Tuberculosis screening in patients with psoriasis before antitumour necrosis factor therapy: comparison of an interferon-gamma release assay vs. tuberculin skin test.

BACKGROUND: Antitumour necrosis factor (anti-TNF) treatments may reactivate latent tuberculosis infection (LTBI). For detecting LTBI, the tuberculin skin test (TST) has low sensitivity and specificity. Interferon-gamma release assays (IGRA) have been shown to be more sensitive and specific than TST. OBJECTIVE: To compare the TST and the T-SPOT.TB IGRA for identifying LTBI in patients with psoriasis before anti-TNF treatment. METHODS: A retrospective study was carried out over a 4-year period on patients with psoriasis requiring anti-TNF treatment. All were subjected to the TST, T-SPOT.TB and chest X-ray. Risk factors for LTBI and history of bacillus Calmette-Guérin (BCG) vaccination were recorded. The association of T-SPOT.TB and TST results with risk factors for LTBI was tested through univariate logistic regression models. Agreement between tests was quantified using kappa statistics. Treatment for LTBI was started 1 month before anti-TNF therapy when indicated. RESULTS: Fifty patients were included; 90% had prior BCG vaccination. A positive T-SPOT.TB was strongly associated with a presumptive diagnosis of LTBI (odds ratio 7.43; 95% confidence interval 1.38-39.9), which was not the case for the TST. Agreement between the T-SPOT.TB and TST was poor, kappa = 0.33 (SD 0.13). LTBI was detected and treated in 20% of the patients. In 20% of the cases, LTBI was not retained in spite of a positive TST but a negative T-SPOT.TB. All patients received an anti-TNF agent for a median of 56 weeks (range 20-188); among patients with a positive TST/negative T-SPOT.TB, no tuberculosis was detected with a median follow-up of 64 weeks (44-188). One case of disseminated tuberculosis occurred after 28 weeks of adalimumab treatment in a patient with LTBI in spite of treatment with rifampicin. CONCLUSION: This study is the first to underline the frequency of LTBI in patients with psoriasis (20%), and to support the use of IGRA instead of the TST for its detection. Nevertheless, there is still a risk of tuberculosis under anti-TNF therapy, even if LTBI is correctly diagnosed and treated.

L'adopció internacional amb nens de Nepal: estudi amb el test projectiu Pota Negra

A Espanya i, especialment a Catalunya, la primera dècada del segle xxi ha estat marcada per un increment excepcional de les adopcions internacionals, configurant així un nou model de famílies i una nova realitat social. Des de la perspectiva de salut mental, s’inicia ara una etapa postadoptiva molt necessitada d’investigacions teòriques i empíriques. Amb aquest treball, volem apropar-nos a la realitat interna del nen adoptat, utilitzant el Test Projectiu temàtic Pota Negra (Corman 1961) i conèixer així les repercussions que té, en el seu desenvolupament emocional, el fet d’ésser un nen adoptat. L’estudi es realitza amb una mostra de 10 nens (5 nenes i 5 nens) d’edats compreses entre 6 i 12 anys, que formen part del grup de nens d’adopció internacional d’Espanya (país d’origen: Nepal). En els criteris d’inclusió per als nens, a més de l’edat i el país ja citats, hi ha també el de fer més de dos anys que s’hagi realitzat l’adopció. El criteri d’inclusió, per a les famílies, és no tenir fills biològics, és a dir, només tenir fills adoptius. Els resultats mostren que les variables afectives pròpies de l’adopció dificulten el desenvolupament emocional. Però, igual que en els altres àmbits, el nen adoptat necessitarà més temps, i possiblement suports específics, per a culminar la seva evolució. D’altra banda, es constata que l’ús de Tècniques Projectives facilita el coneixement del món intern del nen adoptat, possibilitant així una anàlisi holística i global de la persona.

An Evaluation of the Calderon Test, HR-80, 1963

As a result of Chang's studies, Calderon's developments, and the need for a new test procedure to determine specific physical properties of an asphalt concrete, the Iowa Highway Research Board sponsored a research project to investigate the correlation of results of the Calderon Test with the Iowa Stability Test and the Marshall and Hveem stability tests using Iowa Type A asphaltic concrete. The project was assigned to the Bituminous. Research Laboratory of Iowa State University as Project HR 80, the. Iowa Highway Research Board, and Project 442-S of the Engineering Experiment Station.

A Continuous Span Aluminum Girder Concrete Deck Bridge - Part 1 of 2: Field Test Performance and Evaluation, 1996

This report addresses the field testing and analysis of those results to establish the behavior of the original Clive Road Bridge that carried highway traffic over Interstate 80 (I-80) in the northwest region of Des Moines, Iowa. The bridge was load tested in 1959, shortly after its construction and in 1993, just prior to its demolition. This report presents some of the results from both field tests, finite element predictions of the behavior of aluminum bridge girders, and load distribution studies.

Etalonnage de trois épreuves de recognition continue : Effets de l'âge, du sexe et du niveau socio-professionnel sur les mesures de discrimination et de biais de réponse. [Standardization of three continuous recognition test forms - Effects of age, sex and socio-economic level on measurements of discrimination and response bias.]

Nous présontons l'étalonnage d'un test mnésique de recognition dans un échantillon de 180 adultes francophones de la Suisse Romande. Le test comprend trois formes utilisant un matériel verbal (mots) ou non verbal (visages ou paysages). Une attention particulière est accordée à l'âge dans la présentation des résultats. Celui-ci affecte plus précocement et plus intensément la performance aux formes non verbales qu'à la forme verbale du test. Il induit également une importante augmentation du nombre de fausses reconnaissances pour les formes non verbales.

Involuntary Discharge from a Long-Term Facility

An involuntary discharge from a long-term care (LTC) facility occurs when the facility provides a 30-day written notice to a resident informing him/her of the need to move out of the facility. The notice must set out the reasons for the transfer or discharge as well as state the effective date, location of transfer or discharge, statement of appeal rights and the contact information (name, address and telephone number) for the Office of the State Long-Term Care Ombudsman.

Letter health consultation : Doty Landfill site, Camanche, Iowa EPA Facility ID: IAD980497556 (2008)

The Doty Landfill encompasses 13 acres of land and is located in the southeastern quarter of Section 29, Township 81 North, Range 6 East, Clinton County, Iowa. The site was used as a landfill for municipal solid waste from 1970 to 1975. In addition, local residents have expressed concern that other chemical-or pesticide waste had been disposed at the site. Previous site investigations had been completed in 1992 and in 2005. In October 2007 water samples from private wells located in the vicinity of the Doty Landfill site were collected and analyzed for dissolved metals. Two of the water samples obtained from drinking water wells contained dissolved arsenic above the US EPA Maximum Contaminant Level (MCL) for arsenic of 10 μg/L (micrograms per liter) or 10 ppb (parts per billion). The water samples in question contained dissolved arsenic at concentrations of 19.3 and 14.9 μg/L or 19.3 and 14.9 ppb.

The Alcohol Use Disorders Identification Test (AUDIT) as a screening tool for excessive drinking in primary care: reliability and validity of a French version.

BACKGROUND: Excessive drinking is a major problem in Western countries. AUDIT (Alcohol Use Disorders Identification Test) is a 10-item questionnaire developed as a transcultural screening tool to detect excessive alcohol consumption and dependence in primary health care settings. OBJECTIVES: The aim of the study is to validate a French version of the Alcohol Use Disorders Identification Test (AUDIT). METHODS: We conducted a validation cross-sectional study in three French-speaking areas (Paris, Geneva and Lausanne). We examined psychometric properties of AUDIT as its internal consistency, and its capacity to correctly diagnose alcohol abuse or dependence as defined by DSM-IV and to detect hazardous drinking (defined as alcohol intake >30 g pure ethanol per day for men and >20 g of pure ethanol per day for women). We calculated sensitivity, specificity, positive and negative predictive values and Receiver Operator Characteristic curves. Finally, we compared the ability of AUDIT to accurately detect "alcohol abuse/dependence" with that of CAGE and MAST. RESULTS: 1207 patients presenting to outpatient clinics (Switzerland, n = 580) or general practitioners' (France, n = 627) successively completed CAGE, MAST and AUDIT self-administered questionnaires, and were independently interviewed by a trained addiction specialist. AUDIT showed a good capacity to discriminate dependent patients (with AUDIT > or =13 for males, sensitivity 70.1%, specificity 95.2%, PPV 85.7%, NPV 94.7% and for females sensitivity 94.7%, specificity 98.2%, PPV 100%, NPV 99.8%); and hazardous drinkers (with AUDIT > or =7, for males sensitivity 83.5%, specificity 79.9%, PPV 55.0%, NPV 82.7% and with AUDIT > or =6 for females, sensitivity 81.2%, specificity 93.7%, PPV 64.0%, NPV 72.0%). AUDIT gives better results than MAST and CAGE for detecting "Alcohol abuse/dependence" as showed on the comparative ROC curves. CONCLUSIONS: The AUDIT questionnaire remains a good screening instrument for French-speaking primary care.

Health consultation : Review of on-site air monitoring data during the removal action at Le Mars coal gas site, Le Mars coal gas plant Le Mars, Plymouth County, Iowa EPA facility ID: IA0001032556 (2005)

The Iowa Department of Public Health (IDPH), Hazardous Waste Site Health Assessment Program was asked by the US Environmental Protection Agency (EPA) to review a round of air sampling data. The air data was collected and analyzed during a removal action at the Le Mars Coal Gas Site in Le Mars, Iowa. EPA asked IDPH to determine from the air data if additional monitoring is necessary throughout the removal action to protect nearby residents from exposure.

Public health assessment : Railroad Avenue groundwater contamination, West Des Moines, Polk County, Iowa EPA facility ID: IA0001610963 (2004)

The Railroad Avenue groundwater contamination site (the site) is in West Des Moines, Polk County, Iowa. Located on approximately 120 acres. The site comprises mixed residential, industrial and commercial properties. Underneath the site, chlorinated volatile organic compounds (VOCs) have contaminatcd the shallow (i.e., 30-50 feet deep) groundwater. These compounds have compromised several shallow wells within the West Des Moines water works system. A contamination source, however, has not yet been identified. In 1993, routine water analysis by the City of West Des Moines identified 1, 2 cis-dichlorocthylcne (1, 2 cis-DCE) at a concentration of 1.2 μg/L (micrograms) per liter of water) in the water supply. Subsequently. several shallow municipal wells were found to be contaminated by VOCs, including 1. 2 cis-DCE, trichloroethylene (TCE), tetrachloroethylene (PCE) and benzene. Five of these wells have been taken out of service. Because of the impact on the West Des Moines water supply, the U.S. Environmental Protection Agency (USEPA) has assigned the site to the National Priorities List. Surface water und sediment at the site have not been impacted by the VOCs. Testing for VOCs in surface soils has not revealed any significant VOC contamination. Subsurface soils -- generally 8 feet or greater in depth -- are contaminated with VOCs, but at levels which should not present a health hazard. The past, present, and future health hazard category chosen for this site is no apparent public health hazard. This category is used when exposure to toxins might be occurring or might have occurrcd in the past, but at levels below any known health hazard. Analysis of available environmental data has not revealed that residental or commercial water customers are or have been exposed to VOCs at concentrations that might cause any adverse health effects.

Health consultation : Mid-America Tanning Company, Sergeant Bluff, Woodbury County, Iowa EPA facility ID: IAD085824688 (2005)

On June 23, 2004, the U.S. Environmental Protection Agency (EPA) announced its intention to remove the Mid-American Tanning Company site from the National Priorities List (NPL). The EPA is inviting public comment on the proposed de-listing of the site from the NPL. The Iowa Department of Public Health in cooperation with the Agency for Toxic Substances and Disease Registry (ATSDR) prepared this health consultation to review the current status of the Mid-America Tanning Company site and to provide an evaluation of any public health consequences of de-listing the site. The information in this health consultation was current at the time of writing. Data that emerges later could alter this document’s conclusions and recommendations.

Health consultation : Hills, Iowa perchlorate groundwater contamination site, Hills, Johnson County, EPA facility ID: IAN 000704368 (2004)

The U. S. Environmental Protection Agency (EPA) Region 7, as well as concerned citizens, asked the Iowa Department of Public Health (IDPH) Hazardous Waste Site Health Assessment Program to perform a health consultation for the Hills, Iowa Perchlorate Groundwater Contamination Site. Specifically, IDPH was asked to determine if EPA’s action of providing bottled water to residents whose private wells had concentrations of greater than 18 μg/L (micrograms per liter) or 18 parts per billion (ppb) perchlorate is protective of public health, and to address some community health concerns. The information included in this health consultation was current at the time of writing. Data that emerges later could alter this document’s conclusions and recommendations.