Epidemiological Surveillance Studies Research Articles

Full-genome amplification and sequencing of Zika viruses using a targeted amplification approach

We have developed methods for full-genome sequencing of Zika viruses (ZIKVs) based on a targeted amplification approach. We used alignments of publicly available complete genome data to design a primer set that selectively amplifies ZIKVs. The approach includes amplification strategies for templates present at both high- and low-copy number, and PCR cycling conditions that have been normalized across genome fragments in order to streamline laboratory handling. Abundant templates can be amplified using a strategy that uses 6 overlapping amplicons to cover the complete viral genome, whereas scarce templates can be amplified using a strategy that uses 11 overlapping amplicons of smaller size. The workflow is sequencing platform agnostic, and thus, can be used in low resource settings where access to traditional Sanger sequencing is the only option available. Given the scarcity of tools for ZIKV, this approach should facilitate epidemiological surveillance and other studies that require the generation of complete viral genomic information quickly and cost-effectively.

Prevalence of Urinary Schistosomiasis in Migrants in Apulia, a Region of Southern Italy, in the Years 2006-2016.

Schistosomiasis is the most prevalent tropical disease in the world after malaria. According to the World Health Organization, the disease afflicts more than 240 million people in about 80 countries. Recently, an epidemiological surveillance study performed between 1997 and 2010 by the European Network for Tropical Medicine and Health Travel regarding schistosomiasis between immigrants and travelers has been published. No data are available in the literature regarding the situation in South Italy. Herein, we report the prevalence of urinary schistosomiasis in a population of migrants in Apulia referring to our outpatient clinic for immigrant diseases in the period 2006–2016. Since all cases of schistosomiasis were related to the last three years of observation, the demographic and clinical characteristics of the study population were compared before and after 2014. Nearly 51% of all patients visited (1762) were from high/moderate endemic countries for schistosomiasis, and nine cases of urinary schistosomiasis were diagnosed. Prevalence was 1% among migrants from endemic areas and 10% in those from Mali and Senegal. Our findings confirm that schistosomiasis is a widespread infection among immigrants, even if it is often underdiagnosed because of the multifaceted clinical presentation. Changes in migratory dynamics can affect clinical observations very quickly.

Identification of volume overload hospitalizations among hemodialysis patients using administrative claims: a validation study.

BackgroundHigh rates of volume overload hospitalizations may indicate inadequate dialysis facility fluid management. Administrative claims databases are often used to study such outcomes, but these data are generated for billing purposes and may not capture clinical nuance. It is unknown if volume overload admissions can be correctly identified in administrative data and if a single claims-based definition for volume overload can be used across epidemiologic surveillance studies, observational studies of exposure-outcome associations and quality assessments. We conducted a validation study to assess the accuracy of claims-based definitions for volume overload hospitalizations among hemodialysis patients.MethodsData were taken from a random sample of 315 adult hemodialysis patients admitted to University of North Carolina Hospitals from January 2010 through June 2013. Standardized chart reviews were conducted to clinically adjudicate the presence or absence of volume overload at hospital admission. Claims-based definitions were constructed from varying combinations of fluid-related ICD-9 discharge diagnosis codes including fluid overload, pulmonary edema, pleural effusion, and heart failure. Using clinically adjudicated volume overload hospitalizations as the reference standard, validity metrics and their 95 % confidence intervals (CIs) were estimated for each definition.ResultsOf the 315 hospital admissions, 77 (24.4 %) were clinically adjudicated as volume overload hospitalizations. The prevalence of claims-identified volume overload admissions varied across definitions, ranging from 1.6 to 37.1 %. When definitions were constructed with discharge diagnosis codes present in any billing position, volume overload hospitalizations defined by fluid overload, pleural effusion or heart failure diagnosis codes had the highest sensitivity, 81.8 % (95 % CI: 71.4 %, 89.7 %). Volume overload hospitalizations defined by pulmonary edema diagnosis codes had the highest specificity, 98.3 % (95 % CI: 95.8 %, 99.5 %). Definitions constructed with discharge diagnosis codes present in any billing position (versus the primary position) captured more false positive events.ConclusionsPrevalence and validity estimates of volume overload hospitalizations vary across claims-based definitions. A universal claims-based definition for volume overload hospitalizations may not apply to all clinical and research scenarios. Investigators and regulators need to consider the implications of misclassifying events when evaluating and monitoring hemodialysis patient volume overload admissions with administrative data. Claims-based definitions should be selected accordingly.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0384-6) contains supplementary material, which is available to authorized users.

A surveillance study on CRISPR/Cas molecular biomarker in Escherichia coli

A new method related to molecular biomarker with CRISPR/Cas (clustered regularly interspaced short palindromic repeats-cas) in Escherichia (E.) coli was developed and used for surveillance programs. CRISPR/Cas sequence that containing 135 strains with complete sequence and 203 strains with whole genome shotgun sequence of E. coli in GenBank by BLAST and 361 strains of E. coli (including 38 strains of E. coli O157∶H7) in laboratory were identified by PCR and analyzed with the CRISPR Finder. Spacers were compared with DANMAN and the phylogenetic trees of cas gene were constructed under Clustal Ⅹ and Mega 5.1. With new perspective, a descriptive method was developed targeting on the position of CRISPR/cas in E. coli. The CRISPR1 was detected in 77.04%, 100.00% and 75.62% and the CRISPR2 was detected in 74.81%, 100.00% and 92.24% and the CRISPR3 and CRISPR4 were detected in 11.85%, 0 and 1.39% for 135 strains with complete sequence, 203 strains with whole genome shotgun sequence and 361 strains in the laboratory, respectively. One strain downloaded in GenBank with whole genome sequencing and 2 strains in the our laboratory were identified that containing four CRISPR locus. The other E. coli strain was with insertion sequence in downstream of the non-cas CRISPR1. The unique CRISPR was found in 8 strains of O55∶H7, in 180 strains of O157∶H7, in 8 strains of O157∶HNM, in 40 strains of O104∶H4, in 4 strains of O145∶H28, in all the 699 E. coli strains. The phylogenetic tree could be divided into two groups-cas with type I-E or type I-F. CRISPR/Cas might be used as a valuable molecular biomarker in epidemiological surveillance studies to identify the high virulent strains or new strains of E. coli. Phage night be related to the missing or obtaining of spacers.

Spatial analysis and identification of high risk plague regions in Pakistan based on associated rodent species distribution.

Plague, caused by Yersinia pestitis, is an infectious bacterial disease that has a high fatality rate if untreated. Rodents are plague reservoirs and play an important role in disease spread. Plague cases have been reported extensively since the second pandemic from the 14th century in countries sharing borders with Pakistan, such as China and India, as well as nearby countries including Russia and central Asia. Despite being centrally located in a plague-infested geographical zone, there has been no plague incidence reported from Pakistan. This study aims to pinpoint some of the potentially important aspects of the disease, which have to be considered when assessing potential risk associated with a plague outbreak in Pakistan. In this context, the occurrence and distribution of plague-associated rodent reservoirs in different regions of Pakistan in relation to those found in the neighboring countries were mapped. In addition, the climatic factors that may also influence disease spread by affecting the growth of the bacteria are also discussed. The combined epidemiological and ecological surveillance studies suggest a prevalence of several potential rodent carriers in certain districts with the possibility of a plague outbreak in Pakistan.

Characterization of unrelated clinical Legionella pneumophila isolates in Catalonia by monoclonal subgrouping and sequence-based typing.

To characterize the genetic diversity of unrelated Legionella pneumophila clinical isolates in Catalonia and compare with other European regions. 95 unrelated isolates were analyzed using monoclonal antibodies and sequence-based typing, 1989-2013. The isolates showed a high diversity (IOD 0.964) with a predominance of some profiles (ST37-Phialdelphia, ST23-Philadelphia and ST1-OLDA). All regions had predominant sequence types (STs) that differed between regions, and only 3% of STs were shared between the three regions. L. pneumophila clinical isolates from Catalonia presented a high diversity and can be used in epidemiological surveillance studies. The heterogeneous predominance of STs between European regions suggested a relationship between geographical distribution and virulence of some STs.

Direct identification of trypanosomatids by matrix-assisted laser desorption ionization-time of flight mass spectrometry (DIT MALDI-TOF MS).

Accurate and rapid determination of trypanosomatids is essential in epidemiological surveillance and therapeutic studies. Matrix-assisted laser desorption ionization/time of flight mass spectrometry (MALDI-TOF MS) has been shown to be a useful and powerful technique to identify bacteria, fungi, metazoa and human intact cells with applications in clinical settings. Here, we developed and optimized a MALDI-TOF MS method to profile trypanosomatids. trypanosomatid cells were deposited on a MALDI target plate followed by addition of matrix solution. The plate was then subjected to MALDI-TOF MS measurement to create reference mass spectra library and unknown samples were identified by pattern matching using the BioTyper software tool. Several m/z peaks reproducibly and uniquely identified trypanosomatids species showing the potentials of direct identification of trypanosomatids by MALDI-TOF MS. Moreover, this method discriminated different life stages of Trypanosoma cruzi, epimastigote and bloodstream trypomastigote and Trypanosoma brucei, procyclic and bloodstream. T. cruzi Discrete Typing Units (DTUs) were also discriminated in three clades. However, it was not possible to achieve enough resolution and software-assisted identification at the strain level. Overall, this study shows the importance of MALDI-TOF MS for the direct identification of trypanosomatids and opens new avenues for mass spectrometry-based detection of parasites in biofluids. Copyright © 2016 John Wiley & Sons, Ltd.

Targeted full-genome amplification and sequencing of dengue virus types 1–4 from South America

We report optimized workflows for full-genome sequencing of dengue viruses (DENVs) 1–4. Based on alignments of publicly available complete genomes we modified and expanded existing primers sets to amplify DENV genotypes that were previously difficult or impossible to sequence. We also report improvements to streamline laboratory handling, including a dual amplification strategy for easy and difficult to sequence “high-copy” and “low-copy” templates, respectively, and normalization of PCR cycling conditions across serotypes. High-copy templates can be sequenced following amplification of as few as 5 overlapping segments covering the complete viral genome, whereas low-copy templates can be sequenced following amplification of no more than 10 overlapping segments of smaller size. These changes have been validated using a balanced set of wild-type DENV genomes (11 of DENV1, 14 of DENV2, 13 of DENV3 and 7 of DENV4) derived from human serum samples collected throughout South America over the past 15 years. The changes described enable generation of complete DENV genomes from wild-type samples without the need for viral enrichment via passaging through laboratory cell lines. This should facilitate quick and cost-effective generation of DENV full-genome sequences of the type needed for accurate epidemiological surveillance and thorough evolutionary studies of wild-type DENVs.

The toxicology of indium tin oxide.

Indium tin oxide (ITO) is a technologically important semiconductor. An increasing number of cases of severe lung effects (characterized by pulmonary alveolar proteinosis and/or interstitial fibrosis) in ITO-exposed workers warrants a review of the toxicological hazards. Short- and long-term inhalation studies in rats and mice revealed persistent alveolar proteinosis, inflammation and fibrosis in the lungs down to concentrations as low as 0.01mg/m(3). In rats, the incidences of bronchiolo-alveolar adenomas and carcinomas were significantly increased at all concentrations. In mice, ITO was not carcinogenic. A few bronchiolo-alveolar adenomas occurring after repeated intratracheal instillation of ITO to hamsters have to be interpreted as treatment-related. In vitro and in vivo studies on the formation of reactive oxygen species suggest epigenetic effects as cause of the lung tumor development. Repeated intratracheal instillation of ITO to hamsters slightly affected the male sexual organs, which might be interpreted as a secondary effect of the lung damage. Epidemiological and medical surveillance studies, serum/blood indium levels in workers as well as data on the exposure to airborne indium concentrations indicate a need for measures to reduce exposure at ITO workplaces.

The Incidence, Classification, and Management of Acute Adverse Reactions to the Low-Osmolar Iodinated Contrast Media Isovue and Ultravist in Contrast-Enhanced Computed Tomography Scanning.

Some epidemiologic surveillance studies have recorded adverse drug reactions to radiocontrast agents. We aimed to investigate the incidence and management of acute adverse reactions (AARs) to Ultravist-370 and Isovue-370 in patients who underwent contrast-enhanced computed tomography (CT) scanning.Data from 137,473 patients were analyzed. They had undergone enhanced CT scanning with intravenous injection of Ultravist-370 or Isovue-370 during the period of January 1, 2006 to December 31, 2012 in our hospital. We investigated and classified AARs according to the American College of Radiology and the Chinese Society of Radiology (CSR) guidelines for iodinated contrast media. We analyzed risk factors for AARs and compared the AARs induced by Ultravist-370 and Isovue-370.Four hundred and twenty-eight (0.31%) patients experienced AARs, which included 330 (0.24%) patients with mild AARs, 82 (0.06%) patients with moderate AARs, and 16 (0.01%) patients with severe AARs (including 3 cases of cardiac arrest and one case of death). The incidence of AARs was higher with Ultravist-370 than with Isovue-370 (0.38% vs 0.24%, P < 0.001), but only for mild AARs (0.32% vs 0.16%, P < 0.001). Analyses on risk factors indicated that female patients (n = 221, 0.43%, P < 0.001), emergency patients (n = 11, 0.51%, P < 0.001), elderly patients aged 50 to 60 years (n = 135, 0.43%, P < 0.001), and patients who underwent coronary computed tomography angiography (CTA) (n = 55, 0.51%, P < 0.001) had a higher risk of AARs. Cutaneous manifestations (50.52%)—especially rash (59.74%)—were the most frequent mild AARs. Cardiovascular manifestations accounted for most moderate and severe AARs (62.91% and 48.28%, respectively). After proper management, the symptoms and signs of 96.5% of the AARs resolved within 24 hours without sequelae.Ultravist-370 and Isovue-370 are safe for patients undergoing enhanced CT scanning. The incidence of AARs is higher with Ultravist-370 than with Isovue-370, but this difference is limited only to the mild AARs. The incidence of AARs could be affected by multiple factors.

Epidemiological Surveillance of HIV-1 Transmitted Drug Resistance in Spain in 2004-2012: Relevance of Transmission Clusters in the Propagation of Resistance Mutations.

Our objectives were to carry out an epidemiological surveillance study on transmitted drug resistance (TDR) among individuals newly diagnosed of HIV-1 infection during a nine year period in Spain and to assess the role of transmission clusters (TC) in the propagation of resistant strains. An overall of 1614 newly diagnosed individuals were included in the study from January 2004 through December 2012. Individuals come from two different Spanish regions: Galicia and the Basque Country. Resistance mutations to reverse transcriptase inhibitors (RTI) and protease inhibitors (PI) were analyzed according to mutations included in the surveillance drug-resistance mutations list updated in 2009. TC were defined as those comprising viruses from five or more individuals whose sequences clustered in maximum likelihood phylogenetic trees with a bootstrap value ≥90%. The overall prevalence of TDR to any drug was 9.9%: 4.9% to nucleoside RTIs (NRTIs), 3.6% to non-nucleoside RTIs (NNRTIs), and 2.7% to PIs. A significant decrease of TDR to NRTIs over time was observed [from 10% in 2004 to 2% in 2012 (p=0.01)]. Sixty eight (42.2%) of 161 sequences with TDR were included in 25 TC composed of 5 or more individuals. Of them, 9 clusters harbored TDR associated with high level resistance to antiretroviral drugs. T215D revertant mutation was transmitted in a large cluster comprising 25 individuals. The impact of epidemiological networks on TDR frequency may explain its persistence in newly diagnosed individuals. The knowledge of the populations involved in TC would facilitate the design of prevention programs and public health interventions.

Morbilidad materna extrema en la Clínica Universitaria Colombia, Bogotá (Colombia), 2012-2013

&lt;p&gt;&lt;strong&gt;Objetivo:&lt;/strong&gt; describir la morbilidad materna extrema en una clínica de alta complejidad obstétrica.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materiales y métodos:&lt;/strong&gt; estudio descriptivo de vigilancia epidemiológica, basado en el análisis de los resultados de la implementación del subsistema de vigilancia de la morbilidad materna extrema (MME) en la Clínica Universitaria Colombia, entre junio de 2012 y junio de 2013. Esta es una institución de referencia que atiende pacientes de una empresa de aseguramiento privado y contributivo en Bogotá. Se estableció el número de gestantes que presentó morbilidad materna extrema en dicho periodo. Se evaluó la edad materna, la situación de salud generadora del reporte, los criterios definitorios de MME y los indicadores de calidad de la MME. Se realiza análisis descriptivo de los datos y se presenta la razón de prevalencia de la morbilidad materna extrema.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Resultados:&lt;/strong&gt; la prevalencia de MME en la institución fue de 11 por 1.000 nacidos vivos. El 55 % de los eventos se relacionaron con hemorragias del embarazo, seguidos por trastornos hipertensivos del embarazo (30 %), complicaciones de comorbilidades cardiacas (9 %) y choque séptico (6 %). Un 58 % de las pacientes presentaron disfunción orgánica, con una utilización de la Unidades de Cuidado Intensivo en 52 %; la transfusión de hemoderivados se requirió en un 61 % de los eventos y la cirugía adicional en un 36 %. El índice de mortalidad fue del 8 %. La relación MME/MM fue de 11:1. El porcentaje de casos de MME con más de tres criterios fue del 73 %.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusión:&lt;/strong&gt; la morbilidad materna extrema es un problema frecuente en esta institución de referencia. Su medición es posible con base en la vigilancia pasiva y activa de los criterios definitorios. Se requiere más información de estos indicadores de calidad a nivel nacional para hacer comparaciones entre instituciones.&lt;/p&gt;

A rapid method of accurate detection and differentiation of Newcastle disease virus pathotypes by demonstrating multiple bands in degenerate primer based nested RT-PCR

A rapid and accurate method of detection and differentiation of virulent and avirulent Newcastle disease virus (NDV) pathotypes was developed. The NDV detection was carried out for different domestic avian field isolates and pigeon paramyxo virus-1 (25 field isolates and 9 vaccine strains) by using APMV-I “fusion” (F) gene Class II specific external primer A and B (535bp), internal primer C and D (238bp) based reverses transcriptase PCR (RT-PCR). The internal degenerative reverse primer D is specific for F gene cleavage position of virulent strain of NDV. The nested RT-PCR products of avirulent strains showed two bands (535bp and 424bp) while virulent strains showed four bands (535bp, 424bp, 349bp and 238bp) on agar gel electrophoresis. This is the first report regarding development and use of degenerate primer based nested RT-PCR for accurate detection and differentiation of NDV pathotypes by demonstrating multiple PCR band patterns. Being a rapid, simple, and economical test, the developed method could serve as a valuable alternate diagnostic tool for characterizing NDV isolates and carrying out molecular epidemiological surveillance studies for this important pathogen of poultry.

An investigation into the minimum accelerometry wear time for reliable estimates of habitual physical activity and definition of a standard measurement day in pre-school children.

The purpose of this study was to determine the number of hours and days of accelerometry data necessary to provide a reliable estimate of habitual physical activity in pre-school children. The impact of a weekend day on reliability estimates was also determined and standard measurement days were defined for weekend and weekdays.Accelerometry data were collected from 112 children (60 males, 52 females, mean (SD) 3.7 (0.7)yr) over 7 d. The Spearman-Brown Prophecy formula (S-B prophecy formula) was used to predict the number of days and hours of data required to achieve an intraclass correlation coefficient (ICC) of 0.7. The impact of including a weekend day was evaluated by comparing the reliability coefficient (r) for any 4 d of data with data for 4 d including one weekend day.Our observations indicate that 3 d of accelerometry monitoring, regardless of whether it includes a weekend day, for at least 7 h d−1 offers sufficient reliability to characterise total physical activity and sedentary behaviour of pre-school children. These findings offer an approach that addresses the underlying tension in epidemiologic surveillance studies between the need to maintain acceptable measurement rigour and retention of a representatively meaningful sample size.

Epidemiological situation of pertussis and strategies to control it: Argentina, 2002-2011.

Pertussis is a challenge for public health. To describe pertussis-related morbidity and mortality and immunization coverage for the 2002-2011 period, profile of cases for 2011, and control strategies implemented by the Ministry of Health (MoH) of Argentina. Descriptive, epidemiological surveillance study. Morbidity data were obtained from the National Health Surveillance System, while mortality data were obtained from the MoH's Health Statistics and Information Department and official jurisdictional reports. Administrative immunization coverage was used based on the data provided by the MoH's jurisdictions. The Epi Info software, version 7.1.2, was used for analysis. The number of reported cases of pertussis increased between 2002 and 2011, reaching its peak in 2011: an incidence of 16 x 100 000 inhabitants, and 76 deaths. Most deaths occurred in infants younger than 1 year old. Immunization coverage achieved at a national level with the third dose and the dose administered at the time of starting primary education was >90%, while the coverage achieved with the first booster dose was 80%-90%. In 2011, 2821 confirmed cases were reported (incidence of 7 x 100 000 inhabitants): 84% in infants <1 year old; 76 deaths: 97% in infants <1 year old (60.5% in infants <2 months old). Among the strategies that were deployed, a total of 906 clinical nodes and 405 laboratory nodes were consolidated; the use of the polymerase chain reaction as a diagnostic method and the differential classification of cases were implemented, and additional vaccine doses were administered. The number of pertussis cases increased between 2002 and 2011; the highest morbidity and mortality occurred in infants younger than 1 year old; immunization coverage reached 80%-90%. . The highest number of pertussis-related deaths was recorded in 2011. The MoH strengthened the epidemiological surveillance and set guidelines for control measures.

Situación epidemiológica de coqueluche y estrategias para su control. Argentina, 2002-2011

Pertussis is a challenge for public health. To describe pertussis-related morbidity and mortality and immunization coverage for the 2002-2011 period, profile of cases for 2011, and control strategies implemented by the Ministry of Health (MoH) of Argentina. Descriptive, epidemiological surveillance study. Morbidity data were obtained from the National Health Surveillance System, while mortality data were obtained from the MoH's Health Statistics and Information Department and official jurisdictional reports. Administrative immunization coverage was used based on the data provided by the MoH's jurisdictions. The Epi Info software, version 7.1.2, was used for analysis. The number of reported cases of pertussis increased between 2002 and 2011, reaching its peak in 2011: an incidence of 16 x 100 000 inhabitants, and 76 deaths. Most deaths occurred in infants younger than 1 year old. Immunization coverage achieved at a national level with the third dose and the dose administered at the time of starting primary education was >90%, while the coverage achieved with the first booster dose was 80%-90%. In 2011, 2821 confirmed cases were reported (incidence of 7 x 100 000 inhabitants): 84% in infants <1 year old; 76 deaths: 97% in infants <1 year old (60.5% in infants <2 months old). Among the strategies that were deployed, a total of 906 clinical nodes and 405 laboratory nodes were consolidated; the use of the polymerase chain reaction as a diagnostic method and the differential classification of cases were implemented, and additional vaccine doses were administered. The number of pertussis cases increased between 2002 and 2011; the highest morbidity and mortality occurred in infants younger than 1 year old; immunization coverage reached 80%-90%. . The highest number of pertussis-related deaths was recorded in 2011. The MoH strengthened the epidemiological surveillance and set guidelines for control measures.

Have we left some behind? Trends in socio-economic inequalities in breastfeeding initiation: a population-based epidemiological surveillance study.

Breastfeeding is associated with improved health. Surveillance data show that breastfeeding initiation rates have increased; however, limited work has examined trends in socio-economic inequalities in initiation. The study's research question was whether socio-economic inequalities in breastfeeding initiation have changed over the past 20 years. This population-based study is a project within PATHS Equity for Children. Analyses used hospital discharge data for Manitoba mother-infant dyads with live births, 1988-2011 (n=316,027). Income quintiles were created, each with ~20% of dyads. Three-year, overall and by-quintile breastfeeding initiation rates were estimated for Manitoba and two hospitals. Age-adjusted rates were estimated for Manitoba. Rates were modelled using generalized linear models. Three measures, rate ratios (RRs), rate differences (RDs) and concentration indices, assessed inequality at each time point. We also compared concentration indices with Gini coefficients to assess breastfeeding inequality vis-à-vis income inequality. Trend analyses tested for changes over time. Manitoba and Hospital A initiation rates increased; Hospital B rates did not change. Significant inequalities existed in nearly every period, across all three measures: RRs, RDs and concentration indices. RRs and concentration indices suggested little to no change in inequality from 1988 to 2011. RDs for Manitoba (comparing initiation in the highest to lowest income quintiles) did not change significantly over time. RDs decreased for Hospital A, suggesting decreasing socio-economic inequalities in breastfeeding; RDs increased for Hospital B. Income inequality increased significantly in Manitoba during the study period. Overall breastfeeding initiation rates can improve while inequality persists or worsens.

The social life of health records: Understanding families' experiences of autism

Outside of the epidemiological surveillance studies of autism prevalence, health records of children diagnosed with autism have not been sufficiently examined, yet they provide an important lens for showing how autism diagnosis, services and interventions are negotiated, coordinated and choreographed by families and practitioners across multiple settings. This article provides a multifaceted understanding of these processes from an ethnographic and discourse analytic perspective that reveals structural and interactional phenomena contributing to disparities in autism diagnosis and services. We consider health records as dualistic, material-discursive artifacts that are socio-interactionally co-constructed and variably interpreted, contested and utilized across home, school and clinic contexts. We chronicle several families' experiences of their children's autism diagnoses and interventions and describe ways in which health records are socially constructed, curated and placed in the middle of clinical encounters. We show how the parents in our study draw upon health records' material-discursive properties to display epistemic authority, expertise and knowledge in interactions with healthcare and school professionals involved in authorizing and planning their children's care. We describe how the parents experience the health records' clinical portrayals of their children and themselves, and how the parents' portrayals of their children are tacitly ratified or negated in the health records. The data include health record reviews, narrative interviews with parents and practitioners, and clinical observations. These data were collected between October 2009 and August 2012 as part of a larger study on disparities in autism diagnosis, interventions and services experienced by African American children with autism and their families living in Los Angeles County, California. Our analysis reveals the central role of health records in maintaining continuity of an autism diagnosis, interventions and services. This article contributes to enhanced professional awareness, parent-professional partnerships, and equity in the provision of healthcare and human services related to autism.

Comparison between phage-open-reading frame typing and automated repetitive-sequence-based PCR for typing MRSA isolates.

The methods for typing and epidemiological study for especially antibiotic-resistant bacteria has been issued but there are the debates regarding which method is best for this purpose. The purpose of this study is to investigate and apply a comparatively new technology, phage-open-reading frame typing (POT) and repetitive-sequence-based PCR (rep-PCR) using DiversiLab system and compare for the discrimination of major methicillin-resistant Staphylococcus aureus (MRSA) lineages in epidemiological surveillance. We analyzed 47 representative MRSA stains isolated in Kobe University Hospital between January and December 2009. We performed MRSA typing using the POT kit and rep-PCR using the DiversiLab system. POT method classified all the MRSA strains into 35 clusters, whereas rep-PCR method typed all the MRSA strains in 10 kinds of clusters with a definition of 95% similarity. The discriminatory power and congruence between the methods were compared using the Simpson's index of diversity, adjusted Rand's and Wallace's coefficients. Our statistical analyses showed that the POT (POT 1-2-3 and POT 2-3) revealed a higher discriminatory power in the Simpson's index of diversity (SID; 0.969, range 0.939-1.000 and 0.967, range 0.935-0.998, respectively) for MRSA isolates than the rep-PCR (0.821 (0.767-0.876)). The adjusted Rand's and Wallace's coefficients did not show higher concordance among the methods. In conclusion, we demonstrated that the POT can perform accurate and reliable epidemiological surveillance studies for analyzing the genetic relatedness of MRSA strains.

A seventeen-year epidemiological surveillance study of Borrelia burgdorferi infections in two provinces of northern Spain.

This paper reports a 17-year seroepidemiological surveillance study of Borrelia burgdorferi infection, performed with the aim of improving our knowledge of the epidemiology of this pathogen. Serum samples (1,179) from patients (623, stratified with respect to age, sex, season, area of residence and occupation) bitten by ticks in two regions of northern Spain were IFA-tested for B. burgdorferi antibodies. Positive results were confirmed by western blotting. Antibodies specific for B. burgdorferi were found in 13.3% of the patients; 7.8% were IgM positive, 9.6% were IgG positive, and 4.33% were both IgM and IgG positive. Five species of ticks were identified in the seropositive patients: Dermacentor marginatus (41.17% of such patients) Dermacentor reticulatus (11.76%), Rhiphicephalus sanguineus (17.64%), Rhiphicephalus turanicus (5.88%) and Ixodes ricinus (23.52%). B. burgdorferi DNA was sought by PCR in ticks when available. One tick, a D. reticulatus male, was found carrying the pathogen. The seroprevalence found was similar to the previously demonstrated in similar studies in Spain and other European countries.