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Established methods of recruiting population controls for case–control studies to investigate gastrointestinal disease outbreaks can be time consuming, resulting in delays in identifying the source or vehicle of infection. After an initial evaluation of using online market research panel members as controls in a case–control study to investigate a Salmonella outbreak in 2013, this method was applied in four further studies in the UK between 2014 and 2016. We used data from all five studies and interviews with members of each outbreak control team and market research panel provider to review operational issues, evaluate risk of bias in this approach and consider methods to reduce confounding and bias. The investigators of each outbreak reported likely time and cost savings from using market research controls. There were systematic differences between case and control groups in some studies but no evidence that conclusions on the likely source or vehicle of infection were incorrect. Potential selection biases introduced by using this sampling frame and the low response rate are unclear. Methods that might reduce confounding and some bias should be balanced with concerns for overmatching. Further evaluation of this approach using comparisons with traditional methods and population-based exposure survey data is recommended.
Traditionally health statistics are derived from civil and/or vital registration. Civil registration in low- to middle-income countries varies from partial coverage to essentially nothing at all. Consequently the state of the art for public health information in low- to middle-income countries is efforts to combine or triangulate data from different sources to produce a more complete picture across both time and space – data amalgamation. Data sources amenable to this approach include sample surveys, sample registration systems, health and demographic surveillance systems, administrative records, census records, health facility records and others. We propose a new statistical framework for gathering health and population data – Hyak – that leverages the benefits of sampling and longitudinal, prospective surveillance to create a cheap, accurate, sustainable monitoring platform. Hyak has three fundamental components:
Data amalgamation: A sampling and surveillance component that organizes two or more data collection systems to work together: (1) data from HDSS with frequent, intense, linked, prospective follow-up and (2) data from sample surveys conducted in large areas surrounding the Health and Demographic Surveillance System (HDSS) sites using informed sampling so as to capture as many events as possible;
Cause of death: Verbal autopsy to characterize the distribution of deaths by cause at the population level; and
Socioeconomic status (SES): Measurement of SES in order to characterize poverty and wealth.
We conduct a simulation study of the informed sampling component of Hyak based on the Agincourt HDSS site in South Africa. Compared with traditional cluster sampling, Hyak's informed sampling captures more deaths, and when combined with an estimation model that includes spatial smoothing, produces estimates of both mortality counts and mortality rates that have lower variance and small bias.
Alkaptonuria is an inborn error of metabolism. It is a multisystem disease with characteristic ENT manifestations. This paper reports, for the first time, the ENT findings in a cohort of alkaptonuria patients.
Patients attending the National Centre for Alkaptonuria (Royal Liverpool and Broadgreen University Hospitals NHS Trust) underwent a full ENT assessment.
Eighteen of the 20 patients (90 per cent) had an ENT sign or symptom. These included discolouration of the pinna, cerumen, nasal septum and pharynx.
Discolouration of cerumen may occur before 30 years of age and may therefore be an important early clinical sign. Further audiological assessment of patients is needed to clarify if an association exists between alkaptonuria and hearing loss. Alkaptonuria is a condition that could present to the otolaryngologist. Successful early diagnosis and referral to a specialist centre is essential so that patients can be offered disease-modifying therapy.
This study aimed to estimate the prevalence and risk factors for hepatitis C virus (HCV) infection in Mexican Americans living in South Texas. We tested plasma for the presence of HCV antibody from the Cameron County Hispanic Cohort (CCHC), a randomized, population-based cohort in an economically disadvantaged Mexican American community on the United States/Mexico border with high rates of chronic disease. A weighted prevalence of HCV antibody of 2·3% [n = 1131, 95% confidence interval (CI) 1·2–3·4] was found. Participants with diabetes had low rates of HCV antibody (0·4%, 95% CI 0·0–0·9) and logistic regression revealed a statistically significant negative association between HCV and diabetes (OR 0·20, 95% CI 0·05–0·77) after adjusting for sociodemographic and clinical factors. This conflicts with reported positive associations of diabetes and HCV infection. No classic risk factors were identified, but important differences between genders emerged in analysis. This population-based study of HCV in Mexican Americans suggests that national studies do not adequately describe the epidemiology of HCV in this border community and that unique risk factors may be involved.
Mindfulness-based cognitive therapy (MBCT) is a group-based intervention similar to mindfulness-based stress reduction, but which includes cognitive therapy techniques. This study investigates its usefulness in the treatment of depressive, anxiety and stress/distress symptoms in cancer patients referred to a psycho-oncology service. It also examines whether effect on depression is mediated by self-compassion.
In phase 1 of this study, 16 cancer patients with mild/moderate psychological distress were randomised to MBCT (n=8) or treatment as usual (TAU; n=8), and assessed pre- and post-treatment. Analysis of variance was performed to examine the effect of treatment on anxiety and depression. In phase 2, the TAU group received the intervention, and results of pre- and post-MBCT assessments were combined with those receiving MBCT in phase 1. Finally, both groups were followed up at 3 months.
In phase 1, the MBCT group had a significant improvement in mindfulness and a decrease in anxiety. Statistically significant improvements in both depression and anxiety were found at 3 month follow-up. Self-compassion appeared to mediate the effect on anxiety/depression.
This small pilot study suggests that MBCT may have a beneficial effect on psychological variables often adversely affected in cancer in a heterogeneous cancer population.
Transmission of hepatitis C (HCV) in Pakistan is a continuing public health problem; 15 years ago it was linked to the practice of reusing therapeutic instruments in healthcare settings. We sought to examine current risk factors for HCV transmission in a hospital population in Karachi, Pakistan. We enrolled 300 laboratory-confirmed HCV-positive participants and 300 laboratory-confirmed HCV-negative participants from clinics at Indus Hospital. Independent and significant risk factors for both men and women were: receiving ⩾12 injections in the past year, blood transfusions, having had dental work performed, and delivery in hospital or transfusion for women. Interestingly, being of Mohajir origin or born in Sindh province were protective. Encouragingly, a strong protective effect was observed for those that reported bringing their own needle for injections (59%). The widespread reuse of therapeutic needles in healthcare settings in Karachi remains a major driver of the HCV epidemic.
Salmonella Enteritidis has emerged as the most prevalent cause of human salmonellosis in Canada. Recent trends of S. Enteritidis subtypes and their potential sources were described by integrating Salmonella data from several Canadian surveillance and monitoring programmes. A threefold increase in S. Enteritidis cases from 2003 to 2009 was identified to be primarily associated with phage types 13, 8 and 13a. Other common phage types (4, 1, 6a) showed winter seasonality and were more likely to be associated with cases linked to international travel. Conversely, phage types 13, 8 and 13a had summer seasonal peaks and were associated with cases of domestically acquired infections. During agri-food surveillance, S. Enteritidis was detected in various commodities, most frequently in chicken (with PT13, PT8 and PT13a predominating). Antimicrobial resistance was low in human and non-human isolates. Continued integrated surveillance and collaborative prevention and control efforts are required to mitigate future illness.
Diarrhoeal mortality rates in Mexican children dramatically declined during the 1980s and 1990s, concomitant with a temporal shift in peak deaths from summer to autumn–winter. The spatial dynamics of these patterns have not previously been studied. We first describe the seasonal features of paediatric diarrhoeal mortality in Mexico as a whole, then across individual states. While no geographical gradients in the magnitude of diarrhoeal mortality rates have been detected in recent years, we identified a distinct spatial pattern in the timing of peak mortality rate. In the 1980s the summer peak mortality was earliest around Mexico's capital and later in states to the southeast and northwest. Our results suggest that the direction and timing of those annual waves are related to the mean monthly precipitation and mean daily temperature. This pattern has disintegrated in recent years as the summer peak has diminished.
Success in the domain of work is a salient developmental task of adulthood and a key indicator of adaptive function in the evaluation of health and psychopathology. Yet few studies have examined pathways to work competence, especially with strategies testing for cumulative cascade effects over time. Cascade models spanning 20 years were tested via structural equation modeling, linking work competence in early adulthood to antecedent competence in work and other domains of competence in childhood and emerging adulthood. Data were drawn from the Project Competence longitudinal study of 205 school children followed for 20 years. Relative fit of alternative models was evaluated by the Bayesian information criterion. As hypothesized, the effectiveness of adaptive behavior in earlier age-salient developmental task domains forecasted later work competence, which also showed strong concurrent links to competence in other domains. Results suggest there are numerous pathways by which success or failure in major developmental task domains in childhood and adolescence may influence adaptation in other domains and eventually work competence, both concurrently and cumulatively over time. Cascade effects highlight the potential significance for later work competence of childhood conduct (antisocial vs. rule-abiding behavior) and social competence with peers, in addition to the ongoing role that academic attainment may have for work success. Work competence also showed considerable stability over a 10-year period during early adulthood. Implications and applications for future research and intervention are discussed.
A case of tracheopathia chondro-osteoplastica causing sub-glottic stenosis is described.
Case report and literature review.
Materials and methods:
A 37-year-old man presented with a 15-year history of gradually worsening dyspnoea and stridor due to sub-glottic stenosis. His medical and radiographic records were reviewed. This patient's presentation, histopathological findings and radiology images are presented and discussed.
Histopathological evaluation of microlaryngoscopy biopsy specimens, taken during laser debulking of the stenosis, confirmed the presence of tracheopathia chondro-osteoplastica.
This is the first reported case of sub-glottic stenosis caused by tracheopathia chondro-osteoplastica which required an urgent tracheostomy.
Fusobacterium necrophorum is implicated as an aetiological agent in a variety of necrotic diseases, such as Lemièrre’s syndrome (LS) in humans. LS was initially described as septic thrombophlebitis of the internal jugular vein secondary to an acute oropharyngeal infection. Other primary sources of infection include parotitis, otitis media, sinusitis, odontogenic infection and m stoiditis. In the pre-antibiotic era LS carried a high mortality. This has been reduced as a result of the widespread use of antibiotics, butthere is still a definite morbidity and mortality associated with infection with this virulent organism. We report three cases of complicatedotitis media caused by Fusobacterium necrophorum. The patients were treated successively with intravenous metronidazole and surgery.
Starting from two-step anodizing recipes available in the literature, we fabricated selfsupporting ordered ion-implantation masks that are several mm2 in area and 1-4 νm thick. SEM micrographs reveal self-organized structures with straight open pores, 25-150 nm in diameter, extending completely through the mask. As reported previously, the pore diameter and spacing depend critically upon the anodization parameters, e.g., type of acid and its molality, the applied voltage and the solution temperature. Ion-milling procedures were developed for opening the bottoms of the anodized pores. These masks appear quite robust during exposure to ion beams of 1-MeV He, Ne, and Kr. The steps necessary to fabricate the implantation masks, including opening the pores, are briefly described. Here we present new results obtained with a mask fabricated with pore dimensions as small as 25 nm in diameter, i.e., at the limit of what is technically feasible. Measurements are reported of the angular dependence of the transmitted ion current; these results are consistent with the physical dimensions of the opened pores. TEM images of a partial array obtained by implantation through the 25-nm pores are also shown.
Polarization versus applied field (P-E) hysteresis loop measurements on Pb(Zr,Ti)O3 (PZT) thin films were performed using a controlled-atmosphere probe station. Measurements were made using two different capacitor configurations, each producing differing results. The capacitor configurations included using either the typical arrangement of two top electrodes (planar) or an arrangement using contacts to the top and the bottom electrodes (sandwich). The films included PZT films deposited using pulsed laser deposition (PLD) and commercially-available rfsputtered PZT thin films. Qualitatively similar results were obtained for both types of films. For both PLD and Ramtron PZT films, translation of ferroelectric hysteresis loops along the polarization axis was observed for sandwich capacitors. The magnitude of this voltage was strongly dependent on the partial pressure of oxygen at room temperature. Translations were not observed for the same films using the planar capacitor configuration. However, for both sandwich and planar configurations, the thin film capacitance was sensitive to changes in pO2.
Glossopharyngeal neuralgia is rare, typically idiopathic and treated with carbamazepine. Surgery to decompress or transect the glossopharyngeal nerve root may be performed if conservative management fails. We present a case following trauma to the neck with foreign body impaction. To our knowledge this is the first case of glossopharyngeal neuralgia due to neck trauma.
We conducted a study to evaluate risk factors for developing typhoid
fever in a setting where
the disease is endemic in Karachi, Pakistan. We enrolled 100 cases with
culture-confirmed Salmonella typhi between July and October 1994
and 200 age-matched
neighbourhood controls. Cases had a median age of 5·8 years. In
a conditional logistic
regression model, eating ice cream (Odds ratio [OR]=2·3;
95% confidence interval [CI]
1·2–4·2, attributable risk [AR]=36%),
eating food from a roadside cabin during the summer
months (OR=4·6, 95% CI 1·6–13·0; AR=18%),
taking antimicrobials in the 2 weeks
preceding the onset of symptoms (OR=5·7, 95% CI
2·3–13·9, AR=21%), and drinking
water at the work-site (OR=44·0, 95% CI 2·8–680,
AR=8%) were all independently
associated with typhoid fever. There was no difference in the microbiological
water quality of
home drinking water between cases and controls. Typhoid fever in Karachi
high-dose exposures from multiple sources with individual susceptibility
increased by young age and
prior antimicrobial use. Improving commercial food hygiene and decreasing
antimicrobial use would be expected to decrease the burden of typhoid fever.
We have studied the effects of intense x-ray irradiation on the stucture of amorphous Si films. The films were obtained by either physical vapor deposition or by implantation of high energy ions into crystalline Si. They were exposed to different total doses of synchrotron x-rays. From the EXAFS and EXELFS measurements we find that an exposure to x-rays increases the Si coordination number. Also in the PVD films a prolonged x-ray exposure enlarges, by about 2 %, the Si-Si bond length. Raman spectroscopy shows that Si amorphized with high energy ions contains small residual amounts of crystalline material. Irradiation of such films with x-rays annihilates those crystallites resulting in homogenously amorphous layer with a close to four-fold coordination of Si atoms. This rearangement of the local structure has a pronounced effect on the crystallization process of the amorphous films. Thermal annealing of x-ray irradiated ion amorphized films leads to nearly defect free solid phase epitaxy at 500°C. Also we observe a delay in the onset of the crystallization process in x-ray irradiated PVD films. We associate this with a reduced concentration of nucleation centers in the x-ray treated materials.