Antibiotic prescribing by primary care physicians for children with upper respiratory tract infections

OBJECTIVES: To determine if the rate of appropriate antibiotic use in the treatment of children with bronchitis, viral upper respiratory tract infections, sinusitis, otitis media, and pharyngitis has changed in recent years and to identify factors that are associated with the use of inappropriate antibiotic therapy. DESIGN: The National Ambulatory Medical Care Survey was used to examine the antimicrobial prescribing habits of physicians who provide primary care for children. Data were analyzed from 1995-1998. SETTING: Office-based physician practices. PARTICIPANTS: Pediatricians, family physicians, and generalists completing survey forms for patients younger than 18 years. MAIN OUTCOME MEASURE: The appropriate use of antibiotics for upper respiratory tract infections. RESULTS: Multivariate analyses were used to examine factors associated with the use of inappropriate antibiotics to treat either upper respiratory tract infections or bronchitis. Patients seen in 1998 and diagnosed as having upper respiratory tract infections were 0.69 (95% confidence interval, 0.59-0.81) times less likely to be treated with antibiotics compared with patients seen in 1995. Multivariate analyses were also used to assess factors associated with the use of antibiotics with a suboptimal therapeutic profile for the treatment of either sinusitis or otitis media. Children diagnosed as having either sinusitis or otitis media were 0.3 (95% confidence interval [CI], 0.16-0.48) times less likely to receive antibiotics with a suboptimal therapeutic effect in 1998 compared with 1995. CONCLUSIONS: Physicians are slowly improving their antibiotic prescribing patterns but the use of inappropriate antibiotics is still common. Almost half of patients with upper respiratory tract infections receive antibiotics.     

Effect of ciprofloxacin on lethal and sublethal challenge with endotoxin and on early cytokine responses in a murine in vivo model

The influence of ciprofloxacin on immune responses has been suggested by results of in vitro and in vivo studies. This effect was studied using a murine model that measured mortality and early cytokine responses after challenge with endotoxin. C57/BL6 mice weighing between 18 and 21 g were given a single intraperitoneal dose of lipopolysaccharide (LPS), ranging from 200 to 1000 microg. Mice were pre-treated with an intraperitoneal injection of 5% dextrose in sterile water containing 0.0-6.0 mg of ciprofloxacin 1 h before LPS challenge. Cytokine responses were assessed by measuring concentrations in serum separated from blood obtained by cardiac puncture of anaesthetized mice at 0, 1, 3, 6 and 24 h following LPS administration. Mice were observed for 72 h following administration of LPS and serum cytokines were measured using ELISA. More than 4.5 mg of ciprofloxacin (675-900 mg/m(2) or 225-300 mg/kg) given 1 h before LPS challenge consistently protected mice from a lethal dose of LPS (14/14 versus 0/7, P < 0.00001). Ciprofloxacin significantly attenuated the production of tumour necrosis factor-alpha and interleukin-12 response after LPS challenge. In addition, ciprofloxacin significantly increased serum interleukin-10 concentrations but had little or no effect on interleukin-6 or interleukin-1beta serum concentrations. Similar effects were evident with sublethal doses of LPS and were most pronounced at the lowest dose of LPS studied. These observations indicate that ciprofloxacin can prevent endotoxin-mediated death and alter early host cytokine responses. This effect may influence the course of infection in a manner that is independent of the drug's antimicrobial activity.     

Laboratory confirmation of meningococcal disease in Scotland, 1993-9

AIMS: To describe the laboratory confirmation of meningococcal disease, using culture and non-culture based techniques, between 1993 and 1999 as part of a national service in Scotland. METHODS: Samples from patients with suspected meningococcal disease in Scotland were analysed by culture and non-culture based techniques to gain a laboratory confirmation of disease. Data were analysed to establish the number of disease cases, the serogroups of the organisms involved, and the importance of the techniques used. RESULTS: Between 1993 and 1999, there was a total of 1749 notified cases of meningococcal disease in Scotland. Culture based methods provided a laboratory confirmation of 788 cases whereas non-culture techniques confirmed 461 cases. CONCLUSIONS: Non-culture techniques were a useful addition to culture based techniques in Scotland and improved the dataset required for public health management, disease surveillance, and vaccine policy.     

An investigation of noise levels in Alberta sawmills

BACKGROUND: Noise exposure in the sawmill industry is an area of concern. This study documents the level of noise exposure in nine sawmills in the province of Alberta, Canada. METHODS: Personal noise monitoring data were collected in nine Alberta sawmills, in winter and in summer (n = 213). Exposures were considered in light of an estimated "real world" noise reduction rating (NRR) calculation assuming use of conventional hearing protection. Limited comparisons were made with spot area monitoring data. RESULTS: Only 10% of the personal monitoring measurements were below the Alberta 8-hr exposure limit of 85 dBA. Twenty-seven percent of the personal monitoring measurements were 95 dBA or higher. Worker enclosures played a large role in reducing noise exposure. There were no significant differences between seasons in noise category distributions (P = 0.61). The planermen and planer infeed operators had the highest percentage of personal monitoring measurements 95 dBA or higher (62% and 82%, respectively). CONCLUSIONS: Based on a conservative formula, a risk of excess noise exposure could exist even when wearing required hearing protection due to very high noise levels found in planing operations in sawmills.     

The seroprevalence of varicella zoster antibodies in Behçet's and other skin diseases

The purpose of this study was to investigate the association of the varicella zoster virus (VZV) IgG, and IgM antibodies with Behçet's and other skin diseases (group 1: recurrent aphthos stomatitis, fungal infections, psoriasis; group 2: vitiligo, lichen planus). Twenty eight patients with Behçet's disease (BD), and 117 patients with dermatological disorders other than BD were evaluated for specific VZV IgG and IgM antibodies by using a third generation enzyme-linked immunosorbent assay (ELISA). The Mantel Heizshel ² method was used to adjust the confounding of age and sex of the patients. The serological positivity for VZV IgG and IgM antibodies in BD was not statistically different from other skin diseases. When we considered the age of the patients, ² = 2.64, CI (0.27–1.65), odds ratio (1, 1.25, 2.21) (p = 0.10) and when we considered the sex of the patients, ² = 0.31, CI (0.81–1.28), odds ratio (1, 1.45, 1.41), (p = 0.57).     

Place of death: analysis of cancer deaths in part of North West England

BACKGROUND: Relatively little work of a detailed geographical nature has been undertaken on the distribution of place of death. In particular, given evidence that most cancer patients would prefer to die at home there is a need to examine the extent to which this preference is met differentially from place to place. METHODS: Using data on cancer deaths for a single Health Authority in North West England we conducted both small area and individual analyses of place of death, using binomial and binary logistic regression models, respectively. RESULTS: Results from the small area analysis show that in more deprived areas cancer patients are more likely to die in hospital or hospice, and less likely to die at home, but that the effect disappears for home and hospice deaths once other factors are controlled for. At the individual level, the probability of death at home decreases among those living in deprived areas, whereas the probability of death in hospital increases as area deprivation increases. Age, gender, type of cancer, and proximity to hospital or hospice all have some effect on the probability of dying in a particular setting. CONCLUSION: There is significant place-to-place variation in place of death among cancer patients in part of North West England. However, studies of place of death among cancer patients need to consider the full range of settings and, if examining the impact of deprivation or social class, need to adjust for other factors, including proximity to different settings.     

Closed reduction of constrained total hip arthroplasty

Many surgeons use acetabular components with constrained polyethylene liners to improve stability in patients with a history of hip dislocation. Considering that the reported incidence of hip dislocation in patients with constrained components is 4% to 29%, it generally is recognized that open reduction would likely be necessary in cases of redislocation. Recent reports have indicated that closed reduction of constrained total hip arthroplasty is possible in some cases. However, it is unknown whether closed reduction damages the constrained polyethylene liner and predisposes patients to additional dislocations. The current study evaluated the integrity of the polyethylene constraint mechanism after in vitro simulation of hip dislocation and closed reduction. After lever-out dislocation and reduction, 76% of the capture mechanism strength was maintained without additionally damaging the polyethylene liner. Also reported is the technique for closed reduction in patients with constrained components and a clinical series of six patients who had successful closed reduction. These patients remain stable without any additional dislocations 7 to 72 months after reduction. These data suggest that closed reduction of Poly-Dial constrained polyethylene liners can be successful without predisposing patients to additional dislocations.     

The Ohio Hospice Bereavement Study: meeting NHPCO standards

Little attention has been paid to documenting the quality and impact of hospice bereavement programs. While quality of life, quality of dying, and quality of end-of-life measures are common indicators of effective clinical service, they are not adequate gauges of quality from a bereavement perspective. The National Hospice and Palliative Care Organization (NHPCO) published standards for hospice and palliative care programs that included a section on bereavement care. Little evaluative work has been done to discover whether hospice programs nationwide are compliant with these standards. The purpose of this study was to evaluate whether hospice programs (n = 32) in the state of Ohio were meeting the NHPCO bereavement standards. Findings indicated that the participating hospice programs were 83 percent compliant at least some of the time.