Global burden of hearing impairment and ear disease.

BACKGROUND: Hearing loss can present at birth or be acquired as a result of illness, middle-ear disease, injury, age, overuse of certain medications, and/or induced by exposure to damaging noise levels. There are serious short-term consequences for people living with hearing impairment, including the effects on language acquisition, education, employment and overall wellbeing. There are also complex long-term implications. OBJECTIVES: This review aimed to present some of the leading causes of ear disease and hearing loss globally, and to identify their impact at both an individual and societal level.

Methicillin resistant Staphylococcus aureus contamination of phlebotomy tourniquets and faucets

Introduction: Methicillin resistant Staphylococcus aureus (MRSA) is transmitted through direct contact or fomites. The most important means of nosocomial spread is by hospital personnel. However, fomites are being increasingly recognized as sources of nosocomial infection. Objectives: Our aim was to describe the MRSA contamination rate of phlebotomy tourniquets and faucets in a tertiary care hospital and to compare the contamination of plastic tourniquets with that of fabric tourniquets. Method: A cross-sectional study was carried out in the general wards of a tertiary care hospital in the Colombo District. Two hundred tourniquets were collected and 100 faucets were swabbed and cultured on CHROMagar™ MRSA medium (CHROMagar Microbiology). Contamination rates of 50 plastic tourniquets and 50 fabric tourniquets were compared. Results: MRSA grew in 26% of tourniquets. Majority were plastic tubes. MRSA contamination of tourniquets did not significantly differ by ward (p>0.4). MRSA was found on 26% of faucets. Contamination rate was highest in the common wards for dermatology, dental, rheumatology, and neurology (55.6%), followed by gynaecology (45.2%), cardiology (33.3%), surgery (18.8%), psychiatry (11.1%), and medicine (5.6%). There was a significant difference in rates of contamination of faucets in the different wards (p<0.01). There was no significant difference in the colony count per surface area of the two types of tourniquets after a single use. Conclusions: MRSA contamination rates of tourniquets and faucets were high. Single-use plastic tourniquets were much less contaminated with MRSA than reused tourniquets.

Training in general paediatrics: is it time for change?

OBJECTIVE: To determine current Australian general paediatrician's perceptions regarding the adequacy of their training particularly in the new morbidity (NM) area (developmental, behavioural and psychosocial). To ascertain if there is a perceived need to change training in this area, the level of support for change and to canvass opinion on how to achieve change. METHODS: Australian general paediatricians were surveyed by mail in April 2002. The data obtained from those trained before and after the 1992 changes to training were compared by chi(2) analysis. RESULTS: The response rate was 76%. More than one in five new referrals were for NM problems according to 62% of the respondents. The majority (67%) of respondents reported that they were poorly or very poorly trained for NM work in contrast to a majority (82%) who rated that they were well or very well trained for general paediatric work (P < 0.001). Respondents believed that they were poorly or very poorly trained in the use of stimulants (74%), selective serotonin reuptake inhibitors (SSRIs) (93%), tricyclic antidepressants (TCAs) (79%) and clonidine (86%), despite a third of scripts being for one of these medications. The majority of all general paediatricians (90%) want changes to advanced training. Seminars/tutorials, organized visits to general paediatricians' rooms and a mandatory 12 month NM term were the most highly supported options for change. CONCLUSIONS: In view of the prevalence of the NM problems, the perception of inadequate training and the overwhelming support for change it is time for new models of training to be developed and tested.

Demographic and Health Survey--1993.

PIP: The author briefly outlines some of the major findings of the 1993 Sri Lanka Demographic and Health Survey. Information is provided on fertility, family planning, infant and child mortality, maternal and child health, breast-feeding, and nutritional status of children.^ieng

Comparison of trimethoprim alone with trimethoprim sulphamethoxazole in the treatment of respiratory and urinary infections with particular reference to selection of trimethoprim resistance.

279 patients were treated with 100 mg trimethoprim or 100 mg trimethoprim combined with 500 mg sulphamethoxazole (co-trimoxazole) twice daily for 5 days in a prospective randomised double-blind trial. In chest infections in patients in general practice and in an acute geriatric assessment unit, the efficacy of each regimen was similar, but there were more side-effects with co-trimoxazole than with trimethoprim alone. In urinary-tract infections the two regimens also produced similar cure rates. Treatment with trimethoprim rarely selected resistant pathogens in the sputum or resistant Enterobacteriacae in the intestine, although the incidence of resistant coagulase-negative staphylococci on the skin increased with both regimens. Most chest and urinary infections hitherto treated with co-trimoxazole should be treated with trimethoprim alone.