Digest4

Спонсорирано от: Dreyfus Health Foundation

DHF, 205 East 64 Street, Suite 404

New York, NY 10021

E-mail: Postmaster@thf.org

http://www.thf.org

Fax # 212-371-2776

Съдържание

НОВИНИ

MEDLINE INFORMATION

- Management of Asthma in Children

- Glaucoma

- Prevention of Poisoning Accidents in Children

PROJECTS COMPLETED AND IN ACTION / ЗАВЪРШЕНИ И ДЕЙСТВАЩИ ПРОЕКТИ

- Glaucoma Regional Program /Регионална програма “Глаукома”

- Improvement of Treatment of Patients with Asthma and Chronic Pulmonary Obstruction/Подобряване на обслужването на болни с бронхиална астма и ХОББ в региона на гр. Видин

- Optimizing Antibiotic Therapy for Bacterial Infections by Determining CRP Levels /Оптимизиране на антибиотичната терапия чрез следене на нивото на CRP в пациенти с бактериални инфекции

- Educational Program for Prevention of Caries in Nursery School Children/Намаляване на кариозността на постоянното съзъбие на децата от II група в ЦДГ “Слънце” чрез провеждане на профилактична образователна програма

- Breast-Feeding Promotion/Промоция на кърменето в гр. Плевен

- Mistakes in Infant Feeding and How To Avoid Them / Грешки при храненето на кърмачетата и неблагоприятните последици върху здравето им

- Reduction of Adolescent Smoking/Програма за ограничаване на тютюнопушенето в ученическа възраст

Новини

На 20 януари в Плевен се проведе семинар за проследяване на работата по част от проекти, разработени в рамките на програма “Решаване на проблеми за по-добро здраве”. Той бе организиран от Клуб “Отворено общество” - Плевен със съдействието на Здравна фондация “Драйфус” - Ню Йорк.

Гости на семинара бяха Мадам Шийла Куин - председател на ”Action for International Medicine”(Англия), д-р Бари Смит - директор на Здравна фондация “Драйфус”(САЩ), г-н Ленин О. Грос - финансов директор и координатор на програмите за Европа, г-жа Делия Коладо - координатор за Централна и Южна Америка, г-н Махмуд Алкам - преподавател в Център за обучение и следдипломна квалификация на медицински кадри в Аманския университет и координатор на програма “Решаване на проблеми за по-добро здраве” (Йордания), д-р Хосе Густаво Сайяс - координатор на програма “Комуникации за по-добро здраве” (Ел Салвадор) и д-р Хосе Игнасио Панягуа - координатор на програма “Решаване на проблеми за по-добро здраве” (Ел Салвадор), представители на обществени организации и журналисти.

Координаторите на следните проекти запознаха присъстващите с извършените мероприятия по проектите и постигнатите до момента резултати. Д-р Явор Иванов (Плевен) представи “Програма ‘Астма’ и кислородолечение”. Освен в Плевен, по проблемите на астмата работят участници в програмата “Решаване на проблеми за по-добро здраве” от Видин (д-р Иво Илиев), Враца (д-р Емил Миленков, д-р Александър Семков) и Русе (д-р Светослав Дачев).

Доц. д-р Мария Александрова (Плевен) представи “Регионална програма за превенция на злоупотреба с наркотични вещества сред подрастващите”. След проведено епидемиологично проучване за установяване на процента експериментиращи и редовно вземащи наркотични вещества, в рамките на регионалната програма за предпазване на подрастващите от вредния навик са включени психиатри, училищни лекари и медицински сестри, учители и родители. Издадени са просветни материали, излъчени са предавания по местните кабелни телевизии и радиа.

Д-р Милена Средкова (Монтана) представи своята програма за ранно диагностициране на глаукома сред населението на 10 села в област Монтана. Освен че са диагностицирани пациенти с глаукома в ранен стадий, в рамките на проекта е оказана специализирана помощ за други очни заболявания, а много от пациентите са насочени за по-нататъшно лечение. Предстои да бъде стартирана регионална програма, комбинирана с програма за профилактика на мозъчно-съдови заболявания, която ще се реализира с помощта на административните и здравните власти в Монтана, както и със съдействието на местни неправителствени организации.

С проекта на планинската спасителна служба в Троян за скъсяване на времето за оказване на първа помощ в планината запозна присъстващите на срещата г-н Петко Панамски. Освен подобряване на комуникациите при оказване на първа помощ в планината екипът на проекта съвместно с други организации и ведомства е изготвил нова туристическа карта на троянския балкан, която също ще допринесе за намаляване на броя на нещастните случаи в планината.

Проектите на ЦСМП в Плевен - “Логаритми на поведение при спешна състояния”, “Създаване на база данни за рискови групи болни към ЦСМП” и обучение на кандидат-водачи на МПС за даване на първа помощ при транспортни произшествия” бяха представени от д-р Мая Джунова.

Интересна и мащабна е и здравно-просветната програма по въпросите на СПИН, наркомания и болести, предавани по полов път” на дружеството “Здраве и морал” - Стара Загора, представена от г-жа Красимира Лазарова. Броят на участниците в реализирането на програмата е нараснал, както и броят и съставът на целевите групи.

Проектът, целящ увеличаване на броя на кръводарителите в Ловешки регион, е разработен от д-р Ивелина Иванова, д-р Цеца Кирова и м. с. София Стоянова от Център по трансфузионна хематология на ОРБ - Ловеч. На срещата те отчетоха резултатите от работата си - спадът в броя на кръводарителите през последните две години е минимален, а индивидуалният и нестандартен подход в контактите с кръводарителите е обещаващ - увеличен е броят на първичните кръводарители.

Локална скринингова програма за навременно диагностициране на рак на млечната жлеза у фамилно обременени жени и локална просветна програма за самоизследване за навременно диагностициране на рак на млечната жлеза на колектив от Университетския онкологичен център на ВМИ - Плевен начело с доц. д-р Ташко Делийски, д-р Румен Стоянов и д-р Георги Байчев също бе представен на семинара. Началните резултати са обнадеждаващи, а усилията на колектива, работещ по проекта, получиха положителна оценка на организираните от Националния онкологичен център “Онкологични дни ’97”. Изложение по проекта бе включено и в програмата на онкологичен семинар с международно участие на тема “Профилактика, скрининг и психосоциални проблеми при болни със злокачествени заболявания”.

От 21 до 23 се проведе нов семинар със здравни специалисти, студенти във факултет “Здравни грижи” на ВМИ - Плевен, от Белене, Бяла Слатина, Велико Търново, Враца, Горна Оряховица, Русе, Плевен, Стара Загора и Харманли., които се обучават във факултет “Здравни грижи” на ВМИ - Плевен. Участниците в семинара бяха приветствани от Ректора на ВМИ доц. К. Игнатов и председателката на Action for International Medicine мадам Шийла Куийн.

По време на семинара те разработиха проекти, прилагайки методиката на Здравна фондация “Драйфус” - разрешаване на здравни проблеми с помощта на наличните финансови, кадрови и логистични ресурси. На края на семинара участниците представиха около 40 здравни проекта, насочени към разрешаването на проблемите на обучението и след-дипломната квалификация на медицинските сестри, подобряване на профилактичните дейности, усъвършенстване на административните дейности, икономично изразходване на средства в здравеопазването, рационализиране на използването на легловата база и други.

По време на семинара мадам Шийла Куин, която е и почетен председател на Европейската асоциация на медицинските сестри, се срещна с участниците отговори на техни въпроси.

Предстоящо

През месец юни в Плевен ще се проведат два еднодневни семинара за проследяване на работата по проекти - един с участниците в семинар през май 1997,и втори - с участниците в семинара през януари 1998 година. Вероятните дати са 23 и 24 юни, за което всички ще бъдат уведомени предварително. На тези семинари ще бъдат обсъдени първите резултати от работата по проектите, възникналите проблеми. Споделянето на опит - положителен или отрицателен е доказало своята ефективност при реализирането на намеренията на работещите по проекти за решаване на проблеми за по-добро здраве.

Ново!

От този брой започваме да поместваме информация за участие на ръководители на проекти в конгреси, семинари, срещи и други мероприятия, на които те са представили работата си по проектите. Очакваме информация и за други участия, която ще намери място в следващите броеве на бюлетина.

* На научно-практическа конференция на тема “Състояние на кърмаческото хранене в България”, организирана от Районен център по здравеопазване - Търговище, Детска клиника на ВМИ - Плевен и фирма “ NESTLE,проф. Никола Мумджиев изнесе доклади по състоянието на кърмаческото хранене у нас, алтернативи на естественото хранене и диетични храни. Докладът на д-р Ваня Недкова запозна участниците с възможности за стимулиране на кърменето, а този на д-р Евгения Бързашка - с най-често срещаните грешки при храненето на кърмачетата.

* На предстоящ конгрес по трансфузионна хематология ще бъде представен проектът на Център по трансфузионна хематология - Ловеч, целящ преодоляване на тенденцията към намаляване на броя на кръводарителите. Колективът, работил по проекта, ще сподели своя опит и постигнатите резултати по запазване на броя на постоянните кръводарители, увеличаване на броя на първичните кръводарители и работата с подрастващото поколение - бъдещи кръводарители.

Важно!

В миналия брой на бюлетина Ви предложихме каталог списък на чуждите периодични издания от 1991 година насам, с които разполага Централната медицинска библиотека на ВМИ - Плевен. Ако желаете да получите ксерокопие от статиите, включени в посочените издания, можете да направите заявка на адреса на програма “Комуникации за по-добро здраве”, включен на заглавната страница на бюлетина. За работещите по проекти доставянето на информация е безплатно, а останалите заплащат само материалите и пощенските разходи.

Очакваме работещите по проекти на програма “Решаване на проблеми за по-добро здраве” да изпращат материали по проектите си - публикации в местния и централния печат и специализираните издания, снимки, агитационни материали, както и попълнени формуляри за извършеното по проектите. Това ще улесни организацията както на проследяването на процеса на работа по проектите, така и на финансирането на дейности по тях.

Очакваме Вашите въпроси, мнения и препоръки и заявки на адреса на програмата!

MEDLINE INFORMATION

MANAGEMENT OF ASTHMA IN CHILDREN

TI: A survey on the diagnosis and management of asthma in young children.

AU: Kourdoulos-D; Schattner-P

AD: Monash University, Department of Community Medicine, Victoria.

SO: Aust-Fam-Physician. 1997 Jul; 26 Suppl 2: S71-5

AB: OBJECTIVE: To examine how asthma in children less than 5 years of age is diagnosed and managed by general practitioners (GPs) and how this compares with the National Asthma Campaign guidelines. METHOD: A cross sectional postal survey of 164 GPs in the eastern suburbs of Melbourne in November, 1995. RESULTS: General practitioners diagnose asthma primarily on history, with the symptoms of nocturnal cough, wheeze and chronic cough considered as most important. Wheeze is the most important sign. An overuse of oral beta 2 agonists and inhaled corticosteroids were found. CONCLUSIONS: Asthma is diagnosed primarily on history and the presence of a wheeze helps to confirm the diagnosis. Management is appropriate overall, but there seems to be an overtreatment of mild asthmatics, and an overuse of inhaled corticosteroids.

TI: Prevalence of childhood asthma based on questionnaires and methacholine bronchial provocation test in Korea.

AU: Kim-YY; Cho-SH; Kim-WK; Park-JK; Song-SH; Kim-YK; Jee-YK; Ha-MN; Ahn-YO; Lee-SI; Min-KU

AD: Department of Internal Medicine, Seoul National University College of Medicine, Korea.

SO: Clin-Exp-Allergy. 1997 Jul; 27(7): 761-8

AB: BACKGROUND: In most epidemiological survey studies, only subjective symptoms and past medical history of asthma have been

used as diagnostic criteria. Even though a questionnaire survey can be performed in a large population study at low cost, limitations such as lack of objectivity and poor predictability in non-specific bronchial hyperresponsiveness cannot be avoided. OBJECTIVES: The purpose of this study was to elucidate the prevalence of current asthma based on questionnaires and methacholine bronchial provocation test, and the prevalence of atopy in Korea. METHODS: We performed modified ATS respiratory questionnaires and allergen skin-prick test with 10 common inhalant allergens among 3219 subjects aged 7-19 years in Seoul and a rural part of a small city, Chungju in Korea. Methacholine bronchial provocation tests were also performed among those who had asthma symptoms according to the questionnaire. The criteria of asthma was presence of both asthma symptoms and non-specific bronchial hyperresponsiveness. Atopy was defined as when an allergen induced weal size is same or larger than that caused by histamine. RESULTS: The prevalence of asthma based on questionnaires and methacholine bronchial provocation tests was 4.6%, while the prevalence of wheeze was 8.2% and 19.3% of total population complained of one or more respiratory symptoms related to asthma on the questionnaires. There was no significant difference according to age, sex and living area. The mean prevalence of atopy was 35.0% and the most common allergens were Dermatophagoides farinae (30.9%), Dermatophagoides pteronyssinus (27.5%), cat fur (20.4%) and cockroach (11.8%). The atopy prevalence in Chungju area was higher than that in Seoul and males showed a higher prevalence than females. The asthma prevalence was higher among atopics (6.8%) than among non-atopics (2.7%). None of questionnaire items were enough to predict the presence of bronchial hyperresponsiveness in terms of sensitivity, specificity and positive predictive value. CONCLUSION: The prevalence rate of current asthma in Korea was 4.6% and the prevalence rate of atopy in Korea was 35.0%. Questionnaire-based surveys are not enough to predict the actual prevalence of asthma.

TI: [Atmospheric air pollution as a factor potentiating the risk of asthma in school children. Epidemiologic studies in Krakow]

TO: Zanieczyszczenia powietrza atmosferycznegojako czynnik potegujacy ryzyko zachorowania na astme u dzieci szkolnych. Badania epidemiologiczne w krakowie.

AU: Jedrychowski-W; Flak-E; Mroz-E

AD: Katedry Epidemiologii i Medycyny, Zapobiegawczej Collegium Medicum,Uniwersytetu Jagiellonskiego w Krakowie.

SO: Przegl-Lek. 1997; 54(3): 158-62

AB: The purpose of this study was to assess the prevalence of asthma in schoolchildren in relation to residency in areas with higher urban air pollution in Krakow. The material consisted of 1129 children aged 9 years among whom health survey based on standardized interviews with parents, together with anthropometry and spirometry has been carried out in 1995. In the asthmatic children allergy diagnosed by doctor was 4 times more prevalent (83.3% vs 20.2%) and asthma or allergy was twofold more prevalent in their biologic parents (42.6% vs 29.3%). The children with asthma resided more frequently in the city areas with the higher air pollution level (62.5% vs 46.2%). Mean spirometric values of FVC, FEV1, FEF25-75% I PEFR did not differ across the groups, however, FEV1/FVC% was significantly higher in nonasthmatic than in asthmatic groups (corresponding values in boys 90.9% vs 88.7%, in girls 92.7% vs 89.8%). After accounting for potential confounders (child’s gender, education level of parents, environmental tobacco smoke, cigarette smoking of mothers in pregnancy and household standard) it was estimated from the multiple logistic regression that the separate effect of air pollution category was relatively small (OR = 2.27; 95%, CI = 1.11-3.93) in comparison with that of allergy (20.5; 95% CI = 9.40-44.7), however, combined effect of both risk factors on the occurrence of asthma in children was multiplicative.

TI: Air pollution and respiratory health among children with asthmatic or cough symptoms.

AU: Timonen-KL; Pekkanen-J

AD: Unit of Environmental Epidemiology, National Public Health Institute, Kuopio, Finland.

SO: Am-J-Respir-Crit-Care-Med. 1997 Aug; 156(2 Pt 1): 546-52

AB: During the winter of 1994, the association between daily changes in air pollution and in the respiratory health of children 7 to 12 yr of age were studied in Kuopio, Finland. Seventy-four children with asthmatic symptoms and 95 children with cough only, living either in urban or suburban areas, were followed for 3 mo. During the study period, the mean daily concentration of particulate air pollution (PM10) was 18 micrograms/m3 in the urban area and 13 micrograms/m3 in the suburban area. Lagged concentrations of PM10, black smoke, and NO2 were significantly associated with declines in morning peak expiratory flow (PEF) among asthmatic children. The regression coefficient (x10) for a 2-d lag of PM10 was -0.911 (SE, 0.386) in the urban and -1.05 (0.596), in the suburban area. Among children with cough only, PM10, black smoke, and NO2 were not significantly associated with PEF. In the urban area, there was a significant association between SO2 and morning and evening PEF and incidence of upper respiratory symptoms among children who cough only. No other associations between air pollution and evening PEF or respiratory symptoms were observed. This study suggests that particulate air pollution is associated with respiratory health, especially among children with asthmatic symptoms.

TI: Childhood asthma in four regions in Scandinavia: risk factors and avoidance effects.

AU: Forsberg-B; Pekkanen-J; Clench-Aas-J; Martensson-MB; Stjernberg-N; Bartonova-A; Timonen-KL; Skerfving-S

AD: Department of Environmental Health, Umea University, Sweden.

SO: Int-J-Epidemiol. 1997 Jun; 26(3): 610-9

AB: BACKGROUND: The high and increasing prevalence of childhood asthma is a major public health issue. Various risk factors have been proposed in local studies with different designs. METHODS: We have made a questionnaire study of the prevalence of childhood asthma, potential risk factors and their relations in four regions in Scandinavia (Umea and Malmo in Sweden, Kuopio in eastern Finland and Oslo, Norway). One urban and one less urbanized area were selected in each region, and a study group of 15962 children aged 6-12 years was recruited. RESULTS: The prevalence of symptoms suggestive of asthma varied considerably between different areas (dry cough 8-19%, asthma attacks 4-8%, physician-diagnosed asthma 4-9%), as did the potential risk factors. Urban residency was generally not a risk factor. However, dry cough was common in the most traffic polluted area. Exposure to some of the risk factors. such as smoking indoors and moisture stains or moulds at home during the first 2 years of life, resulted in an increased risk. However, current exposure was associated with odds ratios less than one. CONCLUSIONS: Our findings were probably due to a combination of early impact and later avoidance of these risk factors. The effects of some risk factors were found to differ significantly between regions. No overall pattern between air pollution and asthma was seen, but air pollution differed less than expected between the areas.

TI: Higher asthma occurrence in an urban than a suburban area: role of house dust mite skin allergy.

AU: Wieringa-MH; Weyler-JJ; Van-Bastelaer-FJ; Nelen-VJ; Van-Sprundel-MP; Vermeire-PA

AD: Dept of Epidemiology & Community Medicine, University of Antwerp, Belgium.

SO: Eur-Respir-J. 1997 Jul; 10(7): 1460-6

AB: Understanding of geographical differences in asthma prevalence may be helpful in explaining recent increases in the occurrence of asthma. We wondered whether differences in allergic sensitization or other factors could explain differences in reported occurrence of asthma between an urban centre and a neighbouring suburban area. From the European Community Respiratory Health Survey (ECRHS) questionnaire, responses on asthma symptoms and risk factors and results of 11 skin allergy tests were available from 656 young adults living in urban or south suburban Antwerp, Belgium. Answers to five asthma questions were selected as dependent variables, and eight personal or environmental risk factors, as well as house dust mite (HDM) allergy, as independent variables. The effect of each independent variable on the association of asthma variables with area was assessed. Prior asthma diagnosis, present asthma symptoms, the selected risk factors and HDM allergy were all more frequently recorded in urban Antwerp. Difference in HDM allergy accounted for most of the difference in prior (mostly childhood) asthma diagnosis, since correction for it decreased the odds ratio from 2.10 to 1.65. On the contrary, the regional differences in recent asthma symptoms were not explained by HDM allergy differences nor by any other factor under study. This urban-suburban comparison indicated that house dust mite allergy is a major determinant of prior (childhood) asthma, whereas factors contributing to higher urban prevalence of present asthma symptoms could not be identified. Furthermore, our results indicate that it may be inappropriate to combine data from neighbouring areas, when their similarity has not been verified.

TI: Epidemiology of pollution-induced airway disease in Japan.

AU: Miyamoto-T

AD: Japan Clinical Allergy Institute, Tokyo, Japan.

SO: Allergy. 1997; 52(38 Suppl): 30-4; discussion 35-6

AB: Air pollution has been implicated as one of the factors responsible for the increased incidence of allergic diseases seen over recent years. Epidemiological studies in Japan demonstrate that atopic subjects living in urban areas are more likely to suffer from the effects of air pollution, with increased coughing, sputum production, wheezing and throat irritation. Furthermore, animal studies show that high concentrations of pollutant gases can promote airway sensitization. The incidence of allergic rhinitis and asthma have been shown to be greater in areas where there is heavy traffic and hence high levels of automobile exhaust emissions. Intranasal administration of diesel exhaust particles in mice produces a stimulatory effect on immunoglobulin E production, and a similar finding has also been shown with suspended particulate matter in air. Air pollutants, such as ozone and nitrogen dioxide (NO2), have been shown to stimulate the production of granulocyte-macrophage colony stimulating factor, which may play a vital role in airway hyperreactivity and asthma. In comparative studies of asthma in urban and rural areas, history of airway infection and a younger age of onset were found to be significantly greater in urban areas. When the asthmatic patients were divided into two groups according to environmental NO2 levels (group I: NO2 > 30 ppb; group II: NO2 < 30 ppb), no significant difference regarding the various parameters was noted between the two groups, except for a greater severity of asthma in adults in group I, and a greater severity in children in group II. These studies imply that air pollution may be one reason for the increase in allergic diseases in Japan, but a definitive conclusion cannot be drawn, and further investigation is warranted.

TI: Epidemiology of pollution-induced airway disease: urban/rural differences in East and West Germany.

AU: Nicolai-T

AD: Universitatskinderklinik Munchen, Dr von Haunersches Kinderspital, Munich, Germany.

SO: Allergy. 1997; 52(38 Suppl): 26-9; discussion 35-6

AB: The prevalence of asthma and allergic disorders was assessed in 9-11 year-old children in Leipzig and Halle in East Germany, as well as in Munich, West Germany. Both East German cities are heavily polluted due to private burning of coal and industrial emissions, while Munich has low smoke emissions but heavy road traffic. All fourth grade pupils in Munich were compared with those in Leipzig and Halle. Non-specific airway disease (bronchitis), cough, and autumn/winter nasal symptoms were most prevalent in Leipzig and Halle. Hay fever and skin test reactivity to aeroallergens were higher in West Germany compared with East Germany. Furthermore, the prevalence of asthma was also higher in the West German study area. Increased skin prick test reactivity in the West explained the increased prevalence of asthma. Longitudinal analysis showed increased respiratory symptoms on days with high mean levels of sulphur dioxide and oxides of nitrogen, as well as on days with a high peak level of 10 mu respirable particles (PM10) in East Germany. The effects of these pollutants were additive. Exposure to heavy road traffic in Munich was related to decreased pulmonary function and non-specific airway symptoms, but not to allergic sensitization and asthma.

TI: Epidemiology of pollution-induced airway disease in Scandinavia and Eastern Europe.

AU: Bjorksten-B

AD: Department of Paediatrics, University Hospital, Linkoping, Sweden.

SO: Allergy. 1997; 52(38 Suppl): 23-5; discussion 35-6

AB: Several potential environmental factors, particularly air pollutants, have been implicated as causal factors for the increased prevalence of allergic disease in western industrialized countries. However, even when combined, these factors can only partly explain the increase. Differences in prevalence of allergy are apparent between urban and rural areas of industrialized countries, with positive skin prick tests being more common in children living in urban regions. However, the prevalence of atopy is lower in children in central and Eastern Europe, where air pollution poses a major problem, than in Western Europe. Indeed, preliminary data from the International Study of Asthma and Allergy in Children (ISAAC) confirm that the prevalence of childhood atopy is lower in Eastern Europe than in Scandinavia. Although air pollution is undoubtedly associated with the development of allergic disease, other factors connected with western lifestyle, such as changes in diet and living conditions, may play an important role and provide a possible explanation for the higher prevalence of allergic disease in western industrialized countries.

TI: Has the prevalence of asthma increased in children? Evidence from a long term study in Israel.

AU: Goren-AI; Hellmann-S

AD: Institute for Environmental Research, Ministry of the Environment and Sackler School of Medicine, Tel-Aviv University, Israel.

SO: J-Epidemiol-Community-Health. 1997 Jun; 51(3): 227-32

AB: BACKGROUND: The permit to build and operate the first 1400 megawatt coal fired power plant in Israel was given provided that three monitoring systems-environmental, agricultural, and health monitoring-be set up near the plant. This study was carried out in the framework of a health monitoring system which included a mortality survey, requests for health services, a schoolchildren’s health survey, and an adult panel study. METHODS: 2nd, 5th, and 8th grade school-children living in three communities with different expected levels of air pollution were followed up every three years. They performed pulmonary function tests (PFT), and their parents filled out American Thoracic Society-National Heart and Lung Institute (ATS-NHLI) health questionnaires. A follow up of the prevalence of respiratory conditions among the studied schoolchildren in four rounds of tests was carried out. This report deals with the changes in the prevalence of asthma, related respiratory conditions, and PFT in the data sets gathered among 5th grade schoolchildren. RESULTS: A significant (p = 0.0024) increase in the prevalence of asthma could be observed among 5th grade children in all three communities studied between 1980 and 1989. At the same time a significant (p = 0.0172) rise in the prevalence of wheezing accompanied by shortness of breath could be observed. A similar trend could not be found for the prevalence of bronchitis and other respiratory conditions among the studied children. PFT (FEV1, FEV1/FVC) of children suffering from asthma or from wheeze accompanied by shortness of breath were lower than those of healthy children. Changes in the prevalence of background variables over time could not explain the significant rise in the prevalence of asthma among the children. CONCLUSIONS: The significant rise in asthma and related respiratory conditions coupled with reduced PFT observed in this study suggest that the increase over time in the prevalence of asthma is a true increase in morbidity and not due to reporting bias. The increased prevalence of asthma could be observed in all the communities studied and does not seem to be connected with the operation of the power plant.

TI: Prevalence of asthma and wheezing in public schoolchildren: association with maternal smoking during pregnancy.

AU: Hu-FB; Persky-V; Flay-BR; Zelli-A; Cooksey-J; Richardson-J

AD: School of Public Health, University of Illinois at Chicago.

SO: Ann-Allergy-Asthma-Immunol. 1997 Jul; 79(1): 80-4

AB: BACKGROUND: Asthma is the most common chronic disease in childhood. The prevalence of asthma is especially high in inner city children. The occurrence of asthma may be associated with many environmental factors, including involuntary exposure to maternal smoking. OBJECTIVES: This study reports prevalence of asthma and wheezing in a sample of public school students in Chicago and examines the association between maternal smoking during pregnancy and childhood asthma. METHODS: A total of 705 fifth grade students from 13 public schools participated in the study. A slightly modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was administered in classrooms to assess students’ wheezing and asthma prevalence. RESULTS: Overall, 34.5% of children reported ever wheezing, 28.9% reported wheezing in the past year, 21.1% reported exercise-related wheezing in the past year, 23.6% reported physician-diagnosed asthma, 16.1% reported taking asthma or wheezing medication in the past 2 weeks, and 15.2% reported visiting emergency rooms for treatment of asthma in the past year. After adjusting for confounding variables in a logistic model, maternal smoking during pregnancy was significantly associated with children’s asthma (adjusted odds ratio = 1.9; 95% confidence interval: 1.1 to 3.5). CONCLUSIONS: This study reports high prevalence of asthma and wheezing among the students and suggests that maternal smoking during pregnancy may increase the risk of asthma in children.

TI: Frequency of patients with acute asthma in relation to ozone, nitrogen dioxide, other pollutants of ambient air and meteorological observations.

AU: Holmen-A; Blomqvist-J; Frindberg-H; Johnelius-Y; Eriksson-NE; Henricson-KA; Herrstrom-P; Hogstedt-B

AD: Department of Occupational Medicine, Central Hospital, Halmstad, Sweden.

SO: Int-Arch-Occup-Environ-Health. 1997; 69(5): 317-22

AB: OBJECTIVE: To study the association of the daily frequency of registration of patients with acute asthma at the emergency department of a central hospital in the south-west of Sweden with levels of air pollution and meteorological observations. METHODS: A retrospective longitudinal study was made of asthma patients taken from a hospital registry. This information was correlated with measurements of ozone, nitrogen dioxide, sulphur dioxide, toluene, temperature and relative humidity. Patients were from the catchment area of the Central Hospital of Halmstad containing around 120,000 inhabitants. A total of 4127 visits of patients with acute asthma to the emergency department at the Central Hospital of Halmstad were registered during a period of 1247 days from January 1990 to May 1993. The differential optical absorption spectroscopy (DOAS) technique was used to monitor levels of air pollutants over a distance of 1000 m in the central part of the town of Halmstad. Data on temperature, relative humidity, precipitation, wind speed and wind direction for the time period were supplied by the Swedish Meteorological and Hydrological Institute (SMHI). RESULTS: There were many statistically significant correlations between the levels of air pollutants and the meteorological measurements and a strong negative correlation between ozone and nitrogen dioxide. There was a statistically significant effect on asthma visits in children of low temperature and high nitrogen dioxide levels, and on asthma visits in adults of high temperature and high levels of ozone. CONCLUSIONS: There was a different reaction pattern in children and adults with asthma regarding temperature and ozone/nitrogen dioxide. The strong correlations between temperature and air pollution and between the levels of ozone and nitrogen dioxide made the true relation between asthma, air pollution and temperature hard to evaluate statistically.

TI: Secular trend in the occurrence of asthma among children and young adults: critical appraisal of repeated cross sectional surveys.

AU: Magnus-P; Jaakkola-JJ

AD: Department of Population Health Sciences, National Institute of Public Health, Oslo, Norway.

SO: BMJ. 1997 Jun 21; 314(7097): 1795-9

AB: OBJECTIVES: To review repeated surveys of the rising prevalence of obstructive lung disease among children and young adults and determine whether systematic biases may explain the observed trends. DESIGN: Review of published reports of repeated cross sectional surveys of asthma and wheezing among children and young adults. The repeated surveys used the same sampling frame, the same definition of outcome variables, and equivalent data collection methods. SETTING: Repeated surveys conducted anywhere in the world. SUBJECTS: All repeated surveys whose last set of results were published in 1983 or later. MAIN OUTCOME MEASURES: Lifetime and current prevalences of asthma and current prevalence of wheezing. The absolute increase (yearly percentage) in the prevalences of asthma and wheezing was calculated and compared between studies. RESULTS: 16 repeated surveys fulfilled the inclusion criteria. 12 reported increases in the current prevalence of asthma (from 0.09% to 0.97% a year) and eight reported increases in the current prevalence of wheezing (from 0.14% to 1.24% a year). Changes in labelling are likely to have occurred for the reporting of asthma, and information biases may have occurred for the reporting of wheezing. Only one study reported an increase in an objective measurement. CONCLUSIONS: The evidence for increased prevalences of asthma and wheezing is weak because the measures used are susceptible to systematic errors. Until repeated surveys incorporating more objective data are available no firm conclusions about increases in obstructive lung disease among children and young adults can be drawn.

TI: [Epidemiological research on incidence of atopic disease in infants and children in relation to their nutrition in infancy]

AU: Arita-M; Mikawa-H; Shirataka-M; Takahashi-K; Hayasawa-H; Tomita-M

AD: Kansai-Denryoku Hospital.

SO: Arerugi. 1997 Apr; 46(4): 354-69

AB: Incidence and relative risk of atopic disease (atopic dermatitis; AD, bronchial asthma; BA, allergic rhinitis; AR) in Japanese infants and children in relation to their nutrition in infancy was analyzed from the data of the epidemiological survey which was conducted for 10,000 mothers of infants and children in 1993. A total of 4,610 replies were received: 2,714 from mothers of infants (12 months old) and 1,896 from mothers of children (2 years old). The subjects were allocated to following 3 groups based on their nutrition during first 3 months after birth; the breast-fed group (BF), the formula-fed group (EF), the mixed-fed group (MF). Incidence of atopic disease in BF, FF and MF was 23.5%, 22.2% and 21.8%, respectively and no statistical difference could be found among these 3 groups. AD was developed 17.0%, 14.4% and 13.9%; BA was 4.4%, 8.5% and 5.2%; AR was 4.9%, 6.5% and 5.8% in BF, FF and MF, respectively. Incidence of AD was significantly different between BF and MF (p < 0.01). Incidence of BA was also significantly different between BF and FF (p < 0.01). Risk of onset of BA and AR in FF was higher (adjusted odds ratio 2.2, 95% confidence interval 1.5-3.2 and adjusted odds ratio 1.5, 95% confidence interval 1.0-2.2, respectively) than that of BF controlled by age and family history with Cochran-Mantel-Haenzel test. With multiple logistic regression analysis, relative risk of the onset of BA in FF at the age of one year was 2.1, 95% confidence interval 1.2-3.5 and at the age of two years old was 2.5, 95% confidence interval 1.4-4.4. These results suggest that the breast-fed have certain suppression effects on incidence of bronchial asthma in infants and children.

TI: The prevalence of allergic diseases in primary school children in Edirne, Turkey.

AU: Selcuk-ZT; Caglar-T; Enunlu-T; Topal-T

AD: Hacettepe University, School of Medicine, Department of Chest Diseases, Ankara, Turkey.

SO: Clin-Exp-Allergy. 1997 Mar; 27(3): 262-9

AB: BACKGROUND: Allergic diseases present a major health burden for children as shown by the rising morbidity and increased mortality from asthma. Information on the prevalences of allergic disorders and contributing factors as well will help to establish feasible measures to change this trend, and more efficient assignment of the limited health resources. OBJECTIVE: To assess the prevalences of asthma and other allergic diseases and the contribution of various risk factors in primary school children in Edirne, Turkey. METHODS: Children aged 7 to 12 in primary schools in the municipality and 24 villages of Edirne were surveyed via a questionnaire completed by the parents. The cumulative (lifetime) and current (last 12 months) prevalences of allergic diseases and the presence of passive smoking, atopic family history, animal contact and breast-feeding in infancy were determined. RESULTS: A total of 5412 children (70.1% from the metropolitan and 29.9% from the rural area) were enrolled. The cumulative and current prevalences of all allergic diseases were 24.6% and 9.9% respectively. The cumulative (lifetime) prevalences of bronchial asthma, wheezing, allergic rhinitis and atopic dermatitis were 16.4%, 18.9%, 12.3% and 2.2%, and the current (last 12 months) prevalences were 5.6%, 5.8%, 4.5% and 0.9% respectively. Three-fourths of the children were exposed to tobacco smoke at home. Atopic heredity appeared the most prominent risk factor for any allergic disorder. Neither age, breast-feeding nor place of habitation affected the occurrence of allergic disorders. Animal contact was a significant risk factor for asthma and wheezing (adjusted odd ratios (OR) and 95% confidence intervals (CI) for current prevalences are 1.38 (CI = 1.04-1.83) and 1.35 (CI = 1.02-1.78) respectively), exposure to indoor tobacco smoke for wheezing (OR = 1.52, CI = 1.10-2.09), and male gender for asthma (OR = 1.50, CI = 1.16-1.93). Current prevalences for all allergic diseases were significantly lower than those previously reported in Ankara, Turkey. CONCLUSIONS: Allergic diseases are a major health burden for primary school children in Edirne, Turkey. Although atopic heredity appears to be the foremost important risk factor, reduction of exposure to indoor tobacco smoke and animal contact, especially for those with atopic family history, are important preventive measures. The impact of environmental exposures on distinguishing prevalences of allergic diseases in Ankara and Edirne should be further investigated.

TI: Childhood asthma and atmospheric conditions.

AU: Yuksel-H; Tanac-R; Tez-E; Demir-E; Coker-M

AD: Department of Pediatric Allergy and Pneumotology, Faculty of Medicine, Ege University,Izmir, Turkey.

SO: Acta-Paediatr-Jpn. 1996 Dec; 38(6): 606-10

AB: Bronchial asthma is the most common chronic respiratory illness in childhood. It is characterized by paroxysmal bronchospastic periods. There are many studies giving reasons to explain the bronchospasm periods. One of the reasons, atmospheric conditions, is effective in creating a clinical picture of asthmatic patients. In the present study, the correlation between atmospheric conditions and asthmatic symptoms in children was investigated using peak expiratory flow rate (PEFR) as the respiratory function test. Twenty-one children with bronchial asthma were monitored in the study. They were followed as outpatients of the Ege University Medical Faculty, Department of Pediatric Allergy and Pneumotology, between November 1993 and June 1994. Atmospheric conditions were recorded from the local meteorology center. Complaints and the PEFR of children were compared with the meteorological data. Asthmatic symptoms were increased by low temperatures in all asthmatic children. An increase was detected in the extrinsic group by relative humidity and ratio of cloud, but in the intrinsic group only by relative humidity.

GLAUCOMA

TI: [Blindness caused by glaucoma]

AU: Krieglstein-GK

SO: Ophthalmologe. 1993 Dec; 90(6): 554-6

AB: The different forms of glaucoma constitute one of the major causes of nonreversible blindness in the industrialized as well as the undeveloped world. Reliable epidemiological data are rare since there are no screening concepts that would be valid for all countries in the same way. The prevalence of open-angle glaucoma in the industrialized world is at least 1.7% in the population over 40 years of age. Race has considerable influence on the relative frequency of the different types of glaucoma, whereby the risk of blindness is especially high in the black glaucoma patient. The number of patients who have gone blind from glaucoma differs in the literature from roughly 5% to 33%. Blindness from glaucoma can be prevented by early diagnosis and therapy, which is again greatly dependent on the economy in developing countries. The immediate efficacy of therapy is directed towards IOP reduction. Long-term therapeutic success, however, must be measured against the preservation of visual function and in this respect against the eradication of glaucoma-induced blindness. The socioeconomic significance of the disease is discussed with reference to a few examples from different countries.

TI: Screening for open-angle glaucoma.

AU: Tucker-JB

SO: Am-Fam-Physician. 1993 Jul; 48(1): 75-80

AB: Chronic (open-angle) glaucoma is a leading cause of new cases of blindness in the United States. This blindness is a result of increased intraocular pressure and deterioration of the optic nerve. Nearly 2 million Americans have glaucoma. “Ocular hypertension” is the term applied to elevation of the ocular pressure above 21 mm Hg. Glaucoma is defined as a group of diseases that have certain common features, including an intraocular pressure too high for the continued health of the eye, cupping and atrophy of the optic nerve head and visual field loss. Although long-term studies evaluating the success of medical treatment are still in progress, medical intervention remains the standard of care for both ocular hypertension and open-angle glaucoma.

TI: Clinical evaluation of a multi-fixation campimeter for the detection of glaucomatous visual field loss.

AU: Mutlukan-E; Damato-BE; Jay-JL

SO: Br-J-Ophthalmol. 1993 Jun; 77(6): 332-8

AB: The multi-fixation glaucoma screening chart, which uses the oculokinetic perimetry (OKP) technique, is a hand-held tangent screen with a central black test stimulus on a white background and a series of 26 numbered fixation targets arranged around the stimulus at various locations. When the numbers on the chart are read by the patient from 40 cm distance, the test stimulus passes through the relevant parts of the central visual field which are most vulnerable to glaucomatous damage. The test is positive (that is, abnormal) if at least one fixation number is associated with consistent disappearance of the stimulus. The OKP test was performed in 222 eyes of 126 glaucoma patients (aged 16-91 years) and 186 right eyes of 186 normal individuals (aged 19-86 years) using a 1.5 mm diameter stimulus. A further 144 eyes of 88 glaucoma patients (aged 60-85 years) and 31 right eyes of 31 normal individuals (aged 60-85 years) were tested with a 3 mm diameter stimulus. All eyes were also tested with conventional perimetry and the results of the conventional perimetry were categorised according to the Aulhorn-Karmeyer classification by four ophthalmologists without any knowledge of the OKP results. When the 1.5 mm stimulus was used, a true positive OKP result was obtained in 45% of eyes with relative scotomas, 81% of eyes with small absolute scotomas separate from the blind spot and 100% of eyes with more severe visual field defects.

TI: [Hormonal changes in open-angle glaucoma. I. Levels of immunoreactive insulin in serum]

AU: Janouskova-K; Tesinsky-P; Topolcan-O

SO: Cesk-Oftalmol. 1993 Jan; 49(1): 13-21

AB: This paper deals with the relation of disorders of carbohydrate metabolism to etiopathogenesis of glaucoma. 102 patients with primary glaucoma of an open angle were examined and it was discovered that 80 patients from this group (78%) had an abnormal immuno-reactive insulin curve, in particular of the hypersecretory type. Standard gauge test for abnormal glucose level was administered with 31 glaucomatous patients (30%). From this point of view screening for immuno-reactive insulin is a more sensitive and reliable method than the glucose standard gauge test. It is recommended that testing for immuno-reactive insulin should be introduced for all glaucomatous patients because this can help both in the detection of early stages of diabetes and in the administration of primary prevention of atherosclerosis among the population.

TI: Impaired vision in the elderly: a preventable condition.

AU: Wun-YT; Lam-CC; Shum-WK

SO: Fam-Pract. 1997 Aug; 14(4): 289-92

AB: BACKGROUND: Vision is thought to deteriorate with age as a number of factors in later life endanger eyesight. Assessment of the visual acuity of the elderly and identification of endangering factors help in detecting those with impaired vision which in turn impairs daily activities. OBJECTIVE: This study measured the visual acuity of the senior citizens and identified those with impaired vision. The probable contributing factors for impaired vision were studied with the aim of preventing visual impairment. METHOD: The study was part of a screening campaign for elderly glaucoma in the community. A convenience sample of ambulatory senior citizens from stratified localities had their visual acuity measured with a standard Snellen’s chart. The test was repeated with pinholes if the visual acuity was less than 0.5. Those without improvement after pinhole were considered as having impaired vision. People with elevated intraocular pressure by the Pulsair were selected for examination by an ophthalmologist for ocular pathology. RESULTS: For the ambulatory population aged > or = 65 the mean visual acuity of either eye before pinhole was 0.3. Nearly 72% had impaired vision (visual acuity not corrected above 0.5 with pinhole). There was a significant association between this impairment and female sex, history of diabetes mellitus or glaucoma, cataract, and infrequent eye examination. CONCLUSION: Impaired vision is highly prevalent in the elderly ambulatory population, a condition which is preventable by tight surveillance of predisposing factors and regular simple measurement of visual acuity. The primary care setting is most suitable for these activities.

TI: Glaucoma: a preventable cause of blindness.

AU: Higginbotham-EJ

SO: Md-Med-J. 1997 Sep; 46(8): 412-4

AB: Glaucoma is a leading cause of blindness within the United States and the leading cause of blindness among African-Americans. Measurement of intraocular pressure only is no longer considered adequate for screening. Recognition of risk factors and examination of the optic nerve are key strategies to identify individuals at risk. Medical and surgical treatment of glaucoma have significantly improved in recent years. Early diagnosis and appropriate therapy will aid in reducing the potential of irreversible blindness.

TI: [Optimizing the distribution and test locations in statistical perimetry. Preliminary results]

AU: Sugimoto-K; Zulauf-M; Schotzau-A; Rentsch-R

SO: Klin-Monatsbl-Augenheilkd. 1997 May; 210(5): 302-4

AB: BACKGROUND: Are short programs useful to glaucoma-screening? We investigated the concept of Program G1x with Octopus 1-2-3, which permits examination of various numbers of test locations i.e., 16, 32, 45, or all 59 test locations. PATIENTS AND METHODS: Using 99 visual fields of glaucomatous or glaucoma-suspect right eyes, we compared mean defect (MD) and loss variance (LV) of the global visual field with MD and LV of the stages of G1x-program (standard strategy). RESULTS: The results showed that stage 1 of Program G1x underestimated the glaucomatous visual field damage present in the entire field. CONCLUSIONS: Thus, the use of only the first stage (16 test locations) of G1x is not advisable. At least 32 test locations, i.e., stages 1 and 2 of program G1x, are recommended for clinical perimetry.

TI: The management of primary open angle glaucoma.

SO: Drug-Ther-Bull. 1997 Jan; 35(1): 4-6

AB: Glaucoma is one of the commonest causes of blindness in the world. In the UK, about 7% of people over the age of 75 years have primary open angle glaucoma, the most common type of glaucoma and the cause of visual impairment in about 13% of those registered blind. Early detection and treatment can usually prevent blindness. However, half of all patients with primary open angle glaucoma in the UK do not present until vision has begun to deteriorate. Here we consider ways of improving detection and management.

TI: Eye diseases in the elderly in Singapore.

AU: Ho-T; Law-NM; Goh-LG; Yoong-T

SO: Singapore-Med-J. 1997 Apr; 38(4): 149-55

AB: OBJECTIVE: The study was conducted to determine the prevalence rates of blindness and visual impairment in those aged 60 years and above in Singapore and to determine the pickup rate of undiagnosed eye diseases through an active screening programme. METHOD: A random frame of 3,000 elderly persons aged 60 years and above was obtained from the Ministry of Home Affairs in Singapore. They were invited by mail to attend eye screening at Hougang Senior Citizens’ Health Care Centre. The eye screening was in two parts: the first part by a trained registered nurse or therapy aide and the second part by the ophthalmologist. For each respondent, autorefraction, tonometry, retinal photography and visual field analysis were done. Examination criteria and disease classification were modelled after the Framingham Eye Study. RESULTS: 574 subjects attended the screening, giving a response rate of 22.2%. The prevalence rates for blindness and visual impairment in the elderly screened were 3.0% and 15.2% respectively. The prevalence rates for cataract, age-related macular degeneration, glaucoma and diabetic retinopathy were 78.6%, 27.0%, 5.7% and 5.1% respectively. For every person known to have cataract, 2 were unknown; for every person with age-related macular degeneration, 154 were unknown. None of the 29 persons with diabetic retinopathy was diagnosed previously. CONCLUSION: Almost 1 in 5 of the elderly screened had some degree of visual disability. The rates of visual impairment and blindness were similar to those reported in other studies and indicate a significant burden of visually impairing diseases in the community.

TI: [A role of oblique flashlight test in screening for primary angle closure glaucoma]

AU: Yu-Q; Xu-J; Zhu-S; Liu-Q

SO: Yen-Ko-Hsueh-Pao. 1995 Dec; 11(4): 177-9

AB: PURPOSE: To study the effect of oblique flashlight test in screening for primary angle closure glaucoma. METHOD: Two hundred adults over 50 years old were sampled randomly at Doumen county of Guangdong province in 1995. 390 eyes were measured by oblique flashlight test according to grading standard photos of oblique flashlight test. Other ocular examinations consisted of intraocular-pressure measurement with Schiotz tonometer, gonioscopy, and optic disc appearance. RESULTS: The result showed 25.2% of the examined eyes had the oblique flashlight grade < or = 2, and tended to be increasing with age (x2 = 8.597, P < 0.05) and in females (x2 = 14.89, P < 0.01). Based on temporal anterior chamber angle < or = 2 (Shaffer’s grade), the obligue flashlight grade < or = 2 found that occludable angle sensitivity was 91.7%, specificity was 91.5%, and 8.16% of the eyes had primary closure angle glaucoma. No patient was found in oblique flashlight grades > or = 3. CONCLUSION: This study shows that oblique flashlight test conforms to screening test needs, and plays an important role in screening for primary closure angle glaucoma. We suggest that oblique flashlight grades < or = 2 as cutoff point of screening for occludable angle.

TI: [The study of grading standard photos of oblique flashlight test]

AU: Yu-Q; Li-S; Ye-T

SO: Yen-Ko-Hsueh-Pao. 1995 Jun; 11(2): 80-5

AB: PURPOSE: We try to establish a convenient, fast, inexpensive and accurate screening test and to make a grading standard. METHODS: 1. In 120 eyes, we measured axial anterior chamber depth (AACD), peripheral anterior chamber depth (PACD), antrior chamber angle (ACA) and took iris pictures under slitlamp microscope imitating the oblique flashlight test. The clear photos from 107 eyes were measured by computerized image analysis to determin the ratio of the width of nasal iris and nasal iris light band (ILBR). Then the linear correlation of ILBR with AACD, PACD and ACA was analyzed statistically. The ILBR was graded according to the analytic results. RESULTS: 1. Relationship of ILBR with PACD, AACD and ACA: the linear correlation analysis showed a positive correlation relationship among ILBR, PACD and AACD (r = 0.9451, P = 0.0001 and r = 0.8725, P = 0.0001), and showed a negative correlation relationship between ILBR and ACA (r = -0.7582, P = 0.0001). 2. ILBR grading standards: grade 1. ILBR < or = 1/5, the gonioscopy usually demonstrates a dangerously narrowed angle (N3-4); grade 2, ILBR > 1/5- < or = 1/4, the gonioscopy will always show a capable of closure angle (N2-3); grade 3, ILBR > 1/4- < or = 1/3, that angle is incapable of closure (N1-2); grade 4, ILBR > 1/3- < or = 1/2, the most angles show wide (W-N1); grade 5, ILBR > 1/2, the gonioscopy shows all wide angle. The linear correlation analysis also showed correlation relationship among ILBR grades PACD, AACD and ACA. CONCLUSION: Through arational ILBR grades and a set of grading standard photos, it is found that the test is not only convenient, fast, and inexpensive, but also accurate as well. The test not only plays an important role in PACG screening, but also may be applied widely to estimate shallow AACD and narrow angle in the clinic.

TI: Screening for glaucoma: the time taken by primary examiners to conduct visual field tests in practice.

AU: Tuck-MW; Crick-RP

SO: Ophthalmic-Physiol-Opt. 1994 Oct; 14(4): 351-5

AB: A panel of 101 primary examiners (optometrists or their ancillary staff) in England and Wales prospectively recorded the time taken to examine the central visual fields of each of 10 (or more) of their patients. The results indicate that the time depended not only on the test procedure but on how frequently the examiner conducted such a test. A basic test with semi-automated field screening equipment, applied routinely by 30 examiners on 547 patients, took an average 3.7 min per patient; (lower quartile 2.8 min). For such examiners, a standard extended test took 4.9 min. Similar times applied whether tests were conducted by an optometrist or an assistant. It was concluded that visual field screening in a normal population could reasonably be assumed to take an average 4 min per patient.

TI: Colour vision screening in glaucoma: the Tritan Album and other simple tests.

AU: Heron-G; Erskine-NA; Farquharson-E; Moore-AT; White-H

SO: Ophthalmic-Physiol-Opt. 1994 Jul; 14(3): 233-8

AB: Results from simple colour vision tests used for the detection of the Type III colour vision deficiency in glaucoma and ocular hypertension are presented. We assessed 49 patients with primary open angle glaucoma, 16 ocular hypertensives, 54 age matched normals and 50 young normal observers using six established tests and the recently introduced Tritan Album. This test was introduced specifically for acquired colour vision deficiencies. Results show in general that individual tests have low sensitivity and poor screening efficiency. The best screening efficiency was achieved by the City University Colour Vision Test and the AO HRR plate test, no acquired tritan defects were identified by the Farnsworth F2 plate, and the Tritan Album had very low sensitivity (the lowest excluding the F2 plate). Best results were obtained from a combination of City University and HRR test scores and this combination could provide useful additional data on colour vision in a glaucoma screening programme.

TI: The sight test fee: effect on ophthalmology referrals and rate of glaucoma detection

AU: Laidlaw-DA; Bloom-PA; Hughes-AO; Sparrow-JM; Marmion-VJ

SO: BMJ. 1994 Sep 10; 309(6955): 634-6

AB: OBJECTIVE—To assess changes, if any, in the numbers of referrals and outcome of glaucoma referrals to the hospital eye service since the introduction of the sight test fee on 1 April 1989. DESIGN—Review of referral records and clinical notes. SETTING—Referrals to the Bristol Eye Hospital. SUBJECTS—51,919 patients referred to the Bristol Eye Hospital between 1984 and 1992. 9438 case notes of patients referred between 1987 and 1991 were examined in detail. MAIN OUTCOME MEASURES—Numbers of referrals; rate of adult true positive glaucoma referrals. RESULTS—Referrals to the Bristol Eye Hospital were between 13.7% and 19.0% fewer than expected after the introduction of the sight test fee. True positive glaucoma referrals were reduced by the same proportion. CONCLUSIONS—The numbers of patients being identified as requiring treatment or follow up for potentially blinding glaucoma have declined by nearly one fifth since the introduction of the sight test fee. An increased prevalence of preventable blindness may result.

TI: The management of primary open angle glaucoma.

SO: Drug-Ther-Bull. 1997 Jan; 35(1): 4-6

TI: [A role of oblique flashlight test in screening for primary angle closure glaucoma]

AU: Yu-Q; Xu-J; Zhu-S; Liu-Q

SO: Yen-Ko-Hsueh-Pao. 1995 Dec; 11(4): 177-9

TI: Keeping an eye on vision: primary care of age-related ocular disease. Part 1.

AU: Butler-RN; Faye-EE; Guazzo-E; Kupfer-C

SO: Geriatrics. 1997 Aug; 52(8): 30-41

AB: Normal changes in the lens, retina, and vitreous accompany aging, but loss of vision in late life is not an inevitable consequence of aging. Cataract, glaucoma, diabetic retinopathy, and age-related macular degeneration (ARMD) account for most vision loss in the older population. Visual impairment reduces older patients’ ability to function independently and increases their risk of depression and of injury due to falls. When older persons have a visual complaint, they tend to blame it on being old and do not tell their physicians. In the primary care office, simple screening questions and examination of the dilated eye can often reveal a need for further examination and/or referral.

TI: [The study of grading standard photos of oblique flashlight test]

AU: Yu-Q; Li-S; Ye-T

SO: Yen-Ko-Hsueh-Pao. 1995 Jun; 11(2): 80-5

TI: [Application of oculokinetic perimetry in examination of the eye]

AU: Wakakura-M; Kageyama-M; Hamanaka-T; Shimizu-K; Joshita-H; Shimizu-T; Baba-H; Kisara-M; Miyata-M

SO: Nippon-Ganka-Gakkai-Zasshi. 1996 Jul; 100(7): 551-7

AB: Oculokinetic perimetry was performed using the same protocol at four health screening facilities to determine its usefulness for identifying visual field abnormalities including glaucoma during complete physical screenings in Japan. Ophthalmoscopy of the optic disc, 26-point oculokinetic perimetry (OKP), and applanation tonometry were performed in 2,768 eyes. If any one of the tests yielded an abnormal result, the eye was then examined with a Humphrey visual field analyzer (HVFA, program 30-2). After the tests were completed, the results were evaluated by ophthalmologists for evidence of primary open-angle glaucoma and normal tension glaucoma and were classified into one of 3 groups: confirmed glaucoma, suspected glaucoma, and no glaucoma. OKP detected abnormalities in the visual field in 96 eyes (3.5%). Of these 96 eyes, 29 eyes had confirmed glaucoma, 52 eyes were suspected of having glaucoma and 15 eyes had no glaucoma. The remaining 15 eyes had no glaucoma, but in 7 of them other ophthalmological disease was diagnosed. The sensitivity, specificity, positive predictive value, and negative predictive value of OKP for detecting glaucomatous visual field defect were 0.46, 0.99, 0.84 and 0.96, respectively. The high specificity and negative predictive value show that OKP is unlikely to produce false positive results, but its low sensitivity suggests that it is not suitable for the early detection of glaucoma. However, OKP identified advanced glaucoma and other ophthalmological diseases associated with visual field abnormalities, suggesting that it is a useful screening test.

PREVENTION OF POISONING ACCIDENTS IN CHILDREN

TI: Poisoning prevention knowledge and practices of parents after a childhood poisoning incident.

AU: Woolf-AD; Saperstein-A; Forjuoh-S

AD: Department of Pediatrics, Harvard Medical School, Boston, MA.

SO: Pediatrics. 1992 Dec; 90(6): 867-70

AB: This study investigated the effectiveness of a poison center-initiated mailed intervention on improving the preventive practices of families whose preschool child had recently experienced a poisoning incident. A low-cost, mailed poisoning prevention packet consisting of telephone stickers, a +f41 coupon for syrup of ipecac, one slide-style cabinet lock, a nine-step checklist for “poison-proofing” the home, pamphlets, and a cover letter was tested prospectively on a population of parents calling a poison center for advice about possible poisoning exposures involving their preschool children. Parents without ipecac 1 week after the incident were randomized so that half received the mailed intervention. A “blind” follow-up telephone interview was conducted 3 months later. Of the 336 original families enrolled in the study, 301 (90% retention) completed the follow-up interview. Those who had received the intervention were more likely to have a telephone sticker than control families (78% vs 39%; P < .0001) and were more likely to be using at least one slide lock in the home (59% vs 40%; P < .001). However, intervention families were no more likely to have ipecac on hand than control families (57% vs 52%; P = not significant) and did not indicate a higher rate of compliance with suggested changes in other behaviors and practices to prevent poisonings. A poisoning recurrence rate of 3.7% was seen in the total sample during the 3-month period of surveillance; there was no difference between groups in recurrence rate. Even after a poisoning event, parents may not be sufficiently motivated to take poisoning prevention measures on their own.(ABSTRACT TRUNCATED AT 250 WORDS)

TI: Comparison of pediatric poisoning hazards: an analysis of 3.8 million exposure incidents. A report from the American Association of Poison Control Centers

AU: Litovitz-T; Manoguerra-A

AD: National Capital Poison Center, Georgetown University Hospital, Washington, DC.

SO: Pediatrics. 1992 Jun; 89(6 Pt 1): 999-1006

AB: This analysis of life-threatening and fatal pediatric poisonings was conducted to aid poison prevention educational efforts, guide product reformulations and aversive agent use, reassess over-the-counter status for selected pharmaceuticals, and identify research areas for clinical advances in the treatment of pediatric poisonings. A hazard factor was devised to assess more objectively the pediatric poisoning hazard posed by pharmaceutical and nonpharmaceutical products. By considering the frequency and extent of injury following actual exposures, the hazard factor reflects more than the acute toxicity of individual ingredients and is also influenced by such variables as packaging, accessibility, availability (as a reflection of marketing), formulations, and closure types. Of the 3,810,405 exposures involving children younger than 6 years of age reported to poison centers in 1985 through 1989, 2117 patients experienced a major outcome (life-threatening effect or residual disability) and an additional 111 fatalities occurred. The three most commonly implicated substance categories, accounting for 30.4% of reported exposures, include cosmetics and personal care products, cleaning substances, and plants. All had low hazard factors, with significant hazards being limited to a small number of products identified herein. Thus this analysis of hazard factors demonstrates that frequent exposure does not imply toxicity. Iron supplements were the single most frequent cause of pediatric unintentional ingestion fatalities, accounting for 30.2% of reported pediatric pharmaceutical unintentional ingestion fatalities reported over an 8-year period. Antidepressants, cardiovascular medications, and methyl salicylate follow in frequency of pediatric pharmaceutical deaths. Hydrocarbons (including five lamp oil deaths) and pesticides were each implicated in 12 pediatric ingestion fatalities during the 8-year period.

TI: [Acute poisoning in childhood]

TO: Akute Vergiftungen im Kindesalter.

AU: Gossweiler-B; Meier-Abt-PJ; Wyss-PA

AD: Schweizerisches Toxikologisches Informationszentrum Zurich.

SO: Ther-Umsch. 1994 Sep; 51(9): 622-7

AB: Accidental ingestions of noxious substances are frequent events during childhood, especially in children one to three years of age. In contrast, severe symptoms and a serious outcome of these intoxications have been observed rather rarely; therefore, it is very important to avoid unnecessary and potentially harmful therapeutic measures. An extensive body of information has been collected nationally and internationally, allowing an accurate risk assessment in a constantly increasing number of cases. If there is need for treatment at all, the early application of activated charcoal (dose: 1 g/kg body weight) will efficiently inhibit absorption of noxious substances in most instances. Whereas the first dose of activated charcoal is administered to block absorption, repeated administration (0.5 g/kg body weight, every 2 to 4 hours) has been shown to shorten half-life and enhance the nonrenal clearance of chemically different substances even after absorption. Only few substances like heavy metals, lithium, or alcohols are not adsorbed by activated charcoal. Whole bowel irrigation may be a valuable alternative in cases where activated charcoal has been shown to be ineffective. Poisoning with ferrum formulations is an instructive example of this type of intoxication. Gastric lavage and pharmacologically induced emesis are no longer considered a routine treatment in poisoning but rather a special therapeutic option for very special situations. In all cases of severe poisoning, maintenance of vital functions, applying the principles of emergency medicine, has to have first priority.

TI: The risk associated with poisonings in children.

AU: Marchi-AG; Messi-G; Renier-S; Gallone-G; Peisino-MG; Vietti-Ramus-M; Raspino-M; Chiossi-M; Lattere-M; Polla-D

AD: Emergency Department and Poison Control Centre, IRCCS Istituto per l’Infanzia, Trieste, Italy.

SO: Vet-Hum-Toxicol. 1994 Apr; 36(2): 112-6

AB: The risk associated with poisonings in children was assessed on 6175 subjects admitted to the pediatric hospitals of 3 regions of Northern Italy between 1975 and 1990. The frequency of exposures and the severity of sequelae allowed high- and low-risk substances to be identified. Risks were studied separately in the 0-4, 5-9 and 10-13 y age group to determine age-related differences. A decrease in drug-related poisonings and an increase of those caused by household products, particularly in the first 2 y of life, were observed in 1983-90 as against 1975-82 in association with the introduction of safety caps and containers for drugs. Our study points out the need to strengthen active primary prevention through health education and parental and adolescent information, and to improve passive prevention through the extension of safety closures to household products.

TI: The effect of providing ipecac to families seeking poison-related services.

AU: Schnell-LR; Tanz-RR

AD: Division of General Academic and Emergency Pediatrics, Children’s Memorial Hospital, Chicago, IL 60614.

SO: Pediatr-Emerg-Care. 1993 Feb; 9(1): 36-9

AB: Although home availability of ipecac is recommended for families with young children in case of unintentional toxic ingestion, fewer than half actually have it. We designed a study to evaluate the efficacy of providing ipecac to families requiring poison-related services. Families (n = 100) contacting the Children’s Memorial Hospital (CMH) emergency department (ED)/poison center were enrolled. Baseline general poison knowledge and self-report of ipecac availability were obtained. Ipecac was discussed, and families were mailed general safety and poison information, the ED telephone number, and a coded package of ipecac, with instructions. Approximately three months later a follow-up call was made to determine change in knowledge, access to our ED (or any poison center) phone number, and availability of ipecac. Initially 71% had heard of ipecac, 51% knew what it did, and 47% said they had it. Ninety families were contacted in follow-up, 82 by phone and eight by mail. Eighty-three of 90 (92%) knew what ipecac did (vs 51/100 initially; P < 0.0001). Sixty-eight of 90 (76%) knew the ED or a poison control phone number (vs 39/100 initially; P < 0.0001). Seventy-seven of 82 (94%) reached by phone read the ipecac code number (vs 47/100 initial self-reports of possession; P < 0.0001). The data indicate that providing ipecac to poison service users increases availability in the home for at least three months. Poison service users may be particularly amenable to anticipatory guidance and interventions related to poisoning prevention and preparedness.

TI: Accidental poisoning of children in Japan: a report from the Japan Poison Information Center.

AU: Goto-K; Kuroki-Y; Shintani-S; Kusakawa-S

AD: Japan Poison Information Center, Tokyo.

SO: Acta-Paediatr-Jpn. 1993 Jun; 35(3): 193-200

AB: The Japan Poison Information Center (JPIC) was founded only 6 years ago as a result of co-operation between the Ministry of Health and Welfare, the Japanese Association for Acute Medicine, the Japan Pediatric Society and other related medical organizations. The JPIC is the only poison information center admitted by the Ministry of Health and Welfare to provide toxicological information to medical personnel and the general public, and has two offices on duty in alternating 24 h shifts. Every year, JPIC receives about 30,000 inquiries. About 82% of these inquiries are from the general public and 84% of the patients are children 5 years and younger. We contrasted the data in the fiscal year 1991 with the data of the American Association of Poison Control Centers (AAPCC). Child poison exposure in Japan is characterized by a high exposure rate of children under 1 year of age to (mostly) household products. The JPIC also analyzed the cause of tobacco ingestion. It is considered that the Japanese lifestyle causes differences from those reported by AAPCC. We report the accidental poisoning of children in Japan.

ЗАВЪРШЕНИ И ДЕЙСТВАЩИ ПРОЕКТИ

РЕГИОНАЛНА ПРОГРАМА “ГЛАУКОМА

Доц. д-р Чавдар Балабанов

От 01.09.1997 г. е разкрит специализиран консултативен глаукомен кабинет, намира се в консултативна поликлиника на ВМИ - Плевен. Кабинетът работи 5 дни в седмицата по 6.5 часа и се обслужва от лекарите д-р Лидия Каменова - ординатор и д-р Диана Топалова - ст. асистент по график и от 1/2 бройка медицинска сестра.

Създадена е компютърна програма за база данни при регистриране на глаукомно болните.

Изготвен е информационен материал, който се раздава на глаукомно болните.

Проведен е еднодневен семинар на офталмолозите от Северозападното дружество на тема “Организация на обхващане и лечение на глаукомно болните в Северозападния регион”.

От стартирането на проекта до м. май 1998 г. в кабинета са извършени 3000 прегледа. Диспансеризирани са 600 глаукомно болни, 112 от които са с новооткрита глаукома.

От м. май, със съдействието на фондация “Отворено общество”, бе дарен компютър, което даде възможност за използване на експертна програма за регистриране на пациентите.

Програмата все още не е добила типичен регионален характер поради липсата на компютри в регионалните глаукомни кабинети и невъзможността на глаукомния център да поеме по-голям брой пациенти.

Съществен проблем е липсата на диагностична литература, съвременен тонометър компютърен периметър и др.

ПодобрЯване на обслужването на болни с бронхиална астма и ХОББ в региона на гр. Видин

д-р Илиев - пневмолог - ч. л. к.

Проектът е терапевтично-образователен и е ориентиран основно към доболничния контрол на болни с бронхиална астма, които са обособени в хетерогенна възрастова група, провела неколкократно групово обучение по типа на “Астма училище” и в момента се контролира в ч. л. к. “Пулма”. Може да се каже, че като цяло целевата група е разширена в сравнение с есента и наброява 125 човека, но коректно партниращите пациенти са около 70.На 28 болни са раздадени ПФМ за надомен мониторинг и те са снабдени с дневни карти. Една част от тях са във фаза на изработване на индивидуален план за поведение при астма. Разполагаме и с 5 оборотни ПФМ, които се ползват за диагностично уточняване. Болните се контролират и със спирометрична оценка в кабинета според индивидуалното протичане на заболяването, но най-малко двукратно. С цел коректно партниране и регулярно посещение сме изработили “Абонаментни карти”, в които се вписва графикът за посещение в кабинета.

Продължава коректното партниране с лекарите от ФСМП, като в резултат на това тяхното поведение преастматично болен е с по висока степен на професионализъм. Не срещнахме партниране в регионите на Белоградчик и Кула за оформяне на целеви групи. В момента се сформира група от болни с ХОББ.

Обстоятелството, че проектът е базиран на територията на частно здравно звено на фона на нерегламентираните на републиканско ниво взаимоотношения между държавно и частно здравеопазване създава затруднения, които ограничават възможността за бързо и качествено обхващане на новооткрити болни и възможностите за партниране със специализираните кабинети от публичното здравеопазване.

Оптимизиране на антибиотиЧната терапиЯ Чрез следене на нивото на CRP в пациенти с бактериални инфекции

д-р Радко Л. Велков

Закупени са реактивите за изолиране на CRP.Разработена е схема за пречистването му и се работи върху получаването на препарат с нужната чистота съвместно с инженер-химик. Осигурени са опитни животни за получаване на диагностични серуми - привлечен е ветеринарен лекар.

Създадена е организация за събиране на човешки серум като суровина за получаване на CRP.

Проектът се развива с по-бавно от очакваното темпо поради трудното намиране на допълнителни средства, осигуряващи реализирането на първите етапи от него.

НамалЯване на кариозността на постоЯнното съзъбие на децата от II група в ЦДГ “Слънце” Чрез провеждане на профилактиЧна образователна програма

Василка Русева

Проведени са срещи с директора на ЦДГ “Слънце” Виолета Гълъбова и с родителите на децата. Попълнени са анкетни карти. По данните, които ще получим след обработката им, ще следим за навиците, които родителите са успели (или не са успели) да създадат в своите деца. Ще се направят изводи за отношението на родителите към профилактиката на зъбния кариес. След приключване на образователно-профилактичната програма ще бъде проведена нова анкета. Анализираните резултати от двете анкети ще бъдат сравнени и ще бъдат направени съответните изводи.

След първата демонстрация за правилно миене на зъбите, децата за запознават с десетте правила за миене на зъбите. Раздадени са и четки за зъби, получени по програма “Решаване на проблеми за по-добро здраве”. Публикация, свързана с проблема за зъбната профилактика излезе във в-к “Посоки”. По кабелна телевизия “Евроком” бе излъчен репортаж, свързан със стартирането на проекта за намаляване зъбния кариес.

ПромоциЯ на кърменето в гр. Плевен

д-р В. Недкова - ВМИ - Детска клиника - Плевен

Кърменето е един незаменим начин за осигуряване на идеална храна за нормален растеж и развитие на малките деца. В много случай социални, икономически и културни причини водят до намаляване продължителността на кърменето. За да може майката да започне и продължи да кърми, тя има нужда от подкрепа от семейството си, от обществото и цялата система на здраве-опазване. Твърде често медицинският персонал няма достатъчни познания за кърменето, няма опит в осигуряването на подходяща подкрепа на майките и не е наясно с основните фактори, които определят дали майките могат да кърмят децата си /1, 2,5,6/.

Цел на нашето проучване беше да установим начинът на хранене на децата през 1997г в района на гр. Плевен след стартиране на една образователна програма за обучение на акушерки, сестри от Детските консултации, на бременни жени по проблемите на физиология на лактацията, методи на стимулиране на кърмата.

МАТЕРИАЛ И МЕТОД

За изпълнение на поставената цел проведохме съвместно с фирмата “НЕСТЛЕ” двудневен курс за обучението по проблемите на кърменето с медицински сестри от Детски консултации. Организирани бяха и две дискусии с акушер - гинеколози, педиатри по проблемите за хранене на новородените и ролята на персонала от женска и детска консултация и АГ клиника. Въведохме воденето на анкети и карти в личните амбулаторни картони за начина на хранене на кърмачетата през първите 6 месеца от живота им. Проучването обхваща 165 деца. Резултатите са сравнени с начина на хранене на 280 деца през 1995г и 46 двумесечни кърмачета през 1996г.Използуван е алтернативен анализ чрез определяне процентното съотношение на децата според начина на хранене.

РЕЗУЛТАТИ

На Таблица 1 е представен начинът на хранене на едномесечни деца през трите изследвани години.

Таблица 1

ХРАНЕНЕ НА ДЕЦАТА ПРЕЗ ПЪРВИЯ МЕСЕЦ /в проценти/

1995г 1996г 1997г

ЕХ 80.0 87.9 79.8

СХ 16.0 0.7 11.3

ИХ 4.0 11.4 8.9

Почти всички деца се кърмят през първия месец от живота им и през трите изследвани години. Само 11.4%за 1996г и 8.9%за 1997г от децата са лишени от майчина кърма.

Таблица 2

ХРАНЕНЕ НА ДЕЦАТА ПРЕЗ ВТОРИЯ МЕСЕЦ /в проценти/

1995г 1996г 1997г

ЕХ 50.0 85.8 49.8

СХ 45.6 3.5 38.6

ИХ 4.4 11.7 11.7

През 1995г и 1997г двумесечните деца са кърмени едва в 50%, но през 1996г се наблюдава увеличение на този процент на 85.8%. Видно е обаче, че процентът на смесено хранените деца е висок за 1995г и 1997г - съответно 45.6%и 38.6%.

През 1997г през четвъртия месец са кърмени 51%от децата, като в района на две от поликлиниките той достига до 53.7%. След четвъртия месец обаче се кърмят едва 23.7%от децата и този показател е чувствително по-нисък в сравнение с 1996г,когато 46.4%от децата са кърмени. Изкуствено хранените деца са консумирали предимно адаптирани млека в 58.0%, а 42.0%са хранени с кв. мляко.

ОБСЪЖДАНЕ:

В последните години в редица страни на Европа се увеличава броя на кърмените деца. Според M.Deheeger - 1998г,71%от французойките кърмят до двумесечна възраст. Нашите резултати също показват, че 80%от децата получават майчина кърма. През 1997г това е за сметка на смесено хранените деца. На 4 месечна възраст се кърмят 51%от децата, а в районите на две от поликлиниките, където образователната програма в подкрепа на кърменето беше добре проведена, кърмените деца бяха 53.7%. Тези данни са по-високи от резултатите за Амстердам /Wal M. F - 1995/, че 21%от децата на 3 месечна възраст получават изключително кърма и 15%са на смесено хранене. След 4 месеца наблюдаваме чувствителен спад на кърмените деца през 1997г - 23.7%, за разлика от 1996г,когато 46.4%от децата са кърмени /3, 4/. Началото на прилагане на здравни и социални мерки за защита и насърчаване на кърменето са поставени. Усилията бяха насочени за информираност на майките в женските и детските консултации по въпросите на детското хранене, както и усилия за повишаване съзнанието за особено важната роля на здравните заведения за защита и поощряване на кърменето.

КНИГОПИС

1.Маринова М. и съавтори. Хранене на деца в кърмаческа възраст, отглеждани в домашна обстановка. Педиатрия 1991,1,78-82.

2.Мумджиев Н. Майчина кърма и кърмене. Медицина и Физкултура. 1984, 175.

3.Ashraf R.N. et al. Early child in Lahore, Pakistan:V. Feeding paterns.Acta Pediatr: Suppl.Vol.82, Suppl. 90, 1993, p 47-61.

4.Byrue B., Hull D., Breast milk for preterm infants. Prof. Care Mother Child: vol 6 N 2, 1996, p 39, 42-45.

5.Blomguist H.K.et al. Sipplementary feeding in the maternity ward shorteus the duration of breast feeding. Acta Periatr.1994, 83, 1122- 6.

6.Zetterstrom R.Trents in research on infant nutrition, past present and future.Acta Pediatr., 1994, Suppl. 402,1-3.

7.Wal M.F.van der. Borstroeding onder autochtone et allchtone moeders in Amsterdam 1992-1993. Breast feeding among autochthonous and allochthonous mothers in Amsterdam 1992-1993. Ned.Tiydschr. Geneeskd.vol.193, N 1,1995,p.19-22.

Грешки при храненето на кърмаЧетата и неблагоприЯтните последици върху здравето им

д-р Евгения Бързашка

Неправилното хранене в кърмаческа възраст води до тежки нарушения в развитието на децата и патологичен терен за протичане на много заболявания -дистрофни, малабсорбционни и мал-дигестивни синдроми.

По наши предварителни проучвания 70.2 % от кърмачетата в Плевенски регион се хранят изкуствено и неправилно се захранват с немлечни храни.

С оглед проучване грешките при храненето на кърмачетата направихме анкетни фишове, с които проспективно регистрирахме храненето и развитието на децата в Плевенския регион.

На първо място трябва да отбележим неблагоприятните тенденции за увеличаване на изкуствено хранените деца през последните години и увеличаване броя на майките, нежелаещи да кърмят.

През 1996 г., 46.4 % от децата до 6-месечна възраст се хранят изкуствено, а през 1997 г. този брой нараства до 76.3 %.

Неблагоприятна, но най-вероятно свързана с промяната на социално-икономическия статус на населението е тенденцията за нарастване броя на децата хранени с квасено мляко.

ИЗКУСТВЕНО ХРАНЕНИ ДЕЦА

1996 г. 1997 г.

Кв. мляко 24.6% 42%

NAN 69% 20.6 %

Други адаптиран млека 6.4 % 34.7 %

Захранването е важен етап от развитието на кърмачето и е свързано с преминаване от млечно към немлечно хранене, приемане на по-консистентна кашава и твърда храна . Чрез него животът на детето започва да се доближава все повече до живота на възрастния организъм. Оптималната възраст на захранването е 16-та седмица. Преди това се смята, че то е немотивирано, но в практиката най-често се възприема индивидуалният подход , в зависимост от начина на хранене, физическото развитие и апетита на детето.

Ранното захранване най-често е свързано с наднормена телесна маса, затлъстяване в по-късна възраст и развитие на атеросклероза. При преждевременно въвеждане на храните у кърмачето започва претоварване на организма с електролити, в момент, когато бъбреците са все още функционално незрели и поддържат нормалния осмаларитет на екстрацелуларната течност.

Алергените от хранителен произход лесно преодоляват несъвършената бариера на чревната лигавица и алергизират организма. Ранното захранване и с по-голям риск от чревни инфекции и последващите след това малабсорбционни смущения.

Късното захранване също има неблагоприятни последици, най-вече развитие на недоимъчни състояния и хипотрофии.

Нашите проучвания показват следните резултати по отношение на захранването на децата.

1. Зеленчуково пюре :

през 4-тия месец - 72%(правилно);

преди 4-тия месец - 19%;

след 4-тия месец - 9%.

2. Жълтък:

през 4-тия месец - 39%(правилно);

преди 4-тия месец - 48%;

след 4-тия месец - 8;

5 % не са получили жълтък до края на първата година.

3. Млечно-брашнени каши:

през 5-тия месец - 25.2%(правилно);

през 4-тия месец - 6.4%;

преди 4-тия месец - 0.7%

след 5-тия месец - 2.1%

8% от децата не са хранени с млечно-брашнени каши.

4.Месно пюре:

през 6-тия месец - 43,6 % (правилно);

през 5-тия месец - 50%;

преди 5-тия месец - 0.7%;

след 6-тия месец - 2.1%;

3.6 % от децата не са хранени с месно пюре.

В заключение трябва да отбележим, че храненето и захранването на децата има не само медицинско, но и социално-икономическо значение и в тежките години на прехода то трябва да бъде грижа на цялото общество.

Програма за ограниЧаване на тютюнопушенето в уЧениЧеска възраст

Георги Пенков - Бургас

В гимназията с преподаване на романски езици "Г.С. Раковски" , гр. Бургас по линия на програмата беше проведе семинар на тема "За по-добро здраве в ученическа възраст, по време на който д-р Руслан Шейков запозна подрастващите - ученици от VIII до Х клас с вредата от тютюнопушенето. Беше направена и промоцията на плакат против тютюнопушенето, който по-късно беше разпространен и в други училища и някои обществени заведения. Беше проведена анкета, целяща да се установи нивото на знания за вредата от пушенето. Същата анкета ще бъде проведена отново с учениците, за да се отчете доколко е резултатна програмата.