During epidemics, healthcare institutions have a duty to protect HCWs and help them cope with their personal fears and the very stressful work situation. Singapore's experience shows that simple protective measures based on sound epidemiological principles, when implemented in a timely manner, go a long way to reassure HCWs.

Aim: To determine prevalence rates, severity, and risk factors for pterygium in adults in provincial Indonesia and to validate a clinical grading scheme in a population based setting. Methods: A population based prevalence survey of 1210 adults aged 21 years and above was conducted in five rural villages and one provincial town in Riau province, Sumatra, Indonesia, an area near to the equator. A one stage household cluster sampling procedure was employed: 100 households were randomly selected from each village or town. Pterygia were graded for severity (T1 to T3, by visibility of episcleral vessels) and the basal and apical extent measured by an ophthalmologist (GG) with a hand held slit lamp. Refraction was measured by hand held autorefractor (Retinomax). Face to face household interviews assessed outdoor activity, occupation, and smoking. The participation rate was 96.7%. Results: The mean age was 36.6 years (SD 13.1), 612 were male. The age adjusted prevalence rate of any pterygium was 10.0% (95% confidence intervals (CI) 8.2 to 11.7) and of bilateral pterygia was 4.1% (95% CI 2.9 to 5.3). There was a significant dose-response relation with age (2.9% (95% CI 0.4 to 5.8) for 21-29 years versus 17.3% (95% CI 10.4 to 24.2) 50 years and above; p for trend <0.001) and occupations with more time outdoors (p for trend = 0.02). This was true for both sexes, all grades of lesion (T1 to T3), and bilateral disease. A multivariate logistic regression model showed pterygium was independently related to increasing age and outdoor activity 10 years earlier. The mean basal diameter = 3.3 mm (SD 1.51, range 0.1-9.5) and extent from limbus = 1.4 mm (SD 1.18, range 0.1-8.0). Higher grade pterygia were larger for basal and apical extent (p for trend <0.001). The presence of pterygium was associated with astigmatism (defined as cylinder at least −0.5 dioptres (D); p <0.001). This association increased with increasing grade of lesion (p for trend <0.001). Median cylinder for those with pterygium (−0.50 D) was greater than for those without (−0.25D), (p <0.001), and increased with higher grade of lesion (p for trend <0.001). For eyes with pterygia, magnitude of astigmatism was associated with greatest extent from the limbus, (p = 0.03), but not basal width (p = 0.99). Conclusions: There is a high prevalence rate of pterygia in provincial Sumatra. The independent increase with age and past outdoor activity (a surrogate for sun exposure) is consistent with previous findings. Clinical grading of pterygium morphology by the opacity of the lesion was a useful additional marker of severity.

No abstract

No abstract

Aims: To assess and compare the self perceived work related stress among emergency department (ED) and general ward (GW) nurses, and to investigate its relation with salivary IgA and lysozyme. Methods: One hundred and thirty two of 208 (63.5%) registered female ED and GW nurses participated in the study. A modified mental health professional stress scale (PSS) was used to measure self perceived stress. ELISA methods were used to determine the salivary IgA and lysozyme levels. Results: On PSS, ED nurses had higher scores (mean 1.51) than GW nurses (1.30). The scores of PSS subscales such as organisational structure and processes (OS), lack of resources (RES), and conflict with other professionals (COF) were higher in ED than in GW nurses. ED nurses had lower secretion rates of IgA (geometric mean (GM) 49.1 µg/min) and lysozyme (GM 20.0 µg/min) than GW nurses (68.2 µg/min, 30.5 µg/min). Significant correlations were observed between PSS and log IgA and lysozyme secretion rates. OS, RES, and COF were correlated with log IgA and lysozyme levels. Conclusion: ED nurses, who reported a higher level of professional stress, showed significantly lower secretion rates of salivary IgA and lysozyme compared to GW nurses. Salivary IgA and lysozyme were inversely correlated with self perceived work related stress. As these salivary biomarkers are reflective of the mucosal immunity, results support the inverse relation between stress and mucosal immunity.

No abstract

The study consisted of 35 male subjects attending an andrology clinic. The subjects all had poor sperm parameters that could not be attributed to any known medical cause. The objective was to evaluate the relation between various seminal characteristics (volume, total sperm count, sperm viability, proportion of progressively motile sperm, and different sperm morphology) and the blood concentrations of lead, cadmium, mercury, copper, and zinc. The mean blood concentrations of lead, mercury, copper, and zinc were within the normal values; cadmium concentration (1.35 pg/L) was much higher than the norms. Asthenozoospermic subjects had significantly (p < ,025) higher blood cadmium levels than normozoosperrnic subjects. No significant differences were noted between the two groups for mean concentration of mercury, zinc, and copper in blood. Significant correlations were observed between blood cadmium levels and volume of semen, midpiece defects, and immature forms of spermatozoa. High blood cadmium levels may have an effect on spermatogenesis. Possible reasons for the high blood cadmium levels among the subjects are discussed.

Little is known about differences in levels of concerns or preparedness for an avian influenza (AI) pandemic among healthcare workers (HCWs) in different types of hospitals. We compared these concerns and preparedness between 326 HCWs of two community hospitals (CHs) and 908 HCWs from a tertiary hospital (TH) using a self-administered questionnaire between March-June 2006. Response rates were 84.2% and 80.0% from the CHs and TH. Most HCWs (71.6%) felt prepared for an AI outbreak and had significant concerns. They perceive an AI pandemic having adverse impacts on their personal life and work, such as people avoiding them (57.1%). A greater percentage of TH compared to CH HCWs expressed concerns such as feeling their jobs put them at great AI exposure (78.3% vs 67.5%, p=0.012). TH HCWs were more likely to report participating in readiness preparation activities, such as training for infection control (90.0% vs 82.2%, p=0.014) and feel that they (74.1% vs 64.7%, p=0.045) and their hospital (86.8% vs 71.8%, p=0.000) were prepared for an outbreak. Healthcare institutions need to include personal, psychological and family concerns on the agenda and increase participation in readiness preparation activities among HCWs to help prepare for such future crises.