House-dust mites and mattresses.

BACKGROUND: Despite considerable efforts to develop anti dust mite strategies, surprisingly few studies have evaluated the allergen content in different types of mattresses in everyday use. This study investigated the presence of mite feces (an indicator of mite allergens) in foam and spring mattresses. METHODS: The homes of 152 schoolchildren in Northern Norway were investigated. Dust samples were collected in a standardized way from 24 foam mattresses without covers, 68 foam mattresses with covers, and 24 spring mattresses, and the presence of mite feces detected by a guanine colorimetric paper test (Acarex). RESULTS: We found mite feces in 15 (40.5%) of the dust samples from the foam mattresses without covers and 18 (26.3%) of the foam mattresses with covers. Only three (12.5%) of the spring mattresses contained detectable amounts of feces. Signs of dampness, age of mattress, cleaning of mattress, frequency of vacuuming the bedroom, mechanical ventilation, bedroom temperature and bedroom relative humidity were associated with the presence of mite feces. After adjustment for relevant confounders, the risk of finding mite feces was four times higher in foam compared to spring mattresses (odds ratio 4.0, 95% confidence interval (CI) 1.1-15.1), and eight times higher for the foam mattresses without cover (OR 8.1, 95% CI 1.8-36.9). CONCLUSION: A simple replacement of foam mattresses with spring mattresses may reduce the exposure to house-dust-mite allergens.

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.

[Improved routines for thrombolytic treatment of acute myocardial infarction]. / Forbedrede rutiner for trombolytisk behandling ved akutt hjerteinfarkt.

A study in 1995 at Harstad District Hospital concluded that too few patients with acute myocardial infarction had received thrombolytic treatment and that the in-hospital delay before administration of thrombolytics had been too long. To evaluate the effect of improvements in medical and nursing routines, data on all patients with acute myocardial infarction treated between October 1996 and October 1997 (n = 122) were analysed prospectively and compared with data from the 1995 study. The proportion of patients who received thrombolytic treatment increased from 24% in 1995 to 37% (p = 0.02). All patients received thrombolytics when indicated. The proportion of patients who died in hospital decreased from 25% in 1995 to 16% (p = 0.06). The proportion of patients who were treated within 60 minutes after arrival at the hospital increased from 20% to 67% (p < 0.001). For patients with typical ECG changes at arrival the mean door-to-needle time was 37 minutes. Mean delay from onset of symptoms to treatment was 4.5 hours. The results indicate that improved routines may have increased the proportion of patients receiving thrombolytic treatment and reduced the in-hospital delay. It is possible that a further reduction of delay may be achieved by reducing the pre-hospital delay, or by starting thrombolytic treatment before arrival to hospital.

[Thrombolytic therapy in acute myocardial infarctions]. / Trombolytisk behandling ved akutt hjerteinfarkt.

Data on all patients with acute myocardial infarction who were treated in Harstad District Hospital in 1995 were analysed. Of the 170 patients, 24% received thrombolytic treatment. Thrombolytics were withheld from 15% of the patients, although there were no contraindications present. Thrombolytics were administered two hours and 18 minutes (mean) after admission to hospital and seven hours after the onset of symptoms. 54% of the patients were admitted to hospital within six hours and 73% within 12 hours. In-hospital delay before the administration of thrombolytics is too long. In Norwegian hospitals this factor has only been analysed to a minor degree. Despite a fairly standardized treatment regimen for thrombolytics, how frequently it is used probably varies from hospital to hospital. There is great potential for improving thrombolytic treatment. The results of our analyses have resulted in an extensive change in routine in our hospital.