What proportion of care home outbreaks are caused by norovirus? An analysis of viral causes of gastroenteritis outbreaks in care homes, North East England, 2016-2018.

BACKGROUND: Outbreaks of infectious gastroenteritis are common in care homes for the elderly. Norovirus can cause these outbreaks, but diagnosis is frequently based solely on clinical characteristics. Our objective in this study was to describe the epidemiology of norovirus and other gastrointestinal pathogens in these settings. METHODS: We analysed surveillance data from gastroenteritis outbreaks reported in North East England between 04 July 2016 to 01 July 2018. Stool samples taken during these outbreaks were tested for a range of viral and bacterial pathogens. We described the epidemiology of these outbreaks and explored the characteristics of norovirus outbreaks versus from other viral causes using multivariable logistic regression. RESULTS: From the 566 care home gastroenteritis outbreaks in this study, we found that norovirus was the pathogen most frequently isolated. Norovirus was detected in 64% of outbreaks with a pathogen identified. Sapovirus was found in 13%; rotavirus in 11%. We found that norovirus outbreaks were associated with higher attack rates (aOR 1.03, 95% CI 1.01-1.05) and fewer cases sampled (aOR 0.74, 95% CI 0.60-0.91), compared to outbreaks caused by other viral pathogens. CONCLUSIONS: These results are important as they quantify the contribution of norovirus to gastroenteritis outbreaks in care homes. Given this evidence, we emphasize the importance of non-specific outbreak interventions that can affect the impact of all such outbreaks. We further recommend that these findings are used to inform the implementation strategies of any norovirus-specific interventions such as a norovirus vaccine.

Exploring the Influence of a Community-Based Peer-Led Wheelchair Skills Training on Satisfaction with Participation in Children and Adolescents with Cerebral Palsy and Spina Bifida: A Pilot Study.

BACKGROUND: Peer-led approaches improve satisfaction with participation, wheelchair skills and wheelchair use self-efficacy in adults, but the evidence is limited in children. This pilot study aimed to explore the influence of community-based, peer-led, group wheelchair training program (i.e., Seating To Go) on satisfaction with participation (primary outcome), wheelchair skills, and wheelchair use self-efficacy in children and adolescents with cerebral palsy and spina bifida. METHODS: A single group pre-post design was used. Invitations were shared online and diffused by clinicians and advocacy and provider groups to recruit a convenience sample of eight pediatric wheelchair users. Participants completed the Seating To Go program in groups that were facilitated by adult wheelchair users. Satisfaction with participation (Wheelchair Outcome Measure-Young People), wheelchair skills (Wheelchair Skills Test), wheelchair use self-efficacy (Wheelchair Use Confidence Scale), and perceived wheelchair skills capacity (Wheelchair Skills Test Questionnaire; proxy rating: parents) were evaluated before and after the Seating To Go program. Descriptive statistics and nonparametric longitudinal data analysis were conducted to explore changes in all outcomes from baseline to post-intervention. RESULTS: Pediatric wheelchair users (ranging in age from 5 to 15 years) and their parents reported statistically significant improvements in satisfaction with participation. The improvements in wheelchair skills and wheelchair confidence were also statistically significant, but not the parents' perception of their children's wheelchair skills. CONCLUSIONS: A community-based peer-led approach to wheelchair skills training seems promising for improving wheelchair outcomes in pediatric wheelchair users. Further controlled studies with larger samples are warranted.

A survey of UK parental attitudes to the MMR vaccine and trust in medical authority.

Contested reports associating the MMR vaccine with autism have resulted in diminished confidence and uptake of the vaccine in the UK. This postal survey of parent's decisions, attitudes and use of information about MMR immunisation was constructed from questions derived from in-depth qualitative work. The setting was a Primary Care Trust in northeast England (N=996). Both MMR-accepting and refusing parents were supportive of immunisation, yet the high level of concern about the safety of the vaccine expressed even by parents who had immunised their children is worrying in its implications for public confidence and trust in health care. The findings suggest that the ability of practitioners to provide effective professional advice about MMR vaccine could be undermined if a government were to directly promote the vaccine to parents. Practitioners should continue to provide parents with accurate information, while communicating respect for parents' intentions to protect their children's health.

Development and characterization of a scalable controlled precipitation process to enhance the dissolution of poorly water-soluble drugs.

PURPOSE: Poorly water-soluble compounds are being found with increasing frequency among pharmacologically active new chemical entities, which is a major concern to the pharmaceutical industry. Some particle engineering technologies have been shown to enhance the dissolution of many promising new compounds that perform poorly in formulation and clinical studies (Rogers et. al., Drug Dev Ind Pharm 27:1003-1015). One novel technology, controlled precipitation, shows significant potential for enhancing the dissolution of poorly soluble compounds. In this study, controlled precipitation is introduced; and process variables, such as mixing zone temperature, are investigated. Finally, scale-up of controlled precipitation from milligram or gram to kilogram quantities is demonstrated. METHODS: Dissolution enhancement capabilities were established using two poorly water-soluble model drugs, danazol and naproxen. Stabilized drug particles from controlled precipitation were compared to milled, physical blend, and bulk drug controls using particle size analysis (Coulter), X-ray powder diffraction (XRD), scanning electron microscopy (SEM), dissolution testing (USP Apparatus 2), and residual solvent analysis. RESULTS: Stabilized nano- and microparticles were produced from controlled precipitation. XRD and SEM analyses confirmed that the drug particles were crystalline. Furthermore, the stabilized particles from controlled precipitation exhibited significantly enhanced dissolution properties. Residual solvent levels were below FDA limits. CONCLUSIONS: Controlled precipitation is a viable and scalable technology that can be used to enhance the dissolution of poorly water-soluble pharmaceutical compounds.