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Hygieia

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Pneumocystis infection of HIV infected individuals in winter

Pneumocystis carinii pneumonia (PCP), a major cause of morbidity and mortality in HIV infected individuals, is more likely to strike HIV-1 infected people in the cold winter months. The authors examined data from the Chelsea and Westminster HIV cohort—one of the largest in Europe—to identify all HIV patients who had received a diagnosis of PCP since 1985. The temperature and rainfall for every month was then obtained from the UK Meteorological Office. January saw the highest number of new cases but did not have the highest monthly rainfall, which occurred in April, (or the lowest monthly temperature) but did have the lowest average rainfall. Encouragingly, the introduction of two treatments—PCP prophylaxis in 1992 and highly active anti-retroviral therapy (HAART) in 1996—played an important part in decreasing the number of new cases. (

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Service improvement needed to stop syphilis

Improvements in genitourinary medicine (GUM) services are urgently required in Manchester, UK, if the area is to effectively control the return of syphilis. The authors created a form to record epidemiological data, which was sent to each of the 11 GUM clinics in Greater Manchester. There were 414 cases of syphilis reported in Greater Manchester in the study period. Men represented 93% of those infected, of which 81% were homosexual. Few reported using a condom at any time for oral sex, and 61% knew the chance of catching syphilis was high but reported still never using a condom. The authors recommend the provision of rapid diagnosis and treatment services as key to controlling the return of the disease. (

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Community factors in sexual infection are important too

HIV research often focuses on individual risk factors, but community characteristics can also play an important part. Researchers used a variety of data sources to examine the association between individual and community risk factors with HIV rates in 5023 men and women in rural Tanzania in the 1990s. Sub-villages were taken as the unit of analysis. The level of social and economic activity, availability of bar workers, population mobility, and distance to the nearest town were all strongly associated with HIV prevalence. Importantly, some individual risk factors changed notably after controlling for community factors. The authors argue that community effects need to be given more prominence in risk analyses and interventional programmes. (

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Warning on short acting β agonist for asthma treatment

Excessive use of short acting β agonists is associated with an increased risk of asthma death. Analysis of data on the General Practice Research Database investigates the effects of respiratory medications on risk of asthma death. It shows a strong association for at least 13 prescriptions per year of short acting β agonists. It also shows that regular use of inhaled corticosteroids is associated with a 60% reduced risk of asthma death. These findings raise the question of whether efficacy evaluations of asthma drugs are based too narrowly on aspects of lung function such as forced expiratory volume in one second (FEV1). (

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Better off children less likely to be labelled asthmatic despite taking medication

Health inequalities between rich and poor are well reported. But what is the precise mechanism of association? Some have suggested diagnostic accuracy plays a part. Researchers in Sheffield found that the prevalence and severity of asthma in 8–9 year old children increases with worsening socioeconomic deprivation. A total of 6021 schoolchildren were given questionnaires for their parents to complete. Deprivation scores were derived from the postcode data available in 4131of the 5011 replies. There was a significant trend in increasing asthma symptoms with worsening deprivation. But they found no link between diagnostic accuracy and deprivation. However, they did observe that in the least deprived areas children taking asthma medication were less likely to be labelled as having asthma, suggesting that socioeconomic differences in diagnostic labelling behaviour exist. (

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Raising the profile of ankylosing spondylitis

The employment prospects of patients with ankylosing spondylitis (AS) is reduced compared with that of the general Dutch population. A cross sectional mail survey assessed the labour market position of 658 patients in relation to disease duration. A broad variety of risk factors including sociodemographic factors, coping styles, disease related factors contribute to withdrawal from the labour force. Some 73% of the withdrawals can be attributed to pacing to cope with the limitations. The authors hope that their findings will encourage a multidisciplinary approach when dealing with work problems in patients with AS. (

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Heart disease in Europe—the widening gap between East and West

Mortality from coronary heart disease (CHD) and cerebrovascular disease (CVD) has continued to fall in Western Europe, USA, and Japan. In most of Eastern Europe, mortality increased up to the late 1990s. Between 1995 and 1998, Ukraine had the highest mortality rates from CHD for both men (393.8/100 000) and women (223.2/100 000), while the Russian Federation had the highest rates from CVD. These figures represent a 10-fold higher mortality than the lowest mortality areas. Using data extracted from the World Health Organisation’s electronic database, Levi et al analysed trends in mortality from CHD and CVD in 48 countries from 1965 to 1998. The largely unfavourable trends in Eastern Europe underscore the urgency for measures to prevent and treat cardiovascular disease in those countries. (

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Consistency in statin prescribing needed

Despite the clear efficacy of statin treatment, reports have suggested that lipid lowering drugs are not being widely used in Britain. The results of a recent study reiterate this. Whincup et al carried out a cross sectional survey within a cohort study carried out at 20 years of follow up in 1998–2000. Their findings show that among patients with recorded coronary heart disease, the overall prevalence of lipid lowering drug was just 29%. In addition it revealed that of those who did receive statin treatment, only 33% received trial validated doses. The study highlights the inadequacies of the current approach to implementation of secondary provision and urges for a more proactive approach if the benefits of statins are to be realised. (

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