Analysis of the incidence of fungal pathogens in air of the Department of Dermatology, Venereology and Allergology of Medical University in Wroclaw.

PURPOSE: Analysis of incidence of fungal pathogens in air of Department of Dermatology, Venereology and Allergology of Medical University in Wroclaw. MATERIAL AND METHODS: Materials for the tests were: the air samples in front of the building, corridors, library, lecture hall, and mycological laboratory. The air pollution was determined using SAS SUPER 100. Humidity and temperature were evaluated by a termohigrometr. Classification of the isolated fungi was made with an accordance to the current procedures. RESULTS: From the air was isolated: in library 69 colonies (mean CFU 138 +/- 41.5), from the bookstands--25 colonies (mean CFU-125 +/- 63.6), lecture hall--119 colonies (mean CFU-380 +/- 98.8), mason room--52 colonies (mean CFU-104 +/- 21.9), mycological laboratory--154 colonies (mean CFU-513 +/- 155.3). Temperature in the tested rooms ranged from 24.5 degrees C (mason room) to 26.1 degrees C (library), humidity ranged from 40.1%-53.1%. Temperature outside of the building was 23.6 degrees C, and humidity 51.6%. Moulds Peniciullium citricum and Aspergillus niger and the yeasts Candida albicans were isolated more frequently. CONCLUSIONS: The highest number of fungi colonies were isolated from the air sampled at the lecture hall and mycological laboratory. Moulds were the most common airborne fungi. Temperature and huimidity in the tested rooms are good conditions for the development of fungi.

Quality of life self-assessment of children living in a children's home, based on own research conducted in the Podlaskie Province.

PURPOSE: The purpose of the study was to diagnose the quality of life (QoL) of children brought up in children's homes, to compare findings with results for peers living in complete families. MATERIAL AND METHODS: In the Stage I was to determine the usefulness of tools for QoL evaluation in a group of 120 children from children's homes in the Podlaskie Province and in a group of 120 children belonging to a control group, brought up in their own families, in the same places where the children's homes were located. Selected research tools were used in Stage II, and the study was carried out in a group of 180 children in the same children's homes and a control group. We used the following survey questionnaires: the standardised CHQ-CF87 survey, standardised KINDL survey and Children's Survey based on WHOQOL-BREF. RESULTS: Significant relationship between the quality of life self-assessment and the place of being brought up for all categories of quality of life was found. A relationship was indicated between the QoL self-assessment and the place of living, age, gender, and physical condition. The charges of a children's home assessed their QoL as significantly lower compared to children living in normal families, mostly in the following categories: health, physical domain and psychological domain, social relations and the ability to function in everyday life. In KINDL survey, strong relationships were found between assessments of QoL categories. CONCLUSIONS: Significant relation between QoL self-assessment and where children were brought up was found. Positive relationship between QoL self-assessment and the place of living, age, gender, and children's physical condition was found.

Relations occurring between health-related behaviour categories and quality of life made by children brought up in a children's home, in the Podlaskie Province.

PURPOSE: The purpose of the study was to determine relations between health-related behaviour categories and quality of life (QoL) categories made by children brought up in a children's home and to compare the results obtained with the results for a group of peers brought up by their own families. MATERIAL AND METHODS: The study was performed on a group of 180 children living in children's homes located in Bialystok, Krasne, Suprasl, Lomza, Nowa Pawlówka; and on a control group of children living with their own families in the same places where children's homes were located. The diagnostic survey method with the Health Behaviour Scale questionnaire, composed of 40 statements defining various behaviours connected with health, and the Children's Questionnaire, based on The World Health Organization Quality of Life (WHOQOL-BREF) was used. RESULTS: Strong correlations between assessments of the Health Behaviour Scale categories and assessments of quality of life categories were found in the group of children living in children's homes, mostly in respect to the relation between health self-assessment and physical activity r = 0.77, mental activity r = 0.74 and environment r = 0.72, and between the physical domain and eating habits r = 0.70, and physical activity and the physical domain r = 0.69. The determination coefficient R2 for the study group had high values for three QoL categories: physical domain 71.5%, mental domain 69.7% and environment 70.1%. CONCLUSIONS: Correlations between Health Behaviour Scale categories and QoL categories were found in the group of children living in children's homes compared to children living with their own families. The relationships for health self-assessment and the physical and mental domains and the environment, and for the physical domain and eating habits and physical activity were found.

Comparative analysis of quality of life women in menopause period in Poland, Greece and Belorussia using MRS Scale. Preliminary report.

PURPOSE: The aim of this study was the assessment of climacteric symptoms, the activity and quality of life of women in menopausal period from Poland, Greece and Belorussia using a Menopause Rating Scale (MRS). MATERIAL AND METHODS: The study was conducted among women in age after 45 years, from Poland (55), Belorussia (50) and Greece (85). MRS was obtained from the Professor Heinemann from Center of Epidemiology and Health Studies in Berlin. The scoring scheme is simple, i.e. the score increases point by point with increasing severity of subjectively perceived symptoms in each of the 11 items (severity 0--no complaints, 4 scoring points--severe). The respondent provides her personal perception by checking one of 5 possible boxes of "severity" for each of the items. RESULTS: Mild and no complaints in similar degree were reported by all women from these three countries. We found significant (p < 0.001) differences between severe complaints reported by Greek women compared with complaints respondents from Belorussia and Poland. Moderate complaints were reported more frequently by women from Poland (32.56%) and Belorussia (34%) compared with women from Greece (28.55%). Severe complaints were noted more rarely in 1.6% Greek women compared with 2.6% Belorussian and 3% Polish respondents. No significant differences between no complainants, mild, moderate, marked and severe between women from Belorussia, Poland and Greece. CONCLUSIONS: Generally we did not observe significant differences between reported complaints by women from Belorussia, Poland and Greece.

Health-related behaviour self-assessment of children living in a children's home; study based on own research realised in the Podlaskie Province.

PURPOSE: The purpose of the study was to diagnose the health-related behaviour of children brought up in children's homes, to compare the obtained results with those obtained from a group of peers brought up in their own families. MATERIAL AND METHODS: The study group included 180 children living in children's homes in the Podlaskie Province and in a control group composed of children brought up in their own families and living in the same places where the children's homes are located. A questionnaire of the Health Behaviour Scale, composed of 40 statements determining health-related issues was used. RESULTS: Self-assessment of health-related behaviour in the studied youth depended on age, for which a statistical significance was shown for: health self-assessment (p = 0.011), categories of stressful situations (p = 0.047), physical activity (p = 0.028) and social support (p = 0.001); gender, for which a statistical significance was shown for the categories of usage of stimulants (p = 0.000) and place of living, in which the factor "place" was significant (p = 0.000) for all categories; and education, where p = 0.000 for the following categories: stressful situations, using stimulants, physical activity, social support and health self-assessment. Relationships between the categories of health-related behaviour were much stronger in the assessments of the children brought up in children's homes were found. CONCLUSIONS: The self-assessment of health-related behaviour of the studied youth depended on age, gender, place of living and education. Relationships between the categories of health-related behaviour were much stronger in assessments of the children brought up in children's homes as compared to controls.

BioSense: implementation of a National Early Event Detection and Situational Awareness System.

BioSense is a CDC initiative to support enhanced early detection, quantification, and localization of possible biologic terrorism attacks and other events of public health concern on a national level. The goals of the BioSense initiative are to advance early detection by providing the standards, infrastructure, and data acquisition for near real-time reporting, analytic evaluation and implementation, and early event detection support for state and local public health officials. BioSense collects and analyzes Department of Defense and Department of Veterans Affairs ambulatory clinical diagnoses and procedures and Laboratory Corporation of America laboratory-test orders. The application summarizes and presents analytical results and data visualizations by source, day, and syndrome for each ZIP code, state, and metropolitan area through maps, graphs, and tables. An initial proof of a concept evaluation project was conducted before the system was made available to state and local users in April 2004. User recruitment involved identifying and training BioSense administrators and users from state and local health departments. User support has been an essential component of the implementation and enhancement process. CDC initiated the BioIntelligence Center (BIC) in June 2004 to conduct internal monitoring of BioSense national data daily. BIC staff have supported state and local system monitoring, conducted data anomaly inquiries, and communicated with state and local public health officials. Substantial investments will be made in providing regional, state, and local data for early event detection and situational awareness, test beds for data and algorithm evaluation, detection algorithm development, and data management technologies, while maintaining the focus on state and local public health needs.

Implementation of laboratory order data in BioSense Early Event Detection and Situation Awareness System.

INTRODUCTION: Laboratory test orders constitute an early outbreak data source. CDC receives laboratory order data in HL7 format from the Laboratory Corporation of America (LabCorp) and plans to use the data in the BioSense Early Event Detection and Situation Awareness System. METHODS: These LabCorp data contain information on tests ordered and include the type of test ordered and the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)-coded reasons for the order. A consensus panel was formed to group test orders on the basis of expert opinion into eight standard syndrome categories to provide an additional data source for early outbreak detection. A laboratory order taxonomy was developed and used in the mapping consolidation phase. The five main classes of this taxonomy are miscellaneous functional tests, fluid screening tests, system-specific tests, tests for specific infections (by primary manifestation), and tests for specific noninfectious diseases. RESULTS: Summary of numbers of laboratory order codes in each syndrome category are fever (53), respiratory (53), gastrointestinal (27), neurological (35), rash (37), lymphadenitis (20), localized cutaneous lesion (11), and specific infection (63). CONCLUSION: With the daily use of laboratory order data in BioSense, the actual distribution of laboratory order codes in syndrome groups can be evaluated, allowing modification of the mapping.

Deciphering data anomalies in BioSense.

INTRODUCTION: Since June 2004, CDC's BioIntelligence Center has monitored daily nationwide syndromic data by using the BioSense surveillance application. OBJECTIVES: The BioSense application has been monitored by a team of full-time CDC analysts. This report examines their role in identifying and deciphering data anomalies. It also discusses the limitations of the current surveillance application, lessons learned, and potential next steps to improve national syndromic surveillance methodology. METHODS: Data on clinical diagnoses (International Classification of Diseases, Ninth Revision, Clinical Modifications [ICD-9-CM]) and medical procedures (CPT codes) are provided by Department of Veterans Affairs and Department of Defense ambulatory-care clinics; data on select sales of over-the-counter health-care products are provided by participating retail pharmacies; and data on laboratory tests ordered are provided by Laboratory Corporation of America, Inc. All data are filtered to exclude information irrelevant to syndromic surveillance. RESULTS: During June-November 2004, of the approximately 160 data anomalies examined, no events involving disease outbreaks or deliberate exposure to a pathogen were detected. Data anomalies were detected by using a combination of statistical algorithms and analytical visualization features. The anomalies primarily reflected unusual changes in either daily data volume or in types of clinical diagnoses and procedures. This report describes steps taken in routine monitoring, including 1) detecting data anomalies, 2) estimating geographic and temporal scope of the anomalies, 3) gathering supplemental facts, 4) comparing data from multiple data sources, 5) developing hypotheses, and 6) ruling out or validating the existence of an actual event. To be useful for early detection, these steps must be completed quickly (i.e., in hours or days). Anomalies described are attributable to multiple causes, including miscoded data, effects of retail sales promotions, and smaller but explainable signals. CONCLUSION: BioSense requires an empirical learning curve to make the best use of the public health data it contains. This process can be made more effective by continued improvements to the user interface and collective input from local public health partners.

Indoor air studies of fungi contamination of social welfare home in Czerewki in north-east part of Poland.

PURPOSE: The contamination of the indoor environment with yeast-like fungi and moulds in social welfare home in Czerewki was evaluated. MATERIAL AND METHODS: The concentration of airborne fungi (in front of the building and in the corridors, patient rooms, study rooms, recreation rooms, kitchens, bathrooms, toilets) was determined using SAS-Super 100 (Pbi International). The fungal concentration on walls was assessed using the Count-Tact applicator and the plate Count-Tact irradiated (BioMerieux). Swabs were taken from the skin of the interdigital spaces of feet and hands, nails and the oral cavity of the residents. The fungi from the swabs were cultured on Sabouraud medium. Fungi were identified using standard microbial procedures. RESULTS: Tests of air and walls revealed significant differences in mycological flora in depending on the place isolation (e.g. corridor, rooms, reading room, nurse, room, kitchen, dining room, bathroom) and season (summer, autumn, winter, spring). A significant increase in the fungi isolated from the air and walls in the social welfare home was found, depending on the season. CONCLUSION: An increase in the fungi isolated from residents was found in relation to the season.

The education of patients with rheumatoid arthritis--the knowledge and expectation of patients-the opinions of rheumatology nurses.

Rheumatoid arthritis (RA) is a chronic, progressive, immunologically dependent, systemic diseases of connective tissue, leading to disability, cripplehood or even premature death. Helping to improve the quality of life of RA patients involves teaching them how to cope with disease-related problems of everyday life, with stress and with suffering. The aim of the presented work is to determine the following: the patients' level of knowledge about rheumatoid arthritis; their educational needs; the impact of the level of knowledge on the patients' pro-health behaviours; the knowledge of nurses and their ability to recognize patients' problems; the nurse's tasks in preparing an RA patient for self-care. The subject group consisted of patients with RA diagnosed according to The American Rheumatism Association criteria and nurses from rheumatology clinics and wards. The research method used was a survey questionnaire, which had been constructed for the purpose of the research. The research results indicate a great need of patients, especially those with early rheumatoid arthritis, for education, support and help in adaptation. At the same time, the nurses, even though they do not fully fulfil their educational role, declare a willingness to participate in organized forms of health education.

The importance of the health education in life quality improvement in patients with psoriasis.

PURPOSE: The aim of the study was to determine the influence of the psoriatic patient knowledge of the disease on the quality of life. MATERIAL AND METHODS: The study was carried out in 149 patients with psoriasis. All patients answered on anonymous questionnaire, in according to Psoriasis Disability Index (PDI). RESULTS: Almost 43% patients could not show any factor which provoked their disease, 31.5% could not tell any recommendations for cure and care of the psoriatic lesions and 32.2% patients could not point out any methods to avoid psoriatic lesions spread. Almost 60% of the group admitted that their quality of life fell because of the disease. At the same time, patients who did not have enough information concerning the disease had lower quality of life index. CONCLUSIONS: The level of the disease knowledge in the patients with psoriasis influences their quality of live. Therefore it is indicated for the patiens and their families to be involved in the proper educational program.

A multistate outbreak of Escherichia coli O157:H7 infections linked to alfalfa sprouts grown from contaminated seeds.

A multistate outbreak of Escherichia coli O157:H7 infections occurred in the United States in June and July 1997. Two concurrent outbreaks were investigated through independent case-control studies in Michigan and Virginia and by subtyping isolates with pulsed-field gel electrophoresis (PFGE). Isolates from 85 persons were indistinguishable by PFGE. Alfalfa sprouts were the only exposure associated with E. coli O157:H7 infection in both Michigan and Virginia. Seeds used for sprouting were traced back to one common lot harvested in Idaho. New subtyping tools such as PFGE used in this investigation are essential to link isolated infections to a single outbreak.

Antimicrobial resistance of nasopharyngeal isolates of Streptococcus pneumoniae and Haemophilus influenzae from children in the Central African Republic.

BACKGROUND: To assist the Central African Republic (CAR) develop national guidelines for treating children with pneumonia, a survey was conducted to determine antimicrobial resistance rates of nasopharyngeal isolates of Streptococcus pneumoniae (SP) and Haemophilus influenzae (HI). Secondary purposes of the survey were to identify risk factors associated with carriage of a resistant isolate and to compare the survey methods of including only children with pneumonia vs. including all ill children. METHODS: A cross-sectional survey of 371 ill children was conducted at 2 outpatient clinics in Bangui, CAR. RESULTS: In all 272 SP isolates and 73 HI isolates were cultured. SP resistance rates to penicillin, trimethoprim-sulfamethoxazole (TMP-SMX), tetracycline and chloramphenicol were 8.8, 6.3, 42.3 and 9.2%, respectively. All penicillin-resistant SP isolates were intermediately resistant. HI resistance rates to ampicillin, TMP-SMX and chloramphenicol were 1.4, 12.3 and 0%, respectively. The most common SP serotypes/groups were 19, 14, 6 and 1; 49% of HI isolates were type b. History of antimicrobial use in the previous 7 days was the only factor associated with carriage of a resistant isolate. Resistance rates were similar among ill children regardless of whether they had pneumonia. CONCLUSIONS: Resistance rates were low for antimicrobials recommended by the World Health Organization for children with pneumonia. We recommended TMP-SMX as the first line treatment for pneumonia in CAR because of its low cost, ease of dosing and activity against malaria.

Cluster of postinjection abscesses related to corticosteroid injections and use of benzalkonium chloride.

Benzalkonium chloride (BC) is an unreliable disinfectant. A matched case-control study and environmental investigation were conducted to determine the cause of and risk factors for a cluster of postinjection abscesses at a private medical clinic where BC was used as a disinfectant. Twenty-eight case-patients who had an abscess at the injection site were matched with 126 control patients who had received an intramuscular injection at the clinic on the same day. Risk factors for abscess development in a multivariable logistic model were corticosteroid injection and being female. All case-patients had received a corticosteroid injection from a multidose vial. Cultures of abscesses from 20 of 23 case-patients grew Pseudomonas aeruginosa. Cultures of BC prepared at the clinic also grew P aeruginosa, suggesting that BC was the source of infection. Injection site cleaning with BC did not appear to be the route of infection since use of BC at the time of injection was not associated with abscess development. A more likely route of infection was injection of contaminated corticosteroid from multidose vials that could have been inoculated with pseudomonads via needle puncture after vial septa were wiped with contaminated BC. Benzalkonium chloride should not be used to clean injection vial septa or injection sites.

Ebola hemorrhagic fever, Kikwit, Democratic Republic of the Congo, 1995: risk factors for patients without a reported exposure.

In 1995, 316 people became ill with Ebola hemorrhagic fever (EHF) in Kikwit, Democratic Republic of the Congo. The exposure source was not reported for 55 patients (17%) at the start of this investigation, and it remained unknown for 12 patients after extensive epidemiologic evaluation. Both admission to a hospital and visiting a person with fever and bleeding were risk factors associated with infection. Nineteen patients appeared to have been exposed while visiting someone with suspected EHF, although they did not provide care. Fourteen of the 19 reported touching the patient with suspected EHF; 5 reported that they had no physical contact. Although close contact while caring for an infected person was probably the major route of transmission in this and previous EHF outbreaks, the virus may have been transmitted by touch, droplet, airborne particle, or fomite; thus, expansion of the use of barrier techniques to include casual contacts might prevent or mitigate future epidemics.

Measles outbreak in Juneau, Alaska, 1996: implications for future outbreak control strategies.

OBJECTIVE: To determine the most effective outbreak control strategy for school-based measles outbreaks as the proportion of children with two doses of measles-containing vaccine (MCV) increases. SETTING: A school-based measles outbreak during 1996 involving 63 cases in Juneau, Alaska (population 29 288), where systematic revaccination with MCV was not implemented. DESIGN: A retrospective evaluation using chain-of-transmission data of three possible outbreak control strategies: no school revaccination, targeted school revaccination (affected schools only), and community-wide school revaccination (all schools). Two-dose MCV coverage among students was estimated from school vaccination records and a survey issued to parents. PRIMARY OUTCOME MEASURES: Potentially preventable cases of measles and doses of MCV administered per case prevented. RESULTS: Two-dose MCV coverage among Juneau students was estimated to be 44% and 53% immediately before and after the outbreak, respectively. Of all the measles cases, an estimated 24 to 28 and 27 to 31 were potentially preventable by the targeted and community-wide school revaccination strategies, respectively. Either strategy might have optimally decreased the outbreak duration by 1 month, sparing one of seven affected schools and 10 of 12 unvaccinated children who had measles. Approximately 133 to 155 and 139 to 160 doses of MCV per case prevented would have been required for targeted and community-wide school revaccination, respectively. CONCLUSIONS: Either targeted or community-wide school revaccination would have been effective control strategies for this outbreak. Targeted school revaccination is probably the intervention of choice for school-based measles outbreaks in larger communities with higher two-dose MCV coverage. As two-dose MCV coverage continues to increase in the United States, public health control measures to respond to outbreaks need to be reevaluated.

Reliability of reported age at menopause.

Age at menopause is an important epidemiologic characteristic whose reliability of reporting in the US population is not known. The authors examined four hypotheses about the reliability of reported age at menopause in the United States: 1) women with hysterectomy-induced menopause more reliably report their age at menopause than women who have undergone natural menopause; 2) reliability declines with time since menopause; 3) reliability declines with age; and 4) women with higher educational levels report their age at menopause more reliably than women with less education. The authors used linear regression models among 2,545 women in the First National Health and Nutrition Examination Survey and Followup Study (1971-1984) and compared responses at first and follow-up interviews. Among women who had undergone a natural menopause, 44% reported their age at menopause within one year from the first to second interviews; among women who had undergone a hysterectomy-induced menopause, 59% reported their age at menopause within one year from first to follow-up interviews. Only hysterectomy status and years from menopause to follow-up interview were significantly associated with the absolute difference between age at menopause reported at first and follow-up interviews. The authors conclude that caution in studies involving age at menopause may enhance our understanding of this critical event in the lives of women.

Estimating the maximum effective dose in a quantitative dose-response experiment.

A simulation study was conducted to compare several procedures for estimating the maximum effective dose in a quantitative dose-response experiment. Using four equally spaced dose levels, data were generated from four different model types: the quadratic growth curve, the Mitcherlich growth curve, the linear-linear plateau spline model, and the quadratic-linear plateau spline model. Each model type was parameterized to create three different model ranges, and for each range, data were generated from populations with three different standard deviations. The existence of unique dose-response curves is assumed; thus, all the procedures compared in this paper require that the data have been modeled by a polynomial or nonlinear regression model. An attempt was made to fit each generated data set with each of the four model types. Maximum effective dose estimation procedures were applied to a data set only when the data were adequately described by a given model. The stimulation indicated that the estimate of the maximum effective dose is influenced more by the choice of model than by the method of estimation. Because of the consistently low estimates produced when the data were modeled by the linear-linear plateau spline, this model is not recommended for use an maximum effective dose estimation experiments. The simulation also demonstrated that the design failed to provide sufficient information about the form of the dose-response curve. Designs with more than four dose levels should be considered.

The role of young children in a community-wide outbreak of hepatitis A.

An Hasidic Jewish community has experienced recurrent hepatitis A outbreaks since 1980. To assess risk factors for illness during a 1985-6 outbreak, the authors reviewed case records and randomly selected 93 households for an interview and serologic survey. In the outbreak, 117 cases of hepatitis A were identified, with the highest attack rate (4.2%) among 3-5 year olds. Among the survey households, the presence of 3-5 year olds was the only risk factor that increased a household's risk of hepatitis A (indeterminant relative risk, P = 0.02). Furthermore, case households from the outbreak were more likely to have 3-5 years olds than were control households from the survey (odds ratio = 16.4, P < 0.001). Children 3-5 years old were more likely to have hepatitis A and may have been the most frequent transmitters of hepatitis A in this community. Hepatitis A vaccination of 3-5 year olds can protect this age group and might prevent future outbreaks in the community.

Episodic versus prophylactic infusions for hemophilia A: a cost-effectiveness analysis.

OBJECTIVE: To assess the incremental cost-effectiveness of prophylactic compared with episodic care in boys with severe hemophilia A. SETTING: Eleven U.S. hemophilia treatment centers. METHODS: Charge data from a randomly selected cohort of 70 boys receiving episodic infusions for bleeding events and from all 27 boys receiving infusions prophylactically were collected from documents obtained from the hemophilia treatment centers during a period of approximately 2 years. Published and public sources were used for conversion to cost, lifetime earnings, and earnings losses from disability. A model was constructed for a hypothetical patient from ages 3 to 50 years by means of three infusion scenarios. RESULTS: The cohort receiving prophylactic treatment had fewer bleeding events each year (median, 3 vs 31) but used more concentrate (3323 vs 1015 units/kg per year). Factor VIII concentrate accounted for more than 93% of the cost of both episodic and prophylactic care. Compared with episodic infusion, prophylaxis from ages 3 to 20 years costs $1100 per bleeding event prevented, in comparison with $1380 for prophylaxis from ages 3 to 50 years. The total cost of prophylactic care from ages 3 to 50 years would equal the current total cost of episodic care if the price of the concentrate were decreased by 50%. CONCLUSION: Prophylactic care markedly reduces the number of bleeding events and should prevent joint function impairment, but at substantial cost.