Lack Of Epidemiological Information Research Articles

A Cross-Sectional Study to Assess the Physical and Psychological Well-Being among Older Adults during COVID-19 Outbreak

Background: The pandemic caused by the COVID-19 virus is an international health crisis that has the potential to have major repercussions for public health, including both physical and mental health. There is a lack of epidemiological information about the COVID-19 outbreak, which makes elderly people more susceptible to the stress it causes. The goal of the study is to evaluate older persons’ physical and mental health during the COVID-19 pandemic. Methods: Mixed method, embedded design was adopted. Fifty older adults were selected through purposive sampling technique from the selected village. Qualitative approach was used to measure physical well-being by interview and quantitative approach was employed to assess psychological well-being by modified psychological general well-being index. Qualitative data analyzed by thematic analysis and quantitative data analyzed by descriptive and inferential statistics. Results: The study findings revealed that, in physical well-being, maximum older adults reported, the daily schedule was totally changed, did not get enough time for doing pleasurable activities, changed their food pattern, sleep was fully disturbed, daily habits were changed by following COVID appropriate behavior, and many discomfort faced in maintaining health during COVID-19 outbreak. The finding of psychological well-being shows, maximum 34 (68%) having moderate level of psychological distress, the domain self-confidence 3.1 ± 30.68 was mostly disturbed. There was a significant association found between the age, education, occupation, performance of basic activity, and vaccination status with the selected demographic variables at P ≤ 0.05 levels. Conclusion: The older adults were considered as vulnerable people as they need more attention in maintaining health during COVID-19 outbreak.

High intestinal parasite infection detected in children from Regi\xf3n Aut\xf3noma Atl\xe1ntico Norte (R.A.A.N.) of Nicaragua

There is a lack of epidemiological information concerning intestinal parasitic infections, and especially in soil-transmitted helminths, occurring in some departments of Nicaragua. Up to now, this is the first study involving two nearby areas (Puerto Cabezas and Siuna municipalities) of the Región Autónoma Atlántico Norte (R.A.A.N.). One stool sample was analyzed by Kato-Katz, formaldehyde-ethyl acetate concentration method and modified Ziehl–Neelsen technique, and a simple questionnaire concerning demographic, sanitary and behavioral data was distributed among 735 children and evaluated. Overall prevalence of infection reached 97.0%, being the highest prevalences detected in all Nicaragua. The higher protozoan prevalence appears in Siuna (94.5%), a rural interior municipality, with a typical tropical monsoon climate, while the higher helminths rates were reached in Puerto Cabezas (92.8%), the urbanized coastal capital, with a typical tropical rainforest climate. No statistical differences were found with regard to sex. However, the 6–11-year age-group children presented the highest prevalences. Most T. trichiura infections (59.4%) were of light intensity, while 51.7% of Ascaris lumbricoides were of moderate intensity. Multivariable logistic regression analysis indicated that those who drink rainwater and walk barefoot were 2.9 and 2.5 times more likely to have helminth infections, respectively. Results from one geographical setting might not be applied to other nearby with different climatic conditions. The use of anthelmintic drugs only will not be sufficient to bring prevalence to low levels. It is necessary to design geographically more specific intervention, with communication and interaction between different disciplines (e.g. parasitology, biochemistry, molecular biology, epidemiology, public health, etc.) being imperative to reduce STH infection.

The extrinsic factors affecting patient access, referral and treatment of lung cancer in selected oncology public health facilities in KwaZulu-Natal

Patients’ insights into the factors affecting access, referral and treatment of lung cancer in public healthcare facilities, are key to the fight against this disease. On the other hand, the lack of epidemiological information on the actual burden of lung cancer, makes it difficult for public healthcare facilities to be adequately equipped to deal with foreseeable challenges in the oncology units. In order to inform patientcentred interventions and lung cancer control programmes, this study explored extrinsic factors that affect lung cancer patients throughout the cancer care continuum in KwaZulu-Natal. Nineteen patients receiving care in the three public healthcare facilities providing oncology services in KwaZulu-Natal, were interviewed using an interview guide. Following data saturation, thematic analysis was used to develop the themes relating to the extrinsic factors affecting the provision of cancer care. Five themes emerged from the analysis, namely: geographical dynamics affecting patient access to a healthcare facility, lung cancer suspicion index in the diagnostic trail within the different levels of care, decision-making trail for the referral system, equipmentinduced delays and healthcare-patient communication. A number of lung cancer patients utilising oncology services in public healthcare facilities in KwaZulu-Natal, are often met with various extrinsic factors affecting their progression through different stages of cancer care continuum. Therefore, the results of the extrinsic factors explored in this paper through the lung cancer patients’ lenses may be used for designing mitigation plans to reduce delays in lung cancer care in KwaZulu-Natal.

SEROSURVEY FOR SELECTED PARASITIC AND BACTERIAL PATHOGENS IN DARWIN'S FOX (LYCALOPEX FULVIPES): NOT ONLY DOG DISEASES ARE A THREAT.

The Darwin's fox (Lycalopex fulvipes) is one of the most endangered carnivores worldwide, with the risk of disease spillover from domestic dogs being a major conservation threat. However, lack of epidemiologic information about generalist, non-dog-transmission-dependent protozoal and bacterial pathogens may be a barrier for disease prevention and management. To determine the exposure of some of these agents in Darwin's fox populations, 54 serum samples were collected from 47 Darwin's foxes in Southern Chile during 2013-18 and assessed for the presence of antibodies against Brucella abortus, Brucella canis, Coxiella burnetii, pathogenic Leptospira (serovars Grippotyphosa, Pomona, Canicola, Hardjo, and Copehageni), Toxoplasma gondii, and Neospora caninum. The highest seroprevalence was detected for T. gondii (78%), followed by pathogenic Leptospira (14%). All the studied Leptospira serovars were confirmed in at least one animal. Two foxes seroconverted to Leptospira and one to T. gondii during the study period. No seroconversions were observed for the other pathogens. No risk factors, either intrinsic (sex, age) or extrinsic (season, year, and degree of landscape anthropization), were associated with the probability of being exposed to T. gondii. Our results indicate that T. gondii exposure is widespread in the Darwin's fox population, including in areas with minimal anthropization, and that T. gondii and pathogenic Leptospira might be neglected threats to the species. Further studies identifying the causes of morbidity and mortality in Darwin's fox are needed to determine if these or other pathogens are having individual or population-wide effects in this species.

Treponema pallidum among Female Sex Workers: A Cross-Sectional Study Conducted in Three Major Cities in Northern Brazil.

Female sex workers (FSWs) are an important group of people vulnerable to sexually transmitted infections. Northern Brazil is a rural and socioeconomically underdeveloped region, with lack of epidemiological information on syphilis in key populations. This study investigated the prevalence and factors associated with exposure to Treponema pallidum among FSWs in three major cities in northern Brazil. This cross-sectional study was conducted with a convenience sample of 415 FSWs from the cities of Belém, Macapá, and Rio Branco. Blood samples and personal data were collected from January 2009 to August 2010. Rapid plasma reagin and immunoenzymatic assays were used to detect antibodies against T. pallidum. Logistic regression models were used to determine factors associated with exposure to T. pallidum. In total, 36.1% were exposed to T. pallidum, and 15.7% had active syphilis. Sexual risk behaviors, use of illicit drugs, low education, and reduced monthly income were associated with exposure to T. pallidum. The high rate of exposure to T. pallidum indicates the urgent need for measures to identify, treat, and prevent syphilis and an education program for the valuation, care, and social inclusion of FSWs in northern Brazil.

Keratoconus in Africa: A systematic review and meta-analysis.

The aim of this review is to evaluate the prevalence of and factors associated with keratoconus in Africa. A systematic online literature search was conducted for articles on keratoconus in Africa. Meta-analysis was performed to estimate the prevalence of keratoconus in Africa. The Freeman-Tukey double arcsine transformation was used to minimize the effects of studies with extremely high or low prevalence estimates on the overall pooled estimates. Leave-one-out sensitivity analysis was used to assess the robustness of the pooled effects and potential outliers. Meta-regression was performed to explore associations between keratoconus, gender and age. Twelve studies were included in the review; 5 from Egypt, 2 from South Africa, 2 from Kenya, 1 from Sudan, 1 from Ghana and 1 from Nigeria. Two studies were conducted in allergic conjunctivitis patients, 4 in keratoconus patients, 1 in contact lens service seekers, 1 in pre-LASIK patients, 1 in refractive patients and 1 in a student population. Eight studies were included in the meta-analysis. The overall prevalence estimate of keratoconus in Africa was 7.9% (95% CI: 2.5%-16.0%). The prevalence of keratoconus among males and females in Africa was estimated to be 9.3% (95% CI: 2.5%-19.5%) and 5.8% (95% CI: 1.5%-12.7%) respectively. The estimated prevalence of unilateral and bilateral keratoconus was 2.6% (95% CI: 0.4%-6.5%) and 5.8% (95% CI: 1.6%-12.3%), respectively. The estimated prevalence of mild keratoconus was 2.2% (95% CI: 0.7%-4.7%), moderate keratoconus was 3.5% (95% CI: 0.0%-11.8%) and severe keratoconus was 4.0% (95% CI: 0.0%-19.6%). There was no significant association between gender and the prevalence of keratoconus in Africa (p=0.63), and age and the prevalence of keratoconus in Africa (p=0.78). The estimated prevalence of keratoconus reported here is higher than prevalence values reported in other meta-analyses or different geographical locations. This is mainly because studies included in this meta-analysis were either conducted on a cohort at high risk of keratoconus or a population with high possibility of finding keratoconus patients. There is a dearth of well-designed population-based studies on keratoconus in Africa, resulting in a lack of epidemiological information. This highlights the urgent need for research on keratoconus in Africa.

ANÁLISE DA CONDIÇÃO DE SAÚDE BUCAL DA POPULAÇÃO EM SITUAÇÃO DE RUA DO MUNICÍPIO DE NATAL-RN

Introdução: Devido à problemática da desigualdade social, tem-se observado nas últimas décadas o aumento da chamada População em Situação de Rua (PSR), a qual sofre com a invisibilidade e a exclusão social. As condições de vida dessa população oferecem diversos riscos à sua saúde. A saúde bucal está entre os principais problemas de saúde referidos, porém há uma carência de informações epidemiológicas que representem as especificidades desse grupo populacional. Objetivo: Estudar a condição de saúde bucal da PSR do município de Natal-RN. Método: Estudo quantitativo observacional e transversal, realizado no Centro de Referência Especializado para PSR (Centro POP). Foram examinadas 60 pessoas, selecionadas de forma aleatória. Utilizou-se um questionário estruturado sobre os hábitos de higiene bucal e dieta, além de exame clínico bucal para verificar a história e a atividade de cárie (CPO-D), doença periodontal (CPI) e a ocorrência de lesões em tecidos moles. Os dados foram tabulados e analisados descritivamente no software SPSS. Resultados: A média de idade foi de 41,43 anos (±11,19); o sexo masculino correspondeu a 86,7% e o feminino 13,3%. Sobre o tempo de rua, obteve-se uma média de 7,42 anos (±8,29). A média do CPO-D foi de 15,35, sendo os componentes cariados, perdidos e restaurados, respectivamente: 3,93; 9,13 e 2,30. A condição periodontal mais prevalente, por sextante, foi o cálculo dentário (média=3,82), seguido pelo sangramento gengival (média= 3,52), bolsa rasa (média=1,27) e bolsa profunda (média=0,40). Em relação ao pior escore do CPI, verificou-se que 46,7% apresentaram bolsa rasa, 26,7% bolsas profundas e 16,7% cálculo dentário. Dos examinados, 15% apresentaram lesões em tecidos moles. Conclusões: A prevalência de cárie e doença periodontal foi elevada. Notou-se uma maior severidade dessas doenças e dificuldade de acesso à assistência odontológica, constatando que o modo de vida dessa população influencia na forma como as principais doenças bucais repercutem sobre eles.

Anti-Leptospira spp. Antibodies in Pigs Slaughtered in the Agreste Region of Pernambuco, Brazil

Background: Swine production and productivity rates can be influenced by several factors, such as genetics, environmental conditions, nutritional factors, previous infections and others. Among infectious diseases, leptospirosis is a well-known cause of reproductive disorders in pigs. These animals are considered carriers of the disease when they are in the terminal stage of the infection and the Veterinary Inspection Service has not been notified when they are slaughtered. Considering the lack of epidemiological information on Leptospira infection in pigs in the state of Pernambuco, the aim of this study was to investigate anti-Leptospira antibodies in pigs slaughtered in the Agreste region of the state of Pernambuco, Brazil.Materials, Methods & Results: Blood samples were collected from 305 pigs in 11 municipalities in the Agreste region of Pernambuco. The animals had no history of vaccination, and were raised on subsistence-oriented family farms. The sera were subjected to the Microscopic Agglutination Test (MAT) for the detection of antibodies. The serovars used in the MAT were: Icterohaemorrhagiae, Copenhageni, Javanica, Canicola, Castellonis, Pyrogenenes, Cynopteri, Autumnalis, Sentot, Djasiman, Australis, Pomona, Grippotyphosa, Hebdomadis, Wolffi, Sejroe, Saxkoebing, Bataviae, Tarassovi, Panama, Patoc, Andamana, Celledoni, Shermani, Brastilava and Hardjo. Sera showing titers of ≥100 were considered positive. The MAT results indicated that 78/305 (25.57%) of the samples were positive, and were distributed in the 11 municipalities. The most frequent serovars were Icterohaemorrhagiae, Copenhageni, and Djasiman, with frequencies of 55.13%, 17.95% and 6.41%, respectively.Discussion: Swine infected with leptospirosis showed few or no signs of the disease. However, the bacteria can be carried for long periods in convoluted tubules of the kidney and their urinary excretion may last for years. A study of Leptospira spp. risk factors on pig farms in the state of Alagoas revealed an absence of rodent control, suggesting that this was the probable cause of infection by this serovar, Icterohaemorrhagiae. Farms that did not control their rodent populations showed a 7.8-fold higher risk of infection among their swine. This exposure poses a problem, since these animals can contaminate the environment, as well as food and water, making them an important source of infection of other animals. The findings of this study indicate that the pigs were exposed to Leptospira spp. The reason that some atypical serovars were identified in this study may be have been incidental infection, since these animals came from a non-technified system, putting them at greater risk of contact with other animal species. This may also be a reason for the identification of the other serovars in this research. Although the serovar Copenhagen is part of the Icterohaemorrhagiae serogroup, few studies have described its importance. The main reservoirs of Copenhageni are also synanthropic rodents, which underscores the importance of these animals as possible sources of contamination on farms that supply pigs to the slaughterhouses of the region under study. The data obtained here indicate the need for animal health surveillance programs in the region. Moreover, they may also be a source of infection of the professionals directly involved in handling and slaughtering pigs. This indicates the need to implement surveillance programs in the region, such as high vaccination coverage at pig farms, as well as integrated pest management against rodents.

Detection and epidemiological progress of quiescent avocado diseases

ABSTRACT: One of the major problems in the commercialization of avocados is the incidence of postharvest diseases, especially anthracnose (Colletotrichum spp.) and stem-end rot (Lasiodiplodia theobromae, Fusicoccum aesculi and Neofusicoccum spp.). As there is a lack of epidemiological information on these pathosystems, the objective of this study was to establish a method to detect quiescent infections and characterize their temporal progression and spatial pattern in a commercial orchard. Detection of quiescent infections was evaluated in flowers and fruits that were immature and in commercial harvest stage, treated with paraquat, ethrel or water. Treatment of flowers and immature fruits with paraquat led to rapid detection of Colletotrichum spp. In two seasons of a ‘Hass’ avocado orchard, the incidence of diseases was evaluated from open flowers to fruit harvest, totaling 11 evaluations at biweekly intervals. When fruits reached the harvest stage, the spatial distribution of diseased fruits in the trees was evaluated by means of dispersion index and modified Taylor’s law. Considering the evaluation of temporal disease progression, anthracnose was the most important disease, presenting a high initial incidence of 60 and 86% diseased flowers in the two seasons, respectively, while fruits showed an average disease incidence of 70 and 87%, respectively. Stem-end rot was observed only in fruits since the beginning of their development and presented low incidence (<8% fruits), significantly inferior to that of anthracnose. The diseases showed random dispersion within the trees, indicating that their initial inoculum is evenly distributed in the plants.

A review of anaemia of inflammatory disease in dogs and cats.

Anaemia of inflammatory disease is a common cause of anaemia in routine veterinary practice. It is most often mild to moderate, normocytic, normochromic and non-regenerative. Shortened red cell life span, inhibition of iron metabolism and impaired bone marrow response to erythropoietin all contribute to its development. Although anaemia of inflammatory disease is a well-known cause of anaemia in dogs and cats, there is a lack of epidemiological information because specific diagnostic criteria have not been established in veterinary species. Anaemia of inflammatory disease is associated with a poor outcome in various disease states in human medicine; however, its clinical significance and treatment in veterinary medicine are not well understood. This review article describes anaemia of inflammatory disease in dogs and cats and considers its potential significance.

Towards measles elimination: Phylogenetic analysis of measles viruses in Turkey (2012-2013) and identification of genotype D8.

Molecular characterization of different measles virus (MV) strains is essential to combat the disease. Sixty measles MV strains were obtained from throat swabs or urine of patients in Turkey between 2012 and 2013 and characterized. MV RNA sequences (n = 60) were analysed for 456 nucleotides representing hypervariable domain of the nucleoprotein (N) gene. Of the 60 strains analysed 53 were the D8 genotype, 6 were B3, 1 was D4, and 1 was A. This report describes MV genotype D8 that was involved in a measles outbreak in Turkey. Sequences of most genotype D8 strains (n = 51) were identical to the sequence of variant D8-Frankfurt-Main, which has been associated with outbreaks throughout Europe. Despite the lack of epidemiologic information, a phylogenetic analysis suggested that the genotype D8 MV may have been brought to Turkey from elsewhere. Phylogenetic and epidemiological findings suggested that strains identified in tourists and associated with importation included one strain of genotype D8, one strain of genotype B3, and one strain of genotype D4. These findings from the 2012 to 2013 outbreak in Turkey confirm that pockets of unimmunised individuals are making the country susceptible to measles outbreaks. To prevent further outbreaks, deliberate and sustained effort must be made to reach, and immunise susceptible age groups. Towards measles elimination process, continued molecular surveillance of measles strains in Turkey will help identify transmission patterns of virus and evaluate vaccination efforts. J. Med. Virol. 88:1867-1873, 2016. © 2016 Wiley Periodicals, Inc.

Epidemiology and prevention of prostate cancer in Vietnam.

Prostate cancer is the second most common cancer in men worldwide and a leading cause of mortality. Incidences continues to rise and vary substantially between populations. Although the prevalence of prostate cancer is relatively low in Vietnam, some hospital-based reports have shown an upward trend in recent years. While certain non-modifiable factors such as age, race and genetics are known to be mainly responsible, the literature has also suggested that environmental exposures can delay the onset of this disease. The present study provides a review of the epidemiology of prostate cancer in Vietnam by systematically searching several electronic databases. The results confirm an increasing trend of prostate cancer over the past decade, with age-standardised rate more than doubled from 2.2 per 100,000 men in 2000 to 4.7 per 100,000 men in 2010. However, no study has been found on modifiable risk factors, with the exception of one in vitro experiment that showed the inhibitory effect of garlic on the growth of prostate cancer cells. The lack of epidemiological information poses a difficulty to develop public health interventions to prevent this emerging malignant disease in Vietnam.

Factors associated with regulatory action involving investigation of illnesses associated with Shiga toxin-producing Escherichia coli in products regulated by the Food Safety and Inspection Service.

We described characteristics of the Escherichia coli O157 and Escherichia coli non-O157 illness investigations conducted by the United States Department of Agriculture's Food Safety and Inspection Service (FSIS) during the 5-year period from 2006 through 2010. We created a multivariable logistic regression model to determine characteristics of these investigations that were associated with FSIS regulatory action, which was defined as having occurred if a product recall occurred or if FSIS personnel performed an environmental health assessment (Food Safety Assessment) at the implicated establishment. During this period, FSIS took regulatory action in 38 of 88 (43%) investigations. Illness investigations in which FoodNet states were involved were more likely to result in regulatory action. Illness investigations in which state and local traceback, or FSIS traceback occurred were more likely to result in regulatory action. Reasons for lack of action included evidence of cross-contamination after the product left a regulated establishment, delayed notification, lack of epidemiological information, and insufficient product information.

Prevalence and risk factors of work-related musculoskeletal disorders in the catering industry: A systematic review\m{1}

This paper aims to systematically explore the prevalence and risk factors of Work-related Musculoskeletal Disorders (WMSDs) in the catering industry by reviewing relevant published literature with the goal of developing future prevention strategies. The systematic review was carried out in nine English medical databases, two Chinese-dominated full-text databases and seven web sites with the designated search strategies. Studies were included if they met the defined inclusion criteria hierarchically to investigate prevalence and or risk factors associated with WMSDs in the catering industry with appropriate epidemiological methodology. Nine English databases yielded 634 citations, and two Chinese databases yielded 401 citations, although only five English and three Chinese studies passed the inclusion criteria. Three-fourths of the studies were cross-sectional. The prevalence of WMSDs varied from 3% to 86% depending on the type of establishment and positions. The most important risk factors were physical job demands, such as work posture, force applied, and repeated movement. The lack of epidemiological information about WMSDs in the catering industry is apparent. Further studies are needed to investigate the relation among prevalence, risk factors and forms of WMSDs, in particular the interaction of risk factors in psychosocial aspects of the catering industry.

The Human African Trypanosomiasis Control and Surveillance Programme of the World Health Organization 2000–2009: The Way Forward

One century ago human African trypanosomiasis (HAT), also known as sleeping sickness, was believed to curb the development of colonial territories. As soon as the cause of the disease was clearly identified, colonial authorities established extensive control operations, fearing an unpopulated continent and a shortage of human labour to exploit natural resources. Systematic screening, treatment, and patient follow-up was established in western and central Africa for the gambiense form of the disease while, animal reservoir and vector control was mainly implemented in eastern and southern Africa for the rhodesiense form. By the 1960s, transmission was practically interrupted in all endemic areas, providing evidence that the elimination of the disease as a public health problem was feasible and could be achieved with basic tools. Thereafter, the rarity of cases led to a loss of interest in sustained surveillance, and the risk of re-emergence of the disease was overlooked. Thus in the 1980s the disease re-emerged. By the 1990s, flareups were observed throughout past endemic areas, leading to a worrisome increase in the number of reported cases. At this time, nongovernmental organizations (NGOs) played a crucial role in the control of HAT. However, their interventions were mainly focused on remote and insecure areas. As emergency operators, their policy understandably excluded support to National Sleeping Sickness Control Programmes (NSSCPs), which resulted in (i) the establishment of substitute HAT control systems (ii), the maintenance of a large part of the population at risk out of the umbrella of NGO projects, and (iii) the difficulty for national programmes to sustain control achievements after the NGOs’ withdrawal. Concurrently, bilateral cooperation continued to support NSSCPs in some historically linked countries. Concerning HAT screening, the card agglutination trypanosomiasis test (CATT) for serological screening of populations at risk of HAT gambiense was developed during the 1970s [1], but its large-scale production encountered many problems, hindering its availability [2]; in addition, production of anti-trypanosomal drugs was seriously threatened due to the lower economic return for manufacturers. Research for new diagnostic tools and drugs was scarce [3]. Only eflornithine, initially developed for cancer treatment, was finally registered for the treatment of the gambiense form of the disease in 1990 [4]. But its cost and complex distribution and administration requirements made it inappropriate for the under-equipped peripheral health services in remote rural areas where HAT was prevalent. Only some well-funded NGOs were able to afford the cost of eflornithine treatment. During the 1990s, security constraints due to civil wars and social upheavals complicated HAT control by preventing access to a large number of HAT-endemic areas, leading to difficulties in reaching a large number of affected populations and consequently to a considerable lack of epidemiological information. The World Health Organization (WHO) Expert Committee on HAT Control and Surveillance held in 1995, in consideration of the huge uncertainties between the reported cases and the factual field situation, estimated that the true number of cases was at least 10 times more than reported. Thus from the 30,000 reported cases annually, it was estimated that some 300,000 infected individuals remained ignored in the field [5]. In 1997, the 50th World Health Assembly expressed its concerns about the major recrudescence of cases by adopting a resolution to raise awareness and national and international interest [6]. Subsequently, WHO enhanced its coordinating role and promoted networking with partners, developing a strong advocacy and awareness campaign. As a result, the private sector recognized its responsibility, which led Aventis Pharma and Bayer Health Care to grant in 2001 and 2002 a substantial support to WHO for the control and surveillance of HAT. This support included HAT drug donation and financial contributions that allowed WHO to strengthen its support to diseaseendemic countries (DECs). The importance of the various components of the epidemiology of trypanosomiasis (human, animal, vector control, agricultural activity, and livestock production) and their impact on the development of rural Africa led WHO, in 1995, to promote together with the Food and Agriculture Organization (FAO), the International Atomic Energy Agency (IAEA), and the African Union InterAfrican Bureau for Animal Resources (AUIBAR), an inter-sectoral initiative that ultimately became, in 1997, the Programme Against African Trypanosomiasis (PAAT, http://www.fao.org/ag/againfo/ programmes/en/paat/disease.html). In parallel, African heads of state and governments established during the Afri-

Incidence and mortality of hip fracture among the elderly population in South Korea: a population-based study using the National Health Insurance claims data

BackgroundThe lack of epidemiologic information on osteoporotic hip fractures hampers the development of preventive or curative measures against osteoporosis in South Korea. We conducted a population-based study to estimate the annual incidence of hip fractures. Also, we examined factors associated with post-fracture mortality among Korean elderly to evaluate the impact of osteoporosis on our society and to identify high-risk populations.MethodsThe Korean National Health Insurance (NHI) claims database was used to identify the incidence of hip fractures, defined as patients having a claim record with a diagnosis of hip fracture and a hip fracture-related operation during 2003. The 6-month period prior to 2003 was set as a 'window period,' such that patients were defined as incident cases only if their first record of fracture was observed after the window period. Cox's proportional hazards model was used to investigate the relationship between survival time and baseline patient and provider characteristics available from the NHI data.ResultsThe age-standardized annual incidence rate of hip fractures requiring operation over 50 years of age was 146.38 per 100,000 women and 61.72 per 100,000 men, yielding a female to male ratio of 2.37. The 1-year mortality was 16.55%, which is 2.85 times higher than the mortality rate for the general population (5.8%) in this age group. The risk of post-fracture mortality at one year is significantly higher for males and for persons having lower socioeconomic status, living in places other than the capital city, not taking anti-osteoporosis pharmacologic therapy following fracture, or receiving fracture-associated operations from more advanced hospitals such as general or tertiary hospitals.ConclusionThis national epidemiological study will help raise awareness of osteoporotic hip fractures among the elderly population and hopefully motivate public health policy makers to develop effective national prevention strategies against osteoporosis to prevent hip fractures.

Worm infestation and the negative association with eczema (atopic/nonatopic) and allergic sensitization

Worm infestations may play a role in preventing allergies. There is a lack of epidemiological information from Western countries on the association between worm infestation and eczema. To investigate the association between worm infestation and eczema in a proper temporal sequence and under consideration of allergic sensitization. Two surveys were performed in East German school children. Questionnaire data included the history of eczema and worm infestation and their time of onset. Specific IgE antibodies to five common aeroallergens were measured and used to define nonatopic and atopic eczema. Logistic regression analyses were performed to control for relevant confounders (age, sex, parental school education and history of allergies). In order to confirm the findings a corresponding conditional regression analysis was applied on cases and controls matched by age and sex. A total of 4169 children participated (response 75 and 76%) who were, on average, 9.2 years old (47% girls). Overall 17.0% reported a prior worm infestation (Ascaris 44%, Oxyuris 33%) and 18.1% had a history of eczema. Eczema occurred significantly less frequent in children who had a worm infestation (prior to the onset of eczema) compared with children without such a history (8.1%vs 16.5%, OR(adj): 0.45, 95% CI: 0.33-0.60). The finding was confirmed by the corresponding matched case-control analysis (OR(adj): 0.57, 95% CI: 0.41-0.79). Atopic eczema was affected more by a prior worm infestation (OR(adj): 0.31, 95% CI: 0.18-0.56) than the nonatopic eczema (OR(adj): 0.58, 95% CI: 0.40-0.84). A total of 29.1% exhibited specific IgE antibodies to at least one aeroallergen. Sensitized children gave significantly less frequent a history of worm infestation (14.2%vs 18.3%, OR(adj): 0.74, 95% CI: 0.60-0.92). Stratified analysis revealed that this effect most pronounced for a sensitization to house dust mite. A worm infestation is associated with a reduced frequency of subsequent eczema, especially the atopic type. Furthermore allergic sensitization, especially to house dust mite, and worm infestation are negatively associated. The data support the concept that a lack of immune-stimulation by parasitic infections contributes to the development of allergies.

Wurminfestationen reduzieren das Risiko für ein atopisches Ekzem

Background Worm infestations may play a role in preventing allergic diseases. There is a lack of epidemiologic information from western countries on the association between worm infestation and atopic eczema (AE). The aim of this study was to investigate the association between worm infestation and AE in a proper temporal sequence and under consideration of the intrinsic and extrinsic subtype.

Congestive Heart Failure and QRS Duration: Establishing Prognosis Study

There is a lack of epidemiologic information about duration of QRS complex in the general heart failure population. We sought to describe age, sex, and clinical subset specific prevalence of QRS prolongation in this population. Data were abstracted from the Resource Utilization Among Congestive Heart Failure Study, which identified 29,686 patients with heart failure from a large, mixed-model managed-care organization during 1989 to 1999. A target population of 3,471 had echocardiographic data and ECG data obtained from automated sources during the first year of diagnosis. Systolic dysfunction was defined as heart failure plus a left ventricular ejection fraction < 45%. Among the heart failure population, 20.8% of the subjects had a QRS duration > or = 120 ms. A total of 425 men (24.7%) and 296 women (16.9%) had a prolonged QRS duration (p < 0.01). There was a linear relationship between increased QRS duration and decreased ejection fraction (p < 0.01). A prolonged QRS duration of 120 to 149 ms demonstrated increased mortality at 60 months (p = 0.001), when adjusted for age, sex, and race (p = 0.001). Systolic dysfunction was associated with graded increases in mortality across ascending levels of QRS prolongation. Approximately 20% of a generalized heart failure population can be expected to have a prolonged QRS duration within the first year of diagnosis, suggesting that as many as 20% of patients with heart failure may be candidates for biventricular pacing.