Julius Weinberg

Social deprivation and hospital admission for respiratory infection:an ecological study

STUDY OBJECTIVEnTo examine the relationship between social deprivation and risk of hospital admission for respiratory infection.nnnMETHODS AND SUBJECTSnEcological study using hospital episode statistics and population census data. Cases were residents of the West Midlands Health Region admitted to hospital with a diagnosis of respiratory infection, acute respiratory infection, pneumonia or influenza over a 5-year period. Postcodes of cases were used to assign Townsend deprivation scores; these were then ranked and divided into five deprivation categories. Poisson regression analysis was used to estimate the magnitude of effect for associations between deprivation category and hospital admission by age and admitting diagnosis.nnnMAIN RESULTSnThere were 136755 admissions for respiratory infection, equivalent to an annual admission rate of 27.1 per 1000 population (95% CI = 26.9-27.2). Deprivation was associated with increased admission rates for all respiratory infection (P < 0.0001) and affected all age-groups. The greatest effect was in the 0-4 years age-group with admission rates 91% higher in the most deprived children compared to the least deprived. Hospital admissions for acute respiratory infection and pneumonia were both significantly associated with deprivation (P < 0.0001).nnnCONCLUSIONSnRespiratory infection is associated with social inequalities in all age-groups, particularly in children. Prevention of respiratory infection could make an important contribution to reducing health inequalities.

The influence of HIV status on single and multiple drug reactions to antituberculous therapy in Africa.

Objective.To document the influence of HIV status on drug reactions occurring in patients on antituberculous therapy in Harare, Zimbabwe. Design.Retrospective cohort study. Setting.City of Harare Tuberculosis Unit. Patients.Records of 906 patients with tuberculosis, of whom 162 reacted to antituberculous therapy, were analysed. Results.Reactions to antituberculous drugs were more frequent in HIV-positive (98 out of 363) than in HIV-negative (64 out of 543; P < 0.0001) patients. The most common drug reaction was cutaneous hypersensitivity, occurring in 139 patients, 89 (64%) of whom were HIV-positive. Thiacetazone was implicated in 115 (82.7%) of the 139 cutaneous reactions and streptomycin in 10 (7.2%). Almost all cutaneous reactions occurred within 8 weeks of beginning treatment. Severe cutaneous reactions occurred more often in HIV-positive patients (P< 0.001) and the only two deaths occurred in this group. Reactions to multiple drugs occurred in 18 HIV-positive and three HIV-negative patients (P = 0.017). Conclusions.The use of thiacetazone and streptomycin in antituberculous drug regimens should be reassessed in those countries where coinfection with HIV and tuberculosis is common.

DISSEMINATED MYCOBACTERIUM XENOPI INFECTION

Une observation tres rare: Mycobacterium xenopi nest pas considere comme pathogene, pour lhomme. 3 observations dinfection seulement ont ete publiees jusquici, et 2 des malades etaient atteints de SIDA

Influence of material deprivation on hospital admissions for gynaecologic infections

This study was conducted to examine the relationship between age, material deprivation, and hospital admissions for selected gynaecologic infections in an English health region. Data from hospital episode statistics relating to hospital admissions for pelvic inflammatory disease (PID), infections of the uterus, and infections of the cervix, vagina, and vulva were obtained. Townsend deprivation scores (based on 1991 census data) were allocated by linking postcodes of cases to enumeration districts (EDs) and then assigning the EDs to appropriate quintiles of material deprivation. Both single variable and multivariable (Poisson regression) analyses were performed. For women with PID, the risk of hospitalisation increased with increasing deprivation (P<0.0001), and women in the most deprived quintile were at increased risk (relative risk [RR] 1.31; 95% confidence interval [95%CI] 1.24–1.39) for hospitalisation. Multivariable analysis identified an elevated risk of hospital admission in women aged 25–44 years for PID (RR 2.03; 95%CI 0.84–4.87) and infections of the cervix, vagina, and vulva (RR 1.47; 95%CI 1.16–1.87), and the incidence of both conditions increased significantly with age. In summary, the results obtained suggest that women from the most deprived areas are at greatest risk of hospitalisation for gynaecologic infections, particularly PID. Preventive measures together with earlier diagnostic, treatment, and referral procedures are required to reduce morbidity.