Search

Paracoccidioidomycosis (PCM) is a systemic mycosis caused by the fungus Paracoccidioides brasiliensis and is endemic to Brazil. The aim of this study was to perform a retrospective analysis of the PCM cases in the countryside south of Rio Grande do Sul, Brazil. The files from four histopathology laboratories located in the city of Pelotas were obtained, and all of the epidemiological and clinical data from the PCM diagnosed cases were collected for analysis. A total of 123 PCM cases diagnosed between 1966 and 2009 were selected. Of these patients, 104 (84.5%) were male, and 17 were female. The patients ranged from 02 to 92 years of age. Fifty-two cases (41.9%) were obtained from the oral pathology laboratory, and the remaining 71 cases (58.1%) were obtained from the three general pathology laboratories. Of all of the patients studied, 65.2% lived in rural zones and worked in agriculture or other related fields. Data on the evolution of this disease was available for 43 cases, and the time frame ranged from 20 to 2920 days (mean = 572.3 days). An accurate diagnosis performed in less than 30 days only occurred in 21% of the cases. PCM is endemic to the countryside of Rio Grande do Sul. Therefore, it is recommended that PCM be included as a differential diagnosis, mainly for individuals between 30 and 60 years of age, living in rural zones and who have respiratory signs and associated-oropharyngeal lesions.

OBJECTIVE—To study the mortality experience of workers at a hydrometallurgical nickel refinery and fertiliser complex in Fort Saskatchewan, Alberta, Canada. METHODS—A total of 1649 male employees of Sherritt International who worked for at least 12 continuous months during the years 1954 to 1978 at the Fort Saskatchewan, Alberta hydrometallurgical nickel refinery and fertiliser complex were followed up for an additional 17 years. Mortality was ascertained from the Canadian mortality data base maintained by Statistics Canada and covered the years 1954-95. Statistics were analysed with Monson's computer program. RESULTS—Total mortality, when compared with the Canadian population, was significantly below expectation. Fewer deaths were found for circulatory disease, ischaemic heart disease, respiratory disease, neoplasms, digestive cancer, and accidents, poisonings, and violence. Among the 718 men in the group exposed to nickel, there were no deaths due to nasal cavity or paranasal sinus cancer. Fewer deaths were found for all causes, circulatory disease, ischaemic heart disease, neoplasms and digestive cancer. Lower death rates were observed than expected for respiratory malignancies and cancer of the bronchus and lung. CONCLUSION—No association was found in this study between exposure to nickel concentrate or metallic nickel in the hydrometallurgical refining process and the subsequent development of respiratory cancer. Keywords: epidemiology; nickel workers; mortality

Randomized carotid trials have clearly shown the importance of carotid endarterectomy (CEA) in reducing the risk of stroke for specific symptomatic and asymptomatic patients. 1–5 Public acknowledgment of the results from these trials has led to an apparent change in the practice patterns of surgeons performing this procedure, resulting in a dramatic increase in the number of CEAs being performed in the United States. 6,7 Unfortunately, the randomized trials have not remained free from criticism. Male patients represented the majority of the trial populations, making it difficult to evaluate the outcome of surgery for certain patient subgroups, such as women and minorities. As a result, the short- and long-term benefits of CEA in women appear to be less clear, and the role of CEA surgery among women with carotid disease remains uncertain. 5,8 A review of the more recent literature has provided conflicting information regarding the effect of female gender on the outcome after CEA. Several multicenter reviews, reviews of state-based hospital discharge databases, collective reviews, and large single-center studies have suggested that female gender may be a predictor of complications after CEA and have questioned the value of surgery in women. 6,9–13 Meanwhile, other reports have shown no evidence of gender-based differences in terms of outcome after CEA. 14,15 Various single-institution reviews have specifically addressed the stroke and death rates between women and men after CEA. 16–20 The authors of these reviews concluded that CEA can be performed safely in women, with success rates similar to those observed in men. The present report highlights our experience with CEA during a 21-year period. The purpose of this review was to evaluate and compare the short- and long-term outcomes in women and men after CEA. By doing so, we sought to provide answers to the following questions: Can CEA be performed safely in women with symptomatic and asymptomatic carotid artery disease? Are the early results in women after CEA comparable to the results in men? Is female gender a risk factor for nonneurologic complications after CEA? Does female gender adversely affect late stroke and death rates after CEA compared with the rates in men? Are the results from our study comparable to the early and late results reported in the Asymptomatic Carotid Atherosclerosis Study (ACAS) and the North American Symptomatic Carotid Endarterectomy Trial (NASCET)? Should the indications for CEA in women remain the same as for men?

Hip fractures have long been considered a major threat to the survival of elderly people. Most of the studies on survival following hip fractures have been reported from developed countries where orthopedic care is well distributed. This report describes the survival experience of 330 elderly hip fracture patients who were seen at hospitals in Chiang Mai, Thailand. The mortality rate during hospitalization was 2.1%. The 3-, 6-, and 12-month survival rates after hip fractures were 91%, 88% and 83%, respectively. The significant predictors of mortality were male sex, age over 80 years, presence of chronic illnesses, poor pre-fracture walking ability, and nonoperative treatment.

Aims—To evaluate the incidence and outcome of acute myeloid leukaemia (AML), FAB M6 (erythroleukaemia). Methods—A demographic study in the Northern Health Region of England between 1983 and 1999. Results—Thirty three cases were diagnosed and registered prospectively. The overall incidence was 0.077 cases/100 000/year. There was a pronounced rise in incidence in patients aged 56 years or more: 6.6 times higher than that in younger patients. Overall survival was poor; median survival was 11 months for those aged less than 56 years, and three months for patients aged 56 years and above (p = 0.045). Acquired karyotypic abnormalities were found in 17 of 27 patients where analysis was attempted. When classified according to the criteria of the Medical Research Council AML trials, karyotype predicted survival, with a median overall survival of 14 months for those with "standard risk" cytogenetic results and two months for "poor risk" results (p = 0.005). Conclusion—This study demonstrates a worse survival for patients with erythroleukaemia than that reported in some published trials of selected patients. Key Words: erythroleukaemia • acute myeloid leukaemia • cytogenetics • population based

SUMMARYWe investigated the seasonality of tuberculosis (TB) in Wuhan, China, to evaluate the increased risk of disease transmission during each season and to develop an effective TB control strategy. We applied spectral analysis to the weekly prevalence data of sputum smear positive (SSP) and sputum smear negative (SSN) pulmonary TB reported from 2006 to 2010. Cases of both SSP and SSN feature 1·0- and 0·5-year periodic modes. The least squares method was used to fit curves to the two periodic modes for SSP and SSN data. The curves demonstrated dominant peaks in spring similar to cases reported previously for other locations. Notably for SSP, dominant peaks were also observed in summer. The spring peaks of SSP and SSN were explained in terms of poorly ventilated and humid rooms and vitamin D deficiency. For the summer peaks of SSP, summer influenza epidemics in Wuhan may contribute to the increase in TB prevalence.

OBJECTIVES—To examine trends in estimated population based incidence of occupational asthma by age, sex, occupation, geographical region, and causal agents based on 9 years of the Surveillance of Work Related and Occupational Respiratory Disease (SWORD) data. METHODS—In January 1989 the SWORD scheme for the surveillance of occupational respiratory disease was established in the United Kingdom to make good the lack of epidemiological information on the incidence of these diseases in the United Kingdom. Between 80% and 90% of chest and occupational physicians report voluntarily all new cases they see, on a monthly or random sampling basis. During the 9 years 1989-97, an estimated 25 674 new cases of occupational respiratory disease, including 7387 of occupational asthma, were reported. Suspected causal agents were classified into 44 categories and estimated annual incidences of asthma were calculated with denominators from the labour force survey. RESULTS—Overall, a third of the suspected causes of asthma were organic, a third chemical, 6% metallic, and the rest miscellaneous, or in 8%, unknown. There was evidence of an increase since 1989 in cases due to latex, and possibly glutaraldehyde, and an apparent drop since 1991 in the proportion of cases attributed to isocyanates. Incidences were higher in men than women and the disparity was especially marked in the population aged 45 years or more in which rates for men were at least twice those for women. Average annual rates per million workers for 1992-7 ranged from 7 (95% confidence interval (95% CI) 5 to 9) for the lowest risk group of professional, clerical, and service workers to 1464 (95% CI 968 to 2173) for coach and other spray painters. Except for laboratory technicians, all other occupations with rates over 100 were concerned with manufacturing and processing that used chemicals, metals, and organic materials. Incidences were two to three times higher in the north and midlands than in East Anglia and the south. The introduction of a sampling scheme in 1992 doubled estimates of reported incidence of occupational asthma, but there was little evidence of other temporal changes. CONCLUSIONS—The SWORD scheme has produced consistent estimates of the causes and incidence of occupational asthma as seen by chest and occupational physicians. It has allowed the epidemiology of occupational asthma in the population to be studied and high risk occupations to be identified. There is certainly more occupational asthma in the population than that which reaches specialists in occupational and chest medicine; therefore the incidence rates presented here are underestimates, but by how much remains unknown. Keywords: occupational asthma; incidence; regional differences

OBJECTIVE To define the incidence of brain tumours in Devon and Cornwall and to discover which case finding methods are the most fruitful. To examine what happens to patients after the diagnosis of a brain tumour. METHODS The primary method of case ascertainment was a review of all CT with contrast and MRI of the head performed on the population of Devon and Cornwall between 1 April 1992 and 31 March 1997. Secondary sources included registrations with the South and West Cancer Intelligence Unit and a search for all patients either admitted to hospital with a brain tumour or operated on for a brain tumour during the same period. RESULTS 16 923 scans were reviewed of which 8774 (52%) were normal. The scan review found 2483 incident intracranial tumours, of which 861 were metastases. Secondary sources of case ascertainment disclosed 46 further cases. Cases were missed by the scan review mainly for technical reasons and only three patients were found who were diagnosed by non-imaging methods. The incidence of primary intracranial tumours standardised to the population of England and Wales was higher than any previously reported (21.04 (17.18–25.62)/100 000 person-years). Overall, 21% of cases were not admitted to hospital. The categories least likely to be admitted were those with sellar and cranial nerve tumours. Those not admitted to hospital were significantly older than those who were. CONCLUSION One fifth of patients are not admitted to hospital after the diagnosis of a brain tumour and incidence studies must use case finding methods which will capture these cases. An audit of imaging results provides almost complete case ascertainment. This study shows that the incidence of primary brain tumours is considerably higher than previously thought. Official figures from the cancer intelligence units significantly underestimate brain tumour incidence, especially for benign tumours.

Objective and design: To relate UK national trends since 1950 in smoking, in smoking cessation, and in lung cancer to the contrasting results from two large case-control studies centred around 1950 and 1990. Setting: United Kingdom. Participants: Hospital patients under 75 years of age with and without lung cancer in 1950 and 1990, plus, in 1990, a matched sample of the local population: 1465 case-control pairs in the 1950 study, and 982 cases plus 3185 controls in the 1990 study. Main outcome measures: Smoking prevalence and lung cancer. Results: For men in early middle age in the United Kingdom the prevalence of smoking halved between 1950 and 1990 but the death rate from lung cancer at ages 35–54 fell even more rapidly, indicating some reduction in the risk among continuing smokers. In contrast, women and older men who were still current smokers in 1990 were more likely than those in 1950 to have been persistent cigarette smokers throughout adult life and so had higher lung cancer rates than current smokers in 1950. The cumulative risk of death from lung cancer by age 75 (in the absence of other causes of death) rose from 6% at 1950 rates to 16% at 1990 rates in male cigarette smokers, and from 1% to 10% in female cigarette smokers. Among both men and women in 1990, however, the former smokers had only a fraction of the lung cancer rate of continuing smokers, and this fraction fell steeply with time since stopping. By 1990 cessation had almost halved the number of lung cancers that would have been expected if the former smokers had continued. For men who stopped at ages 60, 50, 40, and 30 the cumulative risks of lung cancer by age 75 were 10%, 6%, 3%, and 2%. Conclusions: People who stop smoking, even well into middle age, avoid most of their subsequent risk of lung cancer, and stopping before middle age avoids more than 90% of the risk attributable to tobacco. Mortality in the near future and throughout the first half of the 21st century could be substantially reduced by current smokers giving up the habit. In contrast, the extent to which young people henceforth become persistent smokers will affect mortality rates chiefly in the middle or second half of the 21st century.

Objectives: To investigate the association between suicide and area based measures of deprivation and social fragmentation. Design: Ecological study. Setting: 633 parliamentary constituencies of Great Britain as defined in 1991. Main outcome measures: Age and sex specific mortality rates for suicide and all other causes for 1981-92. Results: Mortality from suicide and all other causes increased with increasing Townsend deprivation score, social fragmentation score, and abstention from voting in all age and sex groups. Suicide mortality was most strongly related to social fragmentation, whereas deaths from other causes were more closely associated with Townsend score. Constituencies with absolute increases in social fragmentation and Townsend scores between 1981 and 1991 tended to have greater increases in suicide rates over the same period. The relation between change in social fragmentation and suicide was largely independent of Townsend score, whereas the association with Townsend score was generally reduced after adjustment for social fragmentation. Conclusions: Suicide rates are more strongly associated with measures of social fragmentation than with poverty at a constituency level. Key messages Place of residence may affect health, and mortality from most common diseases tends to be higher in areas characterised by low socioeconomic position Research dating back over 100 years suggests that social fragmentation may influence suicide In the 1980s and 1990s, parliamentary constituencies with high levels of social fragmentation had high rates of suicide, independent of deprivation Constituencies with the greatest increases in social fragmentation between 1981 and 1991 also had the greatest increases in suicide rates over the same period Any targeting of suicide prevention may be more effective if aimed at socially fragmented rather than deprived areas

Objectives: To investigate the association between the duration of exclusive breast feeding and the development of asthma related outcomes in children at age 6 years. Design: Prospective cohort study. Setting: Western Australia. Subjects: 2187 children ascertained through antenatal clinics at the major tertiary obstetric hospital in Perth and followed to age 6 years. Main outcome measures: Unconditional logistic regression to model the association between duration of exclusive breast feeding and outcomes related to asthma or atopy at 6 years of age, allowing for several important confounders: sex, gestational age, smoking in the household, and early childcare. Results: After adjustment for confounders, the introduction of milk other than breast milk before 4 months of age was a significant risk factor for all asthma and atopy related outcomes in children aged 6 years: asthma diagnosed by a doctor (odds ratio 1.25, 95% confidence interval 1.02 to 1.52); wheeze three or more times since 1 year of age (1.41, 1.14 to 1.76); wheeze in the past year (1.31, 1.05 to 1.64); sleep disturbance due to wheeze within the past year (1.42, 1.07 to 1.89); age when doctor diagnosed asthma (hazard ratio 1.22, 1.03 to 1.43); age at first wheeze (1.36, 1.17 to 1.59); and positive skin prick test reaction to at least one common aeroallergen (1.30, 1.04 to 1.61). Conclusion: A significant reduction in the risk of childhood asthma at age 6 years occurs if exclusive breast feeding is continued for at least the 4 months after birth. These findings are important for our understanding of the cause of childhood asthma and suggest that public health interventions to optimise breast feeding may help to reduce the community burden of childhood asthma and its associated traits. #### Key messages

OBJECTIVES: To determine prevalence and incidence of carpal tunnel syndrome (CTS) in a modern meat packing plant. The secondary objective was to explore the relation between ethnicity and CTS. METHODS: Six hundred and sixty five workers were interviewed and examined to find the prevalence of CTS. Subsequently, 421 workers without CTS were followed up and examined at a median interval of 253 days; of those, 333 remained without CTS and were again examined at a median interval of 148 days. RESULTS: The prevalence and incidence of CTS was 21% and 11/100 person-years, respectively. The incidence for Asian mixed, white, and other ethnicities was 12.0, 12.2, and 7.2 cases/100 person- years, respectively. The observed incidence for men and women was 9.7 and 18.4 cases/100 person-years, respectively. This difference was not quite significant (p = 0.068) with an estimated relative risk (women v men) of 1.9 (95% confidence interval (95% CI) 0.9 to 3.8). The interaction between sex and use of tools was significant (p = 0.04), however, although the relative risk for CTS in women who used tools was 4.2 the numbers were small and not significant. The relative risk for men who used tools was 0.64 and not significant. The percentage of incident cases with comorbid disease was only 6.3% (3/47). CONCLUSIONS: The prevalence and incidence of CTS in this workforce were higher than in the general population. However, the prevalence of CTS in this modern, mechanised plant was not significantly different from that reported in older plants. No relation was found between ethnicity, age, body mass index, and CTS for either prevalence or incidence. Comorbid disease among the cases of CTS is significantly less than that found in other industry.

Objective: To define the relations between age, sex, lower limb symptoms, and the presence of trunk varicose veins on clinical examination. Design: Cross sectional population study. Setting: 12 general practices with catchment areas geographically and socioeconomically distributed throughout Edinburgh. Participants: An age stratified random sample of 1566 people (699 men and 867 women) aged 18-64 selected from the computerised age-sex registers of participating practices. Main outcome measures: Self administered questionnaire on the presence of lower limb symptoms and physical examination to determine the presence and severity of varicose veins. Results: Women were significantly more likely than men to report lower limb symptoms such as heaviness or tension, swelling, aching, restless legs, cramps, and itching. The prevalence of symptoms tended to increase with age in both sexes. In men, only itching was significantly related to the presence and severity of trunk varices (linear test for trend, P=0.011). In women there was a significant relation between trunk varices and the symptoms of heaviness or tension (P 0.001), aching (P 0.001), and itching (P 0.005). However, the level of agreement between the presence of symptoms and trunk varices was too low to be of clinical value, especially in men. Conclusions: Even in the presence of trunk varices, most lower limb symptoms probably have a non-venous cause. Surgical extirpation of trunk varices is unlikely to ameliorate such symptoms in most patients.

OBJECTIVES—Data from a sample of 2494 patients affected with Huntington's disease (HD), collected as part of the National Research Roster for Huntington Disease Patients and Families, were examined to determine if there was a relation between age at onset and duration of illness. METHODS—Sufficient data for inclusion in analysis was available from 2068 patients, of whom 828 were deceased and 1240 were living. The median duration of disease was 21.4 years with a range of 1.2 to 40.8 years. Patients were categorised into one of four groups based on their age at onset. RESULTS—Significant differences in duration based on the age at onset were found (p

OBJECTIVES: To investigate concern that local industrial air pollution in Teesside, England, was causing poor health, several areas there were compared with parts of the City of Sunderland. METHODS: Populations in similar social and economic circumstances but varying in their proximity to major industries were compared. Study populations lived in 27 housing estates in Teesside and Sunderland, north east England, with some data from subsets of estates. The estates were aggregated into zones (designated as A, B, and C in Teesside where A is closest to and C furthest from industry, and S in Sunderland). Zone S provided a reference area. The hypothesis was that a health gradient both within Teesside (A > B > C) and between Teesside and Sunderland (ABC > S) would indicate a possible health effect of local industrial air pollution. Data presented were: mortality (1981-91) from 27 housing estates; population self completion questionnaire survey data (1993, 9115 subjects) from 15 housing estates; and general practitioner (GP) consultation data (1989-94) from 2201 subjects in 12 Teesside estates. RESULTS: The populations in the four zones were comparable for indicators including smoking habits, residential histories, and unemployment. All cause and cause specific mortalities were high compared with England and Wales. Mortality in all Teesside zones (ABC) combined was mostly higher than in zone S. In people aged 0-64, lung cancer and respiratory disease showed gradients with highest mortality in areas closest to industry (A > B > C and ABC > S). The association was clearest for lung cancer in women (0-64 years old, trend across zones ABC, p = 0.07, directly standardised rate ratio relative to zone S was 169 (95% confidence interval (95% CI) 116-122)). There were no important, consistent gradients in the hypothesised direction between zones in consultation rates in general practice, and self reported respiratory and nonrespiratory health including asthma. CONCLUSIONS: There was no clear evidence that living close to industry was associated with morbidity, including asthma, or for most measures of mortality. For lung cancer in women the gradients indicated a health effect of local industrial air pollution. In the age group 0-64 observed gradients in lung cancer in men and mortality from respiratory disease in men and women were consistent with the study hypothesis, although not significant. The reasons for the different patterns at different ages, and between men and women, remain a puzzle.

Objectives : To investigate the association between suicide and socioeconomic status, unemployment, and chronic illness. Design : Longitudinal study. Setting : England and Wales. Subjects : Individuals from the Office for National Statistics longitudinal study for whom 1981 census data were available. The longitudinal study is a representative 1% sample of the population of England and Wales in which census variables are linked to mortality data. Main outcome measures : Suicide and undetermined deaths occurring between 1983 and 1992. Odds ratios estimated with logistic regression adjusted for attrition of cohort members. Results : There was a strong independent association between suicide and individuals who were unemployed (odds ratio 2.6; 95% confidence interval 2.0 to 3.4) and permanently sick (2.5; 1.6 to 4.0). Those without access to a car had an increased risk (1.3; 1.0 to 1.5), but other measures of socioeconomic status were not associated with suicide. Conclusions : The association between suicide and unemployment is more important than the association with other socioeconomic measures. Although some potentially important confounders were not adjusted for, the findings support the idea that unemployment or lack of job security increases the risk of suicide and that social and economic policies that reduce unemployment will also reduce the rate of suicide.

OBJECTIVES: To perform a comprehensive survey of myasthenia gravis in the county of Cambridgeshire, England, establishing contemporary epidemiological data. METHODS: Cases were ascertained from multiple sources. Prevalent patients were visited and assessed by means of a standardised questionnaire and examination complemented by review of medical case notes. RESULTS: One hundred cases were identified in a population of 684000 (prevalence 15 per 100000 population, 95% confidence intervals (95% CIs) 12-18). Thirty eight new diagnoses were made over a five year period providing an incidence of 1.1/100000 population/year. The sex ratio was 2:1 F:M. After a mean follow up of 11.7 years, symptomatic disease was still restricted to ocular muscles in 25 patients. Thirty four of 100 patients underwent thymectomy a mean of 0.8 years after presentation, and a thymoma was present in 12. Highest remission rates were seen in patients presenting with generalised disease who underwent thymectomy but did not have a thymoma (27%). Cosegregation of an additional autoimmune disease occurred in 27 patients and in 24/49 (49%) women with onset

Objective: To determine the long term relative survival of all patients who had surgery for abdominal aortic aneurysm in Western Australia during 1985-94. Design:Population based study. Setting:Western Australia. Subjects: All patients who had had surgery for abdominal aortic aneurysm in Western Australia during 1985-94. Main outcome measures: Morbidity and mortality data of patients admitted and surgically treated for abdominal aortic aneurysm in Western Australia during 1985-94. Elective, ruptured, and acute non-ruptured cases were analysed separately. Independent analyses for sex and patients aged 80 years or more were also undertaken. Postoperative (>30 days) relative survival was assessed against age and sex matched controls. Results: Overall, 1475 (1257 men, 218 women) cases were identified. The crude five year survival after elective surgery, including deaths within 30 days of surgery, was 79% for both men and women. When compared with a matched population the five year relative survival after elective surgery was 94.9% (95% confidence interval 89.9% to 99.9%) for men but only 88.0% (76.3% to 99.7%) for women. The five year relative survival of those aged 80 years and over was good: 116.6% (89.1% to 144.0%) compared with 92.4% (87.7% to 97.0%) for those under 80 years of age (men and women combined). Cardiovascular disease caused 57.8% of the 341 deaths after 30 days. Conclusion: In a condition such as abdominal aortic aneurysm, which occurs in elderly patients, relative survival is more clinically meaningful than crude survival. The five year relative survival in cases of elective and ruptured abdominal aortic aneurysm was better in men than in women. This is probably because of greater comorbidity in women with abdominal aortic aneurysm and this deserves more attention in the future. The long term survival outcome in octogenarians supports surgery in selected cases.

Objectives: To estimate the incidence of HIV and hepatitis C virus and risk factors for seroconversion among a cohort of injecting drug users. Design: Retrospective cohort study. Setting: Primary healthcare facility in central Sydney. Subjects: Injecting drug users tested for HIV-1 antibody (n=1179) and antibodies to hepatitis C virus (n=1078) from February 1992 to October 1995. Main outcome measures: Incidence of HIV-1 and hepatitis C virus among seronegative subjects who injected drugs and underwent repeat testing. Demographic and behavioural risk factors for hepatitis seroconversion. Results: Incidence of HIV-1 among 426 initially seronegative injecting drug users was 0.17/100 person years (two seroconversions) compared with an incidence of hepatitis C virus of 20.9/100 person years (31 seroconversions) among 152 injecting drug users initially negative for hepatitis C virus. Incidence of hepatitis C virus among injecting drug users aged less than 20 years was 75.6/100 person years. Independent risk factors for hepatitis C virus seroconversion were age less than 20 years and a history of imprisonment. Conclusions: In a setting where prevention measures have contributed to the maintenance of low prevalence and incidence of HIV-1, transmission of hepatitis C virus continues at extremely high levels, particularly among young injecting drug users. Key messages The prevalence and incidence of hepatitis C virus is high, while the prevalence and incidence of HIV remains low among injecting drug users Young age and history of imprisonment are risk factors for acquisition of hepatitis C virus infection HIV prevention strategies have been relatively ineffective in preventing hepatitis C virus infection in this population The role of imprisonment in the acquisition of hepatitis C infection should be further investigated

OBJECTIVES: The combination of high psychological job demands and low decision latitude (high job strain) has been associated with an increased risk of coronary heart disease. It has been proposed that this may also be the case for low social support at work. The aim of this study was to analyse the relations between these psychosocial factors and incidence of myocardial infarction. METHODS: Associations between psychosocial work characteristics and incidence of myocardial infarction was investigated through a population based case-control study. The study base comprised employed men and women in five Swedish counties during the years 1976-84. Cases of first myocardial infarction were identified from hospital discharge registers and death records from outside hospital, controls were selected through a random sample, and psychosocial work environment was assessed through a job exposure matrix on the basis of the occupation in the 1970 and 1975 censuses. RESULTS: An increased incidence of myocardial infarction was found for men and women in occupations characterised by low decision latitude. For men this increase was seen primarily in combination with high psychological demands (high job strain) and low social support at work. Younger men (30-54 years of age) in occupations with both high job strain and low social support at work had a relative risk of 1.79 (95% confidence interval (95% CI) 1.22 to 2.65) compared with subjects in low strain and high social support jobs after controlling for age, county of residence, and socioeconomic group. CONCLUSIONS: Our results indicate that jobs characterised by low decision latitude, high job strain, or low social support at work may be associated with an increased risk of acute myocardial infarction. If these associations are causal they may be of substantial importance from the point of view of workers' health.

Objectives : To determine the demands on healthcare resources caused by different types of illnesses and variation with age and sex. Design: Information on healthcare use was obtained from all 22 healthcare sectors in the Netherlands. Most important sectors (hospitals, nursing homes, inpatient psychiatric care, institutions for mentally disabled people) have national registries. Total expenditures for each sector were subdivided into 21 age groups, sex, and 34 diagnostic groups. Setting: Netherlands, 1994. Main outcome measures: Proportion of healthcare budget spent on each category of disease and cost of health care per person at various ages. Results: After the first year of life, costs per person for children were lowest. Costs rose slowly throughout adult life and increased exponentially from age 50 onwards till the oldest age group (95). The top five areas of healthcare costs were mental retardation, musculoskeletal disease (predominantly joint disease and dorsopathy), dementia, a heterogeneous group of other mental disorders, and ill defined conditions. Stroke, all cancers combined, and coronary heart disease ranked 7, 8, and 10, respectively. Conclusions: The main determinants of healthcare use in the Netherlands are old age and disabling conditions, particularly mental disability. A large share of the healthcare budget is spent on long term nursing care, and this cost will inevitably increase further in an ageing population. Non-specific cost containment measures may endanger the quality of care for old and mentally disabled people. Key messages Little is known about demands for health care outside acute sectors In the Netherlands health costs are strongly age dependent, increasing exponentially after age 50 The five highest healthcare costs are for mental retardation, musculoskeletal disease, dementia, other mental disorders, and ill defined conditions Coronary heart disease, all cancers, and stroke accounted for only 9% of costs The main healthcare costs are for care not cure and costs are likely to increase rapidly in an ageing society

OBJECTIVES: An updated version of a national surveillance system of traumatic occupational fatalities was used to explore adjusted and unadjusted trends in rates of fatal injury. METHODS: Data from the national traumatic occupational fatalities surveillance system were combined with data on employment from the United States Bureau of Labor Statistics. Poisson regression was then used to examine trends in rates of occupational fatality injuries while controlling for demographic and workplace characteristics. RESULTS: Adjusted annual changes in rates of fatal injuries ranged from a decline of 6.2% for workers in technical and administrative support occupations--for example, health, science, and engineering technicians, pilots, computer programmers--to an increase of 1.6% in machine operators, assemblers, and inspectors. For industries, annual changes ranged from a decline of 5.3% for workers in public administration--for example, justice, public order, and safety workers--to an increase of 2.6% for workers in the wholesale trade. By comparison, the annual decline over all industries and occupations was 3.1%. In many industries and occupations, an effect modification of annual trends by the age of the worker was also found with the oldest workers experiencing either no decline or a significant increase in rates of fatal injuries. CONCLUSIONS: This general pattern of decline, adjusted for the effects of demographic characteristics of the worker population, is encouraging; however, increases in rates of fatal injuries found in particular industries and occupations, suggest appropriate targets for increased injury prevention efforts.

Objectives: To analyse trends in rates of genital chlamydial infection and ectopic pregnancy between 1985 and 1995 in a county in Sweden. Setting: Uppsala county where screening for chlamydial infection, treatment, and contact tracing has been widespread and where ectopic pregnancies are recorded. Methods: Rates of chlamydial infections and ectopic pregnancy between 1985 and 1995 were calculated for women aged 20-39 years. Poisson and linear regression were used to examine the association between the risk of ectopic pregnancy and the current rates of chlamydial infection and rates of chlamydial infection from up to 5 years earlier. Main outcome measures: Rates of chlamydial infection per 100 examinations, rates of ectopic pregnancy per 1000 pregnancies, rate ratios and 95% confidence intervals for an increase in chlamydial infections of 5 new cases per 100 examinations. Results: 103 870 cervical samples from women aged 15-39 years were analysed; 5648 (5.4%) were positive for chlamydia. 51 630 pregnancies were analysed; 930 (1.8%) were ectopic. Both rates declined over time. For women aged 20-24 years there was a strong correlation between the rate of ectopic pregnancy and the rate of chlamydial infection in the same year (r=0.93, P Conclusions: Declining rates of genital chlamydial infections have probably led to a fall in the rate of ectopic pregnancies. The timing of the decline in the rate of ectopic pregnancies varies with age. Among young women falling rates of chlamydial infection have been accompanied by an immediate reduction in the rate of ectopic pregnancy. Key messages The effect of measures to diagnose and treat genital chlamydial infections on the risk of ectopic pregnancy was examined in a county in Sweden Rates of chlamydial infection and ectopic pregnancy both declined between 1985 and 1995 Chlamydial infections seem to be the main cause of ectopic pregnancy in young women; the risk of ectopic pregnancy decreased concurrently with the decline in chlamydial infections In older women the associations were less pronounced

Objective: To estimate the magnitude of serious eye disorders and of visual impairment in a defined elderly population of a typical metropolitan area in England, and to assess the frequency they were in touch with, or known to, the eye care services. Design: Cross sectional survey using two stage cluster random sampling. Setting: General practices in north London. Subjects: Random sample of people aged 65 and older, drawn from a defined population of elderly people registered with 17 general practice groups. Main outcome measures: Proportions and population prevalence estimates were determined for visual acuity, assessed with the person9s own spectacles (if any), classified into four categories: prevalence of cataract, age related macular degeneration, and refractive error causing visual impairment and of definite primary open angle glaucoma; and status of contact with eye services. Results: 1547 of 1840 (84%) eligible people were examined. The population prevalence of bilateral visual impairment (visual acuity Conclusions: Untreated visual impairment and eye disorders affect a substantial proportion of people aged 65 years and older. These findings should contribute to the setting up of future strategies for preservation of sight and eye health services in general. Key messages Data have not been adequate to reliably estimate the extent of visual impairment and serious eye disease in metropolitan areas in Britain Data from north London shows that 30% of a sample of the population aged 65 or older are visually impaired in both eyes More than 72% of the bilateral visual impairment was potentially remediable by surgery or glasses, nearly one in three people had visually impairing cataract, and 88% of these people were not in touch with eye services Eye problems were more prevalent in people living in relatively underprivileged areas

A total of 1429 Saudi children of either sex and under 5 years of age who were admitted to King Khalid University Hospital, Riyadh during a three year period (April 1993–March 1996) with complaints suggestive of acute respiratory tract infections (ARTI) were investigated for viral aetiology of the infection. Viruses could be detected in 522 (37 per cent) cases with respiratory syncytial virus (RSV) the most commonly detected (79 per cent) followed by parainfluenza type 3 (8 per cent). Detection of influenza A, B and adenoviruses accounted for 6 per cent, 3 per cent and 2 per cent respectively. Except for parainfluenza virus type 3 the peak of activity of the respiratory viruses was during the winter months (October–February). Parainfluenza virus type 3 could be detected all year round but epidemics can occur in the hottest months of the year (June–August) when the temperature can exceed 40°C. Association between clinical manifestation, type of causative agent, and age was evaluated in 137 infected Saudi children in the first year of the study (April 1993–March 1994). The majority of our cases presented with bronchiolltis (58 per cent) while only 26 per cent had bronchopneumonla. There was a significant association between bronchiolitis and lower age groups (0–6 months), with RSV as the major causative agent of bronchiolitis cases (88 per cent).

The inverse care law proposing that medical services are distributed inversely to population health needs, and that this law operates more completely where medical care is most exposed to market forces, was first suggested by Tudor Hart in 1971. This paper considers whether an inverse care law can be observed for the provision of informal care as well as for medical care.Using data from the 2001 census we sought to investigate the contemporary relevance of the inverse care law.Cross-sectional study.England and Wales.Data from the 2001 census for the population of England and Wales were analysed at the county, unitary, or former metropolitan authority level. The prevalence of the conjunction of general health status and limiting long-term illness was correlated with the percentage of the local population who were working as qualified healthcare workers (nurses, qualified medical practitioners, dentists, and other health professionals and therapists) and with the percentage of the population providing 50 or more hours of unpaid care per week.In 2001, 7.6% of people reported that their health was not good and that they had a limiting long-term illness (the need for care). Over one million people reported providing 50 or more hours of unpaid care per week. An inverse care law was found at the ecological level between the need for care and the proportion of the population who were working as qualified medical practitioners, dentists, and other health professionals. Informal care was almost perfectly positively correlated with the need for care (r = 0.97). These relationships were more marked for areas in the north of the country compared with the south. In the north more people provide unpaid care as more people need that care and because there are fewer working qualified medical professionals, other than nurses, providing such care per head.Medical care is distributed inversely to need, whereas the provision of informal care is positively related to need--where care is most needed, informal care is most likely to be provided. The greater the market forces that are allowed to intervene in the relationships between the need for care and its provision, the more likely the inverse care law is to be found to apply. Where no market forces apply, where people give up their time for free to provide care, an almost perfectly positive care law is found to apply.

OBJECTIVES Previous studies have shown that multiple sclerosis is very uncommon among Indian and Pakistani immigrants to England but that their children born in the United Kingdom, in the age groups available for study, have a similar risk of developing the disease as occurs in the general British population. The present study was to ascertain if these immigrants who enter England as children below the age of 15, have a higher risk of developing multiple sclerosis than those that enter after this age. METHODS A search was made in Greater London, the West Midlands, Leicester, Bradford, Halifax, and Huddersfield to find ethnic Indian, Pakistani, and Bangladeshi immigrants to England with multiple sclerosis. During the course of the study some immigrants from the Caribbean with multiple sclerosis were also found. The population at risk by ethnic group and age at entry was not available from the 1991 Census but was available in the annual Labour Force Surveys. RESULTS Indian and Pakistani immigrants who entered England younger than 15 had a higher risk of developing multiple sclerosis than those that entered after this age. Caribbean immigrants, who have a higher multiple sclerosis prevalence than Asian immigrants, did not show this difference. CONCLUSION This study confirms previous studies which show that the environment during childhood is a major factor in determining the risk of developing multiple sclerosis.

OBJECTIVE To identify clinical characteristics of various forms of Guillain-Barre syndrome in Taiwan. METHODS The clinical and electrophysiological data of 167 consecutive patients with Guillain-Barre syndrome admitted to Chang Gung Memorial Hospital, a general paediatric and adult hospital in Taiwan, were reviewed. RESULTS Analysis of age distribution disclosed a high incidence (21%) among patients under the age of 10 years. Seasonal preponderance in Spring (March to May) was found. Utilising clinical and electrophysiological data, these 167 patients with Guillain-Barre syndrome were subclassified; 82 (49%) had acute inflammatory demyelinating polyradiculoneuropathy (AIDP), 32 (19%) had Fisher syndrome (FS), and six (4%) had axonal forms of Guillain-Barre syndrome. The remaining 47 (28%) patients were unclassified. Patients with AIDP and FS had many common clinical features, including seasonal distribution, history of preceding illness, sensory abnormalities, cranial nerve involvement except for extraocular motor nerves, and albuminocytological dissociation on examination of CSF. Follow up study on 145 patients disclosed that 127 (87%) recovered satisfactorily, 14 (10%) were persistently disabled, and four (3%) died during admission to hospital. Clinical features associated with poor outcome (persistent disability or death) were requirement for mechanical ventilation, a low mean compound muscle action potential amplitude (⩽ 10% of the lower limit of normal), and age greater than 40 years. CONCLUSION Guillain-Barre syndrome in Taiwan showed a peculiar age and seasonal distribution and a high frequency of FS not seen in other series. Given that patients with AIDP and FS had many common clinical features, AIDP and FS may have similar underlying pathological mechanisms.

Background: with continued ageing, levels of frailty are an increasing concern. Women live longer than men, but how life expectancies (LE) with frailty differ between men and women and whether sex differences are the same for all European countries is unknown. Objective: to compare sex differences in LE in phenotypic frailty categories and disability at age ≥50 between European countries. Design: the Survey of Health, Ageing and Retirement in Europe (SHARE). Subjects: a total of 50,351 people aged ≥50 from SHARE wave 4 (included countries: Austria, Belgium, Czech Republic, Denmark, Estonia, France, Germany, Hungary, Italy, the Netherlands, Poland, Portugal, Slovenia, Spain, Sweden). Methods: the SHARE Frailty Instrument for Primary Care and the Global Activity Limitation Indicator were combined to define four phenotypic frailty and disability categories: robust, pre-frail, frail and severely limited. LEs with each state by sex and country were calculated using Sullivan's method. Results: at age 70, the LE robust ranged from 4.1 to 10.4 years (men) and 3.0 to 8.9 years (women), LE pre-frail from 0.8–3.1 years (men) and 2.2–5.5 years (women), LE frail from 0.1–1.8 years (men) and 0.4–5.5 years (women) and LE with severe activity limitation from 1.9 to 4.4 years (men) and 2.9 to 7.5 years (women). At all ages and both sexes the fewest years were spent frail. Conclusions: this study is the first to compare differences in LE in frailty categories across European countries. In most European countries, years spent robust (free of frailty or limitation) are significantly less for women than men, perhaps due to socio-economic as well as biological factors.

Objectives: time trends of age-adjusted incidence rates of 19 ageing-related diseases were evaluated for 1992–2005 period with the National Long Term Care Survey and the Surveillance, Epidemiology and End Results Registry data both linked to Medicare data (NLTCS-Medicare and SEER-Medicare, respectively). Methods: the rates were calculated using individual medical histories (34,077 individuals from NLTCS-Medicare and 199,418 from SEER-Medicare) reconstructed using information on diagnoses coded in Medicare data, dates of medical services/procedures and Medicare enrolment/disenrolment. Results: increases of incidence rates were dramatic for renal disease [the average annual percent change (APC) is 8.56%, 95% CI = 7.62, 9.50%], goiter (APC = 6.67%, 95% CI = 5, 90, 7, 44%), melanoma (APC = 6.15%, 95% CI = 4.31, 8.02%) and Alzheimer's disease (APC = 3.96%, 95% CI = 2.67, 5.26%), and less prominent for diabetes and lung cancer. Decreases of incidence rates were remarkable for angina pectoris (APC = −6.17%, 95% CI = −6.96, −5.38%); chronic obstructive pulmonary disease (APC = −5.14%, 95% CI = −6.78,−3.47%), and ulcer (APC = −5.82%, 95% CI = −6.77,−4.86%) and less dramatic for carcinomas of colon and prostate, stroke, hip fracture and asthma. Incidence rates of female breast carcinoma, myocardial infarction, Parkinson's disease and rheumatoid arthritis were almost stable. For most diseases, an excellent agreement was observed for incidence rates between NLTCS-Medicare and SEER-Medicare. A sensitivity analysis proved the stability of the evaluated time trends. Conclusion: time trends of the incidence of diseases common in the US elderly population were evaluated. The results show dramatic increase in incidence rates of melanoma, goiter, chronic renal and Alzheimer's disease in 1992–2005. Besides specifying widely recognised time trends on age-associated diseases, new information was obtained for trends of asthma, ulcer and goiter among the older adults in the USA.

The study examined the secular trends in growth of preschool children from rural Maharashtra, India, during 1985-2001. Anthropometric data collected on preschool (6 years old) children during 2001 (n = 1,171) and 1985 (n = 979) from the same villages were compared. Decadal change increased with age and was marginally higher in boys than girls. It was the lowest among infants (-0.1 to 0.1 kg and 0.4 to 0.7 cm in both sexes) and the highest among boys of 4+ years (1.3 kg and 2.9 cm) and girls of 5+ years (1.2 kg and 2.1 cm). Increase in weight was higher (10-15%) compared to that in height (3-5%) and, consequently, reduction in the prevalence of wasting was marked (around 68% in boys and 48% in girls) than that in stunting (42% in boys and 27% in girls) among these children. The improvement was higher in boys than in girls. Negligible secular changes in younger children indicate the need for creating health and nutritional awareness among rural mothers while relatively higher improvement in weight than height among older children warns the future possibility of childhood adiposity even among rural populations.

Hepatitis B virus (HBV) is an important clinical problem due to its worldwide distribution and potential of adverse sequelae, including hepatocellular carcinoma (HCC). We studied the prevalence of hepatitis B virus e antigen (HBeAg) among individuals determined to be HBV surface antigen-positive (HBsAg+) and analyzed the gender/age category associated with more active HBV infection. A total of 572 HBsAg+ individuals, as determined by a double antibody sandwich ELISA method, participated in the study. They were tested for HbeAg, using a lateral flow chromatographic immunoassay. One hundred and ten individuals were found to be HBeAg-positive giving an overall prevalence of 19.2%. Of these 110 individuals, 20 (18.2%) were females, and 90 (81.8%) were males. Thus, the prevalence of HBeAg appears to be higher in males than in females (p < 0.05). Our data also revealed that the prevalence of HBeAg was higher in patients between the age-group of 0-10 years and 11-20 years and appeared to decrease with increase in age. Taken together, our data show that approximately 1/5 of HBV-infected individuals are HBeAg+, suggesting that the virus is actively replicating and infecting liver-cells thereby ensuring an HBV-transmission pool within the Nigerian population. We suggest strengthening of the childhood HBV vaccination programmes, massive intervention activities, and treatment programmes, especially among young people to reverse the possible devastating effect of HBV infection. The success of these efforts will depend on our resolution to make the elimination of HBV infection a top priority on the public-health agenda as we start the second decade of this new century.

Summary Guidance is provided in a European setting on the assessment and treatment of postmenopausal women at risk from fractures due to osteoporosis. Introduction The International Osteoporosis Foundation and European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis published guidance for the diagnosis and management of osteoporosis in 2013. This manuscript updates these in a European setting. Methods Systematic reviews were updated. Results The following areas are reviewed: the role of bone mineral density measurement for the diagnosis of osteoporosis and assessment of fracture risk; general and pharmacological management of osteoporosis; monitoring of treatment; assessment of fracture risk; case-finding strategies; investigation of patients; health economics of treatment. The update includes new information on the evaluation of bone microstructure evaluation in facture risk assessment, the role of FRAX® and Fracture Liaison Services in secondary fracture prevention, long-term effects on fracture risk of dietary intakes, and increased fracture risk on stopping drug treatment. Conclusions A platform is provided on which specific guidelines can be developed for national use.

Summary\ud \ud The scorecard summarises key indicators of the burden of osteoporosis and its management in each of the member states of the European Union. The resulting scorecard elements were then assembled on a single sheet to provide a unique overview of osteoporosis in Europe.\ud \ud Introduction\ud \ud The scorecard for osteoporosis in Europe (SCOPE) is an independent project that seeks to raise awareness of osteoporosis care in Europe. The aim of this project was to develop a scorecard and background documents to draw attention to gaps and inequalities in the provision of primary and secondary prevention of fractures due to osteoporosis.\ud \ud Methods\ud \ud The SCOPE panel reviewed the information available on osteoporosis and the resulting fractures for each of the 27 countries of the European Union (EU27). The information researched covered four domains: background information (e.g. the burden of osteoporosis and fractures), policy framework, service provision and service uptake e.g. the proportion of men and women at high risk that do not receive treatment (the treatment gap).\ud \ud Results\ud \ud There was a marked difference in fracture risk among the EU27. Of concern was the marked heterogeneity in the policy framework, service provision and service uptake for osteoporotic fracture that bore little relation to the fracture burden. For example, despite the wide availability of treatments to prevent fractures, in the majority of the EU27, only a minority of patients at high risk receive treatment for osteoporosis even after their first fracture. The elements of each domain in each country were scored and coded using a traffic light system (red, orange, green) and used to synthesise a scorecard. The resulting scorecard elements were then assembled on a single sheet to provide a unique overview of osteoporosis in Europe.\ud \ud Conclusions\ud \ud The scorecard will enable healthcare professionals and policy makers to assess their country’s general approach to the disease and provide indicators to inform future provision of healthcare.

To obtain a series of parameters describing the shape and bone thickness of the fixation route along the superior border of the arcuate line, so as to provide references for pelvic and acetabular surgery and design pelvic anatomic internal fixators.A total of 175 complete pelvic computed tomography (CT) scans of normal adult pelvises were collected. Each person's CT scans were reconstructed to create a three-dimensional pelvic model. A curve of the fixation route was delineated and divided into 11 equal parts. The total length of the curve, the radius of curvature, and the bone thickness at each decile point were all measured. The position of the pelvic inlet, the anterior and posterior sagittal diameter were measured.The radius of curvature at each decile point were 29.18 ± 15.53, 55.27 ± 29.48, 43.04 ± 14.42, 59.62 ± 21.02, 91.67 ± 52.01, 78.9 ± 38.66, 75.76 ± 25.87, 61.75 ± 16.68, 54.62 ± 14.88, and 43.61 ± 19.10 mm, respectively. The anterior and posterior sagittal diameter of the pelvic inlet was 66.01 ± 9.15 and 41.36 ± 8.19 mm, respectively. For all groups divided by the ratio of the posterior and the anterior sagittal diameter, the decile points 1, 3, and 10 had smaller radii of curvature than the before and after points, respectively.The curve of the fixation route along superior border of arcuate line has a relatively greater bending degree at the pubic tubercle, iliopubic eminence and close to the sacroiliac joint. With the transition of the pelvic inlet shape from android to gynecoid and platypelloid type, the bone surface at the iliopubic eminence becomes flatter. Pelvic and acetabular surgery could be more accurate by referring to the previous key bending points and the change of the pelvic inlet shape.

SUMMARYIn order to estimate influenza-associated excess mortality in southern Brazil, we applied Serfling regression models to monthly mortality data from 1980 to 2008 for pneumonia/influenza- and respiratory/circulatory-coded deaths for all ages and for those aged ⩾60 years. According to viral data, 73·5% of influenza viruses were detected between April and August in southern Brazil. There was no clear influenza season for northern Brazil. In southern Brazil, influenza-associated excess mortality was 1·4/100 000 for all ages and 9·2/100 000 person-years for persons aged ⩾60 years using underlying pneumonia/influenza-coded deaths and 10·0/100 000 for all ages and 86·6/100 000 person-years for persons aged ⩾60 years using underlying respiratory/circulatory-coded deaths. Influenza-associated excess mortality rates for southern Brazil are similar to those published for other countries. Our data support the need for continued influenza surveillance to guide vaccination campaigns to age groups most affected by this virus in Brazil.

Background: Anxiety is a common preprocedural problem and during processing especially in interventional medical processes. Aim: Aim of this study was to assess the level of anxiety in patients who will undergo upper gastrointestinal endoscopy and coloscopy. Methods: Five hundred patients scheduled to undergo sedation for elective upper gastrointestinal endoscopy and colonoscopy were studied. Beck Anxiety Inventory (BAI) was administered to each patient before brought to the endoscopy room. Demographic data of patients were collected. Results: BAI scores and anxiety levels were significantly lower in; males compared to females, patients with no comorbidity compared to patients with comorbidity (both P values < 0.001). BAI scores were significantly lower in patients educational status university and upper compared to patients educational status primary-high school (p=0.026). There were no significant difference between BAI and anxiety levels compared to procedures (Respectively, P=0.144 P=0.054). There were no significant difference between BAI scores and anxiety levels compared to age groups (Respectively, P=0.301 P=0.214). Conclusions: We think that level of anxiety in patients who will undergo upper gastrointestinal endoscopy and colonoscopy was effected by presence of comorbidities and gender but was not effected by features such as age, procedure type and educational status.

BACKGROUND One of the complications aneurysms subarachnoid hemorrhage is the development of vasospasm, which is the leading cause of disability and death from ruptured cerebral aneurysm. AIM To evaluate the significance of previous comorbidities on early outcome of patients with subarachnoid hemorrhage caused by rupture of a cerebral aneurysm in the prevention of vasospasm. PATIENTS AND METHODS The study had prospective character in which included 50 patients, whose diagnosed with SAH caused by the rupture of a brain aneurysm in the period from 2011to 2013. Two groups of patients were formed. Group I: patients in addition to the standard initial treatment and "3H therapy" administered nimodipine at a dose of 15-30 mg / kg bw / h (3-10 ml) for the duration of the initial treatment. Group II: patients in addition to the standard initial treatment and "3H therapy" administered with MgSO4 at a dose of 12 grams in 500 ml of 0.9% NaCl / 24 h during the initial treatment. RESULTS Two-thirds of the patients (68%) from both groups had a good outcome measured with values according to GOS scales, GOS IV and V. The poorer outcome, GOS III had 20% patients, the GOS II was at 2% and GOS I within 10% of patients. If we analyze the impact of comorbidity on the outcome, it shows that there is a significant relationship between the presence of comorbidity and outcomes. The patients without comorbidity (83.30%) had a good outcome (GOS IV and V), the same outcome was observed (59.4%) with comorbidities, which has a statistically significant difference (p = 0.04). Patients without diabetes (32%) had a good outcome (GOS IV and V), while the percentage of patients with diabetes less frequent (2%) with a good outcome, a statistically significant difference (p = 0.009). CONCLUSION The outcome of treatment 30 days after the subarachnoid hemorrhage analyzed values WFNS and GOS, is not dependent on the method of prevention and treatment of vasospasm. Most concomitant diseases in patients with SAH which, requiring additional treatment measures are arterial hypertension and diabetes mellitus. The best predictors in the initial treatment of patients with subarachnoid hemorrhage caused by rupture of a cerebral aneurysm has the presence of comorbidity, which has statistical significance.