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The introduction of treatment and systematic vaccination has significantly reduced diphtheria mortality; however, toxigenic strains continue to circulate worldwide. The emergence of an indigenous diphtheria case with fatal outcome in Greece, after 30 years, raised challenges for laboratory confirmation, clinical and public health management. Toxigenic Corynebacterium diphtheriae was isolated from an incompletely vaccinated 8-year-old boy with underlying conditions. The child passed away due to respiratory distress syndrome, before the administration of diphtheria antitoxin (DAT). All close contacts in family, school and hospital settings were investigated. Pharyngeal swabs were obtained to determine asymptomatic carriage. Chemoprophylaxis was given for 7 days to all close contacts and a booster dose to those incompletely vaccinated. Testing revealed a classmate, belonging to a subpopulation group (Roma), and incompletely vaccinated, as an asymptomatic carrier with an indistinguishable toxigenic strain (same novel multilocus sequence type, designated ST698). This case highlights the role of asymptomatic carriage, as the entry of toxigenic strains into susceptible populations can put individuals and their environment at risk. Maintenance of high-level epidemiological and microbiological surveillance, implementation of systematic vaccination in children and adults with primary and booster doses, availability of a DAT stockpile, and allowing timely administration are the cornerstone to prevent similar incidents in the future.
To model the potential impact and equity impact of fortifying rice on nutritional adequacy of different subpopulations in Nepal.
Using 24-h dietary recall data and a household consumption survey, we estimated: rice intakes; probability of adequacy (PA) of eight micronutrients commonly fortified in rice (vitamin A, niacin (B3), pyridoxine (B6), cobalamin (B12), thiamin (B1), folate (B9), Fe and Zn) plus riboflavin (B2), vitamin C and Ca and mean probability of adequacy (MPA) of these micronutrients. We modelled: no fortification; fortification of purchased rice, averaged across all households and in rice-buying households only. We compared adequacy increases between population subgroups.
(i) Dhanusha and Mahottari districts of Nepal (24-h recall) and (ii) all agro-ecological zones of Nepal (consumption data).
(i) Pregnant women (n 128), mothers-in-law and male household heads; (ii) households (n 4360).
Unfortified diets were especially inadequate in vitamins B12, A, B9, Zn and Fe. Fortification of purchased rice in rice-purchasing households increased PA > 0·9 for thiamin, niacin, B6, folate and Zn, but B12 and Fe remained inadequate even after fortification (PA range 0·3–0·9). Pregnant women’s increases exceeded men’s for thiamin, niacin, B6, folate and MPA; men had larger gains in vitamin A, B12 and Zn. Adequacy improved more in the hills (coefficient 0·08 (95 % CI 0·05, 0·10)) and mountains (coefficient 0·07 (95 % CI 0·01, 0·14)) but less in rural areas (coefficient −0·05 (95 % CI −0·09, −0·01)).
Consumption of purchased fortified rice improves adequacy and gender equity of nutrient intake, especially in non-rice-growing areas.
This article presents the results of a program of radiocarbon dating and Bayesian modeling from the precontact Yup'ik site of Nunalleq (GDN-248) in subarctic southwestern Alaska. Nunalleq is deeply stratified, presenting a robust relative chronological framework of well-defined individual house floors abundant in ecofacts suitable for radiocarbon dating. Capitalizing on this potential, we present the results of one of the first applications of Bayesian statistical modeling of radiocarbon data from an archaeological site in the North American Arctic. Using these methods, we demonstrate that it is possible to generate robust, high-resolution chronological models from Arctic archaeology. Radiocarbon dates, procured prior to the program of dating and modeling presented here, suggested an approximately three-century duration of occupation at the site. The results of Bayesian modeling nuance this interpretation. While it is possible that there may have been activity for almost three centuries (beginning in the late fourteenth century), occupation of the dwelling complex, which dominates the site, was more likely to have endured for no more than a century. The results presented here suggest that the occupation of Nunalleq likely encompassed three generations beginning cal AD 1570–1630 before being curtailed by conflict around cal AD 1645–1675.
To outline the development of a smartphone-based tool to collect thrice-repeated 24 h dietary recall data in rural Nepal, and to describe energy intakes, common errors and researchers’ experiences using the tool.
We designed a novel tool to collect multi-pass 24 h dietary recalls in rural Nepal by combining the use of a CommCare questionnaire on smartphones, a paper form, a QR (quick response)-coded list of foods and a photographic atlas of portion sizes. Twenty interviewers collected dietary data on three non-consecutive days per respondent, with three respondents per household. Intakes were converted into nutrients using databases on nutritional composition of foods, recipes and portion sizes.
Dhanusha and Mahottari districts, Nepal.
Pregnant women, their mothers-in-law and male household heads. Energy intakes assessed in 150 households; data corrections and our experiences reported from 805 households and 6765 individual recalls.
Dietary intake estimates gave plausible values, with male household heads appearing to have higher energy intakes (median (25th–75th centile): 12 079 (9293–14 108) kJ/d) than female members (8979 (7234–11 042) kJ/d for pregnant women). Manual editing of data was required when interviewers mistook portions for food codes and for coding items not on the food list. Smartphones enabled quick monitoring of data and interviewer performance, but we initially faced technical challenges with CommCare forms crashing.
With sufficient time dedicated to development and pre-testing, this novel smartphone-based tool provides a useful method to collect data. Future work is needed to further validate this tool and adapt it for other contexts.
Public Health England conducts enhanced national surveillance of tetanus, a potentially life-threatening vaccine-preventable disease. A standardized questionnaire was used to ascertain clinical and demographic details of individuals reported with clinically suspected tetanus. The 96 cases identified between 2001 and 2014 were analysed. The average annual incidence was 0·13/million (95% confidence interval 0·10–0·16) of which 50·0% were male. Where reported, 70·3% of injuries occurred in the home/garden (45/64). Overall, 40·3% (31/77) cases were in people who inject drugs (PWID), including a cluster of 22 cases during 2003–2004. Where known (n = 68), only 8·8% were age-appropriately immunized. The overall case-fatality rate was 11·0% (9/82). All tetanus-associated deaths occurred in adults aged >45 years, none of whom were fully immunized. Due to the success of the childhood immunization programme, tetanus remains a rare disease in England with the majority of cases occurring in older unimmunized or partially immunized adults. Minor injuries in the home/garden were the most commonly reported likely sources of infection, although cases in PWID increased during this period. It is essential that high routine vaccine coverage is maintained and that susceptible individuals, particularly older adults, are protected through vaccination and are offered timely post-exposure management following a tetanus-prone wound.
Entropy maximising spatial interaction models have been widely exploited in a range of disciplines and applications: from trade and migration flows to the spread of riots and the understanding of spatial patterns in archaeological sites of interest. When embedded into a dynamic system and framed in the context of a retail model, the dynamics of centre growth poses an interesting mathematical problem, with bifurcations and phase changes, which may be addressed analytically. In this paper, we present some analysis of the continuous retail model and the corresponding discrete version, which yields insights into the effect of space on the evolving system, and an understanding of why certain retail centres are more successful than others. The slowly developing growths and the fast explosive growths that are of particular concern are explained in detail.
Within the field of environmental management and conservation, the concept of well-being is starting to gain traction in monitoring the socio-economic and cultural impact of interventions on local people. Here we consider the practical trade-offs policy makers and practitioners must navigate when utilizing the concept of well-being in environmental interventions. We first review current concepts of well-being before considering the need to balance the complexity and practical applicability of the definition used and to consider both positive and negative components of well-being. A key determinant of how well-being is operationalized is the identity of the organization wishing to monitor it. We describe the trade-offs around the external and internal validity of different approaches to measuring well-being and the relative contributions of qualitative and quantitative information to understanding well-being. We explore how these trade-offs may be decided as a result of a power struggle between stakeholders. Well-being is a complex, multi-dimensional, dynamic concept that cannot be easily defined and measured. Local perspectives are often missed during the project design process as a result of the more powerful voices of national governments and international NGOs, so for equity and local relevance it is important to ensure these perspectives are represented at a high level in project design and implementation.
This review summarises evidence for an association between vitamin D status and CVD and the mechanisms involved. Vitamin D3 is predominantly provided by the action of UVB from sunlight on skin. Average UK diets supply 2–3 μg/d vitamin D but diets containing at least one portion of oily fish per week supply about 7 μg/d. Pharmacological doses of vitamin D2 (bolus injection of 7500 μg or intakes >50 μg/d) result in a smaller increase in plasma 25(OH)D than those of D3 but physiological doses 5–25 μg/d seem equivalent. Plasma 25(OH)D concentrations are also influenced by clothing, obesity and skin pigmentation. Up to 40 % of the population have plasma 25(OH)D concentrations <25 nmol/l in the winter compared with <10 % in the summer. The relative risk of CVD death is 1·41 (95 % CI 1·18, 1·68) greater in the lowest quintile of plasma 25(OH)D according to meta-analysis of prospective cohort studies. Acute deficiency may inhibit insulin secretion and promote inflammation thus increasing the risk of plaque rupture and arterial thrombosis. Chronic insufficiency may increase arterial stiffness. There is no evidence to support claims of reduced CVD from existing trials with bone-related health outcomes where vitamin D was usually co-administered with calcium. Although several trials with cardiovascular endpoints are in progress, these are using pharmacological doses. In view of the potential toxicity of pharmacological doses, there remains a need for long-term trials of physiological doses of D2 and D3 with CVD incidence as the primary outcome.
Death certificate reports and laboratory-confirmed influenza deaths probably underestimate paediatric deaths attributable to influenza. Using US mortality data for persons aged <18 years who died during 28 September 2003 to 2 October 2010, we estimated influenza-attributable deaths using a generalized linear regression model based on seasonal covariates, influenza-certified deaths (deaths for which influenza was a reported cause of death), and occurrence during the 2009 pandemic period. Of 32 783 paediatric deaths in the death categories examined, 853 (3%) were influenza-certified. The estimated number of influenza-attributable deaths over the study period was 1·8 [95% confidence interval (CI) 1·3–2·8] times higher than the number of influenza-certified deaths. Influenza-attributable deaths were 2·1 (95% CI 1·5–3·4) times higher than influenza-certified deaths during the non-pandemic period and 1·1 (95% CI 1·0–1·8) times higher during the pandemic. Overall, US paediatric deaths attributable to influenza were almost twice the number reported by death certificate codes in the seasons prior to the 2009 pandemic.
We analysed a cross-sectional telephone survey of U.S. adults to assess the impact of selected characteristics on healthcare-seeking behaviours and treatment practices of people with influenza-like illness (ILI) from September 2009 to March 2010. Of 216 431 respondents, 8·1% reported ILI. After adjusting for selected characteristics, respondents aged 18–64 years with the following factors were more likely to report ILI: a diagnosis of asthma [adjusted odds ratio (aOR) 1·88, 95% CI 1·67–2·13] or heart disease (aOR 1·41, 95% CI 1·17–1·70), being disabled (aOR 1·75, 95% CI 1·57–1·96), and reporting financial barriers to healthcare access (aOR 1·63, 95% CI 1·45–1·82). Similar associations were seen in respondents aged ⩾65 years. Forty percent of respondents with ILI sought healthcare, and 14% who sought healthcare reported receiving influenza antiviral treatment. Treatment was not more frequent in patients with high-risk conditions, except those aged 18–64 years with heart disease (aOR 1·90, 95% CI 1·03–3·51). Of patients at high risk for influenza complications, self-reported ILI was greater but receipt of antiviral treatment was not, despite guidelines recommending their use in this population.
A typically pessimistic view of aging is that it leads to a steady decline in physical and mental abilities. In this volume leading gerontologists and geriatric researchers explore the immense potential of older adults to overcome the challenges of old age and pursue active lives with renewed vitality. The contributors believe that resilience capacities diminishing with old age is a misconception and argue that individuals may successfully capitalize on their existing resources, skills and cognitive processes in order to achieve new learning, continuing growth, and enhanced life-satisfaction. By identifying useful psychological resources such as social connectedness, personal engagement and commitment, openness to new experiences, social support and sustained cognitive activity, the authors present a balanced picture of resilient aging. Older adults, while coping with adversity and losses, can be helped to maintain a complementary focus on psychological strengths, positive emotions, and regenerative capacities to achieve continued growth and healthy longevity.
This volume addresses the topic of “new frontiers in resilient aging,” which is of ever-increasing significance in current gerontological and geriatric discourse and research. The topic is not only very complex, but has enormous scope and breadth, encompassing a number of psychosocial and biological models of aging, theoretical formulations, definitions, and dimensions of resilience, and the core determinants of resilience that lay the foundations for discourse and research. Resilience as a psychological construct emerged from the study of children and youth at risk, and discourse on resilience, adaptation, and healthy longevity has focused mainly on younger adults, perhaps because of a misconception that resilience capacities diminish rapidly and perhaps irreversibly after young adulthood. Currently, increased life-expectancy without the compression of morbidity and vulnerability, together with the rising costs of healthcare, has highlighted the need for greater attention to the capacity for resilience throughout adulthood and in late life.
More recently, factors that influence resilience in later life are being studied more extensively. Within the last few years the theme of resilience in an aging society has been featured prominently in a number of national and international conferences and is the subject of intensive study in institutes of health sciences, mental health, and gerontology. This confluence of events suggests that the time is ripe to highlight some of the more recent and important research and writing on the topic of resilience in later life, and to bring the strands of this rapidly emerging scholarship together to showcase the movement toward promoting healthier aging.
Although pneumonia is a leading cause of death from infectious disease worldwide, comprehensive information about its causes and incidence in low- and middle-income countries is lacking. Active surveillance of hospitalized patients with pneumonia is ongoing in Thailand. Consenting patients are tested for seven bacterial and 14 viral respiratory pathogens by PCR and viral culture on nasopharyngeal swab specimens, serology on acute/convalescent sera, sputum smears and antigen detection tests on urine. Between September 2003 and December 2005, there were 1730 episodes of radiographically confirmed pneumonia (34·6% in children aged <5 years); 66 patients (3·8%) died. A recognized pathogen was identified in 42·5% of episodes. Respiratory syncytial virus (RSV) infection was associated with 16·7% of all pneumonias, 41·2% in children. The viral pathogen with the highest incidence in children aged <5 years was RSV (417·1/100 000 per year) and in persons aged ⩾50 years, influenza virus A (38·8/100 000 per year). These data can help guide health policy towards effective prevention strategies.