Provincial mortality in South Africa, 2000 - priority-setting for now and a benchmark for the future

Background. Cause-of-death statistics are an essential component of health information. Despite improvements, underregistration and misclassification of causes make it difficult to interpret the official death statistics. Objective. To estimate consistent cause-specific death rates for the year 2000 and to identify the leading causes of death and premature mortality in the provinces. Methods. Total number of deaths and population size were estimated using the Actuarial Society of South Africa ASSA2000 AIDS and demographic model. Cause-of-death profiles based on Statistics South Africa's 15% sample, adjusted for misclassification of deaths due to ill-defined causes and AIDS deaths due to indicator conditions, were applied to the total deaths by age and sex. Age-standardised rates and years of life lost were calculated using age weighting and discounting. Results. Life expectancy in KwaZulu-Natal and Mpumalanga is about 10 years lower than that in the Western Cape, the province with the lowest mortality rate. HIV/AIDS is the leading cause of premature mortality for all provinces. Mortality due to pre-transitional causes, such as diarrhoea, is more pronounced in the poorer and more rural provinces. In contrast, non-communicable disease mortality is similar across all provinces, although the cause profiles differ. Injury mortality rates are particularly high in provinces with large metropolitan areas and in Mpumalanga. Conclusion. The quadruple burden experienced in all provinces requires a broad range of interventions, including improved access to health care; ensuring that basic needs such as those related to water and sanitation are met; disease and injury prevention; and promotion of a healthy lifestyle. High death rates as a result of HIV/AIDS highlight the urgent need to accelerate the implementation of the treatment and prevention plan. In addition, there is an urgent need to improve the cause-of-death data system to provide reliable cause-of-death statistics at health district level.

Surveillance snapshot of Clostridium difficile infection in hospitals across Queensland detects binary toxin producing ribotype UK 244

In North America and Europe, the binary toxin positive Clostridium difficile strains of the ribotypes 027 and 078 have been associated with death, toxic megacolon and other adverse outcomes. Following an increase in C. difficile infections (CDIs) in Queensland, a prevalence study involving 175 hospitals was undertaken in early 2012, identifying 168 cases of CDI over a 2 month period. Patient demographics and clinical characteristics were recorded, and C. difficile isolates were ribotyped and tested for the presence of binary toxin genes. Most patients (106/168, 63.1%) were aged over 60 years. Overall, 98 (58.3%) developed symptoms after hospitalisation; 89 cases (53.0%) developed symptoms more than 48 hours after admission. Furthermore, 27 of the 62 (67.7%) patients who developed symptoms in the community ad been hospitalised within the last 3 months. Thirteen of the 168 (7.7%) cases identified had severe disease, resulting in admission to the Intensive Care Unit or death within 30 days of the onset of symptoms. The 3 most common ribotypes isolated were UK 002 (22.9%), UK 014 (13.3%) and the binary toxin-positive ribotype UK 244 (8.4%). The only other binary toxin positive ribotype isolated was UK 078 (n = 1). Of concern was the detection of the binary toxin positive ribotype UK 244, which has recently been described in other parts of Australia and New Zealand. No isolates were of the international epidemic clone of ribotype UK 027, although ribotype UK 244 is genetically related to this clone. Further studies are required to track the epidemiology of ribotype UK 244 in Australia and New Zealand. Commun Dis Intell 2014;38(4):E279–E284.

Household food insecurity, diet, and weight status in a disadvantaged district of Ho Chi Minh City, Vietnam: A cross-sectional study

Background Food security exists when all people, at all times, have physical, economic and socially acceptable access to safe, sufficient, and adequately nutritious food in order to meet their dietary needs for an active and healthy life. For high income countries and those experiencing the nutrition transition, food security is not only about the quantity of available food but also the nutritional quality as related to over- and under-nutrition. Vietnam is currently undergoing this nutrition transition, and as a result the relationship between food insecurity, socio-demographic factors and weight status is complex. The primary objective of this study was to therefore measure the prevalence of household food insecurity in a disadvantaged urban district in Ho Chi Minh City (HCMC) in Vietnam using a more comprehensive tool. This study also aims to examine the relationships between food insecurity and socio-demographic factors, weight status, and food intakes. Methods A cross-sectional study was conducted using multi-stage sampling. Adults who were mainly responsible for cooking were interviewed in 250 households. Data was collected on socioeconomic and demographic factors using previously validated tools. Food security was assessed using the Latin American and Caribbean Household Food Security Scale (ELCSA) tool and households were categorized as food secure or mildly, moderately or severely food insecure. Questions regarding food intake were based on routinely used and validated questions in HCMC, weight status was self-reported. Results Cronbach’s alpha coefficient was 0.87, showing the ELCSA had a good internal reliability. Approximately 34.4% of households were food insecure. Food insecurity was inversely related to total household income (OR = 0.09, 95% CI = 0.04 - 0.22) and fruit intakes (OR = 2.2, 95% CI 1.31 - 4.22). There was no association between weight and food security status. Conclusions Despite rapid industrialization and modernization, food insecurity remains an important public health issue in large urban areas of HCMC, suggesting that strategies to address food insecurity should be implemented in urban settings, and not just rural locations. Fruit consumption among food insecure households may be compromised because of financial difficulties, which may lead to poorer health outcomes particularly related to non-communicable disease prevention and management.

The health professional behind the syringe: Benefits of a pharmacist vaccination program

Background: The Queensland Pharmacist Immunisation Pilot (QPIP) which ran in 2014 was Australia’s first to allow pharmacists to administer vaccinations. An aim of QPIP was to investigate the benefits of trained pharmacists administering vaccinations in a community pharmacy setting. Methods: Participant demographics and previous influenza vaccination experiences were recorded using GuildCare software. Participants also completed a ‘post-vaccination satisfaction survey’ following their influenza vaccination. Results: A total of 10,889 participant records and 8,737 satisfaction surveys were analysed. Overall, 1.9% of the participants reported living with a chronic illness, and 22.5% were taking concomitant medications. As part of the consultation before receiving the vaccine, participants acknowledged the opportunity to discuss other aspects of their health with the pharmacist, including concerns about their general health, allergies, and other medications they were taking. It was worth noting that 17.5% of people would not have received an influenza vaccination if the QPIP service was unavailable. Additionally, approximately 10% of all participants were eligible to receive a free vaccination from the National Immunisation Program, but still opted to receive their vaccine from a pharmacist. Conclusion: The findings from this pilot demonstrate the benefit of a pharmacist vaccination program in increasing vaccination rates, and have helped pave the way for expanding the scope of practice for pharmacists.

Reproductive Biology of Amblema neislerii, Elliptoideus sloatianus, Lampsilis subangulata, Medionidus penicillatus, and Pleurobema pyriforme (Bivalvia: Unionidae): final report

A study on the reproductive biology of Amblema neislerii, Elliptoideus sloatianus, Lampsilis subangulata, Medionidus penicillatus, and Pleurobema pyriforme was conducted from May 1995 to May 1997. The objectives of this study were as follows: 1) determine period of gravidity for each of the five mussel species, 2) determine host fish via laboratory experiments, 3) test whether unionid glochidia will transform on a nonidingenous fish, and 4) describe the glochidial morphology for each of the five mussel species using a scanning electron microscope. Amblema neislerii are tachytictic breeders and were found with mature glochidia in May. Elliptoideus sloatianus are tachytictic breeders and were found with mature glochidia from late February to early April. Lampsilis subangulata are bradytictic breeders and were found with mature glochidia from December to August. Superconglutinates were released by L. subangulata from late May to early July. Medionidus penicillatus are bradytictic breeders and were found with mature glochidia in November and February to April. Pleurobema pyriforme are tachytictic breeders and were found with mature glochidia from March to July. The following fish species served as hosts for A. neislerii: Notropis texanus, Lepomis macrochirus, L. microlophus, Micropterus salmoides, and Percina nigrofasciata. The following fish species served as hosts for E. sloatianus: Gambusia holbrooki, Poecilia reticulata, and P. nigrofasciata. The following fish species served as hosts for L. subangulata: G. holbrooki, P. reticulata, L. macrochirus, Micropterus punctulatus, and M. salmoides. The following fish species served as hosts for M. penicillatus: G. holbrooki, P. reticulata, Etheostoma edwini, and P. nigrofasciata. The following fish species served as hosts for P. pyriforme: Pteronotropis hypselopterus, G. holbrooki, and P. reticulata. Poecilia reticulata, a nonindigenous fish, served as a host for E. sloatianus, L. subangulata, M. penicillatus, and P. pyriforme. (76 page document)

Baseline aquatic faunal survey of Avon Park Air Force Range, Florida: fishes, mollusks, and crayfishes

This report presents results of the first systematic study of the diversity and distribution of fishes and mussels in Avon Park Air Force Range (APR). We also provide information on crayfishes and aquatic snails taken during our fish and mussel sampling activities. Our surveys documented the presence of 46 species of fishes (43 native and 3 nonindigenous), 9 species of mussels (including 8 native and 1 nonindigenous species), 5 species of aquatic snails, and two crayfish species. (347 page document)

The health significance of heterotrophic bacteria in drinking water

Tap water is not sterile; it contains organisms which grow in water distribution systems or inside taps and their fittings. The absence of known pathogenic bacteria is assured by the absence of the indicator organisms but concerns have been raised in the past few years that drinking water fulfilling the standards laid down in the EC Directive ECC 80/778 may still cause disease. These concerns have arisen from several sources: the fact that a cause has been identified in only half of all suspected waterborne outbreaks of disease; reports have suggested that heterotrophic bacteria possessing single pathogenic mechanisms such as haemolysin may cause disease; reports of heterotrophic organisms causing water contact diseases in hospitals. These concerns led to a reappraisal of the pathogenic potential of heteretrophic bacteria, by carrying out an extensive literature search and review commissioned by the UK Water Research Company. This research identified many papers showing an association between drinking water and heterotrophic bacteria but only very few reports of suspected waterborne disease associated with the heterotrophs. The organisms demonstrating potential to cause disease were species of Aeromonas and Yersinia, but typing of organisms identified in patients and isolated from the water revealed very few similarities. The potential of Aeromonas and Yersinia to cause waterborne disease is thought to be very low and the Communicable Disease Surveillance Centre database of laboratory infections due to these two genera of organisms was analysed to produce population-related incidences for each health region in England and Wales. Additionally a laboratory questionnaire revealed different levels of ascertainment of these two organisms in different laboratories of the Public Health Laboratory Service.

Um panorama do tabagismo em 16 capitais brasileiras e Distrito Federal: tendências e heterogeneidades

Esta tese inclui dois artigos que têm por objetivo apresentar um panorama das tendências e heterogeneidades do tabagismo nas capitais brasileiras e, assim, oferecer subsídios ao planejamento e avaliação de medidas de controle do tabaco no País. Utilizaram-se os dados da Pesquisa Nacional sobre Saúde e Nutrição (PNSN), e do Inquérito Domiciliar Sobre Comportamentos de Risco e Morbidade Referida de Doenças e Agravos Não Transmissíveis (InqDANT). No primeiro artigo estimou-se a diferença na prevalência de tabagismo em 14 capitais brasileiras entre pessoas de 15 anos ou mais em 1989 (PNSN) e 2002/2003 (InqDANT) relacionando as mudanças observadas às principais medidas de controle do tabaco desenvolvidas no período. O estudo mostrou que o percentual de fumantes diminuiu de 30,2% para 19,4% no período. Entre homens, a prevalência passou de 37,5% para 23,2% (1,1% /ano) e entre mulheres, de 24,3% para 16,5% (0,6% /ano). A avaliação cronológica sugere que as principais medidas de impacto refletidas no decréscimo observado foram a lei que obriga que haja advertências sobre os malefícios do tabagismo nas embalagens e propagandas de cigarros, a restrição e proibição da propaganda de produtos do tabaco e as intervenções relacionadas à proteção ao tabagismo passivo. O declínio da prevalência observado no estudo foi um dos maiores do mundo. No segundo artigo, fez-se uma descrição da situação do tabagismo no Brasil considerando heterogeneidades regionais e de subgrupos populacionais a partir de uma amostra de 24.681 indivíduos de 15 anos ou mais residentes em 16 capitais brasileiras incluídas no InqDANT. A prevalência de tabagismo no gênero masculino variou de 17,0% a 28,2% e no feminino, de 10% a 22,9%. Entre mulheres, menores prevalências foram observadas nas regiões Norte, Nordeste e Centro-Oeste. Este padrão não se repetiu entre homens. Independentemente de gênero, maiores percentuais de fumantes foram encontrados entre pessoas de menor escolaridade e faixa etária 40-49 anos. A cessação média entre homens e mulheres foi de 50%. Os dados indicaram que as políticas públicas de controle do tabaco têm sido efetivas particularmente na indução à cessação de fumar. Contudo, a elevada prevalência em jovens mostrou a importância de reforço a medidas que contenham a iniciação. As heterogeneidades observadas mostraram a necessidade de ações específicas por região. Além dos dois estudos referidos, esta Tese também descreveu novas pesquisas sobre tabagismo utilizando-se dados do InqDANT. Subsequentemente, com base na discussão prévia, delineou-se uma proposta sumária das principais linhas de investigação a serem desenvolvidas no Brasil a fim de subsidiar o Programa Nacional de Controle do Tabagismo e a implantação da Convenção Quadro Para o Controle do Tabaco.

Perfil epidemiológico dos pacientes incluídos no Sistema de Cadastramento e Acompanhamento de Hipertensos e Diabéticos, no município de Rio Claro, RJ

Introdução. As doenças cardiovasculares constituem a principal causa de morbimortalidade na população brasileira. Desta forma, o Ministério da Saúde apresentou o HiperDia, um sistema de cadastramento e acompanhamento de portadores de HAS e DM atendidos na rede ambulatorial do SUS. Objetivo. Descrever o perfil dos hipertensos e diabéticos cadastrados no sistema HiperDia das oito unidades básicas do município de Rio Claro/RJ, no período de janeiro a dezembro de 2012. Métodos. Os dados de óbitos foram obtidos a partir do Sistema de Informações de Mortalidade (SIM), e as populações estimadas pelo IBGE, foram também obtidas na página do MS. As demais informações foram coletadas por meio de uma planilha de dados agregados, elaborada a partir da própria ficha de cadastramento do HiperDia e distribuído às unidades. Resultados. Pôde-se observar que a grande maioria dos pacientes cadastrados no HiperDia era portadora de hipertensão (95%) e que mais de 1/5 (21%) dos pacientes tinham as duas doenças concomitantemente. Além disso, mais de 4/5 (82%) dos pacientes com DM também apresentou HAS. As mulheres cadastradas foram maioria em ambas as doenças, tendo sido 63,2% e 71%, para HAS e DM, respectivamente. No que diz respeito à idade, ambas as doenças tiveram ocorrência mais elevada em grupos etários mais velhos, embora a prevalência de DM pareça ter se mantido constante para aqueles com 60 anos de idade ou mais. O fator de risco mais relevante para as duas doenças foi o sedentarismo, referido por 76% e 69% daqueles com HAS e DM, respectivamente. Conclusão. Conclui-se sobre a necessidade de modificar a ficha de coleta de dados do HiperDia e de monitoramento mais assíduo dos pacientes. Sugestões de Saúde Pública. Sugere-se inclusão de informações na ficha de coleta de dados do HiperDia sobre os níveis de glicemia e amputação de extremidades dos membros inferiores depois de três anos matriculados no programa, no caso de DM, e informação sobre a manutenção de níveis de pressão arterial sob controle, no caso de HAS, além de informações mais detalhadas sobre os fatores de risco referidos.

Epidemiological and nutrition transition in developing countries: impact on human health and development

Whereas common infectious and parasitic diseases such as malaria and the HIV/AIDS pandemic remain major unresolved health problems in many developing countries, emerging non-communicable diseases relating to diet and lifestyle have been increasing over the last two decades, thus creating a double burden of disease and impacting negatively on already over-stretched health services in these countries. Prevalence rates for type 2 diabetes mellitus and CVD in sub-Saharan Africa have seen a 10-fold increase in the last 20 years. In the Arab Gulf current prevalence rates are between 25 and 35% for the adult population, whilst evidence of the metabolic syndrome is emerging in children and adolescents. The present review focuses on the concept of the epidemiological and nutritional transition. It looks at historical trends in socio-economic status and lifestyle and trends in nutrition-related non-communicable diseases over the last two decades, particularly in developing countries with rising income levels, as well as the other extreme of poverty, chronic hunger and coping strategies and metabolic adaptations in fetal life that predispose to non-communicable disease risk in later life. The role of preventable environmental risk factors for obesity and the metabolic syndrome in developing countries is emphasized and also these challenges are related to meeting the millennium development goals. The possible implications of these changing trends for human and economic development in poorly-resourced healthcare settings and the implications for nutrition training are also discussed.

Association Testing of Previously Reported Variants in a Large Case-Control Meta-analysis of Diabetic Nephropathy

We formed the GEnetics of Nephropathy–an International Effort (GENIE) consortium to examine previously reported genetic associations with diabetic nephropathy (DN) in type 1 diabetes. GENIE consists of 6,366 similarly ascertained participants of European ancestry with type 1 diabetes, with and without DN, from the All Ireland-Warren 3-Genetics of Kidneys in Diabetes U.K. and Republic of Ireland (U.K.-R.O.I.) collection and the Finnish Diabetic Nephropathy Study (FinnDiane), combined with reanalyzed data from the Genetics of Kidneys in Diabetes U.S. Study (U.S. GoKinD). We found little evidence for the association of the EPO promoter polymorphism, rs161740, with the combined phenotype of proliferative retinopathy and end-stage renal disease in U.K.-R.O.I. (odds ratio [OR] 1.14, P = 0.19) or FinnDiane (OR 1.06, P = 0.60). However, a fixed-effects meta-analysis that included the previously reported cohorts retained a genome-wide significant association with that phenotype (OR 1.31, P = 2 × 10-9). An expanded investigation of the ELMO1 locus and genetic regions reported to be associated with DN in the U.S. GoKinD yielded only nominal statistical significance for these loci. Finally, top candidates identified in a recent meta-analysis failed to reach genome-wide significance. In conclusion, we were unable to replicate most of the previously reported genetic associations for DN, and significance for the EPO promoter association was attenuated.

Liderazgo educativo: revisión de la situación actual

Este trabajo lleva a cabo una compilación del material escrito acerca del liderazgo educativo, sus implicaciones sociales, educativas y culturales. Así mismo identifica las corrientes que actualmente predominan en el liderazgo educativo como es el Liderazgo pedagógico y el liderazgo administrativo. También brinda un acercamiento a los esfuerzos y la situación actual del liderazgo educativo en Colombia, con el fin de determinar si existe en efecto y liderazgo educativo efectivo en nuestro país. Este trabajo se lleva a cabo recopilando la información de la situación actual y literatura de varios países y encontrando puntos en comuna lo largo de los mismos.