摘要 :
Large-scale HIV management in resource-limited settings has been remarkably successful in a relatively short time frame. Once combination antiretroviral therapy (cART) became more universally available, national treatment programs...
展开
Large-scale HIV management in resource-limited settings has been remarkably successful in a relatively short time frame. Once combination antiretroviral therapy (cART) became more universally available, national treatment programs were able to provide much of the needed therapy which was originally prioritized towards patients with the most advanced and symptomatic disease. At the time, it was thought that comprehensive laboratory monitoring for safety and efficacy was either unavailable, too expensive or would detract from the focus of providing life-saving treatment to as many individuals who needed it as possible .
收起
摘要 :
Abstract Objectives To investigate the performance of the routine serum galactomannan (sGM) assay in the diagnosis of invasive aspergillosis (IA) in high-risk haematology patients receiving prophylaxis with micafungin. Methods Ret...
展开
Abstract Objectives To investigate the performance of the routine serum galactomannan (sGM) assay in the diagnosis of invasive aspergillosis (IA) in high-risk haematology patients receiving prophylaxis with micafungin. Methods Retrospective study including all haematological patients who received prophylaxis with micafungin during high-risk IA episodes (neutropenic patients after chemotherapy for acute myeloid leukaemia/myelodysplastic syndrome; allogeneic haematopoietic stem-cell transplantation during early neutropenic phase or graft-versus-host disease requiring high prednisone doses) and for whom at least one sGM result was available. Episodes were classified as follows: true-positive (positive GM in the context of IA), false-positive (positive GM result in patients who had no evidence of IA), true-negative (negative GM test results and no IA), or false-negative (negative GM test in the context of IA). Non-evaluable patients were excluded. Results Among 146 evaluable episodes, four were true-positive in the context of probable breakthrough IA (incidence of breakthrough IA, 2.7%); 111/146 high-risk episodes (76%) were considered true-negative and 31/146 (21.2%) were considered false-positive. No false-negative episodes were detected. All but one of the false-positive episodes were detected in surveillance GM tests, leading to high-resolution CT scans in eight cases (8/31; 25.8%), all of which were negative. The positive predictive and negative predictive values of sGM for surveillance and diagnostic approaches were 3.2% (1/31) and 100% (110/110) and 75% (3/4) and 100% (1/1), respectively. Conclusions Surveillance of asymptomatic patients receiving prophylaxis with micafungin using sGM is unnecessary, because the results are either negative or false-positive. However, sGM remains useful in the diagnosis of breakthrough IA in symptomatic patients during prophylaxis.
收起
摘要 :
Background Surveillance of healthcare-associated infections (HAI) is the basis of each infection control programme and, in case of acute care hospitals, should ideally include all hospital wards, medical specialties as well as all...
展开
Background Surveillance of healthcare-associated infections (HAI) is the basis of each infection control programme and, in case of acute care hospitals, should ideally include all hospital wards, medical specialties as well as all types of HAI. Traditional surveillance is labour intensive and electronically assisted surveillance systems (EASS) hold the promise to increase efficiency. Objectives To give insight in the performance characteristics of different approaches to EASS and the quality of the studies designed to evaluate them. Methods In this systematic review, online databases were searched and studies that compared an EASS with a traditional surveillance method were included. Two different indicators were extracted from each study, one regarding the quality of design (including reporting efficiency) and one based on the performance (e.g. specificity and sensitivity) of the EASS presented. Results A total of 78 studies were included. The majority of EASS (n?=?72) consisted of an algorithm-based selection step followed by confirmatory assessment. The algorithms used different sets of variables. Only a minority (n?=?7) of EASS were hospital-wide and designed to detect all types of HAI. Sensitivity of EASS was generally high (>?0.8), but specificity varied (0.37–1). Less than 20% (n?=?14) of the studies presented data on the efficiency gains achieved. Conclusions Electronically assisted surveillance of HAI has yet to reach a mature stage and to be used routinely in healthcare settings. We recommend that future studies on the development and implementation of EASS of HAI focus on thorough validation, reproducibility, standardised datasets and detailed information on efficiency.
收起
摘要 :
Background and aims Seasonal influenza vaccination (SIV) uptake (SIVU) rates in France are below target. We (i) describe trends in French SIVU over 10 consecutive seasons among different target groups and (ii) examine the effects ...
展开
Background and aims Seasonal influenza vaccination (SIV) uptake (SIVU) rates in France are below target. We (i) describe trends in French SIVU over 10 consecutive seasons among different target groups and (ii) examine the effects of the 2009 influenza A(H1N1) pandemic and the publication of new SIV recommendations in 2011 and 2013. Methods Our study was based on records of vaccines delivered in community pharmacies for a permanent, representative sample of 805,000 beneficiaries of the French National Health Insurance Fund. For the first objective, we analysed SIVU rate trends among ≥ 65 year olds as well as among ?<?65 year olds with each of the following conditions: diabetes, respiratory, cardiovascular, neuromuscular, or chronic liver disease. For the second goal, we computed segmented log-binomial regression analyses. Results After the 2009 pandemic, except for the target group with liver diseases, where the difference was not statistically significant, SIVU fell significantly in all groups during the 2010/11 season, remaining relatively stable until 2015/16 in groups not targeted by new recommendations. Crude SIVU rates in 2015/16 were 48% (43,950/91,794) for ≥ 65 year olds and between 16% (407/2,565) and 29% (873/3,056) for ?<?65 year olds depending on their condition. SIVU increased modestly after new recommendations were published, but only in patients newly eligible for a free vaccine voucher. Conclusions Our results suggest: (i) a prolonged confidence crisis in SIV, initially impelled by the 2009 pandemic vaccination campaign; (ii) that new recommendations are ineffective without additional measures. Interventional research in this field is a priority.
收起
摘要 :
Background Chagas disease is endemic in Latin America and affects 8 million people worldwide. In 2010, Catalonia introduced systematic public health surveillance to detect and treat congenital Chagas disease. Aim The objective was...
展开
Background Chagas disease is endemic in Latin America and affects 8 million people worldwide. In 2010, Catalonia introduced systematic public health surveillance to detect and treat congenital Chagas disease. Aim The objective was to evaluate the health outcomes of the congenital Chagas disease screening programme during the first 6 years (2010–2015) after its introduction in Catalonia. Methods In a surveillance system, we screened pregnant women and newborns and other children of positive mothers, and treated Chagas-positive newborns and children. Diagnosis was confirmed for pregnant women and children with two positive serological tests and for newborns with microhaematocrit and/or PCR at birth or serology at age 9 months. Results From 2010 to 2015, the estimated screening coverage rate increased from 68.4% to 88.6%. In this period, 33,469 pregnant women were tested for Trypanosoma cruzi and 937 positive cases were diagnosed. The overall prevalence was 2.8 cases per 100 pregnancies per year (15.8 in Bolivian women). We followed 82.8% of newborns until serological testing at age 9–12 months and 28 were diagnosed with Chagas disease (congenital transmission rate: 4.17%). Of 518 siblings, 178 (34.3%) were tested and 14 (7.8%) were positive for T. cruzi . Having other children with Chagas disease and the heart clinical form of Chagas disease were maternal risk factors associated with congenital T. cruzi infection (p?<?0.05). Conclusion The increased screening coverage rate indicates consolidation of the programme in Catalonia. The rate of Chagas disease congenital transmission in Catalonia is in accordance with the range in non-endemic countries.
收起
摘要 :
This article examines the role of stigma in social and institutional responses to infectious disease emergencies, to better understand and minimize these dynamics in the event of a pandemic of virulent influenza. In addition to th...
展开
This article examines the role of stigma in social and institutional responses to infectious disease emergencies, to better understand and minimize these dynamics in the event of a pandemic of virulent influenza. In addition to their impact on human suffering, fear and stigma can seriously delay detection and treatment efforts, cooperation with contact tracing and isolation measures, and the effective distribution of resources for the prevention and control of infectious diseases. These dynamics are illustrated by the Indian plague epidemic of 1994, which occurred in a region where H5N1 influenza has been detected recently. Public fear and stigma also played a significant role in the social and institutional responses to the 1918 influenza pandemic. These historical models provide important lessons for pandemic preparedness and global health policy.
收起
摘要 :
BACKGROUND: HIV infection, hepatitis C virus (HCV) liver disease, and mitochondrial DNA (mtDNA) polymorphisms are three possibly interrelated factors that might be associated with progression of liver disease. The aim of this stud...
展开
BACKGROUND: HIV infection, hepatitis C virus (HCV) liver disease, and mitochondrial DNA (mtDNA) polymorphisms are three possibly interrelated factors that might be associated with progression of liver disease. The aim of this study was to investigate whether mtDNA haplogroups had any influence on liver fibrosis progression in HIV/HCV coinfected patients. METHODS: We carried out a cross-sectional study in 231 patients who were genotyped via Sequenom's MassARRAY platform (San Diego, California, USA). Liver fibrosis was estimated based on the METAVIR score. In each patient, fibrosis progression rate (FPR) was calculated by dividing the fibrosis stage (0-4) by the estimated duration of HCV infection in years. RESULTS: The cluster or major haplogroup HV was significantly associated with reduced odds ratios (OR) for advanced fibrosis [OR 0.35, 95% confidence interval (CI) 0.16-0.77, P = 0.009], cirrhosis (OR 0.16, 95% CI 0.04-0.60, P = 0.007), or high FPR (OR 0.43, 95% CI 0.21-0.84, P = 0.015). Within the major haplogroup HV, haplogroup H was significantly associated with an absence of advanced fibrosis (OR 0.40, 95% CI 0.18-0.91, P = 0.029), cirrhosis (OR 0.14, 95% CI 0.03-0.67, P = 0.014), or high FPR (OR 0.47, 95% CI 0.23-0.95, P = 0.035). We also found a significant association with increased odds of cirrhosis (OR 5.25, 95% CI 1.76-15.64, P = 0.003) in the closely related major haplogroup U. CONCLUSION: The mtDNA haplogroups HV and H were associated with slower fibrosis progression, and the haplogroup U was associated with faster fibrosis progression in HIV/HCV coinfected patients. These data suggest that mtDNA haplogroup may play a significant role in liver fibrogenesis during HCV infection.
收起
摘要 :
Antimicrobial use in animals is known to contribute to the global burden of antimicrobial resistance. Therefore, it is critical to monitor antimicrobial sales for livestock and pets. Despite the availability of veterinary antimicr...
展开
Antimicrobial use in animals is known to contribute to the global burden of antimicrobial resistance. Therefore, it is critical to monitor antimicrobial sales for livestock and pets. Despite the availability of veterinary antimicrobial sales data in most European countries, surveillance currently lacks consumption monitoring at the animal species level. In this study, alternative methods were investigated for stratifying antimicrobial sales per species using Swiss data (2006?2013). Three approaches were considered: (i) Equal Distribution (ED) allocated antimicrobial sales evenly across all species each product was licensed for; (ii) Biomass Distribution (BMD) stratified antimicrobial consumption, weighting the representativeness of each species' total biomass; and (iii) Longitudinal Study Extrapolation (LSE) assigned antimicrobial sales per species based on a field study describing prescription patterns in Switzerland. LSE is expected to provide the best estimates because it relies on field data. Given the Swiss example, BMD appears to be a reliable method when prescription data are not available, whereas ED seems to underestimate consumption in species with larger populations and higher treatment intensity. These methods represent a valuable tool for improving the monitoring systems of veterinary antimicrobial consumption across Europe. Keywords: antibiotic use, public health policy, surveillance, livestock, antimicrobial resistanceIntroductionAntimicrobial resistance has been gaining momentum as one of the most important topics within the public health sphere [1]. Part of the antimicrobial resistance burden for public health lies on the use of antimicrobials for veterinary purposes. Results from several studies have suggested that antimicrobial exposure in livestock is contributing to the emergence, selection and spread of antimicrobial resistant bacteria [2-4]. In addition, it is known that the use of antimicrobials in pets influences the resistance patterns found in those animals [5]. The subsequent spread of resistant bacteria from animals to humans can occur through multiple potential routes.Monitoring systems in veterinary medicine can provide useful insights into temporal trends of antimicrobial consumption and ensure compliance with prudent usage practices, programmes or regulations. Furthermore, they can assist in identifying the most efficient interventions for optimising antimicrobial usage. When combined with antimicrobial resistance data, quantification of antimicrobial usage can be useful not only in identifying risk factors for the emergence of resistance, but also in describing temporal associations between antimicrobial usage and resistance [6,7]. Finally, monitoring systems can be a source of highly informative data for boosting research on the complex topic of emergence, selection and spread of antimicrobial resistance. Thus, monitoring antimicrobial consumption in livestock and companion animals is undoubtedly an important tool in the battle against antimicrobial resistance.Research on the veterinary use of antimicrobials has focused on livestock species because their populations are larger and their antimicrobial consumption is higher than that of pet animals. Recognition of the importance of quantifying antimicrobial use in livestock emerged more than a decade ago [8] and the European Commission and the European Medicines Agency (EMA) have also emphasised the importance of monitoring antimicrobial use [9-11]. There is no binding European Union (EU) legislation with respect to the implementation of such monitoring programmes at national level and it is up to each country to define its strategy. In Switzerland, a non-EU country, the legal basis for sales data collection was defined in Article 35 of the Federal Ordinance on Veterinary Medicinal Products, enacted in September 2004 [12].The European Surveillance of Veterinary Antimicrobial Consumption (ESVAC) project, initiated in 2010 by the EMA, has contributed considerably to the collection of standardised data on veterinary consumption in Europe [13]. ESVAC reports are published annually and are currently based on data provided by 26 countries, including Switzerland [14].Prompted by the European Commission’s Action plan against the rising threats from Antimicrobial Resistance [10], ESVAC published guidance for data collection on antimicrobial consumption at the species level [15]. Furthermore, international guidelines such as the World Organisation for Animal Health’s Terrestrial Animal Health Code [7] and Integrated Surveillance of Antimicrobial Resistance: Guidance from a WHO Advisory Group [16], mention usage data at the species level as an important aspect that should be considered in monitoring systems. Data at the species and the production type level (such as dairy or beef cattle; broilers or laying hens; breeding, farrowing or fattening units) provide a better estimate of the antimicrobial exposure in each population and are t
收起
摘要 :
An outbreak of isoniazid-resistant tuberculosis first identified in London has now been ongoing for 20 years, making it the largest drug-resistant outbreak of tuberculosis documented to date worldwide. We identified culture-confir...
展开
An outbreak of isoniazid-resistant tuberculosis first identified in London has now been ongoing for 20 years, making it the largest drug-resistant outbreak of tuberculosis documented to date worldwide. We identified culture-confirmed cases with indistinguishable molecular strain types and extracted demographic, clinical, microbiological and social risk factor data from surveillance systems. We summarised changes over time and used kernel-density estimation and k-function analysis to assess geographic clustering. From 1995 to 2014, 508 cases were reported, with a declining trend in recent years. Overall, 70% were male (n?=?360), 60% born in the United Kingdom (n?=?306), 39% white (n?=?199), and 26% black Caribbean (n?=?134). Median age increased from 25 years in the first 5 years to 42 in the last 5. Approximately two thirds of cases reported social risk factors: 45% drug use (n?=?227), 37% prison link (n?=?189), 25% homelessness (n?=?125) and 13% alcohol dependence (n?=?64). Treatment was completed at 12 months by 52% of cases (n?=?206), and was significantly lower for those with social risk factors (p?收起
原文获取