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.

Iowa Influenza Surveillance Network Final Report 2006-2008

The Iowa Influenza Surveillance Network (IISN) tracks the overall activity, age groups impacted, outbreaks, type and strain, and severity of seasonal influenza. In the 2006-2007 season the network had more than 90 reporting sites that included physicians, clinics, hospitals, schools and long term care facilities (Appendix A). Other non-network reporters who contributed influenza data included medical clinics, hospitals, laboratories, local public health departments and neighboring state health departments. 010203040506070424548495051521234567891011121314MMWR weekNumber of cases2006-20072005-2006 The 2006-2007 influenza season in Iowa began earlier than any previously recorded data indicates, however, the season’s peak occurred much later in the season. In addition to early cases, this season was also unusual in that all three anticipated strains (AH1N1, AH3N2, and B) were reported by the first of December (Appendix B). The first laboratory-confirmed case in the 2005-2006 season was identified December 5, 2005; the first case for the 2006-2007 season was on November 2, 2006. The predominant strain for 2005-2006 was influenza AH3, but for 2006-2007 both influenza AH1 and B dominated influenza infections. However improvements in influenza specimen submission to the University Hygienic Laboratory may have also played a role in early detection and overall case detection. In summary, all influenza activity indicators show a peak between the MMWR weeks 5 and 9 (i.e. February 14- March 4). Children from five years to eight years of age were impacted more than other age groups. There were few influenza hospitalizations and fatalities in all age groups.

Surveillance Network Overview, 2007-2008

Seasonal influenza surveillance is conducted October through March every year. The overall goal of surveillance is to be able to characterize the impact of seasonal influenza to create and design interventions that might reduce the burden of disease.

Maintenance of neuronal expression of calbindin by a muscular extract in cultures of chick dorsal root ganglion cells.

Calbindin D-28K is a calcium-binding protein which is expressed by subpopulations of dorsal root ganglion cells cultured from 10-day-old (E10) chick embryos. After 7 or 10 days of culture, more than 20% of the ganglion cells are immunostained by an anticalbindin-antiserum; however, after 14 days of culture, the proportion drops to 10%. This fall can be prevented by addition of muscle extract to cultures at 10 days. Thus the transitory expression of calbindin-immunoreactivity by responsive sensory neurons would be not only induced but also maintained by a differentiation factor of muscular origin.

Dépistage du cancer colorectal: surveillance après résection de polypes coliques ou d'un cancer colorectal [Colorectal cancer screening: follow-up of patients with adenomatous and colorectal cancer]

Les différentes méthodes de dépistage du cancer colorectal sont présentées et commentées. Nos recommandations restent inchangées : à partir de 50 ans, une coloscopie de dépistage est indiquée chez les personnes saines sans risque particulier de développer un cancer colorectal. Les acquisitions de 2007 : lors d'une conférence de consensus interdisciplinaire, de nouvelles recommandations suisses ont été élaborées pour le suivi de patients opérés d'un cancer colorectal ou après polypectomie colorectale. The different methods of colorectal cancer screening are discussed. Our recommendations had not changed: we recommend as colorectal cancer screening a colonoscopy at the age of 50 years in all healthy persons with average risk for colorectal cancer. A 2007 interdisciplinary consensus conference revised the Swiss recommendations for the follow-up of patients with operated colorectal cancer or after polypectomy

Développement d'outils de surveillance biologique pour l'évaluation des risques à la santé de travailleurs en arboriculture et en viticulture exposés aux fongicides

De nombreux travailleurs utilisent le captan et le folpet comme fongicides en agriculture, mais leur exposition n'est pas toujours mesurée de manière spécifique et précise. La surveillance biologique est un excellent outil à cet effet puisqu'elle permet de quantifier l'exposition réelle. Toutefois, la majorité des connaissances toxicologiques pour ces fongicides proviennent d'études sur les animaux, et les données chez l'humain sont limitées.Le but du présent projet est donc de développer des outils de surveillance biologique pour évaluer l'exposition de travailleurs au captan et au folpet. Dans cette perspective, le projet a été subdivisé en trois parties complémentaires, soit i) de développer des méthodes analytiques spécifiques pour quantifier les biomarqueurs d'intérêt du captan, à savoir le tétrahydrophtalimide (THPI), et du folpet, à savoir le phtalimide (PI) et l'acide phtalique, dans le plasma et l'urine; ii) de déterminer la toxicocinétique des deux fongicides en exposant desvolontaires de façon aigüe à de faibles doses de captan ou de folpet par voie orale et cutanée dans des conditions semi-contrôlées et en quantifiant les biomarqueurs dans chacune des deux matrices, excepté l'acide phtalique qui a été mesuré seulement dans l'urine; iii) de valider les biomarqueurs d'exposition sélectionnés et d'évaluer l'exposition réelle des travailleurs et les voies prédominantes d'exposition au captan et au folpet en collectant des données biologiques chez des travailleurs en arboriculture et en viticulture lors d'activités de traitement et d'effeuillage pendant sept jours consécutifs.Selon ces travaux, le THPI et le PI sont deux biomarqueurs valides et spécifiques pour quantifier l'exposition au captan et au folpet, respectivement, chez l'humain. En effet, les méthodes développées pour ces deux métabolites sont robustes avec des limites de détection plus sensibles que celles rapportées dans la littérature, un taux de recouvrement de 90% pour le THPI et de 75% pour le PI, une très bonne linéarité (R2>0,99) et une bonne stabilité avec des variations intra- et inter-journalières faibles (RSD<15%). Elles ont permis de déterminer les profils cinétiques des deux métabolites chez les volontaires et chez les travailleurs. Ces derniers indiquent d'ailleurs une élimination rapide, avec une demi-vie d'élimination dans l'urine de 11,7 h et 18,7 h pour le THPI et de 27,3 h et 28,8 h pour le PI, respectivement après une absorption par voie orale et cutanée, ainsi qu'une faible absorption cutanée lorsque les valeurs sont comparées pour les deux voies d'exposition. Des profils parallèles sont aussi observés entre le PI et l'acide phtalique pour les volontaires et les agriculteurs, mais le folpet se retrouve davantage métabolisé sous forme d'acide phtalique que de PI. Quant à l'étude des agriculteurs, elle montre que la voie principale d'exposition de ces travailleurs est la voiecutanée. Il est aussi souligné qu'il est important 1) de favoriser les collectes d'urines complètes sur 24 h au urines ponctuelles, 2) de mesurer plusieurs métabolites, et 3) d'associer les données de surveillance biologique à la toxicocinétique. Ainsi, les connaissances acquises par cette étude peuvent s'appliquer à d'autres fongicides, voire d'autres substances.

Changes of beta-amyloid precursor protein splice patterns in brain cell aggregate cultures.

The splice pattern of beta-amyloid precursor protein (beta-APP) has been studied in a variety of neuronal and glial cells and in brain cell aggregate cultures by the polymerase chain reaction (PCR). The brain-typical pattern, in which beta-APP695 is the dominant form, has been found only in aggregate cultures but not in any of the other cell types including neuronal cell lines. Selective elimination of glial cells from aggregates resulted in increased quantities of beta-APP695, whereas removal of neurons led to a reduction of beta-APP695 and to an elevation of beta-APP751 and beta-APP770. This shift of splice pattern was not observed in cocultures of the neuronal cell line PC 12 with primary astrocytes combined in a variety of cellular ratios. Blood serum, which is an essential component of these cultures, tested on aggregates, did not reduce the amount of beta-APP695 or have any marked effects on splice patterns generally. From these results it is concluded that investigations on brain-typical splicing of beta-APP require primary neurons. Neuronal cell lines may be no suitable model systems. Splicing events favoring production of beta-APP695 may mark an important, very early step of amyloid formation in the brain.

Prevention of vitamin K deficiency bleeding with three oral mixed micellar phylloquinone doses: results of a 6-year (2005-2011) surveillance in Switzerland.

In 2003, the Swiss guidelines to prevent vitamin K deficiency bleeding (VKDB) were adapted. As two oral doses (2 mg, hour/day 4) of mixed micellar VK preparation had failed to abolish late VKDB, a third dose (week 4) was introduced. This report summarizes the new guidelines acceptance by Swiss pediatricians and the results of a prospective 6-year surveillance to study their influence on the incidence of VKDB. The new guidelines acceptance by Swiss pediatricians was evaluated by a questionnaire sent to all pediatricians of the Swiss Society of Paediatrics. With the help of the Swiss Paediatric Surveillance Unit, the incidence of VKDB was monitored prospectively from July 1, 2005 until June 30, 2011. Over a 6-year period (458,184 live births), there was one case of early and four cases of late VKDB. Overall incidence was 1.09/10(5) (95 % confidence intervals (CI) 0.4-2.6). Late VKDB incidence was 0.87/10(5) (95 % CI 0.24-2.24). All four infants with late VKDB had an undiagnosed cholestasis at the time of bleeding; parents of 3/4 had refused VK prophylaxis, and in 1/4, the third VK dose had been forgotten. Compared with historical control who had received only two oral doses of mixed micellar VK (18 cases for 475,372 live births), the incidence of late VKDB was significantly lower with three oral doses (Chi(2),Yates correction, P = 0.007). CONCLUSION: VKDB prophylaxis with 3 × 2 mg oral doses of mixed micellar VK seems to prevent adequately infants from VKDB. The main risk factors for VKDB in breast-fed infants are parental VK prophylaxis refusal or an unknown cholestasis.

Non-Risk-Adapted Surveillance in Clinical Stage I Nonseminomatous Germ Cell Tumors: The Princess Margaret Hospital's Experience.

BACKGROUND: Since 1981 Princess Margaret Hospital has used initial active surveillance (AS) with delayed treatment at relapse as the preferred management for all patients with clinical stage I nonseminomatous germ cell tumors (NSGCT). OBJECTIVE: Our aim was to report our overall AS experience and compare outcomes over different periods using this non-risk-adapted approach. DESIGN, SETTING, AND PARTICIPANTS: Three hundred and seventy-one patients with stage I NSGCT were managed by AS from 1981 to 2005. For analysis by time period, patients were divided into two cohorts by diagnosis date: initial cohort, 1981-1992 (n=157), and recent cohort, 1993-2005 (n=214). INTERVENTION: Patients were followed at regular intervals, and treatment was only given for relapse. MEASUREMENTS: Recurrence rates, time to relapse, risk factors for recurrence, disease-specific survival, and overall survival were determined. RESULTS AND LIMITATIONS: With a median follow-up of 6.3 yr, 104 patients (28%) relapsed: 53 of 157 (33.8%) in the initial group and 51 of 214 (23.8%) in the recent group. Median time to relapse was 7 mo. Lymphovascular invasion (p<0.0001) and pure embryonal carcinoma (p=0.02) were independent predictors of recurrence; 125 patients (33.7%) were designated as high risk based on the presence of one or both factors. In the initial cohort, 66 of 157 patients (42.0%) were high risk and 36 of 66 patients (54.5%) relapsed versus 17 of 91 low-risk patients (18.7%) (p<0.0001). In the recent cohort, 59 of 214 patients (27.6%) were high risk and 29 of 59 had a recurrence (49.2%) versus 22 of 155 low-risk patients (14.2%) (p<0.0001). Three patients (0.8%) died from testis cancer. The estimated 5-yr disease-specific survival was 99.3% in the initial group and 98.9% in the recent one. CONCLUSIONS: Non-risk-adapted surveillance is an effective, simple strategy for the management of all stage I NSGCT.

Lead acetate toxicity in vitro: Dependence on the cell composition of the cultures.

It is well known that exposure to low doses of lead causes long-lasting neurobehavioural deficits, but the cellular changes underlying these behavioural changes remain to be elucidated. A protective role of glial cells on neurons through lead sequestration by astrocytes has been proposed. The possible modulation of lead neurotoxicity by neuron-glia interactions was examined in three-dimensional cultures of foetal rat telencephalon. Mixed-brain cell cultures or cultures enriched in either neurons or glial cells were treated for 10 days with lead acetate (10(-6) m), a concentration below the limit of cytotoxicity. Intracellular lead content and cell type-specific enzyme activities were determined. It was found that in enriched cultures neurons stored more lead than glial cells, and each cell type alone stored more lead than in co-culture. Moreover, glial cells but not neurons were more affected by lead in enriched culture than in co-culture. These results show that neuron-glia interactions attenuate the cellular lead uptake and the glial susceptibility to lead, but they do not support the idea of a protective role of astrocytes.

Between Cultures: The Dyadic and Triadic Therapeutic Alliance in Multicultural Setting

Many researchers have identified the therapeutic alliance (TA) as the main factor that predicts psychotherapeutic success regardless the type of approach or treatment. In a multicultural setting, the construction of the therapeutic alliance is accompanied by elements that specially influence the flow of the interaction. Some examples of these elements are language, cultural beliefs, and traditions. For Hispanic-American clients in Lausanne (Switzerland), this encounter could take place in a dyadic setting, in the presence of a therapist who speaks Spanish and shares or not the client's culture of origin. On the other hand, it can take place in a triadic setting, in the presence of a therapist who does not speak Spanish and an interpreter that serves as a communication bridge. This present project has the purpose of studying the TA between different health professionals and the Hispanic- American clients who are assisted with and without an interpreter in Lausanne's health system. My goal is to study this relationship in the clients' context (many of them are clandestine) and based on their perception and subjective experience through a quantitative and qualitative complementary methodology. Because this project is in progress, this communication will focus on presenting the population's socio-demographic characteristics, the research questionings, methodology, and preliminary results.This project can enhance our knowledge about relationships between two cultures in a therapeutic encounter (psychological/psychiatric or medical). At the same time, it can bring us a better understanding about the migration movements of Hispanic-Americans in Switzerland.

Age and adverse drug reactions from psychopharmacological treatment: Data from the AMSP drug surveillance programme in Switzerland.

QUESTION UNDER STUDY: The frequency of severe adverse drug reactions (ADRs) from psychotropic drugs was investigated in hospitalised psychiatric patients in relation to their age. Specifically, the incidence of ADRs in patients up to 60 years was compared to that of patients older than 60 years. METHODS: Prescription rates of psychotropic drugs and reports of severe ADRs were collected in psychiatric hospitals in Switzerland between 2001 and 2010. The data stem from the drug surveillance programme AMSP. RESULTS: A total of 699 patients exhibited severe ADRs: 517 out of 28,282 patients up to 60 years (1.8%); 182 out of 11,446 elderly patients (1.6%, ns). Logistic regression analyses showed a significantly negative relationship between the incidence of ADRs and patients' age in general and in particular for weight gain, extrapyramidal motor system (EPMS) symptoms, increased liver enzymes and galactorrhoea. A significantly negative relationship was observed for age and the dosages of olanzapine, quetiapine, risperidone, valproic acid and lamotrigine. When comparing age groups, frequency of ADRs was lower in general for antipsychotic drugs and anticonvulsants, in particular for valproic acid in the elderly. Weight gain was found to be lower in the elderly for antipsychotic drugs, in particular for olanzapine. For the group of mood-stabilising anticonvulsants (carbamazepine, lamotrigine and valproic acid) the elderly exhibited a lower incidence of reported allergic skin reactions. CONCLUSION: The results suggest that for psychiatric inpatients the incidence of common severe ADRs (e.g., weight gain or EPMS symptoms) arising from psychotropic medication decreases with the age of patients.