Epidemiological Update Research Articles

La leishmaniose canine à Leishmania Infantum : actualités épidémiologiques – applications

Canine leishmaniosis epidemiological update and applications. Canine leishmaniosis is a vector-borne disease caused by Leishmania infantum mainly transmitted by the bites of phlebotomine sandflies. The epidemiological role of domestic dogs (safe, asymptomatic, sick or vaccinated) is very important because it is the main source of parasites for the vector. But the proved or potential epidemiological role of wild animals (rabbit, hare,…) require more investigations for a best efficacy. The displacement or importation of infected dogs combined with the climatic modifications contribute to a significative incidence of canine and human clinical cases. Vaccination associated with topical insecticides should be recommanded for dogs living or travelling in endemic areas.

<i>Acinetobacter baumannii</i> in Birds’ Feces: A Public Health Threat to Vegetables and Irrigation Farmers

The rising trend of resistance in Acintobacter baumannii had in recent days become a public health care concern with most literature reported from samples collected from hospital environment. This research therefore, wishes to determine the occurrence of multidrug-resistant A. baumannii in birds’ droppings, associated with irrigated farms vegetables, for epidemiological update and future clinical forecast. Forty eight birds fecal samples were collected and processed for isolation and identification of A. baumannii on MacConkey agar and Microbact 24E (Oxoid), and tested against 10 commonly used antibiotics (quinolones, fluoroquinolones, aminoglycosides, sulfonamides). A. baumannii was isolated from 31.25% of samples and had shown more resistant to ceporex (100.00%) and to streptomycin with 80.00% and 90.00% for Jakara and Sharada farms’ fecal samples respectively; isolates were however sensitive to co-trimoxazole. Forty eight (46.67%) of the isolates were resistant to at least 6 drugs, with strong correlation between some drugs. By this result, wild birds’ fecal materials demonstrate high potential of A. baumannii carrying capacity and dissemination, and thus pose risk of contaminating vegetables, infecting human and transmitting resistance phenotype to other non-multidrug-resistant bacteria—a situation quite challenging to health care management and public health. And thus it further suggests for screening of additional probable contributing factors, so as to develop possible detailed transmission pathway and control strategies.

Epidemiology and geographical distribution of enteric protozoan infections in sydney, australia.

BackgroundEnteric protozoa are associated with diarrhoeal illnesses in humans; however there are no recent studies on their epidemiology and geographical distribution in Australia. This study describes the epidemiology of enteric protozoa in the state of New South Wales and incorporates spatial analysis to describe their distribution.Design and methodsLaboratory and clinical records from four public hospitals in Sydney for 910 patients, who tested positive for enteric protozoa over the period January 2007 - December 2010, were identified, examined and analysed. We selected 580 cases which had residence post code data available, enabling us to examine the geographic distribution of patients, and reviewed the clinical data of 252 patients to examine possible links between protozoa, demographic and clinical features.ResultsFrequently detected protozoa were Blastocystis spp. (57%), Giardia intestinalis (27%) and Dientamoeba fragilis (12%). The age distribution showed that the prevalence of protozoa decreased with age up to 24 years but increasing with age from 25 years onwards. The geographic provenance of the patients indicates that the majority of cases of Blastocystis (53.1%) are clustered in and around the Sydney City Business District, while pockets of giardiasis were identified in regional/rural areas. The distribution of cases suggests higher risk of protozoan infection may exist for some communities.ConclusionsThese findings provide useful information for policy makers to design and tailor interventions to target high risk communities. Follow-up investigation into the risk factors for giardiasis in regional/rural areas is needed.Significance for public healthThis research is significant since it provides the most recent epidemiological update on the common enteric protozoa affecting Australians. It reveals that enteric protozoa cause considerable disease burden in high risk city dwellers, and provides the evidence base for development of targeted interventions for their prevention and control in high risk populations. The prevalence of enteric protozoa in this metropolitan setting underscores that microorganisms do not respect borders and that a collaborative approach is needed to contain the global spread of infectious diseases. Incorporating spatial analysis is valuable in providing a compelling picture of the geographical distribution of these often neglected diseases. Local and State Public Health departments can use this information to support further inves-

The (possibly) deceptive figures of decreased coronary heart disease mortality in Europe: Figure 1

This editorial refers to ‘Cardiovascular disease in Europe: epidemiological update’[†][1], by M. Nichols et al. , on page 3028 and ‘Trends in age-specific coronary heart disease mortality in the European Union over three decades: 1980–2009’[‡][2], by M. Nichols et al. , on page 3017 Nichols et al . have presented updated data on the distribution of cardiovascular disease in Europe,1 and describe the trends observed in coronary heart disease (CHD) mortality in the European Union over a period of 30 years, from 1980 to 2009.2 The authors analyse sex-specific data from the World Health Organization (WHO), with the intention of determining the burden of cardiovascular disease in European countries, and whether the known overall decrease in CHD mortality has been uniform during this period of time, across countries, sex, and age groups. Unfortunately, cardiovascular disease remains the leading cause of mortality in Europe, accounting for 46% of the total number of deaths, with ∼20% related to coronary artery disease and 12% to stroke. It still is the leading cause of death among both men and women. In a few countries, mainly from Western and Southern Europe, however, cancer has become the leading cause of death. Perhaps more importantly still, cardiovascular disease caused the premature death of 1.5 million people before the age of 75. When comparing the most recent data for age-standardized mortality across European countries, huge differences can be observed, with lower rates in Israel, France, Spain, and The Netherlands, and up to seven-fold higher rates in Eastern countries such as the Russian Federation or Uzbekistan. Beyond mortality, cardiovascular disease also has a major impact on morbidity, although figures on hospitalization for cardiovascular disease represent a gross approximation of the burden this condition may represent. Between-country and time comparisons are, however, difficult to make, as the reported rates are … [1]: #fn-2 [2]: #fn-3

Current Understanding of Lifestyle and Environmental Factors and Risk of Non-Hodgkin Lymphoma: An Epidemiological Update

The incidence rates of non-Hodgkin lymphoma (NHL) have steadily increased over the last several decades in the United States, and the temporal trends in incidence can only be partially explained by the HIV epidemic. In 1992, an international workshop sponsored by the United States National Cancer Institute concluded that there was an “emerging epidemic” of NHL and emphasized the need to investigate the factors responsible for the increasing incidence of this disease. Over the past two decades, numerous epidemiological studies have examined the risk factors for NHL, particularly for putative environmental and lifestyle risk factors, and international consortia have been established in order to investigate rare exposures and NHL subtype-specific associations. While few consistent risk factors for NHL aside from immunosuppression and certain infectious agents have emerged, suggestive associations with several lifestyle and environmental factors have been reported in epidemiologic studies. Further, increasing evidence has suggested that the effects of these and other exposures may be limited to or stronger for particular NHL subtypes. This paper examines the progress that has been made over the last twenty years in elucidating the etiology of NHL, with a primary emphasis on lifestyle factors and environmental exposures.

Hormone replacement therapy and a risk for breast cancer in postmenopausal women: analysis of some epidemiological studies

The paper provides an epidemiological update on a risk for breast cancer during menopausal hormone replacement therapy. It gives the results of large observational and randomized clinical trials, as well as the point of view of the International Menopause Society in the context of evidence-based medicine.

Paediatric testicular cancer: an updated review of incidence and conditional survival from the Surveillance, Epidemiology and End Results database

To determine, using the Surveillance, Epidemiology, and End Results (SEER) population-based database, the epidemiological variables and update the understanding of testicular tumours in children, as knowledge of their incidence and survival is predicated upon multi-institutional cooperation. Using the SEER database, we ascertained the incidence rate, 5-year survival by disease stage at diagnosis, and 5-year conditional survival after surviving for 1-3 years for cases recorded between 1973 and 2005. We stratified the incidence rate by race and histology to examine if these factors affect disease characteristics. We identified 195 cases of testicular tumours in children from birth to age 14 years, and 785 for children aged 15-18 years. Yolk sac tumour was the most common testicular tumour, and overall, Caucasian children were most at risk and four times more likely to be affected than African-American children. The incidence rate of testicular tumour overall has not increased significantly since 1973. Conditional survival is excellent for all testicular malignancies, with a 1-year conditional survival (chance of surviving 5-years after having survived the first year) of 99.6%. We present an updated analysis of the SEER database for the incidence and survival of testicular tumours, and revisit the issue of whether the incidence of testicular tumours in children is increasing. We also present to our knowledge, the first calculation of conditional survival in children for this malignancy. There has been no significant increase in the incidence of testicular tumours for children aged <14 years. By contrast, the postpubertal group aged 15-18 years showed a reversal in this trend.

Immuno–parasitological assessment of bancroftian filariasis in a highly endemic area along the River Sabaki, in Malindi district, Kenya

Lymphatic filariasis is endemic in the coastal areas of Kenya, with four major foci identified in the early 1970s. The prevalence and intensity of Wuchereria bancrofti infection, together with antifilarial antibody responses, were assessed in a historically highly endemic focus along the River Sabaki, in Malindi district. The prevalences of microfilaraemia and antigenaemia (detected by Og4C3 ELISA) were >20% and >40%, respectively, and both increased steadily with age. The high prevalences of antifilarial IgG1 (86%) and IgG4 (91%) responses indicate that most people living in this setting are exposed to W. bancrofti infection. The children investigated had higher levels of antifilarial IgG1 than the adults. The results of this study, based on a battery of currently available parasitological and immunological methods, provide an epidemiological update on lymphatic filariasis on the northern Kenyan coast. They show that the River Sabaki area is still an important focus for bancroftian filariasis and highlight the importance of implementing an elimination programme, to interrupt the transmission of W. bancrofti in all areas of endemicity in Kenya. The detailed baseline data collected in the River Sabaki area make the communities studied ideal as sentinel sites for epidemiological monitoring and the evaluation of the impact of mass drug administrations to eliminate lymphatic filariasis.

Crohn's disease in Stockholm County during 1990-2001: an epidemiological update.

To further assess of the incidence and localization of Crohn's disease (CD) in a well-defined population during the 1990s and to evaluate the prevalence of CD on the 1st of January 2002. In a retrospective population based study, all 16-90 years old citizens of Stockholm County diagnosed as having CD according to Lennard Jones' criteria between 1990 and 2001 were included. Case identification was made by using computerized inpatient and outpatient registers. Moreover private gastroenterologists were asked for possible cases. The extent of the disease and the frequency of anorectal fistulae were determined as were the ages at diagnosis. Further, the prevalence of CD on the 1(st) of January 2002 was assessed. All the 1 389 patients, 689 men and 700 women, fulfilled the criteria for CD. The mean incidence rate for the whole period was 8.3 per 10(5) (95%CI 7.9 -8.8). There was no difference between the genders. The mean annual incidence of the whole study period for colorectal disease and ileocecal disease, was 4.4 (95%CI 4.0-4.7) and 2.4 (95%CI 2.1-2.6) per 10(5), respectively. Perianal disease occurred in 13.7% (95%CI 11.9-15.7 %) of the patients. The prevalence of CD was 213 per 100,000 inhabitants. The incidence of CD has markedly increased during the last decade in Stockholm County and 0.2% of the population suffers from CD. The increase is attributed to a further increase of colorectal disease, while the incidence of ileocecal disease has remained stable.

Role of Anti-Oxidants in Atherosclerosis: Epidemiological and Clinical Update

Low density lipoprotein (LDL) oxidative modification in the vascular wall seems to be a key factor in atherosclerosis development. Oxidised LDLs might recruit monocytes and favour their transformation into foam cells through a receptor-mediated intake (scavenger pathway). Moreover oxidised LDLs show cytotoxic potential which is probably responsible for endothelial cell damage and macrophage degeneration in the atherosclerotic human plaque. Following the oxidation hypothesis of atherosclerosis the role of natural antioxidants, i.e. Vitamin C, Vitamin E and carotenoids, has been investigated in a large number of epidemiological, clinical and experimental studies. Animal studies indicate that dietary antioxidants may reduce atherosclerosis progression, and observational data in humans suggest that antioxidant vitamin ingestion is associated with reduced cardiovascular disease, but the results of randomised controlled trials are mainly disappointing. It has been suggested that natural antioxidants may be effective only in selected subgroups of patients with high levels of oxidative stress or depletion of natural antioxidant defence systems. The favourable effects shown by some studies relating antioxidant dietary intake and cardiovascular disease, may have been exerted by other chemicals present in foods. Flavonoids are the ideal candidates, since they are plentiful in foods containing antioxidant vitamins (i.e. fruits and vegetables) and are potent antioxidants. Tea and wine, rich in flavonoids, seem to have beneficial effects on multiple mechanisms involved in atherosclerosis. Future studies should probably select patients in a context of high-oxidative stress / low-antioxidant defence, to verify if antioxidants may really prove useful as therapeutic anti-atherosclerotic agents.

Epidemiological Update of Hepatitis B, C and Delta in Latin America

Viral hepatitis B, C and delta still remain a serious problem in Latin America. Data from the 1980s indicated that HBV and HDV infection are the main causes of chronic hepatitis. However, the spread of HBV infection could be controlled through the implementation of immunization programmes. Different countries from Mexico to Argentina display marked differences in terms of HBV genotype distribution. HBV genotype F has been identified as the most frequent in most Latin America countries, except for Mexico and Brazil, where genotypes H and A are the most frequent, respectively. In Latin America, the overall prevalence of HCV antibody is estimated to be 1.5%. Latin American countries have been very proactive in screening their blood supplies, thus minimizing risk of HCV transmission through transfusion. The number of diagnosed and treated patients is still low, thereby increasing the burden of complications such as liver cirrhosis or hepatocellular carcinoma. The most prevalent HCV genotype is 1, which is the genotype with the greatest worldwide spread, but it is a different genotype from other regions like Africa and Asia. HDV is present worldwide but its distribution pattern is not uniform. HDV was recently detected in novel geographic regions, reinforcing that it is a very serious health threat in under-developed countries. The main prevalence areas are the Mediterranean basin, the Middle East, central and northern Asia, western and central Africa, the Amazonian basin (Brazil, Peru, Venezuela and Colombia) and the Pacific islands. Novel strategies to increase HBV immunization in the Latin American population are needed to warrant thorough coverage in the rural areas.

Les symptômes psychologiques et comportementaux de la démence : description et prise en charge

Behavioral and Psychological Symptoms in Dementia (BPSD) are, beside cognitive disorders, major features of Alzheimer's disease and related disorders. Diagnosis is important to enhance our knowledge of the pathophysiology of dementia and of their functional consequences for patients and caregivers. Pharmacological and non-pharmacological management of dementia depends to a large extent on the presence of BPSD. A committee of geriatricians, neurologists and psychiatrists specialized in dementia (THEMA 2) has promoted an epidemiological, diagnostic and therapeutic update in this field. This work was based on the BPSD Consensus Conference Report edited in 2000 by the International Psychogeriatric Association. This report was updated with the most recent literature reports, and was adapted to the French environment. This paper is a synthesis of this meeting, validated and corrected by the entire Thema 2 group.

Oral recurrent aphthous ulcers/stomatitis. Prevalence in Malaysia and an epidemiological update.

One of the objectives of this short communication was to add to the literature on the prevalence of oral recurrent aphthous stomatitis (ORAS). This research is based on a total of 11,697 randomly selected Malaysian subjects with an age range of 25-115 years and a mean age of 44.5 +/- 13.9 years who were examined for oral mucosal lesions (ORAS). The prevalence of ORAS detected during the oral examination (average point prevalence) was found to be 0.5% (64 subjects). ORAS formed 5.7% of all lesions detected during the survey. The average point prevalence of ORAS was highest in the indigenous people of Sabah and Sarawak (1.2%), followed by the Chinese (0.7%), the Malays (0.5%) and the Indians (0.1%). This difference was statistically significant (p < 0.001). A review of the English literature on the prevalence of ORAS revealed different prevalence types used by different researchers, namely average point prevalence (APP), self reported life-time prevalence (SLP) and self reported two-year prevalence (STP). The other objective of this paper was to present the different types of prevalence that have been reported in the literature and to discuss the usefulness of such prevalence types in relation to using epidemiology in deriving certain possible etiological associations.

Silica, Silicosis, and Lung Cancer: An Epidemiological Update

Abstract Excluding reports on coal miners and foundrymen, which are difficult to interpret, there have been at least 39 useful studies of mortality since 1978 in workers potentially exposed to crystalline silica, and some 16 studies of persons compensated or hospitalized for silicosis. Virtually all of the latter show evidence of an approximately threefold increase in lung cancer risk, perhaps higher in the hospitalized subjects. Mainly by reason of various probable biases associated with case selection and confounding, it cannot be confidently concluded from these findings that crystalline silica alone was responsible for the elevated risk. Of the 39 reports on silica-exposed workers—34 of cohort design—18 were in metal miners, 8 in quarrymen, 9 in ceramic and other manufacturing processes, and 4 in mixed industries. Detailed review of the 39 studies suggests that any lung cancer risk in metal miners could well be explained by radon or arsenic, and whether or not there is an excess in quarrymen is uncertain. The evidence in pottery work, and especially in refractory brick manufacture and calcining of diatomaceous earth, is more sure. It has long been suggested that cristobalite, and perhaps tridymite, both produced by high temperature treatment of quartz or amorphous silica, are the most toxic forms of the crystalline mineral. The epidemiological findings on lung cancer to date appear compatible with this gradient and point to the need for closer examination of this hypothesis. Meanwhile, although quantitative data on exposure—response are extremely scanty, there is little to suggest that any excess risk of lung cancer would be detectable at exposure levels sufficient to control the occurrence of radiologically apparent silicosis. McDonald, C.: Silica, Silicosis, and Lung Cancer: An Epidemiological Update. Appl. Occup. Environ. Hyg. 10(12):1056–1063; 1995.

Increased risk of cardiovascular disease at suboptimal plasma concentrations of essential antioxidants: an epidemiological update with special attention to carotene and vitamin C

For the prolongation of life expectancy and reduction of ischemic heart disease (IHD) dietary guidelines generally recommend lowering saturated mammalian fat with partial replacement by vegetable oils and increasing generously vegetables, legumes, and fruits, which provide more essential antioxidants. Plasma antioxidants as assayed in epidemiological studies of complementary type (ie the cross-cultural MONICA Vitamin Substudy reevaluation considering the "Finland-Factor", the Edinburgh Angina-Control Study, and the Basel Prospective Study) consistently revealed an increased risk of IHD (and stroke) at low plasma concentrations of antioxidants, with the rank order as follows: lipid-standardized vitamin E >> carotene = vitamin C > vitamin A, independently of classical IHD risk factors. Decreasing IHD risk through nutrition may be possible when plasma concentrations have the following values: > 27.5-30.0 mumol vitamin E/L, 0.4-0.5 mumol carotene/L, 40-50 mumol vitamin C/L and 2.2-2.8 mumol vitamin A/L. Thus, previous prudent regimens may now be updated, aiming at an optimal status of all essential and synergistically linked antioxidants.

HIV infection: educational programs and policies for school personnel.

Acquired Immunodeficiency Syndrome (AIDS) challenges schools as the frontline defense against this epidemic. School personnel should become knowledgeable about human immunodeficiency virus (HIV) infection and get involved in presenting quality HIV/AIDS education programs. This paper provides an epidemiological update on AIDS as it relates to the school-age population. Evidence establishing modes of transmission is emphasized, and recommendations are presented for handling students infected with HIV. Information is provided to assist school staff implement HIV/AIDS education programs, including core concepts to be emphasized.