Case Report: Urticaria During Triple Therapy for Helicobacter pylori Infection (Clinical Implications)

The widespread use of an ever-increasing numberof drugs is responsible for the multiple adversereactions observed by the clinician. Current practiceadvocates eradication of Helicobacter pylori infections, and this is achieved quite well by the use oftriple therapy (1). However, a survey of the recentliterature revealed that the safety of such regimens hasoften been discussed but never properly investigated (1-3). We describe a case in which adverseeffects were noted to each of the three components oftherapy.     

Live poultry exposures, Hong Kong and Hanoi, 2006

Since 1997, the largest epidemic of highly pathogenic avian influenza (H5N1) ever recorded has caused 172 human and several billion bird deaths. Recently administered questionnaires determined that live poultry exposures have declined by approximately 63% in Hong Kong since 2004 and that, in Vietnam, domestic backyard exposures to poultry are likely more important than retail exposures.     

Comparison of the dynamics and correlates of transmission of Herpes Simplex Virus-1 (HSV-1) and Varicella-Zoster Virus (VZV) in a sample of the Israeli population

Herpes simplex virus types-1 (HSV-1) and Varicella-zoster virus (VZV) are herpes viruses that share many characteristics. However, HSV-1 spreads by close contact while VZV spreads mainly by the airborne route. In this study we compared the dynamics and correlates of transmission of these viruses in the same population. In 2000–2001, 1555 sera from an age-stratified general population sample were tested using commercial ELISA kits to measure type-specific HSV-1 and varicella IgG antibodies. The VZV seroprevalence increased rapidly with age reaching 50% seropositivity by the age of 3 years, while HSV-1 reached 50% seropositivity at the age of 14 years. The highest VZV force of infection was in the 3.5–5.5-year age group followed by the 5.5–10.5 years age group, while for HSV-1 the age specific force of infection was substantially lower and stable over the various age groups. Multivariate analysis revealed that HSV-1 seroprevalence was significantly, independently associated with age, country of birth, country of origin, ethnicity, socio-economic status and VZV sero-status. Only age, country of origin and HSV-1 sero-status were found to be associated with VZV seropositivity. In developed countries such as Israel the transmission of VZV is much quicker and less dependent on socioeconomic status as compared with HSV-1. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Delirium part two: nursing management

Delirium is a common and under-reported problem in older adults. It can have a negative effect on patient outcomes and nurses often fail to identify it. This is the second part of an article that outlines nursing interventions based on the Roper, Logan and Tierney model of the activities of living. The first part of this article, which examined the clinical features, risk factors and assessment of delirium, was published in last week's Nursing Standard.     

The impact of symptoms, coping capacity, and social support on quality of life experience over time in patients with lung cancer

The aims of the study were to investigate lung cancer patients' quality of life (QoL) over time in a palliative setting and to determine how QoL is influenced by symptoms, coping capacity, and social support. One hundred and five consecutive patients with incurable lung cancer were included. A comprehensive set of questionnaires was used at baseline, including the Assessment of Quality of Life at the End of Life, Cancer Dyspnea Scale, Visual Analog Scale of Dyspnea, Hospital Anxiety and Depression scale, Sense of Coherence Questionnaire, and Social Support Survey, of which the first four were used also at three, six, nine, and 12 months. Dyspnea, depression, and global QoL deteriorated over time. Performance status, anxiety, depression, components of dyspnea, pain, and the meaningfulness component of coping capacity correlated with global QoL at all, or all but one follow-up measurements. In a multivariate analysis with global QoL as the dependent variable, depression was a significant predictor at four out of five assessments, whereas coping capacity, anxiety, performance status, pain, and social support entered the model at one or two assessments. Emotional distress and coping capacity influence QoL and might be targets for intervention in palliative care.     

Assessing the readiness and training needs of non-urban physicians in public health emergency and response.

Emergency readiness has become a public health priority for United States communities after the 9/11 attacks. Communities that have a less developed public health infrastructure are challenged to organize preparedness and response efforts and to ensure that health care providers are capable of caring for victims of terrorist acts. A survey was used to assess non-urban physicians' prior experience with and self-confidence in treating, and preferred training needs for responding to chemical, biologic, radiologic, nuclear, and explosive (CBRNE) cases. Data were collected through a mailed and Web-based survey. Although the response rate was calculated at 30%, approximately one third of the surveys were not able to be delivered. Most respondents reported never having seen or treated CBRNE-inflicted cases and were not confident in their ability to diagnose or treat CBRNE cases, but many were willing to participate in a state-led response plan. Almost half of the individuals had not participated in any related training but expressed interest in receiving training in small group workshops or through CD-ROM. These results provide potential direction for strategic preparedness planning for non-urban health care providers.     

A spatial-temporal approach to surveillance of prostate cancer disparities in population subgroups

BACKGROUND: Prostate cancer mortality disparities exist among racial/ethnic groups in the United States, yet few studies have explored the spatiotemporal trend of the disease burden. To better understand mortality disparities by geographic regions over time, the present study analyzed the geographic variations of prostate cancer mortality by three Texas racial/ethnic groups over a 22-year period. METHODS: The Spatial Scan Statistic developed by Kulldorff et al was used. Excess mortality was detected using scan windows of 50% and 90% of the study period and a spatial cluster size of 50% of the population at risk. Time trend was analyzed to examine the potential temporal effects of clustering. Spatial queries were used to identify regions with multiple racial/ethnic groups having excess mortality. RESULTS: The most likely area of excess mortality for blacks occurred in Dallas-Metroplex and upper east Texas areas between 1990 and 1999; for Hispanics, in central Texas between 1992 and 1996: and for non-Hispanic whites, in the upper south and west to central Texas areas between 1990 and 1996. Excess mortality persisted among all racial/ethnic groups in the identified counties. The second scan revealed that three counties in west Texas presented an excess mortality for Hispanics from 1980-2001. Many counties bore an excess mortality burden for multiple groups. There is no time trend decline in prostate cancer mortality for blacks and non-Hispanic whites in Texas. CONCLUSION: Disparities in prostate cancer mortality among racial/ethnic groups existed in Texas. Central Texas counties with excess mortality in multiple subgroups warrant further investigation.     

Health-related quality of life during adjuvant treatment for breast cancer among postmenopausal women.

The purpose of the present study was twofold: first, to describe changes of Health-Related Quality of Life (HRQoL) during the adjuvant treatment among postmenopausal women with breast cancer; second, in the same population to identify the best predictors of Overall Quality of Life (QoL) after treatment, from perceived functioning, symptoms, emotional distress and clinical/demographic variables measured at baseline. The study group was 150 women (> or = 55 years of age) scheduled for adjuvant chemotherapy (CT, n=75) or radiotherapy (RT, n=75). They were examined before (baseline), during and after completing the treatment. Data about QoL, perceived functioning, symptoms and emotional distress were collected with the European Organisation for Research and Treatment of Cancer (EORTC)-QLQ-C30, BR23 and Hospital Anxiety and Depression Scale (HADS) questionnaires. The general finding was that the adjuvant treatments were associated with decrease in overall QoL, physical and role functioning, anxiety and body image, as well as with increase in fatigue, dyspnoea, pain, nausea/vomiting, constipation and systemic therapy side effects measured over time. For women receiving CT, better emotional functioning and less pain at baseline predicted better overall QoL at the end of the treatment. For women receiving RT, better physical and emotional functioning, less breast symptoms and lower tumour stage at baseline predicted better overall QoL at the end of the treatment.