RESUMO
Antimicrobial resistance is a priority emerging public health threat, and the ability to detect promptly outbreaks caused by resistant pathogens is critical for resistance containment and disease control efforts. We describe and evaluate the use of an electronic laboratory data system (WHONET) and a space-time permutation scan statistic for semi-automated disease outbreak detection. In collaboration with WHONET-Argentina, the national network for surveillance of antimicrobial resistance, we applied the system to the detection of local and regional outbreaks of Shigella spp. We searched for clusters on the basis of genus, species, and resistance phenotype and identified 19 statistical 'events' in a 12-month period. Of the six known outbreaks reported to the Ministry of Health, four had good or suggestive agreement with SaTScan-detected events. The most discriminating analyses were those involving resistance phenotypes. Electronic laboratory-based disease surveillance incorporating statistical cluster detection methods can enhance infectious disease outbreak detection and response.
Assuntos
Surtos de Doenças/estatística & dados numéricos , Farmacorresistência Bacteriana , Disenteria Bacilar/epidemiologia , Shigella/isolamento & purificação , Argentina/epidemiologia , Análise por Conglomerados , Surtos de Doenças/prevenção & controle , Geografia , Humanos , Fenótipo , Vigilância de Evento Sentinela , Shigella/classificação , Shigella/genéticaRESUMO
OBJECTIVES: This study reviewed evidence on the effect of maternal smoking on early weaning. METHODS: The following databases and journals were searched: Medline, Scientific Citation Index, Pediatrics, Journal of Pediatrics, New England Journal of Medicine, and Lancet. Analysis was restricted to studies in which infants who had never been breastfed were excluded or the prevalence of breastfeeding initiation was more than 90%. RESULTS: In smoking vs nonsmoking mothers, the random effects odds ratio for weaning before 3 months was 1.93 (95% confidence interval [CI] = 1.55, 2.40). An adjusted odds ratio of 1.50 (95% CI = 1.34, 1.68) was shown in studies that had lost-to-follow-up rates below 15% and included adequate adjustment for confounding. CONCLUSIONS: Maternal smoking increases the risk of early weaning.
Assuntos
Atitude Frente a Saúde , Aleitamento Materno/psicologia , Aleitamento Materno/estatística & dados numéricos , Mães/psicologia , Transtornos Puerperais/psicologia , Fumar/psicologia , Desmame , Adulto , Análise de Variância , Viés , Estudos de Casos e Controles , Fatores de Confusão Epidemiológicos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Lactente , Recém-Nascido , Razão de Chances , Análise de Regressão , Projetos de Pesquisa , Fatores de Risco , Fatores de TempoRESUMO
OBJECTIVE: To compare Cambodian and Central American adolescent refugees to Quebec with their Quebec-born peers in regard to emotional and behavioural problems, feelings of competence, and risk-behaviour profiles, and to examine relations between emotional variables and living conditions in the 3 groups. METHOD: The sample consisted of 76 Cambodian, 82 Central American and 67 Québécois youth living in the Montreal area. The teenagers' internalization and externalization symptoms were assessed using the Child Behaviour Checklist (CBCL) and the Youth Self-Report (YSR); the YSR also provided a measure of their feelings of competence. Risk behaviour was reported by the teenagers. The socioeconomic status of the teenagers' households was taken into account in multiple regression analyses conducted for each group. RESULTS: The level of emotional and behavioural problems reported by teenagers was lowest in Central Americans and highest in Québécois; the latter group also reported more risk behaviours than did either refugee group. The socioeconomic status of the Cambodian and Central American refugee households was lower than that of the Québécois. Living conditions were not a major determinant of emotional distress in young Cambodians, but low annual income was associated with internalizing symptoms among Central American youth. The most powerful predictor of externalizing symptoms among the Québécois youth was having a single-parent household. CONCLUSION: This study underscores the contrast between the living conditions of young Cambodian and Central American refugees to Quebec and those of Quebec-born youth. These refugees' precarious socioeconomic status is not accompanied by an increase in adolescents' emotional and behavioural problems.
Assuntos
Sintomas Afetivos/etnologia , Transtornos do Comportamento Infantil/etnologia , Comparação Transcultural , Etnicidade/psicologia , Refugiados/psicologia , Fatores Socioeconômicos , Adolescente , Sintomas Afetivos/psicologia , Camboja/etnologia , América Central/etnologia , Transtornos do Comportamento Infantil/psicologia , Feminino , Humanos , Controle Interno-Externo , Masculino , Quebeque , Fatores de Risco , Pais Solteiros/psicologia , Transtornos de Estresse Pós-Traumáticos/etnologia , Transtornos de Estresse Pós-Traumáticos/psicologiaRESUMO
Because studies of the treatment of children with occult bacteremia have yielded conflicting results, we compared ceftriaxone with amoxicillin for therapy. Inclusion criteria were age 3 to 36 months, temperature > or = 39 degrees C, an acute febrile illness with no focal findings or with otitis media (6/10 centers), and culture of blood. Subjects were randomly assigned to receive either ceftriaxone, 50 mg/kg intramuscularly, or amoxicillin, 20 mg/kg/dose orally for six doses. Of 6733 patients enrolled, 195 had bacteremia and 192 were evaluable: 164 Streptococcus pneumoniae, 9 Haemophilus influenzae type b, 7 Salmonella, 2 Neisseria meningitidis, and 10 other. After treatment, three patients receiving amoxicillin had the same organism isolated from their blood (two H. influenzae type b, one Salmonella) and two from the spinal fluid (two H. influenzae type b), compared with none given ceftriaxone. Probable or definite infections occurred in three children treated with ceftriaxone and six given amoxicillin (adjusted odds ratio 0.43, 95% confidence interval 0.08 to 1.82, p = 0.31). The five children with definite bacterial infections (three meningitis, one pneumonia, one sepsis) received amoxicillin (adjusted odds ratio 0.00, 95% confidence interval 0.00 to 0.52, p = 0.02). Fever persisted less often with ceftriaxone (adjusted odds ratio 0.52, 95% confidence interval 0.28 to 0.94, p = 0.04). Although the difference in total infections was not significant, ceftriaxone eradicated bacteremia, prevented significantly more definite focal bacterial complications, and was associated with less persistent fever.