Asthma and indoor environment in Nepal.

BACKGROUND: The development of asthma seems to be influenced by the adoption of a Western lifestyle. A study was undertaken to assess the importance of indoor environmental factors in Nepal where the lifestyle and home environment differ from that in the West. METHODS: The home environment of 121 schoolchildren with asthma and 126 controls aged 11-17 years was studied. The homes of all participants were investigated and the children and their mothers were interviewed using a standardised questionnaire. Cases and controls were identified from an ISAAC (International Study of Asthma and Allergy in Childhood) based population study of 2330 schoolchildren in Kathmandu, Nepal. RESULTS: Keeping cattle inside the house during the night was related to a lower risk for having asthma (adjusted odds ratio (OR) 0.2 (95% CI 0.1 to 0.5)) while there was no association between asthma and cattle kept outside. Asthma was associated with cigarette smoking by two or more family members (OR 1.9 (95% CI 1.0 to 3.9)) and with the domestic use of smoky fuels (OR 2.2 (95% CI 1.0 to 4.5)). In analyses stratified by sex, passive smoking and the use of smoky fuels were significantly associated with asthma only in boys. CONCLUSIONS: The risk of asthma in Nepalese children was lower in subjects exposed to cattle kept inside the house and higher in subjects exposed to passive smoking and indoor use of smoky fuels. Childhood exposure to microorganisms or allergens from cattle may protect against the development of atopic disease.

[Evaluation by public health physicians of collaboration and workload within municipal health services]. / Samfundsmedicinerens vurdering af samarbejde or arbejdsbelastning i kommunehelsetjenesten.

BACKGROUND: We wanted to explore the quality and importance of the collaboration between public health physicians and selected groups of professionals and politicians. MATERIAL AND METHODS: The study was a cross-sectional survey based on self-administered questionnaires with closed questions. Response came from 218 public health doctors who worked in the municipalities throughout the study period (1988-91), and from 98 doctors who left public health during the same period (81% and 86% of the study populations respectively). RESULTS: The doctors reported good and important collaboration with other health professionals, but less good and less important collaboration with other professionals and with politicians. With increased administrative distance between the doctor and other municipality staff, the perceived quality of the collaboration decreased. INTERPRETATION: Closer collaboration between public health doctors and important decision makers in the municipality promotes job satisfaction among doctors and may reduce turn-over.

[Job satisfaction among physicians employed in public health services]. / Trivsel blandt laeger i kommunale samfundsmedicinske stillinger.

For several years the high turnover of doctors in municipal public health positions has been a cause of concern in Norway. More information on the causes of the higher turnover, and of factors that could promote greater satisfaction, could provide a basis for discussing what needs to be done. In order to find out the main sources of satisfaction, or dissatisfaction, and their relative importance, a questionnaire was mailed to all doctors in public health positions from 1988 through 1991. They were asked about 12 different aspects of their jobs and general family well-being. 218 (81%) of the doctors who had held such a position for the whole period ("the stable"), and 98 (87%) of those who had quit ("the quitters") responded. Sources of great satisfaction were opportunities for outdoor recreation and the well-being of the family. The doctors were least satisfied with the level of income and the heavy load of work. When asked to state the most important sources of satisfaction, both stable and quitters gave first priority to the professional content of the work and collaboration with colleagues. The stable also gave high priority to general family well-being. For the quitters, an important negative factor was the heavy work load. About 27% of the stable and 42% of the quitters thought the job required too much effort. More of the stable group than of the quitters felt professionally competent, and that they were doing a good job. On the other hand, more of the quitters than of the stable group felt they had little influence on the local health policy, and that the job was uninteresting. In the efforts to reduce the turnover of doctors in public health positions, the health authorities should consider the wider aspects of the job, not just the wage. To increase stability and job satisfaction, greater attention should be given to the professional content of the work, the need for professional collaboration, and the heavy work load.

[Turnover of positions as the medically responsible physician in Norwegian municipalities 1988-91]. / Gennemtraek i stillingerne som medicinsk fagligt ansvarlig laege i norske kommuner 1988-91.

The aim of the study was to measure turnover in public health posts in Norwegian municipalities from 1 January 1988 to 31 December 1991. From various publications and a self-administered questionnaire mailed to the authorities in selected municipalities we identified 164 (37%) municipalities out of 445 with a change of doctor in the public health post. During the study period, about 200 different doctors had been employed in these 164 municipalities. Additionally, at least 200 doctors had been engaged as public health officers on a short term basis. The findings indicate that counting announcements of vacant public health posts in the Journal of the Norwegian Medical Association is a reliable method for measuring turnover in such posts.

[The value of C-reactive protein testing in suspected lower respiratory tract infections. A study from general practice on the effect of a rapid test on antibiotic research and course of the disease in adults]. / Nytten av å teste C-reaktivt protein ved mulig nedre luftveisinfeksjon. En undersøkelse fra allmennpraksis av en hurtigtests innvirkning på antibiotikaforskrivning og sykdomsforløp hos voksne.

We wanted to assess whether routine use of a rapid test for C-reactive protein (CRP) could reduce prescription of antibiotics for adults with possible lower respiratory tract infection. 239 patients were randomized into a CRP group, tested with the rapid test (n = 108) and a control group (n = 121). Before knowing to which group the patient belonged the doctors made a preliminary decision about antibacterial treatment. The C-reactive protein value was then released if the patient belonged to the CRP group, and the therapy could be adjusted in light of the result. Antibacterial courses prescribed during the consultations and in the following three weeks were registered. The clinical course was evaluated by interview after one week and again after three weeks. Antibiotics were prescribed for altogether 56% of the patients in the CRP group and 60% in the control group. The difference was not statistically significant. Prescription of antibiotics was strongly associated with the finding of crackles and wheezes, but not with cough, dyspnoea or chest pain. Slow recovery was associated with high age, absence of fever and a normal value of C-reactive protein. No significant benefit of the CRP test was demonstrated. We discuss whether the doctors made full practical use of the information provided by the test. Bronchial obstruction should probably be considered to be the problem more often in coughing patients with a normal CRP value.

[Written information from hospital to primary physician about discharged patients]. / Skriftlig informasjon fra sykehuset til primaerlegen om utskrevne pasienter.

Discharge communications from hospitals to general practitioners in respect of 203 patients have been analyzed in two municipalities in Western Norway. The average interval between discharge from hospital and the first visit to the GP was 25 days (1-198 days). The mean period before arrival of the final report was 28 days (0-175 days). In 38% of the cases the GPs had received no written communication from the hospital upon first contact after discharge. 42% of the preliminary reports and 18% of the final reports were judged to be inadequate. At the first attendance, the GPs were uncertain about the drug regimen in 25% of the cases and about other forms of treatment in 32%. They felt uncertainty about follow-up procedures in the case of 44%. As evaluated by the GPs, in 22% of the cases the absence or inadequacy of the discharge letters might have had a negative influence on the patient's health. A survey of the literature provides a basis for the following recommendations: On leaving the hospital the patient should be given an interim discharge summary containing any information essential for immediate follow-up, to be delivered to the general practitioner by hand. The final discharge letter should focus upon topics of particular interest for the general practitioner: results from clinical examinations and laboratory investigations should be restricted to data necessary for making clinical decisions; treatment given in hospital, including adverse reactions, and drug regimen at discharge; any information on the nature and prognosis of the disease given to the patient and/or relatives during the stay in hospital; evaluation of prognosis and advice on sociomedical rehabilitation in everyday life and at work; a plan for future management of the patient with emphasis on well-defined sharing of tasks and responsibilities between the hospital, the outpatient department and the GP.

The epidemiology of onchocerciasis in the Tukuyu Valley, South West Tanzania.

In the Tukuyu valley in Tanzania 21 villages were surveyed and 2,043 people were examined. In total village populations aged 1 year and over, the highest prevalence of 62.8% (49/78) was found near the Lufilyo River, corresponding to the highest transmission potential. Villages with higher endemicity were not found and there was no difference in blindness rates between villages with little or onchocerciasis and those with mesoendemic onchocerciasis.

Praziquantel: a new schistosomicide against Schistosoma haematobium.

The effectiveness of the new schistosomicide praziquantel was assessed in African schoolchildren infected with Schistosoma haematobium. They were stratified according to the severity of their infection and were then randomly allocated to treatment with two single-dose regimens (30 and 40 mg/kg) and a split regimen of two doses of 20 mg/kg given four hours apart. All three regimens were highly effective and produced few side effects. Children who initially had very high pretreatment egg loads showed a poorer therapeutic response at all dose levels, and further investigations are necessary to find the optimum dose. Because of its effectiveness in a single dose and lack of toxicity, praziquantel may prove to be the ideal schistosomicide.

Tanzania Filariasis Project: a provocative day test with diethylcarbamazine for the detection of microfilariae of nocturnally periodic Wuchereria bancrofti in the blood.

In coastal Tanzania, an area where the microfilariae (mf) of Wuchereria bancrofti exhibit nocturnal periodicity, the administration of 2 mg diethylcarbamazine (DEC) per kg body weight in the daytime provoked mf to enter the peripheral blood. In persons on normal daily activities the daytime DEC provocative method proved to be as sensitive in detecting microfilaraemia as was the examination of night blood. Its use in routine surveys is therefore justified. Although mf densities by day and night were highly correlated (r = 0.83) they tended to be lower after provocative daytime DEC than in the corresponding night blood, except in very light infections. This method was also useful in assessing the parasitological response to mass chemotherapy with DEC, but, in comparison with the results of the night blood examinations, the sensitivity and magnitude of the counts in persons remaining positive progressively decreased as the period of DEC administration increased. A correction factor has to be calculated to take account of this, and/or additional night blood samples must be taken.The dose of 2 mg of DEC per kg body weight used was readily acceptable to the people in coastal East Africa, whose cooperation is difficult to obtain for night blood surveys. Apart from W. bancrofti, the only human filarial infection occasionally encountered in this area was Dipetalonema perstans. Because of the risk of a severe Mazzotti reaction the test is contraindicated in onchocerciasis endemic regions. Severe reactions may also occur in subjects with loaiasis.

The lethal effects of the cibarial and pharyngeal armatures of mosquitoes on microfilariae.

Microfilariae of Wuchereria bancrofti and Brugia pahangi were killed by the chewing action of the cibarial and pharyngeal armatures and other papillae and spines in the fore-gut of mosquitoes. The proportion of ingested microfilariae that were killed was largely dependent on the presence and shape of the cibarial armature. Anopheles farauti No. 1 and Anopheles gambiae species A and B have well developed cibarial armatures and killed 36 to 96% of the ingested microfilariae. Culex pipiens fatigans has a poorly developed cibarial armature and killed only 6% of the microfilariae. Aedes aegypti and Aedes togoi lack cibarial armatures but have the remaining fore-gut structures. They killed only 2 to 22% of the microfilariae. The significance of these observations in relation to the control of filariasis with diethylcarbamazine is discussed.