Withholding antimalarials in febrile children who have a negative result for a rapid diagnostic test.

BACKGROUND: The availability of a rapid diagnostic test for malaria (RDTm) allows accurate diagnosis at all levels of health facilities. The objective of the present study was to evaluate the safety of withholding antimalarials in febrile children who have a negative test result. METHODS: We conducted a prospective 2-arm longitudinal study in areas of Tanzania that are moderately and highly endemic for malaria. Children with a history of fever were managed routinely by resident clinicians of 2 health facilities, except that no antimalarials were prescribed if the RDTm result was negative. Children were followed up at home on day 7. The main outcome was the occurrence of complications in children with negative RDTm results; children with positive RDTm results were followed up for the same outcomes for indirect comparison. RESULTS: One thousand children (median age, 24 months) were recruited. Six hundred three children (60%) had a negative RDTm result. Five hundred seventy-three (97%) of these children were cured on day 7. Forty-nine (8%) of the children with negative RDTm results spontaneously visited the dispensary before day 7, compared with 10 (3%) of the children with positive RDTm results. All children who had negative initial results had negative results again when they were tested either at spontaneous attendance or on day 7 because they were not cured clinically, except for 3 who gave positive results on days 2, 4, and 7 respectively but who did not experience any complication. Four children who had negative initial results were admitted to the hospital subsequently, all with negative results for malaria tests upon admission. Two of them died, of causes other than malaria. CONCLUSIONS: Not giving antimalarial drugs in febrile children who had a negative RDTm result was safe, even in an area highly endemic for malaria. Our study provides evidence for treatment recommendations based on parasitological diagnosis in children <5 years old.

Isolation of Pseudomonas cepacia in cystic fibrosis patient

Pulmonary infection on cystic fibrosis (CF) patients are associated with a limited qualitative number of microorganisms. During the colonization process, Staphylococcus aureus usually preceedes Pseudomonas aeruginosa. This latter is at first non-mucoid, being replaced or associated to a mucoid morphotype which is rare in other diseases. In 1980, Pseudomonas cepacia appeared as an important agent in CF pulmonary infections with a mean frequency of about 6.1% isolations in different parts of the world. The primus colonization mainly occurs in the presence of pre-existent tissue lesions and the clinical progress of the disease is variable. In some patients it can be fulminant; in others it can cause a gradual and slow decrease in their pulmonary functions. The concern with this germ isolation is justified by its antibiotic multiple resistence and the possibility of direct transmission from a colonized patient to a non-colonized one. We reported the first case of P. cepacia infection in a CF patient in our area. The microbiological attendance to this patient had been made from 1986 to 1991 and the first positive culture appeared in 1988. The sensitivity profile showed that the primus colonization strain was sensitive to 9 of 17 tested antibiotics, however in the last culture the strain was resistent to all antibiotics. These data corroborate the need for monitoring the bacterial flora on CF patients respiratory system.

Risc i efectes a la salut de la desinfecció de l'aigua: una aproximació a la relació entre els subproductes de la cloració de l'aigua i el càncer colorectal

Aquest projecte es centra en l'estimació del risc ambiental que suposen els subproductes de la desinfecció de l'aigua (amb els trihalometans com a marcadors) per a la incidència de càncer colorectal. Això s'estudia mesurant les exposicions i usos de l'aigua d'un grup de casos i controls a diversos llocs de l'Estat Espanyol, comparant els nivells de trihalometans d'aquestes ciutats, estimant-ne l'absorció i, per últim, calculant-ne el risc mitjançant la odds ratio (probabilitat de patir la malaltia dividit per la probabilitat de no desenvolupar-la). Per assolir-ho és vital l'acurada estimació de l'exposició de la població a aquests productes, ja que, tot i que l'aigua de xarxa és una exposició ubiqua i, per tant, ambiental, hi ha persones més exposades que d'altres. Comparant els nivells de trihalometans arreu d'Espanya, la qualitat de l'aigua de consum varia molt als diferents llocs d'estudi, essent Barcelona la de pitjor qualitat ambiental i Guipúscoa la millor. La primera estimació al risc (l'estudi oficial, dut a terme pel Centre de Recerca en Epidemiologia Ambiental, no està conclòs) dóna positiu en la majoria d'exposicions, amb l'excepció de l'assistència a piscines durant l'hivern.

Anàlisi ambiental de les platges de Sitges: evolució de la qualitat del litoral i estudi d'impactes

L’explosió del sector turístic experimentat en les costes catalanes des de principis dels anys 60 ha provocat un important impacte sobre el medi litoral català i el seu principal atractiu turístic, les platges. Sitges és un municipi annex a una important zona urbana (Barcelona), i s'ofereix com a indret de segona residència i ciutat de vacances, sobretot a l’estiu, incrementant fortament la pressió sobre el medi. L'objectiu principal d'aquest projecte ha estat estudiar les pertorbacions sobre alguns aspectes del sistema litoral Sitgetà: el perfil litoral i la dinàmica sedimentària, la qualitat microbiològica de les aigües i la sorra, els cabals d'aigües residuals tractades i els residus de les platges. A partir dels registres de neteja en platges, proposem el rebuig i envasos en sorra (concentració de residus, kg/m2) com a nou indicador de presència d’usuaris a les platges (usuaris/m2). La diagnosi realitzada indica que l'estat físic de les platges de Sitges respon a les actuacions en matèria d'obres marítimes en interacció amb les dinàmiques sedimentaries. Pel que fa als anàlisis microbiològics de l'aigua i la sorra trobem una situació regulada a excepció de pics provocats per pluges puntuals. Malauradament hem vist com es podrien potenciar el valors ambientals de totes les parts treballades si es fomentessin figures de protecció del medi, la regeneració d’espècies vegetals tan fora com dins de l'aigua i es garantís una gestió de l’aigua 100% eficient i sense causar intromissions en el desenvolupament dels ecosistemes.

Aprendre a Ensenyar a Resoldre Problemes

La finalitat general del projecte és la millora de la formació dels estudiants de magisteri i de professorat, pel que fa a la seva visió i els seus coneixements sobre l'ensenyament i aprenentatge de les matemàtiques, a partir d'una redefinició de les diferents assignatures de didàctica de les matemàtiques. Es pren l'aprenentatge de l'ensenyament de la resolució de problemes com a eix vertebrador de les assignatures, introduint la realitat de l'aula per mitjà de la interpretació de casos professionals gravats en videoclips. El projecte pretén elaborar materials docents així com dissenyar i experimentar noves metodologies, tant en l'àmbit presencial com virtual, i al mateix temps fomentar la coordinació del professorat que imparteix les assignatures de didàctica. Tot el material es recollirà en una base de dades en l'ADRE, que permetrà la consulta tant presencial com virtual dels materials docents i casos professionals recollits per parts de l'alumnat i professorat. Els objectius a assolits responen a la finalitat del projecte i estan relacionats amb moltes de les prioritats de la convocatòria, ja que impliquen, entre altres coses, la producció de material docent, l’experimentació de noves metodologies i la interrelació entre teoria i pràctica professional.

Mesurer la pratique religieuse: différentes enquêtes, différents taux? Analyse comparative à partir de la Suisse

In Switzerland, national census data imply that 84.5 percent are affiliated with religious groups and national survey data imply that 15 percent attend a service on a given weekend in 2009. Research in other countries has shown that attendance is often over-reported, but the level of over-report varies across countries. Thus, in the United States, polls show high and stable levels of religious practice, while Church participation surveys indicate rates twice lower. This article assesses the validity of self-reported affiliation and attendance in Switzerland using the 2009 Swiss National Congregations Study (NCS). Results confirm the observation offered by others that the Swiss census undercounts the persuasions absent from the stylized response categories and they show for the first time that Swiss probably over-report their church attendance, though not as much as in the United States.

Understanding the religious behaviour of Muslims in the Netherlands and the UK

The position of Muslims in Western societies is the subject of intense study and debate. However, remarkably little attention has been paid to the practice of European Muslims and how Muslim religiosity relates to conventional measures of social and economic integration. In this paper we draw on theories of secularization, assimilation, revitalization and integration to explore the correlates of attendance at religious meetings for Muslims of different backgrounds in the Netherlands and the UK. We conclude that patterns of religiosity and secularisation cannot be generalised across national contexts.

Nasopharyngeal carriage of individual Streptococcus pneumoniae serotypes during pediatric radiologically confirmed community acquired pneumonia following PCV7 introduction in Switzerland.

BACKGROUND: Community-acquired pneumonia (CAP) is a serious cause of morbidity among children in developed countries. The real impact of 7-valent pneumococcal conjugate vaccine (PCV7) on pneumococcal pneumonia is difficult to assess accurately. METHODS: Children aged ≤16 years with clinical and radiological pneumonia were enrolled in a multicenter prospective study. Children aged ≤16 years admitted for a minor elective surgery was recruited as controls. Nasopharyngeal samples for PCR serotyping of S. pneumoniae were obtained in both groups. Informations on age, gender, PCV7 vaccination status, day care/school attendance, siblings, tobacco exposure were collected. RESULTS: In children with CAP (n=236), 54% of the nasopharyngeal swabs were PCR-positive for S. pneumoniae compared to 32% in controls (n=105) (p=0.003). Serotype 19A was the most common pneumococcal serotype carried in children with CAP (13%) and in controls (15%). Most common serotypes were non-vaccine types (39.4% for CAP and 47.1% for controls) and serotypes included only in PCV13 (32.3% for CAP and 23.5% for controls). There was no significant difference in vaccine serotype distribution between the two groups. In fully vaccinated children with CAP, the proportion of serotypes carried only in PCV13 was higher (51.4%) than in partially vaccinated or non vaccinated children (27.6% and 28.6% respectively, p=0.037). CONCLUSIONS: Two to 4 years following introduction of PCV7, predominant S. pneumoniae serotypes carried in children with CAP were non PCV7 serotypes, and the 6 new serotypes included in PCV13 accounted for 51.4% of carried serotypes in fully vaccinated children.

Regional Advisory Committee on Cancer - Report on Endocrine Cancer (September 2004) (PDF 144 KB)

There is already a good infrastructure for the management of endocrine cancer in Northern Ireland but to develop and strengthen it we recommend the following: • Increasing the already close cooperation between the individual parts of the service for endocrine cancer by use of shared protocols for assessment and follow up: • The main hub of management should remain at the RGH focussed on The Regional Centre for Endocrinology and Diabetes and the Endocrine Surgery department where there has been a long-term interest in the management of these patients. This includes a close working relationship between the endocrinologists and surgeon at the Belfast City Hospital. • This does not suggest that current developments of shared follow-up should not be encouraged. They should but with the provision of adequately resourced registers to allow adequate audit and to ensure adequate assessment of follow-up attendance. The issues regarding informed consent for such registers are currently being discussed for all forms of cancer. In the rarer conditions follow-up should remain central to allow adequate numbers and experience to maintain internationally recognisable outcomes and to allow training of future specialists to continue åÊ

Missed appointments in an adolescent outpatient clinic: descriptive analyses of consultations over 8 years.

Missed appointments represent an important medical and economical issue. Few studies on the subject are reported in the literature, particularly regarding adolescents. Our aim was to characterize missed and cancelled appointments in a multidisciplinary outpatient clinic for adolescents, to assess the effectiveness of a policy aimed at reducing missed appointments by introducing payment for those missed appointments not cancelled in advance, and to compare the rates between staff and resident physicians. A total of 32,816 consultations (representing 35 patients aged 12-20 years, 82.4% females) between 1999 and 200 were analysed. The missed appointment rate was 11.8% whilst another 10.9% were cancellations. Females cancelled more than males (11.3% vs. 8.4%, AOR 1.31, 99% CI 1.08-1.59), but there was no difference for missed appointments (11.6% vs. 12.3%, AOR 0.88, 99% CI 0.61-1.08). April and June to October (vacation months) were associated with more missed appointments. Globally mornings had higher rates of missed appointments than afternoons (13.6% vs. 11.2%, AOR 1.25, 99% CI 1.11-1.40). There was a slight difference in missed appointment rates between staff physicians and residents (10.4%; 11.8%, AOR 1.20, 99% CI 1.08-1.33). Missed appointment rates before and after the new policy on missed appointments were similar (1999-2003: 11.9%; 2004-2006: 11.6%, AOR 0.96, 99% CI 0.83-1.10). Conversely, cancellation rates increased from 8.4% (1999-2003) to 14.5% (2004-2006) (AOR 1.83, 99% CI 1.63-2.05). Attendance rates among adolescents show variations depending on vacation and school hours. Being attentive to these factors could help prevent missed appointments. Although having to pay for missed appointments does not increase attendance, it increases cancellations with the advantage that the appointment can be rescheduled.

Memòria metodològica de treball plantejada per a l'elaboració del projecte Alfabetització informacional : disseny d'estratègies, de serveis i recursos per a la fidelització d'usuaris de la biblioteca universitària

El treball se centra en l'anàlisi de les causes de la baixa participació en les sessions de formació d'usuaris per part dels estudiants, professors i investigadors universitaris de la Biblioteca de Física i Química de la Universitat de Barcelona. Es remarca la importància d'aquesta formació en la cerca, selecció i difusió de la informació així com la inclusió d'un programa d'alfabetització informacional. Es presenten possibles solucions i propostes per tal d'augmentar aquesta assistència (major difusió, publicitat...), amortitzar els recursos i serveis que preparen els bibliotecaris i en definitiva fidelitzar aquests usuaris.

Rise & Shine Breakfast Club

The Rise ‘n’ Shine club was set up in January 2013. The main aims of the club are to improve attendance, increase participation in class, and reinforce healthy eating policy in pupils. The club is run each morning by a group of volunteers which includes teachers, parents and 6th class children. The Home School Community Liaison Officer co-ordinates the club. On average, 20 – 25 girls attend each morning. A selection of cereals is served each morning along with toast and fruit juice. Different foods are served for special occasions, such as pancakes on Pancake Tuesday. This club is part of the Pilot Programme of Breakfast Clubs which is funded through Kellogg's Corporate Citizenship Fund. Part of theBreakfast Clubs Pilot Programme Initiative Type Breakfast Clubs Location Dublin 5 Target Groups Children ( 4-12 years) Funding This club is part of the Pilot Programme of Breakfast Clubs which is funded through Kellogg's Corporate Citizenship Fund. Start 13th Jan 2013

The Breakfast Club

The Breakfast Club was set up in January 2013. The aim of the breakfast club is to provide pupils with breakfast in a safe, structured and warm environment at the beginning of each school day so as to enhance their - Concentration- Attendance and punctuality- Nutrition- Social and personal development- Communication skills. The club is run by two parents and co-ordinated by the school principal. On average, 15 children attend the breakfast club each morning. A selection of cereals, fruit, toast and fruit juice are served each morning. All food is laid out in a buffet-style and children can serve themselves (with a little help from staff if needed). The breakfast club is part of the Pilot Programme of Breakfast Clubs which is funded through the Kellogg's Corporate Citizenship Fund. Part of theBreakfast Clubs Pilot Programme Initiative Type Breakfast Clubs Location Dublin 7 Target Groups Children ( 4-12 years) Funding The breakfast club is part of the Pilot Programme of Breakfast Clubs which is funded through the Kellogg's Corporate Citizenship Fund. Start 20th Jan 2013

Alcohol and nonlethal injuries: a Swiss emergency department study on the risk relationship between acute alcohol consumption and type of injury.

BACKGROUND: Acute alcohol consumption has been reported to be an important risk factor for injury, but clear scientific evidence on issues such as injury type is not available. The present study aims to improve the knowledge of the importance of alcohol consumption as an injury determinant with regards to two dimensions of the type of injury, namely the nature and the body region involved. METHODS: Risk relationships between two injury type components and acute alcohol use were estimated through multinomial and logistic regression models based on data from 7,529 patients-among whom 3,682 had injury diagnoses-gathered in a Swiss emergency department. RESULTS: Depending on the type of injury, between 31.1% and 48.7% of casualties report alcohol use before emergency department attendance. The multinomial regression models show that even low alcohol levels are consistently associated with nearly all natures of injury and body regions. A persistent dose-response effect between alcohol levels and risk associations was observed for almost all injury types. CONCLUSIONS: The results highlight the importance and consistency of the risk association between low and moderate levels of acute alcohol consumption and all types of injury. None of the body regions and natures of injury could pride on absence of association between alcohol and injury. Public health, prevention, and care implications are considered.

Activ8: A children and obesity project

This project is a 6 x weekly food and activity programme using the local sports centre as a venue. Overweight/obese children, together with a parent / carer and sibling were recruited. A lifestyle pre-course assessment was made with each child, resulting in 5 individual goals. Evaluation was based on attendance; individual goals; post course questionnaire; anthropometric measurements and a food diary. Follow up at 4/52,3/12 and 6/12.