (95% CI = 16.27-20.59) of the subjects. Ninety-three subjects (7.2%) were positive for anti-HBs alone. An association between age, HSV-2 positivity, working nurses and HBV infection has been observed. One patient was HDV positive. The prevalence for HCV was 0.5% (95% CI: 0.22-1.12%). HAV infection seems to be high-intermediate, while HBV shows an intermediate endemicity. It is necessary to highlight the importance of an immunization strategy against HAV and HBV in reducing the incidence of the infection. The prevalence for HCV was very low.     

Prevalence of and risk factors for IgE sensitization to Anisakis simplex in a Spanish population

BACKGROUND: The number of allergic reactions to A. simplex reported in Spain has increased dramatically in the last decade. Nevertheless, there have been no studies of the prevalence of and possible risk factors for IgE sensitization to this parasite, possibly because suitably specific diagnostic methods have only recently become available. The objective was to investigate the prevalence of and risk factors for IgE sensitization to A. simplex in Galicia, a region of northwestern Spain with a population of about 3 million and high average fish consumption (78.5 g/person per day). METHODS: The study was performed with a random sample of 2801 healthy blood donors distributed in 53 geographic areas, proportional to the density of donors. IgE sensitization to A. simplex was tested by a capture ELISA method that has proved to be the most specific method currently available. RESULTS: The results showed a total of only 12 positive subjects, of whom five also showed IgG1 sensitization. All positive subjects and 101 randomly selected seronegative subjects were then included in a case-control study of risk factors for sensitization to A. simplex, based on a telephone interview about fish consumption (especially raw and undercooked fish). All seropositive subjects (but only 25% of seronegative subjects) reported consumption of undercooked fish or homemade raw-fish products. CONCLUSIONS: Our results strongly suggest that sensitization to A. simplex is caused only by live larvae, and not by allergens contained in fish tissues, and that ingestion of homemade boquerones (anchovies [Engraulis encrasicholus] in vinegar), and to a much lesser extent of undercooked fish, are the main risk factors for IgE sensitization to Anisakis in this region.     

Prevalence and risk factors for latex-related diseases among healthcare workers in an Italian general hospital

Latex allergy has become an occupational hazard among healthcare workers. Atopy and degree of exposure have been recognized as predisposing factors for latex sensitization. We investigated the prevalence of latex allergy and the potential risk factors for latex sensitization, by distributing a questionnaire to 284 employees of a general hospital in central Italy. We collected information about occupational history, including specific tasks performed; time of first exposure to latex gloves; number of pairs of gloves; and duration of daily exposure. We also investigated the interval between first exposure and onset of symptoms, as well as the exact circumstances of their appearance. We evaluated pre-existing rhinoconjunctivitis, asthma, atopic and contact dermatitis, and allergies to drugs and foods using prick and patch tests. Latex allergy was established by means of skin-prick test, specific IgE, patch-test, and latex-glove-wearing test. This survey documented a high prevalence of symptoms related to the use of latex (47%) among the hospital staff, demonstrable sensitization to latex was considerably lower (12%), though strongly associated to atopy and duration of occupational exposure. Despite non-specificity, validated questionnaires constitute the most useful means to implement health surveillance and prevention of latex-related diseases among healthcare workers.     

Prevalence of non-organ specific autoantibodies in HCV-infected subjects in the general population

The significance of non-organ specific antibodies (NOSAs) in HCV-related chronic hepatitis is largely unclear. In this study we evaluated the prevalence of NOSAs in a non-selected population of HCV-infected subjects. One hundred and seventy anti-HCV positive and 192 anti-HCV negative sex and age-matched subjects (median age 64 years, range 7-91 years, female 68%) enrolled from the general population of a small Italian town were evaluated for NOSAs by indirect immunofluorescence on rat tissue sections and HEp-2 cells, and by counterimmunoelectrophoresis with thymus and spleen extracts as the antigen source. One hundred and sixty-three (96%) HCV-infected subjects had normal ALT serum levels and no evidence of liver disease. NOSAs were found in 31 out of 170 (18%) anti-HCV positive subjects and in 20 out of 192 (10%) controls (P = NS), with similar median titre (1:40) and range (1:40 to 1:160). Neither liver/kidney microsomal antibody type 1 nor antiactin reactivity were detected. No significant association between NOSAs and HCV genotypes was observed. In the general population, HCV-infected subjects and healthy controls have a similar prevalence of NOSAs. Without continuous liver damage HCV infection is unlikely to induce the appearance of NOSAs.     

Prevalence of reported suicidal behaviour in the general population and mental health-care staff

BACKGROUND: Higher rates of suicidal behaviour have been reported among staff in mental health care than in the general population. However, no studies of these two groups have been carried out simultaneously, using the same methods. This study aims to investigate whether they differ in terms of age- and sex-standardized prevalence of suicidal behaviour. METHODS: Identical questions about suicidal behaviour were addressed in the same year to a random sample of the general population and to mental health-care staff in Stockholm. Life weariness among the latter was also investigated. RESULTS: Age- and sex-standardized past year prevalences of suicidal thoughts and suicide attempts were found to be similar among mental health-care staff and the general population. Lifetime prevalence of both suicidal thoughts and suicide attempts was significantly higher among mental health-care staff than among the general population. Psychologists/social workers have a higher probability of: lifetime thoughts of life is not worth living; death wishes; and, suicidal thoughts, than nurses/assistant nurses. CONCLUSIONS: Reports on lifetime prevalence of suicidal behaviour may be biased in populations that are not reminded of these problems in everyday life. Data on past year prevalence of suicidal behaviour show clearly the similarity between the general population and the mental health-care staff.     

Prevalence of HIV infection in a general psychiatric outpatient population

The prevalence of human immunodeficiency virus (HIV) infection in the general psychiatric population is unknown. The authors conducted a retrospective review of all patients evaluated through the psychiatric outpatient clinics at Duke University Medical Center from 2001 to 2004 in order to determine the prevalence of comorbid HIV infection and mental illness. HIV infection was present in 1.2% of the psychiatric outpatients, approximately four times the occurrence of HIV infection in the general adult population of the United States. The major psychiatric diagnostic categories with a high prevalence of HIV infection were substance abuse disorders (5%), personality disorders (3.1%), bipolar disorders (2.6%), and posttraumatic stress disorder (2.1%).