Changes In Number Of Cases Research Articles

Predicting COVID-19 outbreak in India using modified SIRD model

In this paper, the existing Susceptible-Infected-Recovered-Deceased (SIRD) compartmental epidemiologic process model is modified for forecasting the coronavirus effect in India. The data from India was studied for weekly fatalities, weekly infected, weekly recovered, new cases, infected and recovered individuals, Reproductive Number R 0 , recovery rate, death rate, and coefficient of transmission from 30 January 2020 to 31 July 2021. SARS Coronavirus 2 (SARS-CoV-2) is the Covid strain that causes Covid sickness (COVID-19), a respiratory ailment that triggered the outbreak of COVID-19 at the beginning of December 2019. We aim to provide a hybrid SIRD model for predicting the COVID-19 outbreak. In the proposed method, to improve the exploration ability of the Grey Wolf Optimizer (GWO) or to avoid stagnation in the swarm, a modified Grey Wolf Optimization Algorithm is used to optimize the initial value of Infected individuals. The modified SIRD model is further applied to get the predicted values. The data is examined on weekly basis to prevent noise. Depending on the fact, that the precise mode of transmission is highly dependent on how and when different precautions such as isolation, confinement, and other preventative measures were implemented, we put together our projections concerning satisfactory speculations based on genuine realities. The experimental results show the various trends observed in the pandemic in terms of number of peaks, increasing trend, decreasing trend, and continuous trend for infected individuals, weekly change in number of cases, weekly deaths, weekly infected, and weekly recoeverd cases of Covid-19. The proposed modified SIRD model could be a valuable tool for assessing the impact of government measures on COVID-19 outbreak.

Effective pandemic policy design through feedback does not need accurate predictions.

The COVID-19 pandemic has had an enormous toll on human health and well-being and led to major social and economic disruptions. Public health interventions in response to burgeoning case numbers and hospitalizations have repeatedly bent down the epidemic curve, effectively creating a feedback control system. Worst case scenarios have been avoided in many places through this responsive feedback. We aim to formalize and illustrate how to incorporate principles of feedback control into pandemic projections and decision-making, and ultimately shift the focus from prediction to the design of interventions. Starting with an epidemiological model for COVID-19, we illustrate how feedback control can be incorporated into pandemic management using a simple design that couples recent changes in case numbers or hospital occupancy with explicit policy restrictions. We demonstrate robust ability to control a pandemic using a design that responds to hospital cases, despite simulating large uncertainty in reproduction number R0 (range: 1.04-5.18) and average time to hospital admission (range: 4-28 days). We show that shorter delays, responding to case counts versus hospital measured infections, reduce both the cumulative case count and the average level of interventions. Finally, we show that feedback is robust to changing compliance to public health directives and to systemic changes associated with variants of concern and with the introduction of a vaccination program. The negative impact of a pandemic on human health and societal disruption can be reduced by coupling models of disease propagation with models of the decision-making process. In contrast to highly varying open-loop projections, incorporating feedback explicitly in the decision-making process is more reflective of the real-world challenge facing public health decision makers. Using feedback principles, effective control strategies can be designed even if the pandemic characteristics are highly uncertain, encouraging earlier and smaller actions that reduce both case counts and the extent of interventions.

2155. Evaluation of the Effect of Omicron Variant on Case Numbers in Children

Abstract Background SARS-CoV-2 Omicron variant has become dominant in many countries, and a significant increase in the number of cases has been noted due to this highly contagious variant. This study aimed to determine the changes in case numbers, age distribution and hospitalized patients’ characteristics in children with COVID-19 by comparing the Omicron variant that was dominant before. Methods 5647 pediatric patients with SARS-CoV-2 PCR positive between 11 March 2020 and 28 February 2021 at Ege University Hospital were included in the study. Two time periods of 2.5 months were determined: Omicron predominant period (16 December 2021 and 28 February 2022) and the pre-Omicron period (1 October and 15 December 2021). The information was obtained from the files of patients retrospectively. Results The Omicron variant caused a significant increase in pediatric patients after December 15, 2021 (Graphic 1). There were 2893 pediatric patients since the beginning of the pandemic, while 2754 pediatric patients after the Omicron variant only the 2.5 months. While the test positivity rate was 10.4% on average before the Omicron, it increased to 30.37% on average after Omicron (Graphic 2). The comparison of the epidemiological characteristics of the Omicron and the pre-Omicron period is given in Table 1. In the Omicron period, 17.1% of the cases were 0-4 years old, and 0-6 months was 3.9%. While the disease was more common in children over 5 years old in the pre-Omicron period, a 4.6-fold increase was observed in 0-4 years after Omicron. Children under the age of 5 constitute 51.9% of the hospitalized children; a 4.5-fold increase occurred in the Omicron period. While hospitalization rates increased after the Omicron, no significant difference was found in intensive care unit admission. There was a significant decrease in the number of patients receiving oxygen and the need for mechanical ventilation. Number of SARS-CoV-2 PCR positive children by months in Ege University Hospital Test positivity rate in children by month at Ege University Hospital Comparaiton of pre-Omicron and Omicron period Conclusion The number of cases in children increased with the effect of the Omicron variant, especially the increase was more pronounced between 0-4 years of age. Despite this increase in the cases, no serious increase was observed in the severity of the disease, but a decrease in pneumonia, oxygen demand, and mechanical ventilator requirement was observed. While the number of tests decreased, test positivity rates increased. Disclosures All Authors: No reported disclosures.

Kratom exposures managed by the British Columbia poison centre, 2012-2019: a descriptive analysis.

Background:Kratom, a plant indigenous to Southeast Asia, which has been used both recreationally and in the treatment of pain and opioid dependence, has received little scrutiny in the United States and almost none in Canada. We analyzed calls to the British Columbia poison centre to describe caller-declared exposures to kratom and the acute health effects of these exposures.Methods:For this descriptive analysis, we accessed electronic records, including transcriptions and extracted variables, of calls specifying kratom exposure managed by the BC Drug and Poison Information Centre (DPIC) from 2012 to 2019. We describe changes in case numbers, reasons for exposure, concurrent drug exposures and clinical outcomes over the study period.Results:We identified 32 cases during the study period. In 23 cases (72%), the DPIC was consulted by a health care worker. Case numbers increased from 0 in 2012 to 9 in 2019. Numbers were highest for males in their 20s (n = 17, 53%). A total of 27 cases (84%) involved ingestion, with online distributors and local stores named as sources of procurement. A concurrent drug exposure was identified in 13 (41%) cases. There were no deaths; in 1 case, the exposed individual was intubated to manage agitation following kratom withdrawal.Interpretation:We observed a steady increase in kratom-related poison centre calls from 2012 to 2019, especially in young adult males. Rising call numbers may reflect increasing availability of kratom and may be a consequence of BC’s opioid crisis, with kratom used by some to lessen symptoms of opioid withdrawal.

Changes in ischemic stroke presentations, management and outcomes during the first year of the COVID-19 pandemic in Alberta: a population study.

Background:Pandemics may promote hospital avoidance, and added precautions may exacerbate treatment delays for medical emergencies such as stroke. We sought to evaluate ischemic stroke presentations, management and outcomes during the first year of the COVID-19 pandemic.Methods:We conducted a population-based study, using linked administrative and stroke registry data from Alberta to identify all patients presenting with stroke before the pandemic (Jan. 1, 2016 to Feb. 27, 2020) and in 5 periods over the first pandemic year (Feb. 28, 2020 to Mar. 31, 2021), reflecting changes in case numbers and restrictions. We evaluated changes in hospital admissions, emergency department presentations, thrombolysis, endovascular therapy, workflow times and outcomes.Results:The study included 19 531 patients in the prepandemic period and 4900 patients across the 5 pandemic periods. Presentations for ischemic stroke dropped in the first pandemic wave (weekly adjusted incidence rate ratio [IRR] 0.54, 95% confidence interval [CI] 0.50 to 0.59). Population-level incidence of thrombolysis (adjusted IRR 0.50, 95% CI 0.41 to 0.62) and endovascular therapy (adjusted IRR 0.63, 95% CI 0.47 to 0.84) also decreased during the first wave, but proportions of patients presenting with stroke who received acute therapies did not decline. Rates of patients presenting with stroke did not return to prepandemic levels, even during a lull in COVID-19 cases between the first 2 waves of the pandemic, and fell further in subsequent waves. In-hospital delays in thrombolysis or endovascular therapy occurred in several pandemic periods. The likelihood of in-hospital death increased in Wave 2 (adjusted odds ratio [OR] 1.48, 95% CI 1.25 to 1.74) and Wave 3 (adjusted OR 1.46, 95% CI 1.07 to 2.00). Out-of-hospital deaths, as a proportion of stroke-related deaths, rose during 4 of 5 pandemic periods.Interpretation:The first year of the COVID-19 pandemic saw persistently reduced rates of patients presenting with ischemic stroke, recurrent treatment delays and higher risk of in-hospital death in later waves. These findings support public health messaging that encourages care-seeking for medical emergencies during pandemic periods, and stroke systems should re-evaluate protocols to mitigate inefficiencies.

De-escalation strategies for non-pharmaceutical interventions following infectious disease outbreaks: a rapid review and a proposed dynamic de-escalation framework

BackgroundThe severity of COVID-19, as well as the speed and scale of its spread, has posed a global challenge. Countries around the world have implemented stringent non-pharmaceutical interventions (NPI) to control transmission and prevent health systems from being overwhelmed. These NPI have had profound negative social and economic impacts. With the timeline to worldwide vaccine roll-out being uncertain, governments need to consider to what extent they need to implement and how to de-escalate these NPI. This rapid review collates de-escalation criteria reported in the literature to provide a guide to criteria that could be used as part of de-escalation strategies globally.MethodsWe reviewed literature published since 2000 relating to pandemics and infectious disease outbreaks. The searches included Embase.com (includes Embase and Medline), LitCovid, grey literature searching, reference harvesting and citation tracking. Over 1,700 documents were reviewed, with 39 documents reporting de-escalation criteria included in the final analysis. Concepts retrieved through a thematic analysis of the included documents were interlinked to build a conceptual dynamic de-escalation framework.ResultsWe identified 52 de-escalation criteria, the most common of which were clustered under surveillance (cited by 43 documents, 10 criteria e.g. ability to actively monitor confirmed cases and contact tracing), health system capacity (cited by 30 documents, 11 criteria, e.g. ability to treat all patients within normal capacity) and epidemiology (cited by 28 documents, 7 criteria, e.g. number or changes in case numbers).De-escalation is a gradual and bi-directional process, and resurgence of infections or emergence of variants of concerns can lead to partial or full re-escalation(s) of response and control measures in place. Hence, it is crucial to rely on a robust public health surveillance system.ConclusionsThis rapid review focusing on de-escalation within the context of COVID-19 provides a conceptual framework and a guide to criteria that countries can use to formulate de-escalation plans.

Predicting the SARS-CoV-2 effective reproduction number using bulk contact data from mobile phones

Over the last months, cases of SARS-CoV-2 surged repeatedly in many countries but could often be controlled with nonpharmaceutical interventions including social distancing. We analyzed deidentified Global Positioning System (GPS) tracking data from 1.15 to 1.4 million cell phones in Germany per day between March and November 2020 to identify encounters between individuals and statistically evaluate contact behavior. Using graph sampling theory, we estimated the contact index (CX), a metric for number and heterogeneity of contacts. We found that CX, and not the total number of contacts, is an accurate predictor for the effective reproduction number R derived from case numbers. A high correlation between CX and R recorded more than 2 wk later allows assessment of social behavior well before changes in case numbers become detectable. By construction, the CX quantifies the role of superspreading and permits assigning risks to specific contact behavior. We provide a critical CX value beyond which R is expected to rise above 1 and propose to use that value to leverage the social-distancing interventions for the coming months.

ESTIMATES OF MOISTURE AND VULNERABILITY OF SOILS OF AGRICULTURAL LANDS OF THE BELARUSIAN POLESIE TO DROUGHT

The evaluation of soil moistening of farmlands of the Belarusian Polesie under the conditions of modern climate change is given. The frequency of occurrence of soil droughts has been determined. A comparative assessment of the change in the frequency of soil droughts during the pre-warming period (1951–1980) and the modern period (1989–2018) is given. The cyclical nature of the change in the average number of cases with soil droughts has been established. Indicators of the degree of vulnerability of soils of farmlands in the region to droughts have been determined. A map of the degree of vulnerability of soils of farmlands to droughts of the Belarusian Polesie and Kalinkovichi district of the Gomel region is presented.

Pandemic Policy Design Via Feedback: A Modelling Study

BackgroundThe COVID-19 pandemic has had an enormous toll on human health and well-being and led to major social and economic disruptions. Public health interventions in response to burgeoning case numbers and hospitalizations have repeatedly bent down the epidemic curve in many jurisdictions, effectively creating a closed-loop dynamic system. We aim to formalize and illustrate how to incorporate principles of feedback control into pandemic projections and decision making.MethodsStarting with a SEEIQR epidemiological model, we illustrate how feedback control can be incorporated into pandemic management using a simple design (proportional-integral or PI control), which couples recent changes in case numbers or hospital occupancy with explicit policy restrictions. We then analyse a closed-loop system between the SEEIQR model and the designed feedback controller to illustrate the potential benefits of pandemic policy design that incorporates feedback.FindingsWe first explored a feedback design that responded to hospital measured infections, demonstrating robust ability to control a pandemic despite simulating large uncertainty in reproduction number R 0 (range: 1.04-5.18) and average time to hospital admission (range: 4-28 days). The second design compared responding to hospital occupancy to responding to case counts, showing that shorter delays reduced both the cumulative case count and the average level of interventions. Finally, we show that feedback is robust to changing public compliance to public health directives, and to systemic changes associated with new variants of concern and with the introduction of a vaccination program.InterpretationThe negative impact of a pandemic on human health and societal disruption can be reduced by coupling models of disease propagation with models of the decision-making process. This creates a closed-loop system that better represents the coupled dynamics of a disease and public health responses. Importantly, we show that feedback control is robust to delays in both measurements and responses, and to uncertainty in model parameters and the efficacy of control measures.

What does calculating impacts of specific morbidity outcomes add to perceptions of air pollution health impact assessment?

Introduction: Health impact assessments often use broad categories of outcomes, e.g. all respiratory or all cardiovascular admissions. This minimises diagnostic misclassification but does not fully communicate the evidence on associations between air pollution and specific diseases. More specific health impact calculations may resonate with the public more than severe but rarer outcomes.Methods: Literature searches were done for meta-analyses pooling evidence on a variety of pollutants (PM10, PM2.5, NO2 and O3) and 40 health outcomes. We investigated the effects of short- and long-term exposure to pollution and did final calculations on 17 morbidity outcomes, rejecting those with weaker evidence, lack of baseline rates, and no priority from focus groups. The selected concentration-response functions were combined with monitoring site, baseline rate/cases and population (e.g. beside roads) data to calculate health impacts in up to 4 scenarios (roadside vs background (daily and annual); 75th vs 25th percentile daily average and a 20% reduction in annual average) across 9 UK and 4 Polish cities. The largest result per pollutant was given rather than summing across pollutants.Results: The largest change in number of cases was for children with low lung function in London (7927 for a 20% reduction in NO2). Changes in cases of acute bronchitis in children in London were also high (3683 for a 20% reduction in PM10). Warsaw had greater impacts on cardiovascular than respiratory endpoints compared with London. Other example statements include ‘living near busy roads in Oxford may stunt lung growth in children by 14%’ and ‘in London on higher pollution days, 142 more children with asthma experience symptoms than on lower pollution days’.Conclusions: Health impact statements for a wider variety of outcomes may aid communication of the importance of different health effects to policymakers and the public.

17 Lyme Disease in Eastern Ontario - A Paediatric Centre’s Experience from 2009-2018

Abstract Background Lyme disease (LD) is caused by the tick-borne bacterium Borrelia burgdorferi. Over the past ten years, robust local public health data indicates that the incidence of LD has increased significantly in the eastern region of Ontario due to the spread of its vector, the blacklegged tick. As a result, we have seen an increase in the number of cases of LD in children at our tertiary paediatric centre, at all stages of infection. Familiarity with Lyme disease is important as incidence increases. We sought to characterize the cases at our centre. Objectives To describe the epidemiology of LD in children at our centre from 2009-2018, as well as the variety of clinical presentations of paediatric LD. Design/Methods We completed a retrospective chart review from 2009-2018 of all cases admitted or seen in the Infectious Disease (ID) clinic or the Emergency Department (ED) with a diagnosis of LD. Demographic, clinical and laboratory data were collected, including geographic location where infection occurred and resource utilization. We used descriptive statistics to describe cases and comparative statistics to determine changes in number of cases over time. Results There were 171 LD cases managed at our centre during this period. Mean age was 7.4 (SD 4.5) years, 89 (52.0%) were male. The annual number of cases from 2009 - 2018 increased from 1 to 44 and peaked in 2017 (47 cases). The highest number of cases occurred among children <6, the lowest in children ≥11. Most cases occurred in summer (60%), with the fewest in winter months (4%). Stage of LD was not documented in 1 case. Of the remainder, 98 (57.6%) cases were early localized, 41 (25.7%) early disseminated and 31 (19.7%) late disseminated LD. Early and late disseminated cases occurred more commonly in the summer and accounted for the majority of admissions. These included neurologic Lyme (lymphocytic meningitis [2, 1.2%], polyneuropathy [1, 0.6%], cranial nerve palsy [13, 7.6%]), Lyme carditis (5, 2.9%), and Lyme arthritis (29, 17.0%). There were 133 (77.8%) patients managed in ED, 66 (38.6%) in the ID clinic and 17 (9.9%) in the inpatient ward; median length of stay was 6 (IQR 5, 9) days, with a range of 1 to 30 days. The most common geographic locations of infection acquisition were Ottawa (120 cases, 71.0%) and Kingston (26, 15.4%). Conclusion Cases of LD managed at our paediatric centre have increased in keeping with population trends, with all LD stages experienced. Severe cases of meningitis, carditis, and arthritis resulted in hospitalization, with increasing numbers over the study period.

Estimated changes in hospital admissions for alcohol intoxication after partial bans on off-premises sales of alcoholic beverages in the canton of Vaud, Switzerland: an interrupted time-series analysis.

To estimate age-specific changes in hospital admissions for alcohol intoxication following two consecutive restrictions on off-premises alcohol sales introduced in the canton of Vaud, Switzerland. Primary analyses used interrupted autoregressive integrated moving average (ARIMA) time-series analyses (repeated cross-sectional), with Lausanne and Vaud as experimental sites and the rest of Switzerland as the control. Secondary analyses used, for example, a different control site (other French-speaking cantons only) or a different statistical model. Switzerland between 2010 and 2016. In-patients (i.e. patients assigned a bed overnight) hospitalized between 8 p.m. and 6 a.m. (n=1 261 564), as documented in the Swiss Hospital Statistics. Ban 1, only effective in the canton's capital, Lausanne, prohibited off-premises sales of all alcoholic beverages after 8 p.m. on Fridays and Saturdays from September 2013 to June 2015. In July 2015, Ban 2 replaced this, covered the whole canton and affected off-premises sales of beer and spirits (but not wine) after 9 p.m. (8 p.m. in Lausanne) every night of the week. Proportions of monthly hospital admissions for alcohol intoxication (ICD-10 diagnoses F10.0/F10.1, T51.0) per 1000 monthly overall admissions. Proportions of overall hospitalizations for alcohol intoxication declined after both bans in Lausanne [ωBan1 =-0.017, 95% confidence interval (CI)=-0.025, -0.008; ωBan2 =-0.021, 95% CI=-0.030, -0.013] but only after Ban 2 in the remainder of the canton of Vaud (ωBan2 =-0.008, 95% CI=-0.014, -0.002). Estimated changes in % were largest among 16-19-year-olds. However, as admission rates for alcohol intoxication were more frequent in adulthood than adolescence, the estimated change in number of cases was also relevant to public health among 20-69-year-olds. Secondary analyses supported the findings of the primary analyses. Even partial restrictions of off-premises sales of alcohol in Switzerland (only 2days per week or only for beer and spirits) appeared to reduce hospital admissions for alcohol intoxication across a wide age range (ages 16-69years).

Trends in Pediatric Central Nervous System Tumor Incidence in the United States, 1998-2013.

Brain and other central nervous system (CNS) cancers are the leading cause of U.S. pediatric cancer mortality. Incidence trends can provide etiologic insight. We report trends in incidence rates of pediatric malignant CNS cancers and pilocytic astrocytoma (nonmalignant but historically registered) in the United States. Age-standardized incidence rates and annual percent changes (APC) in rates during 1998 to 2013 were calculated for children aged 0 to 19, stratified by subtype, age, sex, and for gliomas, histology and location. We estimated the absolute change in number of cases diagnosed U.S.-wide during 2013 compared with the expected number of cases had 1998 rates remained stable. Rates of all pediatric malignant CNS cancer combined (n = 18,612) did not change [APC: 0.16; 95% confidence interval (CI): -0.21-0.53]. There were statistically significant changes in several subtypes; however, glioma incidence (n = 10,664) increased by 0.77% per year (95% CI: 0.29-1.26), embryonal cancer rates (n = 5,423) decreased by 0.88% per year (95% CI: -1.33 to -0.43), and pilocytic astrocytoma rates (n = 6,858) increased by 0.89% per year (95% CI: 0.21-1.58). Of the 1,171 malignant tumors and 450 pilocytic astrocytomas diagnosed in U.S. children in 2013, we estimated 120 excess gliomas, 94 excess pilocytic astrocytomas, and 72 fewer embryonal CNS tumors than would be expected had 1998 rates remained stable. The gradual changes in incidence we observed for specific types of pediatric CNS cancers are likely due to a combination of changes in classification and diagnosis and true changes in CNS cancer. Continued surveillance of pediatric CNS tumors should remain a priority, given their significant contribution to pediatric cancer-related deaths.

FINRA’s disciplinary actions in 2017: increased restitution ordered with minimal changes in number of cases

Purpose The purpose of this paper is to analyze the Financial Industry Regulatory Authority’s (FINRA) 2017 disciplinary actions, the issues that resulted in the most significant fines and restitution and the emerging enforcement trends from 2017 and beyond. Design/methodology/approach The approach of this paper discusses the disciplinary actions in 2017 and prior years, details the top 2017 enforcement issues measured by total fines assessed, including anti-money laundering, trade reporting, electronic communications, books and records, research analysts and research reports, and explains current enforcement trends, including restitution, suitability cases and technological issues. Findings In 2017, restitution more than doubled from the prior year, resulting in the fourth highest total sanctions (fines combined with restitution and disgorgement) assessed by FINRA over the past 10 years. Practical implications Firms and their representatives should heed the trends in both the substantial restitution FINRA is ordering and the related enforcement issues in the cases FINRA has brought. Originality/value This paper provides expert analysis and guidance from experienced securities enforcement lawyers.

Impact of PCV13 on community-acquired pneumonia by C-reactive protein and procalcitonin levels in children

Many countries have observed an early and strong impact of implementation of the 13-valent pneumococcal conjugate vaccine (PCV13) on community-acquired pneumonia (CAP). High levels of C-reactive protein (CRP) and procalcitonin (PCT) are considered biomarkers of bacterial infection (particularly infection due to pneumococcus); therefore, PCV13 implementation should have different effectiveness on CAP depending on the levels of these two biomarkers. To demonstrate this assumption, we analyzed the evolution of number of CAP cases seen in pediatric emergency departments in France after PCV13 implementation (in 2010) by levels of these two biomarkers. From June 2009 to May 2015, 8 pediatric emergency units prospectively enrolled all children (1month to 15years) with radiologically confirmed CAP. A cohort of 9586 children with CAP was enrolled (median age 3years). CAP with pleural effusion (PE-CAP) and proven pneumococcal pneumonia (PP-CAP) accounted for 5.5% and 2.0% of cases. During the study period, the number of cases of overall CAP decreased by 25.4%, hospitalized CAP by 30.5%, PE-CAP by 63.4%, CAP with CRP level≥100mg/L by 50.9%, CAP with PCT level≥4ng/L by 60.4% and PP-CAP by 86.4%. We found no change in number of cases of CAP with low levels of CRP (<20 or <40mg/L) or PCT (<0.5ng/mL). The number of cases of CAP overall increased (20.0%) in the last year of the study as compared with the preceeding year but not cases with CRP level≥100mg/L and/or PCT level≥4ng/mL. PCV13 implementation has had a strong impact on number of CAP cases with high levels of CRP and/or PCT in children but no impact on that with low levels of these two biomarkers. Five years after PCV13 implementation, a sustained reduction in CAP cases is observed.

Epidemiology of Tropical Neglected Diseases in Ecuador in the Last 20 Years.

BackgroundTropical and zoonotic diseases are major problems in developing countries like Ecuador. Poorly designed houses, the high proportion of isolated indigenous population and under developed infrastructure represent a fertile environment for vectors to proliferate. Control campaigns in Ecuador over the years have had varying success, depending on the disease and vectors targeted.AimsIn our study we analyse the current situation of some neglected diseases in Ecuador and the efficiency of the control campaigns (by measuring changes in numbers of cases reported) that the Ecuadorian government has been running to limit the spread of these infectious and parasitic diseases.ResultsOur study reveals that Brucellosis, Chagas Disease, Rabies and Onchocerciasis have been controlled, but small outbreaks are still detected in endemic areas. Leptospirosis and Echinococcosis have been increasing steadily in recent years in Ecuador since the first records. The same increase has been reported world-wide also. Better diagnosis has resulted in a higher number of cases being identified, particularly with regard to the linking of outdoor activities and contact with farm animals as contributing vectors. Improvements in diagnosis are due to regular professional training, implementation of automatized systems, establishing diagnosis protocols and the creation of an epidemiological vigilance network that acts as soon as a case is reported.ConclusionControl campaigns performed in Ecuador have been successful in recent years, although natural phenomena limit their efficiency. Leptospirosis and Echinococcosis infections remain a growing problem in Ecuador as it is worldwide.

Local and National Trends in General Surgery Residents’ Operative Experience: Do Work Hour Limitations Negatively Affect Case Volume in Small Community-Based Programs?

The goals of this study were to analyze the impact of work hour restrictions on the operative case volume at a small community-based general surgery residency training program and compare changes with the national level. Annual national resident case log data from Accreditation Council for Graduate Medical Education (ACGME) website and case logs of graduating Easton Hospital residents (years 2002-2009) were used for analysis. Weighted average change in total number of cases in our institution was -1.20 (P = 0.52) vs 1.78 (P = 0.07) for the national program average with statistically significant difference on comparison (P = 0.027). We also found significant difference in case volume changes at the national level compared with our institution for the following ACGME defined subcategories: alimentary tract [8.19 (P < 0.01) vs -1.08 (P = 0.54)], abdomen [8.48 (P < 0.01) vs -6.29 (P < 0.01)], breast [1.91 (P = 0.89) vs -3.6 (P = 0.02)], and vascular [4.03 (P = 0.02) vs -3.98 (P = 0.01)]. Comparing the national trend to the community hospital we see that there is total increase in cases at the national level whereas there is a decrease in case volume at the community hospital. These trends can also be followed in ACGME defined subcategories which form the major case load for a general surgical training such as alimentary tract, abdominal, breast, and vascular procedures. We hypothesize that work hour restrictions have been favorable for the larger programs, as these programs were able to better integrate the night float system, restructure their call schedule, and implement institutional modifications which are too resource demanding for smaller training programs.

An exploratory study of anxiety in carers of stroke survivors

To investigate anxiety in informal carers of stroke survivors in the first three months after discharge. Informal carers, also called caregivers, play a vital role in supporting stroke survivors. However, caring for stroke survivors can have adverse consequences amongst carers such as burden, stress and reduced quality of life. Emotional distress is also commonly reported but anxiety has received less attention than depression. Prospective, longitudinal, descriptive study. Forty-five carers completed the Hospital Anxiety and Depression Scale on two occasions - within one month and at three months after discharge from stroke and rehabilitation units. Carers were more likely to have scores indicating anxiety than depression. In the first month, half the carers (51·1%) scored in the cut-off for anxiety and a third were in the cut-off for depression (31·1%). At three months, the picture was very similar with nearly identical proportions in the anxious and depressed categories (48·9% and 28·9%, respectively). Changes in numbers of cases of anxiety and depression and in mean anxiety scores were non-significant but there was a significant decrease in depression scores (p=0·048). Fourteen carers (31·1%) at one month and eleven (24·4%) at three months fell into both anxious and depressed categories. Anxiety is a relatively neglected emotional outcome in stroke carers. Our study suggests anxiety is an important issue very early in caring whilst other research suggests it remains prevalent for many months. Given the significant role carers play in rehabilitation of stroke survivors, greater recognition of their emotional state is required. Further, longitudinal research with larger sample sizes from a range of geographical areas and improved understanding of factors associated with anxiety is needed. Nurses working in the community are ideally placed to identify and support carers suffering from anxiety.

Health Care Consequences of Demographic Changes in Mecklenburg–West Pomerania

The population in the German federal state of Mecklenburg-West Pomerania is growing older. A resulting rise in age-related diseases will likely lead to a greater need for medical care, even though the population as a whole is declining. The predicted number of patients affected by these diseases varies from one district to another because of local differences in demographic trends. Case numbers were forecasted on the basis of representative data on the morbidity from chronic diseases, which were derived from the Study of Health in Pomerania (SHIP), the conjoint cancer registry of the East German federal states (GKR), and a study on dementia morbidity. These data were combined with demographic prognoses for Mecklenburg-West Pomerania and its rural and urban districts up to the year 2020. The largest increases in case numbers are predicted for dementia (+91.1%), myocardial infarction (+28.3%), diabetes mellitus (+21.4%), and incident colon carcinoma (+31.0%; all figures are expressed in relation to the year 2005 as a baseline). The predicted changes in case numbers vary widely from one district to another. All of the German federal states located in the former East Germany are likely to experience similar developments to those predicted for Mecklenburg-West Pomerania, as will many rural areas of the former West Germany, in which a demographic transition is already evident. Because of the predicted rise in the number of patients, new health care concepts will have to be rapidly developed, implemented, and evaluated in order to ensure that comprehensive medical care will be delivered where it is needed.

Impact of pneumococcal vaccination on the incidence of invasive pneumococcal disease in UK PICUs

Aims To determine the impact of pneumococcal vaccination (introduced in 2006) on the incidence of invasive pneumococcal disease (IPD) seen in UK paediatric intensive care units (PICUs). Methods Retrospective review of cases of IPD seen in UK PICUs from 2005 to 2009, identified by primary diagnosis reported to PICANET (the national PICU Audit Network). Results Total numbers of cases of IPD have not changed significantly since vaccination was introduced, with 64 cases in a total of 14 056 PICU admissions in 2005, 72/14 328 in 2006, 54/15 579 in 2007 and 64/16 089 in 2008 (χ2 p=0.18). The presentation has also remained unchanged over this period, with around 60% of cases presenting as meningitis±sepsis, 20% cases presenting as sepsis±pneumonia and 20% presenting as isolated pneumonia. Conclusions The seven valent pneumococcal vaccine (PCV7), which covers serotypes 4, 6B, 9V, 14, 18C, 19F and 23F, was introduced in September 2006. The authors9 findings suggest that despite good uptake of this vaccine, there has been no decrease in the number of cases of IPD admitted to UK PICUs. These findings are consistent with data from the Health Protection Agency,1 which demonstrate that although vaccine serotypes have been almost eradicated since vaccination, there has been no change in the total number of cases of IPD. This is due to serotype replacement with non-vaccine serotypes. IPD is still an important cause of critical illness in children despite the pneumococcal vaccination programme.