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JOURNAL OF

PREVENTIVE

MEDICINE

2008, VOLUME 16(3-4)

 ISSN: 1582-5388

 

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C O N T E N T S

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. Ü FULL TEXT.PDF

 

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 Ü FULL TEXT.PDF

 

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 Ü FULL TEXT.PDF

 

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 Ü FULL TEXT.PDF

 

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  Ü FULL TEXT.PDF

 

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 Ü FULL TEXT.PDF

 

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  Ü FULL TEXT.PDF

 

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  Ü FULL TEXT.PDF

 

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