Ope M, Sonoiya S, Kariuki J
… +4 more, Mboera LE, Gandham RN, Schneidman M, Kimura M
Emerg Health Threats J
· 2013 · PMID 23362409
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The East African Integrated Disease Surveillance Network (EAIDSNet) was formed in response to a growing frequency of cross-border malaria outbreaks in the 1990s and a growing recognition that fragmented disease intervent...The East African Integrated Disease Surveillance Network (EAIDSNet) was formed in response to a growing frequency of cross-border malaria outbreaks in the 1990s and a growing recognition that fragmented disease interventions, coupled with weak laboratory capacity, were making it difficult to respond in a timely manner to the outbreaks of malaria and other infectious diseases. The East Africa Community (EAC) partner states, with financial support from the Rockefeller Foundation, established EAIDSNet in 2000 to develop and strengthen the communication channels necessary for integrated cross-border disease surveillance and control efforts. The objective of this paper is to review the regional EAIDSNet initiative and highlight achievements and challenges in its implementation. Major accomplishments of EAIDSNet include influencing the establishment of a Department of Health within the EAC Secretariat to support a regional health agenda; successfully completing a regional field simulation exercise in pandemic influenza preparedness; and piloting a web-based portal for linking animal and human health disease surveillance. The strategic direction of EAIDSNet was shaped, in part, by lessons learned following a visit to the more established Mekong Basin Disease Surveillance (MBDS) regional network. Looking to the future, EAIDSNet is collaborating with the East, Central and Southern Africa Health Community (ECSA-HC), EAC partner states, and the World Health Organization to implement the World Bank-funded East Africa Public Health Laboratory Networking Project (EAPHLNP). The network has also begun lobbying East African countries for funding to support EAIDSNet activities.
Rubio-Perez I, Martin-Perez E, Garcia DD
… +2 more, Calvo ML, Barrera EL
Emerg Health Threats J
· 2012 · PMID 22822411
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INTRODUCTION: Extended-spectrum beta-lactamase (ESBL) producing bacteria have been increasingly reported as causal agents of nosocomial infection worldwide. Resistance patterns vary internationally, and even locally, fro...INTRODUCTION: Extended-spectrum beta-lactamase (ESBL) producing bacteria have been increasingly reported as causal agents of nosocomial infection worldwide. Resistance patterns vary internationally, and even locally, from one institution to the other. We investigated the clinical isolates positive for ESBL-producing bacteria in our institution, a tertiary care hospital in Madrid (Spain), during a 2-year period (2007-2008). METHODS: Clinical and microbiological data were retrospectively reviewed. Two hundred and nineteen patients were included in the study. RESULTS: Advanced age, diabetes, use of catheters, previous hospitalization and previous antibiotic treatment were some of the risk factors found among patients. Escherichia coli was the most frequent isolate, and urinary tract the most common site of isolation. Internal Medicine, Intensive Care Unit (ICU) and General Surgery presented the highest number of isolates. There were no outbreaks during the study period. Antibiotic patterns showed high resistance rates to quinolones in all isolates. There was 100% sensitivity to carbapenems. CONCLUSION: Carbapenems continue to be the treatment of choice for ESBL-producing bacteria. Infection control measures are of great importance to avoid the spread of these nosocomial infections.
Aitken P, Leggat P, Harley H
… +2 more, Speare R, Leclercq M
Emerg Health Threats J
· 2012 · PMID 22666307
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BACKGROUND: Calls for disaster medical assistance teams (DMATs) are likely to continue in response to international disasters. As part of a national survey, this study was designed to evaluate Australian DMAT experience...BACKGROUND: Calls for disaster medical assistance teams (DMATs) are likely to continue in response to international disasters. As part of a national survey, this study was designed to evaluate Australian DMAT experience in relation to the human resources issues associated with deployment. METHODS: Data was collected via an anonymous mailed survey distributed via State and Territory representatives on the Australian Health Protection Committee, who identified team members associated with Australian DMAT deployments from the 2004 South East Asian Tsunami disaster. RESULTS: The response rate for this survey was 50% (59/118). Most personnel had deployed to the Asian Tsunami affected areas with DMAT members having significant clinical and international experience. While all except one respondent stated they received a full orientation prior to deployment, only 34% of respondents (20/59) felt their role was clearly defined pre deployment. Approximately 56% (33/59) felt their actual role matched their intended role and that their clinical background was well suited to their tasks. Most respondents were prepared to be available for deployment for 1 month (34%, 20/59). The most common period of notice needed to deploy was 6-12 hours for 29% (17/59) followed by 12-24 hours for 24% (14/59). The preferred period of overseas deployment was 14-21 days (46%, 27/59) followed by 1 month (25%, 15/59) and the optimum shift period was felt to be 12 hours by 66% (39/59). The majority felt that there was both adequate pay (71%, 42/59) and adequate indemnity (66%, 39/59). Almost half (49%, 29/59) stated it was better to work with people from the same hospital and, while most felt their deployment could be easily covered by staff from their workplace (56%, 33/59) and caused an inconvenience to their colleagues (51%, 30/59), it was less likely to interrupt service delivery in their workplace (10%, 6/59) or cause an inconvenience to patients (9%, 5/59). Deployment was felt to benefit the affected community by nearly all (95%, 56/59) while less (42%, 25/59) felt that there was a benefit for their own local community. Nearly all felt their role was recognised on return (93%, 55/59) and an identical number (93%, 55/59) enjoyed the experience. All stated they would volunteer again, with 88% strongly agreeing with this statement. CONCLUSIONS: This study of Australian DMAT members provides significant insights into a number of human resources issues and should help guide future deployments. The preferred 'on call' arrangements, notice to deploy, period of overseas deployment and shift length are all identified. This extended period of operations needs to be supported by planning and provision of rest cycles, food, temporary accommodation and rest areas for staff. The study also suggests that more emphasis should be placed on team selection and clarification of roles. While the majority felt that there was both adequate pay and adequate indemnity, further work clarifying this, based on national conditions of service should be, and are, being explored currently by the state based teams in Australia. Importantly, the deployment was viewed positively by team members who all stated they would volunteer again, which allows the development of an experienced cohort of team members.
Emerg Health Threats J
· 2012 · PMID 22662021
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Rapid developments in nano-technology are likely to confer significant benefits on mankind. But, as with perhaps all new technologies, these benefits are likely to be accompanied by risks, perhaps by new risks. Nano-toxi...Rapid developments in nano-technology are likely to confer significant benefits on mankind. But, as with perhaps all new technologies, these benefits are likely to be accompanied by risks, perhaps by new risks. Nano-toxicology is developing in parallel with nano-technology and seeks to define the hazards and risks associated with nano-materials: only when risks have been identified they can be controlled. This article discusses the reasons for concern about the potential effects on health of exposure to nano-materials and relates these to the evidence of the effects on health of the ambient aerosol. A number of hypotheses are proposed and the dangers of adopting unsubstantiated hypotheses are stressed. Nano-toxicology presents many challenges and will need substantial financial support if it is to develop at a rate sufficient to cope with developments in nano-technology.
Milton AH, Hore SK, Hossain MZ
… +1 more, Rahman M
Emerg Health Threats J
· 2012 · PMID 22558005
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Ensuring access to safe drinking water by 2015 is a global commitment by the Millennium Development Goals (MDGs). In Bangladesh, significant achievements in providing safe water were made earlier by nationwide tubewell-i...Ensuring access to safe drinking water by 2015 is a global commitment by the Millennium Development Goals (MDGs). In Bangladesh, significant achievements in providing safe water were made earlier by nationwide tubewell-installation programme. This achievement was overshadowed in 1993 by the presence of arsenic in underground water. A total of 6 million tubewells have been tested for arsenic since then, the results of which warranted immediate mitigation. Mitigation measures included tubewell testing and replacing; usage of deeper wells; surface water preservation and treatment; use of sanitary dug wells, river sand and pond sand filters; rainwater collection and storage; household-scale and large-scale arsenic filtrations; and rural pipeline water supply installation. Shallow tubewell installation was discouraged. Efforts have been made to increase people's awareness. This paper describes the lessons learned about mitigation efforts by the authors from experience of arsenic-related work. In spite of national mitigation plans and efforts, a few challenges still persist: inadequate coordination between stakeholders, differences in inter-sectoral attitudes, inadequate research to identify region-specific, suitable safe water options, poor quality of works by various implementing agencies, and inadequate dissemination of the knowledge and experiences to the people by those organizations. Issues such as long-time adaptation using ground water, poor surface water quality including bad smell and turbidity, and refusal to using neighbor's water have delayed mitigation measures so far. Region-specific mitigation water supply policy led by the health sector could be adopted with multisectoral involvement and responsibility. Large-scale piped water supply could be arranged through Public Private Partnerships (PPP) in new national approach.
Emerg Health Threats J
· 2012 · PMID 22558004
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There are currently no widely accepted animal surveillance guidelines for human Ebola hemorrhagic fever (EHF) outbreak investigations to identify potential sources of Ebolavirus (EBOV) spillover into humans and other ani...There are currently no widely accepted animal surveillance guidelines for human Ebola hemorrhagic fever (EHF) outbreak investigations to identify potential sources of Ebolavirus (EBOV) spillover into humans and other animals. Animal field surveillance during and following an outbreak has several purposes, from helping identify the specific animal source of a human case to guiding control activities by describing the spatial and temporal distribution of wild circulating EBOV, informing public health efforts, and contributing to broader EHF research questions. Since 1976, researchers have sampled over 10,000 individual vertebrates from areas associated with human EHF outbreaks and tested for EBOV or antibodies. Using field surveillance data associated with EHF outbreaks, this review provides guidance on animal sampling for resource-limited outbreak situations, target species, and in some cases which diagnostics should be prioritized to rapidly assess the presence of EBOV in animal reservoirs. In brief, EBOV detection was 32.7% (18/55) for carcasses (animals found dead) and 0.2% (13/5309) for live captured animals. Our review indicates that for the purposes of identifying potential sources of transmission from animals to humans and isolating suspected virus in an animal in outbreak situations, (1) surveillance of free-ranging non-human primate mortality and morbidity should be a priority, (2) any wildlife morbidity or mortality events should be investigated and may hold the most promise for locating virus or viral genome sequences, (3) surveillance of some bat species is worthwhile to isolate and detect evidence of exposure, and (4) morbidity, mortality, and serology studies of domestic animals should prioritize dogs and pigs and include testing for virus and previous exposure.
Dyche J, Anch AM, Fogler KA
… +2 more, Barnett DW, Thomas C
Emerg Health Threats J
· 2012 · PMID 22529876
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BACKGROUND: Studies investigating the effect of power frequency (50-60 Hz) electromagnetic fields (EMF) on melatonin synthesis in rats have been inconsistent with several showing suppression of melatonin synthesis, other...BACKGROUND: Studies investigating the effect of power frequency (50-60 Hz) electromagnetic fields (EMF) on melatonin synthesis in rats have been inconsistent with several showing suppression of melatonin synthesis, others showing no effect and a few actually demonstrating small increases. Scant research has focused on the ensuing sleep patterns of EMF exposed rats. The present study was designed to examine the effects of extremely low power frequency electromagnetic fields (EMF) on the production of melatonin and the subsequent sleep structure in rats. METHODS: Eighteen male Sprague-Dawley rats were exposed to a 1000 milligauss (mG) magnetic field for 1 month. Urine was collected for the final 3 days of the exposure period for analysis of 6-sulphatoxymelatonin, the major catabolic product of melatonin found in urine. Subsequent sleep was analyzed over a 24-hour period. RESULTS: Melatonin production was mildly increased in exposed animals. Although there were no statistically significant changes in sleep structure, exposed animals showed slight decreases in REM (rapid eye movement) sleep as compared to sham (non-exposed) animals. CONCLUSIONS: Power frequency magnetic fields induced a marginally statistically significant increase in melatonin levels in exposed rats compared to control. Subsequent sleep analysis indicated little effect on the sleep architecture of rats, at least not within the first day after 1 month's continuous exposure. Varying results in the literature are discussed and future research suggested.
Lee HC, Yanting Chee D, Selander H
… +1 more, Falkmer T
Emerg Health Threats J
· 2012 · PMID 22461850
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BACKGROUND: Current methods of determining licence retainment or cancellation is through on-road driving tests. Previous research has shown that occupational therapists frequently assess drivers' visual attention while s...BACKGROUND: Current methods of determining licence retainment or cancellation is through on-road driving tests. Previous research has shown that occupational therapists frequently assess drivers' visual attention while sitting in the back seat on the opposite side of the driver. Since the eyes of the driver are not always visible, assessment by eye contact becomes problematic. Such procedural drawbacks may challenge validity and reliability of the visual attention assessments. In terms of correctly classified attention, the aim of the study was to establish the accuracy and the inter-rater reliability of driving assessments of visual attention from the back seat. Furthermore, by establishing eye contact between the assessor and the driver through an additional mirror on the wind screen, the present study aimed to establish how much such an intervention would enhance the accuracy of the visual attention assessment. METHODS: Two drivers with Parkinson's disease (PD) and six control drivers drove a fixed route in a driving simulator while wearing a head mounted eye tracker. The eye tracker data showed where the foveal visual attention actually was directed. These data were time stamped and compared with the simultaneous manual scoring of the visual attention of the drivers. In four of the drivers, one with Parkinson's disease, a mirror on the windscreen was set up to arrange for eye contact between the driver and the assessor. Inter-rater reliability was performed with one of the Parkinson drivers driving, but without the mirror. RESULTS: Without mirror, the overall accuracy was 56% when assessing the three control drivers and with mirror 83%. However, for the PD driver without mirror the accuracy was 94%, whereas for the PD driver with a mirror the accuracy was 90%. With respect to the inter-rater reliability, a 73% agreement was found. CONCLUSION: If the final outcome of a driving assessment is dependent on the subcategory of a protocol assessing visual attention, we suggest the use of an additional mirror to establish eye contact between the assessor and the driver. The clinicians' observations on-road should not be a standalone assessment in driving assessments. Instead, eye trackers should be employed for further analyses and correlation in cases where there is doubt about a driver's attention.
Aitken P, Leggat P, Harley H
… +2 more, Speare R, Leclercq M
Emerg Health Threats J
· 2012 · PMID 22461849
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BACKGROUND: It is likely that calls for disaster medical assistance teams (DMATs) continue in response to international disasters. As part of a national survey, the present study was designed to evaluate the Australian D...BACKGROUND: It is likely that calls for disaster medical assistance teams (DMATs) continue in response to international disasters. As part of a national survey, the present study was designed to evaluate the Australian DMAT experience and the need for logistic support. METHODS: Data were collected via an anonymous mailed survey distributed via State and Territory representatives on the Australian Health Protection Committee, who identified team members associated with Australian DMAT deployments from the 2004 Asian Tsunami disaster. RESULTS: The response rate for this survey was 50% (59/118). Most of the personnel had deployed to the South East Asian Tsunami affected areas. The DMAT members had significant clinical and international experience. There was unanimous support for dedicated logistic support with 80% (47/59) strongly agreeing. Only one respondent (2%) disagreed with teams being self sufficient for a minimum of 72 hours. Most felt that transport around the site was not a problem (59%; 35/59), however, 34% (20/59) felt that transport to the site itself was problematic. Only 37% (22/59) felt that pre-deployment information was accurate. Communication with local health providers and other agencies was felt to be adequate by 53% (31/59) and 47% (28/59) respectively, while only 28% (17/59) felt that documentation methods were easy to use and reliable. Less than half (47%; 28/59) felt that equipment could be moved easily between areas by team members and 37% (22/59) that packaging enabled materials to be found easily. The maximum safe container weight was felt to be between 20 and 40 kg by 58% (34/59). CONCLUSIONS: This study emphasises the importance of dedicated logistic support for DMAT and the need for teams to be self sufficient for a minimum period of 72 hours. There is a need for accurate pre deployment information to guide resource prioritisation with clearly labelled pre packaging to assist access on site. Container weights should be restricted to between 20 and 40 kg, which would assist transport around the site, while transport to the site was seen as problematic. There was also support for training of all team members in use of basic equipment such as communications equipment, tents and shelters and water purification systems.
Emerg Health Threats J
· 2012 · PMID 22461848
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BACKGROUND: Emergency physicians see many people who present to the emergency department stating that they are immunized against tetanus, when in fact, they are not. The patient history is not dependable for determining...BACKGROUND: Emergency physicians see many people who present to the emergency department stating that they are immunized against tetanus, when in fact, they are not. The patient history is not dependable for determining true tetanus status and simple patient surveys do not provide actual prevalence. The objective of this study was to determine the prevalence of tetanus status by antibody titer seropositivity and quantify such status among patients reporting tetanus protection. METHODS: This study is a single center prospective convenience sample of patients presenting to the emergency department 12 years of age or older. Patients deemed study candidates and willing to be in the study filled out an eight-question questionnaire that included the question 'is your tetanus shot up to date'. A blood sample was then drawn for tetanus antibody titer and quantified according to a pre-determined cutoff for protection. RESULTS: A total of 163 patients were enrolled. Of patients responding yes to the query 'is your tetanus shot up to date' 12.8% (N=5) of them were not seropositive. Of the 26 people who were seronegative in the study all had been to a doctor in the past year and 88.5% (N=23) had been to their family physician. CONCLUSION: The study suggests that it may be difficult to trust the tetanus immunization history given by patients presenting to the emergency room. The study also observed that a large percentage of patients who were serenegative were seen by a primary care physician and not had a necessary tetanus immunization.
Boldor N, Bar-Dayan Y, Rosenbloom T
… +2 more, Shemer J, Bar-Dayan Y
Emerg Health Threats J
· 2012 · PMID 22461847
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Optimism has several orientations. One such outlook is a general tendency to regard the world as a positive place, accepting difficulties as mere challenges instead of impassable barriers. Among health care workers, opti...Optimism has several orientations. One such outlook is a general tendency to regard the world as a positive place, accepting difficulties as mere challenges instead of impassable barriers. Among health care workers, optimism improves their level of functioning, their patients' satisfaction, and their therapeutic results. Optimistic staff members report feeling less pressure, use fewer avoidance strategies, focus on practical problem solutions, seek social support, and have more trust in people and organizations. The aim of this article is to provide a review of the literature concerning the role of optimism, both in daily life and in crisis situations. An attempt was made to find the linkage between optimism among health care workers during disasters and their active response, with special emphasis on the relationship between optimism and knowledge, feelings or behavior. Based on the literature, optimism was found to be helpful both in daily medical work and in cases of medical emergencies. Optimism was also revealed one of the key components of resilience and self-efficacy. Therefore, it is recommended to consider strengthening the optimism through initiative programs. Obtaining optimism can be included in toolkit preparedness for health care workers in order to confront the complications in the aftermath of disaster. These programs, together with appropriate information, social support, professional trust, and leaders modeling behavior, will raise the well-being and enhance coping skills of the health care workers during and aftermath of disaster scenarios.
López-Picado A, Apiñaniz A, Ramos AL
… +6 more, Miranda-Serrano E, Cobos R, Parraza-Díez N, Amezua P, Martinez-Cengotitabengoa M, Aizpuru F
Emerg Health Threats J
· 2012 · PMID 22461846
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OBJECTIVE: To determine the intention of health professionals, doctors and nurses, concerning whether or not to be vaccinated against A/H1N1 influenza virus, and their perception of the severity of this pandemic compared...OBJECTIVE: To determine the intention of health professionals, doctors and nurses, concerning whether or not to be vaccinated against A/H1N1 influenza virus, and their perception of the severity of this pandemic compared with seasonal flu. MATERIAL AND METHODS: A cross-sectional study was carried out based on an questionnaire e-mailed to health professionals in public healthcare centres in Vitoria between 6 and 16 November 2009; the percentage of respondents who wanted to be vaccinated and who perceived the pandemic flu to carry a high risk of death were calculated. RESULTS: A total of 115 people completed the questionnaire of whom 61.7% (n=71) were doctors and 38.3% (n=44) were nurses. Of these, 33.3% (n=23) of doctors and 13.6% (n=6) of nurses intended to be vaccinated (p=0.019). Even among those who considered themselves to be at a high risk, 70.6% (n=48) of doctors and 31.7% (n=13) of nurses participating in the study (p=0.001) planned to have the vaccination. CONCLUSIONS: Most health professionals, and in particular nurses, had no intention to be vaccinated against A/H1N1 influenza virus at the beginning of the vaccination campaign.
Emerg Health Threats J
· 2011 Sep · PMID 24149042
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Studies have been done on public health significance of brucellosis using serology with little or no emphasis to risk factors. Therefore, this study was designed to investigate seroprevalence of brucellosis and assess ep...Studies have been done on public health significance of brucellosis using serology with little or no emphasis to risk factors. Therefore, this study was designed to investigate seroprevalence of brucellosis and assess epidemiological variables associated with human brucellosis. After obtaining verbal consent, 241 peripheral blood samples were collected from occupationally exposed groups with and without pyrexia of unknown origin. A structured questionnaire was prepared to gather risk factors, such as occupation, age, sex, history of consuming raw milk and other unpasteurised dairy products, direct contact with domestic animals, general knowledge about the route of transmission and awareness level. Purposive sampling was used to select the key informants. All serum samples were first screened by Rose Bengal Plate Test (RBPT) and further analysed by Standard Tube Agglutination Test (STAT). The results revealed that 24.5% were positive by RBPT and diagnosis was established in 26.6% using STAT with a titre range between 80 and 1,280 IU/ml. Among occupational groups, prevalence was 17.8% in veterinarians and pharmacists but was not statistically significant. The most common clinical symptoms at presentation were fever, headache, back pain, arthralgia and myalgia. No female reactor was found and the mean age and standard deviation of seropositive patients was 34.69±10.97 years. Risk factors such as residence in rural area, participation in vaccination of animals and eating during working hours were significantly associated (P<0.05) with brucellosis by univariate and multivariate analysis. In conclusion, to deal with occupation-related disease like brucellosis, awareness on risk factors must be part of extension education campaign. Besides, regular surveillance of the disease needs to be integrated into control and prevention programme at a local and national level.
Emerg Health Threats J
· 2011 Jul · PMID 24149036
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There are important lessons to be learnt from the recent 'Swine Flu' pandemic. Before we call it a pandemic, we need to have appropriate trigger points that involve not only the spread of the virus but also its level of...There are important lessons to be learnt from the recent 'Swine Flu' pandemic. Before we call it a pandemic, we need to have appropriate trigger points that involve not only the spread of the virus but also its level of virulence. This was not done for H1N1 (swine flu). We need to ensure that we improve the techniques used in trying to decrease the spread of infection-both in the community and within our hospitals. This means improved infection control and hygiene, and the use of masks, alcohol hand rubs and so on. We also need to have a different approach to vaccines. Effective vaccines were produced only after the epidemic had passed and therefore had relatively little impact in preventing many infections. Mass population strategies involving vaccines and antivirals also misused large amounts of scarce medical resources.