http://hdl.handle.net/1956/966 Search the Channel search http://bora.uib.no/simple-search http://hdl.handle.net/1956/2265 Title: Antimicrobial resistance in bacterial infections in urban and rural Tanzania <br/> <br/>Authors: Blomberg, Bjørn <br/> <br/>Abstract: Infectious diseases cause one in every six deaths worldwide. Antimicrobial drugs have helped dramatically in curing patients suffering from bacterial infections. However, emerging antimicrobial resistance in bacteria threatens to undermine the management of bacterial infections. Developing countries have greater burden of infectious diseases. A number of factors, which may promote antimicrobial resistance such as availability of antimicrobials without prescription, use of counterfeit or substandard antimicrobial drugs, suboptimal hygiene, immunosuppression due to malnutrition or HIV, may be more frequent in developing countries. At the same time, consequences of antimicrobial resistance may be felt harder in resource-poor settings, since second-line antimicrobial drugs for resistant bacteria may be unavailable or unaffordable. There are many unresolved questions regarding antimicrobial resistance in general, including regarding its impact on patient outcome. In Sub-Saharan, some studies on antimicrobial resistance have been done, but, by and large, the issue has received far too little attention. We set out to improve available antimicrobial susceptibility data in Tanzania. We implemented a free-of-charge computerized software (WHONET) for resistance surveillance in the University Teaching Hospital in Dar es Salaam. This exercise showed that resistance surveillance is feasible in the setting and provided useful data on antimicrobial resistance. The surveillance data indicated high rates of resistance to common antibiotics in Gram-negative bacteria. We performed a prospective, observational cohort study of bloodstream infections in 1828 admissions of children with fever or suspected serious infection at the hospital. We performed blood culture, malaria testing and HIV testing and collected clinical data from the study subjects. The study showed that a disturbingly high proportion of Gram-negative bacteria produced extended-spectrum beta-lactamases (ESBL), with prevalent genotypes being TEM-63, SHV-12 and CTX-M 15. The ESBL-producing bacteria had a high rate of resistance to almost all other available drugs, except for ciprofloxacin, and bloodstream infection caused by these multiresistant bacteria were associated with extremely high case-fatality rates. The study showed that inappropriate treatment due to antimicrobial resistance, as well as malnutrition and HIV-infection, were risk factors for death in children admitted with bloodstream infections. We investigated an outbreak of pediatric / neonatal meningitis at Haydom Lutheran Hospital, finding that Salmonella serovar Enteritidis, resistant to ampicillin and susceptible to gentamicin, was the cause of the outbreak. Although the numbers were small, the case-fatality rate for meningitis caused by these organisms was 100% (5/5). Antimicrobial resistance varies greatly from one geographical area to another. Thus, data obtained at major hospitals in urban centers may not be representative for the whole country. We analyzed the antimicrobial susceptibilities of isolates of uropathogenic bacterial obtained from the urine of pregnant women in a rural area in Northern Tanzania. This study indicated that there is less antimicrobial resistance in E. coli isolates from this rural area than in isolates from the commercial capital, Dar es Salaam. In formulating guidelines for antimicrobial use this possible rural-urban difference should be taken into account. For some of the bacteria carrying resistance traits for multiple antimicrobials, there are actually no good alternative drugs available. Based on the findings of these studies, we recommend sober, rational use of antimicrobial drugs, restrictions on sale and use of antimicrobials, and attention to hygiene. Tue, 15 May 2007 22:58:59 GMT http://hdl.handle.net/1956/2142 Title: Early outcome and restenosis after coronary stenting : intervention with stent-coatings, antioxidants and radiation <br/> <br/>Authors: Kuiper, Karel Kier-Jan Thu, 15 Mar 2007 22:58:59 GMT http://hdl.handle.net/1956/2101 Title: The effects of smoking cessation intervention in patients with coronary heart disease : a randomised, controlled trial <br/> <br/>Authors: Quist-Paulsen, Petter <br/> <br/>Abstract: Background: Smoking cessation is the most important action to reduce mortality after a coronary event. Largely, it has previously been unknown whether a smoking cessation program applicable in an ordinary clinical setting has any impact on smoking cessation rates in patients with coronary heart disease, and whether such a program is cost effective. Objectives: To determine whether a nurse managed smoking cessation intervention changes abstinence rates in patients admitted for coronary heart disease, to assess the predictors of smoking cessation, to evaluate whether smoking cessation has any impact on Quality of Life, to estimate the cost effectiveness of the smoking cessation program, and to appraise the feasibility of a fear arousal message. Design: Randomised controlled trial of usual care compared with individual smoking cessation intervention. Setting: The cardiac ward in Sørlandet Sykehus, Kristiansand, Norway. Participants: 240 smokers under 76 years of age admitted for myocardial infarction, unstable angina or cardiac bypass surgery. 118 were randomly assigned to the intervention and 122 to usual care (control group). 218 patients (91%) completed the study and were assessable at 12 months follow up. Methods: The intervention was based on an especially made 17 page booklet and focused on fear arousal and relapse prevention. Individual smoking cessation was delivered by cardiac nurses without special training. The intervention was initiated in hospital, and the participants were telephoned regularly for at least five months. Abstinence rates were determined by self report and biochemical verification. Survival data from previously published investigations, with life time extrapolation of the survival curves by survival function modelling, were used to be able to estimate the cost effectiveness of the program. Baseline characteristics were prospectively recorded, and health-related Quality of Life was measured at baseline and at 12 months follow up. The patient satisfaction was assessed at 12 months follow up. Results: 12 months after randomisation 57.0% and 37.3% were abstinent in the intervention and control groups, respectively (95% confidence interval for the difference 6.4 to 33.0). The number needed to treat to get one additional quitter was 5.1 (95% CI 3.0 to 15.6). Assuming all drop outs returned to smoking at 12 months, the cessation rates were 50.0% and 37.0% in the intervention and control group, respectively (95% CI for the difference 0.4 to 25.7). In a life time perspective, the incremental cost per year of life gained by the cessation program was Euro 280 and Euro 110 in the low and high risk group, respectively (2000 prices). These costs compare favourably to other treatment modalities in patients with coronary heart disease, being approximately 1/25 the cost of both statins in the low risk group and angiotensin converting enzyme inhibitors in the high risk group. In a sensitivity analysis, the costs remained low in a wide range of assumptions. The participants were in general satisfied with the cessation program, indicating that implementing a fear arousal message is a feasible method. In multivariate logistic regression analysis, a high level of nicotine addiction was a strong negative predictor of smoking cessation in both the intervention and the control group. The quitters and sustained smokers had similar improvements in all Quality of Life domains from baseline to 12 months follow up. Further, after adjustment for differences in baseline characteristics, the Quality of Life at baseline was not significantly associated with smoking cessation at 12 months follow up. Conclusions: A smoking cessation program delivered by cardiac nurses without special training, significantly reduced smoking rates 12 months after hospitalisation for coronary heart disease. The program was very cost effective compared to other treatment modalities in patients with coronary heart disease in terms of cost per life year gained. Among those with a high level of nicotine addiction, more effective cessation programs are needed. Thu, 08 Feb 2007 22:58:59 GMT http://hdl.handle.net/1956/2068 Title: Small-Diameter Nerve Fiber Neuropathy in Patients with Systemic Autoimmune Diseases <br/> <br/>Authors: Gøransson, Lasse Gunnar Thu, 12 Oct 2006 22:58:59 GMT http://hdl.handle.net/1956/1919 Title: Antiretroviral therapy at a district hospital in Ethiopia prevents death and tuberculosis in a cohort of HIV patients <br/> <br/>Authors: Jerene, Degu; Næss, Are; Lindtjørn, Bernt <br/> <br/>Abstract: Background: Although highly active antiretroviral therapy (HAART) reduces mortality in the developed world, it remains undocumented in resource-poor settings. We assessed the effect of HAART on patient mortality and tuberculosis incidence rate under routine clinical care conditions in Ethiopia. The objective of this study was to assess the effect of HAART on patient mortality and tuberculosis incidence rate under routine clinical care conditions in a resource-limited setting in south Ethiopia. Starting in January 2003, we followed all consecutive adult HIV infected patients who visited the HIV clinic. Since August 2003, we treated patients with HAART. Only basic laboratory services were available. Results: We followed 185 patients in the pre-HAART cohort and 180 patients in the HAART cohort. The mortality rate was 15.4 per 100 person-years of observation (PYO) in the HAART group and tuberculosis incidence rate was 3.7 per 100 PYO. In the pre-HAART group, the mortality rate was 58.1 per 100 PYO and the tuberculosis incidence rate was 11.1 per 100 PYO. HAART resulted in a 65% decline in mortality (adjusted hazard ratio [95%CI] = 0.35 [0.19–0.63]; P < 0.001). Tuberculosis incidence rate was lower in the HAART group (adjusted hazard ratio [95%CI] = 0.11 [0.03–0.48]; P < 0.01). Most of the deaths occurred during the first three months of treatment. Conclusion: HAART improved survival and decreased tuberculosis incidence to a level similar to that achieved in the developed countries during the early years of HAART. However, both the mortality and the tuberculosis incidence rate were much higher in terms of absolute figures in this resource-limited setting. Attention should be paid to the early weeks of treatment when mortality is high. The high tuberculosis incidence rate, when coupled with the improved survival, may lead to increased tuberculosis transmission. This highlights the need for strengthening tuberculosis prevention efforts with the scale-up of treatment programmes Thu, 06 Apr 2006 22:58:59 GMT http://hdl.handle.net/1956/1916 Title: A large community outbreak of waterborne giardiasis- delayed detection in a non-endemic urban area <br/> <br/>Authors: Nygård, Karin; Schimmer, Barbara; Søbstad, Øystein; Walde, Anna; Tveit, Ingvar; Langeland, Nina; Hausken, Trygve; Aavitsland, Preben <br/> <br/>Abstract: Background: Giardia is not endemic in Norway, and more than 90% of reported cases acquire the infection abroad. In late October 2004, an increase in laboratory confirmed cases of giardiasis was reported in the city of Bergen. An investigation was started to determine the source and extent of the outbreak in order to implement control measures. Methods: Cases were identified through the laboratory conducting giardia diagnostics in the area. All laboratory-confirmed cases were mapped based on address of residence, and attack rates and relative risks were calculated for each water supply zone. A case control study was conducted among people living in the central area of Bergen using age- and sex matched controls randomly selected from the population register. Results: The outbreak investigation showed that the outbreak started in late August and peaked in early October. A total of 1300 laboratory-confirmed cases were reported. Data from the Norwegian Prescription Database gave an estimate of 2500 cases treated for giardiasis probably linked to the outbreak. There was a predominance of women aged 20–29 years, with few children or elderly. The risk of infection for persons receiving water from the water supply serving Bergen city centre was significantly higher than for those receiving water from other supplies. Leaking sewage pipes combined with insufficient water treatment was the likely cause of the outbreak. Conclusion: Late detection contributed to the large public health impact of this outbreak. Passive surveillance of laboratory-confirmed cases is not sufficient for timely detection of outbreaks with non-endemic infections. Wed, 24 May 2006 22:58:59 GMT