Typhoid fever in Ujung Pandang, Indonesia--high-risk groups and high-risk behaviours.

We performed a hospital-based case-control study to identify high risk groups and routes of transmission of typhoid fever in the city of Ujung Pandang on the island of Sulawesi, Indonesia. The annual incidence of this disease in southern Sulawesi is estimated at 3.1/1000 and the case fatality at 5.1% Cases were 50 patients over 13 years of age admitted to Stella Maris Hospital with a diagnosis of typhoid fever between June and September 1991. Diagnosis was made on clinical grounds and in 90% of cases confirmed by a Widal test. Controls were 42 patients admitted for non-infectious disorders during the same period and individually matched by age and sex. Controls did not have a history of typhoid fever. Interviews took place in hospital. Analysis was by unconditional logistic regression. High-risk groups consisted of those who were single, unemployed and those who had a university education. Median age of cases was 22 years. Consumption of food from warungs (food stalls in the street) was strongly associated with risk (OR = 45). Both cases and controls washed hands after use of the toilet and before meals, but cases used soap significantly less often (OR = 30). The results of this study can be used to take preventive measures against this severe disease of educated and single young adults by targetting them for IEC-activities emphasizing the importance of thorough hand-washing and the need to take care in the selection of street-foods.

Late neurobehavioural symptoms after mild head injury.

The present study examined whether patients (n = 11) with post-concussional symptoms (PCS) 12-34 months after mild head injury (MHI) performed less well on selected neuropsychological tests than patients with MHI without PCS (n = 11) and healthy controls (n = 11). Patients with PCS were individually matched with controls for the time elapsed after the injury, age, sex, education and IQ. There were no overall gross differences between the groups in cognitive functioning, except for an isolated deficit on a sustained attention task. Post-hoc analysis of results obtained with two behavioural rating scales showed that patients with higher ratings on a post-concussive/cognitive complaints scale performed less well on a sustained attention task than subjects with lower ratings.

Late outcome of mild head injury: results from a controlled postal survey.

There is insufficient information about the long-term sequelae of mild head injury (postconcussional symptoms, PCS). Therefore, a questionnaire-based investigation was carried out in patients 1-5 years after mild head injury (MHI) and in non-concussed subjects in order to study the nature of long-term complaints after MHI. A three-factor model of residual subjective and psychological complaints that contained a dysthymic factor, a vegetative/bodily complaints factor, and a cognitive performance factor were identified in the patient population. Three rating scales were constructed from the relevant items or factors, and were used to compare the MHI patients with non-concussed controls. It was found that the profile of distresses and discomforts mentioned by a population of MHI patients 1-5 years after the trauma was similar to that of a non-concussed control population. These symptoms were indistinguishable from those encountered in ordinary everyday life. These symptoms were significantly more severe in the MHI patients. Stepwise regression analysis in the patient population indicated that a number of parameters were statistically of predictive importance: comorbidity, sex, and neurological complication at the time of the trauma. The results support the hypothesis that MHI may not ever be completely reversible.

Recovery from visual and acoustic hyperaesthesia after mild head injury in relation to patterns of behavioural dysfunction.

Patients with head injuries frequently complain of a decreased ability to endure intense light and sound stimuli. The few psychophysical studies that have objectively studied this type of hyperaesthesia have not assessed to what extent patients recover from this hyperaesthesia after mild head injury (MHI). A computerised rating technique was used to assess tolerance to intense sound (95 dB) and light (1500 lux) stimuli in patients with an uncomplicated MHI. Patients were tested 10 days and five weeks after the injury. Although most patients substantially recovered from both visual and acoustic hyperaesthesia, 25% of the patients were still not able to endure intense stimuli by five weeks. Analysis of data obtained with two behavioural rating scales (one with post-concussive/cognitive complaints and a second with emotional/vegetative complaints) indicated that visual hyperaesthesia was specifically related to the post-concussive/cognitive complaints scale.

Tolerance for light and sound of patients with persistent post-concussional symptoms 6 months after mild head injury.

Patients with post-concussional symptoms (PCS) about 6 months after a mild head injury (MHI) were examined for tolerance of light and sound in comparison with concussed patients without PCS and non-concussed healthy controls. MHI patients with PCS were individually matched with subjects from the two control groups for the time elapsed from the injury, and for age and sex. Using a computerized rating technique, we assessed both the maximal and submaximal levels of lowered tolerance for light and sound over a wide range of stimuli. We found that the MHI patients with PCS 6 months after the trauma (n = 11) tolerated significantly less well stimuli of intensities of 71 dB and 500 lx than MHI patients without PCS (n = 11) and non-concussed controls (n = 11). There were no significant differences in tolerance for light and sound between MHI patients without PCS and the non-injured controls. Decreased tolerance for light and sound may contribute to the persistence of symptoms up to 6 months after a mild head injury. The psychophysical method provides an objective measure for the evaluation of the late persistent post-concussional syndrome.