An outbreak of nosocomial hepatitis B virus infection in a nursing home for the elderly in Antwerp (Belgium).

After notification of a case of fulminant hepatitis B virus (HBV) infection in a 83-year-old female resident of a nursing home to the Flemish Health Inspectorate, a seroepidemiological study and a retrospective cohort study were conducted among the 94 residents and 47 nursing staff to assess the extent of HBV transmission and to identify risk factors. Susceptible residents were vaccinated against HBV and their serological response to hepatitis B vaccination determined. From December 2002 to April 2003, five residents with acute hepatitis B infection were identified with an attack rate of 5.5% and a case fatality rate of 40%. Three other residents were identified as HBV surface antigen and e-antigen positive carrier. None of the nursing staff tested positive for acute HBV infection or HBV carriage. Diabetic patients who were exposed to a shared finger-stick device for blood sampling were 10.7 times more likely to contract an acute HBV infection (RR 10.7; 95% CI 1.3-91.3). Other potential risk factors were undergoing podiatric care and being exposed to the shared razor blade of the hairdresser. The transmission of the infection could be controlled by restricting the use of finger-stick capillary sampling devices to individual patients, assigning separate glucometers to individual patients and, implementation of standard infection-control recommendations like wearing gloves and performing hand hygiene by the nursing staff, assigning separate podiatric sets to individual patients. HBV vaccination of the residents with three doses of HBV vaccine has not induced a sufficient degree of protection. The outbreak stresses the need for appropriate and generally applied standard procedures in nursing homes to prevent bloodborne pathogens.

Memory impairment in multiple sclerosis.

We compared the performance of 50 multiple sclerosis (MS) patients and 35 normal controls on a variety of memory tasks to determine the nature and severity of memory deficits in the MS patients and the proportion of patients affected. We also determined the relationship between memory and other cognitive functions, demographic factors, disease characteristics, depression, and psychoactive medication. We found significant differences between patients and controls on almost all memory tests. Patterns of learning, effects of interference, and improvement with cuing were similar for both groups. Thirty percent of patients showed severe memory impairment, 30% were moderately impaired, and 40% were mildly or not impaired. Memory dysfunction was related to impairment of other cognitive functions, lower socioeconomic status, chronic progressive type of MS, and use of antianxiety medication, but not to severity of disability, duration of MS symptoms or depression.

Methodological issues in screening for dementia: the problem of education adjustment.

The methodological problems of developing efficient and unbiased screening methods for population-based studies of dementia have received scant attention. The potential advantages of education-adjusted screening methods are discussed. The implications for adjustment techniques of a negative correlation of educational attainment with age are emphasized. Two education adjustment methods, a stratified regression method and a nonparametric method, which take the age-education correlation into account are described, compared, and illustrated.