RESUMO
When measuring inequality using conventional inequality measures, ethical assumptions about distributional preferences are often implicitly made. In this paper, we ask whether the ethical assumptions underlying the concentration index for income-related health inequality and the Gini index for income inequality are supported in a representative sample of the Swedish population using an internet-based survey. We find that the median subject has preferences regarding income-related health inequality that are in line with the ethical assumptions implied by the concentration index, but put higher weight on the poor than what is implied by the Gini index of income inequality. We find that women and individuals with a poorer health status put higher weight on the poor than men and healthier individuals. Ethically flexible inequality measures, such as the s-Gini index and the extended concentration index, imply that researchers have to choose from a toolbox of infinitely many inequality indices. The results of this paper are indicative of which indices (i.e. which parameter values) reflect the views of the population regarding how inequality should be defined.
Assuntos
Disparidades nos Níveis de Saúde , Renda , Feminino , Nível de Saúde , Humanos , Masculino , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Bacterial meningitis is a serious disease with a mortality rate of 15-20% in adults. We conducted a population-based study of bacterial meningitis in adults (≥ 16 y) in Iceland, 1995-2010. METHODS: Cases were identified based on positive bacterial cultures from cerebrospinal fluid (CSF) and/or the ICD codes for bacterial meningitis. Medical charts were reviewed and outcomes were assessed using the national population registry. The study period was divided into 2 equal parts, 1995-2002 and 2003-2010, before and after implementation of routine childhood vaccination against serogroup C meningococci, respectively. RESULTS: In total, 111 episodes occurred in 110 individuals. The most common causative organisms were Neisseria meningitidis (41%) and Streptococcus pneumoniae (30%). Only 30% of the patients presented with the classical symptom triad of fever, neck stiffness, and an altered mental status. The overall incidence was 3.2/100,000 inhabitants/y, and dropped significantly between the first and second halves of the study (p = 0.03). This drop was due to a reduced incidence of N. meningitidis meningitis: 34 and 12 cases in the first and second periods, respectively (p = 0.006). The incidence of meningitis caused by S. pneumoniae remained unchanged. The case fatality rates were 18% and 13% in the first and second halves of the study, respectively (difference not significant). CONCLUSIONS: The incidence of bacterial meningitis has decreased since the implementation of meningococcal C vaccination in 2002. However, the case fatality rate has remained unchanged.
Assuntos
Meningites Bacterianas/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Islândia/epidemiologia , Masculino , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/microbiologia , Pessoa de Meia-Idade , Neisseria meningitidis/isolamento & purificação , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/epidemiologia , Estudos Retrospectivos , Streptococcus pneumoniae/isolamento & purificação , Adulto JovemRESUMO
BACKGROUND: Bacterial meningitis is a serious and potentially rapid life-threatening disease. Therefore, to ensure appropriate treatment, early recognition of signs and symptoms is imperative, along with knowledge of the epidemiology and microbiology of the disease. METHODS: A long-term, nationwide epidemiological study of bacterial causes of meningitis in children (≤ 18 y) in Iceland during the period 1975-2010 was carried out. A detailed chart review was performed of all cases diagnosed in 1995-2010. RESULTS: A total of 477 children were diagnosed with bacterial meningitis during the period 1975-2010. Of these, 67% were aged under 5 y. The most common pathogens were Neisseria meningitidis (n = 265), Haemophilus influenzae (n = 132), Streptococcus pneumoniae (n = 47), and Streptococcus agalactiae (n = 19); their incidences varied according to age. The age-specific incidence (cases/100,000/y) dropped from 26 in 1975 to 1 in 2010 (p < 0.001). The most common symptoms during the period 1995-2010 were fever (92%), vomiting (67%), nuchal rigidity (60%), and rashes/petechiae (51%). H. influenzae type b disappeared following implementation of Hib vaccination in 1989, and, likewise, the incidence of meningococcal meningitis fell significantly after vaccination against meningococcus serogroup C was initiated in 2002 (p < 0.001). The overall 30-day case fatality rate of bacterial meningitis was 4.4% and remained unchanged during the study period. CONCLUSIONS: The incidence of childhood bacterial meningitis has been reduced significantly by successful vaccinations against H. influenzae type b and N. meningitidis serogroup C. Nevertheless, the case fatality rate has remained unchanged and thus the disease is still a serious threat to childhood health. Further prevention by novel vaccines and improved management of childhood meningitis is an exciting challenge.
Assuntos
Bactérias/classificação , Bactérias/isolamento & purificação , Meningites Bacterianas/epidemiologia , Meningites Bacterianas/microbiologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Islândia/epidemiologia , Incidência , Lactente , Recém-Nascido , Masculino , Mortalidade , Vacinação/estatística & dados numéricosRESUMO
Efficiency calculations of violence prevention are likely to be severely biased if the hard-to-measure value of utility reductions due to victimization is not included. We measure the monetary compensation needed to offset the welfare loss associated with being subjected to violence, by applying the compensating-income-variation method to data from an Icelandic health-and-lifestyle survey carried out in 2017. We examine differences in the monetary compensation needed by (i) types of violence, (ii) duration since the exposure, and (iii) the relationship with the perpetrator. Our results show that the average compensation needed to offset the welfare loss due to psychological violence is $43,750 per year, $22,202 per year for sexual violence, and $10,938 per year for physical violence. Further, we find that the monetary compensation needed is highest when the perpetrator is a spouse or an ex-spouse, and when the violence happened recently.
Assuntos
Vítimas de Crime , Violência , Humanos , Vítimas de Crime/psicologia , Renda , Seguridade Social , DorRESUMO
To estimate the proportion of methicillin-resistant Staphylococcus aureus (MRSA) isolates from humans that were sequence type (ST) 398, we surveyed 24 laboratories in 17 countries in Europe in 2007. Livestock-associated MRSA ST398 accounted for only a small proportion of MRSA isolates from humans; most were from the Netherlands, Belgium, Denmark, and Austria.
Assuntos
Bovinos/microbiologia , Reservatórios de Doenças/microbiologia , Gado/microbiologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/epidemiologia , Suínos/microbiologia , Animais , Antibacterianos/farmacologia , Áustria/epidemiologia , Técnicas de Tipagem Bacteriana , Bélgica/epidemiologia , Dinamarca/epidemiologia , Europa (Continente)/epidemiologia , Humanos , Staphylococcus aureus Resistente à Meticilina/classificação , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/genética , Testes de Sensibilidade Microbiana , Países Baixos/epidemiologia , Reação em Cadeia da Polimerase , Prevalência , Infecções Estafilocócicas/microbiologiaRESUMO
The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) is continuously changing. Iceland has a low incidence of MRSA. A "search and destroy" policy (screening patients with defined risk factors and attempting eradication in carriers) has been implemented since 1991. Clinical and microbiological data of all MRSA patients from the years 2000 to 2008 were collected prospectively. Isolates were characterized by pulsed-field gel electrophoresis (PFGE), sequencing of the repeat region of the Staphylococcus protein A gene (spa typing), staphylococcal cassette chromosome mec (SCCmec) typing, and screening for the Panton-Valentine leukocidin (PVL) gene. Two hundred twenty-six infected (60%) or colonized (40%) individuals were detected (annual incidence 2.5 to 16/100,000). From 2000 to 2003, two health care-associated outbreaks dominated (spa types t037 and t2802), which were successfully controlled with extensive infection control measures. After 2004, an increasing number of community-associated (CA) cases without relation to the health care system occurred. A great variety of clones (40 PFGE types and 49 spa types) were found, reflecting an influx of MRSA from abroad. The USA300 and Southwest Pacific (SWP) clones were common. SCCmec type IV was most common (72%), and 38% of the isolates were PVL positive. The incidence of MRSA in Iceland has increased since 1999 but remains low and has been stable in the last years. The search and destroy policy was effective to control MRSA in the health care setting. However, MRSA in Iceland is now shifting into the community, challenging the current Icelandic guidelines, which are tailored to the health care system.
Assuntos
Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Toxinas Bacterianas/genética , Técnicas de Tipagem Bacteriana , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Impressões Digitais de DNA , Surtos de Doenças , Eletroforese em Gel de Campo Pulsado , Exotoxinas/genética , Feminino , Humanos , Islândia/epidemiologia , Incidência , Lactente , Leucocidinas/genética , Masculino , Staphylococcus aureus Resistente à Meticilina/classificação , Staphylococcus aureus Resistente à Meticilina/genética , Pessoa de Meia-Idade , Infecções Estafilocócicas/patologia , Fatores de Virulência/genética , Adulto JovemRESUMO
BACKGROUND: Increasing resistance of Helicobacter pylori (H. pylori) to antibiotics calls for constant re-evaluation of multidrug regimens that have been used to eradicate the infection. The aim of this study was to evaluate the current antibiotic susceptibility of H. pylori in an Icelandic cohort. METHODS: Patients referred for gastroscopy were recruited prospectively. Those found to have a positive rapid urease test were included in the study. Susceptibility testing was conducted by the Epsilometer test (E-test) method for ampicillin, clarithromycin, levofloxacin, metronidazole and tetracycline. Results were obtained after three days of incubation in microaerophilic conditions at 37 °C, except for the metronidazole were the first 24 hours were anaerobic. RESULTS: Of the 613 patients who underwent gastroscopy, 138 (23%) had a positive rapid urease test. H. pylori was successfully cultured from 105 (76%) of the urease test positive patients and the isolates were tested for antibiotic susceptibility. Five patients had prior H. pylori eradication. Antibiotic resistance for ampicillin, clarithromycin, levofloxacin, metronidazole and tetracycline was 0%, 9%, 4%, 1% and 0%, respectively. If those who had previously undergone eradication treatment were excluded, the resistance was 0%, 6%, 3%, 1% and 0%, respectively. Clarithromycin resistance was higher amongst women than men, 13% vs. 5%, however, not significantly. Clarithromycin resistance was 60% amongst those who had previously received eradication treatment compared to 6% of those who had not (p < .0001). CONCLUSIONS: Clarithromycin resistance amongst the H. pylori isolates can be considered relatively low. Therefore, in the current cohort, standard triple-drug clarithromycin-containing regimen should remain the first-line treatment against H. pylori.
Assuntos
Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana Múltipla , Infecções por Helicobacter/microbiologia , Helicobacter pylori/efeitos dos fármacos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Claritromicina/administração & dosagem , Claritromicina/farmacologia , Claritromicina/uso terapêutico , Quimioterapia Combinada , Feminino , Gastroscopia , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/epidemiologia , Humanos , Islândia/epidemiologia , Levofloxacino/administração & dosagem , Levofloxacino/farmacologia , Levofloxacino/uso terapêutico , Masculino , Metronidazol/administração & dosagem , Metronidazol/farmacologia , Metronidazol/uso terapêutico , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto JovemRESUMO
New vaccines targeting meningococci expressing serogroup B polysaccharide have been developed, with some being licensed in Europe. Coverage depends on the distribution of disease-associated genotypes, which may vary by age. It is well established that a small number of hyperinvasive lineages account for most disease, and these lineages are associated with particular antigens, including vaccine candidates. A collection of 4,048 representative meningococcal disease isolates from 18 European countries, collected over a 3-year period, were characterized by multilocus sequence typing (MLST). Age data were available for 3,147 isolates. The proportions of hyperinvasive lineages, identified as particular clonal complexes (ccs) by MLST, differed among age groups. Subjects <1 year of age experienced lower risk of sequence type 11 (ST-11) cc, ST-32 cc, and ST-269 cc disease and higher risk of disease due to unassigned STs, 1- to 4-year-olds experienced lower risk of ST-11 cc and ST-32 cc disease, 5- to 14-year-olds were less likely to experience ST-11 cc and ST-269 cc disease, and ≥25-year-olds were more likely to experience disease due to less common ccs and unassigned STs. Younger and older subjects were vulnerable to a more diverse set of genotypes, indicating the more clonal nature of genotypes affecting adolescents and young adults. Knowledge of temporal and spatial diversity and the dynamics of meningococcal populations is essential for disease control by vaccines, as coverage is lineage specific. The nonrandom age distribution of hyperinvasive lineages has consequences for the design and implementation of vaccines, as different variants, or perhaps targets, may be required for different age groups.
Assuntos
Cápsulas Bacterianas/imunologia , Meningite Meningocócica/prevenção & controle , Vacinas Meningocócicas/imunologia , Neisseria meningitidis Sorogrupo B/imunologia , Neisseria meningitidis/imunologia , Adolescente , Adulto , Distribuição por Idade , Antígenos de Bactérias/imunologia , Sequência de Bases , Criança , Pré-Escolar , Humanos , Lactente , Meningite Meningocócica/imunologia , Meningite Meningocócica/microbiologia , Tipagem de Sequências Multilocus , Neisseria meningitidis/isolamento & purificação , Análise de Sequência de DNA , Adulto JovemRESUMO
The recent increase in the incidence of methicillin-resistant Staphylococcus aureus in all the Nordic countries prompted the Scandinavian Society for Antimicrobial Chemotherapy (SSAC) to create the 'SSAC Working Party on MRSA' with the objective to identify methods to keep the invasive MRSA infections in the Nordic countries below 1%. The lack of common definitions was recognized as a major obstacle for a joint Nordic effort to combat MRSA. The aim of this publication is to present proposals for epidemiological definitions of individual cases, for how to report MRSA frequency per country, and for communication of MRSA strain characteristics between the countries.
Assuntos
Controle de Doenças Transmissíveis/normas , Métodos Epidemiológicos , Resistência a Meticilina , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Europa (Continente)/epidemiologia , Humanos , Staphylococcus aureus/isolamento & purificaçãoRESUMO
Invasive meningococcal infections are hyperendemic in Iceland, a relatively isolated country in the mid-Atlantic. We performed a nationwide study on all viable meningococcal strains (N = 362) from 1977 to 2004. We analyzed the association of patient's age and sex, meningococcal serogroups, and sequence types (STs) with outcomes. Overall, 59 different STs were identified, 19 of which were unique to Iceland. The most common STs were 32 (24.6%), 11 (19.9%), and 10 (10.2%). The unique ST-3492 ranked fourth (7.7%). The most common serogroups were B (56.4%), C (39.8%), and A (2.2%). Age (p < 0.001) and infection with a unique ST (p = 0.011) were independently associated with increased death rates, whereas isolation of meningococci from cerebrospinal fluid only was associated with lower death rates (p = 0.046). This study shows evolutionary trends of meningococcal isolates in a relatively isolated community and highlights an association between unique STs and poor outcome.
Assuntos
Infecções Meningocócicas/microbiologia , Infecções Meningocócicas/mortalidade , Neisseria meningitidis/genética , Adolescente , Adulto , Envelhecimento , Antibacterianos/farmacologia , Criança , Pré-Escolar , Farmacorresistência Bacteriana , Feminino , Humanos , Islândia/epidemiologia , Lactente , Estudos Longitudinais , Masculino , Infecções Meningocócicas/epidemiologia , Neisseria meningitidis/classificação , Neisseria meningitidis/efeitos dos fármacos , Filogenia , Fatores de RiscoRESUMO
A total of 75 Salmonella enterica serovar Typhimurium strains of various (mainly human and animal) origins were typed by pulsed-field gel electrophoresis (PFGE) and phage typing. These strains were collected during an outbreak in Iceland in 1999 and 2000. The typing revealed that 84% of the strains belonged to the same PFGE and phage type (PT), namely, PFGE type 1Aa and PT 1.
Assuntos
Técnicas de Tipagem Bacteriana , Surtos de Doenças , Infecções por Salmonella/epidemiologia , Salmonella typhimurium/classificação , Animais , Animais Domésticos , Tipagem de Bacteriófagos , Gatos , Bovinos , Cães , Eletroforese em Gel de Campo Pulsado , Humanos , Islândia/epidemiologia , Infecções por Salmonella/microbiologia , Salmonelose Animal/epidemiologia , Salmonelose Animal/microbiologia , Salmonella typhimurium/isolamento & purificaçãoRESUMO
From July through September 2000, patients in five European countries were infected with a multidrug-resistant strain of Salmonella Typhimurium DT204b. Epidemiologic investigations were facilitated by the transmission of electronic images (Tagged Image Files) of pulsed-field gel electrophoresis profiles. This investigation highlights the importance of standardized protocols for molecular typing in international outbreaks of foodborne disease.