[Creating the future of nursing].
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Career Choice↗
Biomedical subjects
H M Hasselhorn
Publications and source records attributed to H M Hasselhorn.
Effect of a diphtheria booster vaccination in adults with a documented history of an incomplete primary series vaccination.
BACKGROUND: An incomplete series of diphtheria vaccination is frequently found in the vaccination documents of adult patients. This paper investigates the effect of a booster vaccination in adults with an incomplete series of primary vaccination. MATERIALS AND METHODS: The effect of one diphtheria booster vaccination in adults with a documented history of only two childhood vaccinations has been investigated in 21 adults. Before the vaccination and 4 to 8 weeks thereafter, blood samples were taken and analyzed with an in vitro neutralization assay. RESULTS: None of the participants had prevaccinal full protective diphtheria antitoxin levels (AT) > or = 0.1 IU/ml and four (19%) had limited serological protection (AT 0.01 to 0.1 IU/ml). After the vaccination, 14 individuals (67%) had protective LeveLs and six (29%) had limited protective levels. The risk for post-booster non-protection (AT < 0.1 IU/ml) was 7.7 times higher in comparison with a group of 170 adults with a history of at least one booster vaccination. CONCLUSION: A specific immunologic memory exists in adults with a history of only two previous diphtheria vaccinations. However, our results also indicate the need for a second booster vaccination in this group if long-term protection is to be achieved.
Adult↗
Personnel-to-patient transmission of hepatitis C virus: underestimation of exposure.
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Bias↗
Endocrine and immunologic parameters indicative of 6-month prognosis after the onset of low back pain or neck/shoulder pain.
STUDY DESIGN: Prospective study. OBJECTIVES: To evaluate the prognosis of spine disease by investigating biologic parameters reflecting different physiologic or psychophysiological systems in men and women with acute onset of low back or neck/shoulder complaints. SUMMARY OF BACKGROUND DATA: Psychosocial factors may be of importance to the etiology and prognosis of musculoskeletal disorders. The possible mechanisms, however, remain unclear. Stress-induced long-lasting energy mobilization resulting in inhibited anabolism has been discussed. Using a theoretical framework within stress physiology, such psychophysiological processes were recorded by measures of substances representing the anabolic, catabolic, immunologic, and opioid systems. METHODS: The study comprised 67 working men and women 21 to 59 years of age seeking care by any caregiver for acute low back and/or neck/shoulder pain. Blood samples were taken and analyzed for 3 methyl 5hydroxy phenylethylene glycol (MHPG, reflecting sympathoadrenomedullary activity), DHEA-s (anabolism), immunoglobulin E, interleukin 6 (immune activity), and beta-endorphin (pain regulation). The participants were followed up for 6 months after the blood samples had been drawn. RESULTS: In women, low MHPG, low DHEA-s, and low beta-endorphin predicted persistent disability due to low back complaints. Few significant findings were made for self-reported pain, for neck/shoulder complaints, and for men. CONCLUSION: Disturbances of the regulation of certain biologic parameters might be indicators of a prolonged course of low back disease in women. Prospective studies are necessary to enable causal conclusions.
Adult↗
[Prevention of diphtheria in Germany: yesterday, today, tomorrow - an overview].
The year 2000 was the first without the registration of any cases of diphtheria in Germany. However, serologic protection against diphtheria amongst the population is very low, especially among young and middle-aged adults, where over 50 % are not or only minimally protected. In a review of the diphtheria cases of the last 7 years (n = 18), three factors were associated with the disease: adult age (14 cases between 18 and 50 years of age), travelling (in 14 of 18 cases travelling to or from endemic areas played a role) and occupational exposure (suspected in 6 of 18 cases). In Germany, the official guidelines which suggest a booster vaccination every ten years are followed very insufficiently. Should vaccination habits fail to improve, population immunity will further decrease and a resurgence of diphtheria will become more likely. Measures for future preventive activities are being discussed.
Adolescent↗
[Transmission of HBV, HCV and HIV by infectious medical personnel--presentation of an overview].
This report analyzes 46 cases of personnel-to-patient transmissions of hepatitis B (HB), hepatitis C (HC) and HIV in health care settings. Similar circumstances were found for transmission of HB (40 cases, 404 infected patients), HC (4 cases, 224 infected patients) and HIV (2 cases, 7 infected patients). Cases with the highest number of transmissions (one anesthesiologist with 217 HC transmissions, and one EEG technologist with 75 HB transmissions) were attributed to poor infection control practices. As long as infected health care workers (HCW) adhere to general infection control measures, a risk for transmission to patients exists only from infected surgeons who perform 'exposure-prone invasive procedures'. Whether changes in duties of infected HCW are necessary should be decided on an individual basis. Often, the infected personnel were assumed to have acquired the disease occupationally. Medical practices and devices bearing a risk of infection should constantly be reviewed with regard to risk for patients and personnel.
Cross Infection↗
[European and North American regulations on employing HBV-, HCV- and HIV-infected persons in health care].
In the United States of America (1991), in Canada (1998), in the UK (1993, 1994) and in Germany (1999) recommendations have been published concerning performance of "exposure-prone procedures" (EPP) by persons infected with Hepatitis-B virus (HBV), Hepatitis-C virus (HCV) or HIV. This review summarises the definition of EPP, methods to reduce the transmission of blood-borne pathogens, immunisation and screening policies, constitution of an advisory panel and the question of trace-back investigations described in these regulations.
Cross-Cultural Comparison↗
Factors influencing immunity against diphtheria in adults.
In about 50% of all adult Germans, serological immunity to diphtheria is lacking even though a vaccination history exists in most cases. In this study, the factors contributing to diphtheria immunity, up to 43 years after the last diphtheria vaccination, were analysed. Serum samples were taken from 287 adults whose complete vaccination history was available, and who had received a standard primary vaccination. The sera were tested by tissue culture neutralization assay for diphtheria antitoxin levels. The time lapse since the last diphtheria vaccination proved to be the most important factor influencing the protection rate. Secondly, the factor last vaccination within the first 3 years of life and, finally, female gender were found to correlate significantly with a low protection rate. No direct effect could be established for age, number of previous vaccinations, occupational contact with patients or travel within any endemic region during the last 10 years. Since diphtheritic infection can occur among previously vaccinated persons, the immunity gap observed among adults should be closed by regular diphtheria boosters. Special attention should be paid to the three groups mentioned. Further investigation is required to determine whether or not a single booster vaccination is sufficient to provide long-term protection for those in the risk groups indicated above.
Adolescent↗
[Nosocomial hepatitis B virus, hepatitis C virus and HIV infections by infectious medial personnel].
Transmission of Hepatitis-B virus (HBV), Hepatitis-C virus (HCV) and Human immunodeficiency virus (HIV) from medical personnel to patients has been observed by many authors. In Germany, however, neither this type of nosocomial infection nor preventive measures have been discussed to date. This review deals with 302 cases documented in national and international journals (HBV 289, HCV 6, HIV 7). Methods of prevention (especially in surgery) are discussed.
Cross Infection↗
[Diphtheria booster immunization for adults].
BACKGROUND AND OBJECTIVE: Nearly 50% of adults in Germany have no measurable antibody protection against diphtheria, even though most of them will have been vaccinated against it in their childhood. We investigated how vaccination should be performed in this situation to provide lasting protection. MATERIAL AND METHODS: 100 adults (53 men, 47 women; mean age 27.7 [19-54] years) whose last diphtheria vaccination had been at least 10 years previously, were injected up to three times with customary commercial monovalent diphtheria vaccine for adults (5 IU toxoid/0.5 ml), at intervals of 4-8 weeks. Each time, before and 4-8 weeks after the latest injection, the antitoxin level was determined by cell-culture neutralization test. RESULTS: Before the vaccination 30 of the 100 subjects had protection against diphtheria (antitoxin level > 0.1 IU/ml), 24 had "basic immunity" (0.01 to < 0.1 IU/ml), and 46 no measurable protection (< 0.01 IU/ml). After the first booster the protection threshold had not been reached in seven of the 100, all of them women. The main determinant for the pre- and post-vaccination antitoxin level was the interval since the last vaccination. In addition, women had significantly lower pre- and postvaccination levels than men. But after the second and third booster the antitoxin level of the seven women had risen to above the protection threshold, while the geometric mean of the whole collective had fallen, despite further boosters. It was 0.015 IU/ml before vaccination, 1.156 IU/ml after the first booster, 0.924 IU/ml after the second, and 0.952 after the third. CONCLUSION: Those adults who were last vaccinated against diphtheria more than 20 years ago should have two booster shots, more than 8 weeks apart, so that the highest possible and most lasting antitoxin level can be achieved. Women in particular should have at least two booster shots, as their antitoxin response tends to be less than that of men.
Adult↗
[Non- and low-response after preventive hepatitis B vaccination].
20 years after the introduction of the hepatitis-B vaccine the question still remains unsolved as to how the 2 to 5 per cent of the vaccinees who, after basic immunisation, respond with no anti-HBs levels (0-10 IU/l nonresponder, NR) or low levels (11-99 IU/l low-responder, LR) should be boostered to acquire sufficient and long-lasting protective anti-HBs levels. In a retrospective analysis of booster results we found in 75 NR and LR that the probability for long-lasting protection is very low for NR, but better for LR (60%). In a second part of this publication, the efficacy of intradermal and intramuscular hepatitis-B boosters was examined by retrospective analysis of booster results among 26 NR and LR. A slight advantage of the intradermal application was found concerning post-booster anti-HBs increase and the maximal HBs values reached. Long-lasting protective anti-HBs values could not be established for either way of application. Finally, a survey of the literature summing up true results of intradermal hepatitis-B basic immunisations with reduced doses (mostly 2 micrograms), shows that whereas the seroconversion rates achieved by this method are almost compatible with those after regular basic vaccination, the GMT values were far lower than those after regular basic vaccination. Prospective and randomised studies are needed to show which kind of booster is most efficient for nonresponders and low-responders.
Adult↗
[Occupational medicine significance of hepatitis C in health care employees].
Transmission of Hepatitis C virus (HCV) is similar to the one observed with hepatitis B virus. The most important route of infection in health care personnel is by needlestick injury. In the course of a literature review 44 publications on HCV prevalence or incidence among hospital employees were studied and an overall transmission incidence of 2.2% was found. As none of the publications dealt with the problem of chronic Hepatitis C, 245 persons with elevated transaminases occupied Freiburg University Hospital were tested for HCV antibodies. 3 out of 82 non-medical professionals and 19 out of 163 health care workers were anti HCV positive (RR = 3.22; p < 0.05). Charwomen in medical departments, nurses and dentists had a higher relative risk than physicians and technical assistants. As no HCV vaccine is available the only way of HCV-prevention is compliance with universal precautions.
Adult↗
An ovomucin-like protein on the surface of migrating primordial germ cells of the chick and rat.
A mucin was discovered on the surface of migratory primordial germ cells (PGCs) from chick and rat embryos by means of two monoclonal antibodies. The protein was found to be identical or closely related to ovomucin, a 600 X 10(3) relative molecular mass glycoprotein, and a major constituent of the vitelline membrane of the avian yolk. Based on its resemblance to ovomucin it is referred to as ovomucin-like protein (OLP). The OLP was expressed on PGCs from E3 to E7 female, and from E3 to E12 male chick embryos as the PGCs migrate and colonize the gonadal ridges. After the PGCs have settled in the gonads, they no longer express OLP. In tissue cultures of dissociated cells from E6 gonads, OLP was present only on cells that were positive for PAS staining, the standard histological method to identify PGCs in the chick embryo. Since unfixed PGCs were recognized by the antibodies, at least part of the OLP is localized on the cell surface. The anti-OLP antibodies also stained PGCs in the gonads of the rat embryo, showing that the expression of this antigen on PGCs is phylogenetically conserved. Ovomucin isolated from vitelline membrane prevented adhesion of fibroblasts but not PGCs when used a as a substratum in vitro. The anti-adhesive quality of the mucin resides in the sialic acid residues of the carbohydrate side chains. We propose that OLP has a similar anti-adhesive quality as the ovomucin from vitelline membrane, and that this anti-adhesive property is important to prevent precocious adhesion of migrating PGCs to blood vessel walls and to connective tissue in the mesentery as they migrate toward the gonadal ridges.
Animals↗
Kinetics and differentiation of somite cells forming the vertebral column: studies on human and chick embryos.
We have studied the kinetics of somite cells with an antibody against proliferating cell nuclear antigen (PCNA/cyclin) in human and chick embryos, and with the BrdU anti-BrdU method in chick embryos, to investigate whether the metameric pattern of the developing vertebral column can be explained by different proliferation rates. Furthermore we applied antibodies against differentiation markers of chondrogenic and myogenic cells of the somites in order to study the correlation between proliferation and differentiation. There are no principal differences in the proliferation pattern of the vertebral column between human and chick embryos. In all stages examined, the cell density is higher in the caudal sclerotome halves than in the cranial halves. Laterally, the caudal sclerotome halves, which give rise to the neural arches, are characterized by a higher proliferative activity than the cranial halves. Although there is a high variability, the labelling indices show significant differences between the two halves with both proliferation markers. With the onset of chondrogenic differentiation, only the perichondrial cells retain a high proliferation rate. During fetal development, the neural arches and their processes grow appositionally. Even at the earliest stages, there is practically no immunostaining for PCNA or BrdU in the desmin-positive myotome cells of human and chick embryos. Axially, a higher proliferation rate is found in the condensed mesenchyme of the anlagen of the intervertebral discs than in the anlagen of the vertebral bodies. During fetal development, cells at the borders between vertebral bodies and intervertebral discs proliferate, indicating appositional growth.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Boostering antitoxic diphtheria immunity in adults.
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Adult↗
Nurses' health, age and the wish to leave the profession--findings from the European NEXT-Study.
BACKGROUND AND OBJECTIVES: In many industrialised countries the number of workers with low health is expected to increase in the nursing profession. This will have implications for occupational health work in health care. The European NEXT-Study (www. next-study. net, funded by EU) investigates working conditions of nurses in ten European countries and provides the opportunity to evaluate the role of health with respect to age and the consideration of leaving nursing. METHODS: 26,263 female registered nurses from Belgium, Germany, Finland, France, England, Italy, Netherlands, Poland and Slovakia were eligible for analysis. RESULTS: In most countries, older nurses considered leaving the profession more frequently than younger nurses. 'Health' was--next to 'professional opportunities' and 'work organisational factors'--strongly associated with the consideration of leaving nursing. However, more than half of all nurses with low health wanted to remain in the profession. This group reported rather positive psychosocial working conditions--but also the highest fear for unemployment. CONCLUSIONS: The findings indicate that 'the nurse with low health' is reality in many health care settings. Both positive supporting working conditions but also lack of occupational alternatives and fear of unemployment may contribute to this. Current economic, political and demographic trends implicate that the number of active nurses with low health will increase. Occupational health surveillance will be challenged by this. But NEXT findings implicate that prevention also will have to regard work organisational factors if the aim is to sustain nurses' health and to enable nurses to remain healthy in their profession until retirement age.
Adolescent↗
[Efficacy of hepatitis B preventive vaccination].
Health care workers are at increased hepatitis B risk. In the course of a study with 5035 persons occupied at the Freiburg university hospital, efficacy of hepatitis B vaccination and duration of protection were investigated. Estimations of post-vaccination-anti Hbs showed that women, younger persons, persons with a body mass index < 25 and non-smokers had higher anti Hbs concentrations than men, elderly persons overweight persons and smokers. 2% of female and 1.5% of male vaccinees did not develop anti Hbs and 4.8% and 7.1%, respectively were low responders (anti Hbs < 100 < 10 IU/l). Estimations of vaccination efficacy revealed that even 10 years after basic immunisation at least 50% of all vaccinees should have anti Hbs concentrations > 100 IU/l. The results of the study show that vaccination of children in accordance with German and WHO recommendations will afford full protection (anti Hbs > 10 IU/l) in at least 99% of all cases.
Adult↗