High prevalence of bronchiectasis is linked to HTLV-1-associated inflammatory disease.

BACKGROUND: Human T-lymphotropic virus type 1 (HTLV-1), a retrovirus, is the causative agent of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and adult T-cell leukaemia/lymphoma (ATLL). The reported association with pulmonary disease such as bronchiectasis is less certain. METHODS: A retrospective case review of a HTLV-1 seropositive cohort attending a national referral centre. The cohort was categorised into HTLV-1 symptomatic patients (SPs) (ATLL, HAM/TSP, Strongyloidiasis and HTLV associated inflammatory disease (HAID)) and HTLV-1 asymptomatic carriers (ACs). The cohort was reviewed for diagnosis of bronchiectasis. RESULT: 34/246 ACs and 30/167 SPs had been investigated for respiratory symptoms by computer tomography (CT) with productive cough +/- recurrent chest infections the predominant indications. Bronchiectasis was diagnosed in one AC (1/246) and 13 SPs (2 HAID, 1 ATLL, 10 HAM/TSP) (13/167, RR 19.2 95 % CI 2.5-14.5, p = 0.004) with high resolution CT. In the multivariate analysis ethnicity (p = 0.02) and disease state (p < 0.001) were independent predictors for bronchiectasis. The relative risk of bronchiectasis in SPs was 19.2 (95 % CI 2.5-14.5, p = 0.004) and in HAM/TSP patients compared with all other categories 8.4 (95 % CI 2.7-26.1, p = 0.0002). Subjects not of African/Afro-Caribbean ethnicity had an increased prevalence of bronchiectasis (RR 3.45 95 % 1.2-9.7, p = 0.02). CONCLUSIONS: Bronchiectasis was common in the cohort (3.4 %). Risk factors were a prior diagnosis of HAM/TSP and ethnicity but not HTLV-1 viral load, age and gender. The spectrum of HTLV-associated disease should now include bronchiectasis and HTLV serology should be considered in patients with unexplained bronchiectasis

Respiratory and Urinary Tract Infections, Arthritis, and Asthma Associated with HTLV-I and HTLV-II Infection

Human T-lymphotropic virus types I and II (HTLV-I and -II) cause myelopathy; HTLV-I, but not HTLV-II, causes adult T-cell leukemia. Whether HTLV-II is associated with other diseases is unknown. Using survival analysis, we studied medical history data from a prospective cohort of HTLV-I– and HTLV-II–infected and –uninfected blood donors, all HIV seronegative. A total of 152 HTLV-I, 387 HTLV-II, and 799 uninfected donors were enrolled and followed for a median of 4.4, 4.3, and 4.4 years, respectively. HTLV-II participants had significantly increased incidences of acute bronchitis (incidence ratio [IR] = 1.68), bladder or kidney infection (IR = 1.55), arthritis (IR = 2.66), and asthma (IR = 3.28), and a borderline increase in pneumonia (IR = 1.82, 95% confidence interval [CI] 0.98 to 3.38). HTLV-I participants had significantly increased incidences of bladder or kidney infection (IR = 1.82), and arthritis (IR = 2.84). We conclude that HTLV-II infection may inhibit immunologic responses to respiratory infections and that both HTLV-I and -II may induce inflammatory or autoimmune reactions

Health Status and Health Maintenance Practices among Doctors and Nurses at Two Hospitals in Jamaica

ABSTRACT The health of doctors and nurses is of paramount importance because they must be well to perform their jobs optimally under difficult conditions. However, the challenge of their working environment and the culture of their professions often lead to physical and mental illnesses. Despite this, there are several barriers to doctors and nurses seeking healthcare. In this study, the health status and health maintenance practices of doctors and nurses at two hospitals in Kingston, Jamaica, were assessed. This population was previously reported to have a 27% prevalence of probable mental distress based on the General Health Questionnaire 30 (GHQ30). Two hundred and twelve doctors and nurses were recruited into the study. The reported prevalence of chronic diseases was determined while mental health status was based on the GHQ30, reported signs and symptoms of stress and job satisfaction. Health maintenance practices studied included, health-seeking behaviour, willingness to seek counselling, reported source of emotional support and use of alcohol and tobacco as coping strategies. Although, less than 50% of study participants reported that they were satisfied with their job, the mean number of days missed from work in the “last six months” was less than two and a half days. The mean time for “last doctor’s visit” for nurses and doctors in the current study were 0.93 and 2.4 years, respectively. Females were more willing to seek medical attention than males. More than 50% reported signs and symptoms of stress and major sources of emotional support were friends (55.7%), followed by spouses (36.0%) and colleagues (12.3%). The prevalence of chronic diseases was less than1% and alcohol and tobacco did not appear to be major coping strategies. The population appeared to be physically healthy and despite the known prevalence of probable mental distress, doctors and nurses appeared unwilling to seek healthcare. Probable barriers to seeking healthcare included confidentiality issues and the need to appear healthy to colleagues, patients and the community. El nivel de Salud y las Prácticas de Mantenimiento de la Salud entre los Doctores y Enfermeras en dos Hospitales de Jamaica RESUMEN La salud de doctores y enfermeras es un asunto de importancia primordial porque ellos tienen que gozar de salud para poder realizar su trabajo de manera óptima bajo condiciones difíciles. Sin embargo, los retos de su ambiente de trabajo y la cultura de sus profesiones conducen a menudo a enfermedades físicas y mentales. A pesar de esto, existen varios obstáculos para los doctores y enfermeras que buscan el cuidado de la salud. En este estudio, se evaluaron el nivel de salud y las prácticas de mantenimiento de la salud de doctores y enfermeras en dos hospitales en Kingston, Jamaica. Previamente se reportó que esta población tenía una prevalencia de un 27% de probable distrés mental, sobre la base del Cuestionario General de Salud 30 (GHQ30). Se reclutaron doscientos doce doctores y enfermeras para el estudio. Se determinó la prevalencia de enfermedades crónicas a partir de reportes, mientras que el nivel de salud se basó en el GHQ30, y los signos y señales de estrés así como la satisfacción del trabajo reportados. Las prácticas de mantenimiento de la salud estudiadas incluyeron el comportamiento de búsqueda de la salud, la disposición a buscar aconsejamiento, reportes de fuentes de apoyo emocional y uso del alcohol y el tabaco como estrategias de enfrentamiento. Aunque menos de 50% de los participantes en el estudio reportaron que estaban satisfechos con su trabajo, el número promedio de días de trabajo perdidos en “los últimos seis meses” fue menos de dos días y medio. El tiempo promedio de “la última visita del médico” para enfermeras y doctores en el estudio presente fue 0.93 y 2.4 años, respectivamente. Las mujeres estuvieron más dispuestas a buscar asistencia médica que los hombres. Más del 50% reportaron signos y síntomas de estrés, y las fuentes principales de apoyo emocional fueron los amigos y amigas (55.7%), seguidos por cónyuges (36.0%) y colegas (12.3%). La prevalencia de las enfermedades crónicas fue menos del 1%, y el alcohol y el tabaco no parecieron ser las estrategias principales de estrategias de enfrentamiento. La población parecía estar físicamente saludable y a pesar de la prevalencia conocida del probable distrés mental, tanto doctores como enfermeras parecían poco dispuestos a buscar atención a la salud. Los obstáculos probables a la búsqueda de la salud incluyeron problemas de confidencialidad y la necesidad de parecer saludable ante sus colegas, sus pacientes y la comunidad

Mental Well-being of Doctors and Nurses in Two Hospitals in Kingston, Jamaica

Hospital work involves some of the most stressful situations found in any workplace. Furthermore, hospital workers may be affected by non-work-related stress such as family responsibilities and financial difficulties, leading to impaired mental well-being and suboptimal performance. The aim of this study was to assess the level of general mental well-being among doctors and nurses from two hospitals in Kingston, Jamaica. A total of 212 doctors and nurses at the Kingston Public Hospital and the University Hospital of the West Indies were studied yielding a participation rate of 83.1%. A self-administered questionnaire was used to gather social and biomedical data and the General Health Questionnaire 30 (GHQ 30) used to determine general mental well-being. Probable caseness was defined as a GHQ 30 score > 5. Focus group discussions were also held with staff at both hospitals. A total of 27.4% of the study population met the GHQ-30 criteria (caseness) defining them as probable cases of mental distress. Cases and non-cases were not different in age, gender or hospital of employment. However, caseness was associated with years of professional experience, work-related and nonwork-related stress, serious financial difficulties and fears of coming to work. Significant predictors of increased risk of caseness were fear of coming to work (OR 3.06; CI 1.40, 6.70); professional experience in excess of five-years and high non-work-related stress. High work-related stress was associated with reduced risk of being classified a case, suggesting that work may have been therapeutic. Focus group discussions suggested that non-work stress was related to financial difficulties, commuting and child care, especially among nurses. Intervention to improve general mental well-being should be targeted at new employees and should address child care, commuting and financial management. "Bienestar Mental de Doctores y Enfermeras en dos Hospitales en Kingston, Jamaica" RESUMEN El trabajo en un hospital conlleva algunas de las situaciones más estresantes que puedan encontrarse en cualquier centro de trabajo. Además, los trabajadores hospitalarios pueden verse afectados por formas de estrés que no guardan relación directa con su trabajo, tales como responsabilidades fami-liares o dificultades financieras, las cuales traen como consecuencia perjuicios para el bienestar mental y una disminución del rendimiento laboral por debajo del nivel óptimo. El objetivo de este estudio es evaluar el nivel del bienestar mental general entre los doctores y enfermeras de los dos hospitales de Kingston, Jamaica. Se estudiaron un total de 212 doctores y enfermeras del Hospital Público de Kingston y el Hospital Universitario de West Indies, para una tasa de participación de 83.1%. Se aplicó una encuesta auto-administrada a fin de compilar datos biomédicos y sociales, y el Cuestionario de Salud General (CSG 30), usado para determinar el bienestar mental general. La casuidad1 probable se definió como una puntuación de CSG 30 > 5. También se sostuvieron dis-cusiones de grupos de enfoque con el personal de ambos hospitales. Un total de 27.4% de la población bajo estudio satisfizo los criterios de CSG 30 (casuidad), que la definen como casos probables de angustia mental. Los casos y los no casos no difirieron en edad, género u hospital de empleo. Sin embargo, la casuidad estuvo asociada con los años de experiencia profesional, estrés relacionado con el trabajo y estrés no relacionado con el trabajo, dificultades financieras serias, y miedo de ir a trabajar. Los predictores significativos del aumento de riesgo de casuidad fueron: el miedo de ir a trabajar (OR 3.06; CI 1.40, 6.70); la experiencia profesional mayor de cinco años; y el estrés elevado no relacionado con el trabajo. El alto estrés relacionado con el trabajo estuvo asociado con la reducción de riesgo de ser clasificado como caso, lo cual sugiere que el trabajo puede haber sido un factor terapéutico. Las discusiones de grupo de enfoque sugieren que el estrés no relacionado con el trabajo estaba asociado con las dificultades financieras, el viaje diario de ida y vuelta al trabajo y la atención a los niños, especialmente entre las enfermeras. La intervención general con el propósito de mejorar el bienestar mental debe dirigirse a los nuevos empleados, y debe abordar el problema del cuidado de los niños, el viaje diario al trabajo y la administración financiera

Assessing the risk of bleeding in patients with atrial fibrillation:the Loire Valley Atrial Fibrillation project

Background— Management decisions for thromboprophylaxis in atrial fibrillation need to balance the risk of stroke against serious hemorrhage. The objective of the present analysis is to compare the Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (&gt;65 years), Drugs/alcohol concomitantly (HAS-BLED) score against other older bleeding risk scores and the new Anticoagulation and Risk Factors in Atrial Fibrillation score in an atrial fibrillation cohort. Methods and Results— Patients diagnosed with nonvalvular atrial fibrillation in a 4-hospital institution between 2000 and 2010 were identified. Independent risk factors of bleeding were investigated using Cox regression. The predictive value of several bleeding risk schema was assessed using the c-statistic and net reclassification improvement. Oral anticoagulation use was highest in moderate-risk patients (59.8%) but only slightly more than high-risk (50.1%) and low-risk (46.4%) patients. Those at higher bleeding risk (HAS-BLED ≥3) were also at highest risk of stroke/thromboembolism or stroke/thromboembolism/death, as well as bleeding and all-cause mortality. On multivariable analysis, independent predictors of bleeding were age ≥75 years and age ≥65 years, alcohol excess, anemia, and heart failure. All risk scores had only modest predictive ability for bleeding, whether on vitamin K antagonist or not (c-statistic ≈0.6). When the HAS-BLED score was compared with other bleeding risk scores, the net reclassification improvement was significantly improved against all other scores tested. Conclusions— Current oral anticoagulation prescribing patterns would suggest that bleeding risk estimation by clinicians is poor and that oral anticoagulation prescribing does not reflect bleeding risk per se. The HAS-BLED score performs well in relation to predicting bleeding events compared with older bleeding scores and the Anticoagulation and Risk Factors in Atrial Fibrillation score, with significantly improved reclassification using HAS-BLED compared with all other bleeding risk scores tested. </jats:sec