Childhood astrovirus-associated diarrhea in the ambulatory setting in a Public Hospital in Cordoba city, Argentina

Human astroviruses have been increasingly identified as important agents of diarrheal disease in children. However, the disease burden of astrovirus infection is still incompletely assessed. This paper reports results on the epidemiological and clinical characteristics of astrovirus-associated diarrhea, as well as the impact of astrovirus infection on the ambulatory setting at a Public Hospital in Córdoba city, Argentina. From February 2001 through January 2002, 97 randomly selected outpatient visits for diarrhea among children < 36 months old were enrolled. A single specimen of stool from each child was collected and tested for astrovirus antigen by enzyme immunoassay. Astroviruses were detected in 12.37% of the diarrheal episodes. All the positive cases occurred in children 4 to 18 months, but the highest rate was in children aged 4 to 6 months (23.80%). The clinical symptoms of astrovirus associated-diarrhea were fever 41.66%, vomiting 25.00% and dehydration 8.33%; overall 16.66% required hospitalization. Astrovirus was identified through the year and no seasonally pattern was detected (cool semester 15.21% versus warm semester 9.80% p > 0.05). According to our estimation about one out of seventy-four children in this cohort would be assisted annually for an astroviral-diarrheal episode in the Public Hospital and one out of eight diarrheal cases could be attributed to astrovirus infection. Astrovirus is a common symptomatic infection in pediatric outpatient visits in the public hospital in the study area, contributing 12.37% of the overall morbidity from diarrhea.

Clustering medical tourism in Algarve: setting the first steps for the the health authority

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

Silent citizens: on silence and silencing in journalism

Constructivist approaches to journalism, which have dominated the field for most of the second half of the 20th century, underline how selection and ranking processes produce representations and interpretations of social reality. Theoretical perspectives such as agenda-setting or framing have been pointing to the ways production of news messages are shaped and issues are defined. Research inspired by these contributions does however seem to keep in an area of relative shade not so much what is said and published but what is not selected: the unsaid, the withheld, the untold of journalism. The reality that remains in silence, for not being noticed or for being silenced, is the reverse of the coin of what is made visible. In this paper, it is suggested that this situation opens up the debate to a relatively unknown continent, which could contribute to the larger discussion on the current crisis in journalism. It is our contention that ‘the untold’ might be at the confluence of different levels: the journalistic agenda-setting by news sources; the deterioration of working conditions of journalists, compromising the investigation; and the social capital asymmetries from important segments of the population, hampering the public word (speech?) and the right to communicate. In order to build a comprehensive picture of the potentialities and contradictions of journalism from the unsaid side, we would put forward the outline of a typology of journalism's silences, with particular emphasis on some aspects of "discursive discrimination" (Boréus, 2006), on the one hand, and on citizen silence in the process of journalistic production, on the other hand.

New and emerging treatment of Staphylococcus aureus infections in the hospital setting.

Methicillin-resistant Staphylococcus aureus (MRSA), both hospital-acquired and community-acquired, is a dangerous pathogen that is involved in an increasing number of serious infections with high risk for morbidity and mortality. Community-acquired MRSA strains have epidemic potential and can be particularly virulent. Vancomycin has been the standard hospital treatment for the past 40 years, but vancomycin-resistant isolates of S. aureus have emerged in the USA, and vancomycin-intermediate isolates are increasingly being reported worldwide. New antimicrobial agents with activity against multidrug-resistant S. aureus and other resistant pathogens are urgently needed. Despite great strides, further advances in our understanding of the molecular and biochemical mechanisms responsible for antimicrobial resistance are still required. Several agents have been recently approved for the treatment of serious Gram-positive infections, including linezolid, daptomycin, and tigecycline. The novel investigational cephalosporin, ceftobiprole, is one of the first penicillinase-resistant agents to target penicillin-binding protein 2a (or PBP2a), an acquired PBP with low beta-lactam-affinity that confers intrinsic beta-lactam resistance to S. aureus and other staphylococci. This mechanism of PBP binding, including inhibition of PBP2a, confers broad-spectrum activity against clinically important Gram-negative and Gram-positive pathogens, including MRSA. Phase III clinical trials comparing ceftobiprole with vancomycin alone and in combination with ceftazidime for the treatment of complicated skin and skin structure infections showed ceftobiprole to have efficacy similar to the efficacy of these comparators as evidenced by non-inferior clinical cure and microbiological eradication rates.

The prevention of transmission of blood-borne diseases in the health-care setting

  The risk of transmission of blood-borne pathogens in the health-care setting has become a matter of increasing concern in Ireland in recent years. Health-care workers undertaking exposure-prone procedures are at risk of contracting blood-borne diseases from the patients they are treating and there is also a small risk that patients who are undergoing such procedures may become infected by the health-care workers who are treating them. An Advisory Group on the Transmission of Infectious Diseases in the Health-Care Setting was established in 1995 to advise the Minister for Health on the prevention of the transmission of such diseases. The Advisory Group published its report in 1997. It was realised at that time that this matter would need to be kept under review and a Standing Advisory Committee was established. Guidelines on this subject were published by the Advisory Committee in June1999. In the current document, these guidelines have been substantially revised in the light of recent information and technical developments and are now considered to be a Code of Practice in the area of prevention of the transmission of blood-borne pathogens in the health-care setting.    

Economies in Drug Usage in the Irish Healthcare Setting

Economies in Drug Usage in the Irish Healthcare Setting Click here to download PDF 237kb

Psycho-oncological interventions and psychotherapy in the oncology setting.

A person who faces the diagnosis of cancer is subjected to changes within his body, but also with regard to his view of himself and his social relationships. Cancer-related psychological distress occurs frequently and has been reported to have different prevalence according to cancer type and stage of disease. Psychological disorders are known to be underdiagnosed and thus undertreated in the oncology setting, since clinicians might miss the symptoms of psychological distress, misinterpret them, or lack the time and resources to respond adequately. The main psychiatric disturbances observed in patients with cancer are adjustment disorders and affective disorders (anxiety and depression), which in the majority of patients are due to stressors related to the disease and pre-existing psychological vulnerabilities; however, they might also be a direct consequence of biological causes either resulting from treatment side effects or from modifications induced by the cancer. This chapter aims to provide theoretical and practical information concerning psycho-oncological approaches, complemented by some reflexions on their clinical and scientific evidence, focussing essentially on verbal psychological interventions and especially on psychotherapy in patients with cancer.

Nutrition matters for the early years: Guidance for feeding under fives in the childcare setting

This booklet for childminders and staff in day nurseries, playgroups and craches outlines straightforward, practical advice and information on a range of nutritional issues related to children up to the age of five to ensure each child gets all the nutrients they need to stay healthy.

The combination of three faecal parasitological methods to improve the diagnosis of schistosomiasis mansoni in a low endemic setting in the state of Ceará, Brazil

Laboratory diagnosis of intestinal schistosomiasis mansoni can be accomplished through various methods of stool examination to detect parasites, ranging from the most classic tests (Kato-Katz) to several methods that are still undergoing validation. This study was conducted to assess two new parasite identification methods for diagnosing schistosomiasis mansoni in residents of a low endemic area in the municipality of Maranguape, in the state of Ceará, Brazil using the Kato-Katz method as a reference and serology (enzyme-linked immunosorbent assay) for the screening of patients. The Kato-Katz, the saline gradient method and the Helmintex® method parasite identification methods were employed only in subjects who exhibited positive serologic tests. The test results were then analysed and treatment of positive individuals was subsequently performed. After comparing the test results, we observed that the saline gradient method and the Helmintex® method were more effective in diagnosing schistosomiasis mansoni in the study area compared with the Kato-Katz method.

Infections nosocomiales en médecine ambulatoire: importance et prévention [Importance and prevention of nosocomial infections in the outpatient setting]

The concept of nosocomial infections (or healthcare-related infections) applies to the outpatients clinics. However, data are scarce and imprecise in this setting compared with hospitals. The choice of preventive measures is therefore difficult. A lower risk in the outpatient facilities does not justify the complete implementation of hospital precautions. The latter can nevertheless be adapted since infection may be acquired during an ambulatory consultation through the same mechanisms as in hospitals. We propose a preventive strategy derived from standard precautions to be applied in every case, transmission-based precautions that are more rarely needed, and asepsis in case of invasive procedure.

L'hémodialyse intermittente aux soins intensifs = [Intermittent hemodialysis in the intensive care setting]

Acute renal failure is a frequent and potentially lethal disease in intensive care units. Renal replacement therapy (RRT) is often required. Either intermittent or continuous methods of RRT can be used. When to start a RRT and which method to use is not always clearly defined and a global evaluation of the clinical situation is required. The choice of the modality of RRT will be up to the general clinical context, hemodynamic stability, the type of molecules to be cleared and the haemorrhagic risk as much as habits and available resources. No study currently showed a superiority of either continuous or intermittent renal replacement therapy. The collaboration between intensive care specialists and nephrologists allows an optimized choice for a given patient and allow better move from one technic to another if required.

Pitfalls in the modeling of forward-looking price setting and investment decisions

The present paper makes progress in explaining the role of capital for inflation and output dynamics. We followWoodford (2003, Ch. 5) in assuming Calvo pricing combined with a convex capital adjustment cost at the firm level. Our main result is that capital accumulation affects inflation dynamics primarily through its impact on the marginal cost. This mechanism is much simpler than the one implied by the analysis in Woodford's text. The reason is that his analysis suffers from a conceptual mistake, as we show. The latter obscures the economic mechanism through which capital affects inflation and output dynamics in the Calvo model, as discussed in Woodford (2004).

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.

Le Soutien psychiatrique Intensif dans le Milieu (SIM) à Lausanne: un projet pilote [Intensive Psychiatric Support at the Setting in Lausanne: a pilot project]

While the hospital remains an important element of the psychiatric health-care system, the fact that it is always the best place to treat acute psychotic episodes is still debated. After a brief review of the literature relative to the main existing community care models, the authors describe the development in the Department Universitaire de Psychiatrie Adulte (DUPA), of an alternative to hospitalisation for patient going through a severe acute psychiatric episode. They present three clinical situations and the aims of the research project, which will follow this pilot phase.