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Recent models of psychopathology suggest the presence of a general factor capturing the shared variance among all symptoms along with specific psychopathology factors (e.g., internalizing and externalizing). However, few studies have examined predictors that may serve as transdiagnostic risk factors for general psychopathology from early development. In the current study we examine, for the first time, whether observed and parent-reported infant temperament dimensions prospectively predict general psychopathology as well as specific psychopathology dimensions (e.g., internalizing and externalizing) across childhood. In a longitudinal cohort (N = 291), temperament dimensions were assessed at 4 months of age. Psychopathology symptoms were assessed at 7, 9, and 12 years of age. A bifactor model was used to estimate general, internalizing, and externalizing psychopathology factors. Across behavioral observations and parent-reports, higher motor activity in infancy significantly predicted greater general psychopathology in mid to late childhood. Moreover, low positive affect was predictive of the internalizing-specific factor. Other temperament dimensions were not related with any of the psychopathology factors after accounting for the general psychopathology factor. The results of this study suggest that infant motor activity may act as an early indicator of transdiagnostic risk. Our findings inform the etiology of general psychopathology and have implications for the early identification for children at risk for psychopathology.
Healthcare personnel (HCP) were recruited to provide serum samples, which were tested for antibodies against Ebola or Lassa virus to evaluate for asymptomatic seroconversion.
From 2014 to 2016, 4 patients with Ebola virus disease (EVD) and 1 patient with Lassa fever (LF) were treated in the Serious Communicable Diseases Unit (SCDU) at Emory University Hospital. Strict infection control and clinical biosafety practices were implemented to prevent nosocomial transmission of EVD or LF to HCP.
All personnel who entered the SCDU who were required to measure their temperatures and complete a symptom questionnaire twice daily were eligible.
No employee developed symptomatic EVD or LF. EVD and LF antibody studies were performed on sera samples from 42 HCP. The 6 participants who had received investigational vaccination with a chimpanzee adenovirus type 3 vectored Ebola glycoprotein vaccine had high antibody titers to Ebola glycoprotein, but none had a response to Ebola nucleoprotein or VP40, or a response to LF antigens.
Patients infected with filoviruses and arenaviruses can be managed successfully without causing occupation-related symptomatic or asymptomatic infections. Meticulous attention to infection control and clinical biosafety practices by highly motivated, trained staff is critical to the safe care of patients with an infection from a special pathogen.
The landscape of antimicrobial resistance (AMR) surveillance is changing rapidly. The primary objective of this study was to assess the benefit of linking population-based infection prevention and control surveillance data on methicillin-resistant Staphylococcus aureus (MRSA) to hospital discharge abstract data (DAD). We assessed the value of this novel data linkage for the characterization of hospital-acquired (HA) and community-acquired MRSA (CA-MRSA) cases.
Incident inpatient MRSA surveillance data for all adults (≥18 years) from 4 acute-care facilities in Calgary, Alberta, between April 1, 2011, and March 31, 2017, were linked to DAD. Personal health number (PHN) and gender were used to identify specific individuals, and specimen collection time-points were used to identify specific hospitalization records. A third common variable on admission date between these databases was used to validate the linkage process. Descriptive statistics were used to characterize HA-MRSA and CA-MRSA cases identified through the linkage process.
A total of 2,430 surveillance records (94.6%) were successfully linked to the correct hospitalization period. By linking surveillance and administrative data, we were able to identify key differences between patients with HA- and CA-MRSA. These differences are consistent with previously reported findings in the literature. Data linkage to DAD may be a novel tool to enhance and augment the details of base surveillance data.
Conclusion and recommendations:
This is the first Canadian study linking a frontline healthcare-associated infection AMR surveillance database to an administrative population database. This work represents an important methodological step toward complementing traditional AMR surveillance data practices. Data linkage to other data types, such as primary care, emergency, social, and biological data, may be the basis of achieving more precise data focused around AMR.
To determine the attributable cost and length of stay of hospital-acquired Clostridioides difficile infection (HA-CDI) from the healthcare payer perspective using linked clinical, administrative, and microcosting data.
A retrospective, population-based, propensity-score–matched cohort study.
Acute-care facilities in Alberta, Canada.
Admitted adult (≥18 years) patients with incident HA-CDI and without CDI between April 1, 2012, and March 31, 2016.
Incident cases of HA-CDI were identified using a clinical surveillance definition. Cases were matched to noncases of CDI (those without a positive C. difficile test or without clinical CDI) on propensity score and exposure time. The outcomes were attributable costs and length of stay of the hospitalization where the CDI was identified. Costs were expressed in 2018 Canadian dollars.
Of the 2,916 HA-CDI cases at facilities with microcosting data available, 98.4% were matched to 13,024 noncases of CDI. The total adjusted cost among HA-CDI cases was 27% greater than noncases of CDI (ratio, 1.27; 95% confidence interval [CI], 1.21–1.33). The mean attributable cost was $18,386 (CAD 2018; USD $14,190; 95% CI, $14,312–$22,460; USD $11,046-$17,334). The adjusted length of stay among HA-CDI cases was 13% greater than for noncases of CDI (ratio, 1.13; 95% CI, 1.07–1.19), which corresponds to an extra 5.6 days (95% CI, 3.10–8.06) in length of hospital stay per HA-CDI case.
In this population-based, propensity score matched analysis using microcosting data, HA-CDI was associated with substantial attributable cost.
Nearly 800,000 primary hip and knee arthroplasty procedures are performed annually in North America. Approximately 1% of these are complicated by a complex surgical site infection (SSI), leading to very high healthcare costs. However, population-based studies to properly estimate the economic burden are lacking. We aimed to address this knowledge gap.
Economic burden study.
Using administrative health and clinical databases, we created a cohort of all patients in Alberta, Canada, who received a primary hip or knee arthroplasty between April 1, 2012, and March 31, 2015. All patients who developed a complex SSI postoperatively were identified through a provincial infection prevention and control database. A combination of corporate microcosting data and gross costing methods were used to determine total mean 12- and 24-month costs, enabling comparison of costs between the infected and noninfected patients.
Mean 12-month total costs were significantly greater in patients who developed a complex SSI compared to those who did not (CAD$95,321 [US$68,150] vs CAD$19,893 [US$14,223]; P < .001). The magnitude of the cost difference persisted even after controlling for underlying patient factors. The most commonly identified causative pathogen (38%) was Staphylococcus aureus (95% MSSA).
Complex SSIs following hip and knee arthroplasty lead to high healthcare costs, which are expected to rise as the yearly number of surgeries increases. Using our costing estimates, the cost-effectiveness of different strategies to prevent SSIs should be investigated.
Hip and knee arthroplasty infections are associated with considerable healthcare costs. The merits of reducing the postoperative surveillance period from 1 year to 90 days have been debated.
To report the first pan-Canadian hip and knee periprosthetic joint infection (PJI) rates and to describe the implications of a shorter (90-day) postoperative surveillance period.
Prospective surveillance for infection following hip and knee arthroplasty was conducted by hospitals participating in the Canadian Nosocomial Infection Surveillance Program (CNISP) using standard surveillance definitions.
Overall hip and knee PJI rates were 1.64 and 1.52 per 100 procedures, respectively. Deep incisional and organ-space hip and knee PJI rates were 0.96 and 0.71, respectively. In total, 93% of hip PJIs and 92% of knee PJIs were identified within 90 days, with a median time to detection of 21 days. However, 11%–16% of deep incisional and organ-space infections were not detected within 90 days. This rate was reduced to 3%–4% at 180 days post procedure. Anaerobic and polymicrobial infections had the shortest median time from procedure to detection (17 and 18 days, respectively) compared with infections due to other microorganisms, including Staphylococcus aureus.
PJI rates were similar to those reported elsewhere, although differences in national surveillance systems limit direct comparisons. Our results suggest that a postoperative surveillance period of 90 days will detect the majority of PJIs; however, up to 16% of deep incisional and organ-space infections may be missed. Extending the surveillance period to 180 days could allow for a better estimate of disease burden.
To conduct a full economic evaluation assessing the costs and consequences related to probiotic use for the primary prevention of Clostridium difficile–associated diarrhea (CDAD).
Cost-effectiveness analysis using decision analytic modeling.
A cost-effectiveness analysis was used to evaluate the risk of CDAD and the costs of receiving oral probiotics versus not over a time horizon of 30 days. The target population modeled was all adult inpatients receiving any therapeutic course of antibiotics from a publicly funded healthcare system perspective. Effectiveness estimates were based on a recent systematic review of probiotics for the primary prevention of CDAD. Additional estimates came from local data and the literature. Sensitivity analyses were conducted to assess how plausible changes in variables impacted the results.
Treatment with oral probiotics led to direct costs of CDN $24 per course of treatment per patient. On average, patients treated with oral probiotics had a lower overall cost compared with usual care (CDN $327 vs $845). The risk of CDAD was reduced from 5.5% in those not receiving oral probiotics to 2% in those receiving oral probiotics. These results were robust to plausible variation in all estimates.
Oral probiotics as a preventive strategy for CDAD resulted in a lower risk of CDAD as well as cost-savings. The cost-savings may be greater in other healthcare systems that experience a higher incidence and cost associated with CDAD.
To evaluate hospital administrative data to identify potential surgical site infections (SSIs) following primary elective total hip or knee arthroplasty.
Retrospective cohort study.
All acute care facilities in Alberta, Canada.
Diagnosis and procedure codes for 6 months following total hip or knee arthroplasty were used to identify potential SSI cases. Medical charts of patients with potential SSIs were reviewed by an infection control professional at the acute care facility where the patient was identified with a diagnosis or procedure code. For SSI decision, infection control professionals used the National Healthcare Safety Network SSI definition. The performance of traditional surveillance methods and administrative data–triggered medical chart review was assessed.
Of the 162 patients identified by diagnosis or procedure code, 46 (28%) were confirmed as an SSI by an infection control professional. More SSIs were identified following total hip vs total knee arthroplasty (42% vs16%). Of 46 confirmed SSI cases, 20 (43%) were identified at an acute care facility different than their procedure facility. Administrative data–triggered medical chart review with infection control professional confirmation resulted in a 1.1- to 1.7-fold increase in SSI rate compared with traditional surveillance. SSIs identified by administrative data resulted in sensitivity of 90% and specificity of 99%.
Medical chart review for cases identified through administrative data is an efficient supplemental SSI surveillance strategy. It improves case-finding by increasing SSI identification and making identification consistent across facilities, and in a provincial surveillance network it identifies SSIs presenting at nonprocedure facilities.
During the first half of the sixteenth century, municipal councils across northern France issued ordinances designed to combat outbreaks of plague. The measures contained in these ordinances were extensive and formed the core of urban responses to plague throughout the early modern period. These ordinances did not appear out of a vacuum; rather, they represented the codification of stratagems adopted during the second half of the fifteenth century. This article will describe and account for the growth of the public health system developed by the magistrates of towns lying in the urban belt of northern and north-eastern France from the 1450s to the 1550s. It will concentrate on the towns and cities of Abbeville, Amiens, Beauvais, Paris, Rouen and Tournai, all of which possess good administrative records for the period. In addition to the texts of plague ordinances, the most valuable documents for this study are the registers of municipal deliberations, which allow us to follow the decision-making process that lay behind the development of plague legislation.
Many of the more celebrated measures against pestilence originated in fourteenth- and fifteenth-century Italy, and the bulk of our knowledge regarding the ways in which urban administrations reacted to these outbreaks is based on studies of northern Italian cities, such as Florence and Venice. Although historians have expanded the geographical scope of such studies to consider municipal responses to plague in England, Spain, Switzerland, Germany and the Low Countries, little research has been done on France during the fifteenth and sixteenth centuries.
This article will examine and compare the way that society coped with two of the major epidemics to affect Renaissance Italy: plague and the Great Pox. Even though these diseases impacted on Italy as severely as they did on the rest of Europe, different countries devised different solutions to the same problems. Discussing the strategies that Italy adopted in the long fifteenth century is valuable not just to those who work on Italian Renaissance history, but also to historians of countries such as England which developed very different measures. Indeed, in the sixteenth century, in the case of plague, the privy council and statesmen such as William Cecil, Lord Burghley, looked to continental and particularly Italian plague measures as a reflection of their ‘civility’, which made them worthy of imitation.
The main elements which constituted this ‘civility’ will be the subject of the first part of this article, which will examine society's reactions to plague in Renaissance Italy through the prism of how contemporaries understood the nature of the disease. One of the more traditional themes of historical studies of Italian plague is the idea that at the time there was a marked division in beliefs between doctors and health boards about how disease was spread, with the former supporting the idea of infected air, or miasma, and the latter espousing contagionist views. This story is complicated still further from the late fifteenth century by the emergence of the Great Pox.
John Clement, a brewer, entered the Norwich franchise in 1447. Over the next decade he was a constable nine times and a tax collector once, but he never discharged any other civic office. In spite of their important role in administering and maintaining order in English cities, men like Clement have been neglected as a result of English urban historians' tendency to focus on the better-documented and wealthier mercantile elite. Prosopographical analyses of urban political, economic, and social groups have directed some attention towards middling artisans and retailers because of their focus on collective biography, but the relative dearth of information about these groups has made even this approach more effective for understanding the senior officials. Moreover, although these studies have revealed much about civic hierarchies, they have perhaps encouraged the perception that a mercantile elite dominated all aspects of urban political life. Although no one would deny the virtual monopoly of high office by a privileged few, there is considerable evidence that mercantile control was not so comprehensive in the lower levels of civic government.
Non-elite urban officials have received little sustained analysis. Indeed, on the few occasions that mid-level offices have been examined they have generally been cast as part of the cursus honorum or as unwelcome chores rather than as potentially valuable positions. By focusing on a group of non-elite personnel, namely, constables, assessors, collectors, supervisors and searchers in Norwich between 1414 and 1473, this paper demonstrates the essential role played by such individuals and postulates that not all urban office-holders nursed greater ambitions.
The fact that the plague in its bubonic, septicaemic and pneumonic forms is still with us in the twenty-first century often comes as a shock to the general public. Memories of school projects have made them vaguely aware of the great pandemic, which arrived in southern Italy in 1347 and then raged across Europe, reaching England and Norway in 1348, through Oslo in 1348 and then through Bergen in 1349, and European Russia in 1351, where the city state of Novgorod was first infected. But then, surely, it went away? Not quite: outbreaks of plague in this second pandemic, first (allegedly) called the Black Death by Mrs Markham in 1823 in her History of England, from which the horrors of history and the complexities of party politics were removed as not suitable for young minds, lasted in England until the early eighteenth century, whilst in Italy what is generally regarded as its final appearance came at Naja, near Bari, in 1815. Even then the disease did not disappear. It merely became dormant until 1855, when a new pandemic began in China, spreading through the Pacific Rim and in 1899 to the United States where plague had previously been unknown. Indeed, as the well-known World Health Organisation map of plague loci and plague outbreaks 1970–1998 shows, the disease is enzootic or sylvatic (ever-present in certain animal populations and their fleas) in some fifty-eight different regions in the world and can still spread to more susceptible animals, including humans, in epizootic outbreaks.
Described as "a golden age of pathogens", the long fifteenth century was notable for a series of international, national and regional epidemics that had a profound effect upon the fabric of society. The impact of pestilence upon the literary, religious, social and political life of men, women and children throughout Europe and beyond continues to excite lively debate among historians, as the ten papers presented in this volume confirm. They deal with the response of urban communities in England, France and Italy to matters of public health, governance and welfare, as well as addressing the reactions of the medical profession to successive outbreaks of disease, and of individuals to the omnipresence of Death, while two, very different, essays examine the important, if sometimes controversial, contribution now being made by microbiologists to our understanding of the Black Death. Contributors: J.L. Bolton, Elma Brenner, Samuel Cohn, John Henderson, Neil Murphy, Elizabeth Rutledge, Samantha Sagui, Karen Smyth, Jane Stevens Crawshaw, Sheila Sweetinburgh