Update on adult immunizations

The past few years have seen numerous additions and modifications to the current immunization schedules. Starting with the 2010 to 2011 influenza season, the Centers for Disease Control and Prevention have recommended universal annual influenza vaccination for all persons without a contraindication who are 6 months of age and older, including healthy persons aged 19 to 49 years. Hepatitis B vaccination is now recommended for all susceptible diabetics ≤60 years of age. One dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine, adsorbed, is recommended to replace one tetanus and diphtheria toxoids adsorbed (adult) vaccination for all adults, including those 65 years of age or older, who are anticipating contact with infants and unvaccinated pregnant women (preferably during the second or third trimester). All adult vaccines remain underused. This article will summarize the most recent changes in the adult immunization recommendations of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.     

Microbiology of adult cellulitis

Needle aspiration of cellulitis sites is commonly advocated to assist in the identification of causative organisms. Twenty-five nondiabetic, adult patients with a clinical diagnosis of cellulitis had site aspirations and blood cultures obtained before antibiotic therapy was initiated. Site cultures were positive in 6 of 25 patients. Blood cultures were positive in 4 of 25 patients. All organisms except one (Enterobacter agglomerans) were staphylococci or streptococci. The gram-negative bacilli were not believed to be a pathogen based on the patient's prompt response to nafcillin. In adult patients who do not have complications, the use of needle aspiration was not supported. Empiric treatment of cellulitis aimed at gram-positive cocci appears to be sufficient.     

Occupation and adult gliomas

Lifetime job histories from a population-based, case-control study of gliomas diagnosed among adults in the San Francisco Bay area between August 1991 and April 1994 were evaluated to assess occupational risk factors. Occupational data for 476 cases and 462 controls were analyzed, with adjustment for age, gender, education, and race. Imprecise increased risks were observed for physicians and surgeons (odds ratio (OR) = 3.5, 95% confidence interval (CI): 0.7, 17.6), artists (OR = 1.9, 95% CI: 0.5, 6.5), foundry and smelter workers (OR = 2.6, 95% CI: 0.5, 13.1), petroleum and gas workers (OR = 4.9, 95% CI: 0.6, 42.2), and painters (OR = 1.6, 95% CI: 0.5, 4.9). Legal and social service workers, shippers, janitors, motor vehicle operators, and aircraft operators had increased odds ratios only with longer duration of employment. Physicians and surgeons, foundry and smelter workers, petroleum and gas workers, and painters showed increased risk for both astrocytic and nonastrocytic tumors. Artists and firemen had increased risk for astrocytic tumors only, while messengers, textile workers, aircraft operators, and vehicle manufacturing workers showed increased risk only for nonastrocytic tumors. Despite study limitations, including small numbers for many of the occupational groups, a high percentage of proxy respondents among cases, and lack of specific exposure information, associations were observed for several occupations previously reported to be at higher risk for brain tumors generally and gliomas specifically.     

Esophago-bronchial fistulas in adult

Esophago-bronchial fistulas in adult are rare and for the most part are due to a malignant tumor. The authors present two cases of benign Esophago-bronchial fistula which were discovered accidentally by esophagography. One case was considered to be congenital. Esophagography is the most useful for diagnosis of this disease.     

北京市部分人群成年人病毒性腹泻病原学和流行病学分析

病毒腹泻的病原主要包括轮状病毒(RV)、诺如病毒(NV)、扎如病毒(SV)、星状病毒(AstV)和肠道腺病毒(AdV),而NV和SV分别为杯状病毒科的两个属,主要感染人类,合称为人类杯状病毒(HuCV).近年来国内外关于引起婴幼儿腹泻的各种病毒病原的研究较多[1-4],而对成年人的研究报道较少,并多集中于单一病毒病原的研究.     

砖茶型氟中毒成人的氟骨症

为了解砖茶型氟中毒在成人中的危害程度 ,运用总摄氟量调查 ,环境氟水平及尿氟含量测定 ,氟骨症临床体征检查及X线检查等 ,对西藏那曲县 111名 3 0～ 78岁成人进行了饮茶习惯 ,氟骨症患病情况调查。结果表明 ,那曲县水源氟浓度仅 (0 10± 0 0 3 )mg L ,但砖茶食物 -糌粑 ,酥油茶氟含量分别达到 (4 5 2± 0 74)mg kg和 (3 2 1± 0 65 )mg kg,他们每日每人总摄氟量达到 11 99mg ,其中 99%来自含砖茶的食物。氟骨症阳性体征检出率为 89% ,X线片确诊氟骨症患病率为 83 %。砖茶型氟骨症的阳性体征与X线片检查均表明 ,骨关节退行性变和骨间膜骨化 ,肌腱钙化是其主要特征 ,硬化型 (骨质增多 )氟骨症患病率占 74%。与我国饮水型、燃煤型氟中毒比较 ,砖茶型氟中毒对人体的危害更大     

Expanding adult day care successfully

Expanding adult day care services successfully by strengthening recruitment and retention, quality assurance, programming, scheduling and financial management requires strong program leadership. Since the vast majority of day care program directors are educated as registered nurses, social workers and recreation therapists, cultivation of effective leadership skills must be achieved through a combination of additional formal education in management, extensive seminar/workshop attendance, outside readings and on the job guidance and experience. The administrator, to whom the program director reports, should devote considerable time and effort toward the director's management development through instruction, counseling and support. Conflicts may arise in areas such as staff and overtime expenses, and marginally efficient equipment purchases, where the director's clinical background may overshadow an objective cost/benefit analysis. Learning to delegate responsibility for basic programming and clinical services to staff, thus developing their skills, is a significant area for director and program growth. A well-trained and motivated nurse's aide can be quite capable of leading discussion and activity groups, perhaps assisted by volunteers. Social work students, with supervision, do a fine job of cofacilitating caregiver support groups and with additional experience, intake assessments.