Prevalence of hepatitis B markers in the population of catalonia (Spain). Rationale for universal vaccination of adolescents

The prevalence of hepatitis B markers was determined in a representative sample of the general population of Catalonia (Spain). HBsAg was found in 0.5% of children (less than 15 years of age) and in 1.7% of adults (more than 15 years of age), and anti HBs in 1.6% and 18%, respecitvely. Age-specific prevalence for both markers showed a low risk for hepatitis B before puberty, and a progressive rise since adolescence, suggesting that perinatal transmission and horizontal transmission in children are relatively uncommon in Spain. Prevalence of hepatitis B markers was significantly higher among subjects with low education level, residing in an urban area and born outside Catalonia, but in the stratified analysis, a statistical significant difference was only maintained in the prevalence of HBV markers between those who live in urban and rural areas, and between those who were born outside Catalonia and in Catalonia. These data may be used as a basis for a strategy of hepatitis B prevention in Spain which include universal vaccination of adolescents, passive-active immunization of newborns to HBsAg positive mothers and vaccination of susceptible adults subjects from high-risk groups.Preventive Medicine Unit.Liver Unit.Corresponding author.     

Relationship between severity,costs and claims of hospitalized patients using the Severity of Illness Index

The results of the prospective application of Horn's Severity of Illness Index in a teaching hospital during 1987, 1989, and 1990 constitute the basis of the present report. The average overall severity of illness scores for the three years were 1.42 in 1987, 1.65 in 1989, and 1.46 in 1990. Most of the processes evaluated in the three periods showed an overall distribution among severity levels 1 and 2, both overall and when the seven dimensions of the severity of illness index were analyzed. A statistically significant correlation between the overall severity of illness and average length of stay was found for patients in 1989 and 1990. The length of stay differed significantly in the different severity levels. When the four levels of the seven dimensions of the severity of illness index for 1987, 1989, and 1990 were compared, it was observed that figures were not uniformly distributed. There was a statistically significant association between severity of illness for hospital service and pharmacy charges per hospital stay for both 1989 and 1990, as well as a statistically significant inverse relationship between severity of illness and the number of claims per hospital service in both periods of time. Case-mix methods that account for the severity of patients constitute a useful indicator of quality for the management of different hospital services and of the hospital as a whole.     

An analysis of the factors affecting the average length of stay in the otolaryngology unit

Specific factors which have an influence on the average length of stay in the otolaryngology unit of a University Hospital are studied; the patients are covered by some type of insurance and have no out-of-pocket expenses. The effect of the following variables on the average length of stay is evaluated: age, sex and type of pathology. The periods of hospitalisation are significantly longer (Mann-Whitney test) in males (p < 0.0001), in older patients (p < 0.008) and in the case of tumours, which prolong the period of stay especially of males (p < 0.0001). It is suggested that the shorter stay in the case of females may be conditioned by social and family factors.     

Immunneuropathien — Aktuelle Aspekte der Diagnostik und Therapie

Zusammenfassung Zu den immunvermittelten Neuropathien rechnen wir das Guillain-Barré-Syndrom, die chronische Polyneuritis, die multifokale motorische Neuropathie mit Leitungsblock, Neuropathien bei monoklonalen Gammopathien und vaskulitische Neuropathien. Wir besprechen in dieser Übersicht zur zertifizierten Fortbildung zunächst das abgestufte diagnostische Vorgehen, um im klinischen Alltag rationale Entscheidungswege aufzuzeigen. Viele Immunneuropathien werden immer noch fälschlich als altersbedingte, metabolisch-toxische oder alkoholische Neuropathie verkannt und keine vollständige Diagnostik durchgeführt. Das ist problematisch, weil erfreulicherweise viele Immunneuropathien heutzutage relativ gut behandelbar, ja sogar heilbar sind. Allerdings sind die meisten verfügbaren Immuntherapien nicht spezifisch. Das Spektrum der immunsuppressiven oder immunmodulatorischen Therapien reicht von Glukokortikosteroiden, Plasmapherese oder der Gabe von Immunglobulinen in der Akutphase bis zum Einsatz von Azathioprin, Cyclosporin, Cyclophosphamid oder auch Immunglobulinen in der Langzeittherapie. Dabei ist oft nicht klar, welche der vermuteten oder gesicherten immunologischen Mechanismen für die Wirkung einer bestimmten Substanz wie z. B der Immunglobuline bei der jeweiligen Neuropathie am wichtigsten sind. Neben medizinischen Gesichtspunkten und Kriterien evidenzbasierter Medizin müssen heutzutage auch wirtschaftliche Aspekte und Fragen der Zulassung einer bestimmten Substanz in die Therapieplanung mit einfließen.A. Bayas: seit April 2005 in der Neurologischen Klinik und klinischen Neurophysiologie, Zentralklinikum Augsburg     

The role of mobile phones in improving vaccination rates in travelers

RATIONALE: Noncompliance with vaccination schedules undermines the potential benefits of immunization. The purpose of this study was to evaluate whether a reminder of the next vaccine dose sent by the Short Messaging Service (SMS) to the vaccinee's mobile phone increases compliance with hepatitis A + B and hepatitis A vaccination schedule. SUBJECTS AND METHODS: In this experimental, controlled study, the study group comprised travelers who went to the Internacional-Clínic Vaccination Centre between the 1st June and 30th September of 2001 for the standard immunization schedule against hepatitis A + B and against hepatitis A. Trained health-care workers entered the data into a computer to generate text messages reminding vaccinees of their scheduled doses. Two control groups, one from the same period of the same year including travelers from the third office (Control 2001) and the second, all travelers seen in the same period of the previous year (Control 2000), were used. RESULTS: For the second hepatitis A + B dose, compliance in the study group (Message Groups) was 88.4% (83.3-92.2); in the Control 2001, 80.7% (76.3-84.4, relative risk [RR] 1.10 [1.02-1.17]); and in the Control 2000, 77.2% (73.3-80.5, RR 1.15 [1.07-1.22]). For the third hepatitis A + B vaccine dose, results were 47.1% (40.5-53.8); 26.9% (22.8-31.7, RR 1.75 [1.41-2.17]); and 23.6% (20.1-27.4, RR 2.00 [1.63-2.45]), respectively. As for the hepatitis A vaccine, compliance rates for the second dose were 27.7% (23.9-31.9); 16.4% (14.4-18.6, RR 1.69 [1.40-2.04]); and 13.2% (11.6-14.9, RR 2.10 [1.75-2.54]); respectively. CONCLUSIONS: SMS seems to be an effective tool for increasing compliance with vaccination schedules.     

Diagnostic principles in myopathies

Myopathies include a broad range of disorders. Diagnostic steps in muscle disorders should therefore be followed sequentially, in order not to miss important information and to avoid unnecessary and cost intensive diagnostic procedures. Specific care should be applied in taking patient's history to ascertain myopathy related complaints, triggers and concomitant diseases possibly being accompanied by a myopathy. Clinical examination may reveal a distribution pattern already suggestive for a specific disorder. An elevated creatine kinase, often leading to neurological evaluation, should at least be repeated once after resting. Metabolic myopathies might be detected by exercise testing. Electromyography, muscle imaging and, usually as the last diagnostic step, muscle biopsy represent further diagnostic tools in the assessment of myopathies. In some disorders molecular genetic techniques can be applied.     

Reactogenicity profile of tetanus-diphtheria (adult-type) vaccine: results of a naturalistic study performed at an adult vaccination center

A prospective observational naturalistic study was conducted at a vaccination center to assess the reactogenicity of tetanus-diphtheria (adult-type) (Td) vaccine. In 1 year, 3072 adult subjects were invited to participate, of whom 1977 (62% women, mean age [+/- SD]: 39 [+/- 14.5] years [range: 18-85 years]) actively did so. A follow-up diary card was provided to all subjects to record all local and general symptoms experienced during the following 4 days after vaccination. Of the study population (n = 1977), 280 received a second Td dose, and 30 received a third dose: the total number of diary cards collected was 2287. Td was always administered (i.m. route) in the left arm. The study population was grouped by age: 52%, 41%, and 7% were ages 18 to 35, 36 to 65, and > 65 years, respectively, most of them being travelers to developing countries. Close to two-thirds of subjects received up to nine different vaccines (mainly hepatitis B, hepatitis A, and typhoid) in addition to Td. Adverse reactions were classified as mild, moderate, and severe. Overall, 50% of subjects reported some type of adverse reaction. Pain, discomfort with arm movement, swelling, malaise, and fever (axillary temperature > or = 38 degrees C) were recorded in 43%, 14%, 3.8%, 5.1%, and 1.7% of all diary cards, respectively. Local and general reactions were considered as mild by almost two-thirds of vaccinees and lasted < or = 48 hours in about three-fourths of them. The incidence of moderate plus severe local reactions was significantly (p < 0.01) more commonly reported in the 18- to 35-year-old group than in the 36- to 65-year-old group. No statistically significant differences were observed when comparing the incidence of general adverse reactions of those receiving Td alone with those receiving additional vaccines or when comparing the duration and intensity by age groups. Only 5.2% of subjects required analgesic/antipyretic treatment. In conclusion, this study shows that Td vaccine is reasonably well tolerated when given alone or with other vaccines. Similar studies should be conducted with other vaccines routinely recommended to adults to assess how they are administered in usual clinical practice and the reactogenicity profile perceived by the vaccinees.