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Inviting
Editorial
Drug resistance in tuberculosis
control. A global and Indian
situation
Harshad Thakur
Tuberculosis (TB) is an infectious disease caused by Mycobacterium
tuberculosis. Its
distribution, morbidity and mortality are linked to socio-economic
indices and lifestyle factors. The problem of tuberculosis is universal,
with nearly a third of the world’s population infected and nearly 3
million people dying annually from the disease of tuberculosis. Global
tuberculosis control is facing major
challenges today. Much effort is still required to make quality care
accessible without barriers of gender, age, type of disease, social
setting, and ability to pay. Coinfection with M. tuberculosis
and HIV (TB/HIV) especially in Africa, multidrug-resistant (MDR) and
extensively drug-resistant (XDR) tuberculosis in all regions, make control
activities more complex and demanding.
India has been declared by the WHO as a high TB burden country.
Tuberculosis is one of the most important public health problems in India.
It is present since many centuries and most commonly affects people from
lower socio economic status. The average prevalence of all forms of
tuberculosis in India is estimated to be 5.05 per thousand, prevalence of
smear-positive cases 2.27 per thousand and average annual incidence of
smear-positive cases at 84 per 1,00,000 annually. TB is also one of the
leading causes of mortality in India. It kills more than 300,000 people in
India every year. Different health care providers’ following different
health systems tries to provide treatment and control the problem. Major
challenges facing TB control are to achieve equity, improve access,
availability and affordability, increase quality of services etc.
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Health Patterns and Determinants
The role of anxiety into the smoking
relapse in adolescents
Patrick Laure
Abstract: Objectives.
With tobacco smoking prevention in mind, 1) to compare trait anxiety
levels between preadolescents who are beginning with smoking and those who
are not, and 2) to measure whether, or not, smoking cessation may
influence levels of trait anxiety. Material and methods. All of the
pupils entering the sixth grade in the Vosges department (France), during
the school year 2001-2002 (age: 11) were followed during four years, by
questionnaire. Data collected: tobacco use and trait anxiety (Spielberger's
State-Trait Anxiety Inventory). Prospective cohort study, by
questionnaire. Results. There is already a small percentage of
regular smokers at age 11 years (3.5 % among boys, 1.2 % among girls).
This percentage increases quickly, as well as the quantity of smoked
cigarettes. Among never smokers, trait anxiety of preadolescent who will
start to smoke within six months, is higher than that of pupils who will
remain non smokers, but this difference is not always significant. Among
smokers, trait anxiety is higher than among non smokers. Finally, trait
anxiety of preadolescents who gave up smoking remained as high as when
they smoked regularly. Discussion. As in other studies, our regular
smokers of both sexes are more anxious than never smokers, and this could
underline the anxiogenic influence of nicotine. But these data change at
13 years and after: while girls remain with a high anxiety trait level,
the difference disappears among boys. Would girls be more sensitive
to nicotine action? Conclusion. These findings could constitute
arguments to carry out prevention actions intended to reduce anxiety among
early adolescent smokers and ex-smokers. As many smokers believe that
tobacco has a calming effect, this measure could help them not to start
smoking again.
Key words: early adolescents,
smoking prevention, anxiety
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Evaluation of
ngo involvement in the
cataract control programme in India
HP Thakur, N Nakkeeran, K
Mukherjee, CAK Yesudian
Abstract: Aim.
This study presents findings of the evaluation of performance of NGOs
under
the World Bank Assisted Cataract Blindness Control Project in India.
Method. 15 NGOs were covered in 3 states of Maharashtra, Andhra
Pradesh and Tamil Nadu. The study was conducted in base hospitals and
their hinterlands in 2002-2003. The field study involved visiting selected
villages where the scheme was implemented and conducting interviews with
beneficiaries and non– beneficiaries. Results. The performance of
NGOs were assessed on the basis of their matching contribution,
achievement of development targets, case selection through camps, number
and type of surgeries performed (performance targets) and quality of
follow up services. Successful models developed by grantee NGOs should
have good geographical camp coverage, better planning, efficient and
effective utilization of resources. The reasons for poor performing NGOs
were poor geographical coverage, unavailability of skilled manpower, poor
follow up services, etc. Conclusions. Though the Scheme has been
successful in streamlining the involvement of the NGOs in addition to
capacity building to a great extent, it is doubtful that the prevalence of
blindness in the assigned area has been reduced. Further studies are
required to identify the reason for the high prevalence of cataract, to
understand the role of each risk factor and to improve the service
delivery through both public and private sector.
Key-words:
cataract, evaluation, Government–NGO collaboration, public-private
partnership,
National Blindness Control Programme
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Inflammatory bowel disease-a public
health problem
Elena Toader
Abstract:
Inflammatory bowel disease
with it’s two distinct entities, ulcerative colitis (UC) and Crohn’s
disease (CD) with increased morbidity, uncertain etiopathogenesis, severe
complication, early invalidity represents a major problem of public health
in many regions of the world. The aim of the our study was to
present some medical, social and economic aspects of IBD relevant for
public health and which resulted from comparative evaluation of this
epidemiological phenomena and its evolution in NE Romanian region as well
as in other regions in the world. Material and method. The size of
the studied population samples (10.81% of the total population of Romania)
allowed us to record 942 cases of IBD in NE Romania region during two
decades. The necessary data in order to evaluate the frequency and
clinical course has been drawn from medical records as well as statistic
reports presented by the literature in the field. Results. The IBD
incidence in NE Romania was 1.89/105 inhabitants (1.54/105
inhabitants for UC and 0.35/105 inhabitants for CD). In 65% of
the cases, the onset of the disease was found at persons younger than 50
years. By evaluating the environmental factors in the appearance of IBD it
has been proved that it is present more frequently at nonsmoker and
without appendectomy patients, while CD is more frequently in smoking
patients. The family history frequency within IBD patients was about 2.4%
and pANCA was identified in 11% patients with UC. Active disease with
sever attacks was reported in 21% patients at IBD onset and in 41% of the
patients with severe complications (such as toxic megacolon reported in
2.2%). Dysplasia, as main pre malignant lesion was identified in 4.4%
patients who presented colon mucosal changes. Conclusion. IBD
incidence of 1.89/105 places the NE Romania zone in the
geographical region groups with low frequency in conformity with European
statistic data. Nevertheless high frequency in young in youth people, the
high risk cancer and severe evolution of the disease, high costs include
this complex disease within important public health problems, that should
must be included in National Health Program.
Key words:
inflammatory bowel disease, public health, frequency, clinical pattern
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The risk assessment in occupational
exposure to asbestos dusts through sputum cytologic examination
Doina Havârneanu, Irina
Alexandrescu, Doina Popa
Abstract: Introduction.
The
permanent existence of large asbestos quantities in many workplaces and
the use of asbestos as raw material in different industries expand the
number of workers who are occupationally exposed to its noxious effects.
Diseases associated with occupational exposure to asbestos are:
mesothelioma, lung cancer, asbestosis, and pleural fibrosis/plaques.
Aim.
The
present paper illustrates the possibility of revealing occupational
exposures to asbestos dusts through sputum cytological examination. This
emphasizes the presence of asbestos fibers and bodies in the sputum
samples, and also enhances the effectiveness of sputum cytological
examination in early diagnosis of possible pretumoral changes in specific
groups of employees.
Material and method.
The
cytological examination was performed on fresh morning sputum samples (3
smears for each patient) from a group of 39 workers occupationally exposed
to asbestos dusts (mean age 38.31±7.12
years, mean work length in asbestos industry 13.10±7.03
years) and a control group of 72 subjects, matched by mean age, mean work
length and smoking habit, respectively.
Results.
Asbestos
bodies were found in the sputum samples of 29 subjects from the exposed
group and, in some of these cases, a high density of free asbestos fibers
was also found. According to the Papanicolau classification, the
cytological types diagnosed in the samples from the exposed subjects were
as follows: 19 cases type I, 16 cases type II, and 4 cases type III. There
was a raising tendency (obvious, but statistically not-significant) for
the type II inflammatory alterations in those patients from the exposed
group with more than 10 years of work length. Related to the smoking
habit, an increasing rate (statistically not-significant) of the type II
and type III cytology cases appears in the group of the heavy smokers.
Conclusions.
The
presence of asbestos bodies in sputum represents an important indicator
for occupational exposure to respirable particles. Sputum cytology
screening is a practical, noninvasive and inexpensive approach for the
diagnosis and assessment of the occupational exposure to asbestos.
Key
words: asbestos, occupational exposure, sputum, risk assessment,
screening
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Exposure and effect biomarkers in shoe
manufacturing personnel and the significance of their changes
Felicia Grădinariu, Carmen
Croitoru, Brigitte Scutaru, Valeria Hurduc, V Cazuc, Al Maftei, Doina
Hăvârneanu, Irina Alexandrescu, Mădălina Bohosievici,
Micaela Mărgineanu, Mirela
Ghiţescu, Liliana Găină
Abstract:
Health monitoring in small and medium enterprises (SMEs) and particularly
in shoe industry is an obvious necessity in current conditions of Romanian
economy in transition, in spite of the difficulties implied by this task.
The aim of this paper was to analyze the relationship between
different exposure and effect markers and other biochemical indices with
the occupational risk factors and to detect if and how they reflect in the
health status of the exposed workers. Material and methods. The
exposed group (61 workers from shoes
manufacturing factory from which 82% female) was investigated by a complex
protocol including biochemical, immunological (IgE), and cytogenetic tests
(oral mucosa micronucleus).
Post-shift
urinary acetone, hippuric and
methylhippuric acid, total phenols and sulphate index were assayed.
Results and discussions. The results were statistically analyzed and
were compared to a control-matched unexposed group (n=58). The most
frequent changes were found in
sulphate index ratio and in micronucleus test.
Serum IgE correlated with urinary acetone (r=0.39, p<0.05, n=35) in
exposed with more than 5 years of service in footwear industry, showing
the link of exposure with the frequent allergic outcomes diagnosed in
these workers. Urinary sulphate index correlated negatively with the
length of exposure in this industry (r = -0.52, p<0.01), showing the time
dependence of this marker. Urinary hippuric acid correlated with total
phenols (r=0.78, p<0.001) and also with urinary creatinine (r=0.57,
p<0.01) suggesting the organism’s intense effort for the detoxification of
the solvents inhaled. Conclusions. We assume that the health status
of the investigated workers seemed to be affected by working conditions.
Our results demonstrate the need for further monitoring of these workers,
in order to avoid harmful occupationally-induced health consequences. We
recommend some measures for the reduction of workplace risk factors impact
upon workers health.
Key words: solvent,
occupational exposure, marker, effect
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Dental Health
First molars sealants – longitudinal
study evaluating the impact on oral health status
Livia Mihailovici, Ioan
Dănilă
Abstract:
The aim of this study was to evaluate the results of primary and
secondary prevention of first molars caries using pit and fissure
sealants. Material and methods. The study included 247 children
initially aged 6-7 years from
Iaşi, with different
socio-economic status, who had their first permanent molars sealed and the
results were estimated periodically for 5 years. Results. The rate
of successful sealants was 79.5% two years after the application and 68.5%
at the end of the study. Only 9.4% of the sealed surfaces presented dental
caries after 5 years and the DMFS (the Decayed, Missing, Filled, Surface)
index of the occlusal surfaces had a reduced increase. The method allowed
the differences in oral health status of children with different
socio-economic status to be significantly reduced. Conclusions.
This study has underlined the effectiveness of the primary and secondary
prevention actions within first molars caries.
Key-words: schoolchildren,
sealants, socio-economic status
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Epidemiological study on the
prevalence and incidence of periodontal disease of patients aged 4-17
years with systemic conditions
Diana Gheban, A Maxim,
Marinela Păsăreanu
Abstract:
The aim of the
study is to characterize from the epidemiological point of
view a group of 122 patients with general diseases, supposed to install
gingival overgrowth and to provide valid data related to some
epidemiological variables (age, gender, type of disease, biological
general data, and clinical aspects of periodontal involvement).
Material and method. The study was conducted on a sample of
hospitalized children and adolescents diagnosed with insulin-dependent
diabetes type I, leukemia, chronic renal failure and epilepsy. The group
consisted in 122 children, 60 girls and 62 boys, aged between 4 and 17
years, from the Clinic Pediatrics Hospital "St. Maria" Iaşi and
Psychiatric Hospital No. 9 Iaşi, in the period 2005-2008. We used for
comparison a control group, composed 30 children of the same age, without
general systemic conditions, which were in dental treatment in assistance
upon request. Periodontal status assessment was made by clinical general
and local examination and comprehensive para-clinical tests. Indices of
periodontal evaluation used: Plaque index (PI), Papillary bleeding
index (PBI) and Gingival overgrowth index. Information on diabetes,
chronic renal failure, epilepsy and leukemia were recorded from the
medical records, discussions with the therapist or family. The systemic
disease diagnostic for all children was made based on their general
symptoms, most of them (92%) being hospitalized with complicated disease.
Results and discussion. As regards the distribution group of study
on gender is a predomination of female sex (53%). Batch distribution
according to age groups is heterogeneous, with maximum values around the
age of 17 years. The distribution by type of disease is as follows: 29
cases of insulin-dependent diabetes type I, 31 cases of chronic renal
failure, 30 epileptic and 32 cases of leukemia. Graphical representation
of classes of variation for plaque index was computed over 10 classes,
observing the relative maximum frequency of 47.2% of values between 1.8
and 2.2, followed by values between 1.21 and 1.4 with relative frequency
of 37.36% and between 2.61 and 2.8 with relative frequency of 15.38%. For
bleeding index were built 10 variation classes; half of the values
recorded were between 1-1.2 and 36.17% of records having values between
1.61 and 2.2. A relative frequency of 13 83% is observed for the PBI index
values between 2.81 and 3. In our group of patients were
recorded overgrowth indices between 1.21-1.4/2 with a relative frequency
of 57.41%, from 1.81-2/2 with a relative frequency of 37.4% and higher
values between 2.61-1.8/2 in 5.56% of cases. Conclusions Drug
induced overgrowths are becoming more frequent because of the widespread
use of phenytoin, cyclosporine A and calcium channel blockers. Among the
factors that influence overgrowth, inflammation, through the oral plaque
and pharmacokinetic variables appear to be most important. Hormonal
disorders and some diseases may contribute to the overall growth rate of
the gingival overgrowth.
Key words: child, gingival
overgrowth, diabetes, renal failure, epilepsy, leukaemia
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