Tackling health inequalities: 2004-06 data and policy update for the 2010 national target

This document provides an update on progress to meet the health inequalities national target to reduce the gap as measured by infant mortality and life expectancy, by 10% by 2010. It includes an assessment of whether the 70 spearhead area local authorities, which map to 62 PCTs, are on track to meet the life expectancy target.

Respiratory infection in congenital cardiac disease. Hospitalizations in young children in Spain during 2004 and 2005: the CIVIC Epidemiologic Study.

OBJECTIVES To evaluate the rate of hospitalization for acute respiratory tract infection in children less than 24 months with haemodynamically significant congenital cardiac disease, and to describe associated risk factors, preventive measures, aetiology, and clinical course. MATERIALS AND METHODS We followed 760 subjects from October 2004 through April 2005 in an epidemiological, multicentric, observational, follow-up, prospective study involving 53 Spanish hospitals. RESULTS Of our cohort, 79 patients (10.4%, 95% CI: 8.2%-12.6%) required a total of 105 admissions to hospital related to respiratory infections. The incidence rate was 21.4 new admissions per 1000 patients-months. Significant associated risk factors for hospitalization included, with odds ratios and 95% confidence intervals shown in parentheses: 22q11 deletion (8.2, 2.5-26.3), weight below the 10th centile (5.2, 1.6-17.4), previous respiratory disease (4.5, 2.3-8.6), incomplete immunoprophylaxis against respiratory syncytial virus (2.2, 1.2-3.9), trisomy 21 (2.1, 1.1-4.2), cardiopulmonary bypass (2.0, 1.1-3.4), and siblings aged less than 11 years old (1.7, 1.1-2.9). Bronchiolitis (51.4%), upper respiratory tract infections (25.7%), and pneumonia (20%) were the main diagnoses. An infectious agent was found in 37 cases (35.2%): respiratory syncytial virus in 25, Streptococcus pneumoniae in 5, and Haemophilus influenzae in 4. The odds ratio for hospitalization due to infection by the respiratory syncytial virus increases by 3.05 (95% CI: 2.14 to 4.35) in patients with incomplete prophylaxis. The median length of hospitalization was 7 days. In 18 patients (17.1%), the clinical course of respiratory infection was complicated and 2 died. CONCLUSIONS Hospital admissions for respiratory infection in young children with haemodynamically significant congenital cardiac disease are mainly associated with non-cardiac conditions, which may be genetic, malnutrition, or respiratory, and to cardiopulmonary bypass. Respiratory syncytial virus was the most commonly identified infectious agent. Incomplete immunoprophylaxis against the virus increased the risk of hospitalization.

Anàlisi sòcio-demogràfica del reagrupament familiar a Catalunya 2004-2010

Aquest treball parteix de l’anàlisi de les dades sobre informes d’adequació de l’habitatge per a l’obtenció d’una autorització de reagrupament familiar realitzats per l’Ajuntament de Barcelona des de 2005 fins 2009, i del registre administratiu de les sol•licituds de reagrupament familiar presentades a les quatre subdelegacions del Govern a Catalunya des de 2004 fins 2010. Per a procedir a la seva anàlisi s’ha hagut de fer un important treball de depuració, harmonització i anonimització d’unes dades procedents de registres administratius no pensades per la seva explotació estadística. L’anàlisi demogràfica ha posat en relleu la importància dels rols de gènere en les estratègies familiars que acabaran conformant el perfil sociodemogràfic tant de les persones reagrupades com de les reagrupadores. També s’ha pogut veure com no hi ha una relació directa entre les persones estrangeres residents en cada municipi i les pautes de reagrupament familiar. La davallada del reagrupament familiar és deguda en bona part a la crisi econòmica, no obstant per a entendre la seva evolució en conjunt cal tenir en compte a més els factors legislatius (la Normalització del 2005 que explica el creixement de 2006 i 2007, però també l’entrada dels romanesos a la UE en 2007), així com la pròpia dinàmica familiar de la població immigrada, amb un esgotament del potencial reagrupadors per a les nacionalitats que precisament protagonitzaren el boom migratori (llatinoamericans). La legislació en matèria de reagrupament familiar s’ha basat en tres principis que han tingut un efecte indubtable i de vegades contrari a l’esperat: 1) la discriminació entre raons econòmiques i familiars en les migracions; 2) La restricció del dret de reagrupar a la definició nuclear de la família; i, 3) L’assumpció de la formació pre-migratòria de la família a reagrupar. Els resultats d’aquest informe aporten indicis que aquesta aproximació apriorística ha tingut efectes perversos, començant pel volum considerable de reagrupacions de facto.

Molecular epidemiology of pseudomonas aeruginosae in intensive care units (ICUs) over a 10-year period (1998-2007)

Pseudomonas aeruginosa, une bactérie environnementale ubiquitaire, est un des pathogènes nosocomiaux les plus fréquents aux soins intensifs. La source de ce microorganisme peut être soit endogène, 2,6 à 24 % des patients hospitalisés étant colonisés au niveau digestif, soit exogène. La proportion des cas d'infections à P. aeruginosa d'origine exogène, donc secondaires à une transmission par manuportage ou par l'eau du réseau utilisée pour la toilette ou d'autres soins, reste débattue. Or une meilleure évaluation du taux d'infections exogènes est importante pour la mise en place de mesures de contrôle appropriées. Le but de cette étude était de déterminer sur une période de 10 ans les rôles respectifs des sources exogènes (robinets, autres patients) et endogène dans la colonisation et/ou l'infection par P.aeruginosa chez les patients des Soins Intensifs, ainsi que de documenter les variations épidémiologiques au cours du temps. L'étude a été menée dans les unités de Soins Intensifs du Centre Hospitalier Universitaire Vaudois (CHUV). Les patients colonisés et/ou infectés par P. aeruginosa entre 1998 et 2007ont été identifiés via la base de données du laboratoire de microbiologie. Ils ont été inclus dans l'étude s'ils étaient hospitalisés dans une des unités de Soins Intensifs, Durant cette période, des prélèvements pour recherche de P. aeruginosa ont été effectués sur des robinets des soins intensifs. Un typage moléculaire a été effectué sur toutes les souches cliniques et environnementales isolées en 1998, 2000, 2003, 2004 et 2007. Les patients inclus dans l'étude ont été répartis en quatre catégories (A-D) selon le résultat du typage moléculaire leur souche de P. aeruginosa. La catégorie A inclut les cas pour lesquels le génotype de P. aeruginosa est identique à un des génotypes retrouvé dans l'environnement. La catégorie B comprend les cas pour lesquels le génotype est identique à celui d'au moins un autre patient. La catégorie C comprend les cas avec un génotype unique et la catégorie D comprend les cas pour lesquels la souche était non disponible pour le typage. Les cas des catégories A et B sont considérés comme ayant une origine exogène. Au cours des années de l'étude, le nombre d'admissions aux soins intensifs est resté stable. En moyenne, 86 patients par année ont été identifiés colonisés ou infectés par P. aeruginosa aux Soins Intensifs. Durant la première année d'investigation, un grand nombre de patients colonisés par une souche de P. aeruginosa identique à une de celles retrouvées dans l'environnement a été mis en évidence. Par la suite, possiblement suite à l'augmentation de la température du réseau d'eau chaude, le nombre de cas dans la catégorie A a diminué. Dans la catégorie B, le nombre de cas varie de 1,9 à 20 cas/1000 admissions selon les années. Ce nombre est supérieur à 10 cas/1000 admissions en 1998, 2003 et 2007 et correspond à des situations épidémiques transitoires. Tout au long des 10 ans de l'étude, le nombre de cas dans la catégorie C (source endogène) est demeuré stable et indépendant des variations du nombre de cas dans les catégories A et B. En conclusion, la contribution relative des réservoirs endogène et exogène dans la colonisation et/ou l'infection des patients de soins Intensifs varie au cours du temps. Les facteurs principaux qui contribuent à de telles variations sont probablement le degré de contamination de l'environnement, la compliance des soignants aux mesures de contrôle des infections et la génétique du pathogène lui-même. Etant donné que ce germe est ubiquitaire dans l'environnement aqueux et colonise jusqu'à 15% des patients hospitalisés, la disparition de son réservoir endogène semble difficile. Cependant, cette étude démontre que son contrôle est possible dans l'environnement, notamment dans les robinets en augmentant la température de l'eau. De plus, si une souche multi-résistante est retrouvée de manière répétée dans l'environnement, des efforts doivent être mis en place pour éliminer cette souche. Des efforts doivent être également entrepris afin de limiter la transmission entre les patients, qui est une cause importante et récurrente de contamination exogène. - Pseudomonas aeruginosa is one of the leading nosocomial pathogens in intensive care units (ICUs). The source of this microorganism can be either endogenous or exogenous. The proportion of cases as a result of transmission is still debated, and its elucidation is important for implementing appropriate control measures. To understand the relative importance of exogenous vs. endogenous sources of P. aeru¬ginosa, molecular typing was performed on all available P. aeruginosa isolated from ICU clinical and environmental specimens in 1998, 2000, 2003, 2004 and 2007. Patient samples were classified according to their P. aeruginosa genotypes into three categories: (A) identical to isolate from faucet; (B) identical to at least one other patient sample and not found in faucet; and (C) unique genotype. Cases in cat¬egories A and Β were considered as possibly exogenous, and cases in category C as possibly endogenous. A mean of 34 cases per 1000 admissions per year were found to be colonized or infected by P. aeruginosa. Higher levels of faucet contamination were correlated with a higher number of cases in category A. The number of cases in category Β varied from 1.9 to 20 cases per 1000 admissions. This num¬ber exceeded 10/1000 admissions on three occasions and was correlated with an outbreak on one occasion. The number of cases con¬sidered as endogenous (category C) was stable and independent of the number of cases in categories A and B. The present study shows that repeated molecular typing can help identify variations in the epidemiology of P. aeruginosa in ICU patients and guide infection control measures.

Special Investigation of the Central Iowa Fair, For the Period July 1, 2004 through September 30, 2006

Other Audit Reports - Special Investigation

Reaudit report on the Lake Park Municipal Utilities for the period July 1, 2004 through June 30, 2005

Reaudit report on the Lake Park Municipal Utilities for the period July 1, 2004 through June 30, 2005

Relatório de Progresso da Implementação do PANA II - ANO 2007

Cabo Verde, país com um ecossistema frágil e não detentor de recursos minerais, aprovou em 2004 o Segundo Plano de Acção Nacional para o Ambiente – PANA II que constitui o documento de politica do sector ambiental, detendo deste modo todas as estratégias e acções com vista o alcance da sua visão que é “ uma sociedade consciente do papel e dos desafios do ambiente para um desenvolvimento económico e social sustentável, e consciente das suas responsabilidades relativamente às gerações futuras e determinada a utilizar os recursos naturais de maneira durável” A implementação do PANA II teve o seu início em 2005, estando assim a caminhar para o seu 4º ano de implementação em 2008. Nesses três anos de implementação, os resultados alcançados são muitos, mas entretanto os desafios são maiores. Para fazer face aos desafios que a implementação da politica ambiental nacional, sector transversal, o seguimento e monitorização de todos os projectos e actividades desenvolvidas pelos sectores e municípios é de suma importância, pois somente com uma monitorização eficiente e eficaz é possível quantificar os resultados obtidos e o alcance das metas previstas para os indicadores de qualidade ambiental previstas no PANA II. Um instrumento de monitorização da Implementação do PANA II é o relatório de progresso das diferentes actividades desenvolvidas no sector ambiental, pelos serviços centrais e pelos Municípios. O presente relatório diz respeito às actividades levadas a cabo no âmbito da implementação da politica ambiental do país - PANAII, referente ao ano de 2007. O Mesmo está estruturado em 6 partes: Introdução, Actividades Programadas, Estado da Implementação, Balanço dos Projectos Implementados, Investimento Realizados no Sector Ambiental e Recomendações.

Reaudit report on the Des Moines Independent Community School District for the period July 1, 2004 through June 30, 2005

Reaudit report on the Des Moines Independent Community School District for the period July 1, 2004 through June 30, 2005

Reaudit report on the City of Keosauqua for the period July 1, 2003 through June 30, 2004

Reaudit report on the City of Keosauqua for the period July 1, 2003 through June 30, 2004

Bioecología del bagre Galeichthys perubianus en el mar del Perú. Periodo 1998-2004

En el siguiente informe se presenta el estudio de la distribución espacio-temporal, abundancia, alimentación y reproducción de esta especie, durante un periodo de seis años, 1998-2004, frente a la costa peruana, y en particular de Lambayeque, norte del Perú.

Trends in the prevalence, risk and pregnancy outcome of multiple births with congenital anomaly: a registry-based study in 14 European countries 1984-2007.

OBJECTIVE: To assess the public health consequences of the rise in multiple births with respect to congenital anomalies. DESIGN: Descriptive epidemiological analysis of data from population-based congenital anomaly registries. SETTING: Fourteen European countries. POPULATION: A total of 5.4 million births 1984-2007, of which 3% were multiple births. METHODS: Cases of congenital anomaly included live births, fetal deaths from 20 weeks of gestation and terminations of pregnancy for fetal anomaly. MAIN OUTCOME MEASURES: Prevalence rates per 10,000 births and relative risk of congenital anomaly in multiple versus singleton births (1984-2007); proportion prenatally diagnosed, proportion by pregnancy outcome (2000-07). Proportion of pairs where both co-twins were cases. RESULTS: Prevalence of congenital anomalies from multiple births increased from 5.9 (1984-87) to 10.7 per 10,000 births (2004-07). Relative risk of nonchromosomal anomaly in multiple births was 1.35 (95% CI 1.31-1.39), increasing over time, and of chromosomal anomalies was 0.72 (95% CI 0.65-0.80), decreasing over time. In 11.4% of affected twin pairs both babies had congenital anomalies (2000-07). The prenatal diagnosis rate was similar for multiple and singleton pregnancies. Cases from multiple pregnancies were less likely to be terminations of pregnancy for fetal anomaly, odds ratio 0.41 (95% CI 0.35-0.48) and more likely to be stillbirths and neonatal deaths. CONCLUSIONS: The increase in babies who are both from a multiple pregnancy and affected by a congenital anomaly has implications for prenatal and postnatal service provision. The contribution of assisted reproductive technologies to the increase in risk needs further research. The deficit of chromosomal anomalies among multiple births has relevance for prenatal risk counselling.

Iowa Influenza Surveillance Network Final Report 2007-2008

The Iowa Influenza Surveillance Network (IISN) was formally established in 2004, though surveillance has been conducted at the Iowa Department of Public Health (IDPH) for more than ten years. The IISN is comprised of four primary surveillance systems- sentinel health care providers, hospital-based, laboratory-based, and school-based. Sentinel health care providers are part of the U.S. Influenza Sentinel Provider Surveillance System. All systems, except certain sentinel sites, report October-March. Schools and long-term care facilities report data weekly into a Web-based reporting system. Schools report the number of students absent due to illness and the total enrolled. Long-term care facilities report cases of influenza and vaccination status of each case. Both passively report outbreaks of illness, including influenza, to IDPH.

Commission on the Status of Iowans of Asian & Pacific Islander Heritage (CAPI), Spring 2007

In the Spring of 2004, the Iowa legislature passed the bill to establish the Commission on the Status of Iowans of Asian and Pacific Islander Heritage (CAPI) within the Department of Human Rights. Nine (9) commissioners were appointed by the Governor in October. In August 2006, the first division administrator was appointed; thus the Division was established. The duties of the Commission, as established in Iowa Code Chapter 216A.152, define the work of the Division. Vision: All Iowans live up to their potential, regardless of ethnicity, station in life, and religion. Mission: To empower Asians and Pacific Islanders, improve their well-being, and celebrate a diverse Iowa.

Iowa Commission on the Status of African-Americans Department of Human Rights Strategic Plan, 2004

The Commission on the Status of African-Americans, formerly known as the Commission on the Status of Blacks, was created by statute in 1988. The nine members of the commission are appointed by the Governor and represent each region of the State where there is a significant African-American population. Meetings are open to the public. The commission sets policy for and provides direction to the Division of the Status of African-Americans within the Department of Human Rights. The division administrator is appointed by the Governor and confirmed by the Iowa Senate.