Cent CI Research Articles

Mortality of Swedish horses with complete life insurance between 1997 and 2000: variations with sex, age, breed and diagnosis

The aim of this study was to evaluate the potential usefulness of the database maintained by the Swedish insurance company Agria for providing mortality statistics on Swedish horses. Mortality statistics...

Dislike of vegetables and type 2 diabetes

PurposeThe study aims to determine whether dislike of vegetables is associated with the presence of metabolic disorders.Design/methodology/approachCross‐sectional analysis of the data of middle‐aged (range 51–59 years) male personnel of the Self‐Defense Forces.FindingsOf subjects studied, 76.4 per cent answered they liked vegetables, 19.2 per cent were intermediate between liking and dislike and 4.4 per cent disliked vegetables. The odds ratio (95 per cent CI) of vegetable dislike to like was 2.22 (1.08–4.57) for the presence of diabetes, 2.46 (1.23–4.94) for hyper‐triglyceridemia and 2.54 (1.33–4.86) for high γ‐glutamyl transferase in a logistic regression analysis adjusted for age and lifestyle factors. Vegetable dislike did not correlate with hypertension, hypercholesterol‐emia or obesity. Vegetable consumption did not correlate with diabetes.Research limitations/implicationsThe results do not show a cause–result relationship. Observed findings may not be applied to age‐matched general population, or to older, younger, female or other ethnic persons.Practical implicationsVegetable dislike may be regarded as a simple marker of metabolic status including type 2 diabetes.Originality/valueThe authors show the cross‐sectional association between dislike of vegetables and type 2 diabetes.

Modelling the transmission dynamics of acute haemorrhagic conjunctivitis: application to the 2003 outbreak in Mexico

We model an outbreak of acute haemorrhagic conjunctivitis (AHC) using a simple epidemic model that includes susceptible, infectious, reported, and recovered classes. The model's framework considers the impact of underreporting and behaviour changes on the transmission rate and is applied to a recent epidemic of AHC in Mexico, using a fit to the cumulative number of cases to estimate model parameters, which agree with those derived from clinical studies. The model predicts a 'mean time from symptomatic onset to diagnosis' of 1.43 days (95 per cent CI: 1-2.5) and that the final size of the Mexican epidemic was underreported by 39 per cent. We estimate that a primary infectious case generates approximately 3 secondary cases (R0* = 2.64, SD 0.65). We explore the impact of interventions on the final epidemic size, and estimate a 36 per cent reduction in the transmission rate due to behaviour changes. The effectiveness of the behaviour changes in slowing the epidemic is evident at 21.90 (SD 0.19) days after the first reported case. Results therefore support current public health policy including expeditious announcement of the outbreak and public health information press releases that instruct individuals on avoiding contagion and encourage them to seek diagnosis in hospital clinics.

Role of HCV Coinfection Towards Disease Progression and Survival in HIV-1 Infected Children: A Follow-Up Study of 10 Years

The present study was taken up to evaluate the pattern of disease progression and survival in a group of HIV-1 positive children, coinfected with HCV infection (n=25) in comparison to those without such coinfection (n=23). There was a significant negative correlation between the rate of decline of the CD4 + T cell percentage and the duration of the AIDS-free interval in most (80.0 per cent) of the HCV seropositive children showing such decline (r=-0.588; p=0.005). The HCV seropositive children had twofold higher risk of progression to development of AIDS than HCV seronegatives (RR=2.51; 95 per cent CI:1.34-4.69; p=0.004). There was a significant negative correlation between the rate of decline of CD4 + T cell percentage and overall survival duration for HCV seropositive group (r=-0.609; p=0.003). Moreover, children coinfected with HCV had more than twofold higher risks of death than those without HCV (RR=2.39; 95 per cent CI:1.17-4.89; p<0.01). It appears that HCV infection may be an important contributor to the rapid disease progression and increase in mortality in HCV-HIV-1 coinfected children of thalassemia major.

Staphylococcus epidermidis as a cause of postoperative wound infection after cardiac surgery: assessment of pathogenicity by a wound-scoring method.

Wound infection after clean surgery prolongs hospital stay but the organism most commonly isolated from wound discharge, Staphylococcus epidermidis, is often dismissed as a contaminant or commensal. The wounds of 517 patients were assessed, after cardiac surgery, by a wound-scoring method ('ASEPSIS') and a close comparison was made of the appearance and clinical outcome of 89 wounds, from which bacteria were isolated. There was no significant difference in the scores of 49 wounds, where S. epidermidis was the sole isolate (9.5 per cent of all wounds, 95 per cent CI 6.9-12.0 per cent), and 13 wounds infected with Staphylococcus aureus (2.5 per cent, 95 per cent CI 1.2-3.9 per cent). Repeat cultures were obtained from 21 of the 49 wounds and, in 16 of these, the second isolate showed the same biochemical reactions and antibiotic resistance pattern as the first. Infection of sternal wounds is commoner with coagulase-negative staphylococci than with S. aureus and, clinically, is just as severe.

Comparison of Cox's and relative survival models when estimating the effects of prognostic factors on disease‐specific mortality: a simulation study under proportional excess hazards

In many prognostic studies focusing on mortality of persons affected by a particular disease, the cause of death of individual patients is not recorded. In such situations, the conventional survival analytical methods, such as the Cox's proportional hazards regression model, do not allow to discriminate the effects of prognostic factors on disease-specific mortality from their effects on all-causes mortality. In the last decade, the relative survival approach has been proposed to deal with the analyses involving population-based cancer registries, where the problem of missing information on the cause of death is very common. However, some questions regarding the ability of the relative survival methods to accurately discriminate between the two sources of mortality remain open. In order to systematically assess the performance of the relative survival model proposed by Esteve et al., and to quantify its potential advantages over the Cox's model analyses, we carried out a series of simulation experiments, based on the population-based colon cancer registry in the French region of Burgundy. Simulations showed a systematic bias induced by the 'crude' conventional Cox's model analyses when individual causes of death are unknown. In simulations where only about 10 per cent of patients died of causes other than colon cancer, the Cox's model over-estimated the effects of male gender and oldest age category by about 17 and 13 per cent, respectively, with the coverage rate of the 95 per cent CI for the latter estimate as low as 65 per cent. In contrast, the effect of higher cancer stages was under-estimated by 8-28 per cent. In contrast to crude survival, relative survival model largely reduced such problems and handled well even such challenging tasks as separating the opposite effects of the same variable on cancer-related versus other-causes mortality. Specifically, in all the cases discussed above, the relative bias in the estimates from the Esteve et al.'s model was always below 10 per cent, with the coverage rates above 81 per cent.

Prevalence, incidence and geographical distribution of serovars of Salmonella on dairy farms in England and Wales

A study of randomly selected dairy farms in England and Wales was made between October 1999 and February 2001 to estimate the prevalence and incidence of Salmonella serovars. The farms...

Antibiotic Use in Community-Based Pediatric Outpatients in Southern Region of Brazil

The irrational use of antibiotics is incriminated for the escalating antimicrobial resistance problem worldwide. This cross-sectional survey was conducted to describe patterns of antibiotic use in community-based pediatric outpatients in the southern region of Brazil. A sample of children (29 days to 18 years of age) was selected from each community-based outpatient clinic. Information related to antibiotic use in the child was obtained by interview with their parents using a structured questionnaire. Of 489 children, 201 (41.1 per cent) had received at least one antimicrobial course in the previous 2 months. The most commonly prescribed antibiotic was amoxicillin (54.0 per cent) and broad-spectrum agents were used in 15.3 per cent of antimirobial courses. Acute respiratory infections were the most frequent diagnosis for antibiotic prescribing (91.2 per cent), but at least 39.5 per cent were conditions of presumed viral etiology. Antibiotic use in the previous 2 months was more likely in children younger than 2 years (PR 1.36, 95 per cent CI 1.10-1.69); with chronic diseases (PR 1.38, 95 per cent CI 1.10-1.75); with higher paternal education level (PR 1.38, 95 per cent CI 1.11-1.72); with parents' pressure on physician for antibiotics (PR 1.66, 95 per cent CI 1.05-2.64) and with parental self-prescribing habit (PR 1.47, 95 per cent CI 1.06-2.04). Antibiotic use in children increased with mother's age (p=0.03 for linear trend). In conclusion, antibiotic prescribing is very common in community-based pediatric outpatients in the southern region of Brazil and inappropriate use is frequent. The independent risk factors for antibiotic use are child's age under 2 years, the presence of chronic diseases in the child, older mother, higher paternal education level, parents' pressure on physician and parental self-prescribing habit.

Child Morbidity and Healthcare Utilization in the Slums of Nairobi, Kenya

Rapid urbanization and inequitable distribution of social services in African cities significantly contribute to the current deterioration of child health indicators in the region. Determinants of child morbidity and healthcare utilization among slum residents in Nairobi City, Kenya were assessed. Using a morbidity surveillance system, we visited 1691 households every 90 days for 9 months and registered 696 children below 5 years. 264 (37.9 per cent) children were reported to have been sick or injured at least once during the study period. A total of 447 illness episodes were reported among the 264 children (an average of 1.7 episodes per child). Cough, fever, diarrhea, skin problems and eye diseases made up the top five causes of morbidity. Child age below 1 year (OR=2.7; 95 per cent CI=1.33, 5.49) and having a working-mother (OR=2.0; 95 per cent CI=1.19, 3.31) were significantly associated with child morbidity report. About half of the mothers sought proper medical care for their sick children mostly from health institutions located outside the slum. Healthcare seeking within the slum heavily relied on informal private clinics. Working mothers sought medical care more often than non-working mothers (OR=0.29; 95 per cent CI=0.12, 0.7) and infants got priorities compared to older sick children (OR=0.2; 95 per cent CI=0.05, 0.83). We conclude that maternal engagement in non-formal low-paying jobs might in the long-run have a questionable gain in child survival among slum residents.

Efficacy of topical aciclovir for the treatment of feline herpetic keratitis: results of a prospective clinical trial and data from in vitro investigations

This study aimed to evaluate the efficacy of topical ophthalmic aciclovir applied five times daily as a treatment for feline herpesvirus type 1 (FHV-1) keratitis in a group of cats...

Risk Factors for Death from Meningococcal Infection in Recife, Brazil

To determine the case fatality rate and risk factors for death in children with invasive meningococcal infection, 163 children admitted with meningococcal disease to the Instituto Materno Infantil de Pernambuco, a tertiary paediatric teaching hospital in Recife, Brazil, were included in this retrospective cohort study. Cases were categorised as meningitis, septicaemia and septicaemia with meningitis. Forty-six (28.2 per cent) children had meningitis alone, 88 (54 per cent) septicaemia and meningitis and 29 (17.8 per cent) only septicaemia. Four of the patients with meningitis died (8.7 per cent), compared to 31 out of the 88 (35.2 per cent) with septicaemia and meningitis and 18 of the 29 (62.1 per cent) with septicaemia alone (p < 0.001). Symptoms <24 h (AOR 3.8, 95 per cent CI 1.1-13.1), platelet count <100 000 mm(3) (AOR 13.8, 95 per cent CI 3.1-60.9) and acidosis (AOR 6.0, 95 per cent CI 1.7-21) were the significant risk factors for death. Invasive meningococcal infection has a high case-fatality rate in this tertiary centre in Recife, especially in the septic forms. The identification of risk factors for death could contribute to the early recognition of patients with higher risk on admission in a middle-income country population.

Year-round daylight saving and serious or fatal road traffic injuries in children in the north-east of England

It has been suggested that year-round daylight saving would reduce road traffic injuries. and results Using 15 years of police data from north-east England, we estimate that 6.9 (95 per cent CI 1.5-12.6) fewer serious or fatal road traffic injuries to child pedestrians would have occurred in this area over this period had year-round daylight saving operated (equivalent to 0.5 per year). The results suggest that operating daylight saving year-round would have a small but tangible effect on the number of serious and fatal road traffic injuries in children in this area. Further work is required to assess the community wide impact of year round daylight saving.

Factors associated with the wastage and achievements in competition of event horses registered in the United Kingdom

The aims of this study were to estimate the wastage of horses registered for eventing in Britain, to investigate the reasons for this wastage and to evaluate factors affecting the...

Incidence and morbidity of hospital‐presenting corneal infiltrative events associated with contact lens wear

Aim: To determine the incidence and morbidity (visual loss) of hospital‐presenting corneal infiltrative events (CIEs) associated with the wearing of current generation contact lenses.Methods: All contact lens wearers presenting with any form of corneal infiltrate/ulcer to a hospital centre in Manchester, UK, were surveyed in this 12‐month, prospective, hospital‐based epidemiological study. A clinical severity matrix was used to quantify the overall severity of presenting signs and symptoms. The size of the hospital catchment population and the wearing modalities (daily wear [DW] or extended wear [EW]) and lens types used in that population were estimated from relevant demographic and market data to facilitate the calculation of incidence. We also attempted to ascertain, from their eye care practitioners, the visual acuity (VA) of patients suffering from CIEs prior to and at about six months following attendance at the hospital.Results: During the survey period, 118 patients presented with CIEs of varying severity. The annual incidence (cases per 10,000 wearers) for all wearing modalities and lens types is 21.3 (95 per cent confidence interval 17.8 to 25.5). The incidence of CIEs for each wearing modality and lens type is: DW rigid, 8.6 (3.9 to 18.7); DW hydrogel daily disposable, 14.0 (9.3 to 21.0); DW hydrogel (excluding daily disposable), 20.4 (15.9 to 26.2); DW silicone hydrogel, 55.9 (9.9 to 309.6); EW rigid, zero (0.0 to 1758.8); EW hydrogel, 144.6 (66.4 to 311.8) and EW silicone hydrogel, 118.6 (75.2 to 186.7). The risk of developing a CIE with EW lenses was 8.1 (5.3 to 12.5) times greater than that with DW lenses (p < 0.0001). Although there was no difference between EW hydrogel and EW silicone hydrogel lenses with respect to the risk of developing CIEs, the clinical severity of CIEs was greater with EW hydrogel lenses (p = 0.04). Results of VA for pre‐and post‐hospital attendance were obtained from 38 patients, none of whom lost more than one line of VA. For the study population, zero patients (95 per cent CI: 0 to 9.2 per cent) suffered a significant loss of VA as a result of developing a CIE.Conclusions: Overall, there is an eight times higher incidence of CIEs in wearers who sleep in contact lenses compared with wearers who use lenses only during the waking hours. For those who choose to routinely or intermittently sleep in soft contact lenses, silicone hydrogels are the lens of first choice because CIEs are less clinically severe with this lens type compared with hydrogel lenses. The rate of significant visual loss as a result of developing a CIE is low.

Unsung heroes who put their lives at risk? Informal caring, health and neighbourhood attachment

Previous studies have highlighted the effects of informal caring on mental health, but evidence for its wider impact remains scant. We explored associations between informal care and a range of health (and health-related) measures. We also considered previously neglected differences between informal care 'at home' and care elsewhere, along with neighbourhood attachment as a possible modifier of the associations we found. The study involved a large population survey in two Primary Care Trusts. Data were collected by postal survey of 15,465 adults; subjects were selected from the local General Practice register. 12.7 per cent of respondents identified themselves as carers. Health measures included psychiatric morbidity, bodily pain, self-assessed health, health-related behaviours, obesity, prescribed drugs and high levels of GP consultation. Of nine measures considered, care at home was associated with psychiatric morbidity (OR 1.46, 95 per cent CI 1.25--1.70), bodily pain (OR 1.19, 95 per cent CI 1.02--1.39), and obesity (OR 1.59, 95 per cent CI 1.34--1.89). Care 'away' was associated with smoking (OR 1.26, 95 per cent CI 1.03--1.54), and inversely with both sedentary living (OR 0.70, 95 per cent CI 0.58--0.85) and poor self-assessed health (OR 0.78, 95 per cent CI 0.62--0.99). Health tended to be poorer when carers lacked a sense of neighbourhood attachment. Informal carers are likely to face serious health challenges besides anxiety and depression. Caring is associated with several aspects of poor health, which are themselves predictors of premature mortality. Proactive and wide-ranging support is required, the more so in neighbourhoods where carers feel alienated. Research and policy should distinguish carers 'at home' from carers 'away'.

Kangaroo Mother Care: A Randomized Controlled Trial on Effectiveness of Early Kangaroo Mother Care for the Low Birthweight Infants in Addis Ababa, Ethiopia

A randomized controlled trial was conducted over a 1-year period (November 2001-November 2002) in Addis Ababa to study the effectiveness of early Kangaroo mother care before stabilization of low birthweight infants as compared with the conventional method of care. There were 259 babies weighing less than 2000 g during the study period and a total of 123 (47.5 per cent) low birthweight infants were included in to the study. Sixty-two infants were enrolled as Kangaroo Mother Care (KMC) and the remaining 61 were Conventional Method of Care (CMC) cases. The demographic and socioeconomic characteristics for both groups were comparable. The mean age at the time of enrollment was 10 and 9.8 h for KMC and CMC, respectively (p>0.05 with 95 per cent confidence interval). The mean birthweight was 1514.8 g (range 1000-1900 g) for KMC and 1471.8 g (range 930-1900 g) for CMC (p>0.05 with 95 per cent CI) and the mean gestational age was 32.42 and 31.59 weeks for KMC and CMC cases, respectively. Fifty-eight per cent of KMC and 52 per cent of CMC cases were on i.v. fluid. Twenty-one of 62 (34 per cent) of KMC and 23/61 (37 per cent) of CMC babies were on oxygen through nasopharyngeal catheter. The mean age at exit from the study was 4.6 days for KMC and 5.4 days for CMC. Ninety-one per cent and 88 per cent of babies in KMC and CMC were discharged from the study in the first 7 days of life, respectively. The study showed that 14/62 (22.5 per cent) of KMC vs. 24/63 (38 per cent) CMC babies died during the study (p<0.05 and CI of 95 per cent.) The majority of deaths occurred during the first 12 h of life. Survival for the preterm low birthweight infants was remarkably better for the early kangaroo mother care group than the babies in the conventional method of care in the first 12 h and there after. More than 95 per cent of mothers reported that they were happy to care for their low birthweight babies using the early Kangaroo mother method. It was recommended to study the feasibility and effectiveness of Kangaroo mother care at the community level.

Does increased use of private health care reduce the demand for NHS care? A prospective survey of General Practice referrals

The use of the private sector for health care is increasing, but it is unclear whether this will reduce demand on the NHS. The aim of this study was to examine the relationship between private and NHS outpatient referral rates accounting for their association with deprivation. This is a prospective survey of general practitioner referrals to private and NHS consultant-led services between 1 January and 31 December 2001 from 10 general practices in the Trent Focus Collaborative Research Network, United Kingdom. Patient referrals were aggregated to give private and NHS referral rates for each electoral ward in each practice. Of 17,137 referrals, 90.4 percent (15,495) were to the NHS and 9.6 percent (1642) to the private sector. Private referral rates were lower in patients from the most deprived fifth of wards compared with the least deprived fifth (rate ratio 0.25, 95 percent CI 0.15 to 0.41, p < 0.001), whereas NHS referral rates were slightly higher in patients in the most deprived fifth of wards (rate ratio 1.18, 95 percent CI 0.98 to 1.42, p = 0.08) both after age standardisation and adjustment for practice. The NHS referral rate was significantly higher (rate ratio 1.40, 95 percent CI 1.15 to 1.71, p = 0.001) in wards with private referral rates in the top fifth compared with the bottom fifth after adjustment for deprivation and practice. Increased private health care activity does not reduce the demand for NHS care: NHS and private referral rates were positively associated with each other after adjusting for age, deprivation and practice.

Women who decline antenatal screening for HIV infection in the era of universal testing: results of an audit of uptake in three London hospitals

Universal screening for HIV in early pregnancy is strongly promoted policy in the United Kingdom with a target of 90 per cent uptake. We identified characteristics of women declining screening by conducting an audit at three hospitals in inner north London. In early 2002 midwives were asked to complete an audit form following first antenatal appointment. Of 2,710 women attending 401 (15 per cent) declined an HIV test. Of women who declined 38 per cent reported they had been tested for HIV in the past; 65 per cent accepted every other antenatal test. In multivariable analysis parity (OR: 1.19; 95 per cent CI 1.10-1.29 per additional child), declining other tests (OR: 3.10; 95 per cent CI 2.44-3.93 per test declined) and previous HIV testing (OR: 1.70; 95 per cent CI 1.30-2.23) were predictors of declining an HIV test. Women declining screening were not obviously from high-risk demographic groups: women from sub-Saharan Africa were not at greater risk of declining an HIV test than women from other regions.

An immigration–death model to estimate the duration of malaria infection when detectability of the parasite is imperfect

Immigration-death models are proposed to analyse the infection dynamics in longitudinal studies of panels of heavily parasitized human hosts where parasites have been typed at regular intervals by PCR. Immigration refers to the acquisition of a new parasitic genotype, occurring at rate lambda, and death refers to the clearance of a parasitic genotype (with rate mu). The models assume that corresponding to each observed process which is the detection or failure to detect a parasitic genotype, is an underlying true process which is hidden as a result of imperfect detection. We consider: (i) a model in which no distinction is made between the different members of the human population, who collectively represent the habitat of the parasites, and (ii) a model that allows for the accrual of infections with age. The models are fitted to a panel data set of malaria genotype of parasites belonging to the msp2 FC27 and 3D7 allelic families from a study of the dynamics of Plasmodium falciparum in Northern Ghana. Maximum likelihood estimates suggest that on average any individual residing in this holo-endemic area will acquire 16 new infections per year (95 per cent CI, 15-18) (defined by their single locus genotypes) and that infection with any of these genotypes lasts on average 152 days (95 per cent CI, 138-169). We estimate that an average of 47 per cent (95 per cent CI, 42-51) of the parasite types present in the host are detected in a finger-prick blood sample. This model provides a basis for analyses of how these quantities vary with the age, and hence the immune status of the host.

Are we falling at the first hurdle? Estimating under-recording of falls in Accident and Emergency

Accident and Emergency (A and E) is the first port of call for most people who have experienced an injurious fall. This provides the potential for identifying patients who may benefit from preventative interventions. This study aims to estimate the percentage of falls attendances that are not recorded on computerised A and E records. A retrospective cohort study design was used to study patients attending A and E with falls related injuries. The survey revealed poor recording of falls with 38 per cent (95 per cent CI +/- 8.82 per cent) of patient reported falls not recorded on computerised A and E records. More than half of those reporting a fall as the reason for attendance at A and E, reported previous falls, with 21 per cent reporting subsequent falls. A and E could play an important role in secondary falls prevention. Improving recording of falls in A and E is an essential prerequisite.