The epidemiology of severe Streptococcus pyogenes disease in Europe

Diseases caused by the Lancefield group A streptococcus, Streptococcus pyogenes, are amongst the most challenging to clinicians and public health specialists alike. Although severe infections caused by S. pyogenes are relatively uncommon, affecting around 3 per 100,000 of the population per annum in developed countries, the case fatality is high relative to many other infections. Despite a long scientific tradition of studying their occurrence and characteristics, many aspects of their epidemiology remain poorly understood, and potential control measures undefined. Epidemiological studies can play an important role in identifying host, pathogen and environmental factors associated with risk of disease, manifestation of particular syndromes or poor survival. This can be of value in targeting prevention activities, as well directing further basic research, potentially paving the way for the identification of novel therapeutic targets. The formation of a European network, Strep-EURO, provided an opportunity to explore epidemiological patterns across Europe. Funded by the Fifth Framework Programme of the European Commission s Directorate-General for Research (QLK2.CT.2002.01398), the Strep-EURO network was launched in September 2002. Twelve participants across eleven countries took part, led by the University of Lund in Sweden. Cases were defined as patients with S. pyogenes isolated from a normally sterile site, or non-sterile site in combination with clinical signs of streptococcal toxic shock syndrome (STSS). All participating countries undertook prospective enhanced surveillance between 1st January 2003 and 31st December 2004 to identify cases diagnosed during this period. A standardised surveillance dataset was defined, comprising demographic, clinical and risk factor information collected through a questionnaire. Isolates were collected by the national reference laboratories and characterised according to their M protein using conventional serological and emm gene typing. Descriptive statistics and multivariable analyses were undertaken to compare characteristics of cases between countries and identify factors associated with increased risk of death or development of STSS. Crude and age-adjusted rates of infection were calculated for each country where a catchment population could be defined. The project succeeded in establishing the first European surveillance network for severe S. pyogenes infections, with 5522 cases identified over the two years. Analysis of data gathered in the eleven countries yielded important new information on the epidemiology of severe S. pyogenes infections in Europe during the 2000s. Comprehensive epidemiological data on these infections were obtained for the first time from France, Greece and Romania. Incidence estimates identified a general north-south gradient, from high to low. Remarkably similar age-standardised rates were observed among the three Nordic participants, between 2.2 and 2.3 per 100,000 population. Rates in the UK were higher still, 2.9/100,000, elevated by an upsurge in drug injectors. Rates from these northern countries were reasonably close to those observed in the USA and Australia during this period. In contrast, rates of reports in the more central and southern countries (Czech Republic, Romania, Cyprus and Italy) were substantially lower, 0.3 to 1.5 per 100,000 population, a likely reflection of poorer uptake of microbiological diagnostic methods within these countries. Analysis of project data brought some new insights into risk factors for severe S. pyogenes infection, especially the importance of injecting drug users in the UK, with infections in this group fundamentally reshaping the epidemiology of these infections during this period. Several novel findings arose through this work, including the high degree of congruence in seasonal patterns between countries and the seasonal changes in case fatality rates. Elderly patients, those with compromised immune systems, those who developed STSS and those infected with an emm/M78, emm/M5, emm/M3 or emm/M1 were found to be most likely to die as a result of their infection, whereas those diagnosed with cellulitis, septic arthritis, puerperal sepsis or with non-focal infection were associated with low risk of death, as were infections occurring during October. Analysis of augmented data from the UK found use of NSAIDs to be significantly associated with development of STSS, adding further fuel to the debate surrounding the role of NSAIDs in the development of severe disease. As a largely community-acquired infection, occurring sporadically and diffusely throughout the population, opportunities for control of severe infections caused by S. pyogenes remain limited, primarily involving contact chemoprophylaxis where clusters arise. Analysis of UK Strep-EURO data were used to quantify the risk to household contacts of cases, forming the basis of national guidance on the management of infection. Vaccines currently under development could offer a more effective control programme in future. Surveillance of invasive infections caused by S. pyogenes is of considerable public health importance as a means of identifying long and short-term trends in incidence, allowing the need for, or impact of, public health measures to be evaluated. As a dynamic pathogen co-existing among a dynamic population, new opportunities for exploitation of its human host are likely to arise periodically, and as such continued monitoring remains essential.

Développement des connaissances et compétences alimentaires, culinaires et nutritionnelles chez les jeunes : le cas des Brigades Culinaires.

Contexte. Depuis quelques décennies, on constate une diminution des occasions d’observer et de transmettre le savoir-faire culinaire aux jeunes encourageant une évolution des compétences culinaires. Cette évolution a un impact sur les choix alimentaires des jeunes et probablement sur la santé de la population. Afin d’initier les adolescents des écoles secondaires du Québec à la cuisine et de les aider à développer leur autonomie alimentaire, un programme parascolaire de 24 ateliers culinaires, les Brigades Culinaires, a été initié par la Tablée des Chefs. Objectifs. L’objectif principal est d’évaluer l’atteinte d’objectifs spécifiques d’éducation nutritionnelle, culinaire et alimentaire visés par les ateliers, et de mesurer le potentiel des ateliers pour éveiller l’intérêt des jeunes pour un choix de carrière relié à la cuisine, à la nutrition ou à l’agriculture. Méthode. Lors du projet 2013-2014, une collecte de données à l’aide de deux questionnaires a été réalisée. Un questionnaire « pré », distribué en début d’année scolaire, a permis de mesurer les connaissances et l’intérêt de futurs participants à l’égard de l’alimentation, de la nutrition et de la cuisine. Un questionnaire « post », distribué aux participants des Brigades Culinaires à la fin des ateliers, a permis de mesurer l’atteinte des objectifs spécifiques en nutrition, cuisine et alimentation. L’intérêt des jeunes pour un choix de carrière relié à la cuisine, à la nutrition ou à l’agriculture a aussi été mesuré à deux reprises. Les données ont été analysées avec SPSS pour générer des statistiques descriptives. Le projet 2013-2014 regroupait 33 écoles à travers le Québec. Ce projet a reçu une approbation éthique par le Comité d’éthique de la recherche en santé de la faculté de médecine de l’Université de Montréal (CERES) et a reçu l’appui financier de Québec en Forme. Résultats. Les résultats des mesures d’évaluation colligées (325 questionnaires pré et 197 questionnaires post) auprès des jeunes participants aux Brigades Culinaires sont très prometteurs. Notamment, pour 68 % des objectifs de développement de connaissances en cuisine, la majorité des participants affichent des apprentissages. Il en est de même pour 82 % des objectifs de développement d’autres apprentissages alimentaires. Les participants ont un grand intérêt pour l’emploi dans des secteurs associés à la cuisine (67 %), la nutrition (39 %) et l’agriculture (25 %) et leur participation aux ateliers des Brigades Culinaires semble d’ailleurs avoir contribué à orienter leurs choix de carrières. D’autre part, les résultats suggèrent que la participation aux ateliers des Brigades Culinaires a un impact sur l’entourage. Conclusion. La participation aux ateliers des Brigades Culinaires contribue à élever le niveau d’implication des participants à l’égard de la nutrition, de la cuisine et de l’alimentation. Les résultats de cette étude permettent de cibler les forces du programme, de même que de proposer des pistes d’actions pour continuer à élever le niveau d’implication des jeunes Québécois à l’égard de leur alimentation.

Chile: the Chilean national investment system and projects integrated bank

Includes bibliography

Guyana: public sector investment programming: the Guyana experience

Includes bibliography

Saint Kitts and Nevis: public sector investment programming: the Saint Kitts and Nevis experience

Includes bibliography

Saint Vincent and the Grenadines: public sector investment programme

Includes bibliography

The role of capacity building in public investment programming

Includes bibliography

From core rigidities to dynamic capabilities: the role of external knowledge. A multiple case study

This study focuses on the processes of change that firms undertake to overcome conditions of organizational rigidity and develop new dynamic capabilities, thanks to the contribution of external knowledge. When external contingencies highlight firms’ core rigidities, external actors can intervene in change projects, providing new competences to firms’ managers. Knowledge transfer and organizational learning processes can lead to the development of new dynamic capabilities. Existing literature does not completely explain how these processes develop and how external knowledge providers, as management consultants, influence them. Dynamic capabilities literature has become very rich in the last years; however, the models that explain how dynamic capabilities evolve are not particularly investigated. Adopting a qualitative approach, this research proposes four relevant case studies in which external actors introduce new knowledge within organizations, activating processes of change. Each case study consists of a management consulting project. Data are collected through in-depth interviews with consultants and managers. A large amount of documents supports evidences from interviews. A narrative approach is adopted to account for change processes and a synthetic approach is proposed to compare case studies along relevant dimensions. This study presents a model of capabilities evolution, supported by empirical evidence, to explain how external knowledge intervenes in capabilities evolution processes: first, external actors solve gaps between environmental demands and firms’ capabilities, changing organizational structures and routines; second, a knowledge transfer between consultants and managers leads to the creation of new ordinary capabilities; third, managers can develop new dynamic capabilities through a deliberate learning process that internalizes new tacit knowledge from consultants. After the end of the consulting project, two elements can influence the deliberate learning process: new external contingencies and changes in the perceptions about external actors.