Asymptomatic carriage of Klebsiella pneumoniae producing extended-spectrum beta-lactamase by patients in a neurological early rehabilitation unit: management of an outbreak.

During 11 months 58 extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-Kp) isolates were grown from 10 patients on a neurological early rehabilitation unit. The patients had no signs of infection but were colonized in the nose and trachea, and unusually only one had colonization in the gut. A single clone of ESBL-Kp was identified by pulse field gel electrophoresis. Strong hygienic precautions similar to those for Methicillin-resistant Staphylococcus aureus patients prevented spread of the bacteria to other wards. However, rehabilitation for patients with severe neurological failures made it very difficult to follow hygienic requirements. Disinfection of mucous membranes was difficult. Eventually the application of a nasal spray containing povidone-iodine proved to be successful.

Longevity of pathogenic bacteria especially Salmonella in cistern water.

Cistern-collected rain water which is used as process water for toilet flushing, cleaning purposes, garden irrigation and linen washing, was experimentally contaminated with pathogenic bacteria, Salmonella enteritidis, Yersinia enterocolitica and Campylobacter jejuni. The longevity of those pathogens was investigated considering different temperatures and contents of organic materials. Neither Salmonella enteritidis, Yersinia enterocolitica nor Campylobacter jejuni are able to grow at temperatures of 5 degrees C, 15 degrees C, 20 degrees C or 37 degrees C. The most sensitive pathogen was Campylobacter jejuni which showed rapidly decreasing of colony counts at 15 degrees C as compared with Yersinia enterocolitica or Salmonella enteritidis. For Salmonella enteritidis the decrease of bacterial concentrations was higher at 37 degrees C than at 5 degrees C. Increasing the concentrations of organic compounds by addition of bacteriological pepton or addition of extreme++ amounts of pidgeon feces lowers the rate of bacterial death but an increase in colony counts could not be observed at the different temperatures investigated. The elimination of salmonella is supported if the cisterns are layered with a biofilm and sediment. So it could be confirmed, that raised amounts of organic material, pidgeon feces together with optimal temperatures which can be observed accidentally in rain water cisterns can not enhance growth of enteropathogenic bacteria.

Women, work and health: issues and implications for worksite health promotion.

This paper identifies issues related to worksite health promotion programs for women by examining ways that work factors, health behaviors, family roles and responsibilities, and women's health are linked. Work conditions may affect women uniquely, as in the case of chemical exposure affecting reproductive health; disproportionately, such as the interaction between work and family roles; or differently from men, as in women's experience of stress in the workplace. The focus is on the differences and uniqueness of working women's health. Drawing on a public health perspective, implications for consideration by worksite health promotion programs specialist, human resource managers, and researchers are presented.

[Microbiological public health aspects in the use of rain water as water reservoirs for toilet flushing, garden irrigation and laundry]. / Mikrobiologisch-hygienische Aspekte bei der Nutzung von Regenwasser als Betriebswasser für Toilettenspülung, Gartenbewässerung und Wäschewaschen.

From a total of 102 rain water cisterns in use for toilet flushing, garden irrigation and laundering washing about 1,600 water samples were collected and subjected to microbiological analysis. The assays included aerobic heterotrophic microorganisms growing at 20 and 37 degrees C, respectively, as well as the identification of Escherichia coli, coliform organisms, faecal streptococci, Pseudomonas aeruginosa, staphylococci, yersiniae, salmonellae, shigellae, legionellae and yeasts. The median of the total number of cells per ml was 1,200 at 20 degrees C and 230 at 37 degrees C, respectively. Approximately 26 E. coli cells and 198 coliform organisms (median values) were found per 100 ml. In the case of cisterns manufactured of plastic the total number of cells was generally found to be lower than in samples collected from concrete or brick-made storage tanks. With the exception of the ubiquitously distributed organism Pseudomonas aeruginosa (found in 11.8% of the samples) and salmonella in only one sample, no other pathogens were detected. More than 95% of all analysed samples met the quality standards for bathing waters as set by the European Community. Provided certain precautions are taken, such as strict separation of mains for drinking water and rain water, as well as correct labelling of pipelines and collection sites, the use of rain water for toilet flushing, garden irrigation and laundry washing presents no unacceptable risk to public health.

[A comparison of BRILA-MUG and lauryl sulfate-MUG bouillon as detection media for total and fecal coliform bacteria in bathing waters in conformity with the Economic Community Guideline 76/160 EWG]. / Ein Vergleich von BRILA-MUG- und Laurylsulfat-MUG-Bouillon als Nachweismedien für gesamt- und fäkalcoliforme Bakterien in Badegewässern gemäss EG-Richtlinie 76/160 EWG.

The spectrum of gram-negative rods occurring in surface waters is wide and depending on the season, i.e. the water temperature. The concentration of bacteria is higher in summer than in winter. However, the seasonal difference of the concentration of Enterobacteriaceae is less than that of the Aeromonas spec. and of the non-fermenters. The comparison of yields of total and faecal coliforms determined in samples of surface water by using the brilliant green bile lactose 4-methylumbelliferyl-beta-D-glucuronide (BRI-LA-MUG) broth and the lauryl sulfate-MUG broth, respectively, shows that the BRILA-MUG broth is more sensitive and gives higher yields than the lauryl sulfate-MUG broth. On the other hand, the lauryl sulfate-MUG broth inhibits more the growth of gram-negative rods, especially that of Aeromonas spec. and non-fermenters, whereas the Enterobacteriaceae are less inhibited.

[Quantification of the gnostic sensitivity via measurement of the vibration threshold and of finger tip sensation]. / Kwantificeren van gnostische sensibiliteit door het meten van de vibratiedrempel en van de vingertopsensatie.

OBJECTIVE: Quantification of vibration perception and fingertip sensation in routine neurological examination. SETTING: Neurological Clinic, University Hospital, Groningen, the Netherlands. DESIGN: Prospective, controlled investigation. METHODS: Vibration perception and fingertip sensation were quantified in a large group of normal control persons of various ages and in neurological patients and compared with the usual sensory tests at routine neurological examination. The vibration perception limit was measured with a biothesiometer without accelerometer, the fingertip sensation with a device for two-point discrimination slightly modified according to Renfrew ('Renfrew meter'). Concordance of the tests was studied by calculating kappa values. RESULTS: The normal values of both sensory qualities had a log-normal distribution and increased with age. The values obtained with the Renfrew meter correlated well with those of the two-point discrimination and stereognosis but were systematically higher than those indicated by Renfrew. CONCLUSION: Both methods appear useful at routine neurological examination if certain measuring precautions are taken.

Development of a BaF2/TMAE PET system.

A detector has been developed for position sensitive registration of annihilation radiation. The 511 keV gamma rays are detected in a set of BaF2 scintillation crystals coupled to low pressure TMAE-filled photosensitive multi wire chambers. In a first experimental detector with two BaF2 crystals we obtained a detection efficiency for 511 keV quanta of 42%. The position resolution is 5 mm and the time resolution is 4 ns. At present a circular detector for three BaF2 crystals with a diameter of 28 cm, each with a thickness of 8 mm, is under construction. Position sensitivity is obtained by means of delayline read out of cathode wires. Detectors of this type can be used as building blocks for a PET system. We are performing simulations of a system consisting of six rectangular detectors in a hexagonal composition. Results are given and a discussion of further innovative developments is presented.

Martin Buber's relevance to institutional mental health care.

A Buberian perspective on problems related to the establishment of therapeutic environments on mental hospital wards is offered. Depersonalization and over-reliance on a medical treatment orientation in human relationships are identified as central problem areas in mental hospitals. The therapeutic community is identified as a major alternative model to respond to these problem areas. Difficulties in applying the therapeutic community model are identified. Buber's social philosophy, especially his interpretations of spiritual crisis, cultural crisis, structural renewal, and genuine dialogue, are identified as useful tools to clarify and resolve those difficulties.

Euthanasia and mental retardation: suggesting the unthinkable.

Current opinions on euthanasia of persons with mental retardation were discussed within the framework of the development of social policy towards this population. Historians of mental retardation have emphasized that incarceration and sterilization were the only two policy options available in the late 19th and early 20th centuries, but a third option, euthanasia, was also suggested. The significance of the euthanasia option as the nation struggled to find a solution to the question of how to deal with what was thought to be a sharp rise in the number of people with mental retardation in the United States in the late 19th and early 20th centuries was examined. The responses of service providers to suggestions that euthanasia be implemented were reviewed. The rejection of proposals for euthanasia on moral and religious grounds and on the basis that custodial institutions, based on eugenics principles, were able to achieve the same end through a scientifically justifiable means was explored.

Spanning the distance and resource gaps in health promotion and health education programs.

Traditionally, health care/health promotion professionals have relied on a face-to-face format for their teaching and are now becoming increasingly involved with new and creative ways to use microcomputers in educational technology. These methodologies have their limitations. Each is limited by the number of participants who can be reached at a given time, the availability of local experts, the existence of the necessary hardware and software, and accessibility due to special characteristics of the audience. These limitations often dictate what presentations health professionals can offer, what media can be used, and which groups will attend. Health care/health promotion professionals must not lose sight of readily available, nontraditional, cost effective methods that serve to enhance high level wellness in a broad and diverse population. The alternative health promotion delivery systems of radio, audioconferencing, and teleconferencing, as discussed in this article, can be used in a variety of settings (school, university, community, and worksite), applied to all levels of health promotion and education (elementary through university education and community/worksite offerings), and can increase awareness of additional methods of communication of health-related information by health professionals.

Work and depression among women in the Federal Republic of Germany.

A study was carried out to test the association between workplace stress and depression among working women and men in the Federal Republic of Germany (FRG). The data are from the 1984 German national health survey. The sample (N = 795) was composed of 319 working women and 476 working men. The hypothesis tested was that depression is related to high job demands and low job decision latitude. Correlation and multiple regression analyses supported the hypothesis for both women and men. However, the mean level of decision latitude was lower for women than men, as was the level of job demands. The mean depression score was higher for women, and correlations between depression and high job demands/low decision latitude were stronger for women than men. It was concluded that low decision latitude combined with high job demands, a condition experienced frequently by working women, contributes to depression among working women in the FRG. Study findings shed light on the health of employed women in the FRG and may also have implications for working women in other Western industrialized countries.

Corporate characteristics and worksite health promotion programs: survey findings from Fortune 500 companies.

A study was carried out to assess the nature and extent of worksite health promotion programs in Fortune 500 companies. Growth and interest in worksite health promotion continues at a remarkable rate. Fortune 500 firms are a good barometer of the state of the art of programs in work settings because these companies have large numbers of employees, an interest in cost savings, and expertise to invest in innovative efforts. Data collection consisted of questionnaires sent to the medical officer or Chief Executive Officer of all companies appearing on the 1984 Fortune 500 list. The following issues were addressed: whether companies offered worksite programs; what health promotion activities were provided in their programs; whether organizations had plans to start up or expand programs; what organizational support existed for programs (i.e. who pays, on whose time employees participate, when activities are offered, and what types of personnel are hired to staff programs); and whether these companies applied needs assessments, evaluation and cost analysis in their programs. Differences in these characteristics were examined in relation to the organizational variables of size (number of employees), Fortune 500 rank and type of industry (low-technology versus high-technology). The response rate for the survey was 49.4% (n = 247). Results of the study indicate a high level of health promotion activity in Fortune 500 firms. Out of the total group of respondents, two-thirds (n = 164) report having worksite programs and two-thirds of organizations with programs have plans to expand their health promotion offerings. One-third of responding organizations without programs planned to initiate them. The health promotion activities provided are numerous and varied, and within units that have programs rates of employee eligibility are reported to be high. However, the participation rates reported are appreciably lower. It is of special interest that, in general, the higher ranked, larger and high-technology companies are more likely to have programs; offer more activities in programs; have plans for program expansion; use a model of sharing costs of, and time to participate in program activities; make greater use of health professionals; and utilize more often needs assessment, evaluation and cost analysis techniques. The results of this study underscore the importance of examining a broad constellation of factors surrounding worksite programs. Given the organizational literature reviewed, it is likely that the characteristics of Fortune 500 programs documented here will serve as models for programs in midsize and smaller companies.

[Rotavirus infection in the older child and adult]. / Die Rotavirusinfektion des älteren Kindes und des Erwachsenen.

Rotaviruses were detected in 1.3% of more than 10,000 stool samples from children--older than 6 years--and adults. Beside rotaviruses the main enteropathogenic agents found were salmonellae (6.3%) and Campylobacter jejuni/coli (1.7%). Similar as the rotavirus infection of infants, in adults symptoms and signs were nearly the same except that the disease was not so severe. A correlation of the rotavirus infection with certain behaviour or eating habits was not found.

[Nitrate concentration in drinking water in southwest Lower Saxony]. / Nitratkonzentration von Trinkwässern in Südwest-Niedersachsen.

The investigation of 8544 water samples from central water supply plants and of about 20,000 from own water supply plants of Southwest Lower Saxony with respect to nitrate pollution showed that 97.5% of the samples from the central water supply plants and of 63.6% from the own water supply plants contained nitrate concentrations lower than 50 mg/l. On the other hand, the nitrate concentrations of samples from own water supply plants were in 12.5% more than 90 mg/l and in 24.0% between 50 and 90 mg/l. There was a remarkable tendency of increasing of the nitrate pollution comparing the data from 1979 and 1984. The nitrate concentrations correlated well with the depth of the wells but not with bacteriological findings.