Comparasion of two minimally invasive methods on the longevity of glass ionomer cement restorations: short-term results of a pilot study

The purpose of this study was to evaluate the clinical performance of glass ionomer cement (GIC) restorations comparing two minimally invasive methods in permanent teeth after 12 months. Fifty pregnant women (second trimester of pregnancy), mean age 22 ± 5.30 years, were treated by two previously trained operators. The treatment approaches tested were: chemomechanical method (CarisolvTM; MediTeam) and atraumatic restorative treatment (ART). A split-mouth study design was used in which the two treatments were randomly placed in 50 matched pairs of permanent teeth. The chemomechanical method (CM) was the test group and the ART was the control group. The treatments were performed in Public Health Centers. The tested restorative material was a high-strength GIC (Ketac Molar; 3M/ESPE). The restorations were placed according to the ART guidelines. Two calibrated independent examiners evaluated the restorations in accordance with ART criteria. The inter-examiner kappa was 0.97. Data were analyzed using 95% confidence interval on the binomial distribution and Fisher's exact test at 5% significance level. In a 12-month follow-up, 86% of the restorations were evaluated. In the test group (CM), 100% (CI=93.3-100%) of the restorations were considered successful. In the control group (ART) 97.6% (CI=87.4-99.9%) of the restorations were considered successful and 2.4% unsuccessful (marginal defect >0.5 mm). There was no statistically significant difference between the 12-mounth success rate for both groups (Fisher's exact test: P=0.49) and between the two operators (Fisher's exact test: P=1.00). Both minimally invasive methods, chemomechanical method and ART, showed a similar clinical performance after 12 months of follow up.

Constipation in Australian women: Prevalence and associated factors

A postal health survey was completed by 14761 young women (aged 18-23 years), 14070 middle-aged women (45-50 years) and 12893 older women (70-75 years). The prevalence of constipation was 14.1% (CI 13.5-14.7) in young women, 26.6% (CI 25.9-27.4) in middle-aged women, and 27% (CI 26.9-28.5) in the older women. The prevalence of hemorrhoids was 3.2% (CI 2.9-3.4 young), 17.7% (CI 17.1-18.4 middle-aged) and 18.3% (CI 17.6-19.0 older). In the middle-aged and older women, those who reported previous gynecologic surgery were between 18% and 63% more likely to report constipation; in the younger cohort, women with one or two children were also more likely to report constipation (adjusted OR 1.43-1.46); One-third of the young women and half the middle-aged and older women had sought help for constipation; the majority indicated that they were satisfied with the help available to them.

Preventing recurrent events long term after coronary artery bypass graft: Suboptimal use of medications in a population study

Background There are few population-based data on long-term management of patients after coronary artery bypass graft (CABG), despite the high risk for future major vascular events among this group. We assessed the prevalence and correlates of pharmacotherapy for prevention of new cardiac events in a large population-based series. Methods A postal survey was conducted of 2500 randomly selected survivors from a state population of patients 6 to 20 years after first CABG. Results Response was 82% (n = 2061). Use of antiplatelet agents (80%) and statins (64%) declined as age increased. Other independent predictors of antiplatelet use included statin use (odds ratio [OR] 1.6, 95% CI 1.26-2.05) and recurrent angina (OR 1.6, CI 1.17-2.06). Current smokers were less likely to use aspirin (OR 0.59, CI 0.4-0.89). Statin use was associated with reported high cholesterol (OR 24.4, CI 8.4-32.4), management by a cardiologist (OR 2.3, CI 1.8-3.0), and the use of calcium channel-blockers. Patients reporting hypertension or heart failure, in addition to high cholesterol, were less likely to use statins. Angiotensin-converting enzyme inhibitors were the most commonly prescribed agents for management of hypertension (59%) and were more frequently used among patients with diabetes and those with symptoms of heart failure. Overall 42% of patients were on angiotensin-converting enzyme inhibitors and 36% on beta-blockers. Conclusions Gaps exist in the use of-recommended medications after CABG. Lower anti-platelet and statin use was associated with older age, freedom from angina, comorbid heart failure or hypertension, and not regularly visiting a cardiologist. Patients who continue to smoke might be less likely to adhere to prescribed medications.

Anti-Phospholipase A2 Receptor Antibodies in the Diagnosis of Idiopathic Membranous Nephropathy

Circulating anti-phospholipase A2 receptor antibodies (anti-PLA2R) have been described in 70% to 80% of the patients with idiopathic membranous nephropathy (iMN), but not in patients with secondary membranous nephropathy or other glomerular diseases. The goal of this study was to evaluate the sensitivity and specificity of the assay for anti-PLA2R in the diagnosis of iMN. Anti-PLA2R IgG, Elisa and immunofluorescence tests were used to detect circulating anti-PLA2R. These tests were applied in 53 patients who had a kidney biopsy. Of these, 38 had histological diagnosis of membranous nephropathy (MN) and the remaining had other glomerular diseases. The MN was classified as idiopathic in 33 patients after clinical exclusion of secondary causes. Anti-PLA2R were positive in 57.6% of the patients with iMN. All patients with secondary membranous nephropathy or other glomerular diseases did not show circulating anti-PLA2R. The sensitivity was 57.6% (CI 39.2-74.5) and specificity 100% (CI 47.8-100), AUC 0.788; p < 0.0001 for the detection of iMN. 71.4% of the iMN patients that tested negative for anti-PLA2R were in partial or complete remission. The detection of anti-PLA2R in the studied population had a specificity of 100% for the iMN diagnosis. Prior treatments seem to make the test negative and contribute to a lower sensitivity.

Aconselhamento médico na prevenção da doença e promoção da saúde : análise a propósito do consumo de tabaco

RESUMO - O consumo de tabaco foi responsável por 100 milhões de mortes no século XX. Apesar dos grandes avanços alcançados no controlo deste problema a nível mundial, sob os auspícios da OMS, no contexto da Convenção-Quadro para o Controlo do Tabaco da OMS, se não forem adoptadas medidas consistentes e efectivas de saúde pública, a morbi-mortalidade que lhe está associada continuará a aumentar durante o presente século. A promoção da cessação tabágica constitui a estratégia populacional que permitirá obter ganhos em saúde a mais curto prazo. Embora a larga maioria dos fumadores faça, ao longo da vida, várias tentativas para parar de fumar sem apoio, apenas uma pequena minoria consegue manter-se abstinente a longo prazo. Os médicos de Medicina Geral e Familiar são, de entre todos os profissionais de saúde, os que podem intervir de modo mais consistente e efectivo neste âmbito e que melhores resultados obtêm na cessação tabágica dos pacientes fumadores, dado o vínculo terapêutico e a interacção frequente e continuada que com eles estabelecem ao longo do seu ciclo de vida. O aconselhamento breve, tendo por base a adopção de um estilo de comunicação motivacional centrado no paciente, adaptado aos estádios de mudança comportamental, tem-se revelado efectivo no apoio à mudança de comportamentos relacionados com a saúde e à resolução da ambivalência que caracteriza este processo. A revisão de literatura evidenciou o facto de os médicos nem sempre intervirem nas áreas preventivas e de promoção da saúde, em particular na área da cessação tabágica, com o investimento e a continuidade desejáveis. Por outro lado, muitos pacientes fumadores referem nunca ter sido aconselhados pelo seu médico a deixar de fumar.. Não são conhecidos estudos de âmbito nacional que permitam conhecer esta realidade, bem como os factores associados às melhores práticas de intervenção ou as barreiras sentidas pelos médicos de MGF à actuação nesta área. O presente trabalho teve como objectivos: (i) avaliar a hipótese de que os médicos que disseram adoptar o método clínico centrado no paciente teriam atitudes mais favoráveis relativamente à cessação tabágica e uma maior probabilidade de aconselhar os seus pacientes a parar de fumar; (ii) estudar a relação entre as atitudes, a percepção de auto-eficácia, a expectativa de efectividade e as práticas de aconselhamento sobre cessação tabágica, auto-referidas pelos médicos; (iii) Identificar as variáveis preditivas da adopção de intervenções breves de aconselhamento adaptadas ao estádio de mudança comportamental dos pacientes fumadores; (iv) identificar as barreiras e os incentivos à adopção de boas práticas de aconselhamento nesta área. A população de estudo foi constituída pelo total de médicos de medicina geral e familiar inscritos na Associação Portuguesa de Médicos de Clínica Geral, residentes em Portugal. Para recolha de informação, foi utilizado um questionário de resposta anónima, de autopreenchimento, aplicado por via postal a 2942 médicos, em duas séries de envio. O questionário integrou perguntas fechadas, semifechadas, escalas de tipo Likert e escalas de tipo visual analógico. Para avaliação da adopção do método clínico centrado no paciente, foi usada a Patient Practitioner Orientation Scale (PPOS). O tratamento estatístico dos dados foi efectuado com o Programa PASW Statistics (ex-SPSS), versão 18. Foram utilizados: o índice de α de Cronbach, diversos testes não paramétricos e a análise de regressão logística binária. Foi obtida uma taxa de resposta de 22,4%. Foram analisadas 639 respostas (67,4% de mulheres e 32,6% de homens). Referiram ser fumadores 23% dos homens e 14% das mulheres. Foi identificada uma grande carência formativa em cessação tabágica, tendo apenas 4% dos médicos afirmado não necessitar de formação nesta área. Responderam necessitar de formação em entrevista motivacional 66%, em prevenção da recaída 59%, de treino numa consulta de apoio intensivo 55%, em intervenção breve 54% e em terapêutica farmacológica 55%. Cerca de 92% dos respondentes consideraram que o aconselhamento para a cessação tabágica é uma tarefa que faz parte das suas atribuições, mas apenas 76% concordaram totalmente com a realização de uma abordagem oportunística deste assunto em todos os contactos com os seus pacientes. Como prática mais frequente, perante um paciente em preparação para parar, 85% dos médicos disseram tomar a iniciativa de aconselhar, 79% avaliar a motivação, 67% avaliar o grau de dependência, 60% marcar o “dia D” e 50% propor terapêutica farmacológica. Apenas 21% assumiram realizar com frequência uma intervenção breve com pacientes em preparação (5 Ás); 13% uma intervenção motivacional com pacientes não motivados para mudar (5 Rs) e 20% uma intervenção segundo os princípios da entrevista motivacional, relativamente a pacientes ambivalentes em relação à mudança. A análise multivariada de regressão logística permitiu concluir que as variáveis com maior influência na decisão de aconselhar os pacientes sobre cessação tabágica foram a percepção de auto-eficácia, o nível de atitudes negativas, a adopção habitual do Programa-tipo de cessação tabágica da DGS, a posse de formação específica nesta área e a não identificação de barreiras ao aconselhamento, em particular organizacionais ou ligadas ao processo de comunicação na consulta. Embora se tenha confirmado a existência de associação entre a adopção do método clínico centrado no paciente e as atitudes face à cessação tabágica, não foi possível confirmar plenamente a associação entre a adopção deste método e as práticas autoreferidas de aconselhamento. Os médicos que manifestaram um nível baixo ou moderado de atitudes negativas, uma percepção elevada de auto-eficácia, que nunca fumaram, que referiram adoptar o Programa-tipo de cessação tabágica e que não identificaram barreiras organizacionais apresentaram uma maior probabilidade de realizar uma intervenção breve (“5 Ás”) de aconselhamento de pacientes fumadores em preparação para parar de fumar. Nunca ter fumado apresentou-se associado a uma probabilidade de realizar uma intervenção breve (“5 Ás”) com frequência, superior à verificada entre os médicos que referiram ser fumadores (Odds-ratio ajustado = 2,6; IC a 95%: 1,1; 5,7). Os médicos com o nível de auto-eficácia no aconselhamento mais elevado apresentaram uma probabilidade superior à encontrada entre os médicos com o menor nível de auto-eficácia de realizar com frequência uma intervenção breve de aconselhamento, integrando as cinco vertentes dos “5 Ás” (Odds ratio ajustado = 2,6; IC a 95%: 1,3; 5,3); de realizar uma intervenção motivacional breve com fumadores renitentes a parar de fumar (Odds ratio ajustado = 3,1; IC a 95%: 1,4; 6,5) ou de realizar com frequência uma intervenção motivacional com pacientes em estádio de ambivalência (Odds ratio = 8,8; IC a 95%: 3,8; 19,9). A falta de tempo, a falta de formação específica e a falta de equipa de apoio foram as barreiras ao aconselhamento mais citadas. Como factores facilitadores de um maior investimento nesta área, cerca de 60% dos médicos referiram a realização de um estágio prático de formação; 57% a possibilidade de dispor do apoio de outros profissionais; cerca de metade a melhoria da sua formação teórica. Cerca de 25% dos médicos investiria mais em cessação tabágica se dispusesse de um incentivo financeiro e 20% se os pacientes demonstrassem maior interesse em discutir o assunto ou existisse uma maior valorização desta área por parte dos colegas e dos órgãos de gestão. As limitações de representatividade da amostra, decorrentes da taxa de resposta obtida, impõem reservas à possibilidade de extrapolação destes resultados para a população de estudo, sendo de admitir que os respondentes possam corresponder aos médicos mais interessados por este tema e que optam por não fumar. Outra importante limitação advém do facto de não ter sido estudada a vertente relativa aos pacientes, no que se refere às suas atitudes, percepções e expectativas quanto à actuação do médico neste campo. Pesem embora estas limitações, os resultados obtidos revelaram uma grande perda de oportunidades de prevenção da doença e de promoção da saúde. Parece ter ficado demonstrada a importante influência que as atitudes, em especial as negativas, e as percepções, em particular a percepção de auto-eficácia, podem exercer sobre as práticas de aconselhamento auto-referidas. Todavia, será necessário aprofundar os resultados agora encontrados com estudos de natureza qualitativa, que permitam compreender melhor, por um lado, as percepções, expectativas e necessidades dos pacientes, por outro, as estratégias de comunicação que deverão ser adoptadas pelo médico, atendendo à complexidade do problema e ao tempo disponível na consulta, tendo em vista aumentar a literacia dos pacientes para uma melhor autogestão da sua saúde. Parece ter ficado igualmente patente a grande carência formativa neste domínio. A adopção do modelo biomédico como paradigma da formação médica pré e pós-graduada, proposto, há precisamente cem anos, por Flexner, tem contribuído para a desvalorização das componentes psicoemocionais e sociais dos fenómenos de saúde e de doença, assim como para criar clivagens entre cuidados curativos e preventivos e entre medicina geral e familiar e saúde pública. Porém, o actual padrão de saúde/doença próprio das sociedades desenvolvidas, caracterizado por “pandemias” de doenças crónicas e incapacitantes, determinadas por factores de natureza sociocultural e comportamental, irá obrigar certamente à revisão daquele paradigma e à necessidade de se (re)adoptarem os grandes princípios Hipocráticos de compreensão dos processos de saúde/doença e do papel da medicina.

Immunodiagnosis of chronic Chagas' disease using the Tc 46 and Tc 58 antigens

The polypeptides of 46 and 58kDa were recognized in different T. cruzi strains (Y, WSL and Colombiana) by serum of all chagasic patients studied. These polypeptides were isolated from T. cruzi Y strain and used in ELISA. The sensitivity and specificity were 97.6% [CI 95%: 86-100%] and 100% [CI 95%: 89.3-100%], respectively when Tc 46 was used. When Tc 58 was used the sensitivity and specificity were 100% [CI 95%: 89.6-100%] and 90.2% [CI 95%: 75.9-96.8%], respectively.

Hepatitis B marker seroprevalence and vaccination coverage in adolescents in the City of Itajaí, State of Santa Catarina, Southern Brazil, in 2008

INTRODUCTION: Hepatitis B infection constitutes an important cause of morbidity and mortality worldwide. In Brazil, however, the current epidemiological situation is not clear. Considering the importance of establishing this prevalence, the aim of this study was to determine the prevalence of HBV markers in voluntary adolescents, junior high (secondary school) students, in the City of Itajaí, State of Santa Catarina, Brazil. METHODS: A seroepidemiological, transverse study was conducted with 353 randomly chosen adolescents from elementary school in 2008. Blood samples were analyzed for HBsAg, anti-HBc and anti-HBs. All analyses were conducted by automated microparticle enzyme immunosorbent assay (Abbott®, AxSYM system, Deerfield, IL, USA), according to the manufacturer's instructions. RESULTS: The prevalence of HBsAg was 0.6% (CI 95% 0.1 - 2.0), that of anti-HBc was 1.1% (CI 95% 0.3 - 2.9) and that of detectable anti-HBs was 83.6% (CI 95% 79.3 - 87.3). Hepatitis B vaccination coverage was 97.5% (CI 95% 95.2 - 98.8). CONCLUSIONS: These results demonstrate the success of the vaccination program against hepatitis B in the region studied and indicate that prevention strategies must be maintained and, if possible, expanded to contribute to the establishment of positive prevalence rates in all age groups.

Factors associated with 24-hour urinary volume: the Swiss salt survey.

BACKGROUND: Low 24-hour urine volume (24 UV) may be a significant risk factor for decline in kidney function. We therefore aimed to study associated markers and possible determinants of 24 UV in a sample of the Swiss population. METHODS: The cross-sectional Swiss Salt Study included a population-based sample of 1535 (746 men and 789 women) individuals from three linguistic regions of Switzerland. Data from 1300 subjects were available for the present analysis. 24 UV was measured using 24-hour urine collection. Determinants of 24 UV were identified using multivariable linear regression models. RESULTS: In bivariate analysis, 24 UV was higher in women compared to men (2000 ml/24 h [interquartile range (IQR): 1354, 2562] versus 1780 ml/24 h [IQR: 1244, 2360], p = 0.002). In multivariable regression analyses, independent associated markers of 24 UV were female sex (^6; = 280, 95% confidence interval [CI]: 174, 386, p < 0.0001), fluid intake (^6; = 604, 95% CI: 539, 670, p < 0.0001), sodium excretion (^6; = 4.2, 95% CI: 3.4, 4.9, p < 0.0001) age (^6; = 6.6, CI: 3.4, 9.7, p < .0001), creatinine clearance (^6; = 2.4, CI: 0.2, 4.6, p = 0.04), living in the German-speaking part of Switzerland (^6; = 124, CI: 29, 219, p = 0.01), alcohol consumption (^6; = 41, CI: 9, 73, p = 0.01 for increasing categories of alcohol consumption), body mass index (^6; = -32, CI: -45, -18, p < 0.0001), current smoking (^6; = -146, CI: -265, -26, p = 0.02), and consumption of meat and cold cut (^6; = -56, CI: -108, -5, p = 0.03). CONCLUSION: In this large population-based, cross-sectional study, we found several strong and independent correlates for 24 UV. These findings may be important to improve our understanding in the development of chronic kidney disease.

A cohort-based analysis of the evolution of lifetime prevalence of recourse to prostitution by men in the general population of Switzerland, 1987-2000

Background: Despite their relevance to the prevention of sexually transmitted infections, there are few data on the frequency of recourse to prostitution in the male population in Switzerland. Using data gathered for the evaluation of the Swiss AIDS prevention strategy, we analysed net aggregate change and cohort-based change in lifetime prevalence of recourse to prostitution. Methods: Seven repeated cross-sectional telephone surveys of the general population aged 17-45 years (17-30 years only for the 1987 and 1988 surveys) were undertaken from 1987 to 2000 providing information on sexual behaviour including men's recourse to prostitution (total n¼9318). Age categories were: 17-20, 21-25, 26-30, 31-35, 36-40 and 41-45 years. Prevalence at 17-30 years was available in all surveys and prevalence at 41-45 was available for 1989-2000, though not for the same cohorts. Intra-cohort increase in prevalence over 10 years was analysed using truncated information for cohorts aged 21-25 and 26-30 years in 1987 and 1990. Population estimates were computed with 95% confidence intervals (CI). Results: No net change occurred in the 17-45 years male population prevalence between 1989 (17.6%, CI ¼ 15.4; 20.0) and 2000 (17.7%, CI ¼ 15.6; 20.0). The median starting prevalence of recourse to prostitution at age 17-20 was 4.8% (in 1989, CI ¼ 2.0; 9.7) and the range was from 1.8 (in 1994) to 10.4% (in 1990). The median ending prevalence at age 41-45 was 21.9% (in 1994, CI 16.7; 27.9) and the range was from 17.9 (in 2000) to 26.1% (in 1992). No clear trend was observed in either starting or ending prevalence. Intra-cohort evolution of the 1997 and 1990 cohorts was very similar. Conclusions: Based on available data, there was no net (aggregate) change in the prevalence of recourse to prostitution by males in Switzerland between 1989 and 2000. Within the time frame available, intra-cohort evolution was also very similar.

Prevalence and factors associated to the epidemic neuropathy in a population assisted by a family doctor in Cuba

With the outbreak of an epidemic neuropathy (EN) of unknown ethiology, a study of the prevalence and factors associated to the disease was carried out in the Zamora community, municipality of Marianao, Havana City. There were 11 patients identified with EN for a prevalence rate of 1.7/100. The major risk group was the one between 45 and 64 years of age, female sex, black skin. In the univaried analysis, a high prevalence ratio (PR) was found linked to beverage intake (PR=5.32 95%; confidence intervals (CI) = 1.2-24.4), frequent drugs intake (PR=6.59; CI=1.8-24.6), consumption of edible of non certified fats (PR=4.48; CI=1.2-16.7) and the smoking habit (PR=3.6; CI=1.1-12.2). More than73/100 (CI= 68.7-78.3) of the people under serologic study were infected with Coxsakie virus A-9 (strain 47) isolated from a patient still under research. It seems there are many factors like linder intake, antecedents of hemorrhagic conjuntivitis, nutritional aspects and others that, with the virus isolated were associated with this epidemiologic situation.

Active and passive screening for tuberculosis in Vaud Canton, Switzerland

Résumé Même si l'incidence de la tuberculose est basse en Suisse, cette maladie reste un problème de santé publique en raison des migrations de populations provenant de pays où l'incidence de la tuberculose est élevée. Les immigrants, à leur arrivée en terre helvétique, doivent s'annoncer auprès d'un des cinq centres d'enregistrement pour les réfugiés (Vallorbe, Bâle, Kreuzlingen, Altstätten et Chiasso) et subir un contrôle médical qui comprend un test tuberculinique et une radiographie du thorax afin de détecter des anomalies compatibles avec une tuberculose. Les requérants avec des signes de maladie sont immédiatement pris en charge dans le but d'éviter une dissémination du bacille de Koch. Cette* étude rétrospective compare la présentation bactériologique et clinique de la tuberculose ainsi que le résultat du traitement de cette maladie chez les immigrants diagnostiqués par dépistage actif (= immigrants venant d'être enregistrés comme requérants d'asile en Suisse) avec d'autres patients diagnostiqués par dépistage passif (= patients suisses, travailleurs étrangers résidents en Suisse ainsi que d'autres étrangers incluant les touristes, les étudiants, les immigrants illégaux ainsi que 11 requérants d'asile détectés tardivement et passivement après leur entrée en Suisse). Parmi les 179 patients, 78% sont des étrangers. La médiane d'âge de la population étrangère atteinte de tuberculose est de 29 ans contre 64 ans pour les Suisses. Le dépistage actif a été effectué auprès de 71 requérants d'asile chez lesquels 49.3% [CI : 37.4 - 61.2] n'avaient pas de symptômes contre 17.6% [Cl : 10.3 - 24.9] chez les 108 passifs. La durée des symptômes était de 2 mois dans le groupe des actifs versus 2.5 mois chez les passifs (ns). L'analyse bactériologique est positive à l'examen direct ou à la culture chez 63.4% des actifs contre 70.4% des passifs (ns). La confirmation bactériologique de la tuberculose chez des patients asymptomatiques s'élevait à 42.2% [Cl : 27.2-57.2] chez les actifs contre 13% [Cl : 5.31-20.7] chez les passifs. Le plus grand danger de dissémination est couru par les patients avec un examen direct positif dont la proportion des asymptomatiques était de 22.2% ([Cl : 9.6-34.8] dans le groupe des actifs contre 11.7% [CI : 4.4-19.0] dans le groupe des passifs. Le résultat du traitement, comprenant les patients guéris (avec confirmation bactériologique de guérison) ainsi que les patients ayant accompli le traitement jusqu'à la fin (mais sans confirmation bactériologique) est similaire dans les groupes des actifs et passifs. Le résultat différent selon le statut légal avec 88% pour les travailleurs étrangers, 85% pour les Suisses, 78% pour les autres étrangers et 83% pour les réfugiés. Ces chiffres sont proches des cibles de l'OMS (85%). Le dépistage actif de la tuberculose permet la détection plus précoce des cas de tuberculose que le dépistage passif. Etant donné que les immigrants proviennent de régions où la prévalence de la tuberculose est supérieure à celle de la Suisse, ce dépistage à la frontière permet non seulement de diminuer la dissémination de cette maladie par la prise en charge immédiate des malades et de réduire la durée des symptômes mais encore de détecter des patients ne présentant aucun symptôme malgré une activité bactériologique positive. Les résultats du traitement ne satisfont pas entièrement aux exigences de l'OMS, ce qui peut être expliqué par le fait que la population de patients tuberculeux suisses étant plus âgés que celles des étrangers, le nombre de décès est plus nombreux (soit par la tuberculose, soit par les complications de maladies sous-jacentes) et que le suivi de patients étrangers est plus difficile car certains disparaissent durant le traitement et d'autres sont transférés ailleurs en Suisse ou retournent dans leur pays. Summary Aim: This retrospective study compared the bacteriological and clinical presentation of tuberculosis and the outcome of treatment in immigrant notified for TB after active screening by chest X-ray at the border with other patients detected by passive screening. Design: Retrospective study of all patients notified for TB in Vaud Canton in 2001 and 2002. Result: In Vaud Canton 78% of the 179 patients notified for TB were foreign-born. Among 71 asylum seekers actively screened at the border, 49.3% [CI 37.4 - 61.2] were symptom-free vs 17.6% [CI 10.3 - 24.9] among 108 passively screened patients. In the passively screened group, the proportion of asymptomatic patients was 15.4% for Swiss patients. 8.6% for foreign workers, and 29.4% for other foreigners. The average duration of symptoms before diagnosis among patients with complaints was 2 months in actively screened foreign-born, compared to 2.5 months in passively screened patients (no significant difference by Wilcoxon-Mann-Whitney test). The proportion of pulmonary TB cases with positive smear or culture was 63.4% in actively screened patients vs 70.4% in passively detected cases. Among actively screened patients with bacteriological confirmation, 42.2% [CI 27.2-57,2] were asymptomatic compared to 13% [CI 5.31-20.7] for passively screened patients. Considering only smear positive patients, the proportion of symptom-free patients was 22.2% [CI 9.6-34.8] in 45 actively screened cases vs 11-7% [4.4 - 19.0] for 77 passive screening. Cure and treatment completion rate for new cases reached 88% for foreign workers, 83% for asylum seekers, 85% for Swiss patients, 78% for other foreigners. Conclusions: Actively screened patients were more frequently asymptomatic than passively detected cases, even when considering only patients with bacteriological confirmation. The active screening by chest X-ray of an immigrant population with a high prevalence of tuberculosis allows the early detection and treatment of tuberculosis. This may contribute to the protection of the resident population for infection. The outcome of treatment for tuberculosis was satisfactory in all population groups.

Molecular characterisation of newly identified HIV-1 infections in Curitiba, Brazil: preponderance of clade C among males with recent infections

As in many areas of Brazil, the AIDS epidemic in Curitiba is relatively stable, but surveillance is important to support public policy. The molecular characteristics of HIV may be instrumental for monitoring epidemic trends. We evaluated plasma HIV-1 RNA (n = 37) from 38 cases presenting with positive serology, who were among 820 consenting volunteers visiting the downtown counselling and serology testing centre. Seroprevalence was 4.6% (CI 95% 3.2-6.3) and the estimated HIV incidence, as defined by the BED assay, was 2.86 persons/years (CI 95% 1.04-4.68). An additional set of contemporaneous, anonymous samples from a local laboratory was also analysed (n = 20). Regions of the HIV-1 polymerase (n = 57) and envelope (n = 34) were evaluated for subtyping, determination of mosaic structure, primary drug resistance mutations (pDRM), envelope V3 loop motifs and amino acid signatures related to viral tropism. HIV-1 clade B was observed in 53% of cases; HIV-1C in 30% and BC mosaics in 14%, with one F genome and one CF mosaic. Clade C infection was associated with recent infections among males (p < 0.03). Stanford surveillance pDRM was observed in 8.8% of sequences, with 7% showing high level resistance to at least one antiretroviral drug. Tropism for CXCR4 co-receptor was predicted in 18% of envelope sequences, which were exclusively among clade B genomes and cases with serological reactivity to chronic infection.

Substance use and suicidal conducts : a study of adolescents hospitalized for suicide attempt and ideation

RESUME Objectifs: Etudier la prévalence des troubles liés à l'utilisation de substances psychoatives parmi des adolescents suicidaires; évaluer l'influence de la prise de substances psychoactives sur le geste suicidaire; analyser l'association entre les troubles liés à l'utilisation de substances psychoactives et le risque de récidive de la conduite suicidaire. Méthode: 186 adolescents, âgés de 16 à 21 ans, hospitalisés pour tentative de suicide ou idées suicidaires envahissantes, ont été inclus. Parmi eux, 148 ont été revus pour évaluation à 6 et/ou 18 mois. Des diagnostics psychiatriques, basés sur les critères du DSM-IV, ont été posés à l'aide d'un questionnaire, le MINI (Mini International Neuropsychiatric Interview). Résultats: A l'inclusion, 39.2% des sujets avaient un trouble lié à l'utilisation de substances psychoactives. Parmi eux, une proportion significativement plus élevée était sous l'influence d'alcool ou drogue au moment de la tentative de suicide (44.3% versus 25.4%). Des 148 adolescents suivis et revus à 6 ou 18 mois, 2 sont décédés par suicide et il y a eu 30 récidives de tentative de suicide durant l'étude. Une association significative a été trouvée entre les récidives de suicide et un diagnostic d'abus/dépendance à l'alcool à l'inclusion (OR=3.3; CI 0.7-15.0; 0R=2.6, CI 0.7-9.3). Des antécédents de plusieurs tentatives de suicide (OR=3.2; CI 1.1-10.0) et un âge supérieur à 19 ans (OR=3.2; CI 1.1-9.2) à l'inclusion étaient associés à la probabilité de mort par suicide ou de récidive de tentative de suicide. Conclusion: Parmi les adolescents hospitalisés pour tentative de suicide ou idées suicidaires envahissantes, le risque de décès ou de récidive est important. Ce risque est associé, entre autres, à des antécédents suicidaires et au diagnostic de trouble lié à l'utilisation de substances psychoactives. Le risque suicidaire ainsi que la consommation de substances psychoactives devrait être évalué chez les adolescents. De plus, les sujets jugés à risque devraient être suivis systématiquement après une hospitalisation pour conduite suicidaire. ABSTRACT Aim: To study the prevalence of psychoactive substance use disorder (PSUD) among suicidal adolescents, psychoactive substance intoxication at the moment of the attempt and the association between PSUD at baseline and either occurrence of suicide or repetition of suicide attempt(s). Methods: 186 adolescents aged 16 to 21 hospitalised for suicide attempt or overwhelming suicidal ideation were included (TO); 148 of them were traced again for evaluations after 6 months and/or 18 months. DSM-IV diagnoses were assessed each time using the Mini International Neuropsychiatric Interview. Results: At TO, 39.2% of the subjects were found to have a PSUD. Among them, a significantly higher proportion was intoxicated at the time of the attempt than those without PSUD (44-.3% vs. 25.4%). Among the 148 adolescents who could be traced at either Ti or T2, two died from suicide and 30 repeated suicide attempt once or more time. A marginally significant association was found between death by suicide/repetition of suicide attempt and alcohol abuse/dependence at baseline (0R=3.3; CI 0.7-15.0; 0R=2.6, CI 0.7-9.3). More than one suicide attempt before admission to hospital at TO (OR=3.2; CI 1.1-10.0) and age over 19 at TO (0R=3.2; CI 1.1-9.2) were independently associated with the likelihood of death by suicide or repetition of suicide attempt. Conclusion: Among adolescents hospitalised for suicide attempt or overwhelming suicidal ideation, the risk of death or repetition of attempt is high and is associated with previous suicide attempts - especially among older adolescents - and also marginally associated with PSUD; these adolescents should be carefully evaluated for such risks and followed up once discharged from the hospital.

Impact of genomic methylation on radiation sensitivity of colorectal carcinoma.

PURPOSE: To investigate the influence of demethylation with 5-aza-cytidine (AZA) on radiation sensitivity and to define the intrinsic radiation sensitivity of methylation deficient colorectal carcinoma cells. METHODS AND MATERIALS: Radiation sensitizing effects of AZA were investigated in four colorectal carcinoma cell lines (HCT116, SW480, L174 T, Co115), defining influence of AZA on proliferation, clonogenic survival, and cell cycling with or without ionizing radiation. The methylation status for cancer or DNA damage response-related genes silenced by promoter methylation was determined. The effect of deletion of the potential target genes (DNMT1, DNMT3b, and double mutants) on radiation sensitivity was analyzed. RESULTS: AZA showed radiation sensitizing properties at >or=1 micromol/l, a concentration that does not interfere with the cell cycle by itself, in all four tested cell lines with a sensitivity-enhancing ratio (SER) of 1.6 to 2.1 (confidence interval [CI] 0.9-3.3). AZA successfully demethylated promoters of p16 and hMLH1, genes associated with ionizing radiation response. Prolonged exposure to low-dose AZA resulted in sustained radiosensitivity if associated with persistent genomic hypomethylation after recovery from AZA. Compared with maternal HCT116 cells, DNMT3b-defcient deficient cells were more sensitive to radiation with a SER of 2.0 (CI 0.9-2.1; p = 0.03), and DNMT3b/DNMT1-/- double-deficient cells showed a SER of 1.6 (CI 0.5-2.7; p = 0.09). CONCLUSIONS: AZA-induced genomic hypomethylation results in enhanced radiation sensitivity in colorectal carcinoma. The mediators leading to sensitization remain unknown. Defining the specific factors associated with radiation sensitization after genomic demethylation may open the way to better targeting for the purpose of radiation sensitization.

Effectiveness of intermittent preventive treatment with sulfadoxine-pyrimethamine during pregnancy on placental malaria, maternal anaemia and birthweight in areas with high and low malaria transmission intensity in Tanzania.

OBJECTIVE: To assess the effectiveness of IPTp in two areas with different malaria transmission intensities. METHODS: Prospective observational study recruiting pregnant women in two health facilities in areas with high and low malaria transmission intensities. A structured questionnaire was used for interview. Maternal clinic cards and medical logs were assessed to determine drug intake. Placental parasitaemia was screened using both light microscopy and real-time quantitative PCR. RESULTS: Of 350 pregnant women were recruited and screened for placental parasitaemia, 175 from each area. Prevalence of placental parasitaemia was 16.6% (CI 11.4-22.9) in the high transmission area and 2.3% (CI 0.6-5.7) in the low transmission area. Being primigravida and residing in a high transmission area were significant risk factors for placental malaria (OR 2.4; CI 1.1-5.0; P = 0.025) and (OR 9.4; CI 3.2-27.7; P < 0.001), respectively. IPTp was associated with a lower risk of placental malaria (OR 0.3; CI 0.1-1.0; P = 0.044); the effect was more pronounced in the high transmission area (OR 0.2; CI 0.06-0.7; P = 0.015) than in the low transmission area (OR 0.4; CI 0.04-4.5; P = 0.478). IPTp use was not associated with reduced risk of maternal anaemia or low birthweight, regardless of transmission intensity. The number needed to treat (NNT) was four (CI 2-6) women in the high transmission area and 33 (20-50) in the low transmission area to prevent one case of placental malaria. CONCLUSION: IPTp may have an effect on lowering the risk of placental malaria in areas of high transmission, but this effect did not translate into a benefit on risks of maternal anaemia or low birthweight. The NNT needs to be considered, and weighted against that of other protective measures, eventually targeting areas which are above a certain threshold of malaria transmission to maximise the benefit.