Iowa Surveillance of Notifiable and Other Diseases Annual Report, 2014

Promoting and protecting the health of Iowans is the mission of the Iowa Department of Public Health (IDPH). Surveillance of notifiable health conditions is essential in establishing what, how, and when events impact the public’s health. Once this information is gathered, public health and health care providers around the state are able to use this data to take steps to prevent illnesses from occurring. Multiple divisions and bureaus are dedicated to accomplishing the goals of surveillance. In 2014, there were more than 86,000 laboratory results of infectious diseases and conditions submitted to IDPH disease surveillance programs. IDPH also investigates non-infectious conditions related to lead, occupational, and environmental hazards like carbon monoxide. In 2014, approximately 71,000 children’s and more than 7,000 adults’ blood tests results were reported to IDPH. ********Amended Annual Report 2014************ Amended May 2, 2016

The Good, Bad, and Ugly of Occupational Health Surveillance Part 2: Region 7 OHI Data, Lead, Fatalities, May 21, 2014

A power point made by the IDPH on promoting and protecting the health of Iowans in the workplace.

Medication exposure during pregnancy: a pilot pharmacovigilance system using health and demographic surveillance platform.

BACKGROUND: There is limited safety information on most drugs used during pregnancy. This is especially true for medication against tropical diseases because pharmacovigilance systems are not much developed in these settings. The aim of the present study was to demonstrate feasibility of using Health and Demographic Surveillance System (HDSS) as a platform to monitor drug safety in pregnancy. METHODS: Pregnant women with gestational age below 20 weeks were recruited from Reproductive and Child Health (RCH) clinics or from monthly house visits carried out for the HDSS. A structured questionnaire was used to interview pregnant women. Participants were followed on monthly basis to record any new drug used as well as pregnancy outcome. RESULTS: 1089 pregnant women were recruited; 994 (91.3%) completed the follow-up until delivery. 98% women reported to have taken at least one medication during pregnancy, mainly those used in antenatal programmes. Other most reported drugs were analgesics (24%), antibiotics (17%), and antimalarial (15%), excluding IPTp. Artemether-lumefantrine (AL) was the most used antimalarial for treating illness by nearly 3/4 compared to other groups of malaria drugs. Overall, antimalarial and antibiotic exposures in pregnancy were not significantly associated with adverse pregnancy outcome. Iron and folic acid supplementation were associated with decreased risk of miscarriage/stillbirth (OR 0.1; 0.08 - 0.3). CONCLUSION: Almost all women were exposed to medication during pregnancy. Exposure to iron and folic acid had a beneficial effect on pregnancy outcome. HDSS proved to be a useful platform to establish a reliable pharmacovigilance system in resource-limited countries. Widening drug safety information is essential to facilitate evidence based risk-benefit decision for treatment during pregnancy, a major challenge with newly marketed medicines.

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.

A Legislator under Surveillance: The Creation and Implementation of Swiss Banking Legislation 1910-1934

This paper analyses how banking regulation was introduced in Switzerland - one of the world's most prominent financial centres - which remained in place until the beginning of the twenty-first century. It shows that the law adopted on 8 November 1934 is a perfect example of capture of the regulator by the regulated. Essentially a political response in the context of the economic crisis of the 1930s, it largely reflected the interests of banking circles by limiting the intervention of the State as much as possible. The introduction of the new legislation was facilitated by the temporary weakness of Swiss banking circles, as they depended on the State to delay or prevent the collapse of many major credit institutions. They did not manage to derail the law as they had two decades earlier when they scuppered the federal bill on banks drawn up between 1914 and 1916. But this time they were better organized and more united, and intervened all the more effectively in the legislative process itself. The 1934 law is thus distinctive in that it made no structural changes to the architecture of the financial centre but merely codified its practices through flexible legislation meant to reassure the public. The law was aimed less at controlling banking activity than at keeping - thanks to skilfully calibrated political concessions - the State from having to intervene more directly in the internal management of banks or in the fixing of interest rates and the export of capital.

Gestion et communication de l'information en surveillance biologique. Une approche éthique et interdisciplinaire [Biomonitoring information management and communication: an ethical and interdisciplinary perspective]

This study explores biomonitoring communication with workers exposed to risks. Using a qualitative approach, semi-directive interviews were performed. Results show that occupational physicians and workers share some perceptions, but also point out communication gaps. Consequently, informed consent is not guaranteed. This article proposes some recommendations for occupational physicians' practices.

Biomarkers, medical treatment and fetal intrapartum surveillance in intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific disorder characterized by maternal pruritus and elevated liver enzymes. It usually begins in the third trimester of pregnancy and resolves spontaneously after delivery. ICP is considered benign for the pregnant woman, but it is associated with an increased risk for unexplained term stillbirth and preterm delivery. There are no specific laboratory markers to diagnose ICP. The diagnosis is currently based on the presence of maternal pruritus and elevated values of alanine aminotransaminases (ALT) and serum bile acids (BA). Recently, ursodeoxycholic acid (UDCA) has been used for treatment. Mechanisms leading to intrauterine fetal death (IUFD) may be multifactorial and are unknown at present. For this thesis, 415 pregnant women with ICP were studied. The aim was to evaluate the value of the liver enzyme glutathione S-transferase alpha (GSTA) as a specific marker of ICP and to assess the effect of maternal UDCA therapy on maternal laboratory values and fetal outcome. The specific markers predisposing the fetus to heart arrhythmia were studied by comparing waveform analysis of fetal electrocardiograms (FECG) during labor in pregnancies complicated by ICP with controls. The levels of maternal GSTA were high and the values correlated with the value of ALT in patients with ICP. UDCA therapy reduced the values of the liver enzymes and alleviated maternal pruritus, but it did not influence maternal hormonal values. Although the newborns experienced an uneventful perinatal outcome, severe ICP was still associated with preterm birth and admission to the neonatal intensive care unit (NICU). There were no significant differences in intrapartum FECG findings between fetuses born to ICP women and controls.

A reconnaissance study of the metamorphic petrology and volcanic geochemistry of a portion of the Island Lake greenstone belt, Manitoba /

The Island Lake greenstone belt is one of the major Archean supracrustal exposures in the northwestern part of the Superior Province of the Canadian Shield. This belt is subdivided into two units: 1) a lower sequence characterised by pillowed to massive, locally pyroclastic, basalt to andesite with a thin central zone of felsic derivatives, all of which are interbedded with and overlain by thick sequences of turbidite facies rock; 2) the upper unit which consists of thick stratified conglomerate overlain by thickly bedded arkose and feldspathic greywacke. Reconnaissance sampling traverses were completed across both the strike of the belt and along its margins with adjacent granitoids. Most of the belt is within the greenschist metamorphic f acies with amphibolite facies occurring in certain areas near t he margins. A post-tectonic, low pressure thermal event may be responsible for the development of a unit of cordierite schi s t which stretches southeastwards from the east end of Cochrane Bay. Volcanism is cyclical in nature changing from tholeiitic to calc-alkaline. There is a general progression in the character of the lavas from mafic t o felsic with stratigraphic height. Chemica l d a ta sugges t that h i gh level fractionation of a mantle- derived ' dry' magma i s t he s ource of the thole i iti c lavas. Contamination of this magma with 'we t' sia l and subsequent fractionation may be r esponsi b l e for the calcalkaline phases .Observations of stratigraphic relationships (in particular the contact between the supracrustals and the granitoids) coupled with the metamorphic and chemical studies, allow the construction of a preliminary model for the evolution of the Island Lake greenstone belt. The following sequential development is suggested: 1) a platform stage characterised by the subaqueous effusion of mafic to intermediate lavas of alternating tholeiitic and calc-alkaline affinities; 2) an edifice stage marked by the eruption of felsic calc-alkaline rocks; 3) an erosional stage characterised by the deposit~on of thick sequences of turbidite facies rocks; 4) the impingement of granitic masses into the margins of the greenstone belt, which was probably related to a downward warping of the supracrustal pilei 5) the erosion of sialic massifs surrounding and within the greenstone belt and of early supracrustal piles, to give the clastic upper unit.

"Canada's toughest neighbourhood" : surveillance, myth and orientalism in Jane-Finch

This study examines coverage of lane-Finch in popular Canadian newspapers in 2007. It explores the often-negative representations of the community through conceptual frameworks based on the work of Michel Foucault, Roland Barthes and Edward Said. The question it attempts to answer is: What knowledge and power relationships are embedded within depictions of lane-Finch in popular Canadian newspapers in 2007? The methodology is a version of critical discourse analysis based on Foucault's The Archaeology of Knowledge. It finds that predominantly-negative connotations of the neighbourhood are reinforced through the perpetuation of dominant discourses, the use of "expert" knowledge sources, and the discounting of subjugated knowledges or livedexperiences of residents. The study concludes by suggesting where further research within the realm of popular culture and community identity can be directed.

The potential utility of age, triage score, and disposition data contained in emergency department electronic records for influenza-like illness surveillance in Montreal

La surveillance de l’influenza s’appuie sur un large spectre de données, dont les données de surveillance syndromique provenant des salles d’urgences. De plus en plus de variables sont enregistrées dans les dossiers électroniques des urgences et mises à la disposition des équipes de surveillance. L’objectif principal de ce mémoire est d’évaluer l’utilité potentielle de l’âge, de la catégorie de triage et de l’orientation au départ de l’urgence pour améliorer la surveillance de la morbidité liée aux cas sévères d’influenza. Les données d’un sous-ensemble des hôpitaux de Montréal ont été utilisées, d’avril 2006 à janvier 2011. Les hospitalisations avec diagnostic de pneumonie ou influenza ont été utilisées comme mesure de la morbidité liée aux cas sévères d’influenza, et ont été modélisées par régression binomiale négative, en tenant compte des tendances séculaires et saisonnières. En comparaison avec les visites avec syndrome d’allure grippale (SAG) totales, les visites avec SAG stratifiées par âge, par catégorie de triage et par orientation de départ ont amélioré le modèle prédictif des hospitalisations avec pneumonie ou influenza. Avant d’intégrer ces variables dans le système de surveillance de Montréal, des étapes additionnelles sont suggérées, incluant l’optimisation de la définition du syndrome d’allure grippale à utiliser, la confirmation de la valeur de ces prédicteurs avec de nouvelles données et l’évaluation de leur utilité pratique.

Esprit du don, dispositifs et reconnaissance : de "Diaries, Notes and Sketches : Also Known as Walden" (1969) à "The First Forty" (2006) de Jonas Mekas.

Après avoir passé plus de 4 ans dans des camps de travail forcé, Jonas Mekas, lituanien, est déporté avec son frère par les Nations-Unies en 1949 aux États-Unis. Les deux rescapés de la seconde guerre mondiale dédient alors leur temps au cinéma. Dès leur arrivée, ils se procurent une caméra 16 mm bolex et se tournent vers le cinéma expérimental, grâce, entre autre, à une de ces cinéastes pionnières américaine Maya Deren. En marge de l'industrie cinématographique hollywoodienne, Jonas Mekas participe à l'édification de structures - coopératives, associations, magazines, journaux - afin de rendre accessible ce genre filmique, de lui obtenir une reconnaissance publique et de, ultimement, le préserver. En 1969, il réalise un film intitulé "Diaries, Notes and Sketches : Also Known as Walden". Mekas réalise ensuite des films qui réemploient des séquences qui se trouvent dans cette première ébauche filmique. Ce processus se retrace au sein de son « premier essai » numérique qu'il réalise à l'ère cybériste intitulé "The First Forty" (2006), composé de vidéos et de descriptions textuelles. Tout comme il l’avait fait avec Walden, Mekas présente explicitement celui-ci à un public, en l’occurrence son nouveau public d'internautes, qui en prend connaissance sur son site web officiel. La présentation numérique et la table des matières papier accompagnant "Diaries, Notes and Sketches : Also Known as Walden" rédigée par l'artiste en 1969 ont une fonction similaire au sens où, par elles, Jonas Mekas donne ces deux créations aux spectateurs. Nous avons choisi d'employer le terme de dispositif pour parler de ces « objets » qui font appel à diverses formes énonciatives afin de créer un effet spécifique chez le spectateur. En explorant la théorie sociologique moderne du don développée par Jacques T. Godbout, notre projet a été de relever « l'esprit de don » qui se retrace au sein de ces dispositifs. Cette étude nous permet de constater que les dispositifs audiovisuels / cinématographiques que développa Mekas sont des « objets » qui peuvent être reçus tel des dons suscitant le désir de donner chez les spectateurs. Ils sont le ciment symbolique personnel et collectif nécessaire à l’accomplissement du processus de « reconnaissance » qu’implique le don.

Assessing the Social Acceptability of New Technologies: Gaps and Tensions Between Science and Regulation

Article

Approbation, mise en marché et surveillance après mise en marché des dispositifs médicaux à risque élevé : examen des enjeux socio-éthiques

La littérature abordant les enjeux socio-éthiques et réglementaires associés aux médicaments est relativement abondante, ce qui n’est pas le cas des dispositifs médicaux (DM). Ce dernier secteur couvre une très large diversité de produits qui servent à de multiples applications: diagnostic, traitement, gestion des symptômes de certaines conditions physiques ou psychiatriques, restauration d’une fonction débilitante, chirurgie, etc. À tort, on a tendance à croire que les DM sont réglementés de la même manière que les médicaments, que ce soit pour les exigences concernant leur mise en marché ou des pratiques de surveillance après mise en marché. Or, au cours des dernières années, leur usage élargi, leur impact sur les coûts des soins de santé, et les rappels majeurs dont certains ont fait l’objet ont commencé à inquiéter la communauté médicale et de nombreux chercheurs. Ils interpellent les autorités réglementaires à exercer une plus grande vigilance tant au niveau de l’évaluation des nouveaux DM à risque élevé avant leur mise en marché, que dans les pratiques de surveillance après mise en marché. Une stratégie plus rigoureuse d’évaluation des nouveaux DM permettrait d’assurer un meilleur suivi des risques associés à leur utilisation, de saisir la portée des divers enjeux socio-éthiques découlant de l’utilisation de certains DM, et de préserver la confiance du public. D’emblée, il faut savoir que les autorités nationales n’ont pas pour mandat d’évaluer la portée des enjeux socio-éthiques, ou encore les coûts des DM qui font l’objet d’une demande de mise en marché. Cette évaluation est essentiellement basée sur une analyse des rapports risques-bénéfices générés par l’usage du DM pour une indication donnée. L’évaluation des impacts socio-éthiques et l’analyse coûts-bénéfices relèvent des agences d’Évaluation des technologies de santé (ÉTS). Notre recherche montre que les DM sont non seulement peu fréquemment évalués par les agences d’ÉTS, mais l’examen des enjeux socio-éthiques est trop souvent encore incomplet. En fait, les recommandations des rapports d’ÉTS sont surtout fondées sur une analyse coûts-bénéfices. Or, le secteur des DM à risque élevé est particulièrement problématique. Plusieurs sont non seulement porteurs de risques pour les patients, mais leur utilisation élargie comporte des impacts importants pour les systèmes de santé. Nous croyons que le Principisme, au cœur de l’éthique biomédicale, que ce soit au plan de l’éthique de la recherche que de l’éthique clinique, constitue un outil pour faciliter la reconnaissance et l’examen, particulièrement par les agences d’ÉTS, des enjeux socio-éthiques en jeu au niveau des DM à risque élevé. Également, le Principe de Précaution pourrait aussi servir d’outil, particulièrement au sein des agences nationales de réglementation, pour mieux cerner, reconnaître, analyser et gérer les risques associés à l’évaluation et l’utilisation de ce type de DM. Le Principisme et le Principe de Précaution pourraient servir de repères 1) pour définir les mesures nécessaires pour éliminer les lacunes observées dans pratiques associées aux processus de réglementation, et 2) pour mieux cerner et documenter les enjeux socio-éthiques spécifiques aux DM à risque élevé.