Factors impacting on the activation and approach times of helicopter emergency medical services in four Alpine countries.

BACKGROUND: The outcome of severely injured or ill patients can be time dependent. Short activation and approach times for emergency medical service (EMS) units are widely recognized to be important quality indicators. The use of a helicopter emergency medical service (HEMS) can significantly shorten rescue missions especially in mountainous areas. We aimed to analyze the HEMS characteristics that influence the activation and approach times. METHODS: In a multi-centre retrospective study, we analyzed 6121 rescue missions from nine HEMS bases situated in mountainous regions of four European countries. RESULTS: We found large differences in mean activation and approach times among HEMS bases. The shortest mean activation time was 2.9 minutes; the longest 17.0 minutes. The shortest mean approach time was 10.4 minutes; the longest 45.0 minutes. Short times are linked (p < 0.001) to the following conditions: helicopter operator is not state owned; HEMS is integrated in EMS; all crew members are at the same location; doctors come from state or private health institutions; organization performing HEMS is privately owned; helicopters are only for HEMS; operation area is around 10.000 km2; HEMS activation is by a dispatching centre of regional government who is in charge of making decisions; there is only one intermediator in the emergency call; helicopter is equipped with hoist or fixed line; HEMS has more than one base with helicopters, and one team per base; closest neighboring base is 90 km away; HEMS is about 20 years old and has more than 650 missions per year; and modern helicopters are used. CONCLUSIONS: An improvement in HEMS activation and approach times is possible. We found 17 factors associated with shorter times.

Palate dimensions in six-year-old children with unilateral cleft lip and palate: a six-center study on dental casts.

OBJECTIVE: To compare palatal dimensions in 6-year-old children with unilateral cleft lip and palate (UCLP) treated by different protocols with those of noncleft children. DESIGN: Retrospective intercenter outcome study. Patients : Upper dental casts from 129 children with repaired UCLP and 30 controls were analyzed by the trigonometric method. SETTING: Six European cleft centers. Main outcome measures : Sagittal, transverse, and vertical dimensions of the palate were observed. STATISTICS: Palate variables were analyzed with descriptive methods and nonparametric tests. Regarding several various characteristics measured on a relatively small number of subjects, hierarchical, k-means clustering, and principal component analyses were used. RESULTS: Mean values of the observed dimensions for five cleft groups differed significantly from the control (p < .05). The group with one-stage closure of the cleft differed significantly from all other cleft groups in most variables (p < .05). Principal component analysis of all 159 cases identified three clusters with specific morphologic characteristics of the palate. A similar number of treated children were classified into each cluster, while all children without clefts were classified in the same cluster. The percentage of treated children from a particular group that fit this cluster ranged from 0% to 70% and increased with age at palatal closure and number of primary surgical procedures. CONCLUSION: At 6 years of age, children with stepwise repair and hard palate closure after the age of two more frequently result in palatal dimensions of noncleft control than children with earlier palatal closure and one-stage cleft repair.

Mesothelioma risk associated with asbestos production in Slovenia.

The aim of this study was to assess malignant mesothelioma morbidity due to exposure to asbestos in a population living in districts Nova Gorica and Tolmin (49,850 people) near the asbestos manufacturing village Anhovo (Slovenia) and to compare it with the entire Slovene population (1,949,750 people). Crude rates per 100,000 people were calculated from the total number of mesotheliomas, and risk assessment in the studied vs. total population was based on 23 years worth of data. Time series data on mesothelioma cases were also processed as a forecast of new cases by 2010.The crude incidence of mesothelioma per 100,000 individuals for all of Slovenia was 21.4, while for the Nova Gorica district including the village Anhovo it is 170.2 and for the Tolmin district 60.9. The probability of a mesothelioma case in the studied population was 8.5 times the probability of the same diagnosis in the whole of Slovenia. Over 23 years, 28% of all mesothelioma cases in Slovenia were diagnosed in the studied population, which makes only 2.5% of the total Slovene population.The outbreak of asbestosis and mesothelioma epidemics in the studied population is associated with manufacture of asbestos products in the local factory from 1922 to 1996.

Salt intake of the Slovene population assessed by 24 h urinary sodium excretion.

OBJECTIVE: To investigate average sodium excretion in 24 h urine as a marker for salt intake in the Slovene population. DESIGN: Salt intake was determined by measuring sodium excretion in 24 h urine collected from a representative sample of geographically diverse Slovene adults. SETTING: Slovenia. SUBJECTS: A random sample of 600 adults aged 25-65 years was generated from census data. The effective sample yield was 143 people, 42·7 % men and 57·3 % women. RESULTS: Urinary sodium excretion was significantly higher in men (220·9 (sd 86·0) mmol Na/d) than in women (169·8 (sd 73·8) mmol Na/d); t test = 14·5, P < 0·001. Average salt intake was 11·3 (sd 4·9) g/d, higher in men than in women (13·0 (sd 5·1) v. 9·9 (sd 4·3) g/d, respectively). Average intakes of salt among regions were not significantly different. Salt intake increases slightly with increasing age, but there was no significant correlation between age and salt intake. Salt intake was increased with BMI (r = 0·384, P < 0·001). CONCLUSIONS: Salt intake in Slovene adults, especially in men, exceeds the WHO recommended population nutrient intake goal of 5 g by more than twofold. A national programme for reducing salt intake in Slovenia needs to be implemented through systematic efforts including public education and involving the health-care sector and the food industry.

The specificity of tests for anti-beta-lactam IgE antibodies declines progressively with increase of total serum IgE.

BACKGROUND: Immediate allergic reactions to beta-lactam antibiotics are mediated by specific IgE antibodies. The Phadia CAP System FEIA is a commercial method for quantification of specific IgE. We wished to determine anti-beta-lactam IgE antibodies in patients without penicillin allergy but with high levels of total IgE. METHODS: Sera from 41 patients (31 with high total IgE, 10 with low total IgE) were analyzed for IgE antibodies specific to penicilloyl G, penicilloyl V, amoxicilloyl and ampicilloyl using the CAP FEIA((R)) method that was available up to 2006. Seven sera that tested positive were rechecked in a new improved system available after 2006. RESULTS: In patients without a history of penicillin allergy, the specificities of commercial tests for anti-beta-lactam IgE antibodies were 100%, 60%, 27% and 20% at total IgE levels of 8-263 kU/l, 500-664 kU/l, 1000-2000 kU/l and > 2000 kU/l, respectively. In seven retested sera, only 2 (28%) were still positive for penicillin-specific IgE antibody. CONCLUSION: Before 2006, tests for anti-beta-lactam IgE antibody in patients with total IgE > 500 kU/l were probably often false positive. Patients who were diagnosed as penicillin allergic before 2006 solely on the basis of a positive CAP FEIA test for specific IgE should be considered for diagnostic reevaluation.

Seroprevalence of IgG antibodies to pertussis toxin in the Slovene population.

BACKGROUND: The use of pertussis vaccines has reduced the morbidity and mortality of whooping cough. Immunity following the natural disease or vaccination is not life-long and reinfections causing an increase of pertussis antibodies can occur. In this study, the distribution of IgG antibodies to pertussis toxin (anti-PT IgG) among different age groups in Slovenia was determined. METHODS: The seroprevalence of anti-PT IgG antibodies to Bordetella pertussis was investigated in 3418 persons (49.1% males). The population under study was stratified into 27 age groups. The serological results were assigned to five groups, according to their titer levels. The geometric mean titers (GMT) were calculated. RESULTS: In 11.5% sera tested, no IgG antibodies to pertussis toxin were detected. High titers (> or =125 U/ml) were confirmed in 2.3% sera. There were no statistically significant differences between age groups in the proportion of antibody levels. Pre-school children from three to five years of age had the lowest anti-PT IgG GMTs (9.6-10.7 U/ml). Vaccinated children (aged from one to two years) and adolescents from 17-18 years of age had the highest GMTs (>20 U/ml). GMTs were not statistically significantly different between males and females. CONCLUSIONS: The study demonstrated an early decline of anti-PT IgG after vaccination. According to the serological profile, school-age children and adolescents have the highest rate of infection. The large proportion of seropositive adults indicates that reinfection with B. pertussis is relatively common.

Management of lower urinary tract infection in women by Slovene GPs.

BACKGROUND: Uncomplicated lower urinary tract infection (LUTI) is one of the most common infections treated in general practice. Although nationwide treatment guidelines for LUTI are increasingly available, most European countries, including Slovenia, have not yet set such guidelines. OBJECTIVES: Our aim was to describe Slovene GPs' management of uncomplicated LUTIs and to analyse doctor and surgery characteristics that influence this management. METHOD: A written case vignette accompanied by open-ended questions regarding doctors' decisions (i.e. investigations and laboratory tests ordered, treatment options, advising sick leave, advice for treatment and follow-up procedures) and questions about doctor and surgery characteristics was sent to a representative sample of Slovene GPs. RESULTS: The response rate was 129/171 (75.4%). There were large variations in management of LUTI: 17.8% of GPs ordered various additional laboratory tests; 57% of GPs prescribed trimethoprim/sulfamethoxazole and 37% norfloxacin; 30% of GPs prescribed a drug for 10-14 days; and 53.5% of GPs put the patient on sick leave of 1-10 days duration. Doctors with heavier workloads and those who have to wait for laboratory results for >24 h ordered more additional investigations. CONCLUSIONS: Effective strategies for quality improvement are needed, together with practice guidelines. The influence of a heavier workload on management of LUTI and the impact of the accessibility of laboratory tests should be explored in future research.