Cent CI Research Articles

Quantifying the source of infection for HIV‐infected hemophiliacs in the U.K. from 1979 to 1984

There is considerable literature on the risk of HIV infection for individuals suffering from hemophilia A in the United Kingdom (U.K.) during the period 1979-1984 when the sources of Factor VIII clotting factor were contaminated with HIV. Toward the end of this period, several investigators reported HIV prevalence among hemophiliacs, often classified by the severity of disease and, to some extent, the source of the clotting factor with which individuals were infused. In the U.K., hemophilia A patients typically received clotting factor from the local National Health Service (NHS) supplies or from commercial product usually imported from the United States. Litigation on behalf of U.K. hemophiliacs, their survivors, and estates remains unresolved, cases in which it becomes important to quantify the fraction of U.K. hemophiliac HIV infections attributable to imported blood product. For HIV-infected individuals who received Factor VIII from one source exclusively, the source of infection is clear, assuming no other risk factors. For patients who used both types of clotting factor, the source of infection is uncertain. For the U.K. as a whole, we produce quantitative estimates of the conditional probability of infection due to a specific source, based on HIV prevalence in groups exclusively exposed to a specific source and the percentage of clotting factor that was imported. With plausible estimates of these input parameters, an estimate of the conditional probability of infection due to imported product is 0.93 (95 per cent CI: 0.90-0.96). This estimate is relatively insensitive to changes in input parameters, but may vary over subgroups of hemophiliacs.

Survey of the prevalence of Salmonella on commercial broiler farms in the United Kingdom, 2005/06

Between October 2005 and September 2006, all European Union member states were required to carry out standardised surveys of the prevalence of Salmonella in broiler flock holdings to establish baseline...

Sexual violence at first intercourse against women in Moshi, northern Tanzania: Prevalence, risk factors, and consequences

To explore the relationship between sexual violence at first intercourse and later sexually transmitted infections (STIs) in Moshi, Tanzania, we analysed data from a representative household survey that comprised face-to-face interviews with 1,835 women and tests for six STIs on biological samples from 1,235 of these women. Overall, 10.9 per cent report forced first intercourse and 15.3 per cent report unwanted first intercourse. Unadjusted analysis shows a relationship between forced first intercourse and STIs (OR: 1.72, 95 per cent CI: 1.19–2.51). Life-course variables mediate this relationship. Significant predictors of having an STI include older age, more sexual partners, and a partner who has children with other women. Coerced first intercourse appears to be associated with changes in the life course of women and with a heightened risk of contracting an STI.

Measuring compliance with surgical antibiotic protocols: an intervention

PurposeThe purpose of the paper is to measure compliance with agreed protocols for prophylactic antibiotics for five elective procedures: transurethral resection of the prostate, cholecystectomy, hysterectomy, joint arthroplasty and herniorrhaphy in two teaching hospitals.Design/methodology/approachCompliance was measured during the pre and post intervention periods by reviewing medical records.FindingsOverall, compliance improved by 18 per cent (95 per cent CI: 12 per cent, 23 per cent) with greater improvements for transurethral resection of the prostate and hysterectomy, increasing by 27 per cent (95 per cent CI: 14 per cent, 40 per cent) and 24 per cent (95 per cent CI: 16 per cent, 32 per cent) respectively. Compliance remained low for cholecystectomy (17 per cent) and hysterectomy (25 per cent). Overall, the proportion of patients not receiving any prophylaxis where its use was indicated, declined by 6 per cent (95 per cent CI: 1 per cent, 11 per cent) from 23 per cent. The use of additional anti‐microbials that were not recommended in the protocol was high for joint arthroplasty 65 per cent and hysterectomy 71 per cent, but overall this practice declined by 8 per cent (95 per cent CI: 3 per cent, 14 per cent). Costs were reduced from $11.72 to $10.53 per patient between the pre and post intervention groups, while a complete adoption of the protocols could reduce costs by 70 per cent to $3.40. There were large variations in correct dosages and timing of antibiotics between procedural groups.Practical implicationsAlthough compliance improved there were large differences between the specialties. The adoption of preventive strategies is fundamental to providing safe patient care. The use of inappropriate antimicrobials is also an important patient safety issue that contributes to antibiotic resistance and is associated with increased costs. Introducing change in health organizations is difficult and the factors influencing successful change strategies require further study.Originality/valueThe paper measures and improves compliance with agreed protocols in health care intervention procedures.

Seroprevalence of bluetongue serotype 8 in cattle in the Netherlands in spring 2007, and its consequences

A cross-sectional study was carried out in spring 2007, at the end of the first bluetongue outbreak season, to determine the geographical spread of bluetongue virus serotype 8 (btv-8) infection...

A young Moon-forming giant impact at 70–110 million years accompanied by late-stage mixing, core formation and degassing of the Earth

New W isotope data for lunar metals demonstrate that the Moon formed late in isotopic equilibrium with the bulk silicate Earth (BSE). On this basis, lunar Sr isotope data are used to define the former composition of the Earth and hence the Rb-Sr age of the Moon, which is 4.48+/-0.02Ga, or 70-110Ma (million years) after the start of the Solar System. This age is significantly later than had been deduced from W isotopes based on model assumptions or isotopic effects now known to be cosmogenic. The Sr age is in excellent agreement with earlier estimates based on the time of lunar Pb loss and the age of the early lunar crust (4.46+/-0.04Ga). Similar ages for the BSE are recorded by xenon and lead-lead, providing evidence of catastrophic terrestrial degassing, atmospheric blow-off and significant late core formation accompanying the ca 100Ma giant impact. Agreement between the age of the Moon based on the Earth's Rb/Sr and the lead-lead age of the Moon is consistent with no major losses of moderately volatile elements from the Earth during the giant impact. The W isotopic composition of the BSE can be explained by end member models of (i) gradual accretion with a mean life of roughly 35Ma or (ii) rapid growth with a mean life of roughly 10Ma, followed by a significant hiatus prior to the giant impact. The former assumes that approximately 60 per cent of the incoming metal from impactors is added directly to the core during accretion. The latter includes complete mixing of all the impactor material into the BSE during accretion. The identical W isotopic composition of the Moon and the BSE limits the amount of material that can be added as a late veneer to the Earth after the giant impact to less than 0.3+/-0.3 per cent of ordinary chondrite or less than 0.5+/-0.6 per cent CI carbonaceous chondrite based on their known W isotopic compositions. Neither of these on their own is sufficient to explain the inventories of both refractory siderophiles such as platinum group elements and rhenium, and volatiles such as sulphur, carbon and water.

Concurrent immune-mediated haemolytic anaemia and severe thrombocytopenia in 21 dogs

The medical records of 21 dogs with concurrent immune-mediated haemolytic anaemia (imha) and severe thrombocytopenia (defined as an automated platelet count of less than 50 × 109/l, confirmed by the...

Comparison of hydroxyapatite and dental enamel for testing shear bond strengths

Abstract Aims To investigate the feasibility of using artificial hydroxyapatite as a future biomimetic laboratory substitute for human enamel in orthodontic bond strength testing by comparing the shear bond strengths and nature of failure of brackets bonded to samples of hydroxyapatite and enamel. Method One hundred and fifty hydroxyapatite discs were prepared by compression at 20 tons and fired in a furnace at 1300°C. One hundred and five enamel samples were prepared from the buccal and palatal/lingual surfaces of healthy premolars extracted for orthodontic purposes. Orthodontic brackets were bonded to each sample and these were subjected to shear bond strength testing using a custom-made jig mounted in an Instron Universal Testing Machine. The force value at bond failure was obtained, together with the nature of failure which was assessed using the Adhesive Remnant Index. Results The mean shear bond strength for the enamel samples was 16.62 MPa (95 per cent CI: 15.26, 17.98) and for the hydroxyapatite samples 20.83 MPa (95 per cent CI: 19.68, 21.98). The difference between the two samples was statistically significant (p < 0.001). When the nature of failure was assessed with the ARI Index, 83 per cent of the enamel samples scored 2 or 3, while 49 per cent of the hydroxyapatite samples scored 0 or 1. Conclusions Hydroxyapatite was an effective biomimetic substrate for bond strength testing with a mean shear bond strength value (20.83 MPa) at the upper end of the normal range attributed to enamel (15–20 MPa). Although the difference between the shear bond strengths for hydroxyapatite and enamel was statistically significant, hydroxyapatite could be used as an alternative to enamel for comparative laboratory studies until a closer alternative is found. This would eliminate the need for extracted teeth to be collected. However, it should be used with caution for quantitative studies where true bond strengths are to be investigated.

The role of aldehyde dehydrogenase-1 (ALDH1A1) polymorphisms in harmful alcohol consumption in a Finnish population

Liver cystolic aldehyde dehydrogenase 1 (ALDH1A1) has been previously associated with both alcohol dependence and alcohol consumption behaviour, and has been implicated in alcohol-induced flushing and alcohol sensitivity in Caucasians. The present study tested for association between ALDH1A1 and alcohol consumption behaviour and susceptibility to problem drinking or alcohol dependence in Finnish cohorts of unrelated male subjects recruited from alcoholism clinical treatment facilities (n = 104) and from the general population (n = 201). All participants completed the Alcohol Use Disorder Identification Test (AUDIT) and were genotyped for eight single nucleotide polymorphisms (SNPs) within or flanking ALDH1A1. To test for association between alcohol consumption behaviour and these polymorphisms, we used generalised linear models and haplotypic analysis. Three SNPs were nominally associated (rs348449, p = 0.043; rs610529, p = 0.013; rs348479, p = 0.025) with the quantitative AUDIT score, which evaluates alcohol consumption behaviour. Two-locus (rs6I0529-rs2288087) haplotype analysis increased the strength of association with AUDIT score (p = 0.00I5). Additionally, rs348449 is highly associated with problem drinking (allelic odds ratio [OR] 7.87, 95 per cent confidence interval [CI] 1.67-37.01) but due to the low minor allele frequency (0.01 and 0.07 in controls and problem drinkers, respectively), more samples are required to validate this observation. Conversely, rs348479 (p = 0.019) and rs6I0529 (allelic OR 0.65, 95 per cent CI 0.43-0.98; genotypic OR 0.32, 95 per cent CI 0.12-0.84) are implicated in alcohol dependence status. This study provides further evidence for a role for ALDH1A1 in alcohol consumption behaviour, including problem drinking and possibly alcohol dependence, in our Finnish population.

Detecting myocardial infarction in critical illness using screening troponin measurements and ECG recordings

IntroductionTo use screening cardiac troponin (cTn) measurements and electrocardiograms (ECGs) to determine the incidence of elevated cTn and of myocardial infarction (MI) in patients admitted to the intensive care unit (ICU), and to assess whether these findings influence prognosis. This is a prospective screening study.Materials and methodsWe enrolled consecutive patients admitted to a general medical-surgical ICU over two months. All patients underwent systematic screening with cTn measurements and ECGs on ICU admission, then daily for the first week in ICU, alternate days for up to one month and weekly thereafter until ICU death or discharge, for a maximum of two months. Patients without these investigations ordered during routine clinical care underwent screening for study purposes but these results were unavailable to the ICU team. After the study, all ECGs were interpreted independently in duplicate for ischaemic changes meeting ESC/ACC criteria supporting a diagnosis of MI. Patients were classified as having MI (elevated cTn and ECG evidence supporting diagnosis of MI), elevated cTn only (no ECG evidence supporting diagnosis of MI), or no cTn elevation.ResultsOne hundred and three patients were admitted to the ICU on 112 occasions. Overall, 37 patients (35.9 per cent) had an MI, 15 patients (14.6 per cent) had an elevated cTn only and 51 patients (49.5 per cent) had no cTn elevation. Patients with MI had longer duration of mechanical ventilation (p < 0.0001), longer ICU stay (p = 0.001), higher ICU mortality (p < 0.0001) and higher hospital mortality (p < 0.0001) compared with those with no cTn elevation. Patients with elevated cTn had higher hospital mortality (p = 0.001) than patients without cTn elevation. Elevated cTn was associated with increased hospital mortality (odds ratio 27.3, 95 per cent CI 1.7 – 449.4), after adjusting for APACHE II score, MI and advanced life support. The ICU team diagnosed 18 patients (17.5 per cent) as having MI on clinical grounds; four of these patients did not have MI by adjudication. Thus, screening detected an additional 23 MIs not diagnosed in practice, reflecting 62.2 per cent of MIs ultimately diagnosed. Patients with MI diagnosed by the ICU team had similar outcomes to patients with MI detected by screening alone.ConclusionSystematic screening detected elevated cTn measurements and MI in more patients than were found in routine practice. Elevated cTn was an independent predictor of hospital mortality. Further research is needed to evaluate whether screening and subsequent treatment of these patients reduces mortality.

Unmet Needs for Medical Care for Sick Children in Rural Bangladesh

While a country's health policy aims to provide health services to all who need them, very little in known about unmet need for medical care from users’ perspectives in Bangladesh. This study examines unmet medical need of 2,123 under-15 sick children by illness and child's socio-economic characteristics in rural Bangladesh. The 1996 health and socio-economic survey conducted in Matlab (Peterson et al. 1996) recorded children's chronic and acute morbidity and unmet needs for medical services in mothers’ views to combat illness. The survey also recorded household socio-economic data. Logistic regression was used to examine the effects of illness and household socio-economic characteristics on unmet medical need for sick children. The results reveal that unmet need for medical care was 5.4 per cent for children with acute illnesses, and 30.2 per cent for children with chronic illnesses. It was lower for girls than for boys. Economic inequalities existed: odds ratio of unmet medical need for children in top one-third of households was 0.42 (95 per cent CI = 0.28–0.64) times the unmet medical need for children in lowest one-third. The critically high unmet needs for children's chronic morbidity reveal that the chronic disease control programme needs urgent revisiting and strengthening.

Survey of the seroprevalence of brucellosis in ruminants in Tajikistan

A cross-sectional serological survey of the prevalence of brucellosis in ruminants in the Region of Republican Subordination and Khatlon oblasts (provinces) in Tajikistan was conducted in May 2003. Sera from 13,625 ruminants involving 3513 households in 172 kishlaks (villages) were collected and screened by the rose bengal test. Doubtful and positive results were further tested with competitive and indirect elisas. The overall serological prevalences (95 per cent confidence intervals [cis]) were 5.8 per cent (5.2 to 6.4 per cent) for sheep, 5.5 per cent (5.0 to 6.0 per cent) for goats and 2.1 per cent (1.0 to 3.2 per cent) for cattle. The results show that brucellosis was a common disease of ruminants that was widely but unevenly distributed throughout the two oblasts. Seropositive animals were found in 119 of the 172 kishlaks (69.2 per cent [95 per cent ci 61.9 to 75.6 per cent]) and 14.4 per cent (95 per cent ci 13.3 to 15.6 per cent) of the 3513 households. Evidence of infection was also found in cattle kept for milk production in urban kishlaks in two major cities and in state-owned dairy farms.

Données épidémiologiques et analyse de‘l’offre de soins de la sclérose en plaques en France

According to the available previous studies, France is considered a zone of medium to high risk of multiple sclerosis (MS) with an estimated overall prevalence of at least 50/100,000 inhabitants, incidence rates were stable in some areas but increased over time in others and a strong ethnic effect on the incidence, clinical presentation, and course of MS is reported. Based on two health insurance survey the prevalence has been deduced. At January 1, 2003 from the data of agricultural health insurance the prevalence is evaluated at 65.5/100,000 inhabitants (95p.cent CI=62.5-67.5) with a gradient of North East towards South-West. The data from the national health insurance were very near. During the period 2000-2004, recent studies in Auvergne and Brittany demonstrated an annual incidence comprising between 4.2 and 5.1 per 100,000 inhabitants. In Lorraine, in a large population-based study, in December 31, 2004 the prevalence rate was 120/100,000 (95p.cent CI: 119 to 121). During the period 1990-2002, the average age- and sex-adjusted annual incidence rate was 5.5/100,000 (95p.cent CI: 4.4-6.6). In Lorraine, we found that the age-adjusted incidence rate increased during the period 1990-2002. The incidence of MS in women increased, whereas that in men did not change significantly during this period. Similarly, in Norway, North Ireland and Denmark, the incidence among women increased the most. The clinical features of MS were compared in 211 North Africans patients and 2 945 Europeans patients in two French MS centres (Lorraine and Nice) with definite MS according to McDonald's criteria. The course of MS appears more aggressive in North Africans than in Europeans patients. For example, we demonstrated a shorter time to reach the Expanded Disability Status Scale score of 4.0 (p=0.001) or 6.0 (p<0.0001) in North Africans patients. The incidence rates found in these studies were comparable to those reported in several European populations. This undoubtedly places France in the category of regions with a high risk zone of MS. The incidence of MS in women increased; thus, exogenous (or epigenetic) factors vary over time and may affect men and women differently. The course of MS appears more aggressive in North Africans than in Europeans patients.

Race and Gender Differences in Pediatricians’ Annual Incomes

To determine the association between race, gender, and pediatricians' annual incomes after controlling for work effort, provider characteristics, and practice characteristics. We conducted a retrospective analysis of 1172 actively practicing black and white male and female pediatricians who responded to the American Medical Association's annual survey of physicians between 1992 and 2001. We used linear regression modeling to calculate annual incomes adjusted for work effort, provider characteristics, and practice characteristics. White men reported annual incomes of $183,430. After adjusting incomes for work effort, provider characteristics, and practice characteristics, black male pediatricians' mean annual income was $175,640 (95 per cent confidence interval [95 per cent CI], $150,344-201,138). This was $7790 (4.2 per cent) lower, but not statistically different from that of white men (P = .5). However, compared with white male pediatricians' incomes, white female pediatricians' incomes were $150,636 (95 per cent CI, $140,975-$160,298), or $32,794 (18 per cent) lower (P < .001); and black female pediatricians' incomes were $133,018 (95 per cent CI, $108,736-$157,300), or $50,412 (27 per cent) lower (P < .001). During the 1990s, female gender was associated with lower annual incomes among pediatricians; differences were greatest for black women. These findings warrant further exploration to determine what factors might cause the gender-based income differences that we found.

Inadequate Therapy and Poor Symptom Control among Children with Asthma: Findings from a Multistate Sample

Asthma continues to cause significant morbidity in children. We hypothesized that many children still do not use recommended preventive medications, or they have ineffective symptom control despite preventive medication use. The aim of this study was 1) to describe the use of preventive medications among children with persistent asthma, 2) to determine whether children using preventive medications have adequate asthma control, and 3) to identify factors associated with poor control. The State and Local Area Integrated Telephone Survey (SLAITS) Asthma Survey provided parent-reported data for children aged <18 years with asthma from a random-digit dial survey implemented in Alabama, California, Illinois, and Texas. We focused this analysis on children with persistent symptoms and/or children using preventive asthma medications (N = 975). Children with inadequate therapy had persistent symptoms and no preventive medication use. Children with suboptimal control had persistent symptoms or > 1 attack in the previous 3 months despite preventive medication use; children in optimal control had intermittent symptoms, < or = 1 attack, and reported using preventive medication. Demographic and asthma-related variables were compared across groups. Among children with persistent asthma, 37 per cent had inadequate therapy, 42.9 per cent had suboptimal control, and only 20.1 per cent had optimal control. In multivariate regression, black race (odds ratio [OR], 2.0; 95 percent confidence interval [CI] 1.1-3.5), Hispanic ethnicity (OR, 1.8; 95 per cent CI, 1.1-2.9), and discontinuous insurance status (OR, 2.4; 95 per cent CI, 1.4-4.3) were associated with inadequate therapy. Potential explanations for poor control included poor adherence, exposure to smoke and other triggers, and lack of written action plans. Inadequate asthma therapy remains a significant problem. A newly highlighted concern is the substantial number of children experiencing poor symptom control despite reported use of preventive medications.

Schoolchildren who are victims of bullying report benefit from health dialogues with the school health nurse

Background School health services are important tools for health promotion among schoolchildren, but little is known about their effects. This article addresses the effects of dialogues with school health nurses among schoolchildren who were victims of bullying. Study population and methods Cross-sectional and school-based survey, the Danish contribution to the international Health Behaviour in School-aged Children (HBSC) study. The study included all students in the fifth, seventh, and ninth grade (11, 13, and 15 year olds) in a random sample of schools. The participation rate was 98 per cent of the students present on the day of data collection and 88 per cent of the enrolled students, n = 5205. Measurements Bullying was measured as recommended by Olweus. Outcome of the dialogue with the school health nurse was measured as self-reports of five responses: (1) reflected on the dialogue, (2) discussed the content with parents, (3) followed the advice from the school health nurse, (4) did what he (she) himself (herself) thought was best, and (5) visited the school health nurse again. Results All outcome measures were more prevalent among students who were victims of bullying. The most pronounced association was that the odds ratio for visiting the school health nurse again was 1.8 (95 per cent CI 1.3–2.5) for students who were bullied at least weekly. Conclusion Schoolchildren who are victims of bullying benefit from health dialogues with the school health nurse.

Risk factors and prevalence of HIV infection in people seeking health care in an STI clinic in Brazil

Comprehensive care for people seeking assistance in sexually transmitted infections (STI) clinics provides access to a group of patients in need of HIV prevention interventions and represents appropriate locations for the implementation of these activities. The goal of this study was to determine the risk factors for HIV infection. A profile of patients seeking care in an STI clinic in Vitória, Brazil; including the motives for this, the risk factors and the prevalence for HIV was carried out. Patients were systematically interviewed regarding demographic information, motivation for seeking assistance, risk exposures, and clinical data. Blood samples were collected to test HIV infection in 562 people enrolled in the study. Prevalence of HIV infection was 6.8 per cent (95 per cent CI 4.7–8.9). Prevention and STI symptoms were the main reasons for seeking care. Variables found to be independently associated with HIV infection were: age (> = 30 years) [OR = 3.24 (95 per cent CI 1.40–7.52)]; seeking medical assistance [OR = 3.88 (95 per cent CI 6.22–40.95)]; and illicit drug use [OR = 14.58 (95 per cent CI 6.11–34.72)]. These results found high prevalence of HIV infection in this population and reinforce the need for ongoing STI prevention activities to further decrease HIV and other STI.

Characteristics, prevalence and aetiology of lesions of the oral mucosa in adult sheep

A total of 214 sheep with lesions of the oral mucosa were recorded at the Veterinary Laboratories Agency regional laboratories between March 15, 2002 and February 28, 2003. Using denominator...

Prevalence of wet litter and the associated risk factors in broiler flocks in the United Kingdom

A postal questionnaire was sent to the managers of 857 broiler farms in the UK to determine the prevalence and risk factors for wet litter. The response rate was 75...

The role of education in biostatistical consulting

Medical students, residents, postdoctoral fellows, and faculty commonly consult with biostatistical experts about study design and data analysis when conducting clinical research. The role of biostatistical training during these consultations is examined, and characterizations of the connections between biostatistical consultation and education are reviewed. The presence and kinds of teaching efforts during biostatistical consults at four academic research institutions over various periods of time between 1999 and 2005 (237 consultations in total) were recorded and are described. By site, 67, 70, 78, and 100 per cent of the consulting sessions included biostatistical training, with an overall 78 per cent (95 per cent CI: 73-83 per cent) of consultations including an educational component when all consultations were combined. Training covered a wide range of biostatistical topics. Seventy-five per cent of the consultations with faculty (120/161), 79 per cent with fellows and residents (31/39), and 100 per cent with medical students (10/10) included some degree of instruction in study design or statistical analysis topics. Results show that both the need and the opportunity exist for specialized biostatistical instruction during one-on-one sessions between a consulting biostatistician and physicians, medical students, and research staff. Academic researchers are ideally positioned to absorb this kind of training when they initiate a request for assistance with their own research project.