hazardous or compromised environment.' As such, injury must be regarded as a disease, with identifiable causative factors. Severe head injury in a child is a sociological disaster that crosses all ... biochemical monitoring, measurement of arterial oxygen and ... three or more organ systems, musculoskeletal injuries occurred ...
Full Text Available Previous modeling studies have identified the vaccination coverage level necessary for preventing influenza epidemics, but have not shown whether this critical coverage can be reached. Here we use computational modeling to determine, for the first time, whether the critical coverage for influenza can be achieved by voluntary vaccination. We construct a novel individual-level model of human cognition and behavior; individuals are characterized by two biological attributes (memory and adaptability that they use when making vaccination decisions. We couple this model with a population-level model of influenza that includes vaccination dynamics. The coupled models allow individual-level decisions to influence influenza epidemiology and, conversely, influenza epidemiology to influence individual-level decisions. By including the effects of adaptive decision-making within an epidemic model, we can reproduce two essential characteristics of influenza epidemiology: annual variation in epidemic severity and sporadic occurrence of severe epidemics. We suggest that individual-level adaptive decision-making may be an important (previously overlooked causal factor in driving influenza epidemiology. We find that severe epidemics cannot be prevented unless vaccination programs offer incentives. Frequency of severe epidemics could be reduced if programs provide, as an incentive to be vaccinated, several years of free vaccines to individuals who pay for one year of vaccination. Magnitude of epidemic amelioration will be determined by the number of years of free vaccination, an individuals' adaptability in decision-making, and their memory. This type of incentive program could control epidemics if individuals are very adaptable and have long-term memories. However, incentive-based programs that provide free vaccination for families could increase the frequency of severe epidemics. We conclude that incentive-based vaccination programs are necessary to control
First page Back Continue Last page Overview Graphics. Epidemics can be prevented with a Doctor on Call. A potential epidemic of Chicken Pox was halted by a simple email to the right people. Instant response from the Government Doctors.
Cattle epidemics broke out many times in Song Dynasty due to pasture transferring to south, abnormal climate, poor stabling hygiene and climatic sickness caused by migration. Mass Mortality and reduction of animal agriculture productivity threatened the stable production of grain, which influenced society and attracted attention from all social classes. Based on the principle of 'prevention before sicken' and 'contagion protection after sicken', the government took a series of medical and economical actions for prevention, such as veterinarians dispatching, drugs providing, pasturage rule regulating, law modifying (cattle trade permitted) and new farm implements popularization (to prevent missing the opportunity of cultivation), which was effective for Cattle Epidemics prevention at that time.
Full Text Available This paper provides a review of a recently published series of studies that give a detailed and comprehensive documentation of the severe acute respiratory syndrome (SARS epidemic in mainland China, which severely struck the country in the spring of 2003. The epidemic spanned a large geographical extent but clustered in two areas: first in Guangdong Province, and about 3 months later in Beijing with its surrounding areas. Reanalysis of all available epidemiological data resulted in a total of 5327 probable cases of SARS, of whom 343 died. The resulting case fatality ratio (CFR of 6.4% was less than half of that in other SARS-affected countries or areas, and this difference could only partly be explained by younger age of patients and higher number of community acquired infections. Analysis of the impact of interventions demonstrated that strong political commitment and a centrally coordinated response was the most important factor to control SARS in mainland China, whereas the most stringent control measures were all initiated when the epidemic was already dying down. The long-term economic consequence of the epidemic was limited, much consumption was merely postponed, but for Beijing irrecoverable losses to the tourist sector were considerable. An important finding from a cohort study was that many former SARS patients currently suffer from avascular osteonecrosis, as a consequence of the treatment with corticosteroids during their infection. The SARS epidemic provided valuable information and lessons relevant in controlling outbreaks of newly emerging infectious diseases, and has led to fundamental reforms of the Chinese health system. In particular, a comprehensive nation-wide internet-based disease reporting system was established.
Robson , Anthony ,
International audience; Diet, lifestyle and environment do not just affect a person's health, they also determine the health of their children and possibly the health of their grandchildren. Mental ill health is an epidemic worldwide because of the combined effect of the modern diet and a sedentary lifestyle. Primary prevention of mental ill health starts, crucially, with optimal adult nutrition before the inception of pregnancy, includes breastfeeding, and continues throughout the life of th...
Robson , Anthony ,
International audience; Diet, lifestyle and environment do not just affect a person's health, they also determine the health of their children and possibly the health of their grandchildren. Non-communicable disease is a global epidemic because of the combined effect of the modern diet (including drug abuse) and a sedentary lifestyle. A low energy dense, drug-free diet rich in bioavailable nutrients-plus-exercise is most effective for preventing non-communicable disease throughout life. Nanoc...
Phanuphak, Nittaya; Lo, Ying-Ru; Shao, Yiming; Solomon, Sunil Suhas; O'Connell, Robert J.; Tovanabutra, Sodsai; Chang, David; Kim, Jerome H.
Abstract An overall decrease of HIV prevalence is now observed in several key Asian countries due to effective prevention programs. The decrease in HIV prevalence and incidence may further improve with the scale-up of combination prevention interventions. The implementation of future prevention trials then faces important challenges. The opportunity to identify heterosexual populations at high risk such as female sex workers may rapidly wane. With unabating HIV epidemics among men who have sex with men (MSM) and transgender (TG) populations, an effective vaccine would likely be the only option to turn the epidemic. It is more likely that efficacy trials will occur among MSM and TG because their higher HIV incidence permits smaller and less costly trials. The constantly evolving patterns of HIV-1 diversity in the region suggest close monitoring of the molecular HIV epidemic in potential target populations for HIV vaccine efficacy trials. CRF01_AE remains predominant in southeast Asian countries and MSM populations in China. This relatively steady pattern is conducive to regional efficacy trials, and as efficacy warrants, to regional licensure. While vaccines inducing nonneutralizing antibodies have promise against HIV acquisition, vaccines designed to induce broadly neutralizing antibodies and cell-mediated immune responses of greater breadth and depth in the mucosal compartments should be considered for testing in MSM and TG. The rationale and design of efficacy trials of combination prevention modalities such as HIV vaccine and preexposure prophylaxis (PrEP) remain hypothetical, require high adherence to PrEP, are more costly, and present new regulatory challenges. The prioritization of prevention interventions should be driven by the HIV epidemic and decided by the country-specific health and regulatory authorities. Modeling the impact and cost–benefit may help this decision process. PMID:26107771
Zarulli, Virginia; Barthold Jones, Julia; Oksuzyan, Anna
Women live longer than men almost everywhere. Research provides evidence for both biological and behavioral factors modulating this gender gap, leaving open the question of what are its fundamental determinants. An unexplored source of information is when men and women experience extremely high...... better than men. In all populations they had lower mortality and, with the exception of one slave population, they lived longer. Infant ages contributed the most to the gender gap in life expectancy, indicating that newborn girls were able to survive extreme mortality better than newborn boys. Our...... mortality risk. Finding that women have longer life expectancy under harsh conditions would support the hypothesis that the female survival advantage is biologically determined. We investigate the survival in 8 populations under high mortality from famines, epidemics and slavery. We find that women survived...
Zarulli, Virginia; Barthold, Julia A.; Oksuzyan, Anna
Women live longer than men almost everywhere. Research provides evidence for both biological and behavioral factors modulating this gender gap, leaving open the question of what are its fundamental determinants. An unexplored source of information is when men and women experience extremely high...... better than men. In all populations they had lower mortality and, with the exception of one slave population, they lived longer. Infant ages contributed the most to the gender gap in life expectancy, indicating that newborn girls were able to survive extreme mortality better than newborn boys. Our...... mortality risk. Finding that women have longer life expectancy under harsh conditions would support the hypothesis that the female survival advantage is biologically determined. We investigate the survival in 8 populations under high mortality from famines, epidemics and slavery. We find that women survived...
Calistri, Paolo; Conte, Annamaria; Natale, Fabrizio; Possenti, Luigi; Savini, Lara; Danzetta, Maria Luisa; Iannetti, Simona; Giovannini, Armando
The development of early warning systems is fundamental for preventing the spread of infectious diseases. Data collection, however, is a costly activity and it is not possible to implement early warning systems everywhere and for all possible events. Hence, tools helping to improve the focus of surveillance efforts are of paramount importance. Risk assessment methods and other provisional modelling techniques may permit to estimate the probability of introduction and spread of infectious diseases in different geographical areas. Similarly, efficient information systems must be in place to assist the veterinary services in case of epidemic emergencies in order to support the prompt application of control measures for the containment of the infection and the reduction of the magnitude of negative consequences. This review describes two recent approaches to the estimation of the probability of introduction and spread of infectious diseases based on the use of risk maps/ spatial modelling and Social Network Analysis (SNA) techniques. The review also describes a web application developed in Italy to help official veterinary services to trace animals in case of outbreaks of infectious diseases.
Severe Acute Respiratory syndrome (SARS) took the world by storm in the later part of February 2003.It is a syndrome characterized by fever, cough, sore throat , shortness of breath and malaise which may deteriorate very rapidly to respiratory failure and death. The symptoms of SARS are quite similar to those of common ...
Full Text Available A severe respiratory disease epidemic outbreak correlates with a high demand of specific supplies and specialized personnel to hold it back in a wide region or set of regions; these supplies would be beds, storage areas, hemodynamic monitors, and mechanical ventilators, as well as physicians, respiratory technicians, and specialized nurses. We describe an online cumulative sum based model named Overcrowd-Severe-Respiratory-Disease-Index based on the Modified Overcrowd Index that simultaneously monitors and informs the demand of those supplies and personnel in a healthcare network generating early warnings of severe respiratory disease epidemic outbreaks through the interpretation of such variables. A post hoc historical archive is generated, helping physicians in charge to improve the transit and future allocation of supplies in the entire hospital network during the outbreak. The model was thoroughly verified in a virtual scenario, generating multiple epidemic outbreaks in a 6-year span for a 13-hospital network. When it was superimposed over the H1N1 influenza outbreak census (2008–2010 taken by the National Institute of Medical Sciences and Nutrition Salvador Zubiran in Mexico City, it showed that it is an effective algorithm to notify early warnings of severe respiratory disease epidemic outbreaks with a minimal rate of false alerts.
Castañón-González, Jorge Alberto; Macías, Alejandro E.; Samaniego, José Lino; Buhse, Thomas; Villanueva-Martínez, Sebastián
A severe respiratory disease epidemic outbreak correlates with a high demand of specific supplies and specialized personnel to hold it back in a wide region or set of regions; these supplies would be beds, storage areas, hemodynamic monitors, and mechanical ventilators, as well as physicians, respiratory technicians, and specialized nurses. We describe an online cumulative sum based model named Overcrowd-Severe-Respiratory-Disease-Index based on the Modified Overcrowd Index that simultaneously monitors and informs the demand of those supplies and personnel in a healthcare network generating early warnings of severe respiratory disease epidemic outbreaks through the interpretation of such variables. A post hoc historical archive is generated, helping physicians in charge to improve the transit and future allocation of supplies in the entire hospital network during the outbreak. The model was thoroughly verified in a virtual scenario, generating multiple epidemic outbreaks in a 6-year span for a 13-hospital network. When it was superimposed over the H1N1 influenza outbreak census (2008–2010) taken by the National Institute of Medical Sciences and Nutrition Salvador Zubiran in Mexico City, it showed that it is an effective algorithm to notify early warnings of severe respiratory disease epidemic outbreaks with a minimal rate of false alerts. PMID:24069063
Pizzi, Marco; Saraggi, Deborah; Fassan, Matteo; Megraud, Francis; Di Mario, Francesco; Rugge, Massimo
Irrespective of its etiology, long-standing, non-self-limiting gastric inflammation (mostly in Helicobacter pylori-associated cases) is the cancerization ground on which epidemic (intestinal-type) gastric carcinoma (GC) can develop. The natural history of invasive gastric adenocarcinoma encompasses gastritis, atrophic mucosal changes, and intraepithelial neoplasia (IEN). The topography, the extent and the severity of the atrophic changes significantly correlate with the risk of developing both IEN and GC. In recent years, both noninvasive (serological) tests and invasive (endoscopy/biopsy) procedures have been proposed to stratify patients according to different classes of GC risk. As a consequence, different patient-tailored GC secondary prevention strategies have been put forward. This review summarizes the histological features of H. pylori-related gastritis and the natural history of the disease. Histological and serological strategies to assess GC risk as well as the clinical management of atrophic gastritis patients are also discussed. © 2014 S. Karger AG, Basel.
Hagenhoff, Carol; And Others
The review provides a social learning model for explaining adolescent sexual behavior and use/nonuse of contraceptives. The model explains behavior patterns responsible for epidemic rates of teenage pregnancies, suggests research that will result in prevention of teenage pregnancies, and incorporates a range of social/cultural factors. (DB)
Zhuo-Hui, Deng; Yue-Yi, Fang
Clonorchiasis is one of the food-borne parasitic diseases. Adult parasites live in the human liver and gallbladder tube system, causing serious complications, such as gallstones, cholecystitis and cholangitis, and even bile duct cancer. The disease is very popular in our country, and the population infection rate is high. It is an important public health problem. Guangdong Province is the earliest province being found of clonorchiasis and with serious epidemic. In the second national human parasitic diseases distribution survey, the results showed that the average infection rate of Clonorchis sinensis in the epidemic areas in Guangdong was 16.42%. It is estimated that the population of C. sinensis infection is over 6 million. The prevention and control of clonorchiasis in China is still in the initial stage currently and we face many challenges such as unclear epidemic characteristics and transmission mode, and lack of long-term prevention and control mechanism. This article introduces the epidemic situation of clonorchiasis and prevention and control strategies and measures in Guangdong.
Wirtz, Andrea L.; Pretorius, Carel; Beyrer, Chris; Baral, Stefan; Decker, Michele R.; Sherman, Susan G.; Sweat, Michael; Poteat, Tonia; Butler, Jennifer; Oelrichs, Robert; Semini, Iris; Kerrigan, Deanna
Introduction Sex workers have endured a high burden of HIV infection in and across HIV epidemics. A comprehensive, community empowerment-based HIV prevention intervention emphasizes sex worker organization and mobilization to address HIV risk and often includes community-led peer education, condom distribution, and other activities. Meta-analysis of such interventions suggests a potential 51% reduction in inconsistent condom use. Mathematical modeling exercises provide theoretical insight into potential impacts of the intervention on HIV incidence and burden in settings where interventions have not yet been implemented. Methods We used a deterministic model, Goals, to project the impact on HIV infections when the community empowerment interventions were scaled up among female sex workers in Kenya, Thailand, Brazil, and Ukraine. Modeling scenarios included expansion of the comprehensive community empowerment-based HIV prevention intervention from baseline coverage over a 5-year period (5–65% in Kenya and Ukraine; 10–70% in Thailand and Brazil), while other interventions were held at baseline levels. A second exercise increased the intervention coverage simultaneously with equitable access to ART for sex workers. Impacts on HIV outcomes among sex workers and adults are observed from 2012–2016 and, compared to status quo when all interventions are held constant. Results Optimistic but feasible coverage (65%–70%) of the intervention demonstrated a range of impacts on HIV: 220 infections averted over 5 yrs. among sex workers in Thailand, 1,830 in Brazil, 2,220 in Ukraine, and 10,800 infections in Kenya. Impacts of the intervention for female sex workers extend to the adult population, cumulatively averting 730 infections in Thailand to 20,700 adult infections in Kenya. Impacts vary by country, influenced by HIV prevalence in risk groups, risk behaviors, intervention use, and population size. Discussion A community empowerment approach to HIV prevention and
Andrea L Wirtz
Full Text Available INTRODUCTION: Sex workers have endured a high burden of HIV infection in and across HIV epidemics. A comprehensive, community empowerment-based HIV prevention intervention emphasizes sex worker organization and mobilization to address HIV risk and often includes community-led peer education, condom distribution, and other activities. Meta-analysis of such interventions suggests a potential 51% reduction in inconsistent condom use. Mathematical modeling exercises provide theoretical insight into potential impacts of the intervention on HIV incidence and burden in settings where interventions have not yet been implemented. METHODS: We used a deterministic model, Goals, to project the impact on HIV infections when the community empowerment interventions were scaled up among female sex workers in Kenya, Thailand, Brazil, and Ukraine. Modeling scenarios included expansion of the comprehensive community empowerment-based HIV prevention intervention from baseline coverage over a 5-year period (5-65% in Kenya and Ukraine; 10-70% in Thailand and Brazil, while other interventions were held at baseline levels. A second exercise increased the intervention coverage simultaneously with equitable access to ART for sex workers. Impacts on HIV outcomes among sex workers and adults are observed from 2012-2016 and, compared to status quo when all interventions are held constant. RESULTS: Optimistic but feasible coverage (65%-70% of the intervention demonstrated a range of impacts on HIV: 220 infections averted over 5 yrs. among sex workers in Thailand, 1,830 in Brazil, 2,220 in Ukraine, and 10,800 infections in Kenya. Impacts of the intervention for female sex workers extend to the adult population, cumulatively averting 730 infections in Thailand to 20,700 adult infections in Kenya. Impacts vary by country, influenced by HIV prevalence in risk groups, risk behaviors, intervention use, and population size. DISCUSSION: A community empowerment approach to HIV
This paper critiques the approach to the elimination of gender inequality as an HIV prevention strategy in the just ended era of the Millennium Development Goals, with the aim of contributing to the formulation of policy guidelines for sub-Saharan Africa in the Sustainable Development Goals. The aim is to underscore the mutual responsibility of women and men in achieving a sustainable HIV response and ending the epidemic. While taking into account the real vulnerability of women, prevention programmes can reflect gender dynamics more accurately so that attention is given to the role of both sexes in propagating - or stemming - a predominantly heterosexual HIV epidemic. More emphasis could be given to the harm caused to both men and women by certain norms related to masculinity and sexuality, and the subsequent need for combined efforts in reducing intimate partner violence and concurrency. The empowerment and engagement of both women and men as agents of change would need to be dealt with more creatively.
Gao Shujing; Chen Lansun; Sun Lihua
In most of population dynamics, increases in population due to birth are assumed to be time-dependent, but many species reproduce only during a single period of the year. In this paper, we propose an epidemic model with density-dependent birth pulses and seasonal prevention. Using the discrete dynamical system determined by stroboscopic map, we obtain the local or global stability, numerical simulation shows there is a characteristic sequence of bifurcations, leading to chaotic dynamics, which implies that the dynamical behaviors of the epidemic model with birth pulses and seasonal prevention are very complex, including small amplitude oscillations, large-amplitude multi-annual cycles and chaos. This suggests that birth pulse, in effect, provides a natural period or cyclicity that may lead a period-doubling route to chaos
Zhu, Xi-Guang; She, Guang-Song
To explore the feasible prevention and control measures for imported falciparum malaria. The epidemic situation of imported falciparum malaria and status of labor export were investigated by using the epidemic statistical method, epidemiological survey and follow-up survey. There were 46 direct network reported cases of imported falciparum malaria in Jiangdu District in 2011, and they were all export laborers to Africa, being aged from 30-49 years, Totally 28 patients of them had the history of disease in foreign countries, and 29 cases were in the same labor export services company. A total of 444 migrant labors were investigated and 24 patients were diagnosed falciparum malaria. In order to prevent and control imported falciparum malaria, we should strengthen the standard management of labor export services market and health education.
Hafeez, Sidrah; Amin, Muhammad; Munir, Bilal Ahmed
Dengue is identified as serious vector born infectious disease by WHO, threating around 2.5 billion people around the globe. Pakistan is facing dengue epidemic since 1994 but 2010 and 2011 dengue outbreaks were worst. During 2011 dengue outbreak 22,562 cases were reported and 363 died due to this fatal infection in Pakistan. In this study, Lahore District was chosen as it was severely affected in 2011 dengue outbreak with 14,000 reported cases and 300 deaths. There is no vaccine developed yet for the disease control, so only effective early warning, prevention and control measures can reduce the potential disease risk. This study proposes a method for detecting spatial autocorrelation of temporal dynamics of disease using Local Index of Spatial Autocorrelation (LISA) using three temporal indices: (a) how often the dengue cases occur, frequency index; (b) how long the epidemic wave prevails, duration index; (c) how significant dengue cases occur in successive periods, severity index. Overlay analysis of LISA value for each temporal index resulted in eight risk types. The mapping of spatio-temporal risk indices and their overlay analysis identified that 10.6% area of Lahore (184.3km 2 and population density 119,110persons/km 2 ) had high values for frequency, duration, and severity index (pSpatial risk identification by using local spatial-autocorrelation helps in identifying other possible causes of disease risk and further strategic planning for prevention and control measures. Copyright © 2017 Elsevier Ltd. All rights reserved.
About 21 times of cattle epidemic with rather strong infectivity happened during the Han-Tang Period, including 6 in the Eastern Han Dynasty, 2 in the Jin Dynasty, 4 in the Southern and Northern Dynasties, 8 in the Tang Dynasty and 1in the Five Dynasty. Most of them were spread along the Yellow River and the northern region of the Huai River. The type of cattle epidemic included the acute cattle plague, cattle bovine mange, cattle yellow fever and cattle rotten hoof disease, etc. Its occurrence and prevalence brought a serious influentce on the society of the Han and Tang Dynasties, causing massive mortality of farm cattle, and then the shortage of animal power, and threatening the agriculture, which drew the attention of the governments, physicians, agriculturists, astrologists and Taoists. The medical measures and economic measures were adopted for the prevention and treatment of cattle epidemic. Especially, prescriptions in the books of medicine and agriculture exerted positive effects on the containment of cattle epidemic. On the other hand, its prevalence and the mass mortality of farm cattle, in a way, promoted, to certain extent, the improvement of the government's function of relief, the updating of the methods of agriculture and the creation of new farm tools, and being regarded as a main cause for the technological innovation of agriculture.
Shakeri, Heman; Sahneh, Faryad Darabi; Scoglio, Caterina; Poggi-Corradini, Pietro; Preciado, Victor M
Launching a prevention campaign to contain the spread of infection requires substantial financial investments; therefore, a trade-off exists between suppressing the epidemic and containing costs. Information exchange among individuals can occur as physical contacts (e.g., word of mouth, gatherings), which provide inherent possibilities of disease transmission, and non-physical contacts (e.g., email, social networks), through which information can be transmitted but the infection cannot be transmitted. Contact network (CN) incorporates physical contacts, and the information dissemination network (IDN) represents non-physical contacts, thereby generating a multilayer network structure. Inherent differences between these two layers cause alerting through CN to be more effective but more expensive than IDN. The constraint for an epidemic to die out derived from a nonlinear Perron-Frobenius problem that was transformed into a semi-definite matrix inequality and served as a constraint for a convex optimization problem. This method guarantees a dying-out epidemic by choosing the best nodes for adopting preventive behaviors with minimum monetary resources. Various numerical simulations with network models and a real-world social network validate our method.
DuPont, Robert L
The current narrative describing the national opioid epidemic as the result of overprescribing opioid pain medicines fails to capture the full dimensions of the problem and leads to inadequate and even confounding solutions. Overlooked is the fact that polysubstance use is nearly ubiquitous among overdose deaths, demonstrating that the opioid overdose death problem is bigger than opioids. The foundation of the nation's opioid overdose crisis - and the totality of the nation's drug epidemic - is widespread recreational pharmacology, the use of drugs for fun or "self-medication." The national focus on opioid overdose deaths provides important new opportunities in both prevention and treatment to make fundamental changes to the way that substance use disorders and related problems are understood and managed. The first-ever US Surgeon General's report on addiction provides a starting point for systemic changes in the nation's approach to preventing, treating and managing substance use disorders as serious, chronic diseases. New prevention efforts need to encourage youth to grow to adulthood not using alcohol, nicotine, marijuana or other drugs for reasons of health. New addiction treatment efforts need to focus on achieving long-term recovery including no use of alcohol, marijuana and other drugs. Copyright © 2017 Elsevier Inc. All rights reserved.
Full Text Available Abstract Background Report a nationwide epidemic of Shiga toxin-producing E. coli (STEC O103:H25 causing hemolytic uremic syndrome (D+HUS in children. Methods Description of clinical presentation, complications and outcome in a nationwide outbreak. Results Ten children (median age 4.3 years developed HUS during the outbreak. One of these was presumed to be a part of the outbreak without microbiological proof. Eight of the patients were oligoanuric and in need of dialysis. Median need for dialysis was 15 days; one girl did not regain renal function and received a kidney transplant. Four patients had seizures and/or reduced consciousness. Cerebral oedema and herniation caused the death of a 4-year-old boy. Two patients developed necrosis of colon with perforation and one of them developed non-autoimmune diabetes. Conclusion This outbreak of STEC was characterized by a high incidence of HUS among the infected children, and many developed severe renal disease and extrarenal complications. A likely explanation is that the O103:H25 (eae and stx2-positive strain was highly pathogen, and we suggest that this serotype should be looked for in patients with HUS caused by STEC, especially in severe forms or outbreaks.
Dietz, William H
The recognition of the obesity epidemic as a national problem began in 1999 with the Centers for Disease Control and Prevention's (CDC's) publication of a series of annual state-based maps that demonstrated the rapid changes in the prevalence of obesity. Increasing rates of obesity had been noted in earlier CDC studies, but the maps provided evidence of a rapid, nationwide increase. The urgent need to respond to the epidemic led to the identification of state targets and the first generation of interventions for obesity prevention and control. The CDC's role was to provide setting- and intervention-specific guidance on implementing these strategies, and to assess changes in targeted policies and behaviors. The CDC's efforts were augmented by Congressional funding for community initiatives to improve nutrition and increase physical activity. Complementary investments by Kaiser Permanente, the Robert Wood Johnson Foundation, and the Institute of Medicine improved the evidence base and provided policy recommendations that reinforced the need for a multisectoral approach. Legislative, regulatory, and voluntary initiatives enacted by President Obama's administration translated many of the strategies into effective practice. Whether current efforts to address obesity can be sustained will depend on whether they can be translated into greater grass-roots engagement consistent with a social movement.
Thyssen, Jacob Pontoppidan; Johansen, Jeanne Duus; Menné, Torkil
Contact dermatitis can be severe and lead to sick leave as well as significant healthcare expenses. The aim of this review is to present the published knowledge on 6 historical epidemics of contact allergy to apply this knowledge on the prevention and control of future contact allergy epidemics...... to prevent contact allergy epidemics. It is essential that dermatologist, scientists, administrators, and consumers organize and structure known methods to accelerate the control of emerging contact allergens....
Zhao, Yuqin; Wood, Daniel T; Kojouharov, Hristo V; Kuang, Yang; Dimitrov, Dobromir T
Mechanistic mathematical models are increasingly used to evaluate the effectiveness of different interventions for HIV prevention and to inform public health decisions. By focusing exclusively on the impact of the interventions, the importance of the demographic processes in these studies is often underestimated. In this paper, we use simple deterministic models to assess the effectiveness of pre-exposure prophylaxis in reducing the HIV transmission and to explore the influence of the recruitment mechanisms on the epidemic and effectiveness projections. We employ three commonly used formulas that correspond to constant, proportional and logistic recruitment and compare the dynamical properties of the resulting models. Our analysis exposes substantial differences in the transient and asymptotic behavior of the models which result in 47 % variation in population size and more than 6 percentage points variation in HIV prevalence over 40 years between models using different recruitment mechanisms. We outline the strong influence of recruitment assumptions on the impact of HIV prevention interventions and conclude that detailed demographic data should be used to inform the integration of recruitment processes in the models before HIV prevention is considered.
Creuza Rachel Vicente
Full Text Available Introduction The prognosis of dengue depends on early diagnosis and treatment, which can help prevent severe forms whose characteristics were evaluated here. Methods A cross-sectional study was conducted involving dengue cases in Vitória, State of Espírito Santo, Brazil, in 2011. Results Two health regions registered 56.3% of 371 cases of severe dengue. Of these cases, 21.3% presented with dengue hemorrhagic fever. There were associations between dengue hemorrhagic fever with younger ages and a longer time before receiving care. Conclusions There was a greater involvement of dengue hemorrhagic fever in young people. Delay in care, poor urban quality and high endemicity were identified as possible risk factors for dengue severity.
Effective planning for the management of severe accidents at nuclear power plants can produce both a reduction in the frequency of such accidents as well as the ability to mitigate their consequences if and when they should occur. This report provides an overview of accident management activities in OECD countries. It also presents the conclusions of a group of international experts regarding the development of accident management methods, the integration of accident management planning into reactor operations, and the benefits of accident management
Dobrovolny, Hana; Deecke, Lucas
Severe, long-lasting influenza infections are often caused by new strains of influenza. The long duration of these infections leads to an increased opportunity for the emergence of drug resistant mutants. This is particularly problematic for new strains of influenza since there is often no vaccine, so drug treatment is the first line of defense. One strategy for trying to minimize drug resistance is to apply periodic treatment. During treatment the wild-type virus decreases, but resistant virus might increase; when there is no treatment, wild-type virus will hopefully out-compete the resistant virus, driving down the number of resistant virus. We combine a mathematical model of severe influenza with a model of drug resistance to study emergence of drug resistance during a long-lasting infection. We apply periodic treatment with two types of antivirals: neuraminidase inhibitors, which block release of virions; and adamantanes, which block replication of virions. We compare the efficacy of the two drugs in reducing emergence of drug resistant mutants and examine the effect of treatment frequency on the emergence of drug resistant mutants.
Chen, Yung-Liang; Yeh, Ming-Yang; Huang, Shau-Yen; Liu, Chi-Ming; Sun, Chi-Chen; Lu, Hsu-Feng; Chiu, Tsan-Hung; Hsia, Te-Chun; Chung, Jing-Gung
Epidemic prevention policies in hospitals address issues such as, indoor air quality control, cleanliness of medical staff clothing and employee hand-washing procedures. Our hospital employed Bio-Kil to treat air-conditioning filters and nursing staff uniforms. We also assessed the efficacy of different detergents. Using Bio-Kil technology, the mean bacterial count in the air was reduced from 108.8 CFU/h/plate (n=420) to 68.6 CFU/h/plate (n=630). On the lower hems of the Bio-Kil-treated gowns, the mean bacterial count was 1,201 CFU/100 cm(2), markedly lower than the bacterial count of 7,753 CFU/100 cm(2), found on the parts of the gowns not treated with Bio-Kil (p=0.0401). On the cuffs of sleeves treated with Bio-Kil, the mean count was 1,165 CFU/100 cm(2), markedly lower than that of 2,131 CFU/100 cm(2), found on the cuffs not treated with Bio-Kil (p=0.0073). With regard to the mean bacterial eradication rates of antimicrobial solutions, Steridal Solution, 75% alcohol and Bio-Kil (3rd generation) were shown to be the most effective, with rates exceeding 80%. Hibiscrub with paper towels and Fresh Protect Skin were the second most effective. Bio-Kil (1st generation), tap water with paper towels, liquid hand soap with paper towels and ozone water were the least effective. One important observation was that hand-washing without the use of paper towels increased the bacterial count by as much as 84% . Bio-Kil is effective in reducing bacterial counts in the air, on nursing staff uniforms and is an effective detergent.
Palk, Laurence; Blower, Sally
In sub-Saharan Africa, where ~ 25 million individuals are infected with HIV and transmission is predominantly heterosexual, there is substantial geographic variation in the severity of epidemics. This variation has yet to be explained. Here, we propose that it is due to geographic variation in the size of the high-risk group (HRG): the group with a high number of sex partners. We test our hypothesis by conducting a geospatial analysis of data from Malawi, where ~ 13% of women and ~ 8% of men are infected with HIV. We used georeferenced HIV testing and behavioral data from ~ 14,000 participants of a nationally representative population-level survey: the 2010 Malawi Demographic and Health Survey (MDHS). We constructed gender-stratified epidemic surface prevalence (ESP) maps by spatially smoothing and interpolating the HIV testing data. We used the behavioral data to construct gender-stratified risk maps that reveal geographic variation in the size of the HRG. We tested our hypothesis by fitting gender-stratified spatial error regression (SER) models to the MDHS data. The ESP maps show considerable geographic variation in prevalence: 1-29% (women), 1-20% (men). Risk maps reveal substantial geographic variation in the size of the HRG: 0-40% (women), 16-58% (men). Prevalence and the size of the HRG are highest in urban centers. However, the majority of HIV-infected individuals (~75% of women, ~ 80% of men) live in rural areas, as does most of the HRG (~ 80% of women, ~ 85% of men). We identify a significant (P national average in districts where > 20% of women are in the HRG. Most importantly, the SER models show that geographic variation in the size of the HRG can explain a substantial proportion (73% for women, 67% for men) of the geographic variation in epidemic severity. Taken together, our results provide substantial support for our hypothesis. They provide a potential mechanistic explanation for the geographic variation in the severity
Zarulli, Virginia; Barthold Jones, Julia A; Oksuzyan, Anna; Lindahl-Jacobsen, Rune; Christensen, Kaare; Vaupel, James W
Women in almost all modern populations live longer than men. Research to date provides evidence for both biological and social factors influencing this gender gap. Conditions when both men and women experience extremely high levels of mortality risk are unexplored sources of information. We investigate the survival of both sexes in seven populations under extreme conditions from famines, epidemics, and slavery. Women survived better than men: In all populations, they had lower mortality across almost all ages, and, with the exception of one slave population, they lived longer on average than men. Gender differences in infant mortality contributed the most to the gender gap in life expectancy, indicating that newborn girls were able to survive extreme mortality hazards better than newborn boys. Our results confirm the ubiquity of a female survival advantage even when mortality is extraordinarily high. The hypothesis that the survival advantage of women has fundamental biological underpinnings is supported by the fact that under very harsh conditions females survive better than males even at infant ages when behavioral and social differences may be minimal or favor males. Our findings also indicate that the female advantage differs across environments and is modulated by social factors. Copyright © 2018 the Author(s). Published by PNAS.
Zarulli, Virginia; Barthold Jones, Julia A.; Oksuzyan, Anna; Lindahl-Jacobsen, Rune; Christensen, Kaare; Vaupel, James W.
Women in almost all modern populations live longer than men. Research to date provides evidence for both biological and social factors influencing this gender gap. Conditions when both men and women experience extremely high levels of mortality risk are unexplored sources of information. We investigate the survival of both sexes in seven populations under extreme conditions from famines, epidemics, and slavery. Women survived better than men: In all populations, they had lower mortality across almost all ages, and, with the exception of one slave population, they lived longer on average than men. Gender differences in infant mortality contributed the most to the gender gap in life expectancy, indicating that newborn girls were able to survive extreme mortality hazards better than newborn boys. Our results confirm the ubiquity of a female survival advantage even when mortality is extraordinarily high. The hypothesis that the survival advantage of women has fundamental biological underpinnings is supported by the fact that under very harsh conditions females survive better than males even at infant ages when behavioral and social differences may be minimal or favor males. Our findings also indicate that the female advantage differs across environments and is modulated by social factors. PMID:29311321
Full Text Available The World Health Organization (WHO Global Tuberculosis Report 2015 states that 28% of the world's 9.6 million new tuberculosis (TB cases are in the WHO Africa Region. The Mano River Union (MRU countries of West Africa–Guinea, Sierra Leone, and Liberia–have made incremental sustained investments into TB control programmes over the past two decades. The devastating Ebola virus disease (EVD outbreak of 2014–2015 in West Africa impacted significantly on all sectors of the healthcare systems in the MRU countries, including the TB prevention and control programmes. The EVD outbreak also had an adverse impact on the healthcare workforce and healthcare service delivery. At the height of the EVD outbreak, numerous staff members in all MRU countries contracted EBV at the Ebola treatment units and died. Many healthcare workers were also infected in healthcare facilities that were not Ebola treatment units but were national hospitals and peripheral health units that were unprepared for receiving patients with EVD. In all three MRU countries, the disruption to TB services due to the EVD epidemic will no doubt have increased Mycobacterium tuberculosis transmission, TB morbidity and mortality, and decreased patient adherence to TB treatment, and the likely impact will not be known for several years to come. In this viewpoint, the impact that the EVD outbreak had on TB diagnostic, management, and prevention services is described. Vaccination against TB with BCG in children under 5 years of age was affected adversely by the EVD epidemic. The EVD outbreak was a result of global failure and represents yet another ‘wake-up call’ to the international community, and particularly to African governments, to reach a consensus on new ways of thinking at the national, regional, and global levels for building healthcare systems that can sustain their function during outbreaks. This is necessary so that other disease control programmes (like those for TB, malaria
Bridge, Jamie; Lazarus, Jeff; Atun, Rifat
This paper describes characteristics of the HIV epidemics in Eastern Europe and Central Asia (EECA) and Asia and Central Asia, and draws comparisons between these regions. It focuses on the role that key populations continue to play in HIV transmission in both regions, the challenges...
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Loftus, Patricia A; Tan, Melin; Patel, Gunj; Lin, Juan; Helman, Sam; Badhey, Arvind; Du, Eugenie; Smith, Richard V; Fried, Marvin P; Ow, Thomas J
To evaluate the etiology and risk factors for severe manifestation and recurrent episodes of angioedema; to evaluate efficacy of short-term and long-term management strategies for angioedema among a high-risk population. Institutional review board-approved retrospective review of a large, urban population. Data from 875 adult patients treated from January 2008 to December 2013 with the diagnosis of angioedema were obtained using the Clinical Looking Glass utility and review of medical records. Demographic and clinicopathologic risk factors were recorded. The major outcomes evaluated were hospital admission, need for airway intervention, and recurrent episodes of angioedema following the first presentation. Initial treatment strategy and follow-up recommendations were also recorded. The most common cause of angioedema was angiotensin converting enzyme inhibitor (ACEi)-induced (496 [56.6%]). Significant risk factors for severe cases of angioedema included older age, Hispanic race, ACEi-induced angioedema type, American Society of Anesthesiologists class III or above, coexistent cardiopulmonary disease, and a positive smoking history. A total of 17.2% of patients experienced recurrent attacks of angioedema; of those patients, 25.9% were still taking an ACEi at subsequent presentation. Risk factors for recurrent episodes included older age, idiopathic angioedema type, and coexistent cardiopulmonary disease. Only 54.1% of patients who experienced ACEi-induced angioedema had electronic medical record documentation of these allergies. Knowledge of risk factors for severe and recurrent episodes of angioedema and improved education for both healthcare providers and patients, specifically related to ACEi use and allergy documentation, may significantly decrease the burden and morbidity of angioedema among high risk populations. 2b. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.
A number of research strategies have been initiated over the last decade to enhance plant biosecurity capacity at the pre-border, border and post-border frontiers. In preparation for emerging plant virus epidemics, diagnostic manuals for economically important plant viruses that threaten local industries have been developed and validated under local conditions. Contingency plans have also been prepared that provide guidelines to stakeholders on diagnostics, surveillance, survey strategies, epidemiology and pest risk analysis. Reference collections containing validated positive virus controls have been expanded to support a wide range of biosecurity sciences. Research has been conducted to introduce high throughput diagnostic capabilities and the design and development of advanced molecular techniques to detect virus genera. These diagnostic tools can be used by post entry quarantine agencies to detect known and unknown plant viral agents. Pre-emptive breeding strategies have also been initiated to protect plant industries if and when key exotic viruses become established in localized areas. With the emergence of free trade agreements between trading partners there is a requirement for quality assurance measures for pathogens, including viruses, which may occur in both the exporting and importing countries. These measures are required to ensure market access for the exporting country and also to minimize the risk of the establishment of a damaging virus epidemic in the importing country.
Michael J Tildesley
Full Text Available The availability of epidemiological data in the early stages of an outbreak of an infectious disease is vital for modelers to make accurate predictions regarding the likely spread of disease and preferred intervention strategies. However, in some countries, the necessary demographic data are only available at an aggregate scale. We investigated the ability of models of livestock infectious diseases to predict epidemic spread and obtain optimal control policies in the event of imperfect, aggregated data. Taking a geographic information approach, we used land cover data to predict UK farm locations and investigated the influence of using these synthetic location data sets upon epidemiological predictions in the event of an outbreak of foot-and-mouth disease. When broadly classified land cover data were used to create synthetic farm locations, model predictions deviated significantly from those simulated on true data. However, when more resolved subclass land use data were used, moderate to highly accurate predictions of epidemic size, duration and optimal vaccination and ring culling strategies were obtained. This suggests that a geographic information approach may be useful where individual farm-level data are not available, to allow predictive analyses to be carried out regarding the likely spread of disease. This method can also be used for contingency planning in collaboration with policy makers to determine preferred control strategies in the event of a future outbreak of infectious disease in livestock.
Kang-Ming, Lin; Jun, Li; Yi-Chao, Yang; Shu-Jiao, Wei; Wei-Wei, Zhang; Xiang-Yang, Feng; Hai-Yan, Wei; Ya-Ming, Huang
To analyze the epidemic characteristics of the imported malaria cases in Guangxi Zhuang Autonomous Region in 2014, so as to assess the transmission risk and explore the prevention and control strategy. The data of the malaria epidemic situation in the network direct report system of Guangxi in 2014 and the annual report of malaria epidemic situation in 14 cities were collected. The epidemiological information of the imported malaria cases was analyzed. A total of 184 malaria patients were reported in Guangxi in 2014, with a descent rate of 85.29% when compared to that in 2013 (1 251 cases), and the incidence rate was 0.35/100 000. All the cases were imported from abroad, and four species of Plasmodium were found in their blood samples. The number of falciparum malaria cases was the most (49.46%), followed by the ovale malaria cases (32.07%). All the cases were distributed in 32 counties (districts) of 11 cities, and 65.76% of them were distributed in Shanglin County. Most of the cases were male (98.37%), and those aged in 20-49 years accounted for 87.50%. The imported cases came from 14 countries of Africa (86.41%) and 2 countries of Southeast Asia (13.59%), in which, 48.37% of the cases were imported from Garner. The main occupation of the cases in abroad was gold mining work (86.96%). The cases were reported all the year around, with no obvious seasonality. The interval time of back home to attack of the patients with tertian malaria and ovale malaria was longer. Africa and Southeast Asia is the main source of imported malaria cases in Guangxi, and the migrant workers returning home may have the risk of malaria recurrence, which should be paid enough attention to.
Fittipaldi, Nahuel; Beres, Stephen B; Olsen, Randall J; Kapur, Vivek; Shea, Patrick R; Watkins, M Ebru; Cantu, Concepcion C; Laucirica, Daniel R; Jenkins, Leslie; Flores, Anthony R; Lovgren, Marguerite; Ardanuy, Carmen; Liñares, Josefina; Low, Donald E; Tyrrell, Gregory J; Musser, James M
Group A Streptococcus (GAS) causes an exceptionally broad range of infections in humans, from relatively mild pharyngitis and skin infections to life-threatening necrotizing fasciitis and toxic shock syndrome. An epidemic of severe invasive human infections caused by type emm59 GAS, heretofore an exceedingly rare cause of disease, spread west to east across Canada over a 3-year period (2006 to 2008). By sequencing the genomes of 601 epidemic, historic, and other emm59 organisms, we discovered that a recently emerged, genetically distinct emm59 clone is responsible for the Canadian epidemic. Using near-real-time genome sequencing, we were able to show spread of the Canadian epidemic clone into the United States. The extensive genome data permitted us to identify patterns of geographic dissemination as well as links between emm59 subclonal lineages that cause infections. Mouse and nonhuman primate models of infection demonstrated that the emerged clone is unusually virulent. Transmission of epidemic emm59 strains may have occurred primarily by skin contact, as suggested by an experimental model of skin transmission. In addition, the emm59 strains had a significantly impaired ability to persist in human saliva and to colonize the oropharynx of mice, and seldom caused human pharyngitis. Our study contributes new information to the rapidly emerging field of molecular pathogenomics of bacterial epidemics and illustrates how full-genome data can be used to precisely illuminate the landscape of strain dissemination during a bacterial epidemic. Copyright © 2012 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.
Cruz-Licea, Verónica; González-Domínguez, Fernando; Avila, Guillermina; Flisser, Ana
To know the frequency of flu symptoms and describe preventive measures practiced by the inhabitants of Mexico City during the AH1N1 epidemic. A cross-sectional design was used and a survey containing demographic and health information was conducted in August and September 2009 in a sample of 4003 randomly selected people living in Mexico City. Referred flu symptoms were: 29% running nose, 25% cough, 25% throat infection, 17% muscle and joint pain, 10% respiratory problems, and 7% fever. Also 16% said having hypertension, 10% diabetes, and 2% morbid obesity. Among the preventive measures, 74% washed hands, 32% covered the nose and mouth with the forearm when coughing or sneezing, 28% used sanitizer gel five times a day in average, and 47% did not greet with a kiss or handshake. Almost all the population followed preventive measures and did not show high percentages of influenza symptoms. Useful elements for prevention were identified, such as the frequency of seasonal influenza vaccination, self-medication, and living with a person diagnosed with AH1N1. It is important to continue with mass communication to strengthen adequate hygiene and health measures.
Quick, R E; Thompson, B L; Zuniga, A; Dominguez, G; De Brizuela, E L; De Palma, O; Almeida, S; Valencia, A; Ries, A A; Bean, N H
In response to the Latin American cholera epidemic, El Salvador began a prevention programme in April 1991. The first case was confirmed in August, and 700 cases were reported within 3 months. A matched case-control study was conducted in rural La Libertad Department in November 1991. Illness was associated with eating cold cooked or raw seafood (odds ratio [OR] = 7.0; 95% confidence limits [CL] = 1.4, 35.0) and with drinking water outside the home (OR = 8.8; 95% CL = 1.7, 44.6). Assertion of knowledge about how to prevent cholera (OR = 0.2; 95% CL = 0.1, 0.8) and eating rice (OR = 0.2; 95% CL = 0.1, 0.8) were protective. More controls than patients regularly used soap (OR = 0.3; 95% CL = 0.1, 1.0). This study demonstrated three important points for cholera prevention: (1) seafood should be eaten cooked and hot; (2) populations at risk should be taught to treat household drinking water and to avoid drinking water outside the home unless it is known to be treated; and (3) education about hygiene can be an important tool in preventing cholera.
José A Ruiz-Postigo
Full Text Available Human African trypanosomiasis (HAT has been a major public health problem in South Sudan for the last century. Recurrent outbreaks with a repetitive pattern of responding-scaling down activities have been observed. Control measures for outbreak response were reduced when the prevalence decreased and/or socio-political crisis erupted, leading to a new increase in the number of cases. This paper aims to raise international awareness of the threat of another outbreak of sleeping sickness in South Sudan. It is a review of the available data, interventions over time, and current reports on the status of HAT in South Sudan. Since 2006, control interventions and treatments providing services for sleeping sickness have been reduced. Access to HAT diagnosis and treatment has been considerably diminished. The current status of control activities for HAT in South Sudan could lead to a new outbreak of the disease unless 1 the remaining competent personnel are used to train younger staff to resume surveillance and treatment in the centers where HAT activities have stopped, and 2 control of HAT continues to be given priority even when the number of cases has been substantially reduced. Failure to implement an effective and sustainable system for HAT control and surveillance will increase the risk of a new epidemic. That would cause considerable suffering for the affected population and would be an impediment to the socioeconomic development of South Sudan.
Kim, Yonghyan; Yang, My; Goyal, Sagar M; Cheeran, Maxim C-J; Torremorell, Montserrat
The effectiveness of biosecurity methods to mitigate the transmission of porcine epidemic diarrhea virus (PEDV) via farm personnel or contaminated fomites is poorly understood. This study was undertaken to evaluate the effectiveness of biosecurity procedures directed at minimizing transmission via personnel following different biosecurity protocols using a controlled experimental setting. PEDV RNA was detected from rectal swabs of experimentally infected (INF) and sentinel pigs by real-time reverse transcription polymerase chain reaction (rRT-PCR). Virus shedding in INF pigs peaked at 1 day post infection (dpi) and viral RNA levels remained elevated through 19 dpi. Sentinel pigs in the low biosecurity group (LB) became PEDV positive after the first movement of study personnel from the INF group. However, rectal swabs from pigs in the medium biosecurity (MB) and high biosecurity (HB) groups were negative during the 10 consecutive days of movements and remained negative through 24 days post movement (dpm) when the first trial was terminated. Viral RNA was detected at 1 dpm through 3 dpm from the personal protective equipment (PPE) of LB personnel. In addition, at 1 dpm, 2 hair/face swabs from MB personnel were positive; however, transmission of virus was not detected. All swabs of fomite from the HB study personnel were negative. These results indicate that indirect PEDV transmission through contaminated PPE occurs rapidly (within 24 h) under modeled conditions. Biosecurity procedures such as changing PPE, washing exposed skin areas, or taking a shower are recommended for pig production systems and appear to be an effective option for lowering the risk of PEDV transmission between groups of pigs.
Overweight and obesity represent a rapidly growing threat to the health of populations in an increasing number of countries. Indeed they are now so common that they are replacing more traditional problems such as undernutrition and infectious diseases as the most significant causes of ill-health. Obesity comorbidities include coronary heart disease, hypertension and stroke, certain types of cancer, non-insulin-dependent diabetes mellitus, gallbladder disease, dyslipidaemia, osteoarthritis and gout, and pulmonary diseases, including sleep apnoea. In addition, the obese suffer from social bias, prejudice and discrimination, on the part not only of the general public but also of health professionals, and this may make them reluctant to seek medical assistance. WHO therefore convened a Consultation on obesity to review current epidemiological information, contributing factors and associated consequences, and this report presents its conclusions and recommendations. In particular, the Consultation considered the system for classifying overweight and obesity based on the body mass index, and concluded that a coherent system is now available and should be adopted internationally. The Consultation also concluded that the fundamental causes of the obesity epidemic are sedentary lifestyles and high-fat energy-dense diets, both resulting from the profound changes taking place in society and the behavioural patterns of communities as a consequence of increased urbanization and industrialization and the disappearance of traditional lifestyles. A reduction in fat intake to around 20-25% of energy is necessary to minimize energy imbalance and weight gain in sedentary individuals. While there is strong evidence that certain genes have an influence on body mass and body fat, most do not qualify as necessary genes, i.e. genes that cause obesity whenever two copies of the defective allele are present; it is likely to be many years before the results of genetic research can be applied
Green, Adam; Kolar, Kat
Social scientific and public health literature on National Institutes of Health-funded HIV behavioural prevention science often assumes that this body of work has a strong biomedical epistemological orientation. We explore this assumption by conducting a systematic content analysis of all NIH-funded HIV behavioural prevention grants for men who have sex with men between 1989 and 2012. We find that while intervention research strongly favours a biomedical orientation, research into the antecedents of HIV risk practices favours a sociological, interpretive and structural orientation. Thus, with respect to NIH-funded HIV prevention science, there exists a major disjunct in the guiding epistemological orientations of how scientists understand HIV risk, on the one hand, and how they engineer behaviour change in behavioural interventions, on the other. Building on the extant literature, we suggest that the cause of this disjunct is probably attributable not to an NIH-wide positivist orientation, but to the specific standards of evidence used to adjudicate HIV intervention grant awards, including randomised controlled trials and other quantitative measures of intervention efficacy. © 2015 The Authors. Sociology of Health & Illness © 2015 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.
Wirtz, A L; Walker, D G; Bollinger, L; Sifakis, F; Baral, S; Johns, B; Oelrichs, R; Beyrer, C
Little is known about the impact of combination HIV prevention interventions for men who have sex with men (MSM) and the impacts on the wider epidemics. Modelling analyses of MSM-specific interventions across varied HIV epidemics may inform evidence-based responses. The Goals model was adapted to project the impacts of providing HIV interventions for MSM and access to expanded coverage of antiretroviral therapy (ART) for adults to measure the effects on the MSM and adult epidemics in Peru, Ukraine, Kenya and Thailand. Positive impacts were observed in all four countries. Across epidemics, 14-25% of infections among MSM may be averted between 2012 and 2016 when MSM interventions are brought to scale and MSM have equal access to expanded ART for adults. Among adults, MSM interventions may avert up to 4000 new infections, in addition to the benefits associated with increased ART. Greatest impacts from expanded interventions were observed in countries where same sex transmission contributes significantly to the HIV epidemic. While significant benefits are observed among the adult and MSM populations with expansion of ART, consideration should be given to the synergies of combining ART expansion with targeted interventions to reach hidden, high-risk populations for HIV testing and counselling and linkages to care.
Full Text Available Atypical environmental conditions with drought followed by heavy rainfall and flooding in arid areas in sub-Saharan Africa can lead to explosive epidemics of malaria, which might be prevented through timely vector-control interventions.Wajir County in Northeast Kenya is classified as having seasonal malaria transmission. The aim of this study was to describe in Wajir town the environmental conditions, the scope and timing of vector-control interventions and the associated resulting burden of malaria at two time periods (1996-1998 and 2005-2007.This is a cross-sectional descriptive and ecological study using data collected for routine program monitoring and evaluation.In both time periods, there were atypical environmental conditions with drought and malnutrition followed by massive monthly rainfall resulting in flooding and animal/human Rift Valley Fever. In 1998, this was associated with a large and explosive malaria epidemic (weekly incidence rates peaking at 54/1,000 population/week with vector-control interventions starting over six months after the massive rainfall and when the malaria epidemic was abating. In 2007, vector-control interventions started sooner within about three months after the massive rainfall and no malaria epidemic was recorded with weekly malaria incidence rates never exceeding 0.5 per 1,000 population per week.Did timely vector-control interventions in Wajir town prevent a malaria epidemic? In 2007, the neighboring county of Garissa experienced similar climatic events as Wajir, but vector-control interventions started six months after the heavy un-seasonal rainfall and large scale flooding resulted in a malaria epidemic with monthly incidence rates peaking at 40/1,000 population. In conclusion, this study suggests that atypical environmental conditions can herald a malaria outbreak in certain settings. In turn, this should alert responsible stakeholders about the need to act rapidly and preemptively with appropriate
Guévart, E; Solle, J; Mouangue, A; Noeske, J; Bita, A; Fonkoua, M-C; Ndayo Wouafo, M
Antibiotics were extensively used, both for curative as for prophylactic purposes, to prevent an explosive spread of the 2004 cholera epidemic in Douala. It was thus necessary to control the antibiotic susceptibility of Vibrio cholerae. The authors had for aim to describe the epidemic, the use of antibiotics, and to follow the susceptibility of V. cholerae. The 14 hospitals in the study all used the same diagnostic, treatment, and preventive protocols, as well as in community practice with home visits. All cases were clinically confirmed and reported. Samples were systematically taken at the beginning and at the end of the epidemic, and randomly during the epidemic. Each identified strain was tested by the disk method for antibiotic susceptibility. Between January and September 2004, 5013 patients and 177,353 people in contact with the patients were given a single dose of doxycycline or amoxicillin for 3 days. Sixty-nine deaths were recorded (lethality 1.37%). One hundred (and) eleven strains of V. cholerae were identified in 187 samples. All of them were resistant to sulfamides and colistin, but susceptible to cyclins, betalactams, and fluoroquinolones, without any modification during the 8 months of follow-up. Despite the risk of a massive and prolonged use of antibiotics, strictly prescribed and controlled, no resistance developed in the identified strain. Chemoprophylaxis must follow rigorous protocols and be continuously monitored.
Maria Vonny Rumampuk
Full Text Available Introduction: Pediculus humanus capitis have cosmopolite attributes, and normally affect school age children. This research aims at obtaining the number of people infested with pediculus humanus capitis and is categorized by the age, sex, education, social-economic status, way of life, and prevalence of lice, louse nymphs and eggs among children living in ten orphanages within the Province of North Sulawesi in 2012. Method: The research is designed using crosssectional approach and is based on samples taken from 568 respondents. Result: The fi ndings of this research indicate that 106 (18.66% children are infested by Pediculus humanus capitis. Statistic test using chi-square approach results in a score of p<0.05 which indicates a correlation between hair length, type of cleansing agents used for hair wash, the frequency of hair wash, the use of towels, the use of combs, sleeping habit, scalp itchiness, and scalp irritation with lice prevalence in the hair. Multivariate analysis using logistic regression test results in a score of p<0.05 attributable to the prevalence of adult lice among children with long hair, hairwash frequency, use of comb and sleeping habit. Those that are mostly attributable to lice prevalence is hairwash frequency with a score of Wald 58 and OR 326. Discussion: Pediculus humanus capitis is found among children of 7 – 12 years, and dominated by girls, elementary school education, low social-economic status, unhealthy way of life, comprising children living in densely populated orphanages. Children infested with head lice suffer from head itches and irritation. It is recommended that orphanages make efforts of head lice prevention, control and eradication as well as instilling the awareness in governesses and orphans of the importance of scalp and hair hygiene. Keywords: epidemiology, Pediculus humanus capitis, child/children, orphanage/orphanages.
Tentner, A. M.; Parma, E.; Wei, T.; Wigeland, R.; Nuclear Engineering Division; SNL; INL
An important goal of the US DOE reactor development program is to conceptualize advanced safety design features for a demonstration Sodium Fast Reactor (SFR). The treatment of severe accidents is one of the key safety issues in the design approach for advanced SFR systems. It is necessary to develop an in-depth understanding of the risk of severe accidents for the SFR so that appropriate risk management measures can be implemented early in the design process. This report presents the results of a review of the SFR features and phenomena that directly influence the sequence of events during a postulated severe accident. The report identifies the safety features used or proposed for various SFR designs in the US and worldwide for the prevention and/or mitigation of Core Disruptive Accidents (CDA). The report provides an overview of the current SFR safety approaches and the role of severe accidents. Mutual understanding of these design features and safety approaches is necessary for future collaborations between the US and its international partners as part of the GEN IV program. The report also reviews the basis for an integrated safety approach to severe accidents for the SFR that reflects the safety design knowledge gained in the US during the Advanced Liquid Metal Reactor (ALMR) and Integral Fast Reactor (IFR) programs. This approach relies on inherent reactor and plant safety performance characteristics to provide additional safety margins. The goal of this approach is to prevent development of severe accident conditions, even in the event of initiators with safety system failures previously recognized to lead directly to reactor damage.
For future pressurized water reactors, which should be designed against core melt down accidents, missiles generated inside the containment present a severe problem for its integrity. The masses and geometries of the missiles as well as their velocities may vary to a great extend. Therefore, a reliable proof of the containment integrity is very difficult. To overcome this problem the potential sources of missiles are discussed. In section 5 it is concluded that the generation of heavy missiles must be prevented. Steam explosions must not damage the reactor vessel head. Thus fragments of the head cannot become missiles endangering the containment shell. Furthermore, during a melt-through failure of the reactor vessel under high pressure the resulting forces must not catapult the whole vessel against the containment shell. Only missiles caused by hydrogen explosions might be tolerable, but shielding structures which protect the containment shell might be required. Here further investigations are necessary. Finally, measures are described showing that the generation of heavy missiles can indeed be prevented. In section 6 investigations are explained which will confirm the strength of the reactor vessel head. In section 7 a device is discussed keeping the fragments of a failing reactor vessel at its place. (author). 12 refs., 8 figs
Gingival inflammation seldom causes discomfort, social embarrassment or loss of function. As most sites with gingival inflammation do not progress to severe periodontal disease, gingivitis should not be considered a public health problem. Periodontitis is always preceded by gingivitis. But most gingivitis remains stable for years without progressing to periodontitis. The number of gingivitis sites that do convert is small. The levels of oral cleanliness achieved by the majority of populations in industrialized countries are below the threshold for severe destructive periodontal disease of personal and public health concern. Because methods of measuring the progression of periodontal disease are unreliable, definitive answers regarding conversion of gingivitis to severe periodontitis are lacking. Gingival inflammation frequently remains contained; most gingivitis remains stable for years without progressing to periodontitis. Decreasing gingivitis does reduce shallow pocketing, but the effect on severe periodontitis is not clear. Although the underlying justification for the reduction of plaque is to reduce gingival inflammation to prevent or reduce severe periodontitis and tooth loss, the basis for the approach is equivocal. A reasonably high level of plaque appears to be compatible with acceptably low levels of periodontal disease. Reducing nonspecific plaque levels to such levels is therefore a rational goal. The conventional methods of controlling periodontal disease involve mechanical removal of plaque and calculus. A complimentary ecological approach, using chemicals, would be to alter the environment of the pocket to prevent growth of putative pathogens. Any ecological approach should be sensitive to the dangers of disrupting the natural ecology of dental plaque. Some antimicrobial and antimetabolic agents such as fluoride, chlorhexidine and triclosan and zinc citrate can selectively suppress certain organisms or inhibit bacterial proteases implicated in
Gougar, Hans [Idaho National Lab. (INL), Idaho Falls, ID (United States)
This document outlines the development of a high fidelity, best estimate nuclear power plant severe transient simulation capability that will complement or enhance the integral system codes historically used for licensing and analysis of severe accidents. As with other tools in the Risk Informed Safety Margin Characterization (RISMC) Toolkit, the ultimate user of Enhanced Severe Transient Analysis and Prevention (ESTAP) capability is the plant decision-maker; the deliverable to that customer is a modern, simulation-based safety analysis capability, applicable to a much broader class of safety issues than is traditional Light Water Reactor (LWR) licensing analysis. Currently, the RISMC pathway’s major emphasis is placed on developing RELAP-7, a next-generation safety analysis code, and on showing how to use RELAP-7 to analyze margin from a modern point of view: that is, by characterizing margin in terms of the probabilistic spectra of the “loads” applied to systems, structures, and components (SSCs), and the “capacity” of those SSCs to resist those loads without failing. The first objective of the ESTAP task, and the focus of one task of this effort, is to augment RELAP-7 analyses with user-selected multi-dimensional, multi-phase models of specific plant components to simulate complex phenomena that may lead to, or exacerbate, severe transients and core damage. Such phenomena include: coolant crossflow between PWR assemblies during a severe reactivity transient, stratified single or two-phase coolant flow in primary coolant piping, inhomogeneous mixing of emergency coolant water or boric acid with hot primary coolant, and water hammer. These are well-documented phenomena associated with plant transients but that are generally not captured in system codes. They are, however, generally limited to specific components, structures, and operating conditions. The second ESTAP task is to similarly augment a severe (post-core damage) accident integral analyses code
Hippocrates gave the term 'epidemic' its medical meaning. From antiquity to modern times, the meaning of the word epidemic has continued to evolve. Over the centuries, researchers have reached an understanding of the varying aspects of epidemics and have tried to combat them. The role played by travel, trade, and human exchanges in the propagation of epidemic infectious diseases has been understood. In 1948, the World Health Organization was created and given the task of advancing ways of combating epidemics. An early warning system to combat epidemics has been implemented by the WHO. The Global Outbreak Alert and Response Network (GOARN) is collaboration between existing institutions and networks that pool their human and technical resources to fight outbreaks. Avian influenza constitutes currently the most deadly epidemic threat, with fears that it could rapidly reach pandemic proportions and put several thousands of lives in jeopardy. Thanks to the WHO's support, most of the world's countries have mobilised and implemented an 'Action Plan for Pandemic Influenza'. As a result, most outbreaks of the H5N1 avian flu virus have so far been speedily contained. Cases of dengue virus introduction in countries possessing every circumstance required for its epidemic spread provide another example pertinent to the prevention of epidemics caused by vector-borne pathogens.
Learn about obesity and the community initiatives taking place to prevent and reduce this epidemic. Created: 7/18/2011 by National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition, Physical Activity and Obesity. Date Released: 7/18/2011.
Chan, Sophia S C; So, Winnie K W; Wong, David C N; Lee, Angel C K; Tiwari, Agnes
The outbreak of severe acute respiratory syndrome (SARS) in Hong Kong posed many challenges for health promotion activities among a group of older adults with low socio-economic status (SES). With concerns that this vulnerable group could be at higher risk of contracting the disease or spreading it to others, the implementation of health promotion activities appropriate to this group was considered to be essential during the epidemic. To assess the effectiveness of delivering a telephone health education programme dealing with anxiety levels, and knowledge and practice of measures to prevent transmission of SARS among a group of older adults with low SES. Pretest/posttest design. Subjects were recruited from registered members of a government subsidized social service center in Hong Kong and living in low-cost housing estates. The eligibility criteria were: (1) aged 55 or above; (2) able to speak Cantonese; (3) no hearing impairment, and (4) reachable by telephone. Of the 295 eligible subjects, 122 older adults completed the whole study. The interviewers approached all eligible subjects by telephone during the period of 15-25 May 2003. After obtaining the participants' verbal consent, the interviewer collected baseline data by use of a questionnaire and implemented a health education programme. A follow-up telephone call was made a week later using the same questionnaire. The level of anxiety was lowered (t=3.28, p<0.001), and knowledge regarding the transmission routes of droplets (p<0.001) and urine and feces (p<0.01) were improved after the intervention. Although statistical significant difference was found in the practice of identified preventive measures before and after intervention, influence on behavioral changes needed further exploration. The telephone health education seemed to be effective in relieving anxiety and improving knowledge of the main transmission routes of SARS in this group, but not the practice of preventing SARS. Telephone contact appears
Abara, Winston E; Garba, Ibrahim
Recent research has presented evidence that men who have sex with men (MSM) bear a disproportionate burden of HIV and are at increased risk for HIV in sub-Saharan Africa (SSA). However, many countries in SSA have failed to address the needs of MSM in national HIV/AIDS programmes. Furthermore, many MSM face structural barriers to HIV prevention and care, the most significant of which include laws that criminalise male-to-male sexual contact and facilitate stigma and discrimination. This in turn increases the vulnerability of MSM to acquiring HIV and presents barriers to HIV prevention, care, and surveillance. This relationship illustrates the link between human rights, social justice, and health outcomes and presents considerable challenges to addressing the HIV epidemic among MSM in SSA. The response to the HIV epidemic in SSA requires a non-discriminatory human rights approach to all at-risk groups, including MSM. Existing international human rights treaties, to which many SSA countries are signatories, and a 'health in all policies' approach provides a strong basis to reduce structural barriers to HIV prevention, care, surveillance, and research, and to ensure that all populations in SSA, including MSM, have access to the full range of rights that help ensure equal opportunities for health and wellness.
Lyerly, W H
Unlike most infectious diseases in Africa, HIV/AIDS affects the urban elite as well as the rural poor, and generally during their most economically productive years. An increase in deaths among young adults of the magnitude predicted is likely to have substantial adverse effects on economic, political, and military/security stability throughout Africa. AIDS is causing increased stress on fragile African economic infrastructures as labor productivity declines, particularly in agricultural, labor-dependent economies. AIDS is causing obstacles to trade, foreign investment and tourism. Health systems and social coping mechanisms already are overburdened. High rates of HIV infection among police and military personnel threaten internal security. Furthermore, the demobilization of military forces in Africa may exacerbate the epidemic when HIV-infected soldiers return home and spread the virus. This presentation will illustrate why African AIDS Programs must be expanded to mitigate the multisectoral impact of the epidemic while preserving its spread.
Full Text Available Objective: The aim of this study was to examine the synchrony of influenza epidemics between Hong Kong and Shenzhen, two neighboring subtropical cities in South China. Methods: Laboratory-confirmed influenza data for the period January 2006 to December 2016 were obtained from the Shenzhen Center for Disease Control and Prevention and the Department of Health in Hong Kong. The population data were retrieved from the 2011 population censuses. The weekly rates of laboratory-confirmed influenza cases were compared between Shenzhen and Hong Kong. Results: Unsynchronized influenza epidemics between Hong Kong and Shenzhen were frequently observed during the study period. Influenza A/H1N1 caused a more severe pandemic in Hong Kong in 2009, but the subsequent seasonal epidemics showed similar magnitudes in both cities. Two influenza A/H3N2 dominant epidemic waves were seen in Hong Kong in 2015, but these epidemics were very minor in Shenzhen. More influenza B epidemics occurred in Shenzhen than in Hong Kong. Conclusions: Influenza epidemics appeared to be unsynchronized between Hong Kong and Shenzhen most of the time. Given the close geographical locations of these two cities, this could be due to the strikingly different age structures of their populations. Keywords: Influenza epidemics, Synchrony, Shenzhen, Hong Kong
Ben Achour, N; Benrhouma, H; Rouissi, A; Touaiti, H; Kraoua, I; Turki, I; Gouider-Khouja, N
Rubella is a mild viral illness in children. Rubella encephalitis is an extremely uncommon complication of rubella affecting unvaccinated children, aged between 5 and 14 years. From May to June 2011, we observed 9 cases of rubella encephalitis diagnosed during an epidemic of rubella. All were previously healthy (8 boys and 1 girl). None of them had received rubella vaccine. The mean age was 11.6 years. The onset of neurological symptoms occurred within 1-5 days after the typical rush and was associated with seizures and altered consciousness in all cases. The presence of serum immunoglobulin M antibody against rubella virus was demonstrated in all patients. EEGs showed slow wave activity in all patients and brain MRI was normal in the 9 cases. Full recovery was obtained in all patients. However, 4 of them required intensive care unit referral. Acute encephalitis is an extremely rare complication of rubella. The main neurological findings are headache, ataxia, and hemiplegia. Epileptic seizure and altered consciousness are rarely observed. Rubella encephalitis is generally self-limiting with about 80% recovery rate with no sequelae. However, severe courses have been reported. These cases illustrated the potential severity of rubella and they should be prevented by encouraging widespread early childhood vaccination. In Tunisia, rubella encephalitis has been reported once previously and vaccination against rubella virus has only recently been included in the national vaccination program, prescribed only for adolescent females. Following this rubella epidemic, vaccination strategies in Tunisia have been revised. Copyright © 2013 Elsevier Masson SAS. All rights reserved.
Full Text Available This article will address how Swedish scientists, physicians and public health officers tried to combat the polio epidemics in the pre-vaccine era. It shows that once polio was considered as an epidemic disease the preventive measures used were based on the hindrance of other infectious diseases. It also illustrates how epidemiological and laboratory studies to some degree affected the thoughts of how polio should be prevented, and that Swedish ideas and experiences differed from those put forward in the USA.
Este artículo trata sobre cómo los científicos, médicos y funcionarios de la sanidad pública de Suecia intentaron combatir la epidemia de la polio en la era anterior a la vacuna y expone que en cuanto la polio fue considerada como una epidemia, las medidas preventivas que se aplicaron se basaban en las de otras enfermedades contagiosas. También ilustra en qué medida los estudios epidemiológicos y los análisis de laboratorio influyeron en la manera de prevenir la polio y también demuestra que las opiniones y experiencias en Suecia eran diferentes a las de los Estados Unidos.
Duffy, Patrick E
.... The long-term objective of this project is to identify and prepare the malaria parasite forms causing severe anemia and then apply functional genomics and bioformatics tools to identify 15 to 30...
Rocha, Benigno A M; Guilarde, Adriana O; Argolo, Angela F L T; Tassara, Marianna Peres; da Silveira, Lucimeire A; Junqueira, Isabela C; Turchi, Marília D; Féres, Valéria C R; Martelli, Celina M T
Please see Additional file 1 for translations of the abstract into the five official working languages of the United Nations. Currently, in Brazil, there is a co-circulation of the four dengue (DENV-1 to DENV-4) serotypes. This study aimed to assess whether different serotypes and antibody response patterns were associated with the severity of the disease during a dengue outbreak, which occurred in 2012/2013 in centre of Brazil. We conducted a prospective study with 452 patients with laboratory confirmed dengue in central Brazil, from January 2012 to July 2013. The clinical outcome was the severity of cases: dengue, dengue with warning signs, and severe dengue. The patients were evaluated at three different moments. Blood sampling for laboratory testing and confirmatory tests for dengue infection were performed. We performed a multinomial analysis considering the three categories of the dependent variable, as outlined above. The odds ratios (ORs) were calculated. A multinomial logistic regression model was applied for variables with a P-value dengue. The dengue virus (DENV) serotypes were identified in 243 cases. DENV-4 was detected in 135 patients (55.6%), DENV-1 in 91 (37.4%), DENV-3 in 13 (5.3%), and DENV-2 in 4 (1.6%). Patients with the DENV-1 serotype were more prone to present with several clinical and laboratory features as compared with DENV-4 patients, including spontaneous bleeding (P = 0.03), intense abdominal pain (P = 0.004), neurological symptoms (P = 0.09), and thrombocytopenia (P = 0.01). Secondary infection was more predominant among DENV-4 cases (80.0%) compared with DENV-1 cases (62.3%) (P = 0.03). The univariate analysis showed that females (OR = 2.12; 95% CI: 1.44-3.13; P dengue with warning signs. The multinomial analysis showed that severe dengue cases with secondary infection had an adjusted OR of 2.80 (95% CI: 0.78-10.00; P = 0.113) as compared with dengue fever with primary infection when adjusted for age and sex. The
Luciano Pamplona de Goes Cavalcanti
Full Text Available In 2009, the World Health Organization (WHO issued a new guideline that stratifies dengue-affected patients into severe (SD and non-severe dengue (NSD (with or without warning signs. To evaluate the new recommendations, we completed a retrospective cross-sectional study of the dengue haemorrhagic fever (DHF cases reported during an outbreak in 2011 in northeastern Brazil. We investigated 84 suspected DHF patients, including 45 (53.6% males and 39 (46.4% females. The ages of the patients ranged from five-83 years and the median age was 29. According to the DHF/dengue shock syndrome classification, 53 (63.1% patients were classified as having dengue fever and 31 (36.9% as having DHF. According to the 2009 WHO classification, 32 (38.1% patients were grouped as having NSD [4 (4.8% without warning signs and 28 (33.3% with warning signs] and 52 (61.9% as having SD. A better performance of the revised classification in the detection of severe clinical manifestations allows for an improved detection of patients with SD and may reduce deaths. The revised classification will not only facilitate effective screening and patient management, but will also enable the collection of standardised surveillance data for future epidemiological and clinical studies.
Isora Ramos Valle
Full Text Available The development of a strong national response involving multiple sectors—including civil society—is an essential aspect of the social management of the HIV/AIDS epidemic. The goals of this response are to control the epidemic and improve the quality of life for people living with HIV/AIDS; this includes combating stigma and discrimination, as well as ensuring due compliance with the law. Cuba has a national program to prevent and control HIV/AIDS. Since 2003 Cuba’s national program has received material and financial support from the Global Fund to Fight AIDS, Tuberculosis and Malaria. Program evaluation is carried out by an independent team at ENSAP (National School of Public Health. This paper reports on results of one part of that evaluation: an assessment of the agencies and sectors who made up the organized social and national response to the HIV/AIDS epidemic. The evaluation primarily used qualitative analyses of the activities and tasks proposed by sectors in their 2006-2008 work plans. Visits were made to the provinces of Ciudad de la Habana, Matanzas, and Holguín. Qualitative techniques included in-depth interviews, semi-structured interviews, observation, and review of documentary evidence of all kinds (videos, reports, minutes, protocols, results of social research, and radio broadcast messages and varied depending on the particular features of each sector. We noted improvements in multi-sector participation in the prevention and response to the national HIV/AIDS epidemic. Conscious of their role, sectors generally carried out their programmed activities and had improved their organization, planning, and systematization; integration among the sectors was also better. These local initiatives provided evidence of a multi-sector response characterized by autonomy, emotional involvement, and an identification with the goals of the project; this went beyond simply meeting targets. Cross-sector work showed a marked increase and a
despite extensive diagnostic workups. Most of these reports pointed out that the outbreak started in Southern China, specifically in the Guandong Province. The initial outbreak in South East Asia has already spread to other Regions in Asia, Europe, North and South America, and South Africa. Many of these cases can be linked through chains of transmission to an index case from the Guandong Province who visited Hong Kong. Although the exact mode of transmission has not been clearly established, the etiology of this syndrome has already been identified. A novel Coronavirus has been identified by electron microscopy and molecular assays in multiple laboratories from respiratory specimens throughout the world. The syndrome has been defined as SARS (Severe Acute Respiratory Syndrome by WHO, and is characterized by an incubation period between 1 and 10 days (average 5 days and by a febrile phase that usually lasts approximately 3 days. During the respiratory phase that begins around day 3, patients start developing a dry cough, shortness of breath and hypoxemia. Mechanical ventilatory support is required in about 10 to 40% of cases and the case-fatality rate ranges between 3 and 16%. The laboratory findings in SARS cases include leukopenia, thrombocytopenia, and a rise in transaminases and lactic dehydrogenase levels. Treatment of SARS includes supportive measures and the empiric use of ribavirin. Respiratory isolation, use of respiratory masks, and compulsory hand hygiene constitute the principal preventive measures. The confirmation of a case can be performed at reference laboratories by serologic and molecular assays. From the onset of this epidemic Mexico established a surveillance system as well as clinical guidelines and recommendations for the identification, prevention of secondary spread, and medical management of suspicious and probable cases by health care personnel.
Corey H Basch
Full Text Available Background:Widespread media attention about Ebola influences public aware-ness and interest, yet there is limited research on what aspects of Ebola have and have not been communicated through the media. Methods:We examined the nature and extent of coverage about Ebola in the three most widely circulated United States (U.S. daily newspapers. Between September 17, 2014 and October 17, 2014, 301 articles about Ebola in The New York Times, USA Today, and The Wall Street Journal were identified and cod-ed. Results:The most common topic was coverage of cases in the United States (39%, followed by the outbreak in Africa (33.6%. Conclusion:This is the first study to describe coverage of the Ebola epidemic in widely circulated U.S. newspapers. A substantial portion of the American public is concerned about being infected with Ebola virus disease (EVD. In this study, a large emphasis was placed on death tolls and the cases in the United States. Much more can be done to educate readers about relevant aspects of the Ebola epidemic, including how Ebola is and is not transmitted.
Basch, Corey H; Basch, Charles E; Redlener, Irwin
Widespread media attention about Ebola influences public awareness and interest, yet there is limited research on what aspects of Ebola have and have not been communicated through the media. We examined the nature and extent of coverage about Ebola in the three most widely circulated United States (U.S.) daily newspapers. Between September 17, 2014 and October 17, 2014, 301 articles about Ebola in The New York Times, USA Today, and The Wall Street Journal were identified and coded. The most common topic was coverage of cases in the United States (39%), followed by the outbreak in Africa (33.6%). This is the first study to describe coverage of the Ebola epidemic in widely circulated U.S. newspapers. A substantial portion of the American public is concerned about being infected with Ebola virus disease (EVD). In this study, a large emphasis was placed on death tolls and the cases in the United States. Much more can be done to educate readers about relevant aspects of the Ebola epidemic, including how Ebola is and is not transmitted.
Current plans have excellent safety records and are cost competitive. For future plants, excellence in safety will remain a prerequisite, as well as increased cost competitiveness. When contemplating solutions to Severe Accident challenges, cost effectiveness is essential in the decision making process. This cost effectiveness must be understood not only in terms of capital cost, but also of Operation and Maintenance costs as well as absence of additional risks to plant operators. Examples are given to illustrate the recommended approach
Bechah, Yassina; Capo, Christian; Mege, Jean-Louis; Raoult, Didier
Epidemic typhus is transmitted to human beings by the body louse Pediculus humanus corporis. The disease is still considered a major threat by public-health authorities, despite the efficacy of antibiotics, because poor sanitary conditions are conducive to louse proliferation. Until recently, Rickettsia prowazekii, the causal agent, was thought to be confined to human beings and their body lice. Since 1975, R prowazekii infection in human beings has been related to contact with the flying squirrel Glaucomys volans in the USA. Moreover, Brill-Zinsser disease, a relapsed form of epidemic typhus that appears as sporadic cases many years after the initial infection, is unrelated to louse infestation. Stress or a waning immune system are likely to reactivate this earlier persistent infection, which could be the source of new epidemics when conditions facilitate louse infestation. Finally, R prowazekii is a potential category B bioterrorism agent, because it is stable in dried louse faeces and can be transmitted through aerosols. An increased understanding of the pathogenesis of epidemic typhus may be useful for protection against this bacterial threat.
Li, Jing; Gong, Xiang-Dong; Yue, Xiaoli; Jiang, Ning
To evaluate club drug use and its potential association with STI among female sex workers (FSWs) in China. From November 2008 to January 2009, participants were recruited at sex work venues in five cities for a questionnaire survey. Free testing for syphilis, Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (NG) was provided. Logistic regression models were used to assess factors associated with club drug use and its association with STI. A total of 1604 eligible FSWs were included. The overall prevalence of any STI infection and club drug use in the past 12 months was 22.6% and 7.4%, respectively. STI prevalence was significantly higher among club drug users (33.1%) than among nonusers (21.7%, P STI symptoms (AOR 2.2, 95% CI 1.4, 3.4). Club drug use and STI were highly prevalent among FSWs in China, especially among young FSWs. Club drug users had more risk behaviors and higher STI rates. A coordinated risk reduction framework is urgently needed to address the dual epidemic of drug use and STI.
Full Text Available Objectives. To evaluate club drug use and its potential association with STI among female sex workers (FSWs in China. Methods. From November 2008 to January 2009, participants were recruited at sex work venues in five cities for a questionnaire survey. Free testing for syphilis, Chlamydia trachomatis (CT, and Neisseria gonorrhoeae (NG was provided. Logistic regression models were used to assess factors associated with club drug use and its association with STI. Results. A total of 1604 eligible FSWs were included. The overall prevalence of any STI infection and club drug use in the past 12 months was 22.6% and 7.4%, respectively. STI prevalence was significantly higher among club drug users (33.1% than among nonusers (21.7%, P<0.05. Multivariable logistic regression found that club drug use was associated with younger age (AOR 2.4, 95% CI 1.0, 6.0, higher education, having injected drugs (AOR 24.4, 95% CI 6.2, 96.8, and having had STI symptoms (AOR 2.2, 95% CI 1.4, 3.4. Conclusions. Club drug use and STI were highly prevalent among FSWs in China, especially among young FSWs. Club drug users had more risk behaviors and higher STI rates. A coordinated risk reduction framework is urgently needed to address the dual epidemic of drug use and STI.
Strutton David R
Full Text Available Abstract Background Influenza pandemic outbreaks occurred in the US in 1918, 1957, and 1968. Historical evidence suggests that the majority of influenza-related deaths during the 1918 US pandemic were attributable to bacterial pneumococcal infections. The 2009 novel influenza A (H1N1 outbreak highlights the importance of interventions that may mitigate the impact of a pandemic. Methods A decision-analytic model was constructed to evaluate the impact of 7-valent pneumococcal conjugate vaccine (PCV7 on pneumococcal disease incidence and mortality during a typical influenza season (13/100 and a severe influenza pandemic (30/100. Outcomes were compared for current PCV7 vaccination practices vs. no vaccination. The model was estimated using published sources and includes indirect (herd protection of non-vaccinated persons. Results The model predicts that PCV7 vaccination in the US is cost saving for a normal influenza season, reducing pneumococcal-related costs by $1.6 billion. In a severe influenza pandemic, vaccination would save $7.3 billion in costs and prevent 512,000 cases of IPD, 719,000 cases of pneumonia, 62,000 IPD deaths, and 47,000 pneumonia deaths; 84% of deaths are prevented due to indirect (herd protection in the unvaccinated. Conclusions PCV7 vaccination is highly effective and cost saving in both normal and severe pandemic influenza seasons. Current infant vaccination practices may prevent >1 million pneumococcal-related deaths in a severe influenza pandemic, primarily due to herd protection.
Rubin, Jaime L; McGarry, Lisa J; Klugman, Keith P; Strutton, David R; Gilmore, Kristen E; Weinstein, Milton C
Influenza pandemic outbreaks occurred in the US in 1918, 1957, and 1968. Historical evidence suggests that the majority of influenza-related deaths during the 1918 US pandemic were attributable to bacterial pneumococcal infections. The 2009 novel influenza A (H1N1) outbreak highlights the importance of interventions that may mitigate the impact of a pandemic. A decision-analytic model was constructed to evaluate the impact of 7-valent pneumococcal conjugate vaccine (PCV7) on pneumococcal disease incidence and mortality during a typical influenza season (13/100) and a severe influenza pandemic (30/100). Outcomes were compared for current PCV7 vaccination practices vs. no vaccination. The model was estimated using published sources and includes indirect (herd) protection of non-vaccinated persons. The model predicts that PCV7 vaccination in the US is cost saving for a normal influenza season, reducing pneumococcal-related costs by $1.6 billion. In a severe influenza pandemic, vaccination would save $7.3 billion in costs and prevent 512,000 cases of IPD, 719,000 cases of pneumonia, 62,000 IPD deaths, and 47,000 pneumonia deaths; 84% of deaths are prevented due to indirect (herd) protection in the unvaccinated. PCV7 vaccination is highly effective and cost saving in both normal and severe pandemic influenza seasons. Current infant vaccination practices may prevent >1 million pneumococcal-related deaths in a severe influenza pandemic, primarily due to herd protection.
Luciano Pamplona de Góes Cavalcanti
Full Text Available Abstract: INTRODUCTION: The dengue classification proposed by the World Health Organization (WHO in 2009 is considered more sensitive than the classification proposed by the WHO in 1997. However, no study has assessed the ability of the WHO 2009 classification to identify dengue deaths among autopsied individuals suspected of having dengue. In the present study, we evaluated the ability of the WHO 2009 classification to identify dengue deaths among autopsied individuals suspected of having dengue in Northeast Brazil, where the disease is endemic. METHODS: This retrospective study included 121 autopsied individuals suspected of having dengue in Northeast Brazil during the epidemics of 2011 and 2012. All the autopsied individuals included in this study were confirmed to have dengue based on the findings of laboratory examinations. RESULTS: The median age of the autopsied individuals was 34 years (range, 1 month to 93 years, and 54.5% of the individuals were males. According to the WHO 1997 classification, 9.1% (11/121 of the cases were classified as dengue hemorrhagic fever (DHF and 3.3% (4/121 as dengue shock syndrome. The remaining 87.6% (106/121 of the cases were classified as dengue with complications. According to the 2009 classification, 100% (121/121 of the cases were classified as severe dengue. The absence of plasma leakage (58.5% and platelet counts <100,000/mm3 (47.2% were the most frequent reasons for the inability to classify cases as DHF. CONCLUSIONS: The WHO 2009 classification is more sensitive than the WHO 1997 classification for identifying dengue deaths among autopsied individuals suspected of having dengue.
Amputation and diabetes: How to protect your feet Good diabetes management and regular foot care help prevent severe foot sores that ... and may require amputation. By Mayo Clinic Staff Diabetes complications can include nerve damage and poor blood ...
Vodret, Simone; Bortolussi, Giulia; Schreuder, Andrea B.; Jasprova, Jana; Vitek, Libor; Verkade, Henkjan J.; Muro, Andres F.
Therapies to prevent severe neonatal unconjugated hyperbilirubinemia and kernicterus are phototherapy and, in unresponsive cases, exchange transfusion, which has significant morbidity and mortality risks. Neurotoxicity is caused by the fraction of unconjugated bilirubin not bound to albumin (free
Peykari, Niloofar; Hashemi, Hassan; Dinarvand, Rasoul; Haji-Aghajani, Mohammad; Malekzadeh, Reza; Sadrolsadat, Ali; Sayyari, Ali Akbar; Asadi-Lari, Mohsen; Delavari, Alireza; Farzadfar, Farshad; Haghdoost, Aliakbar; Heshmat, Ramin; Jamshidi, Hamidreza; Kalantari, Naser; Koosha, Ahmad; Takian, Amirhossein; Larijani, Bagher
Emerging Non-communicable diseases burden move United Nation to call for 25% reduction by 2025 in premature mortality from non-communicable diseases (NCDs). The World Health Organization (WHO) developed global action plan for prevention and control NCDs, but the countries' contexts, priorities, and health care system might be different. Therefore, WHO expects from countries to meet national commitments to achieve the 25 by 25 goal through adapted targets and action plan. In this regards, sustainable high-level political statement plays a key role in rules and regulation support, and multi-sectoral collaborations to NCDs' prevention and control by considering the sustainable development goals and universal health coverage factors. Therefore, Iran established the national authority's structure as Iranian Non Communicable Diseases Committee (INCDC) and developed NCDs' national action plan through multi-sectoral approach and collaboration researchers and policy makers. Translation Iran's expertise could be benefit to mobilizing leadership in other countries for practical action to save the millions of peoples.
Lönnroth, Knut; Roglic, Gojka; Harries, Anthony D
Diabetes triples the risk of tuberculosis and is also a risk factor for adverse tuberculosis treatment outcomes, including death. Prevalence of diabetes is increasing globally, but most rapidly in low-income and middle-income countries where tuberculosis is a grave public health problem. Growth in this double disease burden creates additional obstacles for tuberculosis care and prevention. We review how the evolution of evidence on the link between tuberculosis and diabetes has informed global policy on collaborative activities, and how practice is starting to change as a consequence. We conclude that coordinated planning and service delivery across communicable and non-communicable disease programmes is necessary, feasible, and creates synergies that will help to reduce the burden of both tuberculosis and diabetes. Copyright © 2014 Elsevier Ltd. All rights reserved.
Ying, Roger; Barnabas, Ruanne V.; Williams, Brian G.
The Joint United Nations Programme on HIV/AIDS (UNAIDS) recently updated its global targets for antiretroviral therapy (ART) coverage for HIV-positive persons under which 90% of HIV-positive people are tested, 90% of those are on ART, and 90% of those achieve viral suppression. Treatment policy is moving toward treating all HIV-infected persons regardless of CD4 cell count—otherwise known as treatment as prevention—in order to realize the full therapeutic and preventive benefits of ART. Mathematical models have played an important role in guiding the development of these policies by projecting long-term health impacts and cost-effectiveness. To guide future policy, new mathematical models must consider the barriers patients face in receiving and taking ART. Here, we describe the HIV care cascade and ART delivery supply chain to examine how mathematical modeling can provide insight into cost-effective strategies for scaling-up ART coverage in sub-Saharan Africa and help achieve universal ART coverage. PMID:25249293
Cheng, Kimhaung; Fucharoen, Supan; Sanchaisuriya, Kanokwan; Fucharoen, Goonnapa; Sanchaisuriya, Pattara; Jetsrisuparb, Arunee
Severe thalassemia diseases are a major health problem in Southeast Asia. In Cambodia, there has never been a significant program for prevention or control of severe thalassemia. We, therefore, studied the effect of a health education program on severe thalassemia prevention and control in Phnom Penh, Cambodia. A quasi-experimental study in several communities around Phnom Penh was done. The respective intervention and control group comprised 124 and 117 people, between 18 and 40 years of age, male and female. Pre- and post-tests using a validated and reliable questionnaire were performed in the intervention group and one test was done in the control group. A health education program was organized to give important information to the intervention group and, at the end of the process, to the control group. The outcomes were evaluations of their knowledge and attitude vis-à-vis severe thalassemia prevention and control, and participating in thalassemia screening. Among participants in the intervention group, 105 (84.7%) considered undergoing blood screening vs. 65 (55.6%) in the control group ( p -value < 0.001). In the intervention group, the respective mean scores for knowledge and attitude to a prevention and control program for severe thalassemia before and after health education were 2.6 VS 6.5 ( p -value < 0.001) and 4.6 VS 6.5 ( p -value < 0.001). The intention to undergo screening was significantly higher in the intervention group than the control group. Knowledge and attitude towards prevention and control of severe thalassemia was significantly improved in the intervention group. Health education clearly heightens awareness and improves consideration of screening for prevention and control of severe thalassemia.
sanctions or foregoing these rewards and thus are most vulnerable to their men folk. We argue that the goals of HIV prevention and optimizing of care can best be achieved through change in gender identities, rather than through a focus on individual sexual behaviours. PMID:20181124
Finnicum, D.J.; Jacob, M.C.; Schneider, R.E.; Weston, R.A.
The System 80 + design is ABB-CE's standardized evolutionary Advanced Light Water Reactor (ALWR) design. It incorporates design enhancements based on Probabilistic Risk Assessment (PRA) insights, guidance from the ALWR Utility Requirements Document (URD), and US NRC's Severe Accident Policy. Major severe accident prevention and mitigation design features of the System 80 + design are described. The results of the System 80 + PRA are presented and the insights gained from the PRA sensitivity analyses are discussed. ABB-CE considered defense-in-depth for accident prevention and mitigation early in the design process and used robust design features to ensure that the System 80 + design achieved a low core damage frequency, low containment conditional failure probability, and excellent deterministic containment performance under severe accident conditions and to ensure that the risk was properly allocated among design features and between prevention and mitigation. (author)
Full Text Available David MG Halpin,1 Marc Miravitlles,2 Norbert Metzdorf,3 Bartolomé Celli4 1Department of Respiratory Medicine, Royal Devon and Exeter Hospital, Exeter, UK; 2Pneumology Department, Hospital Universitari Vall d’Hebron, CIBER de Enfermedades Respiratorias (CIBERES, Barcelona, Spain; 3Respiratory Medicine, Boehringer Ingelheim Pharma GmBH & Co KG, Ingelheim am Rhein, Germany; 4Pulmonary Division, Brigham and Women’s Hospital, Boston, MA, USA Abstract: Severe exacerbations of COPD, ie, those leading to hospitalization, have profound clinical implications for patients and significant economic consequences for society. The prevalence and burden of severe COPD exacerbations remain high, despite recognition of the importance of exacerbation prevention and the availability of new treatment options. Severe COPD exacerbations are associated with high mortality, have negative impact on quality of life, are linked to cardiovascular complications, and are a significant burden on the health-care system. This review identified risk factors that contribute to the development of severe exacerbations, treatment options (bronchodilators, antibiotics, corticosteroids [CSs], oxygen therapy, and ventilator support to manage severe exacerbations, and strategies to prevent readmission to hospital. Risk factors that are amenable to change have been highlighted. A number of bronchodilators have demonstrated successful reduction in risk of severe exacerbations, including long-acting muscarinic antagonist or long-acting β2-agonist mono- or combination therapies, in addition to vaccination, mucolytic and antibiotic therapy, and nonpharmacological interventions, such as pulmonary rehabilitation. Recognition of the importance of severe exacerbations is an essential step in improving outcomes for patients with COPD. Evidence-based approaches to prevent and manage severe exacerbations should be implemented as part of targeted strategies for disease management. Keywords
Las epidemias de cólera en Córdoba a través del periodismo: la oferta de productos preservativos y curativos durante la epidemia de 1867-1868 Cholera epidemics in Córdoba as seen through the press: the supply of preventive and curative products during the 1867-68 epidemic
Full Text Available La enfermedad es un momento de crisis tanto individual como social. La cercanía de la muerte debido a la dolencia genera en las sociedades estrategias para evadirla o curarla. Las epidemias y especialmente las de cólera tuvieron una impronta muy fuerte en la sociedad argentina y especialmente en la cordobesa ya que la primera de ellas fue devastadora en términos demográficos y sociales. En este artículo pretendemos analizar el ofrecimiento de productos, que se publicaba en la prensa escrita en la primer epidemia del año 1867/68. Partimos de la hipótesis de que los productos que se ofrecían desarrollaban un comercio de carácter suntuario que no eran objeto de transacciones comerciales habitualmente por la población en momentos no epidémicos y que a su vez estaban dirigidos hacia los sectores de mayor nivel adquisitivo.Throughout human history, disease has always represented a moment of crisis for individuals and societies. When death brought by disease hangs heavy over societies, they are led to develop strategies to prevent and cure it. Epidemics, especially cholera epidemics, have had a strong impact on Argentine society and especially on Córdoba residents, because the first cholera outbreak was demographically and socially highly devastating. In this article we analyze the supply of products advertised in the press (the only media available at the time during the first epidemic, which broke out in 1867-8. Our hypothesis is that the products available, which we believe were consumed by some groups in society, led to a sumptuary trade that was not common among the population when there were no epidemics. At times of epidemics, these products were directed towards more affluent groups. We also believe that the supply of such products changed as their trade increased.
Godbole, Sheela; Sane, Suvarna; Kamble, Pranil; Raj, Yujwal; Dulhani, Nisha; Venkatesh, Srinivasan; Reddy, D. C. S.; Chavan, Laxmikant; Bhattacharya, Madhulekha; Bindoria, Suchitra; Kadam, Dilip; Thakur, Savita; Narwani, Prakash; Pereira, Elmira; Paranjape, Ramesh; Risbud, Arun
Background Indian cultural tradition demanding marriage, many MSM howsoever they self-identify are likely to be married or have sex with women. To consolidate India's HIV prevention gains, it is important to understand and address the interaction between the MSM and heterosexual epidemics in India and create specific interventions for bisexual MSM. The challenge is to identify and intervene this hard to reach population. Data from HIV Sentinel Surveillance 2011 among MSM in four Indian states were analyzed to assess predictors and prevalence of bisexual behaviour in MSM. Methods Between March-May 2011, 4682 men (15–49 years) who had anal/oral sex with a male partner in the past month, attending intervention sites and consenting for an un-linked anonymous survey answered an 11- item questionnaire and provided blood for HIV test by finger stick at 19 designated surveillance sites. Results Of 4682 MSM tested overall, 5% were illiterate, 51% reported only receptive anal intercourse, 21% only penetrative and 28% both. 36% MSM had ever received money for sex. Overall 6.8% were HIV infected. 44% MSM were bisexual in the last six months. On multivariate analysis, ‘being bisexual’ was found to be independently associated with ‘older age’: 26–30 years [AOR = 3.1, 95% CI(2.7, 3.7)], >30 years [AOR = 6.5, 95% CI(5.5, 7.7)]; ‘reporting penetrative behaviour alone’ with other men [AOR = 5.8, 95% CI(4.8, 7.0), pbehaviour’ [AOR = 2.7, 95% CI(2.3, 3.1) pbehaviour with other men, could help in reaching this population. PMID:25211511
Timothy C Reluga
Full Text Available Social distancing practices are changes in behavior that prevent disease transmission by reducing contact rates between susceptible individuals and infected individuals who may transmit the disease. Social distancing practices can reduce the severity of an epidemic, but the benefits of social distancing depend on the extent to which it is used by individuals. Individuals are sometimes reluctant to pay the costs inherent in social distancing, and this can limit its effectiveness as a control measure. This paper formulates a differential-game to identify how individuals would best use social distancing and related self-protective behaviors during an epidemic. The epidemic is described by a simple, well-mixed ordinary differential equation model. We use the differential game to study potential value of social distancing as a mitigation measure by calculating the equilibrium behaviors under a variety of cost-functions. Numerical methods are used to calculate the total costs of an epidemic under equilibrium behaviors as a function of the time to mass vaccination, following epidemic identification. The key parameters in the analysis are the basic reproduction number and the baseline efficiency of social distancing. The results show that social distancing is most beneficial to individuals for basic reproduction numbers around 2. In the absence of vaccination or other intervention measures, optimal social distancing never recovers more than 30% of the cost of infection. We also show how the window of opportunity for vaccine development lengthens as the efficiency of social distancing and detection improve.
Bae, Moohoon; Choi, Yong Won; Shin, Andong; Suh, Namduk
Based on this characteristic of fast reactor core, potential impact of CDA (Core Disruptive Accident) caused by ATWS has been considered as an important safety issue, although it is extremely unlikely. In order to prevent and mitigate the severe accident, the fast reactor core has been designed with various safety features. In this paper, as a part of study to develop the domestic regulatory requirements and guidelines related to SFR core safety, international trends on safety features which have been considered in current SFR cores are reviewed. In order to develop the regulatory requirements and guidelines related to a SFR core design for prevention of CDA, the core safety features were reviewed. The safety features considered in current SFR cores have a function that prevents to progress into next step in accident sequences. The trends on current safety features are as follows: · 'passive shutdown systems' to prevent initiating events such as ULOF, UTOP, ULOHS, etc · 'core designs with low void effect' to prevent the large void reactivity insertion in initiating phase · 'specific provisions for core with conventional positive void effect' to prevent the core recriticality in transition phase Consequently, in regulatory review requirements and guidelines developed for SFR, contents for not only reduction of positive void effect but also features to ensure the safety of overall system should be reflected
Bondü, Rebecca; Scheithauer, Herbert
In March and September 2009 the school shootings in Winnenden and Ansbach once again demonstrated the need for preventive approaches in order to prevent further offences in Germany. Due to the low frequency of such offences and the low specificity of relevant risk factors known so far, prediction and prevention seems difficult though. None the less, several preventive approaches are currently discussed. The present article highlights these approaches and their specific advantages and disadvantages. As school shootings are multicausally determined, approaches focussing only on single aspects (i.e. prohibiting violent computer games or further strengthening gun laws) do not meet requirements. Other measures such as installing technical safety devices or optimizing actions of police and school attendants are supposed to reduce harm in case of emergency. Instead, scientifically founded and promising preventive approaches focus on secondary prevention and for this purpose employ the threat assessment approach, which is widespread within the USA. In this framework, responsible occupational groups such as teachers, school psychologists and police officers are to be trained in identifying students' warning signs, judging danger of these students for self and others in a systematic process and initiating suitable interventions.
Jutla, Antarpreet; Whitcombe, Elizabeth; Hasan, Nur; Haley, Bradd; Akanda, Ali; Huq, Anwar; Alam, Munir; Sack, R. Bradley; Colwell, Rita
Cholera outbreak following the earthquake of 2010 in Haiti has reaffirmed that the disease is a major public health threat. Vibrio cholerae is autochthonous to aquatic environment, hence, it cannot be eradicated but hydroclimatology-based prediction and prevention is an achievable goal. Using data from the 1800s, we describe uniqueness in seasonality and mechanism of occurrence of cholera in the epidemic regions of Asia and Latin America. Epidemic regions are located near regional rivers and are characterized by sporadic outbreaks, which are likely to be initiated during episodes of prevailing warm air temperature with low river flows, creating favorable environmental conditions for growth of cholera bacteria. Heavy rainfall, through inundation or breakdown of sanitary infrastructure, accelerates interaction between contaminated water and human activities, resulting in an epidemic. This causal mechanism is markedly different from endemic cholera where tidal intrusion of seawater carrying bacteria from estuary to inland regions, results in outbreaks. PMID:23897993
Rulloda, Rudolfo Barcena
School violence has mushroomed into a devastating epidemic and is deteriorating the basic foundation of education. In this article, the author will present several teaching strategies for preventing school violence from becoming an arduous enigma within the classroom and school environments, and focus on assessment and reflection in order to…
Predictors of bisexual behaviour among MSM attending intervention sites may help in prevention interventions for this bridge to the heterosexual epidemic in India: data from HIV sentinel surveillance.
Full Text Available Indian cultural tradition demanding marriage, many MSM howsoever they self-identify are likely to be married or have sex with women. To consolidate India's HIV prevention gains, it is important to understand and address the interaction between the MSM and heterosexual epidemics in India and create specific interventions for bisexual MSM. The challenge is to identify and intervene this hard to reach population. Data from HIV Sentinel Surveillance 2011 among MSM in four Indian states were analyzed to assess predictors and prevalence of bisexual behaviour in MSM.Between March-May 2011, 4682 men (15-49 years who had anal/oral sex with a male partner in the past month, attending intervention sites and consenting for an un-linked anonymous survey answered an 11- item questionnaire and provided blood for HIV test by finger stick at 19 designated surveillance sites.Of 4682 MSM tested overall, 5% were illiterate, 51% reported only receptive anal intercourse, 21% only penetrative and 28% both. 36% MSM had ever received money for sex. Overall 6.8% were HIV infected. 44% MSM were bisexual in the last six months. On multivariate analysis, 'being bisexual' was found to be independently associated with 'older age': 26-30 years [AOR = 3.1, 95% CI(2.7, 3.7], >30 years [AOR = 6.5, 95% CI(5.5, 7.7]; 'reporting penetrative behaviour alone' with other men [AOR = 5.8, 95% CI(4.8, 7.0, p<0.01] and 'reporting both penetrative and receptive behaviour' [AOR = 2.7, 95% CI(2.3, 3.1 p<0.01]. Those who both paid and received money for sex [AOR = 0.49, 95% CI (0.38, 0.62] were significantly less likely to be bisexual.A substantial proportion of men receiving services from Targeted Intervention programs are bisexual and the easy opportunity for intervention in this setting should be capitalised upon. Focusing on older MSM, as well as MSM who show penetrative behaviour with other men, could help in reaching this population.
Nordfeldt, Sam; Johansson, Calle; Carlsson, Eric; Hammersjö, Jan-Ake
To study the long-term use of self-study material in type 1 diabetes patient education targeted at the prevention of severe hypoglycaemia. Randomized 1:1:1 control study in three local hospitals. We studied 332 type 1 diabetes patients from the geographic population, aged 2.6-18.9 y at entry. The intervention group received a videotape and brochure in which interviewed patients, parents and medical experts reviewed in detail practical skills for self-control and treatment, with the aim of preventing severe hypoglycaemia. There were two control groups: one received a videotape and brochure with general diabetes information and the other only traditional treatment. Primary endpoints were severe hypoglycaemia needing assistance by another person and HbA1c. Dissemination, reading/viewing level, patients' attitudes and extra contact with caregivers were also investigated. At 24 mo, 249 subjects provided data. The yearly incidence of severe hypoglycaemia decreased at 24 mo from 42% to 25% (difference 17%, 95% CI 3-31, p = 0.0241) in the intervention group, but not in controls. HbA1c remained unchanged. Video use during months 13-24 was higher in the intervention group than in controls (p = 0.0477), ranging from 1-15 (median 2) times, among 37% of patients (months 1-12, 100%). Higher future use was anticipated for intervention material (p = 0.0003). Extra caregiver contact was related to severe hypoglycaemia (p = 0.0009). The cost of the material was quality video programmes and brochures may reach high dissemination levels and, when targeted, contribute to the prevention of severe hypoglycaemia over a longer period of time, being a cost-effective complement to traditional care.
Wada, M; Nagano, N; Furuya, Y; Chin, J; Nemeth, E F; Fox, J
Calcimimetic NPS R-568 prevents parathyroid hyperplasia in rats with severe secondary hyperparathyroidism. Secondary hyperparathyroidism (secondary HPT) in chronic renal insufficiency (CRI) is characterized by multiglandular hyperplasia. In this study, we investigated the effects of the calcimimetic NPS R-568 on the parathyroid gland in rats with CRI induced by ligation of the renal arteries and severe secondary HPT induced by dietary phosphorus loading. Six days after surgery, high-phosphorus diet feeding was started, and NPS R-568 was administered to the rats for 56 days either by daily gavage (30 or 100 micromol/kg) or by continuous subcutaneous infusion (20 micromol/kg. day). After 54 days, serum PTH levels in vehicle-treated CRI rats were 1019 vs. 104 pg/mL in sham-operated controls. Infusion of NPS R-568 maintained serum PTH at levels comparable with those of sham-operated controls, whereas daily gavage also prevented much of the increase in CRI controls and decreased PTH levels intermittently in a dose-dependent fashion. Parathyroid gland enlargement was caused predominantly by hyperplasia. Total cell number per kg body wt was 3.5-fold higher in vehicle-treated CRI rats than in sham-operated controls. Both infusion and high-dose gavage of NPS R-568 completely prevented the increase in parathyroid cell number. These results demonstrate that the calcimimetic compound NPS R-568 can prevent both the increase in serum PTH levels and parathyroid hyperplasia in rats with CRI and severe secondary HPT. Moreover, these changes occurred despite decreases in serum 1, 25(OH)2D3 and increases in serum phosphate, suggesting a dominant role for the calcium receptor in regulating parathyroid cell proliferation.
Ruepp, Sarah Renée; Fagertun, Anna Manolova
This paper presents the implementation of a failure propagation model for transport networks when multiple failures occur resulting in an epidemic. We model the Susceptible Infected Disabled (SID) epidemic model and validate it by comparing it to analytical solutions. Furthermore, we evaluate...... to evaluate multiple epidemic scenarios in various network types....
Azarian, G.; Gandrille, P.; Gasperini, M.; Klein, R.
The EPR TM has incorporated several design features in order to specifically address major severe accident safety issues. In particular, it was designed with the objective to transfer high pressure core melt scenarios into a low pressure scenario with high reliability so that a high pressure vessel failure can be practically eliminated. It is the key issue in the defense-in-depth approach, for a postulated severe accident with core melting, to prevent any risk of containment failure due to possible Direct Containment Heating or due to reactor vessel rocketing which results from vessel failure at high pressure. Temperature-induced steam generator tube rupture, which could lead to a radiological containment bypass, has also to be prevented. On the basis of the analysis of the main high pressure core melt scenarios which are calculated with the MAAP4.07 code which was developed to support the EPR TM, this paper explores the benefits of primary depressurization by dedicated valves on transient evolutions. It specifically addresses the thermal response of the structures by sensitivity studies involving the timing of valve actuation. It outlines that a grace period of at least one hour is available for a delayed valve actuation without inducing excessive loads and without increasing the risk of a temperature-induced steam generator tube rupture. (authors)
Carnegie, Nicole Bohme
Understanding the dynamics of disease spread is key to developing effective interventions to control or prevent an epidemic. The structure of the network of contacts over which the disease spreads has been shown to have a strong influence on the outcome of the epidemic, but an open question remains as to whether it is possible to estimate contact network features from data collected in an epidemic. The approach taken in this paper is to examine the distributions of epidemic outcomes arising from epidemics on networks with particular structural features to assess whether that structure could be measured from epidemic data and what other constraints might be needed to make the problem identifiable. To this end, we vary the network size, mean degree, and transmissibility of the pathogen, as well as the network feature of interest: clustering, degree assortativity, or attribute-based preferential mixing. We record several standard measures of the size and spread of the epidemic, as well as measures that describe the shape of the transmission tree in order to ascertain whether there are detectable signals in the final data from the outbreak. The results suggest that there is potential to estimate contact network features from transmission trees or pure epidemic data, particularly for diseases with high transmissibility or for which the relevant contact network is of low mean degree. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.
Dunlop, Boadie W; Li, Thomas; Kornstein, Susan G; Friedman, Edward S; Rothschild, Anthony J; Pedersen, Ron; Ninan, Philip; Keller, Martin
The degree of agreement between patient- and clinician-rated scales of depressive severity varies widely. This study analyzed agreement between commonly used depression rating scales in the Prevention of Recurrent Episodes of Depression with Venlafaxine Extended Release (ER) for Two Years (PREVENT) trial. The PREVENT trial was a multiphase, randomized, double-blind study of patients with recurrent major depressive disorder. This secondary analysis evaluated acute (10weeks) and continuation phase (6months) data. Pearson correlation coefficients at each acute-phase (weekly) and continuation-phase (monthly) visit were calculated for patient-rated (30-item Inventory of Depressive Symptomatology-Self-Rated [IDS-SR30] and clinician-rated (17-item Hamilton Rating Scale for Depression [HAM-D17] and Clinical Global Impressions-Severity [CGI-S]) measures and for response and remission. Data from 1,047 patients were analyzed. The respective correlation coefficients at baseline, week 10, and month 6 were: IDS-SR30: HAM-D17: 0.46, 0.75, 0.70; and for IDS-SR30: CGI-S 0.28, 0.67, 0.65. Agreement between IDS-SR30- and HAM-D17-defined remission and response was relatively poor: week 10, 0.52 and 0.34, respectively; month 6, 0.45 and 0.32, respectively. These findings suggest that patient-rated measures of depression severity do not correspond strongly with clinician ratings, and are particularly poor prior to the initiation of treatment. Copyright 2010 Elsevier Ltd. All rights reserved.
Dunlop, Boadie W.; Li, Thomas; Kornstein, Susan G.; Friedman, Edward S.; Rothschild, Anthony J.; Pedersen, Ron; Ninan, Philip; Keller, Martin
Background The degree of agreement between patient- and clinician-rated scales of depressive severity varies widely. This study analyzed agreement between commonly used depression rating scales in the Prevention of Recurrent Episodes of Depression with Venlafaxine Extended Release (ER) for Two Years (PREVENT) trial. Methods The PREVENT trial was a multiphase, randomized, double-blind study of patients with recurrent major depressive disorder. This secondary analysis evaluated acute (10 weeks) and continuation phase (6 months) data. Pearson correlation coefficients at each acute-phase (weekly) and continuation-phase (monthly) visit were calculated for patient-rated (30-item Inventory of Depressive Symptomatology-Self-Rated [IDS-SR30] and clinician-rated (17-item Hamilton Rating Scale for Depression [HAM-D17] and Clinical Global Impressions-Severity [CGI-S]) measures and for response and remission. Results Data from 1,047 patients were analyzed. The respective correlation coefficients at baseline, week 10, and month 6 were: IDS-SR30: HAM-D17: 0.46, 0.75, 0.70; and for IDS-SR30: CGI-S 0.28, 0.67, 0.65. Agreement between IDS-SR30- and HAM-D17-defined remission and response was relatively poor: week 10, 0.52 and 0.34, respectively; month 6, 0.45 and 0.32, respectively. Conclusions These findings suggest that patient-rated measures of depression severity do not correspond strongly with clinician ratings, and are particularly poor prior to the initiation of treatment. PMID:20304503
Azbel, Lyuba; Polonsky, Maxim; Wegman, Martin; Shumskaya, Natalya; Kurmanalieva, Ainura; Asanov, Akylbek; Wickersham, Jeffrey A; Dvoriak, Sergii; Altice, Frederick L
Central Asia is afflicted with increasing HIV incidence, low antiretroviral therapy (ART) coverage and increasing AIDS mortality, driven primarily by people who inject drugs (PWID). Reliable data about HIV, other infectious diseases, and substance use disorders in prisoners in this region is lacking and could provide important insights into how to improve HIV prevention and treatment efforts in the region. A randomly sampled, nationwide biobehavioural health survey was conducted in 8 prisons in Kyrgyzstan among all soon-to-be-released prisoners; women were oversampled. Consented participants underwent computer-assisted, standardized behavioural health assessment surveys and testing for HIV, HCV, HBV, and syphilis. Prevalence and means were computed, and generalized linear modelling was conducted, with all analyses using weights to account for disproportionate sampling by strata. Among 381 prisoners who underwent consent procedures, 368 (96.6%) were enrolled in the study. Women were significantly older than men (40.6 vs. 36.5; p=0.004). Weighted prevalence (%), with confidence interval (CI), for each infection was high: HCV (49.7%; CI: 44.8-54.6%), syphilis (19.2%; CI: 15.1-23.5%), HIV (10.3%; CI: 6.9-13.8%), and HBV (6.2%; CI: 3.6-8.9%). Among the 31 people with HIV, 46.5% were aware of being HIV-infected. Men, compared to women, were significantly more likely to have injected drugs (38.3% vs.16.0%; p=0.001). Pre-incarceration and within-prison drug injection, primarily of opioids, was 35.4% and 30.8%, respectively. Independent correlates of HIV infection included lifetime drug injection (adjusted odds ratio [AOR]=38.75; p=0.001), mean number of years injecting (AOR=0.93; p=0.018), mean number of days experiencing drug problems (AOR=1.09; p=0.025), increasing duration of imprisonment (AOR=1.08; p=0.02 for each year) and having syphilis (AOR=3.51; p=0.003), while being female (AOR=3.06; p=0.004) and being a recidivist offender (AOR=2.67; p=0.008) were independently
Grover-Kopec, Emily; Kawano, Mika; Klaver, Robert W.; Blumenthal, Benno; Ceccato, Pietro; Connor, Stephen J.
Periodic epidemics of malaria are a major public health problem for many sub-Saharan African countries. Populations in epidemic prone areas have a poorly developed immunity to malaria and the disease remains life threatening to all age groups. The impact of epidemics could be minimized by prediction and improved prevention through timely vector control and deployment of appropriate drugs. Malaria Early Warning Systems are advocated as a means of improving the opportunity for preparedness and timely response.Rainfall is one of the major factors triggering epidemics in warm semi-arid and desert-fringe areas. Explosive epidemics often occur in these regions after excessive rains and, where these follow periods of drought and poor food security, can be especially severe. Consequently, rainfall monitoring forms one of the essential elements for the development of integrated Malaria Early Warning Systems for sub-Saharan Africa, as outlined by the World Health Organization.The Roll Back Malaria Technical Resource Network on Prevention and Control of Epidemics recommended that a simple indicator of changes in epidemic risk in regions of marginal transmission, consisting primarily of rainfall anomaly maps, could provide immediate benefit to early warning efforts. In response to these recommendations, the Famine Early Warning Systems Network produced maps that combine information about dekadal rainfall anomalies, and epidemic malaria risk, available via their Africa Data Dissemination Service. These maps were later made available in a format that is directly compatible with HealthMapper, the mapping and surveillance software developed by the WHO's Communicable Disease Surveillance and Response Department. A new monitoring interface has recently been developed at the International Research Institute for Climate Prediction (IRI) that enables the user to gain a more contextual perspective of the current rainfall estimates by comparing them to previous seasons and climatological
Full Text Available Abstract Periodic epidemics of malaria are a major public health problem for many sub-Saharan African countries. Populations in epidemic prone areas have a poorly developed immunity to malaria and the disease remains life threatening to all age groups. The impact of epidemics could be minimized by prediction and improved prevention through timely vector control and deployment of appropriate drugs. Malaria Early Warning Systems are advocated as a means of improving the opportunity for preparedness and timely response. Rainfall is one of the major factors triggering epidemics in warm semi-arid and desert-fringe areas. Explosive epidemics often occur in these regions after excessive rains and, where these follow periods of drought and poor food security, can be especially severe. Consequently, rainfall monitoring forms one of the essential elements for the development of integrated Malaria Early Warning Systems for sub-Saharan Africa, as outlined by the World Health Organization. The Roll Back Malaria Technical Resource Network on Prevention and Control of Epidemics recommended that a simple indicator of changes in epidemic risk in regions of marginal transmission, consisting primarily of rainfall anomaly maps, could provide immediate benefit to early warning efforts. In response to these recommendations, the Famine Early Warning Systems Network produced maps that combine information about dekadal rainfall anomalies, and epidemic malaria risk, available via their Africa Data Dissemination Service. These maps were later made available in a format that is directly compatible with HealthMapper, the mapping and surveillance software developed by the WHO's Communicable Disease Surveillance and Response Department. A new monitoring interface has recently been developed at the International Research Institute for Climate Prediction (IRI that enables the user to gain a more contextual perspective of the current rainfall estimates by comparing them to
Perkins, K.R.; Hsu, C.J.; Lehner, J.R.; Luckas, W.J.; Cho, N.; Fitzpatrick, R.G.; Pratt, W.T.; Eltawila, F.; Maly, J.A.
Plant features and operator actions which have been found to be important in either preventing or mitigating severe accidents in PWRs with large dry containments have been identified. These features and actions were developed from insights derived from reviews of risk assessments performed specifically for the Zion plant and from assessments of other relevant studies. Accident sequences that dominate the core-damage frequency and those accident sequences that are of potentially high consequence were identified. Vulnerabilities of the large dry containment to severe accident containment loads were also identified. In addition, those features of a PWR with a large dry containment, which are important for preventing core damage and are available for mitigating fission-product release to the environment were identified. The report is issued to provide focus to the analyst examining an individual plant. The report calls attention to plant features and operator actions and provides a list of deterministic tributes for assessing those features and actions found to be helpful in reducing the overall risk for Zion and other PWRs with large dry containments. Thus, the guidance is offered as a resource in examining the subject plant to determine if the same, or similar, plant features and operator actions will be of value in reducing overall plant risk. This report is intended to serve solely as guidance
Hsu, C.J.; Perkins, K.R.; Luckas, W.J.; Fitzpatrick, R.G.; Cho, N.; Lehner, J.R.; Pratt, W.T.; Eltawila, F.; Maly, J.A.
Plant features and operator actions which have been found to be important in either preventing and mitigating severe accidents in PWRs with ice-condenser containments have been identified. Thus features and actions were developed from insights derived from reviews of risk assessments performed specifically for the Sequoyah plant and from assessments of other relevant studies. Accident sequences that dominate the core-damage frequency and those accident sequences that are of potentially high consequence were identified. Vulnerabilities of the ice-condenser containment to sever accident containment loads were also identified. In addition, those features of a PWR with an ice-condenser containment, which are important for preventing core damage and are available for mitigating fission-product release to the environment were identified. This report is issued to provide focus to an analyst examining an individual plant. The report calls attention to plant features and operator actions and provides a list of deterministic attributes for assessing those features and actions found to be helpful in reducing the overall risk for Sequoyah and other PWRs with ice-condenser containments. Thus, the guidance is offered as a resource in examining the subject plant to determine if the same, or similar, plant features and operator actions will be of value in reducing overall plant risk. This report is intended to serve solely as guidance. 14 tabs
Lehner, J.R.; Hsu, C.J.; Eltawila, F.; Perkins, K.R.; Luckas, W.J.; Fitzpatrick, R.G.; Pratt, W.T.
Plant features and operator actions, which have been found to be important in either preventing or mitigating severe accidents in BWRs with Mark II containments (BWR Mark II's) have been identified. These features and actions were developed from insights derived from reviews of in-depth risk assessments performed specifically for the Limerick and Shoreham plants and from other relevant studies. Accident sequences that dominate the core-damage frequency and those accident sequences that are of potentially high consequence were identified. Vulnerabilities of the BWR Mark II to severe-accident containment loads were also noted. In addition, those features of a BWR Mark II, which are important for preventing core damage and are available for mitigating fission-product release to the environment were also identified. This report is issued to provide focus to an analyst examining an individual plant. This report calls attention to plant features and operator actions and provides a list of deterministic attributes for assessing those features and actions found to be helpful in reducing the overall risk for Mark II plants. Thus, the guidance is offered as a resource in examining the subject plant to determine if the same, or similar, plant features and operator actions will be of value in reducing overall plant risk. This report is intended to serve solely as guidance
Moustafa Hemdan Ahmed MOHARAM
Full Text Available The preventative and curative effects of some plant derived agents based on plant extracts or essential oils were studied at different concentrations against Erysiphe cichoracearum DC. ex Merat, the causal pathogen of okra powdery mildew by the detached leaf-disk and potted plants bioassays. Through detached leaf-disk assay, the highest mean preventative effect (97.74% was recorded by neem seed oil followed by jojoba oil (89.82% and extract of Rynoutria sachalinensis (82.77%. Neem seed oil at 1% was the most effective agent followed by jojoba oil and extract of R. sachalinensis at 1.5% and 2%, respectively, where they suppressed E. cichoracearum completely. Potted plants assay revealed that neem seed oil, jojoba oil and extract of R. sachalinensis as well as the fungicide (active ingredient dinocap showed higher preventative efficacy at all leaf olds treated after 7 and 14 days of inoculation as compared with extracts of henna and garlic. Moreover, the preventative efficacy partly remained apparent after 14 days of inoculation at all leaf olds tested. In field trials through 2010 and 2011 growing seasons, when the first symptoms of powdery mildew appeared naturally, 1.5% jojoba oil, 2% extract of R. sachalinensis and 1% neem seed oil were sprayed individually twice on grown plants to evaluate their efficacy on controlling powdery mildew, growth and yield of okra. Resulted showed that neem seed oil was the most effective agent and highly decreased the disease severity to 29.92%, recorded the highly curative effect (68.15% and also improved plant growth and pods yield.
Visser, T.; Dijkman, J.J.; Grijpink, J.H.A.M.|info:eu-repo/dai/nl/095130861; Plomp, M.G.A.|info:eu-repo/dai/nl/313946809; Seignette, P.
This article presents the results of the chain analysis of the epidemic control chain according to the method of chain-computerisation. The goal of the epidemic control chain is to prevent the disruption of society that is caused by disease or excess of preventive measures. The current
Rizzi, Matteo; Kullgren, Anders; Tingvall, Claes
Several studies have reported the benefits of motorcycle antilock braking systems (ABS) in reducing injury crashes, due to improved stability and braking performance. Both aspects may prevent crashes but may also reduce the crash severity when a collision occurs. However, it is still unknown to what extent the reductions in injury crashes with ABS may be due to a combination of these mechanisms. Swedish hospital and police reports (2003-2012) were used. The risk for permanent medical impairment (RPMI) was calculated, showing the risk of at least 1 or 10% permanent medical impairment. In total, 165 crashes involving ABS-equipped motorcycles were compared with 500 crashes with similar motorcycles without ABS. The analysis was performed in 3 steps. First, the reduction in emergency care visits with ABS was calculated using an induced exposure approach. Secondly, the injury mitigating effects of ABS were investigated. The mean RPMI 1+ and RPMI 10+ were analyzed for different crash types. The distributions of impairing injuries (PMI 1+) and severely impairing injuries (PMI 10+) were also analyzed. In the third step, the total reduction of PMI 1+ and PMI 10+ injured motorcyclists was calculated by combining the reductions found in the previous steps. An additional analysis of combined braking systems (CBS) together with ABS was also performed. The results showed that emergency care visits were reduced by 47% with ABS. In the second step, it was found that the mean RPMI 1+ and RPMI 10+ with ABS were 15 and 37% lower, respectively. Finally, the third step showed that the total reductions in terms of crash avoidance and mitigation of PMI 1+ and PMI 10+ injured motorcyclists with ABS were 67 and 55%, respectively. However, PMI 1+ and PMI 10+ leg injuries were not reduced by ABS to the same extent. Indications were found suggesting that the benefits of ABS together with CBS may be greater than ABS alone. This article indicated that motorcycle ABS reduced impairing injuries
Larsen, Erik Roj; Mosekilde, Leif; Foldspang, Anders
Background and aims: We evaluated the effect of two programs for the prevention of falls leading to acute hospital admission in a population of elderly community-dwelling Danish residents. Methods: This was a factorial, pragmatic, intervention study. We included 9605 community-dwelling city......, or no intervention. Results: The Calcium and Vitamin D program was followed by 50.3% and the Environmental and Health Program by 46.4%. According to a multivariate analysis including age, marital status and intervention program, female residents who followed the Calcium and Vitamin D Program had a 12% risk reduction...... in severe falls (RR 0.88; 95% CI 0.79-0.98; pfalls leading to acute hospitalization in community-dwelling elderly females in a northern European region known to be deficient in vitamin D....
Witte, J J; Bigler, W J
Florida ranked fourth in the nation with 1,707 tuberculosis cases reported in 1992 for a rate of 12.7 per 100,000 population. Thirteen percent of these patients had AIDS. Recent cases in prisons, shelters, hospitals and schools have stimulated interest and media coverage. Resurgence of strains of multiple-drug resistant tuberculosis is a serious concern. The Florida Department of Health and Rehabilitative Services, in collaboration with allied agencies, has utilized several initiatives in response. The most significant, Tuberculosis Epidemic Containment Plan, details intervention strategies needed to eliminate TB in the state by the year 2010. Successful implementation depends upon local TB prevention and control coalitions that include private and public sector providers.
Kuehne, M.; Kerak, M.; Severa, M.
Accident Management means - generally speaking - all measures taken to 'rectum the plant to a safe state and mitigate the consequences of accidents' in the design basis as well as the beyond design basis realm. Sometimes accident management is interpreted as reforming in particular to those actions which are taken to cope with beyond design basis accidents, i.e. in very unlikely situations. The objectives of the measures depend on the category of the accident: design basis accident: * to keep systems and the plant within the licensed limits beyond design basis accident: * to prevent severe core damage, especially at high pressure in the reactor pressurize vessel and or * to mitigate the consequences of severe accidents for the environment The system use is different: design basis accident: * operation of systems within design limits beyond design basis accident: * best use of all available systems even beyond their design limits assuming best estimate conditions for components and systems. With respect to the different system uses it is expedient to distinguish between measures to control accidents under design basis accident conditions or to manage beyond design basis accidents. The evaluation of a safety concept should give precedence to the systems fundamental roles in the design basis realm. beyond design basis -accident management should be seen as an additional, last-resort tool to cope with scenarios in the beyond design basis realm and should therefore be treated separately as a supplement to the 'normal' design basis measures
Rao, Amrut K; Chaudhuri, Souvik; Joseph, Tim T; Kamble, Deependra; Gotur, Gopal; Venkatesh, Sandeep
A well-secured endotracheal tube (ETT) is essential for safe anesthesia. The ETT has to be fixed with the adhesive plasters or with tie along with adhesive plasters appropriately. It is specially required in patients having beard, in intensive care unit (ICU) patients or in oral surgeries. If re-adjustment of the ETT is necessary, we should be cautious while removal of the plasters and tie, as there may be damage to the cuff inflation system. This can be a rare cause of ETT cuff leak, thus making maintenance of adequate ventilation difficult and requiring re-intubation. In a difficult airway scenario, it can be extremely challenging to re-intubate again. We report an incidence where the ETT cuff tubing was severed while attempting to re-adjust and re-fix the ETT and the patient required re-intubation. Retrospectively, we thought of and describe a safe, reliable and novel technique to prevent cuff deflation of the severed inflation tube. The technique can also be used to monitor cuff pressure in such scenarios.
Strona, Giovanni; Castellano, Claudio
Several recent studies have tackled the issue of optimal network immunization by providing efficient criteria to identify key nodes to be removed in order to break apart a network, thus preventing the occurrence of extensive epidemic outbreaks. Yet, although the efficiency of those criteria has been demonstrated also in empirical networks, preventive immunization is rarely applied to real-world scenarios, where the usual approach is the a posteriori attempt to contain epidemic outbreaks using quarantine measures. Here we compare the efficiency of prevention with that of quarantine in terms of the tradeoff between the number of removed and saved nodes on both synthetic and empirical topologies. We show how, consistent with common sense, but contrary to common practice, in many cases preventing is better than curing: depending on network structure, rescuing an infected network by quarantine could become inefficient soon after the first infection.
Liu, Jian Ping; Nikolova, Dimitrinka; Fei, Yutong
Hepatitis A (infectious hepatitis) is a common epidemic disease. Immunoglobulins for passive immunisation are used as prevention.......Hepatitis A (infectious hepatitis) is a common epidemic disease. Immunoglobulins for passive immunisation are used as prevention....
Materials of the IAEA Regional Workshop contain 24 presented lectures. Authors deal with development and validation of emergency operating procedures as well as with accident management guidelines (EOP/AMG) for effective prevention and mitigation of severe core damage
Full Text Available Calcium-containing crystals participate in the pathogenesis of OA. Sodium thiosulfate (STS has been shown to be an effective treatment in calcification disorders such as calciphylaxis and vascular calcification. This study investigated the effects and mechanisms of action of STS in a murine model of OA and in chondrocyte calcification.Hydroxyapatite (HA crystals-stimulated murine chondrocytes and macrophages were treated with STS. Mineralization and cellular production of IL-6, MCP-1 and reactive oxygen species (ROS were assayed. STS's effects on genes involved in calcification, inflammation and cartilage matrix degradation were studied by RT-PCR. STS was administered in the menisectomy model of murine OA, and the effect on periarticular calcific deposits and cartilage degeneration was investigated by micro-CT-scan and histology.In vitro, STS prevented in a dose-dependent manner calcium crystal deposition in chondrocytes and inhibited Annexin V gene expression. In addition, there was a reduction in crystal-induced IL-6 and MCP-1 production. STS also had an antioxidant effect, diminished HA-induced ROS generation and abrogated HA-induced catabolic responses in chondrocytes. In vivo, administration of STS reduced the histological severity of OA, by limiting the size of new periarticular calcific deposits and reducing the severity of cartilage damage.STS reduces the severity of periarticular calcification and cartilage damage in an animal model of OA via its effects on chondrocyte mineralization and its attenuation of crystal-induced inflammation as well as catabolic enzymes and ROS generation. Our study suggests that STS may be a disease-modifying drug in crystal-associated OA.
Casado, Itziar; Domínguez, Ángela; Toledo, Diana; Chamorro, Judith; Astray, Jenaro; Egurrola, Mikel; Fernández-Sierra, María Amelia; Martín, Vicente; Morales-Suárez-Varela, María; Godoy, Pere; Castilla, Jesús
The effectiveness of repeated vaccination for influenza to prevent severe cases remains unclear. We evaluated the effectiveness of influenza vaccination on preventing admissions to hospital for influenza and reducing disease severity. We conducted a case-control study in 20 hospitals in Spain during the 2013/14 and 2014/15 influenza seasons. Community-dwelling adults aged 65 years or older who were admitted to hospital for laboratory-confirmed influenza were matched with inpatient controls by sex, age, hospital and admission date. The effectiveness of vaccination in the current and 3 previous seasons in preventing influenza was estimated for inpatients with nonsevere influenza and for those with severe influenza who were admitted to intensive care units (ICUs) or who died. We enrolled 130 inpatients with severe and 598 with nonsevere influenza who were matched to 333 and 1493 controls, respectively. Compared with patients who were unvaccinated in the current and 3 previous seasons, adjusted effectiveness of influenza vaccination in the current and any previous season was 31% (95% confidence interval [CI] 13%-46%) in preventing admission to hospital for nonsevere influenza, 74% (95% CI 42%-88%) in preventing admissions to ICU and 70% (95% CI 34%-87%) in preventing death. Vaccination in the current season only had no significant effect on cases of severe influenza. Among inpatients with influenza, vaccination in the current and any previous season reduced the risk of severe outcomes (adjusted odds ratio 0.45, 95% CI 0.26-0.76). Among older adults, repeated vaccination for influenza was twice as effective in preventing severe influenza compared with nonsevere influenza in patients who were admitted to hospital, which is attributable to the combination of the number of admissions to hospital for influenza that were prevented and reduced disease severity. These results reinforce recommendations for annual vaccination for influenza in older adults. © 2018 Joule Inc. or
A. V. Rudakova
Full Text Available Respiratory syncytial virus plays a significant role in etiology of respiratory infections in infants, and preterm children have muchhigher risk of severe course of the disease, than common population of children at the age less than 2 years old. Palivizumab is usedefficiently to prevent this infection. The aim of this study was to assess the efficacy of the costs on palivizumab in preterm childrenin the Russian Federation. The assessment was based on meta-analysis of randomized clinical trials. According to the World Health organization recommendations, the acceptable value of the variable «costs/efficacy» must not be higher than threefold of the gross domestic product per person. On the assumption of this fact, the coefficient «costs/efficacy» for the Russian Federation according to the 2011 year results must not be higher than 1140 thousand rubles per 1 extra year of life. Analysis from the position of health care system shows, that coefficient «costs/efficacy» with palivazumab usage in children with gestation age from 28 to 32 weeks rangesfrom 594,4 to 1030,4 thousand roubles per 1 extra year of life when starting the prophylaxis during first 6 month of life. Under the social perspective of the study (accounting for direct and indirect costs the coefficient «costs/efficacy» decreases to 515,8–951,8 thousands roubles per 1 extra year of life. Thereby, nowadays the prophylaxis of severe respiratory cyncytial infection with palivazumab is acceptable according to the economical point of view in preterm children with the gestation age 32 weeks and less when starting during first 6 months of life.
Saxena, Anil Kumar; Limaye, Sanjay Prabhakar; Bera, Subrata; Deo, Anuj Kumar
Specified Emergency Core Cooling System (ECCS) flow rate is testimony of clad reaching to temperature lower than its softening temperature during loss of coolant accident (LOCA) in nuclear reactors. Coolant channel(s) of nuclear reactors with vertical fuel-assemblies e. g. LWRs gets voided in a short time as a result of double ended guillotine rupture in coolant pipeline. There is rapid and almost steep rise in clad temperature due to stored energy and decay heat if ECCS flow rate is less than a specified value. A computer program, based on moving mesh methodology, is developed to calculate rewetting velocity. The program is validated using experimental data. Numerical equations are solved by marching technique. The paper will bring out the fact that if coolant flow is less than a specified value the wet front will not reach the top of the clad. This will result some unrewetted clad portion. As the heating of this unrewetted clad is continued it may result softening of clad. If it happens in many channels the integrity of clad as a whole will be lost. There will be high probability that severe accident will take place. The paper presents a method to prevent softening and thus to ensure accident free operation of nuclear reactor. (author)
Full Text Available Abstract With the exception of post-exposure prophylaxis for reported rape, no preventive strategy addresses the choice disabled – those who might like to benefit from AIDS prevention but who are unable to do so because they do not have the power to make and to act on prevention decisions. In southern African countries, where one in every three has been forced to have sex by the age of 18 years, a very large proportion of the population is choice disabled. This group is at higher risk of HIV infection and unable to respond to AIDS prevention programmes; they represent a reservoir of infection. Reduction of sexual violence would probably decrease HIV transmission directly, but also indirectly as more people can respond to existing AIDS prevention programmes.
Rozanova, Liudmila; Alekseev, Vadim; Temerev, Alexander
that amount of data transferred between network nodes possesses a Pareto distribution, implying scale-free properties. In this context, more heterogeneity in susceptibility means the less severe epidemic progression, and, on the contrary, more heterogeneity in infectivity leads to more severe epidemics...... — assuming that the other parameter (either heterogeneity or susceptibility) stays fixed. The results are general enough to be useful for estimating the epidemic progression with no significant acquired immunity — in the cases where Pareto distribution holds....
Barrais, Robert; Faucher, Benoît; Haus, Rachel; Piarroux, Martine; Gaudart, Jean; Magloire, Roc; Raoult, Didier
After onset of a cholera epidemic in Haiti in mid-October 2010, a team of researchers from France and Haiti implemented field investigations and built a database of daily cases to facilitate identification of communes most affected. Several models were used to identify spatiotemporal clusters, assess relative risk associated with the epidemic’s spread, and investigate causes of its rapid expansion in Artibonite Department. Spatiotemporal analyses highlighted 5 significant clusters (p<0.001): 1 near Mirebalais (October 16–19) next to a United Nations camp with deficient sanitation, 1 along the Artibonite River (October 20–28), and 3 caused by the centrifugal epidemic spread during November. The regression model indicated that cholera more severely affected communes in the coastal plain (risk ratio 4.91) along the Artibonite River downstream of Mirebalais (risk ratio 4.60). Our findings strongly suggest that contamination of the Artibonite and 1 of its tributaries downstream from a military camp triggered the epidemic. PMID:21762567
Probst-Hensch, Nicole; Tanner, Marcel; Kessler, Claudia; Burri, Christian; Künzli, Nino
The United Nations General Assembly has convened a Summit on non-communicable diseases (NCDs), an historic moment in the global combat of these disorders. Lifestyles in increasingly urban and globalised environments have led to a steep surge in NCD incidence in low and middle income countries, where two thirds of all NCD deaths occur (most importantly from cancer, cardiovascular and respiratory disease as well as diabetes). Treatment of NCDs is usually long term and expensive, thus threatening patients' and nations' budgets and putting them at high risk for poverty. The NCD Summit offers an opportunity for strengthening and shaping primary prevention, the most cost-effective instrument to fight major risk factors such as tobacco smoking, alcohol abuse, physical inactivity and unhealthy diet. From a Swiss perspective, we also emphasised the efforts for new laws on prevention and diagnosis registration, in accordance with the recommendations of the NCD summit in order to strengthen primary prevention and disease monitoring. In addition, the need for structural prevention across all policy sectors with leadership in environmental policy making to prevent NCDs as well as the need to adapt and strengthen primary health care are equally relevant for Switzerland. To compliment efforts in primary prevention, the field of NCDs requires special R&D platforms for affordable NCD drugs and diagnostics for neglected population segments in both Switzerland and low and middle income countries. Switzerland has a track record in research and development against diseases of poverty on a global scale that now needs to be applied to NCDs.
Mackey, Eleanor R; Olson, Alexandra; DiFazio, Marc; Cassidy, Omni
Obesity is widespread, associated with several physical and psychosocial comorbidities, and is difficult to treat. Prevention of obesity across the lifespan is critical to improving the health of individuals and society. Screening and prevention efforts in primary care are an important step in addressing the obesity epidemic. Each period of human development is associated with unique risks, challenges, and opportunities for prevention and intervention. Screening tools for overweight/obesity, although imperfect, are quick and easy to administer. Screening should be conducted at every primary care visit and tracked longitudinally. Screening tools and cutoffs for overweight and obesity vary by age group. Copyright © 2016 Elsevier Inc. All rights reserved.
Overdose related to prescription opioids has become an epidemic. This podcast discusses the risks of this type of drug sometimes used to treat pain, and how to protect yourself. . Created: 4/19/2016 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). Date Released: 4/19/2016.
Granell, Clara; Gómez, Sergio; Arenas, Alex
We present the analysis of the interrelation between two processes accounting for the spreading of an epidemic, and the information awareness to prevent its infection, on top of multiplex networks. This scenario is representative of an epidemic process spreading on a network of persistent real contacts, and a cyclic information awareness process diffusing in the network of virtual social contacts between the same individuals. The topology corresponds to a multiplex network where two diffusive processes are interacting affecting each other. The analysis using a microscopic Markov chain approach reveals the phase diagram of the incidence of the epidemics and allows us to capture the evolution of the epidemic threshold depending on the topological structure of the multiplex and the interrelation with the awareness process. Interestingly, the critical point for the onset of the epidemics has a critical value (metacritical point) defined by the awareness dynamics and the topology of the virtual network, from which the onset increases and the epidemics incidence decreases.
Kelly, Jeffrey A; Amirkhanian, Yuri A
HIV/AIDS has emerged as a grave public health threat in Central and Eastern Europe and in the Central Asian republics over the past five years. Massive political, social, cultural, and behavioural changes - along with economic upheaval and collapse of the public health infrastructure in many countries - have created circumstances conducive to the rapid spread of HIV. This paper reviews HIV and sexually transmitted disease (STD) data for all countries in the region, as well as behavioural, social, cultural, and other HIV epidemic enabling factors. The epidemiological picture of HIV in the region is mixed. Russia, Ukraine, Moldova and Belarus already have advanced epidemics. Some other countries in the region share similar enabling factors and have seen a very high proportion of their total number of HIV infections detected in only the past 18 months, indicating the emergence of recent epidemics. Several countries are more stable in their HIV incidence. Behavioural studies indicate that risky sexual and injection related practices are common in many vulnerable populations. HIV prevention steps, if taken quickly enough and on a large scale, can limit the scope of the HIV epidemic that is now unfolding in Central and Eastern Europe. This will require new models of government/non-governmental organization cooperation, policy approaches for addressing structural factors underlying the epidemic, and attention to human rights protection.
Among all the types of accidents to be considered for the safety licensing of a plant, some have a very low probability of occurrence but might have very important consequences: the severe accidents or Hypothetical Core Disruptive Accidents (HCDA). The studies on the scenario of these accidents are performed in parallel to the prevention studies. In this PhD report, two representative safety cases are studied: the Unprotected Loss Of Flow (ULOF) and the Total Instantaneous Blockage (TIB). The objectives are to understand what causes the reactivity increase during these accidents and to find means to reduce the energetic release of the scenario (ULOF) or to find ways to trigger the core prior to the propagation of the accident (TIB). At first, the accidents are studied in static calculations with the ERANOS code system. The accidents are divided into several steps and the reactivity insertions at each step are explained. This study shows the importance of the removal of the structures as well as of the radial leakage changes during the core slumping-down. The study also gives the amounts of fuel to be ejected or of absorber to be injected in both accidents. These values give tracks to the following more accurate studies, the transient studies. The transient studies were performed with the SIMMER code system, coupling thermo-hydraulics and neutronics. SIMMER data and algorithms have been improved so as to better predict ERANOS results (former discrepancies were up to 1.5$). The SIMMER reactivity calculation is improved by 0.8$ with variations of reactivity due to the motion of materials correctly predicted. A new algorithm for the β-effective was implemented in SIMMER so as to be more accurate and easier to manage. SIMMER is then used to calculate the secondary phase of the ULOF, while the primary phase is calculated with ERANOS thanks to some assumptions. The assumptions are very much based on the fact that the movement of materials stops whenever the energy
Thielecke, Marlene; Raharimanga, Vaomalala; Stauss-Grabo, Manuela; Rogier, Christophe; Richard, Vincent; Feldmeier, Hermann
Tungiasis (sand flea disease) is a neglected tropical disease. Heavy infestation results in mutilation of the feet and difficulty in walking. We identified eight individuals with extremely severe tungiasis in rural Madagascar. To prevent reinfestation, four individuals received solid shoes and four received a daily application of an herbal repellent effective against Tunga penetrans. Over a period of 10 weeks the feet were examined and the severity of tungiasis-associated morbidity was measur...
DeVylder, Jordan E.
Schizophrenia is a leading cause of disability and health expenditure worldwide and is associated with homelessness, substance use, familial and social isolation, unemployment, involvement with the criminal justice system, stigma, and excess mortality. Prevention may be feasible through intervention with help-seeking "clinical high-risk"…
Napierala Mavedzenge, Sue; Olson, Rick; Doyle, Aoife M; Changalucha, John; Ross, David A
Broad patterns of HIV epidemiology are frequently used to design generic HIV programs in sub-Saharan Africa. We reviewed the epidemiology of HIV among young people in sub-Saharan Africa, and explored the unique dynamics of infection in its different regions. In 2009, HIV prevalence among youth in sub-Saharan Africa was an estimated 1.4% in males and 3.4% in females, but these values mask wide variation at regional and national levels. Within countries there are further major differences in HIV prevalence, such as by sex, urban/rural location, economic status, education, or ethnic group. Within this highly nuanced context, HIV prevention programs targeting youth must consider both where new infections are occurring and where they are coming from. Given the epidemiology, one-size-fits-all HIV prevention programs are usually inappropriate at regional and national levels. Consideration of local context and risk associated with life transitions, such as leaving school or getting married, is imperative to successful programming for young people. Copyright © 2011 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
Seeberg, Jens; Christensen, Fie Lund Lindegaard
is skewed in favour of boys, and girls with autism tend to be diagnosed much later than boys. Building and further developing the notion of ‘configuration’ of epidemics, this article explores the configuration of autism in Denmark, with a particular focus on the health system and social support to families...... with children diagnosed with autism, seen from a parental perspective. The article points to diagnostic dynamics that contribute to explaining why girls with autism are not diagnosed as easily as boys. We unfold these dynamics through the analysis of a case of a Danish family with autism.......Autism has been described as an epidemic, but this claim is contested and may point to an awareness epidemic, i.e. changes in the definition of what autism is and more attention being invested in diagnosis leading to a rise in registered cases. The sex ratio of children diagnosed with autism...
McKelvie William R
Full Text Available Abstract Background A lack of consensus on how to define malaria epidemics has impeded the evaluation of early detection systems. This study aimed to develop local definitions of malaria epidemics in a known malarious area of Iran, and to use that definition to evaluate the validity of several epidemic alert thresholds. Methods Epidemic definition variables generated from surveillance data were plotted against weekly malaria counts to assess which most accurately labelled aberrations. Various alert thresholds were then generated from weekly counts or log counts. Finally, the best epidemic definition was used to calculate and compare sensitivities, specificities, detection delays, and areas under ROC curves of the alert thresholds. Results The best epidemic definition used a minimum duration of four weeks and week-specific and overall smoothed geometric means plus 1.0 standard deviation. It defined 13 epidemics. A modified C-SUM alert of untransformed weekly counts using a threshold of mean + 0.25 SD had the highest combined sensitivity and specificity. Untransformed C-SUM alerts also had the highest area under the ROC curve. Conclusions Defining local malaria epidemics using objective criteria facilitated the evaluation of alert thresholds. This approach needs further study to refine epidemic definitions and prospectively evaluate epidemic alerts.
McKelvie, William R; Haghdoost, Ali Akbar; Raeisi, Ahmad
A lack of consensus on how to define malaria epidemics has impeded the evaluation of early detection systems. This study aimed to develop local definitions of malaria epidemics in a known malarious area of Iran, and to use that definition to evaluate the validity of several epidemic alert thresholds. Epidemic definition variables generated from surveillance data were plotted against weekly malaria counts to assess which most accurately labelled aberrations. Various alert thresholds were then generated from weekly counts or log counts. Finally, the best epidemic definition was used to calculate and compare sensitivities, specificities, detection delays, and areas under ROC curves of the alert thresholds. The best epidemic definition used a minimum duration of four weeks and week-specific and overall smoothed geometric means plus 1.0 standard deviation. It defined 13 epidemics. A modified C-SUM alert of untransformed weekly counts using a threshold of mean+0.25 SD had the highest combined sensitivity and specificity. Untransformed C-SUM alerts also had the highest area under the ROC curve. Defining local malaria epidemics using objective criteria facilitated the evaluation of alert thresholds. This approach needs further study to refine epidemic definitions and prospectively evaluate epidemic alerts.
Brauer, Fred; Feng, Zhilan; Castillo-Chavez, Carlos
The mathematical theory of single outbreak epidemic models really began with the work of Kermack and Mackendrick about decades ago. This gave a simple answer to the long-standing question of why epidemics woould appear suddenly and then disappear just as suddenly without having infected an entire population. Therefore it seemed natural to expect that theoreticians would immediately proceed to expand this mathematical framework both because the need to handle recurrent single infectious disease outbreaks has always been a priority for public health officials and because theoreticians often try to push the limits of exiting theories. However, the expansion of the theory via the inclusion of refined epidemiological classifications or through the incorporation of categories that are essential for the evaluation of intervention strategies, in the context of ongoing epidemic outbreaks, did not materialize. It was the global threat posed by SARS in that caused theoreticians to expand the Kermack-McKendrick single-outbreak framework. Most recently, efforts to connect theoretical work to data have exploded as attempts to deal with the threat of emergent and re-emergent diseases including the most recent H1N1 influenza pandemic, have marched to the forefront of our global priorities. Since data are collected and/or reported over discrete units of time, developing single outbreak models that fit collected data naturally is relevant. In this note, we introduce a discrete-epidemic framework and highlight, through our analyses, the similarities between single-outbreak comparable classical continuous-time epidemic models and the discrete-time models introduced in this note. The emphasis is on comparisons driven by expressions for the final epidemic size.
Barinskiĭ, I F; Ulasov, V I; Kravchenko, V M; Toloknov, A S; Lycheva, I A; Alimbarova, L M; Kosiakova, N P
Results of experimental studies of mice and pigs infected with foot-and-mouth disease virus, minks infected with Aujeszky's disease virus, and dogs infected with canine distemper virus are described. In animals with foot-and-mouth disease and Aujeszky's disease, combined treatment with killed vaccine and immunomodulator Ridostin by the scheme of urgent prophylaxis (3 days before infection) caused 75% (foot-and-mouth disease) and 100% (Aujeszky's disease) prevention of animal death and development of generalized infection. The use of Ridostin by the scheme of urgent prophylaxis in a canine distemper infection focus arrested clinical symptoms of the disease in 50% of animals received immunomodulator. Clinical symptoms of canine distemper in the other dogs treated with immunomodulator were manifested in a mild form, and their appearance was delayed to 23-25 days after contact with infected animal.
Yablon, Yaacov B.
Early detection of severe violence is a significant challenge for many schools. Three studies were conducted on samples of 6th, 8th, and 10th graders (12-16 years old). The first study, based on paired reports of teachers and students (n = 130), showed that a high percentage of both victims and perpetrators of severe violence are not identified by…
Reyes, Osvaldo A; Gonzalez, Geneva M
In patients with severe preeclampsia there is an increased risk of postpartum hemorrhage, but the hemodynamic changes associated with severe preeclampsia make the management of any kind of bleeding particularly troublesome. There are many pharmacological options for the management of postpartum hemorrhage, oxytocin being the first line of treatment. There is as yet no evidence about the safety and efficacy of using carbetocin, an oxytocin agonist, in these patients. We aimed to compare oxytocin with carbetocin for the routine prevention of postpartum hemorrhage in patients with severe preeclampsia. We performed a prospective double-blind randomized controlled trial in 60 women with severe preeclampsia, recruited between July and September 2010. The women were randomized to receive either oxytocin or carbetocin during the third stage of labour. The primary outcome measure was postpartum hemorrhage requiring additional uterotonics, and the secondary outcome measures were the difference in hemoglobin levels between groups, the development of oliguria, and hemodynamic status (mean arterial pressure and heart rate) after administration of the drug. Carbetocin was as effective as oxytocin in the prevention of postpartum hemorrhage in women with severe preeclampsia. Carbetocin had a safety profile similar to that of oxytocin, and it was not associated with the development of oliguria or hypertension in this cohort. Carbetocin is an appropriate alternative to oxytocin for the prevention of postpartum hemorrhage in women with severe preeclampsia. Considering that it appears not to have a major hemodynamic effect in women with severe preeclampsia and that it uses a lower volume per dose than oxytocin, it should be considered a valid option in the management of the third stage of labour in women with hypertensive disorders of pregnancy.
Trovato, Francesca Maria; Catalano, Daniela; Musumeci, Giuseppe; Trovato, Guglielmo M
Relationship between adipose tissue and fatty liver, and its possible evolution in fibrosis, is supported by clinical and research experience. Given the multifactorial pathogenesis of non-alcoholic fatty liver disease (NAFLD), treatments for various contributory risk factors have been proposed; however, there is no single validated therapy or drug association recommended for all cases which can stand alone. Mechanisms, diagnostics, prevention and treatment of obesity, fatty liver and insulin resistance are displayed along with recommendations and position points. Evidences and practice can get sustainable and cost-benefit valuable outcomes by participatory interventions. These recommendations can be enhanced by comprehensive research projects, addressed to societal issues and innovation, market appeal and industry development, cultural acceptance and sustainability. The basis of participatory medicine is a greater widespread awareness of a condition which is both a disease and an easy documented and inclusive clue for associated diseases and unhealthy lifestyle. This model is suitable for addressing prevention and useful for monitoring improvement, worsening and adherence with non-invasive imaging tools which allow targeted approaches. The latter include health psychology and nutritional and physical exercise prescription expertise disseminated by continuous medical education but, more important, by concrete curricula for training undergraduate and postgraduate students. It is possible and recommended to do it by early formal teaching of ultrasound imaging procedures and of practical lifestyle intervention strategies, including approaches aimed to healthier fashion suggestions. Guidelines and requirements of research project funding calls should be addressed also to NAFLD and allied conditions and should encompass the goal of training by research and the inclusion of participatory medicine topics. A deeper awareness of ethics of competences in health professionals
. Taking effective preventive measures against drug abuse has led to the decrease in the incidence of HIV-infection among this group of risk and changes of transmission routes. In 2015 in the structure of the leading transmission routes there were (22.6 ± 1.8 % of parenteral and (56.9 ± 2.1 % of sexual cases (p<0.05. These data indicate that the implementation tract infection due to injecting drug use leads to a concentrated stage of the HIV epidemic. At the same time the increase in the proportion of sexual transmission increase in the number of infected women indicate a threat to the output of the epidemic risk groups to the general set of the population. Conclusions. 1. The incidence of HIV-infection in the region was in several times lower than on the whole in Ukraine (accordingly 2.4 - 23.7 and 10.6 - 47.1 per 100 000 population. 2. Carried out research in the region revealed the peculiarities of the epidemic process of HIV-infection. So the level of growth of newly registered cases of HIV-infection from 0.1 per 100 000 population in 1995 to 20.5 per 100 000 population in 2015 was set (the growth rate was +7.0 %; a gradual change in the sexual spectrum of HIV-infected people (women from 12.9 % to 41.0 % and men from 87.1 % to 59.0 % and the structure of the leading transmission routes (parenteral from 77.1 % to 22.6% and sexual from 5.7 % to 59.6 %; involvement in the epidemic process of all age groups with a predominance of the most working-age population 25 – 49 years. 3. The HIV epidemic is concentrated on the most vulnerable groups of population, but there is a risk of generalized spreading of HIV among the population. 4. Epidemiological surveillance of HIV infection must be adapted to the local epidemiological conditions, and preventive measures aimed at the timely detection of infection cases and the suspension of the epidemic.
Rojek, Amanda M; Horby, Peter W
Emerging and epidemic infectious disease outbreaks are a significant public health problem and global health security threat. As an outbreak begins, epidemiological investigations and traditional public health responses are generally mounted very quickly. However, patient-centred research is usually not prioritised when planning and enacting the response. Instead, the clinical research response occurs subsequent to and separate from the public health response, and is inadequate for evidence-based decision-making at the bedside or in the offices of public health policymakers. The deficiencies of the clinical research response to severe acute respiratory syndrome, pandemic influenza, Middle East respiratory syndrome coronavirus and Ebola virus demonstrate that current research models do not adequately inform and improve the quality of clinical care or public health response. Three suggestions for improvements are made. First, integrate the data and sample collection needs for clinical and public health decision-making within a unified framework, combined with a risk-based, rather than a discipline-based, approach to ethical review and consent. Second, develop clinical study methods and tools that are specifically designed to meet the epidemiological and contextual challenges of emerging and epidemic infectious diseases. Third, invest in investigator-led clinical research networks that are primed and incentivised to respond to outbreak infections, and which can call on the support and resources of a central centre of excellence. It is crucial that the field of epidemic science matures to place patients at the heart of the response. This can only be achieved when patient-centred research is integrated in the outbreak response from day one and practical steps are taken to reduce the barriers to the generation of reliable and useful evidence.
Vuillermin, C; Rodda, J; Rutz, E; Shore, B J; Smith, K; Graham, H K
We studied the prevalence of severe crouch gait over a 15-year period in a defined population of children with spastic diplegia and Gross Motor Function Classification System levels II and III, to determine if there had been a decrease following changes to the management of equinus gait. These changes were replacing observational with three-dimensional gait analysis, replacing single level with multilevel surgery, and replacing gastrocsoleus lengthening with gastrocnemius recession. Of 464 children and adolescents with spastic diplegia who underwent three-dimensional gait analysis, 27 had severe crouch gait. Seventeen of these had been managed by isolated lengthening of the gastrocsoleus. Following changes in the management of equinus gait, the prevalence of severe crouch gait decreased from 25% and stabilised at a significantly lower rate, fluctuating between 0% and 4% annually (p spastic diplegia.
The first peak was related to water contamination which began in December 1990. The second peak was related to failure of municipal authorities to chlorinate water during the 2nd week of February 1991. The epidemic came under control quickly after water contamination was controlled, providing confirmation for role of ...
Park, Rae Joon; Je, Moo Sung; Park, Chang Kyoo [Korea Atomic Energy Research Institute, TaeJon (Korea, Republic of)
As a part of the evaluation of accident management strategies for severe accident prevention or mitigation in a station blackout scenario for YGN 3 and 4, an external vessel cooling strategy for the prevention of reactor vessel failure has been estimated using the MAAP4 computer code. The sensitivity studies have been performed such as actuating timings and the number of spray pumps used. To explore external vessel cooling strategies, containment spray pumps were actuated by varying time spanning core uncovery, core melting and relocation of molten core material. It was shown that flooding of the reactor cavity using the containment spray system may prevent reactor vessel failure but may not prevent the failure of the relocation of molten core material during the station blackout sequence of YGN 3 and 4. Reactor vessel failure can be prevented by external vessel cooling using condensed water from the operation of two containment spray pumps at the time of core melting and using water from the operation of one containment spray pumps at the time of core melting and using water from the operation of one containment spray pump at the time of core uncovery. (Author) 46 refs., 26 figs., 5 tabs.
Thielecke, Marlene; Raharimanga, Vaomalala; Stauss-Grabo, Manuela; Rogier, Christophe; Richard, Vincent; Feldmeier, Hermann
Tungiasis (sand flea disease) is a neglected tropical disease. Heavy infestation results in mutilation of the feet and difficulty in walking. We identified eight individuals with extremely severe tungiasis in rural Madagascar. To prevent reinfestation, four individuals received solid shoes and four received a daily application of an herbal repellent effective against Tunga penetrans. Over a period of 10 weeks the feet were examined and the severity of tungiasis-associated morbidity was measured. Within this period, the severity score for acute tungiasis decreased 41% in the shoe group and 89% in the repellent group. The four major inflammation-related symptoms disappeared in the four patients of the repellent group, but only in two patients of the shoe group. Those observations indicate that cases with extremely severe tungiasis, associated morbidity almost totally disappears within 10 weeks if the feet are protected by a repellent. Wearing shoes reduced acute morbidity only marginally.
Over 8500 reactor-years of operating experience have been accumulated with the current nuclear energy systems. New generations of nuclear power plants are being developed, building upon this background of experience. During the last decade, requirements for equipment specifically intended to minimize releases of radioactive material to the environment in the event of a core melt accident have been introduced, and designs for new plants include measures for preventing and mitigating a range of severe accident scenarios. The IAEA Technical Committee Meeting on Impact of Severe Accidents on Plant Design and Layout of Advanced Water Cooled Reactors was jointly organized by the Department of Nuclear Energy and the Department of Nuclear Safety to review measures which are being incorporated into advanced water cooled reactor designs for preventing and mitigating severe accidents, the status of experimental and analytical investigations of severe accident phenomena and challenges which support design decisions and accident management procedures, and to understand the impact of explicitly addressing severe accidents on the cost of nuclear power plants. This publication is intended to provide an objective source of information on this topic. It includes 14 papers presented at the Technical Committee meeting held in Vienna between 21-25 October 1996. It also includes a Summary and Findings of the Working Groups. The papers were grouped in three sections. A separate abstract was prepared for each paper
Piarroux, Renaud; Grenouillet, Frédéric; Balvay, Patrick; Tran, Véronique; Blasco, Gilles; Millon, Laurence; Boillot, Annie
To assess the efficacy of a preemptive antifungal therapy in preventing proven candidiasis in critically ill surgical patients. Before/after intervention study, with 2-yr prospective and 2-yr historical control cohorts. Surgical intensive care unit (SICU) in a university-affiliated hospital. Nine hundred and thirty-three patients, 478 in the prospective group and 455 in the control group, with SICU stay > or =5 days. During the prospective period, systematic mycological screening was performed on all patients admitted to the SICU, immediately at admittance and then weekly until discharge. A corrected colonization index was used to assess intensity of Candida mucosal colonization. Patients with corrected colonization index > or =0.4 received early preemptive antifungal therapy (fluconazole intravenously: loading dose 800 mg, then 400 mg/day for 2 wks). End points of this study were the frequency of proven candidiasis, especially SICU-acquired candidiasis. During the retrospective period, 32 patients of 455 (7%) presented with proven candidiasis: 22 (4.8%) were imported and 10 (2.2%) were SICU-acquired cases. During the prospective period, 96 patients with corrected colonization index > or =0.4 of 478 received preemptive antifungal treatment and only 18 cases (3.8%) of proven candidiasis were diagnosed; all were imported infections. Candida infections occurred more frequently in the control cohort (7% vs. 3.8%; p = .03). Incidence of SICU-acquired proven candidiasis significantly decreased from 2.2% to 0% (p test). Incidence of proven imported candidiasis remained unchanged (4.8% vs. 3.8%; p = .42). No emergence of azole-resistant Candida species (especially Candida glabrata, Candida krusei) was noted during the prospective period. Targeted preemptive strategy may efficiently prevent acquisition of proven candidiasis in SICU patients. Further studies are being performed to assess cost-effectiveness of this strategy and its impact on selection of azole
Kwok M Ho
Full Text Available Road trauma is a leading cause of death and injury in young people. Traffic offences are common, but their importance as a risk indicator for subsequent road trauma is unknown. This cohort study assessed whether severe road trauma could be predicted by a history of prior traffic offences.Clinical data of all adult road trauma patients admitted to the Western Australia (WA State Trauma Centre between 1998 and 2013 were linked to traffic offences records at the WA Department of Transport. The primary outcomes were alcohol exposure prior to road trauma, severe trauma (defined by Injury Severity Score >15, and intensive care admission (ICU or death, analyzed by logistic regression. Traffic offences directly leading to the road trauma admissions were excluded. Of the 10,330 patients included (median age 34 years-old, 78% male, 1955 (18.9% had alcohol-exposure before road trauma, 2415 (23.4% had severe trauma, 1360 (13.2% required ICU admission, and 267 (2.6% died. Prior traffic offences were recorded in 6269 (60.7% patients. The number of prior traffic offences was significantly associated with alcohol-related road trauma (odds ratio [OR] per offence 1.03, 95% confidence interval [CI] 1.02-1.05, severe trauma (OR 1.13, 95%CI 1.14-1.15, and ICU admission or death (OR 1.10, 95%CI 1.08-1.11. Drink-drinking, seat-belt, and use of handheld electronic device offences were specific offences strongly associated with road trauma leading to ICU admission or death--all in a 'dose-related' fashion. For those who recovered from road trauma after an ICU admission, there was a significant reduction in subsequent traffic offences (mean difference 1.8, 95%CI 1.5 to 2.0 and demerit points (mean difference 7.0, 95%CI 6.5 to 7.6 compared to before the trauma event.Previous traffic offences were a significant risk factor for alcohol-related road trauma and severe road trauma leading to ICU admission or death.
Ho, Kwok M; Rao, Sudhakar; Burrell, Maxine; Weeramanthri, Tarun S
Road trauma is a leading cause of death and injury in young people. Traffic offences are common, but their importance as a risk indicator for subsequent road trauma is unknown. This cohort study assessed whether severe road trauma could be predicted by a history of prior traffic offences. Clinical data of all adult road trauma patients admitted to the Western Australia (WA) State Trauma Centre between 1998 and 2013 were linked to traffic offences records at the WA Department of Transport. The primary outcomes were alcohol exposure prior to road trauma, severe trauma (defined by Injury Severity Score >15), and intensive care admission (ICU) or death, analyzed by logistic regression. Traffic offences directly leading to the road trauma admissions were excluded. Of the 10,330 patients included (median age 34 years-old, 78% male), 1955 (18.9%) had alcohol-exposure before road trauma, 2415 (23.4%) had severe trauma, 1360 (13.2%) required ICU admission, and 267 (2.6%) died. Prior traffic offences were recorded in 6269 (60.7%) patients. The number of prior traffic offences was significantly associated with alcohol-related road trauma (odds ratio [OR] per offence 1.03, 95% confidence interval [CI] 1.02-1.05), severe trauma (OR 1.13, 95%CI 1.14-1.15), and ICU admission or death (OR 1.10, 95%CI 1.08-1.11). Drink-drinking, seat-belt, and use of handheld electronic device offences were specific offences strongly associated with road trauma leading to ICU admission or death--all in a 'dose-related' fashion. For those who recovered from road trauma after an ICU admission, there was a significant reduction in subsequent traffic offences (mean difference 1.8, 95%CI 1.5 to 2.0) and demerit points (mean difference 7.0, 95%CI 6.5 to 7.6) compared to before the trauma event. Previous traffic offences were a significant risk factor for alcohol-related road trauma and severe road trauma leading to ICU admission or death.
The first well recorded epidemic was in 1955-56 here in Delhi with nearly 30000 cases. Large outbreaks occurred in 1978 in Kashmir. My interest in this disease began in 1991 during investigations into a large epidemic of hepatitis E in Kanpur that my mentor, later Prof SR Naik, and I undertook. I will use this epidemic as an ...
Singh, Neetu; Suresh, Gautham
Posthemorrhagic anemia is a rare but important cause of anemia in neonates, second only to hemolytic anemia of newborn. Most cases of posthemorrhagic anemia are reported from fetomaternal hemorrhage or umbilical cord accidents in utero. This case report describes a preterm infant who developed severe anemia and shock immediately after delivery related to an acute hemorrhage through patent umbilical cord vessels secondary to a tear in the umbilical cord at the site of cord clamping. We believe...
Mallouh, A A; Imseeh, G; Abu-Osba, Y K; Hamdan, J A
Infants with the severe variant of glucose-6-phosphate dehydrogenase (G6PD) deficiency may develop hyperbilirubinaemia sufficiently severe to cause kernicterus and death, acute haemolysis on exposure to oxidant stress, congenital non-spherocytic haemolytic anaemia and, rarely, increased susceptibility to bacterial infection. In spite of these potential problems, G6PD deficiency is often not included among screening programmes for inherited disorders. In a comprehensive screening and educational programme, we tested around 34,000 infants for G6PD deficiency. Of the total group, 18.4% (24.5% boys and 11.8% girls) were deficient. Forty-two of the 6246 (0.67%) G6PD-deficient infants required exchange transfusion. None of them developed kernicterus. By contrast, of 4755 infants who had not been screened because they were born at home, three developed kernicterus. In addition, four G6PD-deficient infants had developed kernicterus in the 20-month period prior to the screening programme. None of the hyperbilirubinaemic infants had blood group incompatibility or any other identifiable cause of hyperbilirubinaemia. To avoid this disastrous result, we believe that neonatal screening for G6PD deficiency, together with a comprehensive education programme, is advisable in those parts of the world where the severe variant of G6PD deficiency is prevalent.
Indirawati Tjahja Notohartojo
Full Text Available Background: Pulmonary TB is an infectious disease of the respiratory tract caused by bacteria. Dental health professionals such as dentists and dental nurses are in charge of health personnel to prevent, treat, cure, teeth the mouth, so as not to arise or aggravate toothache. In doing their job as dental health workers is expected to use gloves or masks, and always wash their hands to avoid the transmission of pulmonary TB disease. Methods: A cross sectional study was conducted involving 78 dental health professionals in 50 primary health centers that were chosen in six districts in three provinces of Banten, South Kalimantan and Gorontalo. Data were obtained by interviews and processed using SPSSResults: More than 90% dental health workers in work wore masks gloves and washed their hands after work. There was a signifi cant relationship between exercise with dental health professionals with a p value of 0.007, which means a signifi cant. Conclusion: In performing their duties, dental health workers have already used personal protective equipment such asmasks, gloves, and washed their hands and did enough exercise. Recommendation: need to increase knowledge about pulmonary TB in dental health professionals.
Zhang Haifeng; Small, Michael; Fu Xinchu
Models for diseases spreading are not just limited to SIS or SIR. For instance, for the spreading of AIDS/HIV, the susceptible individuals can be classified into different cases according to their immunity, and similarly, the infected individuals can be sorted into different classes according to their infectivity. Moreover, some diseases may develop through several stages. Many authors have shown that the individuals' relation can be viewed as a complex network. So in this paper, in order to better explain the dynamical behavior of epidemics, we consider different epidemic models on complex networks, and obtain the epidemic threshold for each case. Finally, we present numerical simulations for each case to verify our results.
Sachs, Marianne Brostrup; Wolffbrandt, Mia Moth; Poulsen, Ingrid
that patients' rehabilitation days be planned in such a manner that activities, mobilisation and training are conducted throughout the day and evening. We also recommend that professional staff are encouraged to seek information about the former life of patients with severe brain injury. This article...... knowledge about PU care and performing the activities. However, our observations revealed one important additional aspect; a very distinct impression that the healthcare professionals were committed to learning about the patients' former life and actively used this knowledge in their planning and provision...
Singh, Neetu; Suresh, Gautham
Posthemorrhagic anemia is a rare but important cause of anemia in neonates, second only to hemolytic anemia of newborn. Most cases of posthemorrhagic anemia are reported from fetomaternal hemorrhage or umbilical cord accidents in utero. This case report describes a preterm infant who developed severe anemia and shock immediately after delivery related to an acute hemorrhage through patent umbilical cord vessels secondary to a tear in the umbilical cord at the site of cord clamping. We believe that umbilical cord bleeding from errors in cord clamping could be an important cause of acute blood loss in the delivery room and that it may result in significant clinical morbidity, especially in extremely premature infants.
Sun, Mengfeng; Lou, Yijun; Duan, Jinqiao; Fu, Xinchu
During the spread of an epidemic, individuals in realistic networks may exhibit collective behaviors. In order to characterize this kind of phenomenon and explore the correlation between collective behaviors and epidemic spread, in this paper, we construct several mathematical models (including without delay, with a coupling delay, and with double delays) of epidemic synchronization by applying the adaptive feedback motivated by real observations. By using Lyapunov function methods, we obtain the conditions for local and global stability of these epidemic synchronization models. Then, we illustrate that quenched mean-field theory is more accurate than heterogeneous mean-field theory in the prediction of epidemic synchronization. Finally, some numerical simulations are performed to complement our theoretical results, which also reveal some unexpected phenomena, for example, the coupling delay and epidemic delay influence the speed of epidemic synchronization. This work makes further exploration on the relationship between epidemic dynamics and synchronization dynamics, in the hope of being helpful to the study of other dynamical phenomena in the process of epidemic spread.
Full Text Available Posthemorrhagic anemia is a rare but important cause of anemia in neonates, second only to hemolytic anemia of newborn. Most cases of posthemorrhagic anemia are reported from fetomaternal hemorrhage or umbilical cord accidents in utero. This case report describes a preterm infant who developed severe anemia and shock immediately after delivery related to an acute hemorrhage through patent umbilical cord vessels secondary to a tear in the umbilical cord at the site of cord clamping. We believe that umbilical cord bleeding from errors in cord clamping could be an important cause of acute blood loss in the delivery room and that it may result in significant clinical morbidity, especially in extremely premature infants.
MacManes, Matthew David
Animals living in desert environments are forced to survive despite severe heat, intense solar radiation, and both acute and chronic dehydration. These animals have evolved phenotypes that effectively address these environmental stressors. To begin to understand the ways in which the desert-adapted rodent Peromyscus eremicus survives, reproductively mature adults were subjected to 72 h of water deprivation, during which they lost, on average, 23% of their body weight. The animals reacted via a series of changes in the kidney, which included modulating expression of genes responsible for reducing the rate of transcription and maintaining water and salt balance. Extracellular matrix turnover appeared to be decreased, and apoptosis was limited. In contrast to the canonical human response, serum creatinine and other biomarkers of kidney injury were not elevated, suggesting that changes in gene expression related to acute dehydration may effectively prohibit widespread kidney damage in the cactus mouse. Copyright © 2017 the American Physiological Society.
Cook, Deborah J; Johnstone, Jennie; Marshall, John C; Lauzier, Francois; Thabane, Lehana; Mehta, Sangeeta; Dodek, Peter M; McIntyre, Lauralyn; Pagliarello, Joe; Henderson, William; Taylor, Robert W; Cartin-Ceba, Rodrigo; Golan, Eyal; Herridge, Margaret; Wood, Gordon; Ovakim, Daniel; Karachi, Tim; Surette, Michael G; Bowdish, Dawn M E; Lamarche, Daphnee; Verschoor, Chris P; Duan, Erick H; Heels-Ansdell, Diane; Arabi, Yaseen; Meade, Maureen
Probiotics are live microorganisms that may confer health benefits when ingested. Randomized trials suggest that probiotics significantly decrease the incidence of ventilator-associated pneumonia (VAP) and the overall incidence of infection in critically ill patients. However, these studies are small, largely single-center, and at risk of bias. The aim of the PROSPECT pilot trial was to determine the feasibility of conducting a larger trial of probiotics to prevent VAP in mechanically ventilated patients in the intensive care unit (ICU). In a randomized blinded trial, patients expected to be mechanically ventilated for ≥72 hours were allocated to receive either 1 × 10(10) colony-forming units of Lactobacillus rhamnosus GG or placebo, twice daily. Patients were excluded if they were at increased risk of L. rhamnosus GG infection or had contraindications to enteral medication. Feasibility objectives were: (1) timely recruitment; (2) maximal protocol adherence; (3) minimal contamination; and (4) estimated VAP rate ≥10 %. We also measured other infections, diarrhea, ICU and hospital length of stay, and mortality. Overall, in 14 centers in Canada and the USA, all feasibility goals were met: (1) 150 patients were randomized in 1 year; (2) protocol adherence was 97 %; (3) no patients received open-label probiotics; and (4) the VAP rate was 19 %. Other infections included: bloodstream infection (19.3 %), urinary tract infections (12.7 %), and skin and soft tissue infections (4.0 %). Diarrhea, defined as Bristol type 6 or 7 stools, occurred in 133 (88.7 %) of patients, the median length of stay in ICU was 12 days (quartile 1 to quartile 3, 7-18 days), and in hospital was 26 days (quartile 1 to quartile 3, 14-44 days); 23 patients (15.3 %) died in the ICU. The PROSPECT pilot trial supports the feasibility of a larger trial to investigate the effect of L. rhamnosus GG on VAP and other nosocomial infections in critically ill patients. Clinicaltrials
Auger, P.; Pouliot, B.; De Grace, M.; Milot, C.; Lafortune, M.; Bergeron, Z.
An outbreak of bacillary dysentery in 1978 affecting 928 persons, most of whom were living in the village of St-Jacques, PQ, is described. An epidemiologic study suggested the water supply as the source of the infection, and it was established that the water carried by the municipal aqueduct was contaminated by feces containing the causal agent, Shigella sonnei. This epidemic, the largest mentioned in he Canadian medical literature, demonstrates how contagious this infection is.
Tan, Annelie N; Cornelissen, Michiel F; Webers, Carroll A B; Erckens, Roel J; Berendschot, Tos T J M; Beckers, Henny J M
To evaluate long-term outcomes on efficacy and safety of severe uveitic glaucoma treated with a Baerveldt glaucoma implant (BGI). A retrospective study of 47 eyes of 47 patients with uveitic glaucoma treated by a BGI between September 2002 and September 2015. Main outcome measures were intraocular pressure (IOP), number of glaucoma medications, course of the uveitis, visual acuity (VA) and complications. Mean IOP dropped from 30.6 ± 8.1 mmHg with 3.6 ± 1.1 glaucoma medications at baseline to 10.6 ± 4.3 mmHg with 1.0 ± 1.3 glaucoma medications after a mean follow-up of 63.6 ± 43.1 months. In the majority of cases, IOP remained stable during follow-up. However, especially in several patients with viral uveitis, episodes with IOP peaks were observed during a flare-up despite a functioning implant. These peaks remained below preoperative levels. During follow-up, 16 patients (34%) experienced a clinically significant VA loss, mainly because of late-stage glaucoma or hypotony maculopathy. Early postoperative complications were transient choroidal effusion (n = 5), shallow/flat anterior chamber (n = 4), hyphaema (n = 2) and suprachoroidal haemorrhage (n = 1). The most important late postoperative complication was hypotony maculopathy (n = 5), three of these in juvenile idiopathic arthritis (JIA) patients. The BGI is an effective and safe treatment for patients with refractive secondary glaucoma due to uveitis. In a majority of patients, VA remains stable and a low and stable IOP is maintained over time with an acceptable number of complications. In particular, patients with viral uveitis and glaucoma should be closely monitored for IOP peaks that may occur during episodes of a flare-up of uveitis, whereas at the other end of the spectrum, patients with JIA seem much more prone to hypotony maculopathy. © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Murray, Clare S; Foden, Philip; Sumner, Helen; Shepley, Elizabeth; Custovic, Adnan; Simpson, Angela
Allergen exposure in sensitized individuals with asthma interacts with viruses to increase the risk of asthma exacerbation. To evaluate the use of house dust mite-impermeable bedding and its impact on severe asthma exacerbations in children. We randomized mite-sensitized children with asthma (ages 3-17 yr) after an emergency hospital attendance with an asthma exacerbation to receive mite-impermeable (active group) or control (placebo group) bed encasings. Over a 12-month intervention period, the occurrence of severe asthma exacerbations was investigated. Of 434 children with asthma who consented, 286 (mean age, 7.7 yr; male sex, 65.8%) were mite sensitized, and 284 were randomized (146 to the active group and 138 to the placebo group). At 12 months, significantly fewer children in the active group than in the placebo group had attended the hospital with an exacerbation (36 [29.3%] of 123 vs. 49 [41.5%] of 118; P = 0.047). In the multivariable analysis, the risk of emergency hospital attendance was 45% lower in the active group (hazard ratio, 0.55; 95% confidence interval [CI], 0.36-0.85; P = 0.006) than in the placebo group. The annual rate of emergency hospital attendance with exacerbations was 27% lower in the active group than in the placebo group, but this did not reach significance (estimated marginal mean [95% CI], active, 0.38 [0.26-0.56] vs. placebo, 0.52 [0.35-0.76]; P = 0.18). No difference between the groups in the risk of prednisolone use for exacerbation was found (hazard ratio, 0.82; 95% CI, 0.58-1.17; P = 0.28). Mite-impermeable encasings are effective in reducing the number of mite-sensitized children with asthma attending the hospital with asthma exacerbations but not the number requiring oral prednisolone. This simple measure may reduce the health care burden of asthma exacerbations in children. Clinical trial registered with www.isrctn.com (ISRCTN 69543196).
Ghafuri, Djamila Labib; Chaturvedi, Shruti; Rodeghier, Mark; Stimpson, Sarah-Jo; McClain, Brandi; Byrd, Jeannie; DeBaun, Michael R
In a retrospective cohort study, we tested the hypothesis that when prescribing hydroxyurea (HU) to children with sickle cell anemia (SCA) to prevent vaso-occlusive events, there will be a secondary benefit of maintaining low transcranial Doppler (TCD) velocity, measured by imaging technique (TCDi). HU was prescribed for 90.9% (110 of 120) of children with SCA ≥5 years of age and followed for a median of 4.4 years, with 70% (n = 77) receiving at least one TCDi evaluation after starting HU. No child prescribed HU had a conditional or abnormal TCDi measurement. HU initiation for disease severity prevention decreases the prevalence of abnormal TCDi velocities. © 2016 Wiley Periodicals, Inc.
Gu, Beom W.; Choi, Su Y.; Yim, Man S.; Rim, Chun T. [Korea Advanced Institute of Science and Technology, Daejeon (Korea, Republic of)
It becomes evident that severe accidents may occur by unexpected disasters such as tsunami, heavy flood, or terror. Once radioactive material is released from NPP through severe accidents, there are no ways to prevent the released radioactive gas spreading in the air. As a remedy for this problem, the idea on the portable filtered air suction system (PoFASS) for the prevention of released radioactive gas under severe accidents was proposed. In this paper, the conceptual design of a PoFASS focusing on the number of robot fingers and robot arm rods are proposed. In order to design a flexible robot suction nozzle, mathematical models for the gaps which represent the lifted heights of extensible covers for given convex shapes of pipes and for the covered areas are developed. In addition, the system requirements for the design of the robot arms of PoFASS are proposed, which determine the accessible range of leakage points of released radioactive gas. In this paper, the conceptual designs of the flexible robot suction nozzle and robot arm have been conducted. As a result, the minimum number of robot fingers and robot arm rods are defined to be four and three, respectively. For further works, extensible cover designs on the flexible robot suction nozzle and the application of the PoFASS to the inside of NPP should be studied because the radioactive gas may be released from connection pipes between the containment building and auxiliary buildings.
Young, G; Mahlangu, J; Kulkarni, R; Nolan, B; Liesner, R; Pasi, J; Barnes, C; Neelakantan, S; Gambino, G; Cristiano, L M; Pierce, G F; Allen, G
Prophylactic factor replacement, which prevents hemarthroses and thereby reduces the musculoskeletal disease burden in children with hemophilia A, requires frequent intravenous infusions (three to four times weekly). Kids A-LONG was a phase 3 open-label study evaluating the safety, efficacy and pharmacokinetics of a longer-acting factor, recombinant factor VIII Fc fusion protein (rFVIIIFc), in previously treated children with severe hemophilia A (endogenous FVIII level of hemophilia A. © 2015 The Authors. Journal of Thrombosis and Haemostasis published by Wiley Periodicals, Inc. on behalf of International Society on Thrombosis and Haemostasis.
Huizer, Y.L.; Kraaij-Dirkzwager, M.M.; Timen, A.; Schuitmaker-Warnaar, T.J.; van Steenbergen, J.E.
When epidemics occur, experts advise the Ministries on effective control measures. There is uncertainty in the translation of epidemiological evidence into effective outbreak management interventions, due to contradicatory problem perspectives, diverse interests and time pressure. Several models
Full Text Available We constructed dynamic Ebola virus disease (EVD transmission models to predict epidemic trends and evaluate intervention measure efficacy following the 2014 EVD epidemic in West Africa. We estimated the effective vaccination rate for the population, with basic reproduction number (R0 as the intermediate variable. Periodic EVD fluctuation was analyzed by solving a Jacobian matrix of differential equations based on a SIR (susceptible, infective, and removed model. A comprehensive compartment model was constructed to fit and predict EVD transmission patterns, and to evaluate the effects of control and prevention measures. Effective EVD vaccination rates were estimated to be 42% (31-50%, 45% (42-48%, and 51% (44-56% among susceptible individuals in Guinea, Liberia and Sierra Leone, respectively. In the absence of control measures, there would be rapid mortality in these three countries, and an EVD epidemic would be likely recur in 2035, and then again 8~9 years later. Oscillation intervals would shorten and outbreak severity would decrease until the periodicity reached ~5.3 years. Measures that reduced the spread of EVD included: early diagnosis, treatment in isolation, isolating/monitoring close contacts, timely corpse removal, post-recovery condom use, and preventing or quarantining imported cases. EVD may re-emerge within two decades without control and prevention measures. Mass vaccination campaigns and control and prevention measures should be instituted to prevent future EVD epidemics.
Nucci, B; Aya, Agm; Aubry, E; Ripart, J
The aim of the study was to compare the incidence of the use of additional uterotonics before and after the change of carbetocin to oxytocin for the prevention of postpartum hemorrhage after cesarean delivery in women with severe preeclampsia. This was an observational retrospective before-and-after study. Operating room, postoperative recovery area. Sixty women with severe preeclampsia undergoing cesarean delivery under spinal anesthesia; American Society of Anesthesiologists 3. Observational study. Blood pressure, heart rate, and biological data (hemoglobin, platelets, haptoglobin, prothrombin time index, activated partial thromboplastin time ratio, blood uric acid, aspartate aminotransferase, alanine aminotransferase, serum urea, serum creatinine, and albumin). The incidence of additional uterotonic administration in the carbetocin and oxytocin groups was 15% and 10%, respectively (P=.70). As carbetocin appears to be as effective and safe as oxytocin in preeclamptic women, its advantages make it a good uterotonic option in this particular setting. Copyright © 2016 Elsevier Inc. All rights reserved.
Katarina Mirjane Janicijevic
Full Text Available Epidemic viral conjunctivitis caused by adenovirus is the most common infectious conjunctivitis. The exact incidence of adenoviral conjunctivitis is still poorly known, but there are two well-defined adenoviral keratoconjunctivitis clinical syndromes: epidemic keratoconjunctivitis (EKC and pharyngoconjunctival fever (PCF. Epidemic keratoconjunctivitis is also the most severe form and presents with watery discharge, hyperemia, chemosis and ipsilateral lymphadenopathy. Diagnosis is mainly clinical, but its etiology can be confirmed using cell cultures, antigen detection, polymerase chain reaction or immune-chromatography. Multiple treatments have been tried for this disease, but none of them seem to be completely effective. Viruses are resistant to desiccation and certain common surface disinfectants. Prevention is the most reliable and recommended strategy to control this epidemic infection. Global epidemic surveillance system definitely needs to be established to monitor and analyze the epidemic conjunctivitis in the future. There is clearly a need for the national and the military public health institutions to work together on guidelines to handle future challenges.
Full Text Available Pressing demands of economic competitiveness, the need for large-scale deployment, minimizing the need of human intervention, and experience from the past events and incidents at operating reactors have guided the evolution and innovations in reactor technologies. Indian innovative reactor ‘AHWR’ is a pressure-tube type natural circulation based boiling water reactor that is designed to meet such requirements, which essentially reflect the needs of next generation reactors. The reactor employs various passive features to prevent and mitigate accidental conditions, like a slightly negative void reactivity coefficient, passive poison injection to scram the reactor in event of failure of the wired shutdown systems, a large elevated pool of water as a heat sink inside the containment, passive decay heat removal based on natural circulation and passive valves, passive ECC injection, etc. It is designed to meet the fundamental safety requirements of safe shutdown, safe decay heat removal and confinement of activity with no impact in public domain, and hence, no need for emergency planning under all conceivable scenarios. This paper examines the role of the various passive safety systems in prevention and mitigation of severe plant conditions that may arise in event of multiple failures. For the purpose of demonstration of the effectiveness of its passive features, postulated scenarios on the lines of three major severe accidents in the history of nuclear power reactors are considered, namely; the Three Mile Island (TMI, Chernobyl and Fukushima accidents. Severe plant conditions along the lines of these scenarios are postulated to the extent conceivable in the reactor under consideration and analyzed using best estimate system thermal-hydraulics code RELAP5/Mod3.2. It is found that the various passive systems incorporated enable the reactor to tolerate the postulated accident conditions without causing severe plant conditions and core degradation.
Jain, Vikas; Nayak, A.; Dhiman, M.; Kulkarni, P. P.; Vijayan, P. K.; Vaze, K. K. [Bhabha Atomic Research Centre, Mumbai (India)
Pressing demands of economic competitiveness, the need for large-scale deployment, minimizing the need of human intervention, and experience from the past events and incidents at operating reactors have guided the evolution and innovations in reactor technologies. Indian innovative reactor 'AHWR' is a pressure-tube type natural circulation based boiling water reactor that is designed to meet such requirements, which essentially reflect the needs of next generation reactors. The reactor employs various passive features to prevent and mitigate accidental conditions, like a slightly negative void reactivity coefficient, passive poison injection to scram the reactor in event of failure of the wired shutdown systems, a large elevated pool of water as a heat sink inside the containment, passive decay heat removal based on natural circulation and passive valves, passive ECC injection, etc. It is designed to meet the fundamental safety requirements of safe shutdown, safe decay heat removal and confinement of activity with no impact in public domain, and hence, no need for emergency planning under all conceivable scenarios. This paper examines the role of the various passive safety systems in prevention and mitigation of severe plant conditions that may arise in event of multiple failures. For the purpose of demonstration of the effectiveness of its passive features, postulated scenarios on the lines of three major severe accidents in the history of nuclear power reactors are considered, namely; the Three Mile Island (TMI), Chernobyl and Fukushima accidents. Severe plant conditions along the lines of these scenarios are postulated to the extent conceivable in the reactor under consideration and analyzed using best estimate system thermal-hydraulics code RELAP5/Mod3.2. It is found that the various passive systems incorporated enable the reactor to tolerate the postulated accident conditions without causing severe plant conditions and core degradation.
Zuckerwise, Lisa C; Lipkind, Heather S
Despite increasing awareness of obstetric safety initiatives, maternal mortality and severe maternal morbidity in the United States have continued to increase over the past 20 years. Since results from large-scale surveillance programs suggest that up to 50% of maternal deaths may be preventable, new efforts are focused on developing and testing early warning systems for the obstetric population. Early warning systems are a set of specific clinical signs or symptoms that trigger the awareness of risk and an urgent patient evaluation, with the goal of reducing severe morbidity and mortality through timely diagnosis and treatment. Early warning systems have proven effective at predicting and reducing mortality and severe morbidity in medical, surgical, and critical care patient populations; however, there has been limited research on how to adapt these tools for use in the obstetric population, where physiologic changes of pregnancy render them inadequate. In this article, we review the available obstetric early warning systems and present evidence for their use in reducing maternal mortality and severe maternal morbidity. We also discuss considerations and strategies for implementation and acceptance of these early warning systems for clinical use in obstetrics. Copyright © 2017 Elsevier Inc. All rights reserved.
Cai, Huihua; Qiao, Lin; Song, KaiJing; He, Yuanli
To compare the efficacy of an oxidized, regenerated cellulose adhesion barrier (Interceed; Ethicon, Somerville, NJ) combined with an intrauterine device (IUD) versus an IUD alone for preventing adhesion recurrence following hysteroscopic adhesiolysis for moderate to severe intrauterine adhesions (IUAs). Retrospective case series (Canadian Task Force classification III). Tertiary care teaching hospital. Patients undergoing treatment for moderate to severe IUAs. The severity of IUA was determined based on the American Fertility Society scoring system (mild, moderate, or severe). All cases of hysteroscopic adhesiolysis were reviewed. Seventy-six women with moderate to severe IUAs treated between March 2009 and August 2015 were included. After hysteroscopic adhesiolysis, 35 patients were treated with an IUD alone (group 1), and 41 patients were treated with Interceed plus an IUD (group 2). A second hysteroscopy was performed in all cases three months after the initial hysteroscopy and both groups achieved significant reduction in adhesion scores and grade, especially in group 2 (scores, p < .001; grade, p = .039). Compared with group 1, menstruation dysfunction, pregnancy rate, and live birth rate in group 2 improved with no statistical difference (menstruation improvement, p = .764; pregnancy rate, p = .310; live birth rate, p = .068). However, an adhesion-free uterine cavity was regained significantly owing to the fewer operations in group 2 compared with group 1 (median, 3 vs 4; p = .001). The interval from initial hysteroscopy to conception was significantly shorter in group 2 (median, 12 months vs 51 months; p < .001). For moderate to severe IUAs, Interceed combined with an IUD may be an alternative approach for reducing adhesion recurrence after hysteroscopic adhesiolysis. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.
Keepanasseril, Anish; Maurya, Dilip Kumar; Manikandan, K; Suriya J, Yavana; Habeebullah, Syed; Raghavan, S Soundara
Optimum dose, route and duration of use of prophylactic magnesium sulphate in women with severe pre-eclampsia is still controversial. We compared the efficacy and safety of 'low-dose Dhaka' regime with 'Loading dose only' regime for seizure prophylaxis in severe preeclampsia using a randomised controlled trial in 402 women. The incidence of eclampsia in the 'low-dose Dhaka' regime group was 1.49% and that in the 'Loading dose only regime' was 2.98% (p = .321). In the low-dose Dhaka regime, injection site abscess and respiratory depression occurred in one woman each. Neonatal outcomes such as Apgar score at 5 minutes (5.0% vs. 8.05% p = .251) and perinatal mortality (20.4% vs. 21.9%, p = .724) were similar in both groups. Loading dose only regime may be considered an effective alternative regime for the prevention of eclampsia in women with severe preeclampsia. Impact statement What is already known on this subject: Efficacy of therapeutic short regime magnesium sulphate in eclampsia has already been reported. Data regarding prophylactic short regime in women with preeclampsia is sparse. What the results of this study add: We have shown that short regime of magnesium sulphate using only the loading dose in the prevention of seizure in preeclampsia is an effective alternative to the low-dose Dhaka regime. What the implications are of these findings for clinical practice and/or further research: The short regime is less resource-intensive. Further larger studies are needed to confirm the efficacy of this short regime and to establish its cost-effectiveness.
van der Feltz-Cornelis, Christina M
There has been much discussion in the media about the question of the existence of a depression epidemic. This leads on to the questions of whether the social and economic approaches are adequate, and what the alternatives are. The concept of the disease 'depression' can be defined using a medical model, or from a patient's or a societal perspective. From a medical perspective, indeed a depression epidemic has ensued from the increased prosperity and the associated decompression of the mortality rate. Society responded with preventative measures and policies aimed at improving functioning in the workplace. However, patients with a major depressive disorder (MDD) who are eligible for treatment are often not motivated to take it up, or are undertreated. Research is necessary in order to explore what patients think about the identification and treatment of depression. The confusion regarding the concept of depression found in the media, needs to be cleared.
Elmahdawy, Mahmoud; Elsisi, Gihan H; Carapinha, Joao; Lamorde, Mohamed; Habib, Abdulrazaq; Agyie-Baffour, Peter; Soualmi, Redouane; Ragab, Samah; Udezi, Anthony W; Usifoh, Cyril; Usifoh, Stella
The Ebola virus has spread across several Western Africa countries, adding a significant financial burden to their health systems and economies. In this article the experience with Ebola is reviewed, and economic challenges and policy recommendations are discussed to help curb the impact of other diseases in the future. The West African Ebola virus disease epidemic started in resource-constrained settings and caused thousands of fatalities during the last epidemic. Nevertheless, given population mobility, international travel, and an increasingly globalized economy, it has the potential to re-occur and evolve into a global pandemic. Struggling health systems in West African countries hinder the ability to reduce the causes and effects of the Ebola epidemic. The lessons learned include the need for strengthening health systems, mainly primary care systems, expedited access to treatments and vaccines to treat the Ebola virus disease, guidance on safety, efficacy, and regulatory standards for such treatments, and ensuring that research and development efforts are directed toward existing needs. Other lessons include adopting policies that allow for better flow of relief, averting the adverse impact of strong quarantine policy that includes exaggerating the aversion behavior by alarming trade and business partners providing financial support to strengthen growth in the affected fragile economies by the Ebola outbreak. Curbing the impact of future Ebola epidemics, or comparable diseases, requires increased long-term investments in health system strengthening, better collaboration between different international organizations, more funding for research and development efforts aimed at developing vaccines and treatments, and tools to detect, treat, and prevent future epidemics. Copyright © 2017. Published by Elsevier Inc.
Barcellos, Christovam; Brasil, Patrícia; Cruz, Oswaldo G.; Honório, Nildimar Alves; Kuper, Hannah; Carvalho, Marilia Sá
The first confirmed case of Zika virus infection in the Americas was reported in Northeast Brazil in May 2015, although phylogenetic studies indicate virus introduction as early as 2013. Zika rapidly spread across Brazil and to more than 50 other countries and territories on the American continent. The Aedes aegypti mosquito is thought to be the principal vector responsible for the widespread transmission of the virus. However, sexual transmission has also been reported. The explosively emerging epidemic has had diverse impacts on population health, coinciding with cases of Guillain–Barré Syndrome and an unexpected epidemic of newborns with microcephaly and other neurological impairments. This led to Brazil declaring a national public health emergency in November 2015, followed by a similar decision by the World Health Organization three months later. While dengue virus serotypes took several decades to spread across Brazil, the Zika virus epidemic diffused within months, extending beyond the area of permanent dengue transmission, which is bound by a climatic barrier in the south and low population density areas in the north. This rapid spread was probably due to a combination of factors, including a massive susceptible population, climatic conditions conducive for the mosquito vector, alternative non-vector transmission, and a highly mobile population. The epidemic has since subsided, but many unanswered questions remain. In this article, we provide an overview of the discovery of Zika virus in Brazil, including its emergence and spread, epidemiological surveillance, vector and non-vector transmission routes, clinical complications, and socio-economic impacts. We discuss gaps in the knowledge and the challenges ahead to anticipate, prevent, and control emerging and re-emerging epidemics of arboviruses in Brazil and worldwide. PMID:29315224
Chen, Hsueh-Fen; Carlson, Erin; Popoola, Taiye; Suzuki, Sumihiro
To examine the impact of rurality on 30-day preventable readmission, and the illness severity and risk of mortality for 30-day preventable readmissions. We analyzed heart failure Medicare beneficiaries who received home health services for postacute care after hospital discharge in 2009. The study was a cross-sectional design with the unit of analysis as the home health episode for postacute care. Data sources included the following: Medicare Beneficiary Summary File, Medicare Provider Analysis Review, Outcome Assessment Information Set, Home Health Agency Research Identifiable File, and Area Health Resources File. The dependent variables were 30-day preventable readmission, and the extreme/major level of illness severity and of risk of mortality for a 30-day preventable readmission. The key independent variable was rurality defined as remote rural, adjacent rural, and micropolitan areas, with urban areas in the reference group. Home health beneficiaries in remote rural areas had 27% lower 30-day preventable readmission than those in urban areas. Home health beneficiaries in adjacent rural areas were 33% less likely to have high illness severity at readmission due to a preventable condition than those in urban areas. Geographical location affects preventable readmission and illness severity of preventable readmission. Patients' geographic location along with patients' risk factors should be taken into consideration in the risk adjustment model for the financial incentive program that penalizes home health agencies with high preventable readmissions. © 2015 National Rural Health Association.
Halliday, Fletcher W; Umbanhowar, James; Mitchell, Charles E
Parasite epidemics may be influenced by interactions among symbionts, which can depend on past events at multiple spatial scales. Within host individuals, interactions can depend on the sequence in which symbionts infect a host, generating priority effects. Across host individuals, interactions can depend on parasite phenology. To test the roles of parasite interactions and phenology in epidemics, we embedded multiple cohorts of sentinel plants, grown from seeds with and without a vertically transmitted symbiont, into a wild host population, and tracked foliar infections caused by three common fungal parasites. Within hosts, parasite growth was influenced by coinfections, but coinfections were often prevented by priority effects among symbionts. Across hosts, parasite phenology altered host susceptibility to secondary infections, symbiont interactions and ultimately the magnitude of parasite epidemics. Together, these results indicate that parasite phenology can influence parasite epidemics by altering the sequence of infection and interactions among symbionts within host individuals. © 2017 John Wiley & Sons Ltd/CNRS.
Guthmann, J P
In the most recent epidemic of cholera in Latin America, nearly a million cases were reported and almost 9000 people died between January 1991 and December 1993. The epidemic spread rapidly from country to country, affecting in three years all the countries of Latin America except Uruguay and the Caribbean. Case-control studies carried out in Peru showed a significant association between drinking water and risk of disease. Cholera was associated with the consumption of unwashed fruit and vegetables, with eating food from street vendors and with contaminated crabmeat transported in travellers' luggage. This article documents the spread of the epidemic and its routes of transmission and discusses whether the introduction of the epidemic to Peru and its subsequent spread throughout the continent could have been prevented.
Notes: We compiled this slide in 1992. It shows dates, locations and number of cases for various epidemics reported from different parts of India till that time. The first well recorded epidemic was in 1955-56 here in Delhi with nearly 30000 cases. Large outbreaks occurred in 1978 in Kashmir. My interest in this disease began ...
Schwensen, Jakob F; Uter, Wolfgang; Bruze, Magnus
BACKGROUND: The use of methylisothiazolinone (MI) in cosmetic products has caused an unprecedented epidemic of MI contact allergy. Current data concerning exposures at a European level are required. OBJECTIVES: To describe demographics and MI exposures for European patients with MI contact allergy....... METHODS: Eleven European dermatology departments from eight European countries prospectively collected data between 1 May and 31 October 2015 among consecutive patients who had positive patch test reactions to MI (2000 ppm aq.). RESULTS: A total of 6.0% (205/3434; range 2.6-13.0%) of patients had positive...... patch test reactions to MI. Dermatitis most frequently affected the hands (43.4%), face (32.7%), arms (14.6%), and eyelids (11.7%); 12.7% had widespread dermatitis. For 72.7% (149/205), MI contact allergy was currently relevant mainly because of exposure to cosmetic products (83.2%; 124...
Full Text Available Severe burn injuries may result in gastrointestinal paralysis, and barrier dysfunction due to gut ischemia and lowered vagus excitability. In this study we investigate whether electroacupuncture (EA at Zusanli (ST36 could prevent severe scalds-induced gut ischemia, paralysis, and barrier dysfunction and whether the protective role of EA at ST36 is related to the vagus nerve. 35% burn area rats were divided into six groups: (a EAN: EA nonchannel acupoints followed by scald injury; (b EA: EA at ST36 after scald injury; (c VGX/EA: vagotomy (VGX before EA at ST36 and scald injury; (d VGX/EAN: VGX before EAN and scald injury; (e atropine/EA: applying atropine before scald injury and then EA at ST36; (f atropine/EAN: applying atropine before scald injury and then EA at nonchannel acupoints. EA at the Zusanli point significantly promoted the intestinal impelling ratio and increased the amount of mucosal blood flow after scald injury. The plasma diamine oxidase (DAO and intestinal permeability decreased significantly after scald injury in the EA group compared with others. However, EA after atropine injection or cervical vagotomy failed to improve intestinal motility and mucosa blood flow suggesting that the mechanism of EA may be related to the activation of the cholinergic nerve pathway.
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Blake, Alexandre; Keita, Veronique Sarr; Sauvageot, Delphine; Saliou, Mamadou; Njanpop, Berthe Marie; Sory, Fode; Sudre, Bertrand; Lamine, Koivogui; Mengel, Martin; Gessner, Bradford D; Sakoba, Keita
infected individuals reacted differently in terms of disease severity as well as their access to treated water and travel habits. Such an in-depth description of cholera epidemics should be systematically carried out in cholera endemic settings in order to prioritize higher risk areas, identify transmission factors, and optimize preventive interventions.
Economou, Antonis; Lopez-Herrero, Maria Jesus
We consider the classical deterministic susceptible-infective-susceptible epidemic model, where the infection and recovery rates depend on a background environmental process that is modeled by a continuous time Markov chain. This framework is able to capture several important characteristics that appear in the evolution of real epidemics in large populations, such as seasonality effects and environmental influences. We propose computational approaches for the determination of various distributions that quantify the evolution of the number of infectives in the population.
Full Text Available Abstract Background Malaria remains an important public health concern in China and is particularly serious in Yunnan, a China’s provincial region of high malaria burden with an incidence of 1.79/105 in 2012. This study aims to examine the epidemiologic profile and spatiotemporal aspects of epidemics of malaria, and to examine risk factors which may influence malaria epidemics in Yunnan Province. Methods The data of malaria cases in 2012 in 125 counties of Yunnan Province was used in this research. The epidemical characteristics of cases were revealed, and time and space clusters of malaria were detected by applying scan statistics method. In addition, we applied the geographically weighted regression (GWR model in identifying underlying risk factors. Results There was a total of 821 cases of malaria, and male patients accounted for 83.9% (689 of the total cases. The incidence in the group aged 20–30 years was the highest, at 3.00/105. The majority (84.1% of malaria cases occurred in farmers and migrant workers, according to occupation statistics. On a space-time basis, epidemics of malaria of varying severity occurred in the summer and autumn months, and the high risk regions were mainly distributed in the southwest counties. Annual average temperature, annual cumulative rainfall, rice yield per square kilometer and proportion of rural employees mainly showed a positive association with the malaria incidence rate, according to the GWR model. Conclusions Malaria continues to be one of serious public health issues in Yunnan Province, especially in border counties in southwestern Yunnan. Temperature, precipitation, rice cultivation and proportion of rural employees were positively associated with malaria incidence. Individuals, and disease prevention and control departments, should implement more stringent preventative strategies in locations with hot and humid environmental conditions to control malaria.
McMinn, Peter; Lindsay, Katie; Perera, David; Chan, Hung Ming; Chan, Kwai Peng; Cardosa, Mary Jane
Enterovirus 71 (EV71) is a frequent cause of hand, foot, and mouth disease (HFMD) epidemics associated with severe neurological sequelae in a small proportion of cases. There has been a significant increase in EV71 epidemic activity throughout the Asia-Pacific region since 1997. Recent HFMD epidemics in this region have been associated with a severe form of brainstem encephalitis associated with pulmonary edema and high case fatality rates. In this study, we show that four genetic lineages of...
Bertuzzo, E.; Mari, L.; Righetto, L.; Casagrandi, R.; Gatto, M.; Rodriguez-Iturbe, I.; Rinaldo, A.
As a major cholera epidemic progresses in Haiti, and the figures of the infection, up to December 2011, climb to 522,000 cases and 7,000 deaths, the development of general models to track and predict the evolution of the outbreak, so as to guide the allocation of medical supplies and staff, is gaining notable urgency. We propose here a spatially explicit epidemic model that accounts for the dynamics of susceptible and infected individuals as well as the redistribution of Vibrio cholera, the causative agent of the disease, among different human communities. In particular, we model two spreading pathways: the advection of pathogens through hydrologic connections and the dissemination due to human mobility described by means of a gravity-like model. To this end the country has been divided into hydrologic units based on drainage directions derived from a digital terrain model. Moreover the population of each unit has been estimated from census data downscaled to 1 km x 1 km resolution via remotely sensed geomorphological information (LandScan project). The model directly accounts for the role of rainfall patterns in driving the seasonality of cholera outbreaks. The two main outbreaks in fact occurred during the rainy seasons (October and May) when extensive floodings severely worsened the sanitation conditions and, in turn, raised the risk of infection. The model capability to reproduce the spatiotemporal features of the epidemic up to date grants robustness to the foreseen future development. To this end, we generate realistic scenario of future precipitation in order to forecast possible epidemic paths up to the end of the 2013. In this context, the duration of acquired immunity, a hotly debated topic in the scientific community, emerges as a controlling factor for progression of the epidemic in the near future. The framework presented here can straightforwardly be used to evaluate the effectiveness of alternative intervention strategies like mass vaccinations
Halken, S; Høst, A
, breastfeeding should be encouraged for 4-6 months. In high-risk infants a documented extensively hydrolysed formula is recommended if exclusive breastfeeding is not possible for the first 4 months of life. There is no evidence for preventive dietary intervention neither during pregnancy nor lactation...... populations. These theories remain to be documented in proper, controlled and prospective studies. Breastfeeding and the late introduction of solid foods (>4 months) is associated with a reduced risk of food allergy, atopic dermatitis, and recurrent wheezing and asthma in early childhood. In all infants....... Preventive dietary restrictions after the age of 4-6 months are not scientifically documented....
Full Text Available The recent Ebola virus disease (EVD outbreak in West Africa has spread wider than any previous human EVD epidemic. While individual-level risk factors that contribute to the spread of EVD have been studied, the population-level attributes of subnational regions associated with outbreak severity have not yet been considered.To investigate the area-level predictors of EVD dynamics, we integrated time series data on cumulative reported cases of EVD from the World Health Organization and covariate data from the Demographic and Health Surveys. We first estimated the early growth rates of epidemics in each second-level administrative district (ADM2 in Guinea, Sierra Leone and Liberia using exponential, logistic and polynomial growth models. We then evaluated how these growth rates, as well as epidemic size within ADM2s, were ecologically associated with several demographic and socio-economic characteristics of the ADM2, using bivariate correlations and multivariable regression models.The polynomial growth model appeared to best fit the ADM2 epidemic curves, displaying the lowest residual standard error. Each outcome was associated with various regional characteristics in bivariate models, however in stepwise multivariable models only mean education levels were consistently associated with a worse local epidemic.By combining two common methods-estimation of epidemic parameters using mathematical models, and estimation of associations using ecological regression models-we identified some factors predicting rapid and severe EVD epidemics in West African subnational regions. While care should be taken interpreting such results as anything more than correlational, we suggest that our approach of using data sources that were publicly available in advance of the epidemic or in real-time provides an analytic framework that may assist countries in understanding the dynamics of future outbreaks as they occur.
Herbst, Jeffrey H.; Glassman, Marlene; Carey, James W.; Painter, Thomas M.; Gelaude, Deborah J.; Fasula, Amy M.; Raiford, Jerris L.; Freeman, Arin E.; Harshbarger, Camilla; Viall, Abigail H.; Purcell, David W.
The HIV/AIDS epidemic in the United States continues despite several recent noteworthy advances in HIV prevention. Contemporary approaches to HIV prevention involve implementing combinations of biomedical, behavioral, and structural interventions in novel ways to achieve high levels of impact on the epidemic. Methods are needed to develop optimal combinations of approaches for improving efficiency, effectiveness, and scalability. This article argues that operational research offers promise as a valuable tool for addressing these issues. We define operational research relative to domestic HIV prevention, identify and illustrate how operational research can improve HIV prevention, and pose a series of questions to guide future operational research. Operational research can help achieve national HIV prevention goals of reducing new infections, improving access to care and optimization of health outcomes of people living with HIV, and reducing HIV-related health disparities. PMID:22217681
Ibrahim, Najihah; Akhir, Nur Shazwani Md.; Hassan, Fadratul Hafinaz
Epidemic disease outbreak had caused nowadays community to raise their great concern over the infectious disease controlling, preventing and handling methods to diminish the disease dissemination percentage and infected area. Backpropagation method was used for the counter measure and prediction analysis of the epidemic disease. The predictive analysis based on the backpropagation method can be determine via machine learning process that promotes the artificial intelligent in pattern recognition, statistics and features selection. This computational learning process will be integrated with data mining by measuring the score output as the classifier to the given set of input features through classification technique. The classification technique is the features selection of the disease dissemination factors that likely have strong interconnection between each other in causing infectious disease outbreaks. The predictive analysis of epidemic disease in determining the infected area was introduced in this preliminary study by using the backpropagation method in observation of other's findings. This study will classify the epidemic disease dissemination factors as the features for weight adjustment on the prediction of epidemic disease outbreaks. Through this preliminary study, the predictive analysis is proven to be effective method in determining the epidemic disease infected area by minimizing the error value through the features classification.
Dassau, Eyal; Jovanovic, Lois; Doyle, Francis J; Zisser, Howard C
Intensive insulin therapy has an inherent risk of hypoglycemia that can lead to loss of consciousness, cardiac arrhythmia, seizure, and death ("dead-in-bed syndrome"). This risk of hypoglycemia is a major concern for patients, families, and physicians. The need for an automated system that can alert in the event of severe hypoglycemia is evident. In engineering systems, where there is a risk of malfunction of the primary control system, alert and safety mechanisms are implemented in layers of protection. This concept has been adopted in the proposed system that integrates a hypoglycemia prediction algorithm with a global position system (GPS) locator and short message service such that the current glucose value with the rate of change (ROC) and the location of the subject can be communicated to a predefined list. Furthermore, if the system is linked to the insulin pump, it can suspend the pump or decrease the basal insulin infusion rate to prevent the pending event. The system was evaluated on clinical datasets of glucose tracings from the DexCom Seven system. Glucose tracings were analyzed for hypoglycemia events and then a text message was broadcast to a predefined list of people who were notified with the glucose value, ROC, GPS coordinates, and a Google map of the location. In addition to providing a safety layer to a future artificial pancreas, this system also can be easily implemented in current continuous glucose monitors to help provide information and alerts to people with diabetes.
This 60 second public service announcement is based on the July 2015 CDC Vital Signs report. Heroin use and heroin-related overdose deaths are increasing. Most people are using it with other drugs, especially prescription opioid painkillers. Learn what can be done to prevent and treat the problem. Created: 7/7/2015 by National Center for Injury Prevention and Control (NCIPC). Date Released: 7/7/2015.
Allen, Linda J S
This monograph provides a summary of the basic theory of branching processes for single-type and multi-type processes. Classic examples of population and epidemic models illustrate the probability of population or epidemic extinction obtained from the theory of branching processes. The first chapter develops the branching process theory, while in the second chapter two applications to population and epidemic processes of single-type branching process theory are explored. The last two chapters present multi-type branching process applications to epidemic models, and then continuous-time and continuous-state branching processes with applications. In addition, several MATLAB programs for simulating stochastic sample paths are provided in an Appendix. These notes originated as part of a lecture series on Stochastics in Biological Systems at the Mathematical Biosciences Institute in Ohio, USA. Professor Linda Allen is a Paul Whitfield Horn Professor of Mathematics in the Department of Mathematics and Statistics ...
Sharp, Tyler M; Moreira, Rosa; Soares, Maria José; Miguel da Costa, Lúis; Mann, Jennifer; DeLorey, Mark; Hunsperger, Elizabeth; Muñoz-Jordán, Jorge L; Colón, Candimar; Margolis, Harold S; de Caravalho, Adelaide; Tomashek, Kay M
During the 2013 dengue epidemic in Luanda, Angola, 811 dengue rapid diagnostic test-positive cases were reported to the Ministry of Health. To better understand the magnitude of the epidemic and identify risk factors for dengue virus (DENV) infection, we conducted cluster surveys around households of case-patients and randomly selected households 6 weeks after the peak of the epidemic. Of 173 case cluster participants, 16 (9%) exhibited evidence of recent DENV infection. Of 247 random cluster participants, 25 (10%) had evidence of recent DENV infection. Of 13 recently infected participants who had a recent febrile illness, 7 (54%) had sought medical care, and 1 (14%) was hospitalized with symptoms consistent with severe dengue; however, none received a diagnosis of dengue. Behavior associated with protection from DENV infection included recent use of mosquito repellent or a bed net. These findings suggest that the 2013 dengue epidemic was larger than indicated by passive surveillance data.
Roy, Manojit; Zinck, Richard D.; Bouma, Menno J.; Pascual, Mercedes
Cholera is on the rise globally, especially epidemic cholera which is characterized by intermittent and unpredictable outbreaks that punctuate periods of regional disease fade-out. These epidemic dynamics remain however poorly understood. Here we examine records for epidemic cholera over both contemporary and historical timelines, from Africa (1990-2006) and former British India (1882-1939). We find that the frequency distribution of outbreak size is fat-tailed, scaling approximately as a power-law. This pattern which shows strong parallels with wildfires is incompatible with existing cholera models developed for endemic regions, as it implies a fundamental role for stochastic transmission and local depletion of susceptible hosts. Application of a recently developed forest-fire model indicates that epidemic cholera dynamics are located above a critical phase transition and propagate in similar ways to aggressive wildfires. These findings have implications for the effectiveness of control measures and the mechanisms that ultimately limit the size of outbreaks.
Bosman A; Mulder YM; Leeuw JRJ de; Meijer A; Du Ry van Beest Holle M; Kamst RA; Velden PG van der; Conyn-van Spaendonck MAE; Koopmans MPG; Ruijten MWMM; Instituut voor Psychotrauma; CIE; MGO; LIS
Executive summary Avian flu epidemic 2003: public health consequences.Risk factors, health, well-being, health care needs and preventive measures during the H7N7 avian flu outbreak control in the Netherlands.An estimated thousand people, possibly more have been infected with avian flu during the
Surveillance for HIV as a public health initiative requires timely, detailed and robust data to systematically understand burden of infection, transmission patterns, direct prevention efforts, guide funding, identify new infections and predict future trends in the epidemic. The methods for HIV surveillance have evolved to reliably ...
Fofana, Abdou Moutalab; Hurford, Amy
An overlooked aspect of disease ecology is considering how and why animals come into contact with one and other resulting in disease transmission. Mathematical models of disease spread frequently assume mass-action transmission, justified by stating that susceptible and infectious hosts mix readily, and foregoing any detailed description of host movement. Numerous recent studies have recorded, analysed and modelled animal movement. These movement models describe how animals move with respect to resources, conspecifics and previous movement directions and have been used to understand the conditions for the occurrence and the spread of infectious diseases when hosts perform a type of movement. Here, we summarize the effect of the different types of movement on the threshold conditions for disease spread. We identify gaps in the literature and suggest several promising directions for future research. The mechanistic inclusion of movement in epidemic models may be beneficial for the following two reasons. Firstly, the estimation of the transmission coefficient in an epidemic model is possible because animal movement data can be used to estimate the rate of contacts between conspecifics. Secondly, unsuccessful transmission events, where a susceptible host contacts an infectious host but does not become infected can be quantified. Following an outbreak, this enables disease ecologists to identify 'near misses' and to explore possible alternative epidemic outcomes given shifts in ecological or immunological parameters.This article is part of the themed issue 'Opening the black box: re-examining the ecology and evolution of parasite transmission'. © 2017 The Author(s).
Full Text Available Dengue fever (DF is a common and rapidly spreading vector-borne viral disease in tropical and subtropical regions. In recent years, this imported disease has posed an increasing threat to public health in China, especially in many southern cities. Although the severity of DF outbreaks in these cities is generally associated with known risk factors at various administrative levels, spatial heterogeneities of these associations remain little understood on a finer scale. In this study, the neighboring Guangzhou and Foshan (GF cities were considered as a joint area for characterizing the spatial variations in the 2014 DF epidemic at various grid levels from 1 × 1 km2 to 6 × 6 km2. On an appropriate scale, geographically weighted regression (GWR models were employed to interpret the influences of socioeconomic and environmental factors on this epidemic across the GF area. DF transmissions in Guangzhou and Foshan cities presented synchronous temporal changes and spatial expansions during the main epidemic months. Across the GF area, this epidemic was obviously spatially featured at various grid levels, especially on the 2 × 2 km2 scale. Its spatial variations were relatively sufficiently explained by population size, road density, and economic status integrated in the GWR model with the lowest Akaike Information Criterion (AICc = 5227.97 and highest adjusted R square (0.732 values. These results indicated that these three socioeconomic factors acted as geographical determinants of spatial variability of the 2014 DF epidemic across the joint GF area, although some other potential factors should be added to improve the explaining the spatial variations in the central zones. This work improves our understanding of the effects of socioeconomic conditions on the spatial variations in this epidemic and helps local hygienic authorities to make targeted joint interventions for preventing and controlling this epidemic across the GF area.
Ocwieja, Karen E.; Fernando, Anira N.; Sherrill-Mix, Scott; Sundararaman, Sesh A.; Tennekoon, Rashika N.; Tippalagama, Rashmi; Krishnananthasivam, Shivankari; Premawansa, Gayani; Premawansa, Sunil; De Silva, Aruna Dharshan
In 2009, a severe epidemic of dengue disease occurred in Sri Lanka, with higher mortality and morbidity than any previously recorded epidemic in the country. It corresponded to a shift to dengue virus 1 as the major disease-causing serotype in Sri Lanka. Dengue disease reached epidemic levels in the next 3 years. We report phylogenetic evidence that the 2009 epidemic DENV-1 strain continued to circulate within the population and caused severe disease in the epidemic of 2012. Bayesian phylogeographic analyses suggest that the 2009 Sri Lankan epidemic DENV-1 strain may have traveled directly or indirectly from Thailand through China to Sri Lanka, and after spreading within the Sri Lankan population, it traveled to Pakistan and Singapore. Our findings delineate the dissemination route of a virulent DENV-1 strain in Asia. Understanding such routes will be of particular importance to global control efforts. PMID:24799375
Nian, Fuzhong; Yao, Shuanglong
Based on the stress responses of individuals, the susceptible-infected-susceptible epidemic model was improved on the small-world networks and BA scale-free networks and the simulations were implemented and analyzed. Results indicate that the behaviors of individual’s stress responses could induce the epidemic spreading resistance and adaptation at the network level. This phenomenon showed that networks were learning how to adapt to the disease and the evolution process could improve their immunization to future infectious diseases and would effectively prevent the spreading of infectious diseases.
Pérez-Reche, Francisco J; Neri, Franco M; Taraskin, Sergei N; Gilligan, Christopher A
Predictability of undesired events is a question of great interest in many scientific disciplines including seismology, economy and epidemiology. Here, we focus on the predictability of invasion of a broad class of epidemics caused by diseases that lead to permanent immunity of infected hosts after recovery or death. We approach the problem from the perspective of the science of complexity by proposing and testing several strategies for the estimation of important characteristics of epidemics, such as the probability of invasion. Our results suggest that parsimonious approximate methodologies may lead to the most reliable and robust predictions. The proposed methodologies are first applied to analysis of experimentally observed epidemics: invasion of the fungal plant pathogen Rhizoctonia solani in replicated host microcosms. We then consider numerical experiments of the susceptible-infected-removed model to investigate the performance of the proposed methods in further detail. The suggested framework can be used as a valuable tool for quick assessment of epidemic threat at the stage when epidemics only start developing. Moreover, our work amplifies the significance of the small-scale and finite-time microcosm realizations of epidemics revealing their predictive power.
Pastor-Satorras, Romualdo; Castellano, Claudio; Van Mieghem, Piet; Vespignani, Alessandro
In recent years the research community has accumulated overwhelming evidence for the emergence of complex and heterogeneous connectivity patterns in a wide range of biological and sociotechnical systems. The complex properties of real-world networks have a profound impact on the behavior of equilibrium and nonequilibrium phenomena occurring in various systems, and the study of epidemic spreading is central to our understanding of the unfolding of dynamical processes in complex networks. The theoretical analysis of epidemic spreading in heterogeneous networks requires the development of novel analytical frameworks, and it has produced results of conceptual and practical relevance. A coherent and comprehensive review of the vast research activity concerning epidemic processes is presented, detailing the successful theoretical approaches as well as making their limits and assumptions clear. Physicists, mathematicians, epidemiologists, computer, and social scientists share a common interest in studying epidemic spreading and rely on similar models for the description of the diffusion of pathogens, knowledge, and innovation. For this reason, while focusing on the main results and the paradigmatic models in infectious disease modeling, the major results concerning generalized social contagion processes are also presented. Finally, the research activity at the forefront in the study of epidemic spreading in coevolving, coupled, and time-varying networks is reported.
Mutevedzi, Portia C; Newell, Marie-Louise
The widespread roll-out of antiretroviral therapy (ART) has substantially changed the face of human immunodeficiency virus (HIV). Timely initiation of ART in HIV-infected individuals dramatically reduces mortality and improves employment rates to levels prior to HIV infection. Recent findings from several studies have shown that ART reduces HIV transmission risk even with modest ART coverage of the HIV-infected population and imperfect ART adherence. While condoms are highly effective in the prevention of HIV acquisition, they are compromised by low and inconsistent usage; male medical circumcision substantially reduces HIV transmission but uptake remains relatively low; ART during pregnancy, delivery and breastfeeding can virtually eliminate mother-to-child transmission but implementation is challenging, especially in resource-limited settings. The current HIV prevention recommendations focus on a combination of preventions approach, including ART as treatment or pre- or post-exposure prophylaxis together with condoms, circumcision and sexual behaviour modification. Improved survival in HIV-infected individuals and reduced HIV transmission risk is beginning to result in limited HIV incidence decline at population level and substantial increases in HIV prevalence. However, achievements in HIV treatment and prevention are threatened by the challenges of lifelong adherence to preventive and therapeutic methods and by the ageing of the HIV-infected cohorts potentially complicating HIV management. Although current thinking suggests prevention of HIV transmission through early detection of infection immediately followed by ART could eventually result in elimination of the HIV epidemic, controversies remain as to whether we can treat our way out of the HIV epidemic. © 2014 John Wiley & Sons Ltd.
Bowser, Benjamin; Fullilove, Robert; Word, Carl
Heroin abuse as an outcome of the prior use of painkillers increased rapidly over the past decade. This "new epidemic" is unique because the new heroin users are primarily young White Americans in rural areas of virtually every state. This commentary argues that the painkiller-to-heroin transition could not be the only cause of heroin use on such a scale and that the new and old heroin epidemics are linked. The social marketing that so successfully drove the old heroin epidemic has innovated and expanded due to the use of cell-phones, text messaging and the "dark web" which requires a Tor browser, and software that allows one to communicate with encrypted sites without detection. Central city gentrification has forced traffickers to take advantage of larger and more lucrative markets. A second outcome is that urban black and Latino communities are no longer needed as heroin stages areas for suburban and exurban illicit drug distribution. Drug dealing can be done directly in predominantly white suburbs and rural areas without the accompanying violence associated with the old epidemic. Denial of the link between the new and old heroin epidemics racially segregates heroin users and more proactive prevention and treatment in the new epidemic than in the old. It also cuts off a half-century of knowledge about the supply-side of heroin drug dealing and the inevitable public policy measures that will have to be implemented to effectively slow and stop both the old and new epidemic. Copyright © 2016 National Medical Association. Published by Elsevier Inc. All rights reserved.
Sadun, A A; Martone, J F; Muci-Mendoza, R; Reyes, L; DuBois, L; Silva, J C; Roman, G; Caballero, B
To characterize and establish a clinical definition of the optic neuropathy that appeared in epidemic form in Cuba in 1992 and 1993. At the invitation of the Cuban Ministry of Health, Havana, members of ORBIS International and the Pan American Health Organization, assembled teams that traveled to Cuba in May 1993. We were initially briefed by Cuban national experts in the areas of virology, nutrition, toxicology, ophthalmology, neurology, and public health. We then examined 20 patients on our own. Thirteen of these patients underwent a comprehensive neuro-ophthalmologic examination, including neurologic examination, ophthalmologic examination, visual fields, optic nerve function studies, contrast sensitivity studies, and funduscopy. We returned 4 months later to perform an additional 12 comprehensive neuro-ophthalmologic and follow-up examinations. Only seven of the 13 patients who were alleged to have the optic form of the epidemic and who were rigorously and systematically examined on the first visit demonstrated a bilateral optic neuropathy. These seven patients had several features that included decreased visual acuity, poor color vision, central scotomas, decreased contrast sensitivity, saccadic eye movements, and most prominent and distinctive of all, nerve fiber layer wedge defects of the papillomacular bundle. Our clinical definition was then implemented by the Cuban ophthalmologists and epidemiologists. On returning 4 months later, we found that all newly presented patients were correctly diagnosed to have the epidemic disease. With the new case definition and the application of a few simple psychophysical tests, the false-positive rate of diagnosis became much lower. After vitamin therapy, we reexamined the patients seen on our initial visit, and all showed marked improvement. The Cuban epidemic was characterized by an optic neuropathy with features that were similar to those of tobacco/alcohol amblyopia and Leber's optic atrophy. Recent political
G.G. Brusselle (Guy); C. VanderStichele (Christine); P. Jordens (Paul); R. Deman (René); H. Slabbynck (Hans); V. Ringoet (Veerle); G. Verleden (Geert); I.K. Demedts (Ingel); K.M.C. Verhamme (Katia); A. Delporte (Anja); B. Demeyere (Bénédicte); T. Claeys (Tine); J. Boelens (Jerina); E. Padalko (Elizaveta); J. Verschakelen (Johny); G. van Maele (Georges); E. Deschepper (Ellen); G.F. Joos (Guy)
markdownabstract__Background:__ Patients with severe asthma are at increased risk of exacerbations and lower respiratory tract infections (LRTI). Severe asthma is heterogeneous, encompassing eosinophilic and non-eosinophilic (mainly neutrophilic) phenotypes. Patients with neutropilic airway diseases
We study a susceptible-infected-susceptible epidemic process over a static contact network where the nodes have partial information about the epidemic state. They react by limiting their interactions with their neighbors when they believe the epidemic is currently prevalent. A node\\'s awareness is weighted by the fraction of infected neighbors in their social network, and a global broadcast of the fraction of infected nodes in the entire network. The dynamics of the benchmark (no awareness) and awareness models are described by discrete-time Markov chains, from which mean-field approximations (MFAs) are derived. The states of the MFA are interpreted as the nodes\\' probabilities of being infected. We show a sufficient condition for the existence of a
Azaele, Sandro; Maritan, Amos; Bertuzzo, Enrico; Rodriguez-Iturbe, Ignacio; Rinaldo, Andrea
We describe the predictions of an analytically tractable stochastic model for cholera epidemics following a single initial outbreak. The exact model relies on a set of assumptions that may restrict the generality of the approach and yet provides a realm of powerful tools and results. Without resorting to the depletion of susceptible individuals, as usually assumed in deterministic susceptible-infected-recovered models, we show that a simple stochastic equation for the number of ill individuals provides a mechanism for the decay of the epidemics occurring on the typical time scale of seasonality. The model is shown to provide a reasonably accurate description of the empirical data of the 2000/2001 cholera epidemic which took place in the Kwa Zulu-Natal Province, South Africa, with possibly notable epidemiological implications.
Ben-Naim, E.; Krapivsky, P. L.
We study the classic Susceptible-Infected-Recovered (SIR) model for the spread of an infectious disease. In this stochastic process, there are two competing mechanism: infection and recovery. Susceptible individuals may contract the disease from infected individuals, while infected ones recover from the disease at a constant rate and are never infected again. Our focus is the behavior at the epidemic threshold where the rates of the infection and recovery processes balance. In the infinite population limit, we establish analytically scaling rules for the time-dependent distribution functions that characterize the sizes of the infected and the recovered sub-populations. Using heuristic arguments, we also obtain scaling laws for the size and duration of the epidemic outbreaks as a function of the total population. We perform numerical simulations to verify the scaling predictions and discuss the consequences of these scaling laws for near-threshold epidemic outbreaks.
Allaranga, Yokouide; Kone, Mamadou Lamine; Formenty, Pierre; Libama, Francois; Boumandouki, Paul; Woodfill, Celia J I; Sow, Idrissa; Duale, Sambe; Alemu, Wondimagegnehu; Yada, Adamou
To review epidemiological surveillance approaches used during Ebola and Marburg hemorrhagic fever epidemics in Africa in the past fifteen years. Overall, 26 hemorrhagic epidemic outbreaks have been registered in 12 countries; 18 caused by the Ebola virus and eight by the Marburg virus. About 2551 cases have been reported, among which 268 were health workers (9,3%). Based on articles and epidemic management reports, this review analyses surveillance approaches, route of introduction of the virus into the population (urban and rural), the collaboration between the human health sector and the wildlife sector and factors that have affected epidemic management. Several factors affecting the epidemiological surveillance during Ebola and Marburg viruses hemorrhagic epidemics have been observed. During epidemics in rural settings, outbreak investigations have shown multiple introductions of the virus into the human population through wildlife. In contrast, during epidemics in urban settings a single introduction of the virus in the community was responsible for the epidemic. Active surveillance is key to containing outbreaks of Ebola and Marburg viruses Collaboration with those in charge of the conservation of wildlife is essential for the early detection of viral hemorrhagic fever epidemics. Hemorrhagic fever epidemics caused by Ebola and Marburg viruses are occurring more and more frequently in Sub-Saharan Africa and only an adapted epidemiological surveillance system will allow for early detection and effective response.
Regan, Mary Elana
Youth violence in the city of Philadelphia, PA, has reached epidemic proportions. The majority of homicides related to gun violence is most prevalent among African American males aged 19 to 24 years. Therefore, it is essential to implement youth violence prevention programs to a target population several years younger than this age group to…
Mitchell, Nia; Catenacci, Vicki; Wyatt, Holly R.; Hill, James O.
Despite growing recognition of the problem, the obesity epidemic continues in the U.S., and obesity rates are increasing around the world. The latest estimates are that approximately 34% of adults and 15–20% of children and adolescents in the U.S. are obese. Obesity affects every segment of the U.S. population. Obesity increases the risk of many chronic diseases in children and adults. The epidemic of obesity arose gradually over time, apparently from a small, consistent degree of positive en...
Wetzel, Eunike; Brown, Anna; Hill, Patrick; Chung, J.M.H.; Robins, R.W.; Roberts, B.W.
Are recent cohorts of college students more narcissistic than their predecessors? To address debates about the so-called “narcissism epidemic,” we used data from three cohorts of students (N1990s = 1,166; N2000s = 33,647; N2010s = 25,412) to test whether narcissism levels (overall and specific
Aug 26, 2014 ... Method: 'Know your epidemic' synthesis suggests that HIV prevalence is rising in older age groups and falling in younger people. Using secondary data analyses of population-based and antenatal care surveillance (ANC) surveys, we explored trends and patterns in HIV prevalence in KwaZulu-Natal and ...
Ernst Kacey C
Full Text Available Abstract Background Malaria epidemics in highland areas of East Africa have caused considerable morbidity and mortality in the past two decades. Knowledge of "hotspot" areas of high malaria incidence would allow for focused preventive interventions in resource-poor areas, particularly if the hotspot areas can be discerned during non-epidemic periods and predicted by ecological factors. Methods To address this issue, spatial distribution of malaria incidence and the relationship of ecological factors to malaria incidence were assessed in the highland area of Kipsamoite, Kenya, from 2001–2004. Results Clustering of disease in a single geographic "hotspot" area occurred in epidemic and non-epidemic years, with a 2.6 to 3.2-fold increased risk of malaria inside the hotspot, as compared to outside the area (P Conclusion In this highland area, areas of high malaria risk are consistent in epidemic and non-epidemic years and are associated with specific ecological risk factors. Ongoing interventions in areas of ecological risk factors could be a cost-effective method of significantly reducing malaria incidence and blunting or preventing epidemics, even in the absence of malaria early warning systems. Further studies should be conducted to see if these findings hold true in varied highland settings.
Frerichs, R R; Keim, P S; Barrais, R; Piarroux, R
Cholera appeared in Haiti in October 2010 for the first time in recorded history. The causative agent was quickly identified by the Haitian National Public Health Laboratory and the United States Centers for Disease Control and Prevention as Vibrio cholerae serogroup O1, serotype Ogawa, biotype El Tor. Since then, >500 000 government-acknowledged cholera cases and >7000 deaths have occurred, the largest cholera epidemic in the world, with the real death toll probably much higher. Questions of origin have been widely debated with some attributing the onset of the epidemic to climatic factors and others to human transmission. None of the evidence on origin supports climatic factors. Instead, recent epidemiological and molecular-genetic evidence point to the United Nations peacekeeping troops from Nepal as the source of cholera to Haiti, following their troop rotation in early October 2010. Such findings have important policy implications for shaping future international relief efforts. © 2012 The Authors. Clinical Microbiology and Infection © 2012 European Society of Clinical Microbiology and Infectious Diseases.
Lefèvre, Claude; Picard, Philippe
This collection of papers gives a representative cross-selectional view of recent developments in the field. After a survey paper by C. Lefèvre, 17 other research papers look at stochastic modeling of epidemics, both from a theoretical and a statistical point of view. Some look more specifically at a particular disease such as AIDS, malaria, schistosomiasis and diabetes.
Schiøler, Henrik; Nielsen, Jens Frederik Dalsgaard; Ngo, Trung Dung
Clock synchronization in swarms of networked mobile robots is studied in a probabilistic, epidemic framework. In this setting communication and synchonization is considered to be a randomized process, taking place at unplanned instants of geographical rendezvous between robots. In combination...... as an infinite-dimensional optimal controlproblem. Illustrative numerical examples are given and commented....
Courtwright, David T.
Discusses the wave of cocaine abuse that followed the drug's recommendation by the late nineteenth-century medical community as a cure all. Details drug addiction among ethnic and social groups at the turn of the century. Warns that drug epidemics have important social and legal consequences. Suggests legal pressure may alter the form of drug…
... About the Epidemic Help, Resources and Information National Opioids Crisis Search Search National Helpline SAMHSA’s National Helpline ... 1-800-662-4357 Visit Helpline Website THE OPIOID EPIDEMIC IN NUMBERS 80% Nearly 80% of heroin ...
Full Text Available At the beginning of the 18th century, the Provence region was hit by several severe epidemics whose causes are still not clearly understood.To draw up epidemic profiles and to identify the pathogenic agents concerned, we constituted a large onomastic database and built ageographic information system for Martigues, a medium-sized community in the south of France. The cross-linking of epidemiological,spatial and demographical data allows us to propose a new diagnosis for the epidemic which reached Martigues in the autumn of 1705.
Vecchi, G. A.; Munoz, A. G.; Thomson, M. C.; Stewart-Ibarra, A. M.; Chourio, X.; Nájera, P.; Moran, Z.; Yang, X.
Given knowledge at the time, the recent 2015-2016 zika virus (ZIKV) epidemic probably could not have been predicted. Without the prior knowledge of ZIKV being already present in South America, and given the lack of understanding of key epidemiologic processes and long-term records of ZIKV cases in the continent, the best related prediction could be carried out for the potential risk of a generic Aedes-borne disease epidemic. Here we use a recently published two-vector basic reproduction number model to assess the predictability of the conditions conducive to epidemics of diseases like zika, chikungunya, or dengue, transmitted by the independent or concurrent presence of Aedes aegypti and Aedes albopictus. We compare the potential risk of transmission forcing the model with the observed climate and with state-of-the-art operational forecasts from the North American Multi Model Ensemble (NMME), finding that the predictive skill of this new seasonal forecast system is highest for multiple countries in Latin America and the Caribbean during the December-February and March-May seasons, and slightly lower—but still of potential use to decision-makers—for the rest of the year. In particular, we find that above-normal suitable conditions for the occurrence of the zika epidemic at the beginning of 2015 could have been successfully predicted at least 1 month in advance for several zika hotspots, and in particular for Northeast Brazil: the heart of the epidemic. Nonetheless, the initiation and spread of an epidemic depends on the effect of multiple factors beyond climate conditions, and thus this type of approach must be considered as a guide and not as a formal predictive tool of vector-borne epidemics.
Ángel G. Muñoz
Full Text Available Given knowledge at the time, the recent 2015–2016 zika virus (ZIKV epidemic probably could not have been predicted. Without the prior knowledge of ZIKV being already present in South America, and given the lack of understanding of key epidemiologic processes and long-term records of ZIKV cases in the continent, the best related prediction could be carried out for the potential risk of a generic Aedes-borne disease epidemic. Here we use a recently published two-vector basic reproduction number model to assess the predictability of the conditions conducive to epidemics of diseases like zika, chikungunya, or dengue, transmitted by the independent or concurrent presence of Aedes aegypti and Aedes albopictus. We compare the potential risk of transmission forcing the model with the observed climate and with state-of-the-art operational forecasts from the North American Multi Model Ensemble (NMME, finding that the predictive skill of this new seasonal forecast system is highest for multiple countries in Latin America and the Caribbean during the December-February and March-May seasons, and slightly lower—but still of potential use to decision-makers—for the rest of the year. In particular, we find that above-normal suitable conditions for the occurrence of the zika epidemic at the beginning of 2015 could have been successfully predicted at least 1 month in advance for several zika hotspots, and in particular for Northeast Brazil: the heart of the epidemic. Nonetheless, the initiation and spread of an epidemic depends on the effect of multiple factors beyond climate conditions, and thus this type of approach must be considered as a guide and not as a formal predictive tool of vector-borne epidemics.
During the late 20th century numerical rating scales became central to the diagnosis of dementia and helped transform attitudes about its causes and prevalence. Concentrating largely on the development and use of the Blessed Dementia Scale, I argue that rating scales served professional ends during the 1960s and 1970s. They helped old age psychiatrists establish jurisdiction over conditions such as dementia and present their field as a vital component of the welfare state, where they argued that ‘reliable modes of diagnosis’ were vital to the allocation of resources. I show how these arguments appealed to politicians, funding bodies and patient groups, who agreed that dementia was a distinct disease and claimed research on its causes and prevention should be designated ‘top priority’. But I also show that worries about the replacement of clinical acumen with technical and depersonalized methods, which could conceivably be applied by anyone, led psychiatrists to stress that rating scales had their limits and could be used only by trained experts. PMID:25866448
2015 Epidemic of Severe Streptococcus agalactiae Sequence Type 283 Infections in Singapore Associated With the Consumption of Raw Freshwater Fish: A Detailed Analysis of Clinical, Epidemiological, and Bacterial Sequencing Data.
Kalimuddin, Shirin; Chen, Swaine L; Lim, Cindy T K; Koh, Tse Hsien; Tan, Thean Yen; Kam, Michelle; Wong, Christopher W; Mehershahi, Kurosh S; Chau, Man Ling; Ng, Lee Ching; Tang, Wen Ying; Badaruddin, Hishamuddin; Teo, Jeanette; Apisarnthanarak, Anucha; Suwantarat, Nuntra; Ip, Margaret; Holden, Matthew T G; Hsu, Li Yang; Barkham, Timothy
Streptococcus agalactiae (group B Streptococcus [GBS]) has not been described as a foodborne pathogen. However, in 2015, a large outbreak of severe invasive sequence type (ST) 283 GBS infections in adults epidemiologically linked to the consumption of raw freshwater fish occurred in Singapore. We attempted to determine the scale of the outbreak, define the clinical spectrum of disease, and link the outbreak to contaminated fish. Time-series analysis was performed on microbiology laboratory data. Food handlers and fishmongers were screened for enteric carriage of GBS. A retrospective cohort study was conducted to assess differences in demographic and clinical characteristics of patients with invasive ST283 and non-ST283 infections. Whole-genome sequencing was performed on human and fish ST283 isolates from Singapore, Thailand, and Hong Kong. The outbreak was estimated to have started in late January 2015. Within the study cohort of 408 patients, ST283 accounted for 35.8% of cases. Patients with ST283 infection were younger and had fewer comorbidities but were more likely to develop meningoencephalitis, septic arthritis, and spinal infection. Of 82 food handlers and fishmongers screened, none carried ST283. Culture of 43 fish samples yielded 13 ST283-positive samples. Phylogenomic analysis of 161 ST283 isolates from humans and fish revealed they formed a tight clade distinguished by 93 single-nucleotide polymorphisms. ST283 is a zoonotic GBS clone associated with farmed freshwater fish, capable of causing severe disease in humans. It caused a large foodborne outbreak in Singapore and poses both a regional and potentially more widespread threat. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: email@example.com.
Faruque, Shah M; Islam, M Johirul; Ahmad, Qazi Shafi; Biswas, Kuntal; Faruque, A S G; Nair, G Balakrish; Sack, R Bradley; Sack, David A; Mekalanos, John J
Predicting cholera epidemics through monitoring the environment for the presence of pathogenic Vibrio cholerae is complicated by the presence in water of a large number of mostly nonpathogenic V. cholerae strains. V. cholerae strains causing recent cholera epidemics in Bangladesh carry the sulfamethoxazole-trimethoprim (SXT) element, which encodes resistance to several antibiotics. Here, we show that the use of a culture medium containing streptomycin, sulfamethoxazole, and trimethoprim (the antibiotic selection technique [AST]) can significantly enhance the isolation of environmental V. cholerae O1 with epidemic potential (Pantibiotic-resistant strain of V. cholerae in Bangladesh. The results of this study support the hypothesis that pre-epidemic amplification of pathogenic V. cholerae occurs in the human host and leads to the start of an epidemic cycle dominated by a single clone of V. cholerae that spreads rapidly through environmental waters.
Schultz et al (2008) raised the question whether regression into autism is triggered, not by the measles-mumps-rubella (MMR) vaccine, but by acetaminophen (Tylenol) given for its fever and pain. Considerable evidence supports this contention, most notably the exponential rise in the incidence of autism since 1980, when acetaminophen began to replace aspirin for infants and young children. The impetus for this shift - a Centers for Disease Control and Prevention warning that aspirin was associated with Reye's syndrome - has since been compellingly debunked. If aspirin is not to be feared as a cause of Reyes syndrome, and acetaminophen is to be feared as a cause of autism, can the autism epidemic be reversed by replacing acetaminophen with aspirin or other remedies?
Bailey, James E; Gibson, Deborah V; Jain, Manoj; Connelly, Stephanie A; Ryder, Kathryn M; Dagogo-Jack, Samuel
This paper summarizes the results of a recent report on diabetes in Tennessee. Diabetes has reached epidemic proportions in Tennessee. In 2001, an estimated 7.7% of the population was diabetic, an increase from 5.8% a decade earlier. This increase is largely due to widespread unhealthy eating habits, physical inactivity, and associated obesity. The majority of diabetes is preventable and can be effectively treated through daily exercise and a healthy diet. Diabetes prevention efforts in Tennessee schools and communities, however, are grossly inadequate. Providers and payers underemphasize prevention. Since the causes of diabetes can be traced to childhood habits, early prevention is the key to reversing the diabetes epidemic. Immediate statewide action must be taken to promote daily exercise and decrease access to high-calorie, high-fat "junk" food in our schools and communities. Physicians, health professional organizations, health plans, government, churches, schools, and employers must work together to battle the diabetes epidemic through public education, community-wide health promotion programs, and efforts to improve quality of diabetes care for all Tennesseans.
Asagai, Yoshimi; Yamamoto, Kengo; Ohshiro, Toshio; Ohshiro, Takafumi
Bone metabolism in children with severe fractures was examined, risk factors for fractures were characterized, and effects of LED (light-emitting diode) irradiation on the risk factors for fractures were investigated. Since insufficiency fracture in children with severe cerebral palsy can be caused without obvious external force in daily care, it is sometimes handled as a medical accident and can lead to a lawsuit. It is very important to explain the possibility of an insufficiency fracture t...
Painter, James E.; Painter, Rosemary; Wang, Xinyue; Schuster, Margaret
Obesity has been increasing in all age groups worldwide for the past several decades. Yet for hundreds of years before the last quarter of the 20th century, obesity was not an issue. The etiology and the cure for the obesity epidemic have been elusive. Weight reduction diets and behavior therapy have not produced the desired results. Perhaps…
Bakker, P. J.; Danner, S. A.; Lange, J. M.; Veenhof, K. H.
Fourteen untreated patients with epidemic Kaposi's sarcoma stages III and IV were treated with etoposide 150 mg/m2 on 3 consecutive days every 4 weeks. No responses were observed. Myelosuppression was severe with white blood count WHO grade 3-4 in nine patients and with platelets WHO grade 3-4 in
Dastjerdi, Akbar; Carr, John; Ellis, Richard J; Steinbach, Falko; Williamson, Susanna
An outbreak of porcine epidemic diarrhea occurred in the summer of 2014 in Ukraine, severely affecting piglets <10 days of age; the mortality rate approached 100%. Full genome sequencing showed the virus to be closely related to strains reported from North America, showing a sequence identity of up to 99.8%.
Fagertun, Anna Manolova; Ruepp, Sarah Renée
In this paper we investigate epidemic failure spreading in large- scale GMPLS-controlled transport networks. By evaluating the effect of the epidemic failure spreading on the network, we design several strategies for cost-effective network performance improvement via differentiated repair times....... First we identify the most vulnerable and the most strategic nodes in the network. Then, via extensive simulations we show that strategic placement of resources for improved failure recovery has better performance than randomly assigning lower repair times among the network nodes. Our OPNET simulation...... model can be used during the network planning process for facilitating cost- effective network survivability design....
Fagertun, Anna Manolova; Ruepp, Sarah Renée
In this paper we investigate epidemic failure spreading in large- scale GMPLS-controlled transport networks. By evaluating the effect of the epidemic failure spreading on the network, we design several strategies for cost-effective network performance improvement via differentiated repair times....... First we identify the most vulnerable and the most strategic nodes in the network. Then, via extensive simulations we show that strategic placement of resources for improved failure recovery has better performance than randomly assigning lower repair times among the network nodes. Our OPNET simulation...
Fagertun, Anna Manolova; Ruepp, Sarah Renée; Manzano, Marc
In this study, the authors investigate epidemic failure spreading in large-scale transport networks under generalisedmulti-protocol label switching control plane. By evaluating the effect of the epidemic failure spreading on the network,they design several strategies for cost-effective network...... performance improvement via differentiated repair times. First, theyidentify the most vulnerable and the most strategic nodes in the network. Then, via extensive event-driven simulations theyshow that strategic placement of resources for improved failure recovery has better performance than randomly...
Westh, Henrik; Boye, Kit; Bartels, Mette Damkjær
INTRODUCTION: We have found an epidemic increase in methicillin-resistant Staphylococcus aureus (MRSA) in Copenhagen. The increase has a complex background and involves hospitals, nursing homes and persons nursed in their own home. MATERIAL AND METHODS: We found 33 MRSA patients in 2003 and 121...... in 2004. All isolates have been spa-typed and epidemiologic information collected. RESULTS: The number of MRSA cases has a doubling time of about six months. The epidemic has been caused by many different MRSA types and 31 staphylococcus protein A genotypes (spa types). MRSA has caused several hospital...
Full Text Available Abstract Background Malaria and Tuberculosis (TB are important causes of morbidity and mortality in Africa. Malaria prevention reduces mortality among HIV patients, pregnant women and children, but its role in TB patients is not clear. In the TB National Reference Center in Guinea-Bissau, admitted patients are in severe clinical conditions and mortality during the rainy season is high. We performed a three-step malaria prevention program to reduce mortality in TB patients during the rainy season. Methods Since 2005 Permethrin treated bed nets were given to every patient. Since 2006 environmental prevention with permethrin derivates was performed both indoor and outdoor during the rainy season. In 2007 cotrimoxazole prophylaxis was added during the rainy season. Care was without charge; health education on malaria prevention was performed weekly. Primary outcomes were death, discharge, drop-out. Results 427, 346, 549 patients were admitted in 2005, 2006, 2007, respectively. Mortality dropped from 26.46% in 2005 to 18.76% in 2007 (p-value 0.003, due to the significant reduction in rainy season mortality (death/discharge ratio: 0.79, 0.55 and 0.26 in 2005, 2006 and 2007 respectively; p-value 0.001 while dry season mortality remained constant (0.39, 0.37 and 0.32; p-value 0.647. Costs of malaria prevention were limited: 2€/person. No drop-outs were observed. Health education attendance was 96-99%. Conclusions Malaria prevention in African tertiary care hospitals seems feasible with limited costs. Vector control, personal protection and cotrimoxazole prophylaxis seem to reduce mortality in severely ill TB patients. Prospective randomized trials are needed to confirm our findings in similar settings. Trial registration number Current Controlled Trials: ISRCTN83944306
Leclerc, Benoit; Smallbone, Stephen; Wortley, Richard
The main aim of this study was to examine the effect of a potential guardian on the severity of child sexual abuse. Using data obtained on crime events from adult child sexual offenders incarcerated in Queensland (Australia), mixed-effects logistic regression analyses were conducted to examine the effect of potential guardianship on the severity of abuse. Controlling for victim and situational characteristics, the analyses showed that the presence of a potential guardian reduced the duration of sexual contact and the occurrence of penetration. Presence of a potential guardian decreased the risk of sexual penetration by 86%. The study highlights the importance of the presence of a potential guardian for reducing the severity of child sexual abuse, and suggests more broadly that guardianship may be an important protective factor in sexual offending. © The Author(s) 2013.
Full Text Available Isoniazid (INH monotherapy has gained widespread acceptance as an efficacious therapy for latent tuberculosis infection (LTBI especially in low-prevalence settings. Although INH related hepatotoxicity is well recognized, progression to severe liver dysfunction requiring care at a transplant center remains unpredictable. We report the management of a five year-old girl who developed progressive liver failure due to INH prophylaxis. This highlights the potential severity of INH related hepatic injury and underscores the significance of vigilant clinical monitoring throughout the duration of the therapy in children.
Brusselle, Guy G; Vanderstichele, Christine; Jordens, Paul; Deman, René; Slabbynck, Hans; Ringoet, Veerle; Verleden, Geert; Demedts, Ingel K; Verhamme, Katia; Delporte, Anja; Demeyere, Bénédicte; Claeys, Geert; Boelens, Jerina; Padalko, Elizaveta; Verschakelen, Johny; Van Maele, Georges; Deschepper, Ellen; Joos, Guy F P
Patients with severe asthma are at increased risk of exacerbations and lower respiratory tract infections (LRTI). Severe asthma is heterogeneous, encompassing eosinophilic and non-eosinophilic (mainly neutrophilic) phenotypes. Patients with neutropilic airway diseases may benefit from macrolides. We performed a randomised double-blind placebo-controlled trial in subjects with exacerbation-prone severe asthma. Subjects received low-dose azithromycin (n=55) or placebo (n=54) as add-on treatment to combination therapy of inhaled corticosteroids and long-acting β2 agonists for 6 months. The primary outcome was the rate of severe exacerbations and LRTI requiring treatment with antibiotics during the 26-week treatment phase. Secondary efficacy outcomes included lung function and scores on the Asthma Control Questionnaire (ACQ) and Asthma Quality of Life Questionnaire (AQLQ). The rate of primary endpoints (PEPs) during 6 months was not significantly different between the two treatment groups: 0.75 PEPs (95% CI 0.55 to 1.01) per subject in the azithromycin group versus 0.81 PEPs (95% CI 0.61 to 1.09) in the placebo group (p=0.682). In a predefined subgroup analysis according to the inflammatory phenotype, azithromycin was associated with a significantly lower PEP rate than placebo in subjects with non-eosinophilic severe asthma (blood eosinophilia ≤200/µl): 0.44 PEPs (95% CI 0.25 to 0.78) versus 1.03 PEPs (95% CI 0.72 to 1.48) (p=0.013). Azithromycin significantly improved the AQLQ score but there were no significant between-group differences in the ACQ score or lung function. Azithromycin was well tolerated, but was associated with increased oropharyngeal carriage of macrolide-resistant streptococci. Azithromycin did not reduce the rate of severe exacerbations and LRTI in patients with severe asthma. However, the significant reduction in the PEP rate in azithromycin-treated patients with non-eosinophilic severe asthma warrants further study. CLINICALTRIALS.GOV NUMBER
Sharp, Tyler M.; Hunsperger, Elizabeth; Santiago, Gilberto A.; Muñoz-Jordan, Jorge L.; Santiago, Luis M.; Rivera, Aidsa; Rodríguez-Acosta, Rosa L.; Gonzalez Feliciano, Lorenzo; Margolis, Harold S.; Tomashek, Kay M.
Background Dengue is a potentially fatal acute febrile illness (AFI) caused by four mosquito-transmitted dengue viruses (DENV-1–4) that are endemic in Puerto Rico. In January 2010, the number of suspected dengue cases reported to the passive dengue surveillance system exceeded the epidemic threshold and an epidemic was declared soon after. Methodology/Principal Findings To characterize the epidemic, surveillance and laboratory diagnostic data were compiled. A suspected case was a dengue-like AFI in a person reported by a health care provider with or without a specimen submitted for diagnostic testing. Laboratory-positive cases had: (i) DENV nucleic acid detected by reverse transcriptase-polymerase chain reaction (RT-PCR) in an acute serum specimen; (ii) anti-DENV IgM antibody detected by ELISA in any serum specimen; or (iii) DENV antigen or nucleic acid detected in an autopsy-tissue specimen. In 2010, a total of 26,766 suspected dengue cases (7.2 per 1,000 residents) were identified, of which 46.6% were laboratory-positive. Of 7,426 RT-PCR-positive specimens, DENV-1 (69.0%) and DENV-4 (23.6%) were detected more frequently than DENV-2 (7.3%) and DENV-3 (dengue with warning signs, 11.1% had severe dengue, and 40 died. Approximately 21% of cases were primary DENV infections, and 1–4 year olds were the only age group for which primary infection was more common than secondary. Individuals infected with DENV-1 were 4.2 (95% confidence interval [CI]: 1.7–9.8) and 4.0 (95% CI: 2.4–6.5) times more likely to have primary infection than those infected with DENV-2 or -4, respectively. Conclusions/Significance This epidemic was long in duration and yielded the highest incidence of reported dengue cases and deaths since surveillance began in Puerto Rico in the late 1960's. This epidemic re-emphasizes the need for more effective primary prevention interventions to reduce the morbidity and mortality of dengue. PMID:23593526
Hernández, D. G.; Risau-Gusman, S.
It is well known that sexually transmitted diseases (STD) spread across a network of human sexual contacts. This network is most often bipartite, as most STD are transmitted between men and women. Even though network models in epidemiology have quite a long history now, there are few general results about bipartite networks. One of them is the simple dependence, predicted using the mean field approximation, between the epidemic threshold and the average and variance of the degree distribution of the network. Here we show that going beyond this approximation can lead to qualitatively different results that are supported by numerical simulations. One of the new features, that can be relevant for applications, is the existence of a critical value for the infectivity of each population, below which no epidemics can arise, regardless of the value of the infectivity of the other population.
Zhao, Dawei; Li, Lixiang; Peng, Haipeng; Luo, Qun; Yang, Yixian
This letter investigates the multiple routes transmitted epidemic process on multiplex networks. We propose detailed theoretical analysis that allows us to accurately calculate the epidemic threshold and outbreak size. It is found that the epidemic can spread across the multiplex network even if all the network layers are well below their respective epidemic thresholds. Strong positive degree–degree correlation of nodes in multiplex network could lead to a much lower epidemic threshold and a relatively smaller outbreak size. However, the average similarity of neighbors from different layers of nodes has no obvious effect on the epidemic threshold and outbreak size. -- Highlights: •We studies multiple routes transmitted epidemic process on multiplex networks. •SIR model and bond percolation theory are used to analyze the epidemic processes. •We derive equations to accurately calculate the epidemic threshold and outbreak size. •ASN has no effect on the epidemic threshold and outbreak size. •Strong positive DDC leads to a lower epidemic threshold and a smaller outbreak size.
Full Text Available The contact structure between hosts shapes disease spread. Most network-based models used in epidemiology tend to ignore heterogeneity in the weighting of contacts between two individuals. However, this assumption is known to be at odds with the data for many networks (e.g. sexual contact networks and to have a critical influence on epidemics' behavior. One of the reasons why models usually ignore heterogeneity in transmission is that we currently lack tools to analyze weighted networks, such that most studies rely on numerical simulations. Here, we present a novel framework to estimate key epidemiological variables, such as the rate of early epidemic expansion (r0 and the basic reproductive ratio (R0, from joint probability distributions of number of partners (contacts and number of interaction events through which contacts are weighted. These distributions are much easier to infer than the exact shape of the network, which makes the approach widely applicable. The framework also allows for a derivation of the full time course of epidemic prevalence and contact behaviour, which we validate with numerical simulations on networks. Overall, incorporating more realistic contact networks into epidemiological models can improve our understanding of the emergence and spread of infectious diseases.
Beetz, Ivo; Steenbakkers, Roel J H M; Chouvalova, Olga; Leemans, Charles R; Doornaert, Patricia; van der Laan, Bernard F A M; Christianen, Miranda E M C; Vissink, Arjan; Bijl, Henk P; van Luijk, Peter; Langendijk, Johannes A
Recently, the Quantitative Analysis of Normal Tissue Effect in the Clinic (QUANTEC) Group defined dose-volume constraints for the parotid glands to avoid severe xerostomia. The aim of this study was to determine if application of these QUANTEC criteria also protected against moderate-to-severe patient-rated xerostomia. The study population consisted of 307 head and neck cancer patients treated with primary (chemo)radiotherapy, either with 3D-CRT (56%) or with IMRT (44%). All patients participated in a standard follow-up program in which radiation-induced toxicity and quality of life were prospectively assessed. Patients who met the QUANTEC criteria were classified as low risk and otherwise as high risk. In total, 41% of the patients (treated with 3D-CRT and IMRT) were classified as low risk patients. In the group treated with 3D-CRT and IMRT, it was possible to meet the QUANTEC criteria in 47% and 32% of the patients, respectively. Sparing the parotid glands with IMRT was considerably more difficult in patients with lymph node metastases and in patients with nasopharyngeal and oropharyngeal tumours. Low risk patients reported significantly less moderate-to-severe xerostomia than high risk patients. However, the predicted risk of elderly patients and patients with pre-existing minor patient-rated xerostomia at baseline was > 20%, even when the QUANTEC criteria were met. Significantly lower rates of radiation-induced patient-rated xerostomia were found among low risk patients treated according to the QUANTEC criteria, but these criteria do not completely protect against xerostomia. Particularly in elderly patients and patients already suffering from minor xerostomia at baseline, the QUANTEC criteria do not sufficiently protect against persistent, moderate-to-severe patient-rated xerostomia.
Children with severe impairment of the central nervous system (CNS) experience gastrointestinal (GI) symptoms at a high rate and severity, including retching, vomiting, GI tract pain, and feeding intolerance. Commonly recognized sources of symptoms include constipation and gastroesophageal reflux disease. There is growing awareness of sources due to the impaired nervous system, including visceral hyperalgesia due to sensitization of sensory neurons in the enteric nervous system and central neuropathic pain due to alterations in the thalamus. Challenging the management of these symptoms is the lack of tests to confirm alterations in the nervous system as a cause of symptom generation, requiring empirical trials directed at such sources. It is also common to have multiple reasons for the observed symptoms, further challenging management. Recurrent emesis and GI tract pain can often be improved, though in some not completely eliminated. In some, this can progress to intractable feeding intolerance. This comprehensive review provides an evidence-based approach to care, a framework for recurrent symptoms, and language strategies when symptoms remain intractable to available interventions. This summary is intended to balance optimal management with a sensitive palliative care approach to persistent GI symptoms in children with severe impairment of the CNS.
Woudenberg, Tom; van Binnendijk, Rob S; Sanders, Elisabeth A M; Wallinga, Jacco; de Melker, Hester E; Ruijs, Wilhelmina L M; Hahné, Susan J M
Since the early 1990s, the Netherlands has experienced several large measles epidemics, in 1992-94, 1999-2000 and in 2013-14. These outbreaks mainly affected orthodox Protestants, a geographically clustered population with overall lower measles-mumps-rubella first dose (MMR-1) vaccination coverage (60%) than the rest of the country (> 95%). In the 2013-14 epidemic described here, which occurred between 27 May 2013 and 12 March 2014, 2,700 cases were reported. Several control measures were implemented including MMR vaccination for 6-14-month-olds and recommendations to reduce the risk in healthcare workers. The vast majority of reported cases were unvaccinated (94%, n = 2,539), mostly for religious reasons (84%, n = 2,135). The median age in the epidemic was 10 years, 4 years older than in the previous epidemic in 1999-2000. A likely explanation is that the inter-epidemic interval before the 2013-2014 epidemic was longer than the interval before the 1999-2000 epidemic. The size of the unvaccinated orthodox Protestant community is insufficient to allow endemic transmission of measles in the Netherlands. However, large epidemics are expected in the future, which is likely to interfere with measles elimination in the Netherlands and elsewhere. This article is copyright of The Authors, 2017.
... both human health and the global and national economies. Before 1970, only 9 countries had experienced severe dengue epidemics. The disease is now endemic in more than 100 countries in the WHO regions of Africa, the Americas, the Eastern Mediterranean, South-East Asia ...
Lopez, Daphne; Gunasekaran, M; Murugan, B Senthil; Kaur, Harpreet; Abbas, Kaja M
The study objective is to develop a big spatial data model to predict the epidemiological impact of influenza in Vellore, India. Large repositories of geospatial and health data provide vital statistics on surveillance and epidemiological metrics, and valuable insight into the spatiotemporal determinants of disease and health. The integration of these big data sources and analytics to assess risk factors and geospatial vulnerability can assist to develop effective prevention and control strategies for influenza epidemics and optimize allocation of limited public health resources. We used the spatial epidemiology data of the HIN1 epidemic collected at the National Informatics Center during 2009-2010 in Vellore. We developed an ecological niche model based on geographically weighted regression for predicting influenza epidemics in Vellore, India during 2013-2014. Data on rainfall, temperature, wind speed, humidity and population are included in the geographically weighted regression analysis. We inferred positive correlations for H1N1 influenza prevalence with rainfall and wind speed, and negative correlations for H1N1 influenza prevalence with temperature and humidity. We evaluated the results of the geographically weighted regression model in predicting the spatial distribution of the influenza epidemic during 2013-2014.
Science and Technology Studies has seen a growing interest in the commercialization of science. In this article, I track the role of corporations in the construction of the obesity epidemic, deemed one of the major public health threats of the century. Focusing on China, a rising superpower in the midst of rampant, state-directed neoliberalization, I unravel the process, mechanisms, and broad effects of the corporate invention of an obesity epidemic. Largely hidden from view, Western firms were central actors at every stage in the creation, definition, and governmental management of obesity as a Chinese disease. Two industry-funded global health entities and the exploitation of personal ties enabled actors to nudge the development of obesity science and policy along lines beneficial to large firms, while obscuring the nudging. From Big Pharma to Big Food and Big Soda, transnational companies have been profiting from the 'epidemic of Chinese obesity', while doing little to effectively treat or prevent it. The China case suggests how obesity might have been constituted an 'epidemic threat' in other parts of the world and underscores the need for global frameworks to guide the study of neoliberal science and policymaking.
Campbell, A John; Robertson, M Clare; La Grow, Steven J; Kerse, Ngaire M; Sanderson, Gordon F; Jacobs, Robert J; Sharp, Dianne M; Hale, Leigh A
Objectives To assess the efficacy and cost effectiveness of a home safety programme and a home exercise programme to reduce falls and injuries in older people with low vision. Design Randomised controlled trial. Setting Dunedin and Auckland, New Zealand. Participants 391 women and men aged ≥75 with visual acuity of 6/24 or worse who were living in the community; 92% (361 of 391) completed one year of follow-up. Interventions Participants received a home safety assessment and modification programme delivered by an occupational therapist (n = 100), an exercise programme prescribed at home by a physiotherapist plus vitamin D supplementation (n = 97), both interventions (n = 98), or social visits (n = 96). Main outcome measures Numbers of falls and injuries resulting from falls, costs of implementing the home safety programme. Results Fewer falls occurred in the group randomised to the home safety programme but not in the exercise programme (incidence rate ratios 0.59 (95% confidence interval 0.42 to 0.83) and 1.15 (0.82 to 1.61), respectively). However, within the exercise programme, stricter adherence was associated with fewer falls (P = 0.001). A conservative analysis showed neither intervention was effective in reducing injuries from falls. Delivering the home safety programme cost $NZ650 (£234, 344 euros, $US432) (at 2004 prices) per fall prevented. Conclusion The home safety programme reduced falls and was more cost effective than an exercise programme in this group of elderly people with poor vision. The Otago exercise programme with vitamin D supplementation was not effective in reducing falls or injuries in this group, possibly due to low levels of adherence. Trial registration number ISRCTN15342873. PMID:16183652
Campbell, A John; Robertson, M Clare; La Grow, Steven J; Kerse, Ngaire M; Sanderson, Gordon F; Jacobs, Robert J; Sharp, Dianne M; Hale, Leigh A
To assess the efficacy and cost effectiveness of a home safety programme and a home exercise programme to reduce falls and injuries in older people with low vision. Randomised controlled trial. Dunedin and Auckland, New Zealand. 391 women and men aged > or =75 with visual acuity of 6/24 or worse who were living in the community; 92% (361 of 391) completed one year of follow-up. Participants received a home safety assessment and modification programme delivered by an occupational therapist (n = 100), an exercise programme prescribed at home by a physiotherapist plus vitamin D supplementation (n = 97), both interventions (n = 98), or social visits (n = 96). Numbers of falls and injuries resulting from falls, costs of implementing the home safety programme. Fewer falls occurred in the group randomised to the home safety programme but not in the exercise programme (incidence rate ratios 0.59 (95% confidence interval 0.42 to 0.83) and 1.15 (0.82 to 1.61), respectively). However, within the exercise programme, stricter adherence was associated with fewer falls (P = 0.001). A conservative analysis showed neither intervention was effective in reducing injuries from falls. Delivering the home safety programme cost NZ650 dollars (234 pounds sterling, 344 euros, US432 dollars) (at 2004 prices) per fall prevented. The home safety programme reduced falls and was more cost effective than an exercise programme in this group of elderly people with poor vision. The Otago exercise programme with vitamin D supplementation was not effective in reducing falls or injuries in this group, possibly due to low levels of adherence. Trial registration number ISRCTN15342873.
New HIV testing technologies in the context of a concentrated epidemic and evolving HIV prevention: qualitative research on HIV self-testing among men who have sex with men and transgender women in Yangon, Myanmar.
Wirtz, Andrea L; Clouse, Emily; Veronese, Vanessa; Thu, Kaung Htet; Naing, Soe; Baral, Stefan D; Beyrer, Chris
Global effort to increase early diagnosis and engagement in HIV care emphasize the importance of developing novel approaches to reaching those missed by traditional methods. Such needs are particularly great for men who have sex with men (MSM), transgender women (TW), and other populations who face stigma. Myanmar's HIV epidemic is concentrated among key populations and the revised National Strategy aims to reduce late diagnosis and barriers to care to curb HIV incidence among these groups. HIV self-testing (HIVST) may be one method to improve testing and diagnosis among key populations, by placing HIV testing and disclosure within the individual's control. Formative, qualitative research including in-depth interviews with adult MSM (N = 12) and TW (N = 13) and focus group discussions with MSM, TW, and community key informants (N = 35) were conducted in June-September 2015 in Yangon, Myanmar. To inform a subsequent HIV care continuum intervention, including HIVST, participants' opinions and perceptions about HIVST were elicited. The confidentiality and privacy of HIVST, particularly as it related to disclosure of HIV status and sexual behaviour, was widely recognized among participants. These major advantages were further supported by the opportunity to avoid stigma, convenience of self-testing (reduced need for transportation and time to go to clinics), and the availability of a pain-free testing option. Participants weighed these benefits against perceived disadvantages of HIVST, the majority of which centred on the perception that HIVST does not include counselling. Participants were concerned that potential lack of counselling would result in poor mental health outcomes, inadequate linkage to HIV care and surveillance, and reductions in disclosure of HIV status. Participants did not view these disadvantages as an impediment, but provided suggestions for future implementation of HIVST in Myanmar. MSM and TW are optimistic about the confidentiality and privacy
Full Text Available Picroside II, from the herb Picrorhiza scrophulariiflora Pennell, has antioxidant and anti-inflammatory activities. However, its function on severe acute pancreatitis (SAP and molecular mechanism remains unknown. The effects of picroside II on the SAP induced by cerulean were investigated. SAP rats were treated with picroside II (25 mg/kg. The severity of SAP was evaluated by using biochemical and histological analyses. Pancreatic cancer cell PANC-1 was transfected with ptfLC3 (an indicator of autophagic activity, pcDNA3.1-NF-κB (nuclear factor kappa B, and pTZU6+1-NF-κB-shRNA and then treated with picroside II. Relative molecules related with NF-κB-dependent autophagy were detected by using Western blot. Autophagic activities were observed by phase-contrast and fluorescent microscopes. Acetylated LC3 was detected by immunoprecipitation. The results showed that picroside II treatment reduced the level of ALT, AST, NF-κB, IL-1β, IL-6, TNF-α, and SIRT1 (NAD+-dependent deacetylase and increased the level of SOD and GSH. The autophagic activity was reduced when NF-κB was silenced, and the levels of TNF-α and SIRT1 were reduced. In contrast, the overexpression of NF-κB increased autophagic activity and the level of TNF-α, which activated SIRT1. SIRT1 deacetylated LC3 and increased autophagic activities. Picroside II ameliorates SAP by improving antioxidant and anti-inflammtory activities of SAP models via NF-κB-dependent autophagy.
First page Back Continue Last page Overview Graphics. CHIK virus was first isolated from patients during an epidemic in Tanzania in 1952-53. Chikungunya means 'that which bends up', and describes the symptoms caused by the severe joint pains.
The Chernobyl psychological epidemic was already latent well prior to 1986 fully broke out after the accident, and continues to spread. It must be halted. But how can we counter a belief which has taken on the appearance of reality. It is the unknown, linked to alarming symbols, which sustains fear. To get beyond this state, radioactivity, ionizing radiation and nuclear energy have to become as ordinary as air travel and electronic calculators. In a climate of confidence and openness, it should be possible to successfully communicate several solid scientific reference points by first targeting teachers, doctors, and journalists. Thirty years ago, nuclear energy was presented as a universal panacea (clean, safe, and renewable). Now things have swung to the other extreme, and it is presented as diabolical. We have shifted from a symbolically white level to a symbolically black level, and both are misleading. It is high time to rejoin the world of facts, a world full of shades of gray
Rogers, Everett M.; And Others
Discusses communication and social construction, AIDS and San Francisco, San Francisco's gay community, and the social construction of AIDS in San Francisco. Describes three eras of HIV-AIDS prevention in San Francisco, a particular HIV prevention program, and the impact of the epidemic in San Francisco. (SR)
Bodó, Ágnes; Katona, Gyula Y; Simon, Péter L
Mathematical modelling of epidemic propagation on networks is extended to hypergraphs in order to account for both the community structure and the nonlinear dependence of the infection pressure on the number of infected neighbours. The exact master equations of the propagation process are derived for an arbitrary hypergraph given by its incidence matrix. Based on these, moment closure approximation and mean-field models are introduced and compared to individual-based stochastic simulations. The simulation algorithm, developed for networks, is extended to hypergraphs. The effects of hypergraph structure and the model parameters are investigated via individual-based simulation results.
Full Text Available A DTN architecture consists of several nodes that are connected with high dynamic topology. The routing protocol is an important part which determine the DTN performance system. Although DTN is addressed to be tolerant of delay, a routing protocol with better performance will maximizing packet delivery rate and minimizing the delivery latency. This paper evaluate a level signal priority epidemic routing protocol for delay tolerant network architecture. Our system adopts DTN2 framework using classic epidemic and priority epidemic dynamic routing protocols. The performance of both dynamic routing is observed and compared based on throughput and delay of transmitted data. The measurement results show that the classic epidemic use more bandwith due to sending the same messages many times. The delay transmission using a level signal priority epidemic routing is smaller than classic epidemic routing protocol in all hops of the test-bed. Epidemic based on signal level routing could make traffic of network more efficient than classic Epidemic routing because of filtering system in node before sending bundle to neighbor node. Keywords: DTN, dynamic routing, level signal priority
van der Gaag, Mark; van den Berg, David; Ising, Helga
Patients with an 'At risk mental state' (ARMS) for developing psychosis can be treated successfully with CBT to postpone and prevent the transition to a first psychotic episode. A characteristic of individuals that meet ARMS criteria is that they are still open for multiple explanations for extraordinary experiences. CBT aims to normalize extraordinary experiences with education and to prevent delusional explanations. The treatment is not only effective, but also cost-saving in averting psychosis as well as in reducing disability adjusted life years at 18- and 48-month follow-up. Profiling within the ARMS group results in a personalized treatment. The screening and early treatment for ARMS fulfills all the criteria of the World Health Organization and is ready to be routine screening and treatment in mental health care. At the same time, ARMS patients are complex patients with multi-morbid disorders. Especially childhood trauma is associated to ARMS status, together with co-morbid PTSD, depression, substance abuse and anxiety disorders. Psychotic symptoms appear to be severity markers in other non-psychotic disorders. Preventing psychosis in ARMS patients should be broadened to also address other disorders and aim to reduce chronicity of psychopathology and improve social functioning in general. Several mechanisms play a part in psychopathology in ARMS patients such as stress sensitivity as a result of adverse experiences, dopamine sensitivity that is associated with salience and aggravates several cognitive biases, dissociation mediating between trauma and hallucinations, and low self-esteem and self-stigma. New avenues to treat the complexity of ARMS patients will be proposed. Copyright © 2017 Elsevier B.V. All rights reserved.
Flynn, John M; Lou, Julia E; Ganley, Theodore J
As children around the world become involved in increasingly competitive and more organized sports activities, the frequency and severity of both acute and overuse injuries continues to rise. Over the past year, several important studies have contributed to our knowledge in the prevention of sports injuries in children. Safety guidelines and protective equipment are crucial to minimizing pediatric recreational injuries. Protective headgear, mouth guards, and wrist and shin guards have all been shown to be effective in preventing injuries. Nutrition and nutritional supplements (eg, creatine) for the pediatric athlete have also received greater attention recently. Combined with appropriate physical activity programs, nutrition is essential in battling the increasing epidemic of childhood obesity. Increased attention has also been directed toward specific injuries and injury rates in the female athlete. Specific training for the female pediatric athlete may have a preventive effect in halting the rising injury rates.
Lessler, Justin; Metcalf, C Jessica E; Cutts, Felicity T; Grenfell, Bryan T
Routine vaccination supplemented by planned campaigns occurring at 2-5 y intervals is the core of current measles control and elimination efforts. Yet, large, unexpected outbreaks still occur, even when control measures appear effective. Supplementing these activities with mass vaccination campaigns triggered when low levels of measles immunity are observed in a sample of the population (i.e., serosurveys) or incident measles cases occur may provide a way to limit the size of outbreaks. Measles incidence was simulated using stochastic age-structured epidemic models in settings conducive to high or low measles incidence, roughly reflecting demographic contexts and measles vaccination coverage of four heterogeneous countries: Nepal, Niger, Yemen, and Zambia. Uncertainty in underlying vaccination rates was modeled. Scenarios with case- or serosurvey-triggered campaigns reaching 20% of the susceptible population were compared to scenarios without triggered campaigns. The best performing of the tested case-triggered campaigns prevent an average of 28,613 (95% CI 25,722-31,505) cases over 15 y in our highest incidence setting and 599 (95% CI 464-735) cases in the lowest incidence setting. Serosurvey-triggered campaigns can prevent 89,173 (95% CI, 86,768-91,577) and 744 (612-876) cases, respectively, but are triggered yearly in high-incidence settings. Triggered campaigns reduce the highest cumulative incidence seen in simulations by up to 80%. While the scenarios considered in this strategic modeling exercise are reflective of real populations, the exact quantitative interpretation of the results is limited by the simplifications in country structure, vaccination policy, and surveillance system performance. Careful investigation into the cost-effectiveness in different contexts would be essential before moving forward with implementation. Serologically triggered campaigns could help prevent severe epidemics in the face of epidemiological and vaccination uncertainty
Manzano, Marc; Calle, Eusebi; Ripoll, Jordi
in telecommunication networks has not been extensively considered, nowadays, with the increasing computation capacity and complexity of operating systems of modern network devices (routers, switches, etc.), the study of possible epidemic-like failure scenarios must be taken into account. When epidemics occur......, such as in other multiple failure scenarios, identifying the level of vulnerability offered by a network is one of the main challenges. In this paper, we present epidemic survivability, a new network measure that describes the vulnerability of each node of a network under a specific epidemic intensity. Moreover......, this metric is able to identify the set of nodes which are more vulnerable under an epidemic attack. In addition, two applications of epidemic survivability are provided. First, we introduce epidemic criticality, a novel robustness metric for epidemic failure scenarios. A case study shows the utility...
Manzano, Marc; Calle, Eusebi; Ripoll, Jordi
Epidemics theory has been used in different contexts in order to describe the propagation of diseases, human interactions or natural phenomena. In computer science, virus spreading has been also characterized using epidemic models. Although in the past the use of epidemic models in telecommunicat......Epidemics theory has been used in different contexts in order to describe the propagation of diseases, human interactions or natural phenomena. In computer science, virus spreading has been also characterized using epidemic models. Although in the past the use of epidemic models...... in telecommunication networks has not been extensively considered, nowadays, with the increasing computation capacity and complexity of operating systems of modern network devices (routers, switches, etc.), the study of possible epidemic-like failure scenarios must be taken into account. When epidemics occur...
Dong, Chao; Yin, Qiuju; Liu, Wenyang; Yan, Zhijun; Shi, Tianyu
Relation existed in the social contact network can affect individuals' behaviors greatly. Considering the diversity of relation intimacy among network nodes, an epidemic propagation model is proposed by incorporating the link-breaking threshold, which is normally neglected in the rewiring strategy. The impact of rewiring strategy on the epidemic spreading in the weighted adaptive network is explored. The results show that the rewiring strategy cannot always control the epidemic prevalence, especially when the link-breaking threshold is low. Meanwhile, as well as strong links, weak links also play a significant role on epidemic spreading.
Buse, Dawn C; Loder, Elizabeth W; Gorman, Jennifer A; Stewart, Walter F; Reed, Michael L; Fanning, Kristina M; Serrano, Daniel; Lipton, Richard B
The strikingly higher prevalence of migraine in females compared with males is one of the hallmarks of migraine. A large global body of evidence exists on the sex differences in the prevalence of migraine with female to male ratios ranging from 2:1 to 3:1 and peaking in midlife. Some data are available on sex differences in associated symptoms, headache-related disability and impairment, and healthcare resource utilization in migraine. Few data are available on corresponding sex differences in probable migraine (PM) and other severe headache (ie, nonmigraine-spectrum severe headache). Gaining a clear understanding of sex differences in a range of severe headache disorders may help differentiate the range of headache types. Herein, we compare sexes on prevalence and a range of clinical variables for migraine, PM, and other severe headache in a large sample from the US population. This study analyzed data from the 2004 American Migraine Prevalence and Prevention Study. Total and demographic-stratified sex-specific, prevalence estimates of headache subtypes (migraine, PM, and other severe headache) are reported. Log-binomial models are used to calculate sex-specific adjusted prevalence ratios and 95% confidence intervals for each across demographic strata. A smoothed sex prevalence ratio (female to male) figure is presented for migraine and PM. One hundred sixty-two thousand seven hundred fifty-six individuals aged 12 and older responded to the 2004 American Migraine Prevalence and Prevention Study survey (64.9% response rate). Twenty-eight thousand two hundred sixty-one (17.4%) reported "severe headache" in the preceding year (23.5% of females and 10.6% of males), 11.8% met International Classification of Headache Disorders-2 criteria for migraine (17.3% of females and 5.7% of males), 4.6% met criteria for PM (5.3% of females and 3.9% of males), and 1.0% were categorized with other severe headache (0.9% of females and 1.0% of males). Sex differences were observed in
Following increases up until the late 1980s, some decline in cancer mortality has been observed in North America and in Western Europe. Approximately half the decline can be attributed to the levelling off in lung and other tobacco-related cancer epidemics and the rest to several factors, including reduced exposure to occupational carcinogens, prevention and early diagnosis, and improved treatment. Between 25 and 30% of all cancer deaths in Europe are due to tobacco smoking. In this review the effect of tobacco smoking on cancer incidence and mortality is examined, together with other important aetiological factors including alcohol, diet and environmental and occupational carcinogens. The effect of new treatments and the potential for prevention of cancer are also discussed.
Shoshan, Noa; Segev, Amir; Abush, Hila; Mizrachi Zer-Aviv, Tomer; Akirav, Irit
Exposure to excessive or uncontrolled stress is a major factor associated with various diseases including posttraumatic stress disorder (PTSD). The consequences of exposure to trauma are affected not only by aspects of the event itself, but also by the frequency and severity of trauma reminders. It was suggested that in PTSD, hippocampal-dependent memory is compromised while amygdala-dependent memory is strengthened. Several lines of evidence support the role of the endocannabinoid (eCB) system as a modulator of the stress response. In this study we aimed to examine cannabinoids modulation of the long-term effects (i.e., 1 month) of exposure to a traumatic event on memory and plasticity in the hippocampus and amygdala. Following exposure to the shock and reminders model of PTSD in an inhibitory avoidance light-dark apparatus rats demonstrated: (i) enhanced fear retrieval and impaired inhibitory extinction (Ext), (ii) no long-term potentiation (LTP) in the CA1, (iii) impaired hippocampal-dependent short-term memory in the object location task, (iv) enhanced LTP in the amygdala, and (v) enhanced amygdala-dependent conditioned taste aversion memory. The cannabinoid CB1/2 receptor agonist WIN55-212,2 (0.5mg/kg, i.p.) and the fatty acid amide hydrolase (FAAH) inhibitor URB597 (0.3mg/kg, i.p.), administered 2 hr after shock exposure prevented these opposing effects on hippocampal- and amygdala-dependent processes. Moreover, the effects of WIN55-212,2 and URB597 on Ext and acoustic startle were prevented by co-administration of a low dose of the CB1 receptor antagonist AM251 (0.5mg/kg, i.p.), suggesting that the preventing effects of both drugs are mediated by CB1 receptors. Exposure to shock and reminders increased CB1 receptor levels in the CA1 and basolateral amygdala 1 month after shock exposure and this increase was also prevented by administering WIN55-212,2 or URB597. Taken together, these findings suggest the involvement of the eCB system, and specifically CB1
Hägglund, Gunnar; Andersson, Sofia; Düppe, Henrik; Lauge-Pedersen, Henrik; Pedertsen, Henrik Lauge; Nordmark, Eva; Westbom, Lena
During the 1990s three new techniques to reduce spasticity and dystonia in children with cerebral palsy (CP) were introduced in southern Sweden: selective dorsal rhizotomy, continuous intrathecal baclofen infusion and botulinum toxin treatment. In 1994 a CP register and a health care programme, aimed to prevent hip dislocation and severe contractures, were initiated in the area. The total population of children with CP born 1990-1991, 1992-1993 and 1994-1995 was evaluated and compared at 8 years of age. In non-ambulant children the passive range of motion in hip, knee and ankle improved significantly from the first to the later age groups. Ambulant children had similar range of motion in the three age groups, with almost no severe contractures. The proportion of children treated with orthopaedic surgery for contracture or skeletal torsion deformity decreased from 40 to 15% (P = 0.0019). One-fifth of the children with spastic diplegia had been treated with selective dorsal rhizotomy. One-third of the children born 1994-1995 had been treated with botulinum toxin before 8 years of age. With early treatment of spasticity, early non-operative treatment of contracture and prevention of hip dislocation, the need for orthopaedic surgery for contracture or torsion deformity is reduced, and the need for multilevel procedures seems to be eliminated.
Yang, Hye Jeong; Kwon, Dae Young; Kim, Min Jung; Kang, Suna; Moon, Na Rang; Daily, James W; Park, Sunmin
Dementia induced by β-amyloid accumulation impairs peripheral glucose homeostasis, but red pepper extract improves glucose homeostasis. We therefore evaluated whether long-term oral consumption of different red pepper extracts improves cognitive dysfunction and glucose homeostasis in type 2 diabetic rats with β-amyloid-induced dementia. Male diabetic rats received hippocampal CA1 infusions of β-amyloid (25-35) (AD) or β-amyloid (35-25, non-plaque forming), at a rate of 3.6 nmol/day for 14 days (Non-AD). AD rats were divided into four dietary groups receiving either 1% lyophilized 70% ethanol extracts of either low, moderate and severe pungency red peppers (AD-LP, AD-MP, and AD-SP) or 1% dextrin (AD-CON) in Western diets (43% energy as fat). The ascending order of control memory deficit measured by passive avoidance test and water maze test. Furthermore, the accumulation of β-amyloid induced glucose intolerance, although serum insulin levels were elevated during the late phase of oral glucose tolerance test (OGTT). All of the red pepper extracts prevented the glucose intolerance in AD rats. Consistent with OGTT results, during euglycemic hyperinulinemic clamp glucose infusion rates were lower in AD-CON than Non-AD-CON with no difference in whole body glucose uptake. Hepatic glucose output at the hyperinsulinemic state was increased in AD-CON. β-amyloid accumulation exacerbated hepatic insulin resistance, but all red pepper extract treatments reversed the insulin resistance in AD rats. The extracts of moderate and severe red peppers were found to prevent the memory deficit and exacerbation of insulin resistance by blocking tau phosphorylation and β-amyloid accumulation in diabetic rats with experimentally induced Alzheimer's-like dementia. These results suggest that red pepper consumption might be an effective intervention for preventing age-related memory deficit.
Roberge, Stéphanie; Giguère, Yves; Villa, Pia; Nicolaides, Kypros; Vainio, Merja; Forest, Jean-Claude; von Dadelszen, Peter; von Dadelzen, Peter; Vaiman, Daniel; Tapp, Sylvie; Bujold, Emmanuel
To determine whether early administration of aspirin prevents severe and mild preeclampsia. A systematic review and meta-analysis of randomized controlled trials were performed. Studies in which women were randomized at or before 16 weeks' gestation to low-dose aspirin versus placebo or no treatment were included. The outcomes of interest were severe preeclampsia and mild preeclampsia. Pooled relative risks with their 95% confidence intervals (CIs) were calculated. Among 7941 citations retrieved, 352 were completely reviewed and four studies (392 women) fulfilled the inclusion criteria and were analyzed. When compared with controls, aspirin started at ≤16 weeks was associated with a significant reduction in severe (relative risk: 0.22, 95% CI: 0.08 to 0.57) but not mild (relative risk: 0.81, 95% CI: 0.33 to 1.96) preeclampsia. Low-dose aspirin initiated at or before 16 weeks reduces the risk of severe preeclampsia, but not mild preeclampsia. Copyright © 2012 by Thieme Medical Publishers
Hufnagel, L; Brockmann, D; Geisel, T
The rapid worldwide spread of severe acute respiratory syndrome demonstrated the potential threat an infectious disease poses in a closely interconnected and interdependent world. Here we introduce a probabilistic model that describes the worldwide spread of infectious diseases and demonstrate that a forecast of the geographical spread of epidemics is indeed possible. This model combines a stochastic local infection dynamics among individuals with stochastic transport in a worldwide network, taking into account national and international civil aviation traffic. Our simulations of the severe acute respiratory syndrome outbreak are in surprisingly good agreement with published case reports. We show that the high degree of predictability is caused by the strong heterogeneity of the network. Our model can be used to predict the worldwide spread of future infectious diseases and to identify endangered regions in advance. The performance of different control strategies is analyzed, and our simulations show that a quick and focused reaction is essential to inhibiting the global spread of epidemics.
Wang, Xiling; Jiang, Hui; Wu, Peng; Uyeki, Timothy M; Feng, Luzhao; Lai, Shengjie; Wang, Lili; Huo, Xiang; Xu, Ke; Chen, Enfu; Wang, Xiaoxiao; He, Jianfeng; Kang, Min; Zhang, Renli; Zhang, Jin; Wu, Jiabing; Hu, Shixiong; Zhang, Hengjiao; Liu, Xiaoqing; Fu, Weijie; Ou, Jianming; Wu, Shenggen; Qin, Ying; Zhang, Zhijie; Shi, Yujing; Zhang, Juanjuan; Artois, Jean; Fang, Vicky J; Zhu, Huachen; Guan, Yi; Gilbert, Marius; Horby, Peter W; Leung, Gabriel M; Gao, George F; Cowling, Benjamin J; Yu, Hongjie
The avian influenza A H7N9 virus has caused infections in human beings in China since 2013. A large epidemic in 2016-17 prompted concerns that the epidemiology of the virus might have changed, increasing the threat of a pandemic. We aimed to describe the epidemiological characteristics, clinical severity, and time-to-event distributions of patients infected with A H7N9 in the 2016-17 epidemic compared with previous epidemics. In this epidemiological study, we obtained information about all laboratory-confirmed human cases of A H7N9 virus infection reported in mainland China as of Feb 23, 2017, from an integrated electronic database managed by the China Center for Disease Control and Prevention (CDC) and provincial CDCs. Every identified human case of A H7N9 virus infection was required to be reported to China CDC within 24 h via a national surveillance system for notifiable infectious diseases. We described the epidemiological characteristics across epidemics, and estimated the risk of death, mechanical ventilation, and admission to the intensive care unit for patients admitted to hospital for routine clinical practice rather than for isolation purpose. We estimated the incubation periods, and time delays from illness onset to hospital admission, illness onset to initiation of antiviral treatment, and hospital admission to death or discharge using survival analysis techniques. Between Feb 19, 2013, and Feb 23, 2017, 1220 laboratory-confirmed human infections with A H7N9 virus were reported in mainland China, with 134 cases reported in the spring of 2013, 306 in 2013-14, 219 in 2014-15, 114 in 2015-16, and 447 in 2016-17. The 2016-17 A H7N9 epidemic began earlier, spread to more districts and counties in affected provinces, and had more confirmed cases than previous epidemics. The proportion of cases in middle-aged adults increased steadily from 41% (55 of 134) to 57% (254 of 447) from the first epidemic to the 2016-17 epidemic. Proportions of cases in semi
This paper aims to study corruption as an epidemic phenomenon using the epidemic diffusion model of Kermack and Mc-Kendrick (1927). We seek to determine the dynamics of corruption and its impact on the composition of the population at a given time. We determine a threshold epidemiological corruption based on the approximation of the honest population.
Ruepp, Sarah Renée; Katsikas, Dimitrios; Fagertun, Anna Manolova
This paper presents a failure propagation model for transport networks which are affected by epidemic failures. The network is controlled using the GMPLS protocol suite. The Susceptible Infected Disabled (SID) epidemic model is investigated and new signaling functionality of GMPLS to support...
Mokrani, K; Fournier, P E; Dalichaouche, M; Tebbal, S; Aouati, A; Raoult, D
We report a case of epidemic typhus in a patient from the Batna region of Algeria, who presented with generalized febrile exanthema. The clinical diagnosis was confirmed by serological cross-adsorption followed by Western blotting. Our report emphasizes the threat of epidemic typhus in the highlands of Algeria.
Bacharier, Leonard B; Guilbert, Theresa W; Mauger, David T; Boehmer, Susan; Beigelman, Avraham; Fitzpatrick, Anne M; Jackson, Daniel J; Baxi, Sachin N; Benson, Mindy; Burnham, Carey-Ann D; Cabana, Michael; Castro, Mario; Chmiel, James F; Covar, Ronina; Daines, Michael; Gaffin, Jonathan M; Gentile, Deborah Ann; Holguin, Fernando; Israel, Elliot; Kelly, H William; Lazarus, Stephen C; Lemanske, Robert F; Ly, Ngoc; Meade, Kelley; Morgan, Wayne; Moy, James; Olin, Tod; Peters, Stephen P; Phipatanakul, Wanda; Pongracic, Jacqueline A; Raissy, Hengameh H; Ross, Kristie; Sheehan, William J; Sorkness, Christine; Szefler, Stanley J; Teague, W Gerald; Thyne, Shannon; Martinez, Fernando D
Many preschool children develop recurrent, severe episodes of lower respiratory tract illness (LRTI). Although viral infections are often present, bacteria may also contribute to illness pathogenesis. Strategies that effectively attenuate such episodes are needed. To evaluate if early administration of azithromycin, started prior to the onset of severe LRTI symptoms, in preschool children with recurrent severe LRTIs can prevent the progression of these episodes. A randomized, double-blind, placebo-controlled, parallel-group trial conducted across 9 academic US medical centers in the National Heart, Lung, and Blood Institute's AsthmaNet network, with enrollment starting in April 2011 and follow-up complete by December 2014. Participants were 607 children aged 12 through 71 months with histories of recurrent, severe LRTIs and minimal day-to-day impairment. Participants were randomly assigned to receive azithromycin (12 mg/kg/d for 5 days; n = 307) or matching placebo (n = 300), started early during each predefined RTI (child's signs or symptoms prior to development of LRTI), based on individualized action plans, over a 12- through 18-month period. The primary outcome measure was the number of RTIs not progressing to a severe LRTI, measured at the level of the RTI, that would in clinical practice trigger the prescription of oral corticosteroids. Presence of azithromycin-resistant organisms in oropharyngeal samples, along with adverse events, were among the secondary outcome measures. A total of 937 treated RTIs (azithromycin group, 473; placebo group, 464) were experienced by 443 children (azithromycin group, 223; placebo group, 220), including 92 severe LRTIs (azithromycin group, 35; placebo group, 57). Azithromycin significantly reduced the risk of progressing to severe LRTI relative to placebo (hazard ratio, 0.64 [95% CI, 0.41-0.98], P = .04; absolute risk for first RTI: 0.05 for azithromycin, 0.08 for placebo; risk difference, 0.03 [95% CI, 0
Male Partner Risk Behaviors Are Associated With Reactive Rapid HIV Antibody Tests Among Pregnant Mexican Women: Implications for Prevention of Vertical and Sexual HIV Transmission in Concentrated HIV Epidemics.
Rivero, Estela; Kendall, Tamil
Mexico's policies on antenatal HIV testing are contradictory, and little is known about social and behavioral characteristics that increase pregnant Mexican women's risks of acquiring HIV. We analyzed the association between risk behaviors reported by pregnant women for themselves and their male partners, and women's rapid HIV antibody test results from a large national sample. Three quarters of pregnant women with a reactive test did not report risk behaviors for themselves and one third did not report risk behaviors for themselves or their male partners. In the retrospective case-control analysis, other than reporting multiple sexual partners, reactive pregnant women reported risk behaviors did not differ from nonreactive women's behaviors. However, reactive pregnant women were significantly more likely to have reported risk behaviors for male partners. Our findings support universal offer of antenatal HIV testing and suggest that HIV prevention for women should focus on reducing risk of HIV acquisition within stable relationships. Copyright © 2015 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.
Visscher, T L S; Heitmann, B L; Rissanen, A
epidemic. However, follow-ups of short duration may, in part, explain the apparent break or decrease in the obesity epidemic. On the other hand, a single focus on body mass index (BMI) ⩾25 or ⩾30 kg m(-)(2) is likely to mask a real increase in the obesity epidemic. And, in both children and adults, trends......Recent epidemiologic papers are presenting prevalence data suggesting breaks and decreases in obesity rates. However, before concluding that the obesity epidemic is not increasing anymore, the validity of the presented data should be discussed more thoroughly. We had a closer look...... into the literature presented in recent reviews to address the major potential biases and distortions, and to develop insights about how to interpret the presented suggestions for a potential break in the obesity epidemic. Decreasing participation rates, the use of reported rather than measured data and small sample...
Smilović, V; Vrbanec-Megla, L; Payerl-Pal, M; Puntarić, D; Baklaić, Z
Two closely related boys from the same house hold (Home 1), aged two and three, were affected with fulminant meningococcal sepsis known as Waterhouse-Friderichsen syndrome. Neisseria meningitidis serogorup B was isolated from their blood and cerebrospinal fluid. The two-year-old boy died one day after the onset of the disease. Epidemiological examination of contacts and pharyngeal swabs were performed in 14 persons from the household, all of them relatives of the affected children, as well as in a number of other contacts. Chemoprophylaxis with cotrimoxazole was simultaneously administered to all contacts. Family histories revealed that two contacts from the household where the patients did not live (Home 2) were inadvertently omitted. Subsequent examinations, following a report of another contagious disease (salmonelosis), revealed that these two persons were Neisseria meningitidis carriers, together with another one in the same household. The carriers most probably caused the infection of a third, five-year-old boy, the deceased boy's brother (Home 1) who also developed fulminant meningococcal sepsis. The failure to take the appropriate prophylaxis led to a prolonged carrier state in the carrier from the second household. Repeated pharyngeal swab sampling revealed two more carriers from both households that had previously been negative. Control of the epidemic was achieved after 5 weeks by repeated and controlled chemoprophylaxis with ciprofloxacin, and by repeated epidemiological examinations, disinfection, and daily health surveillance by the Sanitary Inspectorate. This extremely rare instance of a familial epidemic with three infected persons emphasizes the need for consistent chemoprophylaxis in meningococcal disease contacts.
Vega, Tomás; Lozano, Jose Eugenio; Meerhoff, Tamara; Snacken, René; Mott, Joshua; Ortiz de Lejarazu, Raul; Nunes, Baltazar
Please cite this paper as: Vega et al. (2012) Influenza surveillance in Europe: establishing epidemic thresholds by the moving epidemic method. Influenza and Other Respiratory Viruses 7(4), 546–558. Background Timely influenza surveillance is important to monitor influenza epidemics. Objectives (i) To calculate the epidemic threshold for influenza‐like illness (ILI) and acute respiratory infections (ARI) in 19 countries, as well as the thresholds for different levels of intensity. (ii) To evaluate the performance of these thresholds. Methods The moving epidemic method (MEM) has been developed to determine the baseline influenza activity and an epidemic threshold. False alerts, detection lags and timeliness of the detection of epidemics were calculated. The performance was evaluated using a cross‐validation procedure. Results The overall sensitivity of the MEM threshold was 71·8% and the specificity was 95·5%. The median of the timeliness was 1 week (range: 0–4·5). Conclusions The method produced a robust and specific signal to detect influenza epidemics. The good balance between the sensitivity and specificity of the epidemic threshold to detect seasonal epidemics and avoid false alerts has advantages for public health purposes. This method may serve as standard to define the start of the annual influenza epidemic in countries in Europe. PMID:22897919
Ghodsi, Seyedeh Zahra; Abbas, Zaheer; Abedeni, Robabeh
Seborrheic dermatitis (SD) is a chronic and relapsing disease and topical therapy may be associated with failure, particularly in severe disease. Itraconazole has been suggested as an effective treatment for severe SD. Previous studies have been open clinical trials with variable results. The aim of this study was to determine the efficacy of oral itraconazole in the treatment of patients with moderate to severe SD. Sixty-eight patients with moderate to severe SD were randomly assigned to the itraconazole (n = 35) or placebo (n = 33) groups. The trial was undertaken in Razi Hospital, Tehran. An internet-generated table was used to allocate treatments. Patients and investigator were blinded to treatments. Itraconazole 200 mg/daily or placebo was prescribed for 1 week and then for the first 2 days of every month for the following 3 months. Patients were followed for 4 months and the Seborrheic Dermatitis Area Severity Index (SDASI) was measured on nine anatomical sites. Fifty-seven patients (29 in the itraconazole group and 28 in the placebo group) completed the study. Statistically significant improvement was observed in SDASI of both itraconazole and placebo groups (p = 0.000) but the itraconazole group showed significantly higher efficacy compared with placebo (p = 0.023). We observed clinical improvements of 93.8, 87.5, and 93.1% at the end of 2 weeks, 1 month, and 4 months, respectively, in the itraconazole group, and 82.1, 64.3, and 53.6% in the placebo group. Furthermore, recurrence rate in the itraconazole group was significantly lower than in the placebo group (p = 0.003). No blood test abnormality was seen in any patient. Itraconazole is not only an effective and safe therapy for controlling exacerbations of SD but may also be used as maintenance therapy to prevent disease recurrence.
Baghiani-Moghadam, Mohamad Hosein; Seyedi-Andi, Seyed Jalil; Shokri-Shirvani, Javad; Khafri, Sorayya; Ghadimi, Reza; Parsian, Hadi
Among all cancers, malignancies of gastrointestinal tract are the most common cancer among Iranian population. Dietary behavior is thought to be the most important risk factor in gastric cancer. Fear and perceived severity are two important constructs of the protection motivation theory (PMT). Despite the evidence of the impact of these two constructs in modifying dietary habits against gastric cancer, their efficiency is not well established. Therefore, the present study was designed to determine the efficiency of the mentioned constructs. This cross-sectional study was performed on 360 participants (180 males and 180 females) aged over 30 years old who presented to health centers in Babol, Iran in 2014. They were selected by a cluster sampling method in a population covered by health centers in Babol. Data collection was done using a questionnaire with acceptable reliability and validity, designed by a researcher based on two constructs of protection motivation theory. The data were analyzed by SPSS Version 20 using descriptive and analytical statistics such as ANOVA, linear and logistic regression analysis. The participants who entered in the study achieved 38.6 and 69.7% of the scores of fear and perceived severity, respectively. There was a significant difference between perceived severity with level of education (pmotivation theory with predicting 38% of the variance of nutritional high risk behaviors had an effective role against gastric cancer and may help in the design and implementation of educational programs for the prevention of gastric cancer.
Domínguez, Àngela; Soldevila, Núria; Toledo, Diana; Torner, Núria; Force, Luis; Pérez, María José; Martín, Vicente; Rodríguez-Rojas, Lourdes; Astray, Jenaro; Egurrola, Mikel; Sanz, Francisco; Castilla, Jesús
Pneumococcal pneumonia is a serious cause of morbidity and mortality in the elderly, but investigation of the etiological agent of community-acquired pneumonia (CAP) is not possible in most hospitalized patients. The aim of this study was to estimate the effect of pneumococcal polysaccharide vaccination (PPSV23) in preventing CAP hospitalization and reducing the risk of intensive care unit admission (ICU) and fatal outcomes in hospitalized people aged ≥65 years. We made a multicenter case-control study in 20 Spanish hospitals during 2013-2014 and 2014-2015. We selected patients aged ≥65 years hospitalized with a diagnosis of pneumonia and controls matched by sex, age and date of hospitalization. Multivariate analysis was performed using conditional logistic regression to estimate vaccine effectiveness and unconditional logistic regression to evaluate the reduction in the risk of severe and fatal outcomes. 1895 cases and 1895 controls were included; 13.7% of cases and 14.4% of controls had received PPSV23 in the last five years. The effectiveness of PPSV23 in preventing CAP hospitalization was 15.2% (95% CI -3.1-30.3). The benefit of PPSV23 in avoiding ICU admission or death was 28.1% (95% CI -14.3-56.9) in all patients, 30.9% (95% CI -32.2-67.4) in immunocompetent patients and 26.9% (95% CI -38.6-64.8) in immunocompromised patients. In conclusion, PPSV23 showed a modest trend to avoidance of hospitalizations due to CAP and to the prevention of death or ICU admission in elderly patients hospitalized with a diagnosis of CAP.
Monteon Ojeda, Abraham; Mora Aguilera, José Antonio; Villegas Monter, Ángel; Nava Diaz, Cristian; Hernández Castro, Elías; Otero-Colina, Gabriel; Hernández Morales, Javier
The temporal progress of anthracnose (Colletotrichum gloeosporioides) epidemics was studied in mango (Mangifera indica) orchards treated with fungicides from different chemical groups, mode of action, and application sequences in two regions of contrasting climates (sub-humid and dry tropics) in Guerrero, Mexico. Full flowering, initial setting, and 8-15mm Ø fruits were identified as critical stages for infection. Epidemics started 20-26 days after swollen buds, and maximum severity was attai...
Yusuf, Salim; Ounpuu, Stephanie; Anand, Sonia
Of the 50 million deaths that occur in the world, 40 million occur in developing countries. Already a substantial proportion of these deaths are due to cardiovascular diseases. It is projected that by the year 2025 well over 80-90% of all the cardiovascular diseases in the world will be occurring in low income and middle income countries. This increase in cardiovascular disease is due to a number of causes which include the following: (1) conquest of deaths in childhood and infancy from nutritional deficiencies and infection; (2) urbanization with increasing levels of obesity; (3) increasing longevity of the population so that a higher proportion of individuals reach the age when they are subject to chronic diseases, and (4) increasing use of tobacco worldwide. In most countries in the world other than those in the West, the burden of disease is still due to a combination of infections and nutritional disorders as well as those due to chronic diseases. This double burden of disease poses a challenge that is not only medical and epidemiological, but also social and political. Tackling this projected global epidemic of cardiovascular disease therefore needs policies that combine sound knowledge of prevention, good clinical care, but also deals with the allocation of resources for both individual level and community level preventive strategies. The former involves dealing with high-risk individuals through appropriate medical and therapeutic interventions. The latter involves societal level changes including laws that curb the use of tobacco, and strategies that promote physical activities, and appropriate nutrition. Copyright 2002 S. Karger AG, Basel
Cui, Ji-Zheng; Zhang, Jin-Wei; Zhang, Yun; Ma, Zheng-Liang
To evaluate the clinical efficacy of intradermal injection of methylene blue for treatment of moderate to severe acute thoracic herpes zoster and prevention of postherpetica neuralgia in elderly patients. Sixty-four elderly patients with herpes zoster were randomized to receive a 10-day course of intradermal injection of methylene blue and lidocaine plus oral valaciclovir (group A, 32 cases) and intradermal injection of lidocaine plus oral valaciclovir (group B).Herpes evaluation index, pain rating index, incidence of postherpetic neuralgia, and comprehensive therapeutic effect were compared between the two groups at 11, 30 and 60 days after the treatment. The baseline characteristics were comparable between the two groups (all P>0.05). Compared with that in group B, the time for no new blister formation, blister incrustation and decrustation, and pain relief was significantly shortened in group A (Pmethylene blue can effectively shorten the disease course, reduce the pain intensity and prevent the development of postherpetic neuralgia in elderly patients with herpes zoster.
Rahman, Ardeshir S; Balodis, Iris M; Pilver, Corey E; Leeman, Robert F; Hoff, Rani A; Steinberg, Marvin A; Rugle, Loreen; Krishnan-Sarin, Suchitra; Potenza, Marc N
The study examined in adolescents how alcohol-drinking frequency relates to gambling-related attitudes and behaviors and perceptions of both problem-gambling prevention strategies and adult (including parental) behaviors/attitudes. A survey assessing alcohol, gambling, and health and functioning measures in 1609 high school students. Students were stratified into low-frequency/nondrinking and high-frequency-drinking groups, and into low-risk and at-risk/problematic gambling groups. High-frequency drinking was associated with at-risk/problematic gambling (χ(2)(1,N = 1842) = 49.22, P drinking versus low-frequency/nondrinking adolescents exhibited more permissive attitudes towards gambling (e.g., less likely to report multiple problem-gambling prevention efforts to be important). At-risk problematic gamblers exhibited more severe drinking patterns and greater likelihood of acknowledging parental approval of drinking (χ(2)(1, N = 1842) = 31.58, P drinking adolescents (odds ratio [OR] = 3.17, 95% confidence interval [95% CI] = [1.97, 5.09]) versus low-frequency/nondrinking (OR = 1.86, 95% CI = [0.61, 2.68]) adolescents (interaction OR = 1.78, 95% CI = [1.05, 3.02]). Interrelationships between problematic drinking and gambling in youth may relate to more permissive attitudes across these domains. Stronger links between at-risk/problem gambling and gambling with adults in the high-frequency-drinking group raises the possibility that interventions targeting adults may help mitigate youth gambling and drinking.
Larsen, Erik Roj; Mosekilde, Leif; Foldspang, Anders
Background and aims: We evaluated the effect of two programs for the prevention of falls leading to acute hospital admission in a population of elderly community-dwelling Danish residents. Methods: This was a factorial, pragmatic, intervention study. We included 9605 community-dwelling city......, or no intervention. Results: The Calcium and Vitamin D program was followed by 50.3% and the Environmental and Health Program by 46.4%. According to a multivariate analysis including age, marital status and intervention program, female residents who followed the Calcium and Vitamin D Program had a 12% risk reduction...... in severe falls (RR 0.88; 95% CI 0.79-0.98; pfalls leading to acute hospitalization in communitydwelling elderly females in a northern European region known to be deficient in vitamin D....
Zhang, Haifeng; Zhang, Jie; Zhou, Changsong; Small, Michael; Wang, Binghong
It is commonly believed that epidemic spreading on scale-free networks is difficult to control and that the disease can spread even with a low infection rate, lacking an epidemic threshold. In this paper, we study epidemic spreading on complex networks under the framework of game theory, in which a voluntary vaccination strategy is incorporated. In particular, individuals face the 'dilemma' of vaccination: they have to decide whether or not to vaccinate according to the trade-off between the risk and the side effects or cost of vaccination. Remarkably and quite excitingly, we find that disease outbreak can be more effectively inhibited on scale-free networks than on random networks. This is because the hub nodes of scale-free networks are more inclined to take self-vaccination after balancing the pros and cons. This result is encouraging as it indicates that real-world networks, which are often claimed to be scale free, can be favorably and easily controlled under voluntary vaccination. Our work provides a way of understanding how to prevent the outbreak of diseases under voluntary vaccination, and is expected to provide valuable information on effective disease control and appropriate decision-making.
Moore, Sandra; Dongdem, Anthony Zunuo; Opare, David; Cottavoz, Paul; Fookes, Maria; Sadji, Adodo Yao; Dzotsi, Emmanuel; Dogbe, Michael; Jeddi, Fakhri; Bidjada, Bawimodom; Piarroux, Martine; Valentin, Ouyi Tante; Glèlè, Clément Kakaï; Rebaudet, Stanislas; Sow, Amy Gassama; Constantin de Magny, Guillaume; Koivogui, Lamine; Dunoyer, Jessica; Bellet, Francois; Garnotel, Eric; Thomson, Nicholas; Piarroux, Renaud
The countries of West Africa are largely portrayed as cholera endemic, although the dynamics of outbreaks in this region of Africa remain largely unclear. To understand the dynamics of cholera in a major portion of West Africa, we analyzed cholera epidemics from 2009 to 2015 from Benin to Mauritania. We conducted a series of field visits as well as multilocus variable tandem repeat analysis and whole-genome sequencing analysis of V. cholerae isolates throughout the study region. During this period, Ghana accounted for 52% of the reported cases in the entire study region (coastal countries from Benin to Mauritania). From 2009 to 2015, we found that one major wave of cholera outbreaks spread from Accra in 2011 northwestward to Sierra Leone and Guinea in 2012. Molecular epidemiology analysis confirmed that the 2011 Ghanaian isolates were related to those that seeded the 2012 epidemics in Guinea and Sierra Leone. Interestingly, we found that many countries deemed "cholera endemic" actually suffered very few outbreaks, with multi-year lulls. This study provides the first cohesive vision of the dynamics of cholera epidemics in a major portion of West Africa. This epidemiological overview shows that from 2009 to 2015, at least 54% of reported cases concerned populations living in the three urban areas of Accra, Freetown, and Conakry. These findings may serve as a guide to better target cholera prevention and control efforts in the identified cholera hotspots in West Africa.
Liu, Guirong; Liu, Zhimei; Jin, Zhen
We establish an SIS-UAU model to present the dynamics of epidemic and information spreading in overlay networks. The overlay network is represented by two layers: one where the dynamics of the epidemic evolves and another where the information spreads. We theoretically derive the explicit formulas for the basic reproduction number of awareness R 0 a by analyzing the self-consistent equation and the basic reproduction number of disease R 0 d by using the next generation matrix. The formula of R 0 d shows that the effect of awareness can reduce the basic reproduction number of disease. In particular, when awareness does not affect epidemic spreading, R 0 d is shown to match the existing theoretical results. Furthermore, we demonstrate that the disease-free equilibrium is globally asymptotically stable if R 0 d 1. Finally, numerical simulations show that information plays a vital role in preventing and controlling disease and effectively reduces the final disease scale. Copyright © 2018 Elsevier Ltd. All rights reserved.
Mr. V. Pydiah
Full Text Available Chikungunya epidemic outbreaks have affected more than 1 million people in 2005-2006 in many Indian Ocean islands and in India. Mauritius experienced a major outbreak in February/March 2006 following a minor outbreak in April/May 2005. No cases have been registered on the island since August 2006. The objectives of this study were to understand the timing and development of the 2006-outbreak in Mauritius, to investigate the possibility of a future outbreak, and to propose measures to prevent the recurrence of an epidemic in Mauritius. Mauritius rainfall, temperature and humidity data were analyzed. A door-to-door household census-type survey was carried out in a study locality on the island. A compartmental human-mosquito interaction model was integrated to understand outbreak evolutions in the surveyed locality and in a theoretical locality. It was observed that the onset of the 2006-outbreak in February followed an abnormally high rainfall in the third week of January 2006. 51% of the surveyed population was found to be suspected Chikungunya cases. Computer simulations indicated that a small number of infected humans and mosquitoes existed in the surveyed locality at the outbreak onset. From simulations in the theoretical locality, it was deduced that the level of infectivity in some localities may be below a herd immunity threshold and that the additional percentage of infected inhabitants in a follow-up epidemic would be significantly reduced with the case-reactive control of infected adult mosquitoes.
Zhang Haifeng; Wang Binghong; Zhang Jie; Small, Michael; Zhou Changsong
It is commonly believed that epidemic spreading on scale-free networks is difficult to control and that the disease can spread even with a low infection rate, lacking an epidemic threshold. In this paper, we study epidemic spreading on complex networks under the framework of game theory, in which a voluntary vaccination strategy is incorporated. In particular, individuals face the 'dilemma' of vaccination: they have to decide whether or not to vaccinate according to the trade-off between the risk and the side effects or cost of vaccination. Remarkably and quite excitingly, we find that disease outbreak can be more effectively inhibited on scale-free networks than on random networks. This is because the hub nodes of scale-free networks are more inclined to take self-vaccination after balancing the pros and cons. This result is encouraging as it indicates that real-world networks, which are often claimed to be scale free, can be favorably and easily controlled under voluntary vaccination. Our work provides a way of understanding how to prevent the outbreak of diseases under voluntary vaccination, and is expected to provide valuable information on effective disease control and appropriate decision-making.
Rahman, Ardeshir S.; Balodis, Iris M.; Pilver, Corey E.; Leeman, Robert F.; Hoff, Rani A.; Steinberg, Marvin A.; Rugle, Loreen; Krishnan-Sarin, Suchitra; Potenza, Marc N.
Background To examine in adolescents how alcohol-drinking frequency relates to gambling-related attitudes and behaviors and their perceptions of both problem-gambling prevention strategies and adult (including parental) behaviors/attitudes. Methods A survey assessing alcohol, gambling and health and functioning measures in 1609 high-school students. Students were stratified into low-frequency/non-drinking and high-frequency drinking groups, and into low-risk and at-risk/problematic gambling groups. Results High-frequency drinking was associated with at-risk/problematic gambling (χ2(1, N=1842)=49.22, pgambling (e.g., less likely to report multiple problem-gambling prevention efforts to be important). At-risk problematic gamblers exhibited more severe drinking patterns and greater likelihood of acknowledging parental approval of drinking (χ2(1, N=1842)=31.58, pProblem-gambling severity was more strongly related to gambling with adults among high-frequency-drinking adolescents (odds ratio [OR]=3.17, 95% confidence interval [95%CI]=[1.97, 5.09]) versus low-frequency/non-drinking (OR=1.86, 95%CI=[0.61, 2.68]) adolescents (Interaction OR=1.78, 95%CI=[1.05, 3.02]). Conclusions Inter-relationships between problematic drinking and gambling in youth may relate to more permissive attitudes across these domains. Stronger links between at-risk/problem gambling and gambling with adults in the high-frequency-drinking group raises the possibility that interventions targeting adults may help mitigate youth gambling and drinking. PMID:25147928
Morelli, Vincent; Davis, Carolyn
Sports psychologists play an important role in enhancing performance among athletes. In conjunction with team physicians, they can also shed light on psychological disorders common in athletes, such as mood and eating disorders, and overtraining syndrome. Sports psychologists can also lend their expertise to assist with injury prevention and recovery and compliance issues. Sports psychology has a role in helping to reverse the growing obesity epidemic among school-aged children. These professionals, working with coaches, can increase children's levels of physical activity. Cognitive-behavioral techniques could lead to enhanced enjoyment, increased participation, improved school performance, and a reduction in obesity. Copyright © 2013 Elsevier Inc. All rights reserved.
Westh, Henrik; Boye, Kit; Bartels, Mette Damkjær
INTRODUCTION: We have found an epidemic increase in methicillin-resistant Staphylococcus aureus (MRSA) in Copenhagen. The increase has a complex background and involves hospitals, nursing homes and persons nursed in their own home. MATERIAL AND METHODS: We found 33 MRSA patients in 2003 and 121...... in 2004. All isolates have been spa-typed and epidemiologic information collected. RESULTS: The number of MRSA cases has a doubling time of about six months. The epidemic has been caused by many different MRSA types and 31 staphylococcus protein A genotypes (spa types). MRSA has caused several hospital...... outbreaks and is endemic in 10 nursing homes. Five staff members from nursing homes have been infected with MRSA. MRSA commonly causes skin and soft tissue infections (76%), but serious infections such as septicaemia and pneumonia are also found. CONCLUSION: Treatment of MRSA-infected patients is costly due...
Jakob, A; Mönch, E
It is reported on an epidemic of hepatitis B of 29 patients in a district hospital. Due to diagnostic errors in importation and a more frequent appearance of diseases of hepatitis B in the surgical department and the 2nd medical department, in which above all diabetics are treated, took place. The average age of the patients was 55 years. In all patients the clinical course was to be regarded as severe. 4 of 29 patients died. In all patients the hepatitis B disease showed a pronounced jaundice with high transaminases, particularly the SGOT and LAP were clearly increased. Also the duration of the presence was longer than in hepatitis A as well as the transition into chronic hepatitis was more frequent. By diagnostic information of the physicians and the other medical staff as well as improved measures of desinfection the epidemic could be restricted.
Full Text Available Japan has been free from rabies since the 1950s. However, during the early 1900s several large-scale epidemics spread throughout the country. Here we investigate the dynamics of these epidemics between 1914 and 1933 in Osaka Prefecture, using archival data including newspapers. The association between dog rabies cases and human population density was investigated using Mixed-effects models and epidemiological parameters such as the basic reproduction number (R0, the incubation and infectious period and the serial interval were estimated. A total of 4,632 animal rabies cases were reported, mainly in dogs (99.0%, 4,584 cases during two epidemics from 1914 to 1921, and 1922 to 1933 respectively. The second epidemic was larger (3,705 cases than the first (879 cases, but had a lower R0 (1.50 versus 2.42. The first epidemic was controlled through capture of stray dogs and tethering of pet dogs. Dog mass vaccination began in 1923, with campaigns to capture stray dogs. Rabies in Osaka Prefecture was finally eliminated in 1933. A total of 3,805 rabid dog-bite injuries, and 75 human deaths were reported. The relatively low incidence of human rabies, high ratio of post-exposure vaccines (PEP and bite injuries by rabid dogs (minimum 6.2 to maximum 73.6, between 1924 and 1928, and a decline in the proportion of bite victims that developed hydrophobia over time (slope = -0.29, se = 3, p < 0.001, indicated that increased awareness and use of PEP might have prevented disease. Although significantly more dog rabies cases were detected at higher human population densities (slope = 0.66, se = 0.03, p < 0.01, there were fewer dog rabies cases detected per capita (slope = -0.34, se = 0.03, p < 0.01. We suggest that the combination of mass vaccination and restriction of dog movement enabled by strong legislation was key to eliminate rabies. Moreover, the prominent role of the media in both reporting rabies cases and efforts to control the disease likely contributed
Dennis, Ann M.; Herbeck, Joshua T.; Brown, Andrew Leigh; Kellam, Paul; de Oliveira, Tulio; Pillay, Deenan; Fraser, Christophe; Cohen, Myron S.
Efficient and effective HIV prevention measures for generalized epidemics in sub-Saharan Africa have not yet been validated at the population-level. Design and impact evaluation of such measures requires fine-scale understanding of local HIV transmission dynamics. The novel tools of HIV phylogenetics and molecular epidemiology may elucidate these transmission dynamics. Such methods have been incorporated into studies of concentrated HIV epidemics to identify proximate and determinant traits associated with ongoing transmission. However, applying similar phylogenetic analyses to generalized epidemics, including the design and evaluation of prevention trials, presents additional challenges. Here we review the scope of these methods and present examples of their use in concentrated epidemics in the context of prevention. Next, we describe the current uses for phylogenetics in generalized epidemics, and discuss their promise for elucidating transmission patterns and informing prevention trials. Finally, we review logistic and technical challenges inherent to large-scale molecular epidemiological studies of generalized epidemics, and suggest potential solutions. PMID:24977473
Full Text Available Introduction: The Ebola epidemic in West Africa sparked many ethical and polarizing public health questions on how to adequately control transmission of the virus. These deliberations had and will continue to influence patients, healthcare workers, public perceptions of disease, and governmental responses. Such extensive and potential ramifications warranted an analysis of prior epidemics to sufficiently inform policy makers and prepare them and other authorities for future epidemics. We analyzed how the general public, medical institutions, federal government, and patients themselves responded during the early stages of the AIDS pandemic in two different countries and cultures, the United States and India. Discussion: Our analysis identified four key findings pertaining to the human rights of patients and healthcare workers and to the crucial roles of the government and medical community. The first demands that authoritative officials acknowledge the presence of high-risk behaviors and properly educate the public without stigmatizing groups of individuals. For this task, the medical community and federal government must form and display to the public a respectful and collaborative partnership towards battling the epidemic. These two synergistic endeavors will then allow appropriate officials to implement effective, yet civil, interventions for limiting transmission. Finally, the same officials must ensure that their interventions maintain the human rights of high-risk populations and of healthcare workers. Conclusions: Applying these findings to future epidemics of infectious diseases can aid policy makers in navigating complicated ethical and public health questions, and help prevent them from repeating past mistakes in handling epidemics.
Full Text Available Zika is a viral disease transmitted mainly by mosquitoes of the genus Aedes. In recent years, it has expanded geographically, changing from an endemic mosquito-borne disease across equatorial Asia and Africa, to an epidemic disease causing large outbreaks in several areas of the world. With the recent Zika virus (ZIKV outbreaks in the Americas, the disease has become a focus of attention of public health agencies and of the international research community, especially due to an association with neurological disorders in adults and to the severe neurological and ophthalmological abnormalities found in fetuses and newborns of mothers exposed to ZIKV during pregnancy. A large number of studies have been published in the last 3 years, revealing the structure of the virus, how it is transmitted and how it affects human cells. Many different animal models have been developed, which recapitulate several features of ZIKV disease and its neurological consequences. Moreover, several vaccine candidates are now in active preclinical development, and three of them have already entered phase I clinical trials. Likewise, many different compounds targeting viral and cellular components are being tested in in vitro and in experimental animal models. This review aims to discuss the current state of this rapidly growing literature from a multidisciplinary perspective, as well as to present an overview of the public health response to Zika and of the perspectives for the prevention and treatment of this disease.
Saiz, Juan-Carlos; Martín-Acebes, Miguel A.; Bueno-Marí, Rubén; Salomón, Oscar D.; Villamil-Jiménez, Luis C.; Heukelbach, Jorg; Alencar, Carlos H.; Armstrong, Paul K.; Ortiga-Carvalho, Tania M.; Mendez-Otero, Rosalia; Rosado-de-Castro, Paulo H.; Pimentel-Coelho, Pedro M.
Zika is a viral disease transmitted mainly by mosquitoes of the genus Aedes. In recent years, it has expanded geographically, changing from an endemic mosquito-borne disease across equatorial Asia and Africa, to an epidemic disease causing large outbreaks in several areas of the world. With the recent Zika virus (ZIKV) outbreaks in the Americas, the disease has become a focus of attention of public health agencies and of the international research community, especially due to an association with neurological disorders in adults and to the severe neurological and ophthalmological abnormalities found in fetuses and newborns of mothers exposed to ZIKV during pregnancy. A large number of studies have been published in the last 3 years, revealing the structure of the virus, how it is transmitted and how it affects human cells. Many different animal models have been developed, which recapitulate several features of ZIKV disease and its neurological consequences. Moreover, several vaccine candidates are now in active preclinical development, and three of them have already entered phase I clinical trials. Likewise, many different compounds targeting viral and cellular components are being tested in in vitro and in experimental animal models. This review aims to discuss the current state of this rapidly growing literature from a multidisciplinary perspective, as well as to present an overview of the public health response to Zika and of the perspectives for the prevention and treatment of this disease. PMID:28878742
Flahault, Antoine; Aumont, Gilles; Boisson, Véronique; de Lamballerile, Xavier; Favier, François; Fontenille, Didier; Gaüzère, Bernard-Alex; Journeaux, Sophie; Lotteau, Vincent; Paupy, Christophe; Sanquer, Marie-Anne; Setbon, Michel
Many triggering factors for onset of emerging infectious diseases are now recognised, such as: globalisation, demographic increase, population movements, international trade, urbanisation, forest destruction, climate changes, loss in biodiversity, and extreme life conditions such as poverty, famine and war. Epidemic burden is often leading to disasters, in terms of human losses, as well as economic, political or social consequences. These outbreaks may jeopardize within a few weeks or months, industry, trade, or tourism. While dengue and its most severe forms (hemorrhagic and shock syndrome) is spreading all over the tropical world, another arbovirosis, chikungunya disease dramatically spread in Indian Ocean islands where 30 to 75% of population were infected in 2005 and 2006, and then extended its progression towards India, Sri Lanka, Indonesia, Malaysia, Maldives islands with more than a million people infected with the East-African strain, replacing the former Asian strain which was known to prevail more than 30 years ago in India. Patients experience sequelae with disability, work loss, and rarely severe outcome recently identified in La Réunion and Mayotte (French overseas territories). No country, no part of the world may consider itself as protected against such events. However, consequences of emerging or re-emerging diseases are more and more unacceptable when they impact the poorest countries of the world. Viruses, bacteria, as well as wild animals, birds, or arthropods are not stopped by borders. It is time now to promote barriers against infectious diseases, including prevention, anticipation, disease surveillance and research. This is not only for humanitarian reasons, but also for contributing to a sustainable development with equity for worldwide population. This report presents comprehensive actions taken in 2006 for tracing the epidemic and mobilise research, as requested to the task force set up by the Prime Minister by March 20, 2006.
Navarro-Robles, Estela; Martínez-Matsushita, Louis; López-Molina, Rubén; Fritz-Hernández, Jimena; Flores-Aldana, Bárbara Aida; Mendoza-Pérez, Juan Carlos
Apply a mathematical model to estimate the epidemic patterns of influenza A (H1N1) in Mexico during the stages of application and suspension of measures to mitigate the epidemic. The effective reproductive number (R) for each state of Mexico during and after the application of social distancing measures was estimated by the SIR model (susceptible, infected, and recovered individuals) based on data published by the Ministry of Health of Mexico. From the beginning of the outbreak until suspension of school activities (28 April-13 May 2009), the national median of R was 1.13. In the following period (14 May-17 July 2009) the national median of R decreased to 1.01. It was demonstrated that several epidemic scenarios occurred at the national level. It is suggested that heterogeneous patterns at the state level be taken into account in decision-making on the adoption of measures to mitigate influenza epidemics.
Finger, F.; Bertuzzo, E.; Mari, L.; Knox, A. C.; Gatto, M.; Rinaldo, A.
Epidemiological models can provide crucial understanding about the dynamics of infectious diseases. Possible applications range from real-time forecasting and allocation of health care resources to testing alternative intervention mechanisms such as vaccines, antibiotics or the improvement of sanitary conditions. We apply a spatially explicit model to the cholera epidemic that struck Haiti in October 2010 and is still ongoing. The dynamics of susceptibles as well as symptomatic and asymptomatic infectives are modelled at the scale of local human communities. Dissemination of Vibrio cholerae through hydrological transport and human mobility along the road network is explicitly taken into account, as well as the effect of rainfall as a driver of increasing disease incidence. The model is calibrated using a dataset of reported cholera cases. We further model the long term impact of several types of interventions on the disease dynamics by varying parameters appropriately. Key epidemiological mechanisms and parameters which affect the efficiency of treatments such as antibiotics are identified. Our results lead to conclusions about the influence of different intervention strategies on the overall epidemiological dynamics.
Yip, Cyril C. Y.; Lau, Susanna K. P.; Woo, Patrick C. Y.; Yuen, Kwok-Yung
Human enterovirus 71 (EV71) epidemics have affected various countries in the past 40 years. EV71 commonly causes hand, foot and mouth disease (HFMD) in children, but can result in neurological and cardiorespiratory complications in severe cases. Genotypic changes of EV71 have been observed in different places over time, with the emergence of novel genotypes or subgenotypes giving rise to serious outbreaks. Since the late 1990s, intra- and inter-typic recombination events in EV71 have been increasingly reported in the Asia-Pacific region. In particular, ‘double-recombinant’ EV71 strains belonging to a novel genotype D have been predominant in mainland China and Hong Kong over the last decade, though co-circulating with a minority of other EV71 subgenotypes and coxsackie A viruses. Continuous surveillance and genome studies are important to detect potential novel mutants or recombinants in the near future. Rapid and sensitive molecular detection of EV71 is of paramount importance in anticipating and combating EV71 outbreaks. PMID:24119538
Zhang, Zhaoyang; Wang, Honggang; Wang, Chonggang; Fang, Hua
Social contact networks and the way people interact with each other are the key factors that impact on epidemics spreading. However, it is challenging to model the behavior of epidemics based on social contact networks due to their high dynamics. Traditional models such as susceptible-infected-recovered (SIR) model ignore the crowding or protection effect and thus has some unrealistic assumption. In this paper, we consider the crowding or protection effect and develop a novel model called improved SIR model. Then, we use both deterministic and stochastic models to characterize the dynamics of epidemics on social contact networks. The results from both simulations and real data set conclude that the epidemics are more likely to outbreak on social contact networks with higher average degree. We also present some potential immunization strategies, such as random set immunization, dominating set immunization, and high degree set immunization to further prove the conclusion.
Seeberg, Jens; Meinert, Lotte
This article argues that the concept of communicability that is central to the distinction between communicable diseases (CDs) and noncommunicable diseases (NCDs) is poorly conceptualized. The epidemic spread of NCDs such as diabetes, depression, and eating disorders demonstrates...
Eng, Thomas R; Butler, William T
.... In addition, STDs increase the risk of HIV transmission. The Hidden Epidemic examines the scope of sexually transmitted infections in the United States and provides a critical assessment of the nation's response to this public health crisis...
Sun, Ye [Institute of Information Economy, Hangzhou Normal University, Hangzhou 311121 (China); Alibaba Research Center of Complexity Science, Hangzhou Normal University, Hangzhou 311121 (China); Liu, Chuang, E-mail: firstname.lastname@example.org [Institute of Information Economy, Hangzhou Normal University, Hangzhou 311121 (China); Alibaba Research Center of Complexity Science, Hangzhou Normal University, Hangzhou 311121 (China); Zhang, Chu-Xu [Institute of Information Economy, Hangzhou Normal University, Hangzhou 311121 (China); Alibaba Research Center of Complexity Science, Hangzhou Normal University, Hangzhou 311121 (China); Zhang, Zi-Ke, E-mail: email@example.com [Institute of Information Economy, Hangzhou Normal University, Hangzhou 311121 (China); Alibaba Research Center of Complexity Science, Hangzhou Normal University, Hangzhou 311121 (China)
Nowadays, the emergence of online services provides various multi-relation information to support the comprehensive understanding of the epidemic spreading process. In this Letter, we consider the edge weights to represent such multi-role relations. In addition, we perform detailed analysis of two representative metrics, outbreak threshold and epidemic prevalence, on SIS and SIR models. Both theoretical and simulation results find good agreements with each other. Furthermore, experiments show that, on fully mixed networks, the weight distribution on edges would not affect the epidemic results once the average weight of whole network is fixed. This work may shed some light on the in-depth understanding of epidemic spreading on multi-relation and weighted networks.
Sun, Ye; Liu, Chuang; Zhang, Chu-Xu; Zhang, Zi-Ke
Nowadays, the emergence of online services provides various multi-relation information to support the comprehensive understanding of the epidemic spreading process. In this Letter, we consider the edge weights to represent such multi-role relations. In addition, we perform detailed analysis of two representative metrics, outbreak threshold and epidemic prevalence, on SIS and SIR models. Both theoretical and simulation results find good agreements with each other. Furthermore, experiments show that, on fully mixed networks, the weight distribution on edges would not affect the epidemic results once the average weight of whole network is fixed. This work may shed some light on the in-depth understanding of epidemic spreading on multi-relation and weighted networks.
Machida, Y; Tanaka, H; Yano, Y; Yano, T; Yoshida, K
We experienced Hepatitis A, B, C and fulminant hepatitis due to Herpes simplex virus type 1 (HSV-1) in our hospital for the severely multi-disabled (SMD) who had both severe motor and intellectual disabilities, and some of whom might be further complicated by blindness and/or deafness. In this hospital, 100 SMDs are hospitalized. Case 1: The disabled, 25 year old male, was transmitted Hepatitis A from a nurse. Case 2: The disabled, 60 year old female carrier of Hepatitis B virus (HBV) who has been cared for more than 10 years. Case 3: The disabled, 46 year old male carrier of Hepatitis C virus (HCV) (RNA type 3), has been cared for more than 4 years. Case 4: The disabled, 39 year old male, had a fever of 39 degrees C for 9 days and suddenly died. He was diagnosed as fulminant hepatitis due to HSV-1 by necropsy. The hospitals for SMD are characteristic in prevention of nosocomial infections; 1) The disabled infected is not aware of the fact that he or she is the source of infection and that the other disabled living with him or her are in risk of infection, because of their severe mental condition. 2) All of the disabled need complete or incomplete helps for activities of daily life (ADL), so that the disabled who is the carrier of some pathogen constantly gives risk of infection to staffs, including medical staffs (doctor, nurse and therapist), psychologist and helpers by bloody secretion from wounds, saliva, urine, feces as well as menstrual blood. 3) If a carrier of some pathogen is hospitalized, the staffs should serve under risk of infection involving blood-mediated infectious disease for many years, because SMDs are permitted lifelong stay in the hospitals for SMD, which also play a role of care house or institution, by public expense in Japan. In case of an outbreak of Hepatitis A, nosocomial infection ended in the original case (a nurse), another nurse and a case of the disabled by general treatment and care against communicable diseases of the digestive
Information propagation through peer-to-peer systems, online social systems, wireless mobile ad hoc networks and other modern structures can be modelled as an epidemic on a network of contacts. Understanding how epidemic processes interact with network topology allows us to predict ultimate course, understand phase transitions and develop strategies to control and optimise dissemination. This book is a concise introduction for applied mathematicians and computer scientists to basic models, analytical tools and mathematical and algorithmic results. Mathematical tools introduced include coupling
Ellner, S.; Gallant, A.R. [North Carolina State Univ., Raleigh, NC (United States). Dept. of Statistics; Theiler, J. [Santa Fe Inst., NM (United States)]|[Los Alamos National Lab., NM (United States)
Historical data on recurrent epidemics have been central to the debate about the prevalence of chaos in biological population dynamics. Schaffer and Kot who first recognized that the abundance and accuracy of disease incidence data opened the door to applying a range of methods for detecting chaos that had been devised in the early 1980`s. Using attractor reconstruction, estimates of dynamical invariants, and comparisons between data and simulation of SEIR models, the ``case for chaos in childhood epidemics`` was made through a series of influential papers beginning in the mid 1980`s. The proposition that the precise timing and magnitude of epidemic outbreaks are deterministic but chaotic is appealing, since it raises the hope of finding determinism and simplicity beneath the apparently stochastic and complicated surface of the data. The initial enthusiasm for methods of detecting chaos in data has been followed by critical re-evaluations of their limitations. Early hopes of a ``one size fits all`` algorithm to diagnose chaos vs. noise in any data set have given way to a recognition that a variety of methods must be used, and interpretation of results must take into account the limitations of each method and the imperfections of the data. Our goals here are to outline some newer methods for detecting nonlinearity and chaos that have a solid statistical basis and are suited to epidemic data, and to begin a re-evaluation of the claims for nonlinear dynamics and chaos in epidemics using these newer methods. We also identify features of epidemic data that create problems for the older, better known methods of detecting chaos. When we ask ``are epidemics nonlinear?``, we are not questioning the existence of global nonlinearities in epidemic dynamics, such as nonlinear transmission rates. Our question is whether the data`s deviations from an annual cyclic trend (which would reflect global nonlinearities) are described by a linear, noise-driven stochastic process.
the impact of improved sexually transmitted disease treatment on the HIV epidemic in rural. Tanzania: 1. Design. AIDS 9, 919-926. Korenromp, E.L. (2001) Treatment of Sexually. Transmitted Diseases as an HIV Prevention. Strategy. PhD Thesis, Erasmus University,. Rotterdam. Kwesigabo, G., Killewo, J., Godoy, C., Urassa, ...
This 60 second PSA is based on the August 2010 CDC Vital Signs report which provides information on obesity and what you can do to help fight the epidemic. Created: 8/3/2010 by Centers for Disease Control and Prevention (CDC). Date Released: 8/3/2010.
'The epidemic in this country has the face of a woman' 1 : Gender and HIV/AIDS in South Africa 2. ... Abstract. Epidemiological data clearly show that the highest levels of HIV prevalence occur in sub-Saharan Africa. ... Keywords: gender inequality, HIV prevention, socio-cultural and material aspects, women. African Journal ...
Real-time HIV genotyping and breaking down local HIV epidemics into phylogenetically distinct sub-epidemics may help to reveal the structure and dynamics of HIV transmission networks in communities, and aid in the design of targeted interventions for members of the acute sub-epidemics that likely fuel local HIV/AIDS epidemics.
James, W P T
Most policy makers do not yet understand that the obesity epidemic is a normal population response to the dramatic reduction in the demand for physical activity and the major changes in the food supply of countries over the last 40 years. A national focus on individual behaviour reflects a failure to confront the facts. Thus, the changes in food supply and physical environment are socioeconomically driven, and the health sector simply picks up the consequences. Urbanization alone in China has reduced daily energy expenditure by about 300-400 kcal d(-1) and cycling/bussing or going to work by car determines another variation of 200 kcal d(-1). Thus, energy demands may have dropped with additional TV/media, mechanization and computerized changes by 400-800 kcal d(-1), so weight gain and obesity are inevitable for most or all the population. Food intake should have fallen substantially despite the community's focus on the value of food after all the food crises of the past. Yet, Chinese fat and sugar intakes are escalating, and these policy-mediated features are amplified by the primeval biological drive for those commodities with specialized taste buds for fatty acids, meat, sugar and salt. Yet, traditionally, Chinese diets had negligible sugar, and 25-year-old data show that the optimum diet for Chinese contains 15% fat. Policies relating to food imports, agriculture, food quality standards, appropriate food traffic light labelling, price adjustments and controlled access to unhealthy foods are all within the grasp of the Chinese government. China has traditionally been far more responsive to the value of policies which limit inequalities and establish standards of care than many western governments, who have yet to recognize that the individualistic free-market approach to obesity prevention is guaranteed to fail. China could therefore lead the way: if it follows western approaches, the health and economic burden will become unsustainable.
Yong-Liang, Yang; Kang-Ming, Lin; Sheng-Rong, Wu; Chuan-Jin, Zheng
To analyze the data of epidemic situation of malaria in Longlin Various Nationalities Autonomous County, Guangxi Zhuang Autonomous Region, China from 1951 to 2014 and discuss the distribution characteristics and epidemic law, so as to provide the evidences for developing the prevention and control strategies of the disease. The data about the epidemic situation of malaria in Longlin Various Nationalities Autonomous County were collected and analyzed statistically with Excel 2007. Totally 93 460 malaria cases were reported from 1951 to 2014 in the county. There were two morbidity peaks of malaria during this period, namely 1950s and 1970s, and the annual average incidence rates were 3 237.94/100 000 and 1 572.12/100 000, respectively, but it began to flatten after 1980s. Before 2000, the local cases were the main type, however, there were no endogenous cases since 2008. In 1950s, falciparum malaria was the main type of the disease, and the cases with falciparum malaria, tertian malaria and quartan malaria were accounted for 45.01% (2 392/5 314), 33.72% (1 792/5 314) and 19.55% (1 039/5 314), respectively; while in 1960s, the proportion of cases with tertian malaria increased, that of the cases with quartan malaria decreased, and there were no quartan malaria cases reported since 1980s. There were imported malaria cases reported since 1990s, and a total of 51 cases were found in this period, among which, 50 cases (98.04%) were tertian malaria, and the main infection sources were the cases from epidemic areas in other provinces of China. After 2000, the imported malaria cases with falciparum malaria increased, with a proportion of 60.00% (21/35), and the infection sources were mainly from Africa and Southeast Asia. The local endemic of malaria in Longlin Various Nationalities Autonomous County has been effectively controlled, but the situation of imported malaria is still severe in this county. Therefore, strengthening the surveillance of floating population
Davies, Hannah G; Bowman, Conor; Luby, Stephen P
Cholera is an acute secretory diarrhoeal infection caused by the bacterium Vibrio cholerae. It is likely to have originated in the Indian sub-continent; however, it spread to cause six worldwide pandemics between 1817-1923. The ongoing seventh worldwide pandemic of cholera began in 1961. The intensity, duration and severity of cholera epidemics have been increasing, signaling the need for more effective control and prevention measures. The response to the cholera pandemics of the 19th century led to the development of safe and effective sanitation and water systems which have effectively removed the risk of cholera in many settings. However, such systems are not in place to protect billions of people worldwide. Although some progress has been made in expanding access to water in recent years, achieving optimal infrastructure will, in the most optimistic scenario, take decades. Climate change, extreme weather events and rapid urbanisation suggests that alternatives to the current paradigm of providing large centralised water and sanitation systems should be considered, including smaller decentralised systems. The aim of this review paper is to provide an overview of current knowledge regarding management of cholera with a focus on prevention measures including vaccination and water and sanitation interventions. © 2017 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
Full Text Available Epidemic diseases that cause mass death has been one of the greatest fears of the society in the past century Usually due to poor living conditions, poverty, the inadequate treatment. Plague is one of them. Plague word is sometimes used synonymously with t he word tâûn, sometimes considered to be a greater sense of the Word plague. These outbreaks occured repeatedly in human society and many times occured between XIII - XV. centuries. Our research aims to examine the plague occured in Syria in the Mamluk state domination discussed period. One of the outbreaks have occured in the period between the years 1347 - 1351. Epidemic was looming at the same time with the European named the black death or large extinction. Many people have been killed in Syria as in other places where the epidemic has spread. Rumors about them are given in the source is situated in the form of the issuance of the number of people who died in one day and sometimes the total number of deaths took place at a given date range. In this study, we aimed to determine which is more severe than the others in the outbreak, to assess the rumor about the number of deaths from this cause, to reveal the difficulties of the funeral of the dead, to uncover practices that people do to get rid of this disease.
Becker, N G
After explaining why martingale methods play an important role in statistical inference for parameters of epidemic models, we give a tutorial introduction to these methods in the more familiar context of data on independent and identically distributed survival times. In this simpler setting we introduce requisite results from martingale theory and demonstrate that martingale methods simply lead to well known estimates and their standard errors. We then turn to the context of epidemics, and illustrate how martingale methods can be used to derive a method of inference for the infection potential in a simple model with removal of infectives. The resulting method involves only simple computations and we demonstrate that the method applies under much more general assumptions. There follows a critical review of several applications of martingale methods for the analysis of infectious disease data. It emerges that the approach provides simple methods of inference in some situations where standard methods of inference are not available, or are too cumbersome. The range of applications seems limited, but new applications continue to be found. Little has been done to confirm high efficiency of martingale methods in epidemic applications.
Matsubara, Yutaka; Matsumoto, Takuya; Yoshiya, Keiji; Yoshida, Ayae; Ikeda, Seiichi; Furuyama, Tadashi; Nakatsu, Yoshimichi; Tsuzuki, Teruhisa; Nomura, Masatoshi; Maehara, Yoshihiko
Severe sepsis is critical to health and can result in acute renal failure (ARF). Tissue factor (TF) and thrombomodulin (TM) play key roles in vascular endothelial functions by helping maintain microcirculation in the kidney. Budding uninhibited by benzimidazole-1 (Bub1) plays a role in Akt and JNK signaling, which control TF and TM, respectively. We hypothesized that Bub1 could control vascular endothelial function in sepsis. The aim of this study was to determine the role of Bub1 in septic ARF. We used Mouse cecum ligation and puncture (CLP) using low Bub1 expressing (Bub1) and wild-type (Bub1) mice in vivo and lipopolysaccharide (LPS) stimulation of human aortic endothelial cell (HAEC) in vitro. Bub1 mice had a higher survival rate after CLP than Bub1. Bub1 mice had more severe ARF after CLP than Bub1 with blood biochemical and pathological analyses. TF expression in Bub1 mice and control HAEC (control) significantly increased in the septic model compared with Bub1 and Bub1 silenced HAEC (siBub1). TM expression in the control significantly decreased after LPS stimulation compared with siBub1. Akt and JNK phosphorylation of siBub1 were attenuated after LPS stimulation. Associations of Bub1 with Akt or JNK after LPS stimulation of HAEC were detected using immunoprecipitation, suggesting that Bub1 is involved in the phosphorylation of Akt and JNK after LPS stimulation. Bub1 insufficiency attenuates TF expression and reduces TM suppression by blocking Akt and JNK phosphorylation, respectively, thus leading to the prevention of ARF and death caused by sepsis.
Christakos, G.; Olea, R.A.; Yu, H.-L.
Indian epidemic, the disease disappeared and reappeared several times at most locations; in Western Europe, once the disease entered a place, it lasted a time proportional to the population and then disappeared for several years (this on-and-off situation lasted more than three centuries); and (6) on average, Black Death moved much faster than bubonic plague to reach virgin territories, despite the fact that India is only slightly larger in area than Western Europe and had a railroad network almost instantly moving infected rats, fleas, and people from one end of the subcontinent to the other. Conclusions: These findings throw new light on the spatiotemporal characteristics of the epidemics and need to be taken into consideration in the scientific discussion concerning the two devastating diseases and the lessons learned from them. ?? 2007 The Royal Institute of Public Health.
Christakos, G; Olea, R A; Yu, H-L
disappeared and reappeared several times at most locations; in Western Europe, once the disease entered a place, it lasted a time proportional to the population and then disappeared for several years (this on-and-off situation lasted more than three centuries); and (6) on average, Black Death moved much faster than bubonic plague to reach virgin territories, despite the fact that India is only slightly larger in area than Western Europe and had a railroad network almost instantly moving infected rats, fleas, and people from one end of the subcontinent to the other. These findings throw new light on the spatiotemporal characteristics of the epidemics and need to be taken into consideration in the scientific discussion concerning the two devastating diseases and the lessons learned from them.
Solomon, Suniti; Chakraborty, Anirban; Yepthomi, Rochelle D'Souza
India has a population of more than 1 billion people. Although only about 0.7% of its population is infected with HIV, it has more cases than any other country in the world, with more than 4.5 million HIV-seropositive patients. The epidemic of HIV/AIDS in India is distributed between the urban and rural populations mainly in the southern and western states of the country (APAC-VHS, Community Prevalence of Sexually Transmitted Diseases in Tamil Nadu-A Report, 1998; Solomon, Kumarasamy, Ganesh, & Amalraj, 1998, International Journal of Medical Research, 85; 335-338). India has several different epidemics in various parts of the country. The epidemic in the western and southern states is primarily heterosexual. The northeastern states of India, being in geographical proximity to the Golden Triangle of Asia, initially experienced HIV in the injection drug user population and their sexual partners, but spread to the heterosexual population has been increasing. At present, the northern states, which are the most densely populated, appear to remain largely unaffected by the HIV epidemic. India has mounted a broad intervention program, including the government, and international, nongovernmental, and community-based organizations. The main barriers to effective control are insufficient resources, illiteracy, and stigma. Antiretroviral drugs are manufactured in the country and exported elsewhere, but their affordability (despite a drastic reduction in costs) and the feasibility of monitoring patients on drugs are in question. Starting April 1, 2004, the government of India has announced free provision of ART drugs to all who need it in the six most prevalent states of India.
Da Silva, Renato Aparecido Pimentel; Viana, Matheus Palhares; Da Fontoura Costa, Luciano
Knowing which individuals can be more efficient in spreading a pathogen throughout a determinate environment is a fundamental question in disease control. Indeed, over recent years the spread of epidemic diseases and its relationship with the topology of the involved system have been a recurrent topic in complex network theory, taking into account both network models and real-world data. In this paper we explore possible correlations between the heterogeneous spread of an epidemic disease governed by the susceptible–infected–recovered (SIR) model, and several attributes of the originating vertices, considering Erdös–Rényi (ER), Barabási–Albert (BA) and random geometric graphs (RGG), as well as a real case study, the US air transportation network, which comprises the 500 busiest airports in the US along with inter-connections. Initially, the heterogeneity of the spreading is achieved by considering the RGG networks, in which we analytically derive an expression for the distribution of the spreading rates among the established contacts, by assuming that such rates decay exponentially with the distance that separates the individuals. Such a distribution is also considered for the ER and BA models, where we observe topological effects on the correlations. In the case of the airport network, the spreading rates are empirically defined, assumed to be directly proportional to the seat availability. Among both the theoretical and real networks considered, we observe a high correlation between the total epidemic prevalence and the degree, as well as the strength and the accessibility of the epidemic sources. For attributes such as the betweenness centrality and the k-shell index, however, the correlation depends on the topology considered. (paper)
Prue, Christine E; Hamner, Heather C; Flores, Alina L
The neural tube defects (NTDs) anencephaly and spina bifida, are serious birth defects of the brain and spine that affect about 3000 pregnancies per year in the United States. Research has found a strong link between periconceptional folic acid consumption and NTD prevention. Because Hispanic women have higher rates of NTD-affected births, targeted folic acid promotion efforts were conducted in several major cities from 1999 to 2002. Efforts included paid and unpaid placements of Spanish language public service announcements (PSAs) and community-level education through the use of promotoras. Analyses focused on whether or not women's reported awareness of folic acid, regardless of promotion type, impacted their knowledge or behavior. Women who reported awareness of folic acid had greater folic acid knowledge and use of vitamins containing folic acid than those not aware. Analyses also examined the use of vitamins containing folic acid by pregnancy intention among women who reported awareness of folic acid. The results were varied. Pregnancy wanters were most likely to use vitamins containing folic acid daily. For this group, however, awareness did not play as large a role in whether they reported consuming a vitamin containing folic acid or not, as it did for pregnancy waiters and avoiders.
Paxton, Lynn A
To discuss the factors pertinent to the use of pre-exposure prophylaxis (PrEP) by at-risk heterosexuals in countries with generalized HIV epidemics. PrEP will have the greatest prevention effect if targeted to those at highest risk, but identifying and engaging such persons is challenging. Serodiscordant couples account for a high proportion of new infections and are an appropriate target for PrEP, but the proportion of people in such relationships is small and outside partnerships are common. Differences in adherence coupled to pharmacology of the drugs may account for differences in efficacy seen in the trials. Mathematical modeling indicates that the benefits of PrEP in highly endemic settings outweigh the risk of induced viral resistance. Behavioral risk compensation was not observed in the trials, but current open-label studies will better determine if disinhibition will be an important problem. PrEP is a potentially useful HIV-prevention strategy for generalized heterosexual epidemics. Optimal implementation will require learning more about ways to improve acceptability and adherence and how best to deliver PrEP within the context of limited resource availability.
Kagaayi, Joseph; Serwadda, David
HIV testing of African immigrants in Belgium showed that HIV existed among Africans by 1983. However, the epidemic was recognized much later in most parts of sub-Saharan Africa (SSA) due to stigma and perceived fear of possible negative consequences to the countries' economies. This delay had devastating mortality, morbidity, and social consequences. In countries where earlier recognition occurred, political leadership was vital in mounting a response. The response involved establishment of AIDS control programs and research on the HIV epidemiology and candidate preventive interventions. Over time, the number of effective interventions has grown; the game changer being triple antiretroviral therapy (ART). ART has led to a rapid decline in HIV-related morbidity and mortality in addition to prevention of onward HIV transmission. Other effective interventions include safe male circumcision, pre-exposure prophylaxis, and post-exposure prophylaxis. However, since none of these is sufficient by itself, delivering a combination package of these interventions is important for ending the HIV epidemic as a public health threat.
Full Text Available Background: Hand, foot, and mouth disease (HFMD is caused mostly by Coxsackievirus A16 (CA16 and enterovirus 71 (EV71. Epidemic of HFMD has occurred in India only once in Kerala in 2003. We report here a recent outbreak of HFMD in three districts of West Bengal, India. Materials and Methods: A case detection system developed with 1 three private clinics in three districts; two at Howrah and one at Hooghly, 2 Pediatrics Department of two medical colleges in Kolkata, 3 12 practioners of these three districts with 4 a central referral center at Department of Dermatology, NRS Medical College, Kolkata where all cases from this system were confirmed by a single observer. Pediatric Dermatology unit of the Institute of Child Health, Kolkata was another independent unit. Results: A total of 38 cases of HFMD were reported till 08.10.07. Age group ranged from 12 months to 12 years (mean 40.76 months, SD 29.49. Males were slightly higher than females (M:F - 21:17. Disease was distributed mostly over buttocks, knees, hands, feet - both dorsum and palmar or the plantar surface and the oral mucosa. Highest severity noted over the buttocks and the knee. Healing time for skin lesions was 6-13 days (mean 9.13 days, SD 1.93. Oral lesions were found in 33 (86.8% cases. Conclusion: This outbreak far away from the initial one confirmed regular outsourcing of the virus with possibilities of future epidemics. Also the fact that EV71 induced epidemic is on rise in this part of globe is alarming for India. We hope this early report will be of help for strategic planning for a better management of the disease and prevention of dreaded neurological complications in India.
Full Text Available Abstract Background Muleba district in North-western Tanzania has experienced malaria epidemics in recent years. Community knowledge, attitudes and practices are important in enhancing disease control interventions. This study investigated determinants of malaria epidemics in the study area in relation to household knowledge, attitudes and practice on malaria. Methods A community based cross-sectional survey involving 504 study participants was conducted between April and June 2007 using a structured questionnaire focusing on knowledge, attitudes and practices of community members in epidemic and non-epidemic villages about malaria transmission, signs and symptoms, treatment, prevention and control. Multivariate logistic regression analysis was used to assess determinants of malaria epidemics. Results A total of 504 respondents (males = 36.9% were interviewed. Overall, 453 (90.1% mentioned malaria as the most important disease in the area. Four hundred and sixty four respondents (92.1% knew that malaria is transmitted through mosquito bite. A total of 436 (86.7%, 306 (60.8% and 162 (32.1% mentioned fever, vomiting and loss of appetite as major symptoms/signs of malaria, respectively. Of those interviewed 328 (65.1% remembered the recent outbreak of 2006. Of the 504 respondents interviewed, 296 (58.7% reported that their households owned at least one mosquito net. Three hundred and ninety seven respondents (78.8% knew insecticides used to impregnate bed nets. About two thirds (63.3% of the respondents had at least a household member who suffered from malaria during the recent epidemic. During the 2006 outbreak, 278 people (87.2% sought treatment from health facilities while 27 (8.5% obtained drugs from drug shops and 10 (3.1% used local herbs. Logistic regression analysis showed that household location and level of knowledge of cause of malaria were significant predictors of a household being affected by epidemic. Conclusions Residents of Muleba
Full Text Available An epidemic of gastroenteritis occurred between July and November 1988 in Ahmedabad City. The epidemic originated from Saijpur Bocha locality of the city and thereafter several new foci also development. The city has a number of Government and Municipal Corporation run hospitals as well as private treatment centers where these cases were treated. The Corporation also took measures to control this epidemic. The present study analysis the cases of gastroenteritis (2008 and cholera (112 admitted to the Civil Hospital during this period. The cases occurred in all age groups and both sexes. However, when compared with hospital records of previous non- epidemic years, more cases were found in the adult population and the case fatality rate was low during this epidemic. The study details the various control measures taken by the Municipal Corporation.
Just, Winfried; Saldaña, Joan; Xin, Ying
We study ODE models of epidemic spreading with a preventive behavioral response that is triggered by awareness of the infection. Previous studies of such models have mostly focused on the impact of the response on the initial growth of an outbreak and the existence and location of endemic equilibria. Here we study the question whether this type of response is sufficient to prevent future flare-ups from low endemic levels if awareness is assumed to decay over time. In the ODE context, such flare-ups would translate into sustained oscillations with significant amplitudes. Our results show that such oscillations are ruled out in Susceptible-Aware-Infectious-Susceptible models with a single compartment of aware hosts, but can occur if we consider two distinct compartments of aware hosts who differ in their willingness to alert other susceptible hosts.
Full Text Available Abstract Severe acute respiratory syndrome (SARS is a new infectious disease caused by a novel coronavirus that leads to deleterious pulmonary pathological features. Due to its high morbidity and mortality and widespread occurrence, SARS has evolved as an important respiratory disease which may be encountered everywhere in the world. The virus was identified as the causative agent of SARS due to the efforts of a WHO-led laboratory network. The potential mutability of the SARS-CoV genome may lead to new SARS outbreaks and several regions of the viral genomes open reading frames have been identified which may contribute to the severe virulence of the virus. With regard to the pathogenesis of SARS, several mechanisms involving both direct effects on target cells and indirect effects via the immune system may exist. Vaccination would offer the most attractive approach to prevent new epidemics of SARS, but the development of vaccines is difficult due to missing data on the role of immune system-virus interactions and the potential mutability of the virus. Even in a situation of no new infections, SARS remains a major health hazard, as new epidemics may arise. Therefore, further experimental and clinical research is required to control the disease.
Bacaër, Nicolas; Ouifki, R.; Pretorius, C.; Wood, R.; Williams, B.
We present a simple mathematical model with six compartments for the interaction between HIV and TB epidemics. Using data from a township near Cape Town, South Africa, where the prevalence of HIV is above 20% and where the TB notification rate is close to 2,000 per 100,000 per year, we estimate some of the model parameters and study how various control measures might change the course of these epidemics. Condom promotion, increased TB detection and TB preventive therapy have a clear positive ...
Table of contents. Severe Acute Respiratory Syndrome- SARS · PowerPoint Presentation · Slide 3 · Global pattern of SARS epidemic · Slide 5 · SARS – clinical features · Radiological features of lungs-showing progression of disease · cT Scan of SARS lungs · Imaging type,cost,therapy · SARS – Lung Pathology.
Full Text Available The 19th century was the age of great reform in American history. After constructing of the canal and railroads, the industrialization began and American society changed so rapidly. In this period, there were so many social crisis and American people tried to solve these problems within the several reform movements. These reform movements were the driving forces to control cholera during the 19th century. Cholera was the endemic disease in Bengal, India, but after the 19th century it had spread globally by the development of trade networks. The 1832 cholera in the United States was the first epidemic cholera in American history. The mortality of cholera was so high, but it was very hard to find out the cause of this fatal infectious disease. So, different social discourses happened to control epidemic cholera in the 19th century, these can be understood within the similar context of American reform movements during this period. Board of Health in New York States made a new public health act to control cholera in 1832, it was ineffective. Some people insisted that the cause of this infectious disease was the corruption of the United States. They emphasized unjust and immoral system in American society. Moral reform expanded to Nativism, because lots of Irish immigrants were the victims of cholera. So, epidemic cholera was the opportunity to spread the desire for moral reform. To control cholera in 1849, the sanitary reform in Britain had affected. The fact that it was so important to improve and maintain the water quality for the control and prevention of disease spread, the sanitary reform happened. There were two different sphere of the sanitary reform. The former was the private reform to improve sewer or privy, the latter was the public reform to build sewage facilities. The 1849 cholera had an important meaning, because the social discourse, which had emphasized the sanitation of people or home expanded to the public sphere. When cholera
The 19th century was the age of great reform in American history. After constructing of the canal and railroads, the industrialization began and American society changed so rapidly. In this period, there were so many social crisis and American people tried to solve these problems within the several reform movements. These reform movements were the driving forces to control cholera during the 19th century. Cholera was the endemic disease in Bengal, India, but after the 19th century it had spread globally by the development of trade networks. The 1832 cholera in the United States was the first epidemic cholera in American history. The mortality of cholera was so high, but it was very hard to find out the cause of this fatal infectious disease. So, different social discourses happened to control epidemic cholera in the 19th century, these can be understood within the similar context of American reform movements during this period. Board of Health in New York States made a new public health act to control cholera in 1832, it was ineffective. Some people insisted that the cause of this infectious disease was the corruption of the United States. They emphasized unjust and immoral system in American society. Moral reform expanded to Nativism, because lots of Irish immigrants were the victims of cholera. So, epidemic cholera was the opportunity to spread the desire for moral reform. To control cholera in 1849, the sanitary reform in Britain had affected. The fact that it was so important to improve and maintain the water quality for the control and prevention of disease spread, the sanitary reform happened. There were two different sphere of the sanitary reform. The former was the private reform to improve sewer or privy, the latter was the public reform to build sewage facilities. The 1849 cholera had an important meaning, because the social discourse, which had emphasized the sanitation of people or home expanded to the public sphere. When cholera broke out in 1866 again
Wimberly, M. C.; Bayabil, E.; Beyane, B.; Bishaw, M.; Henebry, G. M.; Lemma, A.; Liu, Y.; Merkord, C. L.; Mihretie, A.; Senay, G. B.; Yalew, W.
Early warning of the timing and locations of malaria epidemics can facilitate the targeting of resources for prevention and emergency response. In response to this need, we are developing the Epidemic Prognosis Incorporating Disease and Environmental Monitoring for Integrated Assessment (EPIDEMIA) computer system. The system incorporates software for capturing, processing, and integrating environmental and epidemiological data from multiple sources; data assimilation techniques that continually update models and forecasts; and a web-based interface that makes the resulting information available to public health decision makers. This technology will enable forecasts based on lagged responses to environmental risk factors as well as information about recent trends in malaria cases. Environmental driving variables will include a variety of remote-sensed hydrological indicators. EPIDEMIA will be implemented and tested in the Amhara Region of Ethiopia in collaboration with local stakeholders. We conducted an initial co-design workshop in July 2014 that included environmental scientists, software engineers, and participants from the NGO, academic, and public health sectors in Ethiopia. A prototype of the EPIDEMIA web interface was presented and a requirements analysis was conducted to characterize the main use cases for the public health community, identify the critical data requirements for malaria risk modeling, and develop of a list of baseline features for the public health interface. Several critical system features were identified, including a secure web-based interface for uploading and validating surveillance data; a flexible query system to allow retrieval of environmental and epidemiological data summaries as tables, charts, and maps; and an alert system to provide automatic warnings in response to environmental and epidemiological risk factors for malaria. Future system development will involve a cycle of implementation, training, usability testing, and
Franco M Neri
Full Text Available Outbreaks of infectious diseases require a rapid response from policy makers. The choice of an adequate level of response relies upon available knowledge of the spatial and temporal parameters governing pathogen spread, affecting, amongst others, the predicted severity of the epidemic. Yet, when a new pathogen is introduced into an alien environment, such information is often lacking or of no use, and epidemiological parameters must be estimated from the first observations of the epidemic. This poses a challenge to epidemiologists: how quickly can the parameters of an emerging disease be estimated? How soon can the future progress of the epidemic be reliably predicted? We investigate these issues using a unique, spatially and temporally resolved dataset for the invasion of a plant disease, Asiatic citrus canker in urban Miami. We use epidemiological models, Bayesian Markov-chain Monte Carlo, and advanced spatial statistical methods to analyse rates and extent of spread of the disease. A rich and complex epidemic behaviour is revealed. The spatial scale of spread is approximately constant over time and can be estimated rapidly with great precision (although the evidence for long-range transmission is inconclusive. In contrast, the rate of infection is characterised by strong monthly fluctuations that we associate with extreme weather events. Uninformed predictions from the early stages of the epidemic, assuming complete ignorance of the future environmental drivers, fail because of the unpredictable variability of the infection rate. Conversely, predictions improve dramatically if we assume prior knowledge of either the main environmental trend, or the main environmental events. A contrast emerges between the high detail attained by modelling in the spatiotemporal description of the epidemic and the bottleneck imposed on epidemic prediction by the limits of meteorological predictability. We argue that identifying such bottlenecks will be a
Marek B. Trawicki
Full Text Available In this paper, the author proposes a new SEIRS model that generalizes several classical deterministic epidemic models (e.g., SIR and SIS and SEIR and SEIRS involving the relationships between the susceptible S, exposed E, infected I, and recovered R individuals for understanding the proliferation of infectious diseases. As a way to incorporate the most important features of the previous models under the assumption of homogeneous mixing (mass-action principle of the individuals in the population N, the SEIRS model utilizes vital dynamics with unequal birth and death rates, vaccinations for newborns and non-newborns, and temporary immunity. In order to determine the equilibrium points, namely the disease-free and endemic equilibrium points, and study their local stability behaviors, the SEIRS model is rescaled with the total time-varying population and analyzed according to its epidemic condition R0 for two cases of no epidemic (R0 ≤ 1 and epidemic (R0 > 1 using the time-series and phase portraits of the susceptible s, exposed e, infected i, and recovered r individuals. Based on the experimental results using a set of arbitrarily-defined parameters for horizontal transmission of the infectious diseases, the proportional population of the SEIRS model consisted primarily of the recovered r (0.7–0.9 individuals and susceptible s (0.0–0.1 individuals (epidemic and recovered r (0.9 individuals with only a small proportional population for the susceptible s (0.1 individuals (no epidemic. Overall, the initial conditions for the susceptible s, exposed e, infected i, and recovered r individuals reached the corresponding equilibrium point for local stability: no epidemic (DFE X ¯ D F E and epidemic (EE X ¯ E E .
Gunnarsdottir, Sandra; Briem, Haraldur; Gottfredsson, Magnus
Measles have increased in incidence in some parts of the developed world in the past 10-15 years. They can be fatal and lead to severe sequelae.Measles were infrequently introduced to Iceland in the 19th century and consequently, epidemics were few but associated with an extremely high mortality. The availability of 19th century church registries enables studies on the impact of measles on mortality. Historical accounts mention two major measles epidemics, starting mid-year 1846 and 1882. We analysed these two epidemics using contemporary historical sources, mainly original church registries. In the 1846 epidemic the data show a clear increase in mortality in June and reach a peak in July of 741 fatal cases total, a four-fold increase from expected baseline rate. The epidemic subsided in the ensuing five months. A cluster of measles was described in the eastern region of Iceland in 1869 but did not spread further. The epidemic of 1882 reached its peak in July, when 1084 individuals died, a five-fold increase from the expected rate. Excess mortality was highest in N-Isafjardarsysla county, 4,7 %, and none in A-Skaftafellssysla county where the illness was described 13 years previously. The highest numbers of fatal cases in the 1882 epidemic (64,6%) was among 0-4 year old children. The number of fatalities among women of child-bearing age was more than two-fold compared to men; the number of births 7-9 months following the 1882 peak dropped significantly by 50%. This study highlights the consequences of measles following introduction into a largely susceptible population and also documents the importance of herd immunity. Information can be identified on most individual fatalities during the 1846 and 1882 measles epidemics in Iceland.
Glaser, Jason; Lemery, Jay; Rajagopalan, Balaji; Diaz, Henry F; García-Trabanino, Ramón; Taduri, Gangadhar; Madero, Magdalena; Amarasinghe, Mala; Abraham, Georgi; Anutrakulchai, Sirirat; Jha, Vivekanand; Stenvinkel, Peter; Roncal-Jimenez, Carlos; Lanaspa, Miguel A; Correa-Rotter, Ricardo; Sheikh-Hamad, David; Burdmann, Emmanuel A; Andres-Hernando, Ana; Milagres, Tamara; Weiss, Ilana; Kanbay, Mehmet; Wesseling, Catharina; Sánchez-Lozada, Laura Gabriela; Johnson, Richard J
Climate change has led to significant rise of 0.8°C-0.9°C in global mean temperature over the last century and has been linked with significant increases in the frequency and severity of heat waves (extreme heat events). Climate change has also been increasingly connected to detrimental human health. One of the consequences of climate-related extreme heat exposure is dehydration and volume loss, leading to acute mortality from exacerbations of pre-existing chronic disease, as well as from outright heat exhaustion and heat stroke. Recent studies have also shown that recurrent heat exposure with physical exertion and inadequate hydration can lead to CKD that is distinct from that caused by diabetes, hypertension, or GN. Epidemics of CKD consistent with heat stress nephropathy are now occurring across the world. Here, we describe this disease, discuss the locations where it appears to be manifesting, link it with increasing temperatures, and discuss ongoing attempts to prevent the disease. Heat stress nephropathy may represent one of the first epidemics due to global warming. Government, industry, and health policy makers in the impacted regions should place greater emphasis on occupational and community interventions. Copyright © 2016 by the American Society of Nephrology.
Migliori, Giovanni Battista; Centis, Rosella; Lange, Chris; Richardson, Morgan D'Arcy; Sotgiu, Giovanni
Drug resistance, particularly through multidrug-resistant tuberculosis (TB) and extensively drug-resistant TB strains, poses a real threat to TB control worldwide. Recent reports from the WHO and the International Union Against Tuberculosis and Lung Disease demonstrate that the emerging epidemic of drug-resistant TB is a global problem, although emphasis has been placed on several 'hot spots' because of lack of good global data. The present article is aimed at reviewing the available information on drug-resistant TB with special focus on the features of the epidemic in Europe, Russia, Latin America, Asia and specifically China, and to discuss the global perspectives related to drug-resistant TB control and care. Drug-resistant TB originates from different human errors, including misuse of anti-TB drugs and other reasons related to prescribers, patients and drug producers. Although there is an urgent need for new drugs, a sound public health approach is necessary for their introduction in clinical treatment settings to prevent/avoid creating additional resistance, as has already been observed for first and second-line anti-TB drugs in many settings.
Trotter, Caroline L; Cibrelus, Laurence; Fernandez, Katya; Lingani, Clément; Ronveaux, Olivier; Stuart, James M
Since 2010, countries in the African meningitis belt have been introducing a new serogroup A meningococcal conjugate vaccine (MenAfriVac(®)) through mass campaigns. With the subsequent decline in meningitis due to Neisseria meningitidis serogroup A (NmA) and relative increase in meningitis due to other serogroups, mainly N. meningitidis serogroup W (NmW), the World Health Organisation (WHO) initiated a review of the incidence thresholds that guide response to meningitis epidemics in the African meningitis belt. Meningitis surveillance data from African meningitis belt countries from 2002 to 2013 were used to construct a single NmW dataset. The performance of different weekly attack rates, used as thresholds to initiate vaccination response, on preventing further cases was estimated. The cumulative seasonal attack rate used to define an epidemic was also varied. Considerable variation in effect at different thresholds was observed. In predicting epidemics defined as a seasonal cumulative incidence of 100/10(5) population, an epidemic threshold of 10 cases/10(5) population/week performed well. Based on this same epidemic threshold, with a 6 week interval between crossing the epidemic threshold and population protection from a meningococcal vaccination campaign, an estimated 17 cases per event would be prevented by vaccination. Lowering the threshold increased the number of cases per event potentially prevented, as did shortening the response interval. If the interval was shortened to 4 weeks at the threshold of 10/10(5), the number of cases prevented would increase to 54 per event. Accelerating time to vaccination could prevent more cases per event than lowering the threshold. Once the meningitis epidemic threshold is crossed, it is of critical importance that vaccination campaigns, where appropriate, are initiated rapidly. Copyright © 2015 Elsevier Ltd. All rights reserved.
Full Text Available Men who have sex with men (MSM and heterosexuals are the populations with the fastest growing HIV infection rates in China. We characterize the epidemic growth and age patterns between these two routes from 2004 to 2015 in Chongqing and Shenzhen, China.Data were downloaded from the National HIV/ AIDS Comprehensive Response Information Management System. For the new HIV diagnoses of heterosexuals and MSM in both cities, we estimated the growth rates by fitting different sub-exponential models. Heat maps are used to show their age patterns. We used histograms to compare these patterns by birth cohort.The MSM epidemics grew significantly in both cities. Chongqing experienced quadratic growth in HIV reported cases with an estimated growth rate of 0.086 per week and a "deceleration rate" of 0.673. HIV reported cases of MSM in Shenzhen grew even more drastically with a growth rate of 0.033 per week and "deceleration rate" of 0.794. The new infections are mainly affecting the ages of 18 to 30 in Chongqing and ages of 20 to 35 in Shenzhen. They peaked in early 1990's and mid-1990's birth cohorts in Chongqing and Shenzhen respectively. The HIV epidemic among heterosexuals grew rapidly in both cities. The growth rates were estimated as 0.02 and 0.028 in Chongqing and Shenzhen respectively whereas the "deceleration rates" were 0.878 and 0.790 in these two places. It affected mostly aged 18 to 75 in males and 18 to 65 in females in Chongqing and aged 18 to 45 in males and 18 to 50 in females in Shenzhen in 2015. In Chongqing, the heterosexual female epidemics display two peaks in HIV diagnoses in the birth cohorts of early 1950's and early 1980's, with heterosexual male epidemics peaked in early 1940's and early 1960's. The heterosexual male and female epidemics display higher rates in the birth cohort 1940-1960, than the birth cohort 1960-1990. It peaked in birth cohorts of 1950's and 1980's in Shenzhen.We revealed striking differences in epidemic growth
Chassagne, P; Bentot-Levasseur, C; Druesne, L; Bercoff, E; Doucet, J
Pneumonia amongst elderly people living in institutions is common and is a frequent cause of mortality and hospital admission. It is important to distinguish between prevention of viral pneumonia, which primarily consists of influenza vaccination programmes, and prevention of bacterial pneumonia. Prevention of influenza infection in institutions requires the vaccination of as many as possible of both residents and caregivers. In the event of a declared epidemic then amantadine can be used to reduce the severity of, and complication rate of, influenza infection. The indications for giving this therapy need to be balanced against potential side-effects, especially neurological ones. For the prevention of bacterial pneumonia risk factors such as immobility or impaired swallowing should be first identified and dealt with as necessary. Anti-pneumoncoccal vaccination may be considered, but on current evidence, the value of systematic vaccination of residents has not yet been established.
Chassagne, P; Bentot-Levasseur, C; Druesne, L; Bercoff, E; Doucet, J
Pneumonia amongst elderly people living in institutions is common and is a frequent cause of mortality and hospital admission. It is important to distinguish between prevention of viral pneumonia, which primarily consists of influenza vaccination programmes, and prevention of bacterial pneumonia. Prevention of influenza infection in institutions requires the vaccination of as many as possible of both residents and caregivers. In the event of a declared epidemic then amantadine can be used to reduce the severity of, and complication rate of, influenza infection. The indications for giving this therapy need to be balanced against potential side-effects, especially neurological ones. For the prevention of bacterial pneumonia risk factors such as immobility or impaired swallowing should be first identified and dealt with as necessary. Anti-pneumoncoccal vaccination may be considered, but on current evidence, the value of systematic vaccination of residents has not yet been established.
Full Text Available Systemic sclerosis (SSc is an autoimmune connective tissue disease involving the skin and internal organs and characterized pathologically by microvascular damage and increased deposition of connective tissue. Skin changes seen in SSc include edema, inflammation, induration, thickening, and progressive skin fibrosis. Histologically, skin fibrosis, accumulation of compact collagen in the dermis, effacement of rete pegs, infiltration by CD4+ T cells, and skin atrophy are observed. The “toxic oil syndrome” reported from Spain caused an outbreak of a scleroderma-like illness and was caused by ingestion of contaminated rapeseed cooking oil. Epidemic dropsy is caused by ingestion of mustard oil contaminated with the oil of Argemone mexicana. The major alkaloids in Argemone oil are sanguinarine and dihydrosanguinarine. These alkaloids produce widespread capillary dilatation, increased capillary permeability, and endothelial proliferation, akin to the toxic oil syndrome. Cutaneous manifestations include erythematous and tender bilaterally symmetrical pitting edema usually involving lower limbs, skin thickening and tethering, pigmentation, and presence of telangiectasias. The dermatopathology observed in epidemic dropsy includes atrophy and flattening of rete pegs, hypertrophy of and deposition of collagen, vascular dilatation and proliferation, and subcutaneous inflammation and fibrosis. Epidemic dropsy usually presents with subacute multisystem involvement, which may mimic a connective tissue disease. Skin involvement in epidemic dropsy may closely mimic cutaneous manifestations in SSc, both clinically and histologically. Thus, the clinician needs to be aware that epidemic dropsy with cutaneous involvement, especially if encountered sporadically, may be mistakenly diagnosed as scleroderma.
Frasca, M.; Rizzo, A.; Gallo, L.; Fortuna, L.; Porfiri, M.
Complex dynamical systems often exhibit collective dynamics that are well described by a reduced set of key variables in a low-dimensional space. Such a low-dimensional description offers a privileged perspective to understand the system behavior across temporal and spatial scales. In this work, we propose a data-driven approach to establish low-dimensional representations of large epidemic datasets by using a dimensionality reduction algorithm based on isometric features mapping (ISOMAP). We demonstrate our approach on synthetic data for epidemic spreading in a population of mobile individuals. We find that ISOMAP is successful in embedding high-dimensional data into a low-dimensional manifold, whose topological features are associated with the epidemic outbreak. Across a range of simulation parameters and model instances, we observe that epidemic outbreaks are embedded into a family of closed curves in a three-dimensional space, in which neighboring points pertain to instants that are close in time. The orientation of each curve is unique to a specific outbreak, and the coordinates correlate with the number of infected individuals. A low-dimensional description of epidemic spreading is expected to improve our understanding of the role of individual response on the outbreak dynamics, inform the selection of meaningful global observables, and, possibly, aid in the design of control and quarantine procedures.
Full Text Available Abstract Background People with severe mental illness (SMI are at increased risk of developing coronary heart disease (CHD and there is growing emphasis on the need to monitor their physical health. However, there is little consensus on how services for the primary prevention of CHD should be organised for this patient group. We explored the views of people with SMI and health professionals from primary care and community mental health teams (CMHTs on how best to provide these services. Methods In-depth interviews were conducted with a purposive sample of patients with SMI (n = 31 and staff from primary care (n = 10 and community mental health teams (n = 25 in North Central London. Transcripts of the qualitative interviews were analysed using a 'framework' approach to identify the main themes in opinions regarding various service models. Results Cardiovascular risk factors in people with SMI were of concern to participants. However, there was some disagreement about the best way to deliver appropriate care. Although staff felt that primary care should take responsibility for risk factor screening and management, patients favoured CHD screening in their CMHT. Problems with both approaches were identified. These included a lack of familiarity in general practice with SMI and antipsychotic side effects and poor communication of physical health issues to the CMHT. Lack of knowledge regarding CHD risk factor screening and difficulties in interpreting screening results and implementing appropriate interventions exist in secondary care. Conclusion Management of physical health care for people with SMI requires complex solutions that cross the primary-secondary care interface. The views expressed by our participants suggest that neither primary nor secondary care services on their own can provide a comprehensive service for all patients. The increased risk of CHD associated with SMI and antipsychotic medications requires flexible solutions with clear
McQuilkin, Patricia A; Udhayashankar, Kanagasabai; Niescierenko, Michelle; Maranda, Louise
The Ebola virus disease (EVD) epidemic, which began in West Africa in December 2013, claimed more than 11,000 lives, with more than 4,800 of these deaths occurring in Liberia. The epidemic had an additional effect of paralyzing the health-care systems in affected countries, which led to even greater mortality and morbidity. Little is known about the impact that the epidemic had on the provision of basic health care. During the period from March to May 2015, we undertook a nationwide, community-based survey to learn more about health-care access during the EVD epidemic in Liberia. A cluster sampling strategy was used to administer a structured in-person survey to heads of households located within the catchment areas surrounding all 21 government hospitals in Liberia. A total of 543 heads of household from all 15 counties in Liberia participated in the study; more than half (67%) of urban respondents and 46% of rural respondents stated that it was very difficult or impossible to access health care during the epidemic. In urban areas, only 20-30% of patients seeking care during the epidemic received care, and in rural areas, only 70-80% of those seeking care were able to access it. Patients requiring prenatal and obstetric care and emergency services had the most difficulty accessing care. The results of this survey support the observation that basic health care was extremely difficult to access during the EVD epidemic in Liberia. Our results underscore the critical need to support essential health-care services during humanitarian crises to minimize preventable morbidity and mortality.
de Boer, Rebecca; Musgrave, Jeffrey; Andersson, Neil; Lutscher, Frithjof
Despite massive investment in HIV control programs, HIV incidence rates in countries with generalized epidemics have not fallen for most of the last decade. It appears that those at risk are not adopting effective prevention strategies. Those who are unable to implement their prevention preferences are referred to as choice disabled. We examined how and to what extent structural intervention measures that support choice-disabled individuals can reduce HIV transmission and prevalence. A mathematical model was developed to describe HIV transmission among and between choice-disabled and choice-enabled individuals. Data were available from field trials identifying factors and effects of choice disability. The model was used to estimate the potential impact of an intervention strategy in which choice-disabled individuals are enabled to make prevention choices. Several scenarios were considered and compared: supporting only one or both genders; supporting only HIV- individuals or also HIV+ choice-disabled individuals. Substantial declines in HIV incidence and prevalence are observed when supportive interventions are included in the model. The magnitude of these declines depends on the scope of the intervention program. The largest positive effect occurs when the support program is offered regardless of HIV status. Addressing the effects of choice disability in any HIV intervention program could be crucial to the program's success. Structural intervention programs to support choice-disabled individuals in implementing prevention strategies greatly reduce HIV incidence and prevalence in mathematical models.
Blake, Lauren E; Garcia-Blanco, Mariano A
We calculated the incidence, mortality, and case fatality rates for Caucasians and non-Caucasians during 19th century yellow fever (YF) epidemics in the United States and determined statistical significance for differences in the rates in different populations. We evaluated nongenetic host factors, including socioeconomic, environmental, cultural, demographic, and acquired immunity status that could have influenced these differences. While differences in incidence rates were not significant between Caucasians and non-Caucasians, differences in mortality and case fatality rates were statistically significant for all epidemics tested (P yellow fever have been observed across diverse populations, but this study is the first to demonstrate a statistically significant association between ancestry and the outcome of yellow fever (YF). With the global burden of mosquito-borne flaviviral infections, such as YF and dengue, on the rise, identifying and characterizing host factors could prove pivotal in the prevention of epidemics and the development of effective treatments. Copyright © 2014 Blake and Garcia-Blanco.
Full Text Available Abstract Background To understand how infectious agents disseminate throughout a population it is essential to capture the social model in a realistic manner. This paper presents a novel approach to modeling the propagation of the influenza virus throughout a realistic interconnection network based on actual individual interactions which we extract from online social networks. The advantage is that these networks can be extracted from existing sources which faithfully record interactions between people in their natural environment. We additionally allow modeling the characteristics of each individual as well as customizing his daily interaction patterns by making them time-dependent. Our purpose is to understand how the infection spreads depending on the structure of the contact network and the individuals who introduce the infection in the population. This would help public health authorities to respond more efficiently to epidemics. Results We implement a scalable, fully distributed simulator and validate the epidemic model by comparing the simulation results against the data in the 2004-2005 New York State Department of Health Report (NYSDOH, with similar temporal distribution results for the number of infected individuals. We analyze the impact of different types of connection models on the virus propagation. Lastly, we analyze and compare the effects of adopting several different vaccination policies, some of them based on individual characteristics -such as age- while others targeting the super-connectors in the social model. Conclusions This paper presents an approach to modeling the propagation of the influenza virus via a realistic social model based on actual individual interactions extracted from online social networks. We implemented a scalable, fully distributed simulator and we analyzed both the dissemination of the infection and the effect of different vaccination policies on the progress of the epidemics. The epidemic values
Full Text Available BACKGROUND: Mass vaccination against measles has successfully lowered the incidence of the disease and has changed the epidemic pattern from a roughly biennial cycle to an irregular sequence of outbreaks. A possible explanation for this sequence of outbreaks is that the vaccinated population is protected by solid herd immunity. If so, we would expect to see the fraction of susceptible individuals remaining below an epidemic threshold. An alternative explanation is the occurrence of occasional localised lapses in herd immunity that allow for major outbreaks in areas with a low vaccine coverage. In that case, we would expect the fraction of susceptible individuals to exceed an epidemic threshold before outbreaks occur. These two explanations for the irregular sequence of measles outbreaks can be tested against observations of both the fraction of susceptible individuals and infection attack rates. METHODS AND FINDINGS: We have estimated both the fraction of susceptible individuals at the start of each epidemic year and the infection attack rates for each epidemic year in the Netherlands over a 28-y period. During this period the vaccine coverage averaged 93%, and there was no sustained measles transmission. Several measles outbreaks occurred in communities with low vaccine coverage, and these ended without intervention. We show that there is a clear threshold value for the fraction of susceptible individuals, below which only minor outbreaks occurred, and above which both minor and major outbreaks occurred. A precise, quantitative relationship exists between the fraction of susceptible individuals in excess of this threshold and the infection attack rate during the major outbreaks. CONCLUSION: In populations with a high but heterogeneous vaccine coverage, measles transmission can be interrupted without establishing solid herd immunity. When infection is reintroduced, a major outbreak can occur in the communities with low vaccine coverage. During
Olusegun Steven Ayodele Oluwole
Full Text Available Epidemics of lathyrism, a neurological syndrome of spastic paraparesis, have occurredduring severe droughts in Europe, Asia, and Africa for millenia. Causation is linked toexposure to β-N-oxalyl-L-α,β-diaminopropionic acid (β-L-ODAP, a neurotoxin in Lathyrussativus. Lathyrism shares neurological features with konzo, a syndrome of predominantlyspastic paraparesis which occurs during droughts in East and Central Africa and is linked to El Nino activity. This study was done to determine the relationship of lathyrism epidemics to phases of El Nino-southern oscillation (ENSO and Pacific decadal oscillation (PDO, and to propose a model to explain why the geospatial distributions of lathyrism and konzo are non-overlapping. Contingency table of phases of ENSO and occurrence of lathyrism epidemics in Central Provinces, India from 1833–1902 was created and odds ratio was calculated. Wavelet spectra of time series of annual occurrence of lathyrism in Rewah district, India, and its coherence with ENSO and PDO from 1894–1920 were performed. Lathyrism epidemic was associated with El Nino phase of ENSO, odds ratio 378 (95 % 32–4475. Global spectra showed peaks at periodicity of 2.5 and 4.6 years for lathyrism; 2.7 and 5.0 years for PDO; and 2.5, 4.6, 7.0 years for ENSO. Spectrograms showed time-varying periodicities of 2.5–3.5 and 4.5–5.5 years for lathyrism; 2.0–3.0 and 6.5–9.0 years for ENSO; and 3.5 and 5.0 years for PDO, p < 0.0001. Spectral coherence were at 2.0–3.5 and 4.5–5.0 years for ENSO and lathyrism p < 0.0001, and 5.0 years for PDO and lathyrism p < 0.05. The droughts of El Ninos initiate dependence on Lathyrus sativus, which exposes the population to neurotoxic β-L-ODAP. Public health control of lathyrism epidemics should include development of models to forecast El Ninos and initiate food programmes in susceptible areas.
Syahrini, Intan; Sriwahyuni; Halfiani, Vera; Meurah Yuni, Syarifah; Iskandar, Taufiq; Rasudin; Ramli, Marwan
Tuberculosis is an infectious disease which has caused a large number of mortality in Indonesia. This disease is caused by Mycrobacterium tuberculosis. Besides affecting lung, this disease also affects other organs such as lymph gland, intestine, kidneys, uterus, bone, and brain. This article discusses the epidemic of tuberculosis through employing the SEIR model. Here, the population is divided into four compartments which are susceptible, exposed, infected and recovered. The susceptible population is further grouped into two which are vaccinated group and unvaccinated group. The behavior of the epidemic is investigated through analysing the equilibrium of the model. The result shows that administering vaccine to the susceptible population contributes to the reduction of the tuberculosis epidemic rate.
Nagatani, Takashi; Ichinose, Genki; Tainaka, Kei-ichi
We present an epidemic model combined with a traffic cellular automaton. Each agent or individual is either susceptible (S) or infected (I). An agent with a certain density moves to a fixed direction on one-dimensional lattice. Simulations for SIS model show that the epidemic spreads via migration. We find a dynamical phase transition between infectious and non-infectious phases. If the density exceeds the critical limit ρC, the epidemic spreads into the population. The value of ρC decreases along with the recovery rate as predicted by mean-field theory. However, this theory cannot explain the simulation result that a traffic jam strongly affects the phase transition. It is found that the minimum value of ρC corresponds to the critical value of the jamming transition.
Manzano, Marc; Calle, Eusebi; Ripoll, Jordi
Our society nowadays is governed by complex networks, examples being the power grids, telecommunication networks, biological networks, and social networks. It has become of paramount importance to understand and characterize the dynamic events (e.g. failures) that might happen in these complex...... networks. For this reason, in this paper, we propose two measures to evaluate the vulnerability of complex networks in two different dynamic multiple failure scenarios: epidemic-like and cascading failures. Firstly, we present epidemic survivability ( ES ), a new network measure that describes...... the vulnerability of each node of a network under a specific epidemic intensity. Secondly, we propose cascading survivability ( CS ), which characterizes how potentially injurious a node is according to a cascading failure scenario. Then, we show that by using the distribution of values obtained from ES and CS...
Shi, Hong-Jing; Duan, Zhi-Sheng; Chen, Guan-Rong; Li, Rong
In this paper, a new susceptible-infected-susceptible (SIS) model on complex networks with imperfect vaccination is proposed. Two types of epidemic spreading patterns (the recovered individuals have or have not immunity) on scale-free networks are discussed. Both theoretical and numerical analyses are presented. The epidemic thresholds related to the vaccination rate, the vaccination-invalid rate and the vaccination success rate on scale-free networks are demonstrated, showing different results from the reported observations. This reveals that whether or not the epidemic can spread over a network under vaccination control is determined not only by the network structure but also by the medicine's effective duration. Moreover, for a given infective rate, the proportion of individuals to vaccinate can be calculated theoretically for the case that the recovered nodes have immunity. Finally, simulated results are presented to show how to control the disease prevalence.
In the current century, the highly developed transportation system can not only boost the economy, but also greatly accelerate the spreading of epidemics. While some epidemic diseases may infect quite a number of people ahead of our awareness, the health care resources such as vaccines and the medical staff are usually locally or even globally insufficient. In this research, with the network of major aviation routes as an example, we present a method to determine the optimal locations to allocate the medical service in order to minimize the impact of the infectious disease with limited resources. Specifically, we demonstrate that when the medical resources are insufficient, we should concentrate our efforts on the travelers with the objective of effectively controlling the spreading rate of the epidemic diseases. © 2011 Springer-Verlag Berlin Heidelberg.
Wimberly, M. C.; Beyane, B.; DeVos, M.; Liu, Y.; Merkord, C. L.; Mihretie, A.
Advance information about the timing and locations of malaria epidemics can facilitate the targeting of resources for prevention and emergency response. Early detection methods can detect incipient outbreaks by identifying deviations from expected seasonal patterns, whereas early warning approaches typically forecast future malaria risk based on lagged responses to meteorological factors. A critical limiting factor for implementing either of these approaches is the need for timely and consistent acquisition, processing and analysis of both environmental and epidemiological data. To address this need, we have developed EPIDEMIA - an integrated system for surveillance and forecasting of malaria epidemics. The EPIDEMIA system includes a public health interface for uploading and querying weekly surveillance reports as well as algorithms for automatically validating incoming data and updating the epidemiological surveillance database. The newly released EASTWeb 2.0 software application automatically downloads, processes, and summaries remotely-sensed environmental data from multiple earth science data archives. EASTWeb was implemented as a component of the EPIDEMIA system, which combines the environmental monitoring data and epidemiological surveillance data into a unified database that supports both early detection and early warning models. Dynamic linear models implemented with Kalman filtering were used to carry out forecasting and model updating. Preliminary forecasts have been disseminated to public health partners in the Amhara Region of Ethiopia and will be validated and refined as the EPIDEMIA system ingests new data. In addition to continued model development and testing, future work will involve updating the public health interface to provide a broader suite of outbreak alerts and data visualization tools that are useful to our public health partners. The EPIDEMIA system demonstrates a feasible approach to synthesizing the information from epidemiological
Full Text Available We formulate an in silico model of pathogen avoidance mechanism and investigate its impact on defensive behavioural measures (e.g., spontaneous social exclusions and distancing, crowd avoidance and voluntary vaccination adaptation. In particular, we use SIR(BS (e.g., susceptible-infected-recovered with additional behavioural component model to investigate the impact of homo-psychologicus aspects of epidemics. We focus on reactionary behavioural changes, which apply to both social distancing and voluntary vaccination participations. Our analyses reveal complex relationships between spontaneous and uncoordinated behavioural changes, the emergence of its contagion properties, and mitigation of infectious diseases. We find that the presence of effective behavioural changes can impede the persistence of disease. Furthermore, it was found that under perfect effective behavioural change, there are three regions in the response factor (e.g., imitation and/or reactionary and behavioural scale factor (e.g., global/local factors ρ–α behavioural space. Mainly, (1 disease is always endemic even in the presence of behavioural change, (2 behavioural-prevalence plasticity is observed and disease can sometimes be eradication, and (3 elimination of endemic disease under permanence of permanent behavioural change is achieved. These results suggest that preventive behavioural changes (e.g., non-pharmaceutical prophylactic measures, social distancing and exclusion, crowd avoidance are influenced by individual differences in perception of risks and are a salient feature of epidemics. Additionally, these findings indicates that care needs to be taken when considering the effect of adaptive behavioural change in predicting the course of epidemics, and as well as the interpretation and development of the public health measures that account for spontaneous behavioural changes.
Full Text Available Infection from the Zika virus is a relatively new disease with limited publications reporting cases and research on outbreaks. It was initially described before 2007 in Africa and Asia, then later in the French Polynesia in the Pacific, and finally in the Americas, in 2015. Brazil confirmed its first case of infection from the Zika virus in March 2015(1 and since October 2015 it has recorded an explosive growth in the number of babies born with microcephaly and also an increase in neurological conditions, including Guillain-Barré syndrome. The strong suspicion that the infection from the Zika virus is related to these manifestations is what brought the Public Health Emergency Committee of the World Health Organization to declare on February 1st of 2016 that the spread of the virus is an emergency international public health problem, meaning that it is a serious, unexpected extraordinary event that could potentially require a coordinated international action(2-3. The absence of another explanation for the dramatic increase in cases of microcephaly and the Guillain-Barré syndrome, both concentrated in areas newly infected by the Zika virus, supports the recommendation of aggressive measures to prevent and reduce infection with the Zika virus, especially among pregnant women and those of reproductive age. In the same document, the World Health Organization recommends monitoring cases of microcephaly and the Guillain-Barré syndrome in the areas of risk and etiological studies of these events to determine whether infection by the Zika virus is causal and if there are other risk factors associated. Measures of additional precautions are as follows: (i Related to the transmission of the virus: epidemiological surveillance, vector control, protection measures, information and counseling for pregnant women and to those who wish to get pregnant. (ii Long-term measures: investment in research for vaccine
Full Text Available Routine vaccination supplemented by planned campaigns occurring at 2-5 y intervals is the core of current measles control and elimination efforts. Yet, large, unexpected outbreaks still occur, even when control measures appear effective. Supplementing these activities with mass vaccination campaigns triggered when low levels of measles immunity are observed in a sample of the population (i.e., serosurveys or incident measles cases occur may provide a way to limit the size of outbreaks.Measles incidence was simulated using stochastic age-structured epidemic models in settings conducive to high or low measles incidence, roughly reflecting demographic contexts and measles vaccination coverage of four heterogeneous countries: Nepal, Niger, Yemen, and Zambia. Uncertainty in underlying vaccination rates was modeled. Scenarios with case- or serosurvey-triggered campaigns reaching 20% of the susceptible population were compared to scenarios without triggered campaigns. The best performing of the tested case-triggered campaigns prevent an average of 28,613 (95% CI 25,722-31,505 cases over 15 y in our highest incidence setting and 599 (95% CI 464-735 cases in the lowest incidence setting. Serosurvey-triggered campaigns can prevent 89,173 (95% CI, 86,768-91,577 and 744 (612-876 cases, respectively, but are triggered yearly in high-incidence settings. Triggered campaigns reduce the highest cumulative incidence seen in simulations by up to 80%. While the scenarios considered in this strategic modeling exercise are reflective of real populations, the exact quantitative interpretation of the results is limited by the simplifications in country structure, vaccination policy, and surveillance system performance. Careful investigation into the cost-effectiveness in different contexts would be essential before moving forward with implementation.Serologically triggered campaigns could help prevent severe epidemics in the face of epidemiological and vaccination
David M Hartley
Full Text Available Cholera is an ancient disease that continues to cause epidemic and pandemic disease despite ongoing efforts to limit its spread. Mathematical models provide one means of assessing the utility of various proposed interventions. However, cholera models that have been developed to date have had limitations, suggesting that there are basic elements of cholera transmission that we still do not understand.Recent laboratory findings suggest that passage of Vibrio cholerae O1 Inaba El Tor through the gastrointestinal tract results in a short-lived, hyperinfectious state of the organism that decays in a matter of hours into a state of lower infectiousness. Incorporation of this hyperinfectious state into our disease model provides a much better fit with the observed epidemic pattern of cholera. These findings help to substantiate the clinical relevance of laboratory observations regarding the hyperinfectious state, and underscore the critical importance of human-to-human versus environment-to-human transmission in the generation of epidemic and pandemic disease.To have maximal impact on limiting epidemic spread of cholera, interventions should be targeted toward minimizing risk of transmission of the short-lived, hyperinfectious form of toxigenic Vibrio cholerae. The possibility of comparable hyperinfectious states in other major epidemic diseases also needs to be evaluated and, as appropriate, incorporated into models of disease prevention.
Full Text Available BACKGROUND: Cholera is an ancient disease that continues to cause epidemic and pandemic disease despite ongoing efforts to limit its spread. Mathematical models provide one means of assessing the utility of various proposed interventions. However, cholera models that have been developed to date have had limitations, suggesting that there are basic elements of cholera transmission that we still do not understand. METHODS AND FINDINGS: Recent laboratory findings suggest that passage of Vibrio cholerae O1 Inaba El Tor through the gastrointestinal tract results in a short-lived, hyperinfectious state of the organism that decays in a matter of hours into a state of lower infectiousness. Incorporation of this hyperinfectious state into our disease model provides a much better fit with the observed epidemic pattern of cholera. These findings help to substantiate the clinical relevance of laboratory observations regarding the hyperinfectious state, and underscore the critical importance of human-to-human versus environment-to-human transmission in the generation of epidemic and pandemic disease. CONCLUSIONS: To have maximal impact on limiting epidemic spread of cholera, interventions should be targeted toward minimizing risk of transmission of the short-lived, hyperinfectious form of toxigenic Vibrio cholerae. The possibility of comparable hyperinfectious states in other major epidemic diseases also needs to be evaluated and, as appropriate, incorporated into models of disease prevention.
Bracho, Gustavo; Varela, Enrique; Fernández, Rolando; Ordaz, Barbara; Marzoa, Natalia; Menéndez, Jorge; García, Luis; Gilling, Esperanza; Leyva, Richard; Rufín, Reynaldo; de la Torre, Rubén; Solis, Rosa L; Batista, Niurka; Borrero, Reinier; Campa, Concepción
Leptospirosis is a zoonotic disease of major importance in the tropics where the incidence peaks in rainy seasons. Natural disasters represent a big challenge to Leptospirosis prevention strategies especially in endemic regions. Vaccination is an effective option but of reduced effectiveness in emergency situations. Homeoprophylactic interventions might help to control epidemics by using highly-diluted pathogens to induce protection in a short time scale. We report the results of a very large-scale homeoprophylaxis (HP) intervention against Leptospirosis in a dangerous epidemic situation in three provinces of Cuba in 2007. Forecast models were used to estimate possible trends of disease incidence. A homeoprophylactic formulation was prepared from dilutions of four circulating strains of Leptospirosis. This formulation was administered orally to 2.3 million persons at high risk in an epidemic in a region affected by natural disasters. The data from surveillance were used to measure the impact of the intervention by comparing with historical trends and non-intervention regions. After the homeoprophylactic intervention a significant decrease of the disease incidence was observed in the intervention regions. No such modifications were observed in non-intervention regions. In the intervention region the incidence of Leptospirosis fell below the historic median. This observation was independent of rainfall. The homeoprophylactic approach was associated with a large reduction of disease incidence and control of the epidemic. The results suggest the use of HP as a feasible tool for epidemic control, further research is warranted. 2010 Elsevier Ltd. All rights reserved.
Meystre-Agustoni, G; Van Melle, G; Chave, J P; Martin, J; Billo, N; Glauser, M P; Francioli, P
A two-phase survey was conducted in the Canton of Vaud among the 1006 registered private practitioners (response rate 98%). The first phase aimed at determining the proportion of these physicians involved in the care of HIV+ persons. The results showed that 43% of the practitioners had been consulted by HIV+ patients. In the second phase, all institutions (hospitals, prisons and IV-drug user rehabilitation and testing centers) and a representative sample of the physicians with HIV+ patients were asked about the transmission category of their HIV+ patients. A mathematical method was used to estimate the true number of known HIV+ individuals by December 1988. Approximately 60% of the HIV+ persons had been seen exclusively by the private practitioners. IV-drug users represented 57% of all HIV+ persons compared to only 27% of the AIDS cases registered in 1988, suggesting that an important change in the transmission categories of AIDS cases is to be expected in the near future. These observations underscore the evolving nature of the HIV epidemic on the one hand, and the crucial role of the private practitioners in the prevention of the HIV infection on the other. This also points to the need for methods specifically designed to monitor HIV and AIDS epidemics respectively.
Enhanced safety features of CHASHMA NPP UNIT-2 to encounter selected severe accidents, various challenges involved to prove the adequacy of severe accidents prevention/mitigation measures and to write management guidelines with one possible solution to these challenges
Iqbal, Z.; Minhaj, A.
This paper describes enhanced safety features of Chashma Nuclear Power Plant Unit-2 (C-2), a 325 MWe PWR to encounter selected severe accidents and discusses various challenges involved to prove the adequacy of severe accidents encountering measures and to write severe accident management guidelines (SAMGs) in compliance with the recently introduced national regulations based on the new IAEA nuclear safety standards. C-2 is being built by China National Nuclear Corporation (CNNC) for Pakistan Atomic Energy Commission (PAEC). Its twin, Unit-1 (C-1) also a 325 MWe PWR, was commissioned in 2000. Nuclear power safety with reference to severe accidents should be treated as a global issue and therefore the developed countries should include the people of developing countries in nuclear power industry's various severe accidents based research and development programs. The implementation of this idea may also deliver few other useful and mutually beneficial byproducts. (author)
Mirian Belkis Nápoles
Full Text Available The humanity has always been tied to the emergence of epidemics and pandemics that affect the course of the history, of the development in entire civilizations. In the epidemiologic transition that happened in last century, the control of transmissible illnesses with the progress of the science and the prevention, it brought about the appearance of chronic not transmissible illnesses. The metabolic syndrome (SM also known as Multimetabolic Syndrome or X Syndrome, is only a constellation of factors of risk lipids and not lipids that can appear in sequential or simultaneous form in the same individual. The objective of the present bibliographical review is to mention some relevant aspects destined to know, prevent and treating to the X Syndrome. For the realization of the same one we base on two types of sources: written material and on-line material. We conclude that a primary prevention and an opportune change of the food habits, environmental factors and life styles, would lead to diminishing the appearance of the Metabolic Syndrome. The treatment is accessible to the patient, of low economical cost, of very easy application for the population, and whose finality will be to prevent complications and to diminish the risks of cardiovascular illness.
Full Text Available . 2005. Climate Drives the Meningitis Epidemics Onset in West Africa. PLoS Medicine, 2: 0043-0049. TAMPLIN, M.L., GAUZENS, A.L., HUQ,A., SACK, D.A. & COLWELL, R.R. 1990. COLWELL. Attachment of Vibrio cholerae Serogroup 01 to Zooplankton...
Sandoval, Ruben; Martinez, Douglas R.
Recently, incidents of police abuse against Hispanics have increased so rapidly that the phenomenon has been called an epidemic. Of special concern to Hispanic leaders is the lack of Federal intervention in these police brutality cases. A list of 56 documented cases involving police brutality against Hispanics is included. (Author/NQ)
Audelin, Anne Margrethe; Cowan, Susan A; Obel, Niels
BACKGROUND:: In Denmark 300 new individuals are diagnosed with HIV every year, despite decades of public health campaigns aimed to raise awareness of potential risk behaviour for HIV transmission. It is important to identify the driving forces of the epidemic, to enable more targeted campaigns...
An epidemic of acute conjunctivitis in Dar es Salaam in 2010 demonstrated the importance of a strong infectious diseases epidemiological surveillance network to minimise disease outbreaks. Misunderstanding of the causes and management of diseases explains the repetitive nature of acute haemorrhagic conjunctivitis ...
Carton, H; Kayembe, K; Kabeya; Odio; Billiau, A; Maertens, K
Epidemiological findings of twenty sporadic cases of epidemic spastic paraparesis (buka-buka) in three areas of Bandundu (Zaire) are reported. These findings suggest the involvement of an infectious agent and do not support the hypothesis of a dietary cyanide intoxication, which has been advanced to explain the outbreak of a very similar disease (Mantakassa) in Mozambique.
Argues that public perceptions of an epidemic of school violence are media-induced; asserts that violence in schools declined during the 1990s; supports assertion with evidence from the National School Safety Center; states the estimates of bullying in school are exaggerated. (PKP)
Malawi Medical Journal. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 13, No 1 (2001) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Cholera Epidemic Control. R Zachariah. Full Text: EMAIL FREE ...
Issue/problem: After disasters, terrorist attacks and wars social epidemics of medically unexplained physical symptoms/syndromes (ups) are often seen. In modern times people feel more vulnerable and especially under pressure of those incidents, everyday symptoms are interpreted as disease and
In April 2013 a porcine epidemic diarrhea virus (PEDV) epidemic began in the United States. As part of the response, real-time RT-PCR assays to detect PEDV were developed by several Veterinary Diagnostic Laboratories. This study evaluated RT-PCR PEDV assays that detect the N gene (gN) and S gene (gS...
Pervaiz, Fahad; Pervaiz, Mansoor; Abdur Rehman, Nabeel; Saif, Umar
The Google Flu Trends service was launched in 2008 to track changes in the volume of online search queries related to flu-like symptoms. Over the last few years, the trend data produced by this service has shown a consistent relationship with the actual number of flu reports collected by the US Centers for Disease Control and Prevention (CDC), often identifying increases in flu cases weeks in advance of CDC records. However, contrary to popular belief, Google Flu Trends is not an early epidemic detection system. Instead, it is designed as a baseline indicator of the trend, or changes, in the number of disease cases. To evaluate whether these trends can be used as a basis for an early warning system for epidemics. We present the first detailed algorithmic analysis of how Google Flu Trends can be used as a basis for building a fully automated system for early warning of epidemics in advance of methods used by the CDC. Based on our work, we present a novel early epidemic detection system, called FluBreaks (dritte.org/flubreaks), based on Google Flu Trends data. We compared the accuracy and practicality of three types of algorithms: normal distribution algorithms, Poisson distribution algorithms, and negative binomial distribution algorithms. We explored the relative merits of these methods, and related our findings to changes in Internet penetration and population size for the regions in Google Flu Trends providing data. Across our performance metrics of percentage true-positives (RTP), percentage false-positives (RFP), percentage overlap (OT), and percentage early alarms (EA), Poisson- and negative binomial-based algorithms performed better in all except RFP. Poisson-based algorithms had average values of 99%, 28%, 71%, and 76% for RTP, RFP, OT, and EA, respectively, whereas negative binomial-based algorithms had average values of 97.8%, 17.8%, 60%, and 55% for RTP, RFP, OT, and EA, respectively. Moreover, the EA was also affected by the region's population size
Boskova, Veronika; Stadler, Tanja; Magnus, Carsten
Each new virus introduced into the human population could potentially spread and cause a worldwide epidemic. Thus, early quantification of epidemic spread is crucial. Real-time sequencing followed by Bayesian phylodynamic analysis has proven to be extremely informative in this respect. Bayesian phylodynamic analyses require a model to be chosen and prior distributions on model parameters to be specified. We study here how choices regarding the tree prior influence quantification of epidemic spread in an emerging epidemic by focusing on estimates of the parameters clock rate, tree height, and reproductive number in the currently ongoing Zika virus epidemic in the Americas. While parameter estimates are quite robust to reasonable variations in the model settings when studying the complete data set, it is impossible to obtain unequivocal estimates when reducing the data to local Zika epidemics in Brazil and Florida, USA. Beyond the empirical insights, this study highlights the conceptual differences between the so-called birth-death and coalescent tree priors: while sequence sampling times alone can strongly inform the tree height and reproductive number under a birth-death model, the coalescent tree height prior is typically only slightly influenced by this information. Such conceptual differences together with non-trivial interactions of different priors complicate proper interpretation of empirical results. Overall, our findings indicate that phylodynamic analyses of early viral spread data must be carried out with care as data sets may not necessarily be informative enough yet to provide estimates robust to prior settings. It is necessary to do a robustness check of these data sets by scanning several models and prior distributions. Only if the posterior distributions are robust to reasonable changes of the prior distribution, the parameter estimates can be trusted. Such robustness tests will help making real-time phylodynamic analyses of spreading epidemic more
Elaine O Nsoesie
Full Text Available Individual-based epidemiology models are increasingly used in the study of influenza epidemics. Several studies on influenza dynamics and evaluation of intervention measures have used the same incubation and infectious period distribution parameters based on the natural history of influenza. A sensitivity analysis evaluating the influence of slight changes to these parameters (in addition to the transmissibility would be useful for future studies and real-time modeling during an influenza pandemic.In this study, we examined individual and joint effects of parameters and ranked parameters based on their influence on the dynamics of simulated epidemics. We also compared the sensitivity of the model across synthetic social networks for Montgomery County in Virginia and New York City (and surrounding metropolitan regions with demographic and rural-urban differences. In addition, we studied the effects of changing the mean infectious period on age-specific epidemics. The research was performed from a public health standpoint using three relevant measures: time to peak, peak infected proportion and total attack rate. We also used statistical methods in the design and analysis of the experiments. The results showed that: (i minute changes in the transmissibility and mean infectious period significantly influenced the attack rate; (ii the mean of the incubation period distribution appeared to be sufficient for determining its effects on the dynamics of epidemics; (iii the infectious period distribution had the strongest influence on the structure of the epidemic curves; (iv the sensitivity of the individual-based model was consistent across social networks investigated in this study and (v age-specific epidemics were sensitive to changes in the mean infectious period irrespective of the susceptibility of the other age groups. These findings suggest that small changes in some of the disease model parameters can significantly influence the uncertainty
Osaka, Shunsuke; Okuzumi, Katsuko; Koide, Shota; Tamai, Kiyoko; Sato, Tomoaki; Tanimoto, Koichi; Tomita, Haruyoshi; Suzuki, Masahiro; Nagano, Yukiko; Shibayama, Keigo; Arakawa, Yoshichika; Nagano, Noriyuki
The decline in methicillin-resistant Staphylococcus aureus (MRSA) isolation rates has become a general observation worldwide, including Japan. We hypothesized that some genetic shift in MRSA might cause this phenomenon, and therefore we investigated the genetic profiles among MRSA clinical isolates obtained from three different epidemic phases in Japan. A total of 353 MRSA isolates were selected from 202 medical facilities in 1990 (pre-epidemic phase), 2004 (epidemic phase) and 2016 (post-epidemic phase). Molecular typing was performed by PCR detection of 22 genes using the polymerase chain reaction (PCR)-based ORF typing (POT) system, including an additional eight genes including small genomic islets and seven toxin genes. Isolates with a POT1 of score 93, identified as presumed clonal complex (pCC)5-staphylococcal cassette chromosome mec (SCCmec) type II including ST5-SCCmec type II New York/Japan clone, represented the major epidemic MRSA lineage in 1990 and 2004. In 2016, however, a marked decrease in isolates with a POT1 score of 93, along with changes in the epidemiology of toxin genes carried, was noted, where the carriers of tst genes including the tst-sec combination were markedly reduced, and those possessing the seb gene alone were markedly increased. Rather, isolates with a POT1 score of 106, including pCC1 or pCC8 among the isolates with SCCmec type IV, which often links to community-associated MRSA, were predominant. Interestingly, the pCC1 and pCC8 lineages were related to sea and tst-sec carriage, respectively. Over time, a transition in MRSA genetic profiles from a POT1 score of 93 in 1990 and 2004 to 106 in 2014 was found in Japan.
Valentine, Gregory; Marquez, Lucila; Pammi, Mohan
Zika Virus (ZIKV), previously the cause of only rare and sporadic human infections, is now considered a Public Health Emergency of International Concern. Over the past two years, ZIKV has become a pandemic encompassing much of the Americas. ZIKV is now proven to cause microcephaly and ophthalmic anomalies in the newborn. Hydrops fetalis, developmental delay, and other anomalies are increasingly being attributed to ZIKV infection in fetuses and neonates. Sequelae of congenital infection and rapid spread of ZIKV throughout the Americas has catapulted Zika virus concerns to the forefront of the medical community. Areas covered: This review seeks to consolidate ZIKV epidemiology, diagnostic testing methods, CDC screening recommendations, and preventive strategies including potential vaccines. Expert commentary: Many unknowns still exist regarding ZIKV infections and its long-term effects in neonates. In addition, further studies need to evaluate if genomic differences that have occurred from the African to the Asian lineage of the virus have led to increased virulence of the virus. The authors believe that all pregnant women with fetuses showing microcephaly and/or intracranial calcifications should be tested for ZIKV infection if they cannot recall their sexual partner travel history. This change from the current CDCs recommendations could increase substantially the number of pregnant women and neonates, screened for ZIKV.
Boushab, M B; Savadogo, M; Sow, M S; Fall-Malick, F Z; Seydi, M
We report three severe cases of hemorrhagic form of Rift Valley Fever which have been observed in the Hospital of Aïoun (two cases) and in the regional hospital of Tidjikdja (one case). The disease manifested itself by an infectious syndrome, an early infectious syndrome (on the second day) with onset of hemorrhagic complications and disorder of consciousness ranging from an agitation to deep coma. The biological examinations showed a severe anemia. Multiple organ failures were also observed. Of the three patients treated one died. Therefore, the management of both suspected and confirmed cases must be initiated as soon as possible in order to control organ damages and prevent fatality. There is no specific treatment. The importance of the epidemiological survey must be emphasized to avoid outbreaks and control any epidemic due to this virus.
Pedro Guevara López
Full Text Available The information technologies have evolved in such a way that communication between computers or hosts has become common, so much that the worldwide organization (governments and corporations depends on it; what could happen if these computers stop working for a long time is catastrophic. Unfortunately, networks are attacked by malware such as viruses and worms that could collapse the system. This has served as motivation for the formal study of computer worms and epidemics to develop strategies for prevention and protection; this is why in this paper, before analyzing epidemiological models, a set of formal definitions based on set theory and functions is proposed for describing 21 concepts used in the study of worms. These definitions provide a basis for future qualitative research on the behavior of computer worms, and quantitative for the study of their epidemiological models.
Rivas, F; Diaz, L A; Cardenas, V M; Daza, E; Bruzon, L; Alcala, A; De la Hoz, O; Caceres, F M; Aristizabal, G; Martinez, J W; Revelo, D; De la Hoz, F; Boshell, J; Camacho, T; Calderon, L; Olano, V A; Villarreal, L I; Roselli, D; Alvarez, G; Ludwig, G; Tsai, T
In 1995, the first Venezuelan equine encephalitis (VEE) outbreak in Colombia in 22 years caused an estimated 75,000 human cases, 3000 with neurologic complications and 300 fatal, in La Guajira State. Of the state's estimated 50,000 equines, 8% may have died. An epizootic IC virus, probably introduced from Venezuela, was rapidly amplified among unvaccinated equines. Record high rainfall, producing high densities of vector Aedes taeniorhynchus, led to extensive epidemic transmission (30% attack rate) in the four affected municipalities. Native Wayuu Indians, constituting 24% of the state's population, were at increased risk of infection (risk ratio, 3.3; 95% confidence interval, 2.2-5.3). Epidemiologic studies found no evidence of human-to-human transmission. A higher-than-expected number of abortions during the outbreak confirmed a previously suspected abortifacient role of VEE infection. Pesticide applications and a mass equine vaccination program contributed to preventing the outbreak's spread south of La Guajira.
Chiyori T Urabe
Full Text Available In recent years, serious infectious diseases tend to transcend national borders and widely spread in a global scale. The incidence and prevalence of epidemics are highly influenced not only by pathogen-dependent disease characteristics such as the force of infection, the latent period, and the infectious period, but also by human mobility and contact patterns. However, the effect of heterogeneous mobility of individuals on epidemic outcomes is not fully understood. Here, we aim to elucidate how spatial mobility of individuals contributes to the final epidemic size in a spatial susceptible-exposed-infectious-recovered (SEIR model with mobile individuals in a square lattice. After illustrating the interplay between the mobility parameters and the other parameters on the spatial epidemic spreading, we propose an index as a function of system parameters, which largely governs the final epidemic size. The main contribution of this study is to show that the proposed index is useful for estimating how parameter scaling affects the final epidemic size. To demonstrate the effectiveness of the proposed index, we show that there is a positive correlation between the proposed index computed with the real data of human airline travels and the actual number of positive incident cases of influenza B in the entire world, implying that the growing incidence of influenza B is attributed to increased human mobility.
Gesser-Edelsburg, Anat; Shir-Raz, Yaffa; Bar-Lev, Oshrat Sassoni; James, James J; Green, Manfred S
Our aim was to examine in what terms leading newspapers' online sites described the current Ebola crisis. We employed a quantitative content analysis of terms attributed to Ebola. We found and analyzed 582 articles published between March 23 and September 30, 2014, on the online websites of 3 newspapers: The New York Times, Daily Mail, and Ynet. Our theoretical framework drew from the fields of health communication and emerging infectious disease communication, including such concepts as framing media literacy, risk signatures, and mental models. We found that outbreak and epidemic were used interchangeably in the articles. From September 16, 2014, onward, epidemic predominated, corresponding to when President Barack Obama explicitly referred to Ebola as an epidemic. Prior to Obama's speech, 86.8% of the articles (323) used the term outbreak and only 8.6% (32) used the term epidemic. Subsequently, both terms were used almost the same amount: 53.8% of the articles (113) used the term outbreak and 53.3% (112) used the term epidemic. Effective communication is crucial during public health emergencies such as Ebola, because language framing affects the decision-making process of social judgments and actions. The choice of one term (outbreak) over another (epidemic) can create different conceptualizations of the disease, thereby influencing the risk signature. (Disaster Med Public Health Preparedness. 2016;10:669-673).
Lantz, P M; Booth, K M
The age-adjusted incidence of breast cancer among U.S. women rose by over 30% during the 1980s. Several population-based studies have concluded that most or all of this observed increase is an artifact of the lead time afforded by mammography screening rather than an indication of a true increase in the rate at which women develop the disease. We conducted a study of the social construction of breast cancer trends as a public health problem in popular U.S. magazines. We documented trends in popular magazine article coverage of breast cancer between 1980 and 1995. In addition, we analyzed the content of a convenience sample of 228 popular magazine articles published between 1987 and 1995, focusing on a subsample of articles (n = 91) that mention the increase in breast cancer incidence. Our results show that the increase in incidence is commonly portrayed as a mysterious, unexplained epidemic occurring primarily among young, professional women in their prime years. Many articles suggest that recent changes in women's behavior such as increases in delayed childbearing, nulliparity, the use of oral contraceptives, induced abortion, and the use of tobacco and alcohol are related to the recent upsurge in the disease. The portrayal of the breast cancer epidemic in the U.S. popular press reflects a strong social desire to create order and control over a frightening disease. In the process, a common message is that the behaviors and choices of young, nontraditional women especially those related to fertility control-have led to pathological repercussions within their bodies, which in turn may be responsible for great disorder and pathology at the societal level in the epidemic of breast cancer.
Full Text Available In Europe, hantaviruses (Bunyaviridae are small mammal-associated zoonotic and emerging pathogens that can cause hemorrhagic fever with renal syndrome (HFRS. Puumala virus, the main etiological agent carried by the bank vole Myodes glareolus is responsible for a mild form of HFRS while Dobrava virus induces less frequent but more severe cases of HFRS.Since 2000 in Europe, more than 3000 cases of HFRS have been recorded, in average, each year, which is nearly double compared to the previous decade. In addition to this upside long-term trend, significant oscillations occur. Epidemic years appear, usually every 2-4 years, with an increased incidence, generally in localised hot spots. Moreover, the virus has been identified in new areas in the recent years.A great number of surveys have been carried out in order to assess the prevalence of the infection in the reservoir host and to identify links with different biotic and abiotic factors. The factors that drive the infections are related to the density and diversity of bank vole populations, prevalence of infection in the reservoir host, viral excretion in the environment, survival of the virus outside its host, and human behaviour, which affect the main transmission virus route through inhalation of infected rodent excreta..At the scale of a rodent population, the prevalence of the infection increases with the age of the individuals but also other parameters, such as sex and genetic variability, interfere. The contamination of the environment may be correlated to the number of newly infected rodents, which heavily excrete the virus. The interactions between these different parameters add to the complexity of the situation and explain the absence of reliable tools to predict epidemics. In this review, the factors that drive the epidemics of hantaviruses in Middle Europe are discussed through a panorama of the epidemiological situation in Belgium, France and Germany.
Transferring the Malaria Epidemic Prediction Model to Users in East Africa. In the highlands of East Africa, epidemic malaria is an emerging climate-related hazard that urgently needs addressing. Malaria incidence increased by 337% during the 1987 epidemic in Rwanda. In Tanzania, Uganda and Kenya, malaria incidence ...
Bone marrow transplantation from genetically HLA-nonidentical donors in children with fatal inherited disorders excluding severe combined immunodeficiencies: use of two monoclonal antibodies to prevent graft rejection.
Jabado, N; Le Deist, F; Cant, A; De Graeff-Meeders, E R; Fasth, A; Morgan, G; Vellodi, A; Hale, G; Bujan, W; Thomas, C; Cavazzana-Calvo, M; Wijdenes, J; Fischer, A
For children with life-threatening inborn errors of metabolism without a matched related bone marrow donor, transplantation from an HLA genetically nonidentical donor is the only therapeutic option. To reduce the high risk of graft rejection in this setting without increasing the conditioning regimen, a protocol based on the infusion of an antiadhesion antibody directed against the CD11a (leukocyte function-associated antigen 1 [LFA-1]) molecule was performed by the European Bone Marrow Transplantation-European Society for Immunodeficiency group with promising results. To optimize engraftment, and thereby survival, further, the additional blockade of a second important leukocyte adhesion and signalization pathway mediated by the CD2 and LFA-3 interaction was attempted in a multicenter protocol conducted by the European Bone Marrow Transplantation-European Society for Immunodeficiency group. Results of this study (ie, engraftment and survival) were compared with a historical control group that received the anti-LFA-1 antibody alone. Factors that may have affected engraftment and survival were also considered in this study. Forty-four children with inborn errors, including inherited immunodeficiencies (excluding severe combined immunodeficiencies), Chédiak-Higashi syndrome, familial hemophagocytic lymphohistiocytosis, and malignant osteopetrosis, received bone marrow from HLA-nonidentical related donors or from HLA-identical unrelated donors at 13 European centers between August 1990 and June 1993. Bone marrow was depleted of T cells by use of either erythrocyte (E) rosetting or monoclonal antibodies (MoAbs) to prevent graft-versus-host disease. The conditioning regimen consisted of busulfan and cyclophosphamide for all patients plus etoposide for patients with osteopetrosis, familial hemophagocytic lymphohistiocytosis, and Chédiak-Higashi syndrome. Infusions of MoAbs specific for the CD11a and the CD2 molecules were started 4 and 3 days, respectively, before and
Outbreaks of infectious diseases require a rapid response from policy makers. The strength and efficacy of the responses depend upon available knowledge of the spatial and temporal parameters governing pathogen spread, affecting, amongst others, the predicted severity of the epidemic. Yet, when a ne...
Stewart, Craig; Warhol, John; Overton, Kim; Wiet, Chad E.; Freeman, Cassy; Bourbeau, John; Moon, Stephen; Crawford, Scott A. G. M.
It is believed hat there are several factors that have contributed to the obesity epidemic that is affecting youths. Certainly a decline in intramural sports is one factor. One should look at the underlying trends that have contributed to this decline. Those trends are: (1) Personnel Issues--How many teachers and coaches have support of a viable…
Vos-de Jong, de C.J.; Nielen, M.; Lopez, E.; Elbers, A.R.W.; Dekker, A.
Emergency vaccination is an effective control strategy for foot-and-mouth disease (FMD) epidemics in densely populated livestock areas, but results in a six-month waiting period before exports can be resumed, incurring severe economic consequences for pig exporting countries. In the European Union,
Constance I. Millar; Bohun B. Kinloch; Robert D. Westfall
Genetic diversity in sugar plne will be severely reduced by the blister rust pandemic predicted within the next 50 to 75 years. We model effects of the epidemic on genetic diversity at the stand and landscape levels for both natural and artificial regeneration. In natural stands, because natural frequencies of the dominant gene (R) for resistance are low, the most...
Sun, Dongbo; Wang, Xinyu; Wei, Shan; Chen, Jianfei; Feng, Li
Porcine epidemic diarrhea (PED) is an intestinal infectious disease caused by porcine epidemic diarrhea virus (PEDV); manifestations of the disease are diarrhea, vomiting and dehydration. Starting from the end of 2010, a PED outbreak occurred in several pig-producing provinces in southern China. Subsequently, the disease spread throughout the country and caused enormous economic losses to the pork industry. Accumulating studies demonstrated that new PEDV variants that appeared in China were responsible for the PED outbreak. In the current mini-review, we summarize PEDV epidemiology and vaccination in China.
Full Text Available This paper examined whether the preventive measures taken by the Hong Kong’s colonial authorities were legitimate during the 1894 Hong Kong plague epidemic, and illuminated the correlation between the plague epidemic and hospital space in Hong Kong in the late 19th century. The quarantine measures taken by the colonial authorities were neither a clear-cut victory for Western medicine nor for a rational quarantine based on scientific medical knowledge. Hong Kong’s medical officials based on the miasma theory, and focused only on house-to-house inspections and forced quarantine or isolation, without encouraging people to wear masks and without conducting disinfection. Even after Hong Kong plague spread, the Hong Kong’s colonial authorities were not interested in what plague bacilli were, but in where they were to be found and how to prevent and control an outbreak of the disease. The germ theory brought significant changes to the disease classification system. Until the 1890s, Hong Kong’s colonial authority had classified cause of death mainly on the basis of symptoms, infectious diseases, parts of the body and diseases of systems. Microbiological analysis of the cause of death in Hong Kong was started by Hunter, a bacteriologist, in 1902. He used bacteriological tests with a microscope to analyze the cause of death. New disease recognition and medical recognition brought large changes to hospital space as well. In particular, from the 1880s to the early 1900s, Western medical circles witnessed shifts from miasma theory to the germ theory, thereby influencing Hong Kong’s hospital spaces. As the germ theory took ground in Hong Kong in 1894, the bacteriological laboratory and isolation ward became inevitable facilities, and hospital space were reorganized accordingly. However, the colonial authorities and local elites’ strategy was different. As a government bacteriologist, Hunter established a central facility to unify several
This paper examined whether the preventive measures taken by the Hong Kong's colonial authorities were legitimate during the 1894 Hong Kong plague epidemic, and illuminated the correlation between the plague epidemic and hospital space in Hong Kong in the late 19th century. The quarantine measures taken by the colonial authorities were neither a clear-cut victory for Western medicine nor for a rational quarantine based on scientific medical knowledge. Hong Kong's medical officials based on the miasma theory, and focused only on house-to-house inspections and forced quarantine or isolation, without encouraging people to wear masks and without conducting disinfection. Even after Hong Kong plague spread, the Hong Kong's colonial authorities were not interested in what plague bacilli were, but in where they were to be found and how to prevent and control an outbreak of the disease. The germ theory brought significant changes to the disease classification system. Until the 1890s, Hong Kong's colonial authority had classified cause of death mainly on the basis of symptoms, infectious diseases, parts of the body and diseases of systems. Microbiological analysis of the cause of death in Hong Kong was started by Hunter, a bacteriologist, in 1902. He used bacteriological tests with a microscope to analyze the cause of death. New disease recognition and medical recognition brought large changes to hospital space as well. In particular, from the 1880s to the early 1900s, Western medical circles witnessed shifts from miasma theory to the germ theory, thereby influencing Hong Kong's hospital spaces. As the germ theory took ground in Hong Kong in 1894, the bacteriological laboratory and isolation ward became inevitable facilities, and hospital space were reorganized accordingly. However, the colonial authorities and local elites' strategy was different. As a government bacteriologist, Hunter established a central facility to unify several laboratories and to manage urban space
Chowell, Gerardo; Viboud, Cécile; Hyman, James M; Simonsen, Lone
While many infectious disease epidemics are initially characterized by an exponential growth in time, we show that district-level Ebola virus disease (EVD) outbreaks in West Africa follow slower polynomial-based growth kinetics over several generations of the disease. We analyzed epidemic growth patterns at three different spatial scales (regional, national, and subnational) of the Ebola virus disease epidemic in Guinea, Sierra Leone and Liberia by compiling publicly available weekly time series of reported EVD case numbers from the patient database available from the World Health Organization website for the period 05-Jan to 17-Dec 2014. We found significant differences in the growth patterns of EVD cases at the scale of the country, district, and other subnational administrative divisions. The national cumulative curves of EVD cases in Guinea, Sierra Leone, and Liberia show periods of approximate exponential growth. In contrast, local epidemics are asynchronous and exhibit slow growth patterns during 3 or more EVD generations, which can be better approximated by a polynomial than an exponential function. The slower than expected growth pattern of local EVD outbreaks could result from a variety of factors, including behavior changes, success of control interventions, or intrinsic features of the disease such as a high level of clustering. Quantifying the contribution of each of these factors could help refine estimates of final epidemic size and the relative impact of different mitigation efforts in current and future EVD outbreaks.
relationship was not linear, probably as a result of the complex relationship between temperature and the different parameters affecting BTV transmission. Rt values for BTV-1 in Andalusia fell below the threshold of 1 when temperatures dropped below 21°C, a much higher threshold than that reported in other BTV outbreaks, such as the BTV-8 epidemic in Northern Europe. This divergence may be explained by differences in the adaptation to temperature of the main vectors of the BTV-1 epidemic in Andalusia (Culicoides imicola compared those of the BTV-8 epidemic in Northern Europe (Culicoides obsoletus. Importantly, we found that BTV transmission (Rt value increased significantly in areas with higher densities of sheep. Our analysis also established that control of BTV-1 in Andalusia was complicated by the simultaneous establishment of several distant foci at the start of the epidemic, which may have been caused by several independent introductions of infected vectors from the North of Africa. We discuss the implications of these findings for BTV surveillance and control in this region of Europe.
Amiroch, S.; Pradana, M. S.; Irawan, M. I.; Mukhlash, I.
Multiple Alignment (MA) is a particularly important tool for studying the viral genome and determine the evolutionary process of the specific virus. Application of MA in the case of the spread of the Severe acute respiratory syndrome (SARS) epidemic is an interesting thing because this virus epidemic a few years ago spread so quickly that medical attention in many countries. Although there has been a lot of software to process multiple sequences, but the use of pairwise alignment to process MA is very important to consider. In previous research, the alignment between the sequences to process MA algorithm, Super Pairwise Alignment, but in this study used a dynamic programming algorithm Needleman wunchs simulated in Matlab. From the analysis of MA obtained and stable region and unstable which indicates the position where the mutation occurs, the system network topology that produced the phylogenetic tree of the SARS epidemic distance method, and system area networks mutation.
Full Text Available Over the recent decades, China experienced several emerging virus outbreaks including those caused by the severe acute respiratory syndrome- (SARS- coronavirus (Cov, H5N1 virus, and H7N9 virus. The SARS tragedy revealed faults in China’s infectious disease prevention system, propelling the Chinese government to enact reforms that enabled better combating of the subsequent H1N1 and H7N9 avian flu epidemics. The system is buttressed by three fundamental, mutually reinforcing components: (1 enduring government administration reforms, including legislation establishing a unified public health emergency management system; (2 prioritized funding for biotechnology and biomedicine industrialization, especially in the areas of pathogen identification, drug production, and the development of vaccines and diagnostics; and (3 increasing investment for public health and establishment of a rapid-response infectious diseases prevention and control system. China is now using its hard-gained experience to support the fight against Ebola in Africa and the Middle East Respiratory Syndrome in its own country.
Full Text Available Abstract Several influenza pandemics have taken place throughout history and it was assumed that the pandemic would emerge from a new human virus resulting from the adaptation of an avian virus strain. Mexico, since 2003 had developed a National Preparedness and Response Plan for an Influenza Pandemic focused in risk communication, health promotion, healthcare, epidemiological surveillance, strategic stockpile, research and development. This plan was challenged on April 2009, when a new influenza A(H1N1 strain of swine origen was detected in Mexico. The situation faced, the decisions and actions taken, allowed to control the first epidemic wave in the country. This document describes the critical moments faced and explicitly point out the lessons learned focused on the decided support by the government, the National Pandemic Influenza Plan, the coordination among all the government levels, the presence and solidarity of international organizations with timely and daily information, diagnosis and the positive effect on the population following the preventive hygienic measures recommended by the health authorities. The international community will be able to use the Mexican experience in the interest of global health.
Xing-Wang, X I
Objective To analyze the epidemic situation of schistosomiasis in Wuhu County from 2012 to 2016, so as to provide the reference for adjusting the control strategy. Methods The data of schistosomiasis prevention and control in Wuhu County from 2012 to 2016 were collected and longitudinally analyzed. Results Since 2013, the average infection rate of schistosomiasis in the population decreased year by year, and the infection rate decreased to 0 in 2016. Since 2012, the infection rate of livestock was 0. The area with Oncomelania hupensis snails decreased year by year, but it drastically rebounded in 2016. No schistosome-infected snails were found since 2012. Conclusions Schistosomiasis epidemic is effectively controlled in Wuhu County, but there is a possibility of recovery. In the next stage, we should focus on strengthening the control of snails and imported infectious sources in order to consolidate the achievements of prevention and control.
Aiken, L H; Smith, H L; Lake, E T
Chile is a country with a relatively low prevalence of HIV infection, where successful prevention has the potential to change the future course of the epidemic. A controversial national prevention strategy based upon public education has emerged in response to characterizations of the epidemic as well-dispersed with a growing involvement of heterosexuals. This characterization is not consistent with the observed facts. There is a comparatively well-organized health care system in Santiago that is doing a good job of detecting HIV infection and already has in place the elements of a targeted intervention scheme. Chile should place priority on the use of the existing health care infrastructure for implementing both the traditional public health interventions for sexually transmitted diseases (contact tracing and partner notification) and the AIDS-necessitated strategy of focused counseling and education.
Pastor-Satorras, Romualdo; Vespignani, Alessandro
We study by analytical methods and large scale simulations a dynamical model for the spreading of epidemics in complex networks. In networks with exponentially bounded connectivity we recover the usual epidemic behavior with a threshold defining a critical point below that the infection prevalence is null. On the contrary, on a wide range of scale-free networks we observe the absence of an epidemic threshold and its associated critical behavior. This implies that scale-free networks are prone to the spreading and the persistence of infections whatever spreading rate the epidemic agents might possess. These results can help understanding computer virus epidemics and other spreading phenomena on communication and social networks
Boulos, Rebecca; Vikre, Emily Kuross; Oppenheimer, Sophie; Chang, Hannah; Kanarek, Robin B
Obesity is a major public health concern in the United States. Over the last several decades, the prevalence of obesity among both adults and children has grown at an alarming rate and is now reaching epidemic proportions. The increase in obesity has been associated with rises in a host of other chronic conditions including cardiovascular disease, type 2 diabetes, and some cancers. While the causes of obesity are multifaceted, there is growing evidence that television viewing is a major contributor. Results of numerous studies indicate a direct association between time spent watching television and body weight. Possible explanations for this relationship include: 1) watching television acts as a sedentary replacement for physical activity; 2) food advertisements for nutrient-poor, high-calorie foods stimulate food intake; and 3) television viewing is associated with "mindless" eating. In addition to decreasing physical activity and increasing the consumption of highly palatable foods, television viewing can also promote weight gain in indirect ways, such as through the use of targeted product placements in television shows; by influencing social perceptions of body image; and airing programs that portray cooking, eating and losing weight as entertainment. This paper will provide an interdisciplinary review of the direct and indirect ways in which television influences the obesity epidemic, and conclude with ways in which the negative impact of television on obesity could be reduced. Copyright © 2012 Elsevier Inc. All rights reserved.
Yoshioka, Eiji; Hanley, Sharon J B; Kawanishi, Yasuyuki; Saijo, Yasuaki
The charcoal burning suicide epidemics in both Hong Kong and Taiwan have been well documented. However, little is known about the situation in Japan. To examine the impact of charcoal burning suicide on the overall and other method-specific suicide rates between 1998 and 2007 in Japan. Using data obtained from the Vital Statistics of Japan, negative binomial regression analyses were performed to investigate the impact of the charcoal burning method. In males and females aged 15-24 and 25-44 years, the charcoal burning epidemic led to a substantial increase in overall suicides, without a decrease in other methods. In all other age groups, no such trend was observed. In young Japanese, the charcoal burning method may have appealed to individuals who might not have chosen other highly or relatively lethal methods, and consequently led to an increase in overall suicides.
Full Text Available Networks offer a fertile framework for studying the spread of infection in human and animal populations. However, owing to the inherent high-dimensionality of networks themselves, modelling transmission through networks is mathematically and computationally challenging. Even the simplest network epidemic models present unanswered questions. Attempts to improve the practical usefulness of network models by including realistic features of contact networks and of host–pathogen biology (e.g. waning immunity have made some progress, but robust analytical results remain scarce. A more general theory is needed to understand the impact of network structure on the dynamics and control of infection. Here we identify a set of challenges that provide scope for active research in the field of network epidemic models.
Worby, Colin J; Chaves, Sandra S; Wallinga, Jacco; Lipsitch, Marc; Finelli, Lyn; Goldstein, Edward
The identification of key "driver" groups in influenza epidemics is of much interest for the implementation of effective public health response strategies, including vaccination programs. However, the relative importance of different age groups in propagating epidemics is uncertain. During a communicable disease outbreak, some groups may be disproportionately represented during the outbreak's ascent due to increased susceptibility and/or contact rates. Such groups or subpopulations can be identified by considering the proportion of cases within the subpopulation occurring before (Bp) and after the epidemic peak (Ap) to calculate the subpopulation's relative risk, RR=Bp/Ap. We estimated RR for several subpopulations (age groups) using data on laboratory-confirmed US influenza hospitalizations during epidemics between 2009-2014. Additionally, we simulated various influenza outbreaks in an age-stratified population, relating the RR to the impact of vaccination in each subpopulation on the epidemic's initial effective reproductive number R_e(0). We found that children aged 5-17 had the highest estimates of RR during the five largest influenza A outbreaks, though the relative magnitude of RR in this age group compared to other age groups varied, being highest for the 2009 A/H1N1 pandemic. For the 2010-2011 and 2012-2013 influenza B epidemics, adults aged 18-49, and 0-4 year-olds had the highest estimates of RR respectively. For 83% of simulated epidemics, the group with the highest RR was also the group for which initial distribution of a given quantity of vaccine would result in the largest reduction of R_e(0). In the largest 40% of simulated outbreaks, the group with the highest RR and the largest vaccination impact was children 5-17. While the relative importance of different age groups in propagating influenza outbreaks varies, children aged 5-17 play the leading role during the largest influenza A epidemics. Extra vaccination efforts for this group may contribute
There are at present approximately 110 million people with diabetes in the world but this number will reach over 220 million by the year 2010, the majority of them with type 2 diabetes. Thus there is an urgent need for strategies to prevent the emerging global epidemic of type 2 diabetes to be implemented. Tackling diabetes must be part of an integrated program that addresses lifestyle related disorders. The prevention and control of type 2 diabetes and the other major noncommunicable diseases (NCDs) can be cost- and health-effective through an integrated (i.e. horizontal) approach to noncommunicable diseases disease prevention and control. With the re-emergence of devastating communicable diseases including AIDS, the Ebola virus and tuberculosis, the pressure is on international and regional agencies to see that the noncommunicable disease epidemic is addressed. The international diabetes and public health communities need to adopt a more pragmatic view of the epidemic of type 2 diabetes and other noncommunicable diseases. The current situation is a symptom of globalization with respect to its social, cultural, economic and political significance. Type 2 diabetes will not be prevented by traditional medical approaches; what is required are major and dramatic changes in the socio-economic and cultural status of people in developing countries and the disadvantaged, minority groups in developed nations. The international diabetes and public health communities must lobby and mobilize politicians, other international agencies such as UNDP, UNICEF, and the World Bank as well as other international nongovernmental agencies dealing with the noncommunicable diseases to address the socio-economic, behavioural, nutritional and public health issues that have led to the type 2 diabetes and noncommunicable diseases epidemic. A multidisciplinary Task Force representing all parties which can contribute to a reversal of the underlying socio-economic causes of the problem is an
Curran, James W; Hoxie, James A
Integration of innovative social and behavioral science with public health approaches for HIV prevention and treatment is of critical importance for slowing the global HIV epidemic. Strengthening and focusing social and behavioral research linking testing and treatment strategies to populations at greatest risk for HIV is crucial. The Social and Behavioral Science Research Network(SBSRN), originated in 2006, involves twenty NIH-funded CFAR Centers and is responding to this challenge.
Zusman, Mara B.
Methamphetamine abuse has become an epidemic in the United States. As methamphetamine becomes increasingly available, more and more people are trying â€“ and becoming addicted to â€“ this potent drug. But although methamphetamine is made using over-the-counter (OTC) drugs containing pseudoephedrine, shifting OTC drugs containing pseudoephedrine to prescription status is not the solution to the methamphetamine crisis. Rather, society must adopt a comprehensive...
Mao, Lingxiang; Fu, Xuemin; Wu, Jing; Shen, Li; Gu, Jiaqi; Yuan, Zhaohu; Chen, Jianguo; Zou, Xinran; Zhang, Chiyu
To investigate the hand, foot and mouth disease (HFMD) epidemic in Zhenjiang, China from 2008 to 2016. A total of 37,202 HFMD cases were investigated and 3707 nasopharyngeal swabs were detected for enterovirus RNA using RT-quantitative PCR. We first reported a mixed pattern of HFMD seasonal epidemic with a combination of single-peak and two-peak patterns in alternate years, and the occurrence of sporadic and epidemic outbreaks of HFMD in kindergartens in Zhenjiang. Children younger than 4 years of age were highly vulnerable to HFMD, and home children and boys had higher risk to develop severe HFMD than nursery children and girls, respectively. Among tested samples, 1709 (46.1%) were detected as enterovirus RNA positive. This study first presents the dynamic of the HFMD epidemic in Zhenjiang from 2008 to 2016.
Onischenko, G G; Popova, A Yu; Moskvitina, E A; Penkovskaya, N A; Listopad, S A; Titova, S V; Kruglikov, V D
The aim of the study was determination of the type of epidemic manifestations of cholera in the Republic of Crimea based on evaluation of epidemic manifestations of cholera risk of introduction and spread of the infection. It was concluded, that, based on the cholera outbreaks, that had taken place, contamination of surface water bodies (fresh and sea) and sewage by Vibrio cholerae O1 ctxA+ and Vibrio cholerae O1 ctXA- potential epidemic danger of introduction of the infection by various types of international transport, population migration, the presence of epidemiologic risk in realization of water pathway of transmission of cholera causative agent and several other social conditions, the Republic of Crimea remains in the group of territories of type I by epidemic manifestations of cholera.
Obesity and metabolic syndromes are major threats to health in both developed and developing countries. This opinion article is a holistic attempt to understand the obesity epidemic, by connecting it to the widespread narcissism in society. The narcissism epidemic refers to an increased prevalence of status-striving individualism and a decreased sense of community, observed in Westerns populations and spreading worldwide. Based on social personality and evolutionary psychology approaches, I speculate that this rise of narcissism underlies a steep social hierarchy resulting in increase of social stress. This social stress markedly affects individuals who are sensitive to social hierarchy dominance due to their personality, yet are relegated at a lower social position. I speculate that over-eating is one major mechanism for coping with this stress, and discuss the possibility that visceral fat may constitute an adaptive behaviour to the lower social hierarchy position, which is perceived as unjust. Connecting the prevalence of obesity to the narcissism epidemic allows for a more thorough examination of factors, which contribute to obesity, which includes early difficult childhood experience, lower rank, and the overall competitive framework of the society. Copyright © 2016 The Author. Published by Elsevier Ltd.. All rights reserved.
Full Text Available The transmission of infectious diseases can be affected by many or even hidden factors, making it difficult to accurately predict when and where outbreaks may emerge. One approach at the moment is to develop and deploy surveillance systems in an effort to detect outbreaks as timely as possible. This enables policy makers to modify and implement strategies for the control of the transmission. The accumulated surveillance data including temporal, spatial, clinical, and demographic information, can provide valuable information with which to infer the underlying epidemic networks. Such networks can be quite informative and insightful as they characterize how infectious diseases transmit from one location to another. The aim of this work is to develop a computational model that allows inferences to be made regarding epidemic network topology in heterogeneous populations. We apply our model on the surveillance data from the 2009 H1N1 pandemic in Hong Kong. The inferred epidemic network displays significant effect on the propagation of infectious diseases.
This paper explores the historical context of the dramatic rise in surgery for glue ear in the mid-20th century, and questions the published assertion that this represented a manufactured 'epidemic'. In examining historical sources, the reader's theoretical viewpoint greatly influences their conclusions: the sustained rise in treatment for glue ear may be seen as the advance of science in a golden age or the resistance of insular professionals to reason in the light of new scientific study methods. Current views on the practice of medicine, consumerism, science and standardisation, rationing and the nature of 'truth' all affect the way that we see this period. Technological advances clearly allowed better diagnosis and more effective treatment, but these did not appear to drive an 'epidemic', rather they were developed to meet the pre-existing challenges of otological practice. The proposition that an 'epidemic' was created does not appear to have any solid grounding. Society's perception of what constitutes disease and what needs treatment may have evolved, but the prevalence of other important diseases changed dramatically over this time period, and a real change in the epidemiology of glue ear cannot be dismissed. In defining the case for and against surgical treatment, a solely positivist, quantitative worldview cannot give us a complete picture of benefit and risk to individuals, families and society at large.
Secher, A L; Stage, E; Ringholm, Lene
history were informed about their additional high risk of severe hypoglycaemia, their treatment was focused on restricted insulin doses during the first 16 gestational weeks, and they were offered real-time continuous glucose monitoring on top of self-monitored plasma glucose measurements. RESULTS: Among......AIMS: Among women with Type 1 diabetes who have had severe hypoglycaemia the year before pregnancy, 70% also experience this complication in pregnancy, and particularly in the first half of pregnancy. We evaluated whether routine use of real-time continuous glucose monitoring from early pregnancy...... 28 women with a recent history of severe hypoglycaemia, 12 (43%) used real-time continuous glucose monitoring from a median (range) of 10 (7-13) gestational weeks for 10 (1-32) weeks. Among these 12 women, eight had experienced a total of 34 (range 1-11) severe hypoglycaemic events in the year before...
YAKA, D. P.; Sultan, B.; Tarbangdo, F.; Thiaw, W. M.
The variations of certain climatic parameters and the degradation of ecosystems, can affect human's health by influencing the transmission, the spatiotemporal repartition and the intensity of infectious diseases. It is mainly the case of meningococcal meningitis (MCM) whose epidemics occur particularly in Sahelo-Soudanian climatic area of Western Africa under quite particular climatic conditions. Meningococcal Meningitis (MCM) is a contagious infection disease due to the bacteria Neisseria meningitis. MCM epidemics occur worldwide but the highest incidence is observed in the "meningitis belt" of sub-Saharan Africa, stretching from Senegal to Ethiopia. In spite of standards, strategies of prevention and control of MCS epidemic from World Health Organization (WHO) and States, African Sahelo-Soudanian countries remain frequently afflicted by disastrous epidemics. In fact, each year, during the dry season (February-April), 25 to 250 thousands of cases are observed. Children under 15 are particularly affected. Among favourable conditions for the resurgence and dispersion of the disease, climatic conditions may be important inducing seasonal fluctuations in disease incidence and contributing to explain the spatial pattern of the disease roughly circumscribed to the ecological Sahelo-Sudanian band. In this study, we tried to analyse the relationships between climatic factors, ecosystems degradation and MCM for a better understanding of MCM epidemic dynamic and their prediction. We have shown that MCM epidemics, whether at the regional, national or local level, occur in a specific period of the year, mainly from January to May characterised by a dry, hot and sandy weather. We have identified both in situ (meteorological synoptic stations) and satellitales climatic variables (NCEP reanalysis dataset) whose seasonal variability is dominating in MCM seasonal transmission. Statistical analysis have measured the links between seasonal variation of certain climatic parameters
Saeedian, M.; Khalighi, M.; Azimi-Tafreshi, N.; Jafari, G. R.; Ausloos, M.
Memory has a great impact on the evolution of every process related to human societies. Among them, the evolution of an epidemic is directly related to the individuals' experiences. Indeed, any real epidemic process is clearly sustained by a non-Markovian dynamics: memory effects play an essential role in the spreading of diseases. Including memory effects in the susceptible-infected-recovered (SIR) epidemic model seems very appropriate for such an investigation. Thus, the memory prone SIR model dynamics is investigated using fractional derivatives. The decay of long-range memory, taken as a power-law function, is directly controlled by the order of the fractional derivatives in the corresponding nonlinear fractional differential evolution equations. Here we assume "fully mixed" approximation and show that the epidemic threshold is shifted to higher values than those for the memoryless system, depending on this memory "length" decay exponent. We also consider the SIR model on structured networks and study the effect of topology on threshold points in a non-Markovian dynamics. Furthermore, the lack of access to the precise information about the initial conditions or the past events plays a very relevant role in the correct estimation or prediction of the epidemic evolution. Such a "constraint" is analyzed and discussed.
Cardiac sympathetic innervation assessed with (123)I-MIBG retains prognostic utility in diabetic patients with severe left ventricular dysfunction evaluated for primary prevention implantable cardioverter-defibrillator.
García-González, P; Fabregat-Andrés, Ó; Cozar-Santiago, P; Sánchez-Jurado, R; Estornell-Erill, J; Valle-Muñoz, A; Quesada-Dorador, A; Payá-Serrano, R; Ferrer-Rebolleda, J; Ridocci-Soriano, F
Scintigraphy with iodine-123-metaiodobenzylguanidine ((123)I-MIBG) is a non-invasive tool for the assessment of cardiac sympathetic innervation (CSI) that has proven to be an independent predictor of survival. Recent studies have shown that diabetic patients with heart failure (HF) have a higher deterioration in CSI. It is unknown if (123)I-MIBG has the same predictive value for diabetic and non-diabetic patients with advanced HF. An analysis is performed to determine whether CSI with (123)I-MIBG retains prognostic utility in diabetic patients with HF, evaluated for a primary prevention implantable cardioverter-defibrillator (ICD). Seventy-eight consecutive HF patients (48 diabetic) evaluated for primary prevention ICD implantation were prospectively enrolled and underwent (123)I-MIBG to assess CSI (heart-to-mediastinum ratio - HMR). A Cox proportional hazards multivariate analysis was used to determine the influence of (123)I-MIBG images for prediction of cardiac events in both diabetic and non-diabetic patients. The primary end-point was a composite of arrhythmic event, cardiac death, or admission due to HF. During a mean follow-up of 19.5 [9.3-29.3] months, the primary end-point occurred in 24 (31%) patients. Late HMR was significantly lower in diabetic patients (1.30 vs. 1.41, p=0.014). Late HMR≤1.30 was an independent predictor of cardiac events in diabetic (hazard ratio 4.53; p=0.012) and non-diabetic patients (hazard ratio 12.31; p=0.023). Diabetic patients with HF evaluated for primary prevention ICD show a higher deterioration in CSI than non-diabetics; nevertheless (123)I-MIBG imaging retained prognostic utility for both diabetic and non-diabetic patients. Copyright © 2015 Elsevier España, S.L.U. and SEMNIM. All rights reserved.
Liu, T; Zhu, G H; Zhang, B; Song, T; Kang, M; Lu, J; Zhao, Y Q; Huang, Z; Huang, Y L; Wang, X J; Yang, X Y; Ma, W J
Since March 2013, China had experienced five seasonal epidemics related to Avian influenza A (H7N9). An unprecedented outbreak of H7N9 epidemic started from September 2016, with 730 cases reported till June 30(th) 2017, in mainland China that caused profound influences on both social development and health of the people. As an emerging infectious disease, information on pathogenic characteristics, transmission patterns and other epidemiological features of H7N9 virus somehow remained unclear. Data from previous studies suggested that the live poultry market (LPM) seemed to have served as main places where H7N9 virus got originated, mutated, spread and thus infected the human beings. Hence, closure of LPMs was suggested a major measure to control and prevent H7N9 epidemics in China. However, the effectiveness of different ways of LPM closures on H7N9 epidemics had been controversial. This study systemically summarized the effects of different ways of LPM closures on H7N epidemics from previous studies, aiming to provide references for developing a better program on H7N9 control and prevention in the country.
Page, Yves; Cuny, Sophie; Hermitte, Thierry; Labrousse, Maxime
The objective of the paper is to give an overview of the road injuries issues in France in the 2010's by determining the frequency and the severity of injuries sustained by car occupants, and to infer the implications in terms of vehicule safety. Three types of analysis are conducted. First, we present a time series analysis at a macro statistical level showing a dramatic decrease of injured and fatally injured occupants in passenger cars compared to other modes of road transport. Secondly, we propose a descriptive statistical analysis of the injuries (frequency and severity) sustained by car occupants, by body regions, using the AIS. Finally we propose some insights into the effectiveness of some safety features. French National crash census (BAAC) is used for a general overview of injury frequencies and raw severity scores (fatal, hospitalized, slighty injured) in car crashes. In-depth crash investigations data are used to specify the body regions and the severity of the injuries sustained by car occupants. Data show that car occupants mortality and morbidity decreased more over the last decade than other road modes: -58 % fatalities and -64 % hospitalized (compared to -39% and -55% for pedestrians, and -21% and -44% for motorcyclists for example). In crashes for which at least one person has been injured, 19 % of occupants are uninjured, 49 % of occupants sustain MAIS 1 injuries, 15 % MAIS2, 8% MAIS 3, and 9 % MAIS 4+. Regardless of seat belt use, the body regions most often injured are head, upper and lower extremities and thorax. However, at least two third up to 92% of involved persons sustain no injury at each of these body regions. The frequency of severe injuries is low, often less than 10 % and concern head and thorax mainly. Finally, the frequency and severity of injuries decrease for belted occupants in newer cars compared to older cars, whatever body regions. The frequency of severe injuries decreased by almost 50 % in these newer cars.
Mohan, Alladi; Kiran, DHN; Manohar, I Chiranjeevi; Kumar, D Prabath
Chikungunya fever, caused by “Chikungunya virus,” is an arbovirus disease transmitted by the bite of infected mosquitoes belonging to the genus Aedes. Chikungunya fever epidemics have been reported from several countries around the world. The disease that was silent for nearly 32 years re-emerged in the October 2005 outbreak in India that is still ongoing. The incubation period ranges from 3 to 12 days. The onset is usually abrupt and the acute stage is characterized by sudden onset with high-grade fever, severe arthralgias, myalgias, and skin rash. Swollen tender joints and crippling arthritis are usually evident. In the chronic stage, relapses that include sensation of fever, asthenia, exacerbation of arthralgias, inflammatory polyarthritis, and stiffness may be evident. Neurological, ocular, and mucocutaneous manifestations have also been described. Chronic arthritis may develop in about 15% of the patients. Viral culture is the gold standard for the diagnosis of Chikungunya fever. Reverse transcription polymerase chain reaction and real-time loop-mediated isothermal amplification have also been found to be useful. Serodiagnostic methods for the detection of immunoglobulin M and immunoglobulin G antibodies against Chikungunya virus are more frequently used. Chikungunya is a self-limiting disease; however, severe manifestations such as meningoencephalitis, fulminant hepatitis, and bleeding manifestations may sometimes be life-threatening. Treatment is symptomatic and supportive. Prevention by educating the community and public health officials, vector control measures appear to be the best approach at controlling Chikungunya fever as no commercially available vaccine is available for public use in India for this condition presently. PMID:20418981
Giaquinto, C.; Rampon, O.; D'Elia, R.; de Rossi, A.; Grosch-Woerner, I.; Feiterna-Sperling, C.; Schmitz, T.; Casteleyn, S.; Mok, J.; de Jose, I.; Bates, I.; Larru, B.; Pena, J. M.; Garcia, J. Gonzalez; Lopez, J. R. Arribas; Garcia-Rodriguez, M. C.; Asensi-Botet, F.; Otero, M. C.; Perez-Tamarit, D.; Suarez, G.; Scherpbier, H.; Kreyenbroek, M.; Godfried, M. H.; Nellen, F. J.; Boer, K.; Bohlin, A. B.; Lindgren, S.; Belfrage, E.; Naver, L.; Anzen, B.; Lidman, K.; Levy, J.; Hainaut, M.; Goetghebuer, T.; Manigart, Y.; Barlow, P.; Ferrazin, A.; Bassetti, D.; de Maria, A.; Bentivoglio, G.; Ferrero, S.; Gotta, C.; Mur, A.; Paya, A.; Lopez-Vilchez, M. A.; Carreras, R.; Valerius, N. H.; Jimenez, J.; Coll, O.; Suy, A.; Perez, J. M.; Fortuny, C.; Boguna, J.; Caro, M. Casellas; Canet, Y.; Pardi, G.; Ravizza, M.; Guerra, B.; Lanari, M.; Bianchi, S.; Bovicelli, L.; Prati, E.; Duse, M.; Scaravelli, G.; Stegagno, M.; de Santis, M.; Savasi, V.; Ferrazzi, E.; Vigano, A.; Giacomet, V.; Probizer, F. Ravagni; Maccabruni, A.; Bucceri, A.; Rancilio, L.; Alberico, S.; Rabusin, M.; Bernardon, M.; Taylor, G. P.; Lyall, E. G. H.; Penn, Z.; Buffolano, W.; Tiseo, R.; Martinelli, P.; Sansone, M.; Agangi, A.; Tibaldi, C.; Marini, S.; Masuelli, G.; Benedetto, C.; Niemiec, T.; Marczynska, M.; Oldakowska, A.; Kaflik, M.; Posokhova, S.; Kaleeva, T.; Stelmah, A.; Kiseleva, G.
Objectives: To carry out an epidemiological analysis of the emerging epidemic in an Eastern European country and to compare the approach to prevention of mother-to-child transmission (MTCT) with that in Western Europe. Design: Prospective cohort study established in 1985 in Western Europe and
Full Text Available Computational simulations are currently used to identify epidemic dynamics, to test potential prevention and intervention strategies, and to study the effects of social behaviors on HIV transmission. The author describes an agent-based epidemic simulation model of a network of individuals who participate in high-risk sexual practices, using number of partners, condom usage, and relationship length to distinguish between high- and low-risk populations. Two new concepts—free links and fixed links—are used to indicate tendencies among individuals who either have large numbers of short-term partners or stay in long-term monogamous relationships. An attempt was made to reproduce epidemic curves of reported HIV cases among male homosexuals in Taiwan prior to using the agent-based model to determine the effects of various policies on epidemic dynamics. Results suggest that when suitable adjustments are made based on available social survey statistics, the model accurately simulates real-world behaviors on a large scale.
Computational simulations are currently used to identify epidemic dynamics, to test potential prevention and intervention strategies, and to study the effects of social behaviors on HIV transmission. The author describes an agent-based epidemic simulation model of a network of individuals who participate in high-risk sexual practices, using number of partners, condom usage, and relationship length to distinguish between high- and low-risk populations. Two new concepts-free links and fixed links-are used to indicate tendencies among individuals who either have large numbers of short-term partners or stay in long-term monogamous relationships. An attempt was made to reproduce epidemic curves of reported HIV cases among male homosexuals in Taiwan prior to using the agent-based model to determine the effects of various policies on epidemic dynamics. Results suggest that when suitable adjustments are made based on available social survey statistics, the model accurately simulates real-world behaviors on a large scale.
Browning, Roger M; Fellingham, William H; O'Loughlin, Edmond J; Brown, Nicholas A; Paech, Michael J
Cesarean delivery is commonly performed under regional anesthesia, which is often associated with maternal shivering. This can cause distress and interfere with monitoring. The study objective was to evaluate the antishivering efficacy of ondansetron, which reduces the incidence and severity of shivering in nonobstetric patients. We hypothesized that there would be a significant decrease in the incidence and/or severity of shivering in women who are given intravenous ondansetron 8 mg before combined spinal epidural (CSE) anesthesia, when compared with placebo. This was a randomized, double-blinded, parallel-group, placebo-controlled trial of 118 women scheduled for elective cesarean surgery. Women received either intravenous ondansetron 8 mg (n = 58) or saline (n = 60) before CSE anesthesia (intrathecal hyperbaric bupivacaine 0.5% 2.2-2.5 mL plus fentanyl 15 μg). The incidence and severity of shivering, measured on a validated 5-point scale, and other outcomes, such as nausea, pruritus, headache, or satisfaction, were assessed at 3 time points during the surgery and postoperative period. The incidence of shivering at any time point did not differ significantly between groups: ondansetron 41% versus placebo 47% (P = 0.54). The incidence of severe shivering at any time was not significantly different: ondansetron 32% versus placebo 33% (P = 0.79). There were no significant differences between the groups for any secondary outcomes. Intravenous ondansetron 8 mg before performing CSE anesthesia in women undergoing elective cesarean delivery does not decrease the incidence or severity of shivering.
Kok, Chee Choy
Human enterovirus 71 (HEV71) is the cause of hand, foot and mouth disease and associated neurological complications in children under five years of age. There has been an increase in HEV71 epidemic activity throughout the Asia-Pacific region in the past decade, and it is predicted to replace poliovirus as the extant neurotropic enterovirus of highest global public health significance. To date there is no effective antiviral treatment and no vaccine is available to prevent HEV71 infection. The increase in prevalence, virulence and geographic spread of HEV71 infection over the past decade provides increasing incentive for the development of new therapeutic and prevention strategies against this emerging viral infection. The current review focuses on the potential, advantages and disadvantages of these strategies. Since the explosion of outbreaks leading to large epidemics in China, research in natural therapeutic products has identified several groups of compounds with anti-HEV71 activities. Concurrently, the search for effective synthetic antivirals has produced promising results. Other therapeutic strategies including immunotherapy and the use of oligonucleotides have also been explored. A sound prevention strategy is crucial in order to control the spread of HEV71. To this end the ultimate goal is the rapid development, regulatory approval and widespread implementation of a safe and effective vaccine. The various forms of HEV71 vaccine designs are highlighted in this review. Given the rapid progress of research in this area, eradication of the virus is likely to be achieved. PMID:25964873
Boyer, Kenneth; Hill, Dolores; Mui, Ernest; Wroblewski, Kristen; Karrison, Theodore; Dubey, J. P.; Sautter, Mari; Noble, A. Gwendolyn; Withers, Shawn; Swisher, Charles; Heydemann, Peter; Hosten, Tiffany; Babiarz, Jane; Lee, Daniel
(See the Editorial Commentary by Linn, on pages 1090–1.) Background. Congenital toxoplasmosis presents as severe, life-altering disease in North America. If mothers of infants with congenital toxoplasmosis could be identified by risks, it would provide strong support for educating pregnant women about risks, to eliminate this disease. Conversely, if not all risks are identifiable, undetectable risks are suggested. A new test detecting antibodies to sporozoites demonstrated that oocysts were the predominant source of Toxoplasma gondii infection in 4 North American epidemics and in mothers of children in the National Collaborative Chicago-based Congenital Toxoplasmosis Study (NCCCTS). This novel test offered the opportunity to determine whether risk factors or demographic characteristics could identify mothers infected with oocysts. Methods. Acutely infected mothers and their congenitally infected infants were evaluated, including in-person interviews concerning risks and evaluation of perinatal maternal serum samples. Results. Fifty-nine (78%) of 76 mothers of congenitally infected infants in NCCCTS had primary infection with oocysts. Only 49% of these mothers identified significant risk factors for sporozoite acquisition. Socioeconomic status, hometown size, maternal clinical presentations, and ethnicity were not reliable predictors. Conclusions. Undetected contamination of food and water by oocysts frequently causes human infections in North America. Risks are often unrecognized by those infected. Demographic characteristics did not identify oocyst infections. Thus, although education programs describing hygienic measures may be beneficial, they will not suffice to prevent the suffering and economic consequences associated with congenital toxoplasmosis. Only a vaccine or implementation of systematic serologic testing of pregnant women and newborns, followed by treatment, will prevent most congenital toxoplasmosis in North America. PMID:22021924
Full Text Available Abstract Background The global spread of the severe acute respiratory syndrome (SARS epidemic has clearly shown the importance of considering the long-range transportation networks in the understanding of emerging diseases outbreaks. The introduction of extensive transportation data sets is therefore an important step in order to develop epidemic models endowed with realism. Methods We develop a general stochastic meta-population model that incorporates actual travel and census data among 3 100 urban areas in 220 countries. The model allows probabilistic predictions on the likelihood of country outbreaks and their magnitude. The level of predictability offered by the model can be quantitatively analyzed and related to the appearance of robust epidemic pathways that represent the most probable routes for the spread of the disease. Results In order to assess the predictive power of the model, the case study of the global spread of SARS is considered. The disease parameter values and initial conditions used in the model are evaluated from empirical data for Hong Kong. The outbreak likelihood for specific countries is evaluated along with the emerging epidemic pathways. Simulation results are in agreement with the empirical data of the SARS worldwide epidemic. Conclusion The presented computational approach shows that the integration of long-range mobility and demographic data provides epidemic models with a predictive power that can be consistently tested and theoretically motivated. This computational strategy can be therefore considered as a general tool in the analysis and forecast of the global spreading of emerging diseases and in the definition of containment policies aimed at reducing the effects of potentially catastrophic outbreaks.
Full Text Available The impact of porcine epidemic diarrhea virus (PEDv infection on the US pork industry has mainly been attributed to the mortality that it causes in suckling piglets, and, consequently, much effort has been invested in the quantification of its effect in sow farms. However, no information on the performance of surviving pigs that were exposed to the PEDv as piglets is available. Here, a retrospective cohort study to evaluate the impact of porcine epidemic diarrhea virus (PEDv infection on growing pigs' performance, as indicated by mortality, average daily gain (ADG, average daily feed intake (ADFI, and feed conversion ratio (FCR was performed using production records from weaned pigs in nursery and wean-to-finish sites from sow farms that became PEDv-infected between May 2013 and June 2014. Production records from the first batch of growing pigs weaned in infected flows after the PEDv outbreak ("infected batches" were compared with those from pigs weaned within the previous 14 to 120 days ("control batches". Performance records from infected and control batches, paired by flow, were compared using non-parametric paired tests. Mortality, ADG and FCR were significantly different in PEDv-positive (infected compared with PEDv-negative (control batches, with a mean increase of mortality and FCR of 11% and 0.5, respectively, and a decrease of ADG of 0.16 lb/day. Our results demonstrate a poorer performance of growing pigs weaned after a PEDv outbreak compared with those weaned within the previous 14-120 days, suggesting that in addition to the mortality induced by PEDv in suckling pigs, the disease also impairs the performance of surviving pig. These findings help to quantify the impact of PEDv infection in the US and, ultimately, contribute to efforts to quantify the cost-effectiveness of disease prevention and control measures.
Edelman, Andrew J.
The martial art of Aikido was used as an intervention with 15 middle and high school students with severe emotional disturbances in an alternative educational setting. Students with an extensive history of violently disruptive and assaultive behaviors were trained for 12 weeks in this nonviolent Japanese martial art in order to achieve the…
Mental health problems in deaf and severely hard of hearing children and adolescents : findings on prevalence, pathogenesis and clinical complexities, and implications for prevention, diagnosis and intervention
Gent, Tiejo van
The aim of this thesis is to expand the knowledge of mental health problems with deaf and severely hard of hearing children and adolescents in the following domains: 1. The prevalence of mental health problems; 2. Specific intra- and interpersonal aspects of pathogenesis; 3. characteristics of the
Paull, Sara H; Horton, Daniel E; Ashfaq, Moetasim; Rastogi, Deeksha; Kramer, Laura D; Diffenbaugh, Noah S; Kilpatrick, A Marm
The effect of global climate change on infectious disease remains hotly debated because multiple extrinsic and intrinsic drivers interact to influence transmission dynamics in nonlinear ways. The dominant drivers of widespread pathogens, like West Nile virus, can be challenging to identify due to regional variability in vector and host ecology, with past studies producing disparate findings. Here, we used analyses at national and state scales to examine a suite of climatic and intrinsic drivers of continental-scale West Nile virus epidemics, including an empirically derived mechanistic relationship between temperature and transmission potential that accounts for spatial variability in vectors. We found that drought was the primary climatic driver of increased West Nile virus epidemics, rather than within-season or winter temperatures, or precipitation independently. Local-scale data from one region suggested drought increased epidemics via changes in mosquito infection prevalence rather than mosquito abundance. In addition, human acquired immunity following regional epidemics limited subsequent transmission in many states. We show that over the next 30 years, increased drought severity from climate change could triple West Nile virus cases, but only in regions with low human immunity. These results illustrate how changes in drought severity can alter the transmission dynamics of vector-borne diseases. © 2017 The Author(s).
Collet, Jean-Philippe; Cayla, Guillaume; Ennezat, Pierre-Vladimir; Leclercq, Florence; Cuisset, Thomas; Elhadad, Simon; Henry, Patrick; Belle, Loic; Cohen, Ariel; Silvain, Johanne; Barthelemy, Olivier; Beygui, Farzin; Diallo, Abdourahmane; Vicaut, Eric; Montalescot, Gilles
The prevalence and associated-risk of asymptomatic multisite artery disease (MSAD) in high risk coronary patients are unknown. Whether systematic identification and aggressive management of asymptomatic MSAD is clinically relevant in high risk coronary patients has not been evaluated. We randomly assigned 521 high risk coronary patients defined by the presence of three-vessel coronary disease (n=304) or recent acute coronary syndrome beyond the age of 75years (n=215) to either a strategy of systematic detection of asymptomatic MSAD combined with an aggressive secondary prevention (n=263) or to a more conventional strategy based on treatment of coronary artery disease only with standard of care (n=258). The primary end point was the time to first occurrence of death, any organ failure or ischemic event leading to re-hospitalization through two years of follow-up. The pro-active strategy identified asymptomatic MSAD in 21.7% of patients with few revascularizations (3.6%); the pro-active pharmacological secondary prevention was obtained in >85% of patients and life-style changes in <60% of patients. At 2-year follow-up, the primary end point occurred in 44.9% of patients in the pro-active group and 43.0% of patients in the conventional group (HR 1.03; 95% confidence interval [CI], 0.80 to 1.34]. The rate of major bleeding did not differ significantly between groups (4.6% vs 5.0%; HR, 0.97; 95% CI, 0.40 to 1.91). In high risk coronary patients, there is no apparent benefit of a systematic detection of asymptomatic extra-coronary atherothrombotic disease and intensified treatment over a 2-year follow-up period. (Funded by the Academic Allies in Cardiovascular Trials Initiatives and Organized Networks and Institut de l'Athérothrombose; AMERICA ClinicalTrials.gov number, NCT00445835). Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.
Katsikas, Dimitrios; Fagertun, Anna Manolova; Ruepp, Sarah Renée
Nowadays, transport networks, carry extremely large amounts of network traffic, and are widely spread across multiple geographical locations. As a result, any possible connectivity failure could directly impact the service delivery of a vast amount of users. Therefore, the network should be able...... to recover fast from a failure in order to provide service continuity to the user. Several recovery techniques have been employed by the Internet Service Providers (ISPs) such as adding redundancy to network equipment (e.g. routers, optical cross-connects, etc.), or by provisioning alternate paths (path...... (OTN) in order to ensure the service delivery. The remainder of the paper is organized as follows: Section 2 describes the GMPLS framework. Section 3 deals with epidemic failures. The simulation study and its results are presented in section 4. Section 5 concludes the paper....
Zumla, Alimuddin; Dar, Osman; Kock, Richard; Muturi, Matthew; Ntoumi, Francine; Kaleebu, Pontiano; Eusebio, Macete; Mfinanga, Sayoki; Bates, Matthew; Mwaba, Peter; Ansumana, Rashid; Khan, Mishal; Alagaili, Abdulaziz N; Cotten, Matthew; Azhar, Esam I; Maeurer, Markus; Ippolito, Giuseppe; Petersen, Eskild
The appearance of novel pathogens of humans with epidemic potential and high mortality rates have threatened global health security for centuries. Over the past few decades new zoonotic infectious diseases of humans caused by pathogens arising from animal reservoirs have included West Nile virus, Yellow fever virus, Ebola virus, Nipah virus, Lassa Fever virus, Hanta virus, Dengue fever virus, Rift Valley fever virus, Crimean-Congo haemorrhagic fever virus, severe acute respiratory syndrome coronavirus, highly pathogenic avian influenza viruses, Middle East Respiratory Syndrome Coronavirus, and Zika virus. The recent Ebola Virus Disease epidemic in West Africa and the ongoing Zika Virus outbreak in South America highlight the urgent need for local, regional and international public health systems to be be more coordinated and better prepared. The One Health concept focuses on the relationship and interconnectedness between Humans, Animals and the Environment, and recognizes that the health and wellbeing of humans is intimately connected to the health of animals and their environment (and vice versa). Critical to the establishment of a One Health platform is the creation of a multidisciplinary team with a range of expertise including public health officers, physicians, veterinarians, animal husbandry specialists, agriculturalists, ecologists, vector biologists, viral phylogeneticists, and researchers to co-operate, collaborate to learn more about zoonotic spread between animals, humans and the environment and to monitor, respond to and prevent major outbreaks. We discuss the unique opportunities for Middle Eastern and African stakeholders to take leadership in building equitable and effective partnerships with all stakeholders involved in human and health systems to take forward a 'One Health' approach to control such zoonotic pathogens with epidemic potential. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.
Full Text Available The appearance of novel pathogens of humans with epidemic potential and high mortality rates have threatened global health security for centuries. Over the past few decades new zoonotic infectious diseases of humans caused by pathogens arising from animal reservoirs have included West Nile virus, Yellow fever virus, Ebola virus, Nipah virus, Lassa Fever virus, Hanta virus, Dengue fever virus, Rift Valley fever virus, Crimean-Congo haemorrhagic fever virus, severe acute respiratory syndrome coronavirus, highly pathogenic avian influenza viruses, Middle East Respiratory Syndrome Coronavirus, and Zika virus. The recent Ebola Virus Disease epidemic in West Africa and the ongoing Zika Virus outbreak in South America highlight the urgent need for local, regional and international public health systems to be be more coordinated and better prepared. The One Health concept focuses on the relationship and interconnectedness between Humans, Animals and the Environment, and recognizes that the health and wellbeing of humans is intimately connected to the health of animals and their environment (and vice versa. Critical to the establishment of a One Health platform is the creation of a multidisciplinary team with a range of expertise including public health officers, physicians, veterinarians, animal husbandry specialists, agriculturalists, ecologists, vector biologists, viral phylogeneticists, and researchers to co-operate, collaborate to learn more about zoonotic spread between animals, humans and the environment and to monitor, respond to and prevent major outbreaks. We discuss the unique opportunities for Middle Eastern and African stakeholders to take leadership in building equitable and effective partnerships with all stakeholders involved in human and health systems to take forward a ‘One Health’ approach to control such zoonotic pathogens with epidemic potential.
Schiffl, Helmut; Lang, Susanne Maria
Overweight and obesity are widespread in the German population, affecting not only adults but also a significant number of children and adolescents. The risk to develop chronic kidney disease is markedly increased in overweight or adipose children, adolescents and adults.Overweight and obesity induced risk factors have a direct impact on the development of chronic renal disease (obesity-associated focal segmental glomerulosclerosis). They accelerate the progression of coexistent nephropathies (diabetic or hypertensive nephropathy, primary glomerulonephritides) and are independent risk factors for the development of acute kidney injury in critically ill patients.Obesity induced nephropathies are basically preventible. Marked weight reduction, normoglycemia and control of hypertension may contribute to an improved glomerular filtration rate and/or reduced proteinuria in early stages of renal damage.The prevalence of kidney diseases in Germany is 13 % and estimated 80 000 patients need renal replacement therapy. In order to avoid a further rapid increase in numbers, preventive measures should be enforced more rigorously.It is necessary to raise the awareness of the negative consequences of obesity in the general public, to motivate the public to adopt a healthier lifestyle and to install nephrological surveillance to contain the obesity "epidemic". © Georg Thieme Verlag KG Stuttgart · New York.
Oulego Erroz, Ignacio; Alonso Quintela, Paula; Jiménez Gonzalez, Aquilina; Terroba Seara, Sandra; Rodríguez Blanco, Silvia; Rosón Varas, María; Castañón López, Leticia
To assess the effect of a protocolised intervention for low systemic blood flow (SBF) in the occurrence of severe intraventricular haemorrhage (IVH) or death in pre-term infants. A study with a quasi-experimental design with retrospective controls was conducted on pre-term infants of less than 30weeks of gestational age, born between January 2016 and July 2017, who were consecutively included in the intervention period. The control cohort included pre-term infants (born between January 2013 and December 2015) matched by gestational age, birth weight, and gender (two controls for each case). The cases of low SBF diagnosed according to functional echocardiography during the study period received dobutamine (5-10μg/kg/min) for 48hours. The study included 29 cases (intervention period) and 54 controls (pre-intervention period). Ten out of 29 (34.5%) infants received dobutamine for low SBF during the intervention period, with 3/29 (10.3%) cases of severe IVH and/or death compared to 17/54 (31.5%) in the control cohort (p=.032). There was an independent association between the intervention and a decreased occurrence of severe IVH/death after adjusting for confounding factors both in the logistic regression model [OR 0.11 (95%CI: 0.01-0.65), p=.015], as well as in the sensitivity analysis using inverse probability of treatment weighting [OR 0.23 (95%CI: 0.09-0.56); p=.001]. In this study with retrospective controls, a protocolised screening, and treatment for low SBF was associated with a decreased occurrence of severe IVH or death in preterm infants. Large, adequately powered trials, are needed in order to determine whether postnatal interventions directed at low SBF can improve neurological outcomes. Copyright © 2018. Publicado por Elsevier España, S.L.U.
de Lima, Tábata Martins; Geihs, Márcio Alberto; Nery, Luiz Eduardo Maia; Maciel, Fábio Everton
The air exposure behavior of the semi-terrestrial crab Neohelice granulata during severe hypoxia was studied. This study also verified whether this behavior mitigates possible oxidative damage, namely lipoperoxidation, caused by hypoxia and reoxygenation cycles. The lethal time for 50% of the crabs subjected to severe hypoxia (0.5 mgO2 · L(-1)) with free access to air was compared to that of crabs subjected to severe hypoxia without access to air. Crabs were placed in aquaria divided into three zones: water (when the animal was fully submersed), land (when the animal was completely emerged) and intermediate (when the animal was in contact with both environments) zones. Then the crabs were held in this condition for 270 min, and the time spent in each zone was recorded. Lipid peroxidation (LPO) damage to the walking leg muscles was determined for the following four experimental conditions: a--normoxic water with free access to air; b--hypoxic water without access to air; c--hypoxic water followed by normoxic water without air access; and d--hypoxic water with free access to air. When exposed to hypoxic water, N. granulata spent significantly more time on land, 135.3 ± 17.7 min, whereas control animals (exposed to normoxic water) spent more time submerged, 187.4 ± 20.2 min. By this behavior, N. granulata was able to maintain a 100% survival rate when exposed to severe hypoxia. However, N. granulata must still return to water after periods of air exposure (~ 14 min), causing a sequence of hypoxia/reoxygenation events. Despite increasing the survival rate, hypoxia with air access does not decrease the lipid peroxidation damage caused by the hypoxia and reoxygenation cycle experienced by these crabs.
Rey, J L; Ramadani, Q; Soarès, J L; Nicand, E; Ibrahime, D; Preteni, E; Buisson, Y; Teyssou, R
In July 1999, after the return of the Kosovar refugees to their country, an outbreak of acute hepatitis A (HAV) and E (HEV) occurred. Epidemic hepatitis and diarrhoea are closely monitored communicable diseases which had been singled out as priorities by the health authorities of the former Republic of Yougoslavia. Several field surveys were undertaken: description of reported cases, serological study of clinical patients, study of anti-HAV seroprevalence in a school and a case control study to assess risk factors. The analysis of the reports indicates an epidemic peak at the end of September, 2 or 3 weeks after the start of the new school year, with an increase of cases relative to the age of the children in school. In a serologic study of 104 samples, we found an anti-HAV IgM positivity in 88% of the cases. Children were more likely to be positive when compared to teenagers and adults; likewise, consumers of well-water as versus those drinking network water (p = 0.03). The study of seroprevalence showed that transmission had taken place within the school. The case control study, in spite of its imperfections, indicated that consumption of water melon, the only fruit cultivated locally, is a factor which facilitates the HAV transmission. Circulation of the hepatitis E virus was confirmed for 4 sick persons (including 2 co-infected HAV-HEV) and in 4 persons without clinical symptoms. These results show the permanent risk of faeco-oral infections in this area and the need to develop a relevant prevention policy.
Roberts, Mick G; Andreasen, Viggo; Lloyd, Alun
Deterministic models have a long history of being applied to the study of infectious disease epidemiology. We highlight and discuss nine challenges in this area. The first two concern the endemic equilibrium and its stability. We indicate the need for models that describe multi-strain infections......, infections with time-varying infectivity, and those where superinfection is possible. We then consider the need for advances in spatial epidemic models, and draw attention to the lack of models that explore the relationship between communicable and non-communicable diseases. The final two challenges concern...
Full Text Available The problem of optimal control of epidemic through vaccination and isolation, taking into account latent period is considered. The target function is minimized - functionality summarizing costs on epidemic prevention and treatment and also considering expenses on infected people left at the end of control T who may be a new source of epidemic. On the left endpoint of the integration segment initial data is given - quantity of infected and confirmed people at the moment t, the right endpoint is free. The dynamic constraints are written by way of a system of simple differential equations describing the speed of changes of number of subjected to infection and number of already infected. Besides the inhomogeneous communi- ty is considered, consisting of four age groups (babies, preschool children, school children and adults. The speed of vaccina- tion (number of vaccinated per a time unit and isolation speed are used as the control functions. There are some restrictions on control above and below. The latent period is described by the constant h and is part of the equation describing the con- tamination speed of people as a retarding in argument t, i.e. a person being in a latent period infects others not being aware of his disease. For problem solving Pontryagin maximum principle is used where it can be seen that the control is piecewise constant. The result of numerical implementation of discrete problem of optimal control is given. The conclusions are made that the latent period significantly influence the incidence rate and as consequence the costs on epidemic suppression. The programme based on the programming language Delphi gives an opportunity to estimate the scale of epidemic at different initial data and restrictions on control as well as to find an optimal control minimizing costs on epimedic suppression.
Full Text Available Abstract The Human Immunodeficiency Virus type 1 (HIV-1 is classified into genetic groups, subtypes and sub-subtypes which show a specific geographic distribution pattern. The HIV-1 epidemic in Italy, as in most of the Western Countries, has traditionally affected the Intra-venous drug user (IDU and Homosexual (Homo risk groups and has been sustained by the genetic B subtype. In the last years, however, the HIV-1 transmission rate among heterosexuals has dramatically increased, becoming the prevalent transmission route. In fact, while the traditional risk groups have high levels of knowledge and avoid high-risk practices, the heterosexuals do not sufficiently perceive the risk of HIV-1 infection. This misperception, linked to the growing number of immigrants from non-Western Countries, where non-B clades and circulating recombinant forms (CRFs are prevalent, is progressively introducing HIV-1 variants of non-B subtype in the Italian epidemic. This is in agreement with reports from other Western European Countries. In this context, the Italian HIV-1 epidemic is still characterized by low subtype heterogeneity and represents a paradigmatic example of the European situation. The continuous molecular evolution of the B subtype HIV-1 isolates, characteristic of a long-lasting epidemic, together with the introduction of new subtypes as well as recombinant forms may have significant implications for diagnostic, treatment, and vaccine development. The study and monitoring of the genetic evolution of the HIV-1 represent, therefore, an essential strategy for controlling the local as well as global HIV-1 epidemic and for developing efficient preventive and therapeutic strategies.
Kobayashi, Tohru; Saji, Tsutomu; Otani, Tetsuya; Takeuchi, Kazuo; Nakamura, Tetsuya; Arakawa, Hirokazu; Kato, Taichi; Hara, Toshiro; Hamaoka, Kenji; Ogawa, Shunichi; Miura, Masaru; Nomura, Yuichi; Fuse, Shigeto; Ichida, Fukiko; Seki, Mitsuru; Fukazawa, Ryuji; Ogawa, Chitose; Furuno, Kenji; Tokunaga, Hirohide; Takatsuki, Shinichi; Hara, Shinya; Morikawa, Akihiro
Evidence indicates that corticosteroid therapy might be beneficial for the primary treatment of severe Kawasaki disease. We assessed whether addition of prednisolone to intravenous immunoglobulin with aspirin would reduce the incidence of coronary artery abnormalities in patients with severe Kawasaki disease. We did a multicentre, prospective, randomised, open-label, blinded-endpoints trial at 74 hospitals in Japan between Sept 29, 2008, and Dec 2, 2010. Patients with severe Kawasaki disease were randomly assigned by a minimisation method to receive either intravenous immunoglobulin (2 g/kg for 24 h and aspirin 30 mg/kg per day) or intravenous immunoglobulin plus prednisolone (the same intravenous immunoglobulin regimen as the intravenous immunoglobulin group plus prednisolone 2 mg/kg per day given over 15 days after concentrations of C-reactive protein normalised). Patients and treating physicians were unmasked to group allocation. The primary endpoint was incidence of coronary artery abnormalities during the study period. Analysis was by intention to treat. This trial is registered with the University Hospital Medical Information Network clinical trials registry, number UMIN000000940. We randomly assigned 125 patients to the intravenous immunoglobulin plus prednisolone group and 123 to the intravenous immunoglobulin group. Incidence of coronary artery abnormalities was significantly lower in the intravenous immunoglobulin plus prednisolone group than in the intravenous immunoglobulin group during the study period (four patients [3%] vs 28 patients [23%]; risk difference 0·20, 95% CI 0·12-0·28, pKawasaki disease in Japan. Further study of intensified primary treatment for this disease in a mixed ethnic population is warranted. Japanese Ministry of Health, Labour and Welfare. Copyright © 2012 Elsevier Ltd. All rights reserved.
Friedman, Samuel R; Rossi, Diana; Braine, Naomi
Political-economic transitions in the Soviet Union, Indonesia, and China, but not the Philippines, were followed by HIV epidemics among drug users. Wars also may sometimes increase HIV risk. Based on similarities in some of the causal pathways through which wars and transitions can affect HIV risk, we use the term "Big Events" to include both. We first critique several prior epidemiological models of Big Events as inadequately incorporating social agency and as somewhat imprecise and over-generalizing in their sociology. We then suggest a model using the following concepts: first, event-specific HIV transmission probabilities are functions of (a) the probability that partners are infection-discordant; (b) the infection-susceptibility of the uninfected partner; (c) the infectivity of the infected--as well as (d) the behaviours engaged in. These probabilities depend on the distributions of HIV and other variables in populations. Sexual or injection events incorporate risk behaviours and are embedded in sexual and injection partnership patterns and community networks, which in turn are shaped by the content of normative regulation in communities. Wars and transitions can change socio-economic variables that can sometimes precipitate increases in the numbers of people who engage in high-risk drug and sexual networks and behaviours and in the riskiness of what they do. These variables that Big Events affect may include population displacement; economic difficulties and policies; police corruption, repressiveness, and failure to preserve order; health services; migration; social movements; gender roles; and inter-communal violence--which, in turn, affect normative regulation, youth alienation, networks and behaviours. As part of these pathways, autonomous action by neighbourhood residents, teenagers, drug users and sex workers to maintain their economic welfare, health or happiness may affect many of these variables or otherwise mediate whether HIV epidemics follow
Shrestha, Munik Kumar
Epidemic processes are common out-of-equilibrium phenomena of broad interdisciplinary interest. In this thesis, we show how message-passing approach can be a helpful tool for simulating epidemic models in disordered medium like networks, and in particular for estimating the probability that a given node will become infectious at a particular time. The sort of dynamics we consider are stochastic, where randomness can arise from the stochastic events or from the randomness of network structures. As in belief propagation, variables or messages in message-passing approach are defined on the directed edges of a network. However, unlike belief propagation, where the posterior distributions are updated according to Bayes' rule, in message-passing approach we write differential equations for the messages over time. It takes correlations between neighboring nodes into account while preventing causal signals from backtracking to their immediate source, and thus avoids "echo chamber effects" where a pair of adjacent nodes each amplify the probability that the other is infectious. In our first results, we develop a message-passing approach to threshold models of behavior popular in sociology. These are models, first proposed by Granovetter, where individuals have to hear about a trend or behavior from some number of neighbors before adopting it themselves. In thermodynamic limit of large random networks, we provide an exact analytic scheme while calculating the time dependence of the probabilities and thus learning about the whole dynamics of bootstrap percolation, which is a simple model known in statistical physics for exhibiting discontinuous phase transition. As an application, we apply a similar model to financial networks, studying when bankruptcies spread due to the sudden devaluation of shared assets in overlapping portfolios. We predict that although diversification may be good for individual institutions, it can create dangerous systemic effects, and as a result
Daily oral intake of theanine prevents the decline of 5-bromo-2′-deoxyuridine incorporation in hippocampal dentate gyrus with concomitant alleviation of behavioral abnormalities in adult mice with severe traumatic stress
Full Text Available Posttraumatic stress disorder is a long-lasting psychiatric disease with the consequence of hippocampal atrophy in humans exposed to severe fatal stress. We demonstrated a positive correlation between the transient decline of 5-bromo-2′-deoxyuridine (BrdU incorporation in the hippocampal dentate gyrus (DG and long-lasting behavioral abnormalities in mice with traumatic stress. Here, we investigated pharmacological properties of theanine on the declined BrdU incorporation and abnormal behaviors in mice with traumatic stress. Prior daily oral administration of theanine at 50–500 mg/kg for 5 days significantly prevented the decline of BrdU incorporation, while theanine significantly prevented the decline in the DG even when administered for 5 days after stress. Consecutive daily administration of theanine significantly inhibited the prolonged immobility in mice with stress in forced swimming test seen 14 days later. Although traumatic stress significantly increased spontaneous locomotor activity over 30 min even when determined 14 days later, the increased total locomotion was significantly ameliorated following the administration of theanine at 50 mg/kg for 14 days after stress. These results suggest that theanine alleviates behavioral abnormalities together with prevention of the transient decline of BrdU incorporation in the hippocampal DG in adult mice with severe traumatic stress.
Martial L Ndeffo Mbah
Full Text Available Deployment of limited resources is an issue of major importance for decision-making in crisis events. This is especially true for large-scale outbreaks of infectious diseases. Little is known when it comes to identifying the most efficient way of deploying scarce resources for control when disease outbreaks occur in different but interconnected regions. The policy maker is frequently faced with the challenge of optimizing efficiency (e.g. minimizing the burden of infection while accounting for social equity (e.g. equal opportunity for infected individuals to access treatment. For a large range of diseases described by a simple SIRS model, we consider strategies that should be used to minimize the discounted number of infected individuals during the course of an epidemic. We show that when faced with the dilemma of choosing between socially equitable and purely efficient strategies, the choice of the control strategy should be informed by key measurable epidemiological factors such as the basic reproductive number and the efficiency of the treatment measure. Our model provides new insights for policy makers in the optimal deployment of limited resources for control in the event of epidemic outbreaks at the landscape scale.
Full Text Available Li-Tzy Wu,1–4 Udi E Ghitza,5 Anne L Burns,6 Paolo Mannelli,1 1Department of Psychiatry and Behavioral Sciences, 2Department of Medicine, 3Duke Clinical Research Institute, Duke University School of Medicine, 4Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, NC, 5Center for Clinical Trials Network, National Institute on Drug Abuse, Bethesda, MD, 6American Pharmacists Association, Washington, DC, USA The USA is experiencing an opioid overdose epidemic. It has been driven largely by prescription opioids and intensified by a surge of illicit opioids (e.g., heroin and fentanyl.1,2 Drug-involved overdose, mainly opioids (e.g., prescription opioids and heroin, is a leading cause of accidental death in the USA. The opioid overdose epidemic has been escalating consistently for over a decade.2 Every day, an estimated 91 Americans die from opioid-related overdose.3 Opioid overdose appears to have disproportionally affected men, adults aged 25–64 years, and non-Hispanic whites.2
Kotsiou, Antonia; Michalaki, Vasiliki; Anagnostopoulou, Helen N
In the recent Greek ages the most devastating epidemics were plague, smallpox, leprosy and cholera. In 1816 plague struck the Ionian and Aegean Islands, mainland Greece, Constantinople and Smyrna. The Venetians ruling the Ionian Islands effectively combated plague in contrast to the Ottomans ruling all other regions. In 1922, plague appeared in Patras refugees who were expelled by the Turks from Smyrna and Asia Minor. Inoculation against smallpox was first performed in Thessaly by the Greek women, and the Greek doctors Emmanouel Timonis (1713, Oxford) and Jakovos Pylarinos (1715, Venice) made relevant scientific publications. The first leper colony opened in Chios Island. In Crete, Spinalonga was transformed into a leper island, which following the Independence War against Turkish occupation and the unification of Crete with Greece in 1913, was classified as an International Leper Hospital. Cholera struck Greece in 1853-1854 brought by the French troops during the Crimean War, and again during the Balkan Wars (1912-13) when the Bulgarian troops brought cholera to northern Greece. Due to successive wars, medical assistance was not always available, so desperate people turned many times to religion through processions in honor of local saints, for their salvation in epidemics.
Clark, David J; Schumacher, Mark A
America is in the midst of an opioid epidemic characterized by aggressive prescribing practices, highly prevalent opioid misuse, and rising rates of prescription and illicit opioid overdose-related deaths. Medical and lay public sentiment have become more cautious with respect to prescription opioid use in the past few years, but a comprehensive strategy to reduce our reliance on prescription opioids is lacking. Addressing this epidemic through reductions in unnecessary access to these drugs while implementing measures to reduce demand will be important components of any comprehensive solution. Key supply-side measures include avoiding overprescribing, reducing diversion, and discouraging misuse through changes in drug formulations. Important demand-side measures center around educating patients and clinicians regarding the pitfalls of opioid overuse and methods to avoid unnecessary exposure to these drugs. Anesthesiologists, by virtue of their expertise in the use of these drugs and their position in guiding opioid use around the time of surgery, have important roles to play in reducing patient exposure to opioids and providing education about appropriate use. Aside from the many immediate steps that can be taken, clinical and basic research directed at understanding the interaction between pain and opioid misuse is critical to identifying the optimal use of these powerful pain relievers in clinical practice.
Soda, K; Morio, S; Tajima, K; Kitamura, K; Toba, M; Ito, A; Kihara, M; Ichikawa, S; Imai, M; Mizushima, S; Ohshige, K
In December 1995 and March 1996, we visited institutes which were conducting epidemiological studied of HIV/AIDS in Cambodia, and obtained data for further collaborative study between Japan and Cambodia. Data included information on AIDS patients and HIV infected persons, and behavioral epidemiology of CSWs (Commercial Sex Workers). The cumulative reported number of AIDS patients and HIV infected persons in Cambodia was 86 and 2,536 cases respectively in 1995. The cause of infection was mostly heterosexual contact with very few cases from injecting drug use (IDU) and other causes. The seroprevalence rate of HIV antibody among donated blood rapidly increased from 0.08% in 1991 to 4.47% in 1995, and those among CSWs and pregnant women were 37.9% and 2.6%, respectively, in 1995. The average rate of condom use among CSWs was 66%, but the rate of usual usage was only 14%. These results indicate that the HIV/AIDS epidemic had spread rapidly through CSWs, that it had been spread among peoples in communities, and that usage of condoms among CSWs was insufficient in Cambodia. Without strong countermeasures against HIV/AIDS in this country, HIV/AIDS epidemic may spread significantly to not only peoples in this country but also those in neighbouring countries in the future.
Kostiukova, N N; Bekhalo, V A
Gonorrhea in spite of its fully elucidated etiopathogenesis and available drugs for etiotropic therapy belongs to infections which are not controlled by vaccination due to absence of immunity formation. Analysis of scientific publication, statistical materials and WHO's data showed that epidemic process of gonorrhea infection depends mainly from people's behaviour, first of all, sexual. Modern epidemic process of gonorrhea infection consists from irregular increases and decreases of incidence due to various reasons. Reasons for increases of incidence appear to be simultaneous action of a range of biologic and anthropogenic factors. First reason--rapid increase of resistance of gonococci to widely used antibacterial preparations as well as synergy of pathogenic effects between HIV and gonococci; anthropogenic--wars, increase of high-risk groups due to urbanization, use of oral contraceptives, rise of prostitution, migration, inadequate access to medical care, poverty, intensification of intercourses (including hetero- and homosexual) between people, as well as demographic changes--increase of proportion of young people in population structure. Same but reciprocal factors lead to decrease of morbidity. Of them, the following were considered as most important: mass implementation of new effective antimicrobial drug as well as intensification of sanitary education, availability of early diagnostics and treatment, increase of material and cultural standards of life, decrease in number of persons belonging to high risk groups. Yet, capabilities of modern science expressed only in continuous development of new antibacterial drugs active against circulating population of gonococci, which is resistant to previously used drug.
Christina C. Chang
Full Text Available Discovered more than 100 years ago as a human pathogen, the Cryptococcus neoformans–Cryptococcus gattii (C. neoformans–C. gattii complex has seen a large global resurgence in its association with clinical disease in the last 30 years. First isolated in fermenting peach juice, and identified as a human pathogen in 1894 in a patient with bone lesions, this environmental pathogen has now found niches in soil, trees, birds, and domestic pets. Cryptococcosis is well recognized as an opportunistic infection and was first noted to be associated with reticuloendothelial cancers in the 1950s. Since then, advances in transplant immunology, medical science and surgical techniques have led to increasing numbers of solid organ transplantations (SOT and hematological stem cell transplantations being performed, and the use of biological immunotherapeutics in increasingly high-risk and older individuals, have contributed to the further rise in cryptococcosis. Globally, however, the major driver for revivification of cryptococcosis is undoubtedly the HIV epidemic, particularly in Sub-Saharan Africa where access to care and antiretroviral therapy remains limited and advanced immunodeficiency, poverty and malnutrition remains the norm. As a zoonotic disease, environmental outbreaks of both human and animal cryptococcosis have been reported, possibly driven by climate change. This is best exemplified by the resurgence of C. gattii infection in Vancouver Island, Canada, and the Pacific Northwest of the United States since 1999. Here we describe how the colliding epidemics of HIV, transplantation and immunologics, climate change and migration have contributed to the rise of cryptococcosis.
Farrahi, Katayoun; Emonet, Rémi; Cebrian, Manuel
Traditional contact tracing relies on knowledge of the interpersonal network of physical interactions, where contagious outbreaks propagate. However, due to privacy constraints and noisy data assimilation, this network is generally difficult to reconstruct accurately. Communication traces obtained by mobile phones are known to be good proxies for the physical interaction network, and they may provide a valuable tool for contact tracing. Motivated by this assumption, we propose a model for contact tracing, where an infection is spreading in the physical interpersonal network, which can never be fully recovered; and contact tracing is occurring in a communication network which acts as a proxy for the first. We apply this dual model to a dataset covering 72 students over a 9 month period, for which both the physical interactions as well as the mobile communication traces are known. Our results suggest that a wide range of contact tracing strategies may significantly reduce the final size of the epidemic, by mainly affecting its peak of incidence. However, we find that for low overlap between the face-to-face and communication interaction network, contact tracing is only efficient at the beginning of the outbreak, due to rapidly increasing costs as the epidemic evolves. Overall, contact tracing via mobile phone communication traces may be a viable option to arrest contagious outbreaks.
Full Text Available Traditional contact tracing relies on knowledge of the interpersonal network of physical interactions, where contagious outbreaks propagate. However, due to privacy constraints and noisy data assimilation, this network is generally difficult to reconstruct accurately. Communication traces obtained by mobile phones are known to be good proxies for the physical interaction network, and they may provide a valuable tool for contact tracing. Motivated by this assumption, we propose a model for contact tracing, where an infection is spreading in the physical interpersonal network, which can never be fully recovered; and contact tracing is occurring in a communication network which acts as a proxy for the first. We apply this dual model to a dataset covering 72 students over a 9 month period, for which both the physical interactions as well as the mobile communication traces are known. Our results suggest that a wide range of contact tracing strategies may significantly reduce the final size of the epidemic, by mainly affecting its peak of incidence. However, we find that for low overlap between the face-to-face and communication interaction network, contact tracing is only efficient at the beginning of the outbreak, due to rapidly increasing costs as the epidemic evolves. Overall, contact tracing via mobile phone communication traces may be a viable option to arrest contagious outbreaks.
Maïnassara, Halima Boubacar; Paireau, Juliette; Idi, Issa; Pelat, Jean-Paul Moulia; Oukem-Boyer, Odile Ouwe Missi; Fontanet, Arnaud; Mueller, Judith E
To inform epidemic response strategies for the African meningitis belt after a meningococcal serogroup A conjugate vaccine was introduced in 2010, we compared the effectiveness and efficiency of meningitis surveillance and vaccine response strategies at district and health area levels using various thresholds of weekly incidence rates. We analyzed reports of suspected cases from 3 regions in Niger during 2002-2012 (154,392 health area weeks), simulating elimination of serogroup A meningitis by excluding health area years with identification of such cases. Effectiveness was highest for health area surveillance and district vaccination (58-366 cases; thresholds 7-20 cases/100,000 doses), whereas efficiency was optimized with health area vaccination (5.6-7.7 cases/100,000 doses). District-level intervention prevented meningitis epidemic response after elimination of serogroup A meningitis.
Bacaër, Nicolas; Ouifki, Rachid; Pretorius, Carel; Wood, Robin; Williams, Brian
We present a simple mathematical model with six compartments for the interaction between HIV and TB epidemics. Using data from a township near Cape Town, South Africa, where the prevalence of HIV is above 20% and where the TB notification rate is close to 2,000 per 100,000 per year, we estimate some of the model parameters and study how various control measures might change the course of these epidemics. Condom promotion, increased TB detection and TB preventive therapy have a clear positive effect. The impact of antiretroviral therapy on the incidence of HIV is unclear and depends on the extent to which it reduces sexual transmission. However, our analysis suggests that it will greatly reduce the TB notification rate.
Sanders, David; Sengupta, Amit; Scott, Vera
While the current Ebola epidemic spiraled out of control to become the biggest in history, the global public health response has been criticized as "too little, too late." Many, like the World Health Organization, are asking what lessons have been learned from this epidemic. We present an analysis of the political economy of this Ebola outbreak that reveals the importance of addressing the social determinants that facilitated the exposure of populations, previously unaffected by Ebola Virus Disease, to infection and restricted the capacity for an effective medical response. To prevent further such crises, the global public health community has a responsibility to advocate for health system investment and development and for fundamental pro-poor changes to economic and power relations in the region. © The Author(s) 2015.
Bornstein, S R; Ehrhart-Bornstein, M; Wong, M L; Licinio, J
Globalization has a major impact on both economic and social determinants in public health. The current worldwide epidemic in obesity needs to be considered in the context of globalization as a communicable rather than non-communicable process. There is increasing evidence that global trends in lifestyle, eating behavior and cultural adaptation contribute to the rapid increase in obesity around the world. Thus, obesity may be defined as a "socially-contagious" feature of globalization. Furthermore, infectious agents are being identified that may cause obesity by central mechanisms or by modulating adipocyte function or at least by contributing to the chronic inflammatory milieu of the metabolic syndrome. Therefore, globalization may indeed form a critical platform for these pathogens to fuel the obesity epidemic. Understanding obesity in the light of globalization as a communicable disorder will allow outlining better avenues of prevention and treatment.
Glover, J A
Over 80 per cent. of school sickness, whether judged by the number of cases or by the time lost, is transmitted by "droplet" infection.The alleged increase in sickness in public schools is partly apparent, due to increased attention to minor febricula and partly real, due (1) to increased influenza prevalence, the aftermath of the great epidemic of 1918, and (2) to the increased demand for public school education leading to pressure upon accommodation, and especially to overcrowding in dormitories.The bulk of the droplet infections are accounted for by (1) influenza; (2) feverish cold, chill, or P.U.O.; (3) tonsillitis; regular infectious diseases make a comparatively small showing. The incidence and bacteriological findings and the variations in the incidence of pneumonia and otitis media are discussed. Are these complications really secondary epidemics? Tonsillitis, bacteriological findings, milk.Prophylaxis.-Efficacy of vaccines uncertain. Some evidence that they may diminish the onset of complications. If given vaccines should be administered before the danger period, i.e., not later than November.Intensive prophylaxia other than vaccines during the first half of the Lent term would probably amply repay any trouble. It should include:-(a) Special efforts to prevent boys returning to school after the Christmas holidays infected with influenza or febricula.(b) Temperature taking for three weeks.(c) Immediate isolation of all pyrexias and catarrhs.(d) No work before breakfast for at least the first six weeks of the term.(e) All hot baths and showers taken during the day or after games to be followed by cold showers.(f) Prevention of chill in watching games, etc.(g) Increased provision for drying clothes, uniforms and boots.Infection mainly takes place in sleeping quarters, and proper spacing out of beds and thorough "cross" ventilation in dormitories is of paramount importance; instances of cross infection due to proximity of beds; illustrated by bed charts and
Juanico, Drandreb Earl [Department of Mathematics, Ateneo de Manila University, Loyola Heights, Quezon City, Philippines 1108 (Philippines); National Institute of Physics, University of the Philippines, Diliman, Quezon City, Philippines 1101 (Philippines)
Epidemics are known to persist in the form of recurrence cycles. Despite intervention efforts through vaccination and targeted social distancing, peaks of activity for infectious diseases like influenza reappear over time. Analysis of a stochastic model is here undertaken to explore a proposed cycle-generating mechanism – the bifurcation crossover. Time series from simulations of the model exhibit oscillations similar to the temporal signature of influenza activity. Power-spectral density indicates a resonant frequency, which corresponds to the annual seasonality of influenza in temperate zones. The study finds that intervention actions influence the extinguishability of epidemic activity. Asymptotic solution to a backward Kolmogorov equation corresponds to a mean extinction time that is a function of both intervention efficacy and population size. Intervention efficacy must be greater than a certain threshold to increase the chances of extinguishing the epidemic. Agreement of the model with several phenomenological features of epidemic cycles lends to it a tractability that may serve as early warning of imminent outbreaks.
Juanico, Drandreb Earl
Epidemics are known to persist in the form of recurrence cycles. Despite intervention efforts through vaccination and targeted social distancing, peaks of activity for infectious diseases like influenza reappear over time. Analysis of a stochastic model is here undertaken to explore a proposed cycle-generating mechanism – the bifurcation crossover. Time series from simulations of the model exhibit oscillations similar to the temporal signature of influenza activity. Power-spectral density indicates a resonant frequency, which corresponds to the annual seasonality of influenza in temperate zones. The study finds that intervention actions influence the extinguishability of epidemic activity. Asymptotic solution to a backward Kolmogorov equation corresponds to a mean extinction time that is a function of both intervention efficacy and population size. Intervention efficacy must be greater than a certain threshold to increase the chances of extinguishing the epidemic. Agreement of the model with several phenomenological features of epidemic cycles lends to it a tractability that may serve as early warning of imminent outbreaks
Aguado, M Teresa; Jodar, Luis; Granoff, Dan; Rabinovich, Regina; Ceccarini, Costante; Perkin, Gordon W
Polysaccharide vaccines had been used to control African meningitis epidemics for >30 years but with little or modest success, largely because of logistical problems in the implementation of reactive vaccination campaigns that are begun after epidemics are under way. After the major group A meningococcal meningitis epidemics in 1996-1997 (250,000 cases and 25,000 deaths), African ministers of health declared the prevention of meningitis a high priority and asked the World Health Organization (WHO) for help in developing better immunization strategies to eliminate meningitis epidemics in Africa. WHO accepted the challenge and created a project called Epidemic Meningitis Vaccines for Africa (EVA) that served as an organizational framework for external consultants, PATH, the US Centers for Disease Control and Prevention (CDC), and the Bill & Melinda Gates Foundation (BMGF). Consultations were initiated with major vaccine manufacturers. EVA commissioned a costing study/business plan for the development of new group A or A/C conjugate vaccines and explored the feasibility of developing these products as a public-private partnership. Representatives from African countries were consulted. They confirmed that the development of conjugate vaccines was a priority and provided information on preferred product characteristics. In parallel, a strategy for successful introduction was also anticipated and discussed. The expert consultations recommended that a group A meningococcal conjugate vaccine be developed and introduced into the African meningitis belt. The results of the costing study indicated that the "cost of goods" to develop a group A - containing conjugate vaccine in the United States would be in the range of US$0.35-$1.35 per dose, depending on composition (A vs A/C), number of doses/vials, and presentation. Following an invitation from BMGF, a proposal was submitted in the spring of 2001. In June 2001, BMGF awarded a grant of US$70 million to create the Meningitis
Full Text Available Objective: To explore the changes of MCP-1, FKN, and related cytokines in the serum and cerebrospinal fluid (CSF in children with epidemic encephalitis B. Methods: A total of 40 children with epidemic encephalitis B who were admitted in our hospital from June, 2014 to June, 2017 were included in the study and divided into the severe group (n=15 and general group (n=25 according to the severity group. Moreover, 20 children who were suffered from oblique inguinal hernia, perineal adhesion, and cryptorchidism were served as the control group. The serum and CSF specimens were collected 24 h after admission and during the recovery period in children with epidemic encephalitis B. The serum specimen was collected 24 h after admission in the control group, and CSF specimen was collected during the lumbar puncture. ELISA was used to detect CMP-1, FKN, IL-1β, IL-18, and TNF-α levels in the serum and CSF. CMP-1, FKN, IL-1β, IL-18, and TNF-α levels in children with epidemic encephalitis B on the day after admission and 2-3 weeks after admission and in the control group were compared. The changes of CMP-1, FKN, IL-1β, IL-18, and TNF-α in children with severe and general epidemic encephalitis B were observed. Results: CMP-1 and FKN levels in the serum and CSF in children with epidemic encephalitis B in the critical stage were significantly higher than those in the recovery stage and in the control group. The serum CMP-1 and FKN levels in children with epidemic encephalitis B during the recovery stage were not significantly different from those in the control group, while CMP-1 and FKN levels in CSF were significantly higher than those in the control group. CMP-1 and FKN levels in the serum and CSF in children with severe epidemic encephalitis B were significantly higher than those in the general group. IL-1β, TNF-α, and IL-18 levels in the serum and CSF in children with epidemic encephalitis B during the critical stage were significantly higher than
Delatorre, Edson; Bello, Gonzalo
Previous studies have shown that the HIV-1 epidemic in Cuba displayed a complex molecular epidemiologic profile with circulation of several subtypes and circulating recombinant forms (CRF); but the evolutionary and population history of those viral variants remains unknown. HIV-1 pol sequences of the most prevalent Cuban lineages (subtypes B, C and G, CRF18_cpx, CRF19_cpx, and CRFs20/23/24_BG) isolated between 1999 and 2011 were analyzed. Maximum-likelihood analyses revealed multiple introductions of subtype B (n≥66), subtype C (n≥10), subtype G (n≥8) and CRF18_cpx (n≥2) viruses in Cuba. The bulk of HIV-1 infections in this country, however, was caused by dissemination of a few founder strains probably introduced from North America/Europe (clades B(CU-I) and B(CU-II)), east Africa (clade C(CU-I)) and central Africa (clades G(CU), CRF18(CU) and CRF19(CU)), or locally generated (clades CRFs20/23/24_BG). Bayesian-coalescent analyses show that the major HIV-1 founder strains were introduced into Cuba during 1985-1995; whereas the CRFs_BG strains emerged in the second half of the 1990s. Most HIV-1 Cuban clades appear to have experienced an initial period of fast exponential spread during the 1990s and early 2000s, followed by a more recent decline in growth rate. The median initial growth rate of HIV-1 Cuban clades ranged from 0.4 year⁻¹ to 1.6 year⁻¹. Thus, the HIV-1 epidemic in Cuba has been a result of the successful introduction of a few viral strains that began to circulate at a rather late time of the AIDS pandemic, but then were rapidly disseminated through local transmission networks.
Estrada, Ernesto; Kalala-Mutombo, Franck; Valverde-Colmeiro, Alba
An “infection,” understood here in a very broad sense, can be propagated through the network of social contacts among individuals. These social contacts include both “close” contacts and “casual” encounters among individuals in transport, leisure, shopping, etc. Knowing the first through the study of the social networks is not a difficult task, but having a clear picture of the network of casual contacts is a very hard problem in a society of increasing mobility. Here we assume, on the basis of several pieces of empirical evidence, that the casual contacts between two individuals are a function of their social distance in the network of close contacts. Then, we assume that we know the network of close contacts and infer the casual encounters by means of nonrandom long-range (LR) interactions determined by the social proximity of the two individuals. This approach is then implemented in a susceptible-infected-susceptible (SIS) model accounting for the spread of infections in complex networks. A parameter called “conductance” controls the feasibility of those casual encounters. In a zero conductance network only contagion through close contacts is allowed. As the conductance increases the probability of having casual encounters also increases. We show here that as the conductance parameter increases, the rate of propagation increases dramatically and the infection is less likely to die out. This increment is particularly marked in networks with scale-free degree distributions, where infections easily become epidemics. Our model provides a general framework for studying epidemic spreading in networks with arbitrary topology with and without casual contacts accounted for by means of LR interactions.
Full Text Available The needle trace method (NTM, created and developed by the Finnish forest pathologists prof. T. Kurkela, dr. R. Jalkanen and T. Aalto during the last decade of the XX century, has been already used by several researchers of different countries for retrospective analysis of needle diseases (Hypodermella sulcigena, by R. Jalkanen et al. in Finland or herbivorous insect pests of Scots pine (Diprion pini, by T. Kurkela et al. in Finland; Bupalus piniaria, by H. Armour et al. in Scotland, but as well of pests of Sitka spruce (Gilpinia hercyniae, by D.T. Williams et al. in England. Scots pine in forest nurseries and young plantations of Estonia is often but irregularly suffering from the epidemics of the needle cast fungus Lophodermium seditiosum. Current environmental regulations exclude from the regulatory (control measures all the others except of well-argued prophylactic systems, built up on reliable prognoses. The last is inconceivable without the availability of a reliable, as well, and long-lasting retrospective time-series of L. seditiosum epidemics, which, as it is known from the last half of the XX century, are occupying large forest areas, usually not least than a half of (the small Estonia. An appropriate time-series would be useful, as well, for the more basic understanding of the accelerated mortality processes during the stand formation in early pole-age Scots pine plantations. Methodological principles of the use of NTM in an appropriate investigation together with the preliminary results of our research work, looking back for more than a century, are introduced and discussed in this investigation.
Full Text Available Previous studies have shown that the HIV-1 epidemic in Cuba displayed a complex molecular epidemiologic profile with circulation of several subtypes and circulating recombinant forms (CRF; but the evolutionary and population history of those viral variants remains unknown. HIV-1 pol sequences of the most prevalent Cuban lineages (subtypes B, C and G, CRF18_cpx, CRF19_cpx, and CRFs20/23/24_BG isolated between 1999 and 2011 were analyzed. Maximum-likelihood analyses revealed multiple introductions of subtype B (n≥66, subtype C (n≥10, subtype G (n≥8 and CRF18_cpx (n≥2 viruses in Cuba. The bulk of HIV-1 infections in this country, however, was caused by dissemination of a few founder strains probably introduced from North America/Europe (clades B(CU-I and B(CU-II, east Africa (clade C(CU-I and central Africa (clades G(CU, CRF18(CU and CRF19(CU, or locally generated (clades CRFs20/23/24_BG. Bayesian-coalescent analyses show that the major HIV-1 founder strains were introduced into Cuba during 1985-1995; whereas the CRFs_BG strains emerged in the second half of the 1990s. Most HIV-1 Cuban clades appear to have experienced an initial period of fast exponential spread during the 1990s and early 2000s, followed by a more recent decline in growth rate. The median initial growth rate of HIV-1 Cuban clades ranged from 0.4 year⁻¹ to 1.6 year⁻¹. Thus, the HIV-1 epidemic in Cuba has been a result of the successful introduction of a few viral strains that began to circulate at a rather late time of the AIDS pandemic, but then were rapidly disseminated through local transmission networks.