A study of hepatitis C prevalence in healthcare workers in the West of Scotland

BACKGROUND AND AIMS: Whether healthcare workers have an increased prevalence of hepatitis C virus infection as a result of exposure to patient's blood and body fluids is controversial. This study assesses the prevalence of hepatitis C virus infection in healthcare workers, and its relation to the performance of exposure prone procedures and duration of occupational exposure, allowing an estimate to be made of the incidence of occupationally acquired hepatitis C infection among medical staff. METHODS: In this anonymous retrospective cohort study, we estimated the prevalence of hepatitis C infection in 10 654 healthcare workers. ELISA-3 testing was performed on pools of five sera collected during immunisation against hepatitis B. Healthcare workers were arranged into five occupational groups, according to the degree of patient exposure, and three age bands (<30 years, 30-39 years, >40 years). RESULTS: Prevalence of antibodies to hepatitis C was 0.28% (30/10 654), comparable in all occupational groups (p=0.34) and unrelated to duration of potential exposure. Assuming that all detected infections had been occupationally acquired, the maximum estimated risk of hepatitis C infection in exposure prone medical staff was low: 1.4% for surgeons and 1.0% for physicians over a 35 year professional career. CONCLUSIONS: Hepatitis C infection is infrequent in healthcare workers in Glasgow. Those conducting exposure prone procedures do not seem to be at higher risk than other healthcare staff.     

Effect of low-glycemic-index dietary advice on dietary quality and food choice in children with type 1 diabetes

BACKGROUND: The practicality of diets with a low glycemic index (GI) is controversial. Theoretically, low-GI diets may limit food choice and increase dietary fat intake, but there is little objective evidence to support such a theory. OBJECTIVE: The objective was to determine the effect of low-GI dietary advice on dietary quality and food choice in children with diabetes. DESIGN: Children aged 8-13 y with type 1 diabetes (n = 104) were recruited to a prospective, randomized study comparing the effects of traditional carbohydrate-exchange dietary advice (CHOx) with those of more flexible low-GI dietary advice (LowGI). We determined the effect on long-term macronutrient intake and food choice with the use of 3-d food diaries. RESULTS: There were no differences in reported macronutrient intakes during any of the recording periods. After 12 mo, intakes of dietary fat (33.5 +/- 5.6% and 34.2 +/- 6.7% of energy, P = 0.65), carbohydrate (48.8 +/- 5.4% and 48.6 +/- 6.5% of energy, P = 0.86), protein (17.6 +/- 2.5% and 17.3 +/- 3.7% of energy, P = 0.61), total sugars, and fiber did not differ significantly between the CHOx and LowGI groups, respectively. The average number of different carbohydrate food choices per day also did not differ significantly. Subjects in the lowest-GI quartile consumed less carbohydrate as potato and white bread, but more carbohydrate as dairy-based foods and whole-grain breads than did subjects in the highest-GI quartile. CONCLUSION: Children with diabetes who receive low-GI dietary advice do not report more limited food choices or a diet with worse macronutrient composition than do children who consume a traditional carbohydrate-exchange diet.     

Mortality in severe meningococcal disease

AIM—To evaluate mortality of critically ill children admitted with meningococcal disease.METHODS—Prospective study of all children admitted to a regional paediatric intensive care unit (PICU) between January 1995 and March 1998 with meningococcal disease. Outcome measures were actual overall mortality, predicted mortality (by PRISM), and standardised mortality ratio.RESULTS—A total of 123 children were admitted with meningococcal disease. There was an overall PICU mortality of 11 children (8.9%). The total mortality predicted by PRISM was 24.9. The standardised mortality ratio (SMR) was 0.44. Results were compared with those from four previously published meningococcal PICU studies (USA, Australia, UK, Netherlands) in which PRISM scores were calculated. The overall PICU mortality and SMR were lower than those in the previously published studies.CONCLUSION—Compared with older studies and calibrating for disease severity, this study found a decrease in the mortality of critically ill children with meningococcal disease.     

Patients'' opinions of CFC‐free inhaler changeover in primary care

Objective: To determine patient's opinions regarding the changeover from CFC containing to CFCfree salbutamol. Design: Patients receiving metered dose salbutamol inhaler therapy were identified and verbal consent was obtained before a semistructured interview was performed.Setting An outpatient respiratory clinic within a busy teaching hospita. Main outcome measures: Knowledge of CFCfree inhaler therapy and acceptance of change. Results: A total of 28 patients were identified of whom only eight (29%) had been changed to a CFCfree product. Six of these (75%) had received counselling from their GP or pharmacist regarding the change. Differences were reported by all of the patients who had been changed to a CFCfree inhaler with comments including difference in taste (6 patients), difference in feel (6), less effective (1) and more effective (1). Three patients preferred the CFCfree inhaler to their previous therapy. Although 13 out of the 20 patients who had not received a CFCfree inhaler stated they were happy with the potential changeover, 10 (80%) has concerns relating to effectiveness. Conclusion: The majority of patients still receiving CFC inhalers were aware that the production of CFCcontaining products had been restricted although they were unaware of the imminent changes that would take place regarding their inhaler therapy. However, the small sample size recruited in this study may mean that the results are unrepresentative of the CFCfree implementation process in the Grampian Health Board area as a whole. Nonetheless, in view of the differences experienced by patients who received CFCfree inhalers and the concerns stated about potential lack of efficacy by patients about to be changed over, it is essential that healthcare professionals provide advice on CFCfree inhalers to all patients.     

The role of low birthweight in the aetiology of type 2 diabetes

The aetiology of type 2 diabetes is still poorly understood. Although it is clear that obesity is a risk factor for the disease, obesity leads to diabetes only in susceptible individuals. Both genetic and environmental factors determine this susceptibility. This review describes the emerging evidence that low birthweight caused by malnutrition or a genetic predisposition increases the risk of type 2 diabetes.     

Practical problems in detecting abnormal mitochondrial function and genomes

Mitochondrial respiratory chain dysfunction causes a wide range of primary diseases in adults and children, with highly variable organ involvement. Diagnosis involves weighing evidence from a number of sources, including the clinical presentation, metabolic measurements in vivo, imaging studies, analysis of respiratory chain function or enzyme activities in vitro, studies of mitochondrial morphology after biopsy, and mitochondrial (mt) DNA mutation analysis. Irrespective of the category of the information, it can be difficult to determine whether abnormal results are due to primary defects of the respiratory chain or to practical problems that complicate the diagnostic methodology. This review describes six sources of such problems: genetic complexity, tissue and temporal variation, methodological limitations, secondary effects, logistical issues, and questions of interpretation. When these issues are all addressed, a reliable categorization of the diagnosis as definite, probable, or possible respiratory chain defect becomes possible.     

Intervening with couples: assessing contraceptive outcomes in a randomized pregnancy and HIV/STD risk reduction intervention trial.

PURPOSE: This study assessed the contraceptive outcomes of the Partners Against Risk-Taking: A Networking, Evaluation and Research Study (PARTNERS). The PARTNERS project developed and evaluated a 3-session intervention to help young women and their male partners reduce their risk for unintended pregnancies, and HIV and other STDs. METHODS: Participating couples were randomly assigned to the 3-session intervention or a 1-session information session for couples. Changes in psychosocial factors related to women's motivation to use contraception and relationship factors were assessed using analysis of variance with repeated measures. Changes in contraceptive outcomes were assessed using logistic regression with generalized estimating equations. RESULTS: Comparison of changes from baseline to 6 months among women who participated in the 3-session intervention with those who participated in the information session showed no significant intervention effect on reports of contraceptive use. Instead, contraceptive use increased in both conditions. Both groups exhibited similar changes in the psychosocial variable measuring the importance of avoiding pregnancy and in the relationship variable measuring women's participation in contraceptive decision making. Members of the intervention group, however, showed greater improvement in the psychosocial variable measuring positive expectations pertaining to partner's support for contraception. CONCLUSION: These findings raise questions for further investigation to better understand couples behavior, and whether and how to intervene with couples.     

The coastal environment and human health: microbial indicators,pathogens, sentinels and reservoirs

Innovative research relating oceans and human health is advancing our understanding of disease-causing organisms in coastal ecosystems. Novel techniques are elucidating the loading, transport and fate of pathogens in coastal ecosystems, and identifying sources of contamination. This research is facilitating improved risk assessments for seafood consumers and those who use the oceans for recreation. A number of challenges still remain and define future directions of research and public policy. Sample processing and molecular detection techniques need to be advanced to allow rapid and specific identification of microbes of public health concern from complex environmental samples. Water quality standards need to be updated to more accurately reflect health risks and to provide managers with improved tools for decision-making. Greater discrimination of virulent versus harmless microbes is needed to identify environmental reservoirs of pathogens and factors leading to human infections. Investigations must include examination of microbial community dynamics that may be important from a human health perspective. Further research is needed to evaluate the ecology of non-enteric water-transmitted diseases. Sentinels should also be established and monitored, providing early warning of dangers to ecosystem health. Taken together, this effort will provide more reliable information about public health risks associated with beaches and seafood consumption, and how human activities can affect their exposure to disease-causing organisms from the oceans.     

Quality of nurses' work life: strategies for enhancement

The radical transformation resulting from health care reform, with its emphasis on restructuring, reorganizing and downsizing, has impacted on the nursing profession and has profoundly effected the quality of nurses' work life. The Health Care Corporation of St. John's experienced the stress associated with change when it simultaneously merged eight health care sites and introduced a programmed-based management structure. This article reviews the strategies developed in response to this transition by the Nurses' Quality of Worklife Team, to help reduce stress and enhance the quality of nurses' work life. In particular, it highlights the development and implementation of a professional support network called the Nursing Peer Support Program.     

Prevalence of risk factors for cardiovascular disease in Canadians 55 to 74 years of age: results from the Canadian Heart Health Surveys, 1986-1992

BACKGROUND: By 2016, the proportion of Canadians older than 65 years of age will increase to 16%, and there will be an increase in the absolute number of cases of cardiovascular disease in older Canadians. The Canadian Heart Health Surveys database provides information about this population upon which health policy related to cardiovascular disease can be based. This paper presents for the first time population-based data on the risk factors for cardiovascular disease in older Canadians. METHODS: Canadians from all 10 provinces participated in surveys of cardiovascular risk factors; health insurance registries were used as sampling frames. In each province, probability samples of 2200 adults 18 to 74 years old not living in institutions, on reserves or in military camps were asked to participate in interviews and to undergo testing at clinics for major risk factors for cardiovascular disease. RESULTS: A total of 2739 men (response rate 70%) and 2617 women (response rate 66%) aged 55 to 74 years participated in the survey and also provided follow-up clinical measurements at the clinic. Overall, 52% of participants were hypertensive, 26% had isolated systolic hypertension, and 30% had a total blood cholesterol level of 6.2 mmol/L or greater. Rates of current smoking were lower in women than men (17% v. 22%). Overall, 87% of men and 78% of women who were current smokers smoked at least 10 cigarettes per day. Only slightly more than half of participants exercised at least once a week for at least 15 minutes, and almost half had a body mass index of 27 or greater. In only 4% was no major risk factor for cardiovascular disease detected. INTERPRETATION: Significant numbers of older Canadians have one or more major risk factors for cardiovascular disease. Many of these risk factors are amenable to modification.