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1.
Antibiotics (Basel) ; 9(5)2020 May 20.
Artículo en Inglés | MEDLINE | ID: mdl-32443700

RESUMEN

BACKGROUND: Infections are one of the most common reasons for patients attending primary care. Antimicrobial resistance (AMR) is perhaps one of the biggest threats to modern medicine; data show that 81% of antibiotics in the UK are prescribed in primary care. AIM: To identify where the perceived gaps in knowledge, skills, guidance and research around infections and antibiotic use lie from the general practitioner (GP) viewpoint. DESIGN AND SETTING: An online questionnaire survey. METHOD: The survey, based on questions asked of Royal College of General Practitioners (RCGP) members in 1999, and covering letter were electronically sent to GPs between May and August 2017 via various primary care dissemination routes. RESULTS: Four hundred and twenty-eight GPs responded. Suspected Infection in the elderly, recurrent urinary tract infection (UTI), surveillance of AMR in the community, leg ulcers, persistent cough and cellulitis all fell into the top six conditions ranked in order of importance that require further research, evidence and guidance. Acute sore throat, otitis media and sinusitis were of lower importance than in 1999. CONCLUSION: This survey will help the NHS, the UK National Institute for Health and Care Excellence (NICE) and researchers to prioritise for the development of guidance and research for chronic conditions highlighted for which there is little evidence base for diagnostic and management guidelines in primary care. In contrast, 20 years of investment into research, guidance and resources for acute respiratory infections have successfully reduced these as priority areas for GPs.

2.
Microorganisms ; 8(4)2020 Mar 25.
Artículo en Inglés | MEDLINE | ID: mdl-32218318

RESUMEN

Enteric parasites including Giardia duodenalis, Cryptosporidium spp., and to a lesser extent, Blastocystis sp. and Enterocytozoon bieneusi, are major worldwide contributors to diarrhoeal disease. Assessing their molecular frequency and diversity is important to ascertain the sources of infection, transmission dynamics, and zoonotic potential. Little molecular information is available on the genotypes of these pathogens circulating in apparently healthy children. Here, we show that asymptomatic carriage of G. duodenalis (17.4%, 95% CI: 15.5‒19.4%), Blastocystis sp. (13.0%, 95% CI: 11.4‒14.8%), and Cryptosporidium spp. (0.9%, 95% CI: 0.5‒1.5%) is common in children (1‒16 years; n = 1512) from Madrid, Spain. Our genotyping data indicate that; (i) the observed frequency and diversity of parasite genetic variants are very similar to those previously identified in Spanish clinical samples, so that the genotype alone does not predict the clinical outcome of the infection, (ii) anthroponotic transmission accounts for a large proportion of the detected cases, highlighting that good personal hygiene practices are important to minimizing the risk of infection, (iii) Blastocystis ST4 may represent a subtype of the parasite with higher pathogenic potential, and (iv) Enterocytozoon bieneusi does not represent a public health concern in healthy children.

4.
J Infect Prev ; 20(6): 281-288, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31762790

RESUMEN

Introduction: The use of debating as an educational tool is increasing in popularity. Students who take part in debates can develop a range of skills such as confidence and communication as well as gaining a greater understanding of the topic discussed. Within this study we have evaluated an antibiotic-resistant debate kit, assessing the ability of the debate lesson to improve student knowledge and awareness around antibiotics. Methods: The debate lesson was delivered in seven schools across South West England to 235 students aged 13-16 years. Change in student knowledge was measured using before and after knowledge questionnaires. Student and teacher feedback and suggestions for improvements for the lesson were also collected through questionnaires and interviews. Results: Quantitative questionnaires found a significant improvement in knowledge for most areas covered in the debate, particularly around the use of antibiotics to treat colds and bacteria developing resistance. Teachers felt their students engaged well with the debate session and made suggestions for minor modifications that could improve the lesson. Conclusions: The results suggest that the e-Bug antibiotic resistant debate kit is able to improve knowledge in young people around antibiotics and antibiotic resistance. Furthermore, the lesson was enjoyed by students and therefore this resource should be promoted more widely to teachers and schools.

5.
Euro Surveill ; 24(44)2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31690364

RESUMEN

BackgroundEvidence of an oseltamivir treatment effect on influenza A(H3N2) virus infections in hospitalised patients is incomplete.AimsThis cohort study aimed to evaluate risk factors for death among PCR-confirmed hospitalised cases of seasonal influenza A(H3N2) of all ages and the impact of oseltamivir.MethodsParticipants included all 332 PCR-confirmed influenza A(H3N2) cases diagnosed between 30 August 2016 and 17 March 2017 in an English university teaching Hospital. Oseltamivir treatment effect on odds of inpatient death was assessed by backward stepwise multivariable logistic regression analysis.ResultsThe odds of death were reduced by two thirds (odds ratio (OR): 0.32; 95% confidence interval (CI): 0.11-0.93), in inpatients treated with a standard course of oseltamivir 75 mg two times daily for 5 days - compared with those untreated with oseltamivir, after adjustment for age, sex, current excess alcohol intake, receipt of 2016/17 seasonal influenza vaccine, serum haemoglobin and hospital vs community attribution of acquisition of influenza.ConclusionsOseltamivir treatment given according to National Institutes of Clinical Excellence (NICE); United States Centres for Disease Control and Prevention (CDC); Infectious Diseases Society of America (IDSA) and World Health Organization (WHO) guidelines was shown to be effective in reducing the odds of mortality in inpatients with PCR-confirmed seasonal influenza A(H3N2) after adjustment in a busy routine English hospital setting. Our results highlight the importance of hospitals complying with relevant guidelines for prompt seasonal influenza PCR testing and ensuring standard oseltamivir treatment to all PCR-confirmed cases of seasonal influenza.

6.
Euro Surveill ; 24(43)2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31662160

RESUMEN

BackgroundProtozoan enteroparasites Cryptosporidium species and Giardia duodenalis are major contributors to the burden of gastrointestinal illness in children globally, whereas the stramenopile Blastocystis species has been associated with irritable bowel syndrome and skin disorders.AimTo investigate the carriage of these parasites in voluntary asymptomatic schoolchildren (4‒14 years) in 12 different primary and secondary schools in Leganés (Madrid, Spain).MethodsIn a prospective cross-sectional study, stool samples and epidemiological questionnaires on demographics and potential risk factors were collected from participating schoolchildren. Detection of enteric parasites was conducted by PCR-based methods and confirmed by sequence analysis. We calculated prevalence and odds ratios (OR) with logistic regression.ResultsStool samples and questionnaires were provided by 1,359 schoolchildren from 12 schools. The individual prevalence for any parasite was 28%; Blastocystis sp.: 13%; G. duodenalis: 18%; Cryptosporidium spp.: 1%. Two schoolchildren were infected with all three species and 53 with two species. Multivariable risk factor analysis using logistic regression models indicated that an existing infection with one parasite increased the odds for an additional infection with another parasite. The odds of Blastocystis sp. carriage increased up to the age of 10 years and being female increased the odds of Cryptosporidium spp. infection. Washing vegetables before preparing a meal was protective for Blastocystis sp. infection.ConclusionWe detected a larger than expected proportion of asymptomatic cases in the participanting schoolchildren. Further investigation of asymptomatic children should be considered. Good hygiene measures should be encouraged for individuals of all ages to protect from protozoal infections.

7.
J Viral Hepat ; 26(12): 1377-1387, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31328838

RESUMEN

From July to August 2016, 4 homeless people who injected drugs (PWID) with acute or recent hepatitis C virus (HCV) infection were reported in Belfast. A multidisciplinary team including public health, homeless and addiction services undertook an investigation to identify risk behaviours and interrupt transmission chains. Recent HCV cases were defined as negative test within the previous year, or reported injecting for less than 1 year; acute cases had tested negative within the previous 6 months. Contacts in the injecting networks of cases were identified for testing. We undertook a cross-sectional survey using structured questionnaires to elicit risk behaviours for PWID and compare behaviours between self-reported hepatitis C positive and negative subjects. During the outbreak investigation until December 2017, 156 PWID were tested and 45 (29%) cases identified, including 7 (16%) recent and 13 (29%) acute infections. 68 PWID, including 12 cases, were interviewed. All respondents reported using heroin, with 76% injecting once or more daily. Sharing was reported for spoons (58%) and filters (53%), but also needles (27%) and syringes (29%). Hepatitis C positive individuals had higher odds to be injecting in public toilets (AOR 17, 95% CI 0.71-400, P < .05) when compared with hepatitis C negative individuals. Hepatitis C positive individuals were more likely to inject in public spaces, but all respondents indicated concerning risk behaviours. We recommend active surveillance with ongoing testing, expanding existing harm reduction programmes and access to bespoke services.

8.
J Epidemiol Community Health ; 73(9): 825-831, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31262728

RESUMEN

BACKGROUND : Back to school (BTS) asthma has been previously reported in children; however, its epidemiology and associated healthcare burden are unclear. We aimed to describe the timing and magnitude of BTS asthma using surveillance data from different health services in England. METHODS : Asthma morbidity data from emergency department attendances and general practitioner (GP) consultations between April 2012 and December 2016 were used from national syndromic surveillance systems in England. Age-specific and sex-specific rates and time series of asthma peaks relative to school term dates were described. The timing of a BTS excess period and adjusted rates of asthma relative to a baseline period were estimated using cumulative sum control chart plots and negative binomial regression. RESULTS : BTS asthma among children aged below 15 years was most pronounced at the start of the school year in September. This effect was not present among those aged 15 years and above. After controlling for sex and study year, the adjusted daily rate of childhood GP in-hours asthma consultations was 2.5-3 times higher in the BTS excess period, with a significantly higher effect among children aged 0-4 years. A distinct age-specific pattern of sex differences in asthma presentations was present, with a higher burden among males in children and among females aged over 15 years. CONCLUSION: We found evidence of a BTS asthma peak in children using surveillance data across a range of healthcare systems, supporting the need for further preventative work to reduce the impact of BTS asthma in children.

9.
JMIR Serious Games ; 7(1): e10915, 2019 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-30707096

RESUMEN

BACKGROUND: e-Bug, led by Public Health England, educates young people about important topics: microbes, infection prevention, and antibiotics. Body Busters and Stop the Spread are 2 new e-Bug educational games. OBJECTIVE: This study aimed to determine students' baseline knowledge, views on the games, and knowledge improvement. METHODS: Students in 5 UK educational provisions were observed playing 2 e-Bug games. Before and after knowledge and evaluation questionnaires were completed, and student focus groups were conducted. RESULTS: A total of 123 junior and 350 senior students completed the questionnaires. Vaccination baseline knowledge was high. Knowledge increased significantly about antibiotic use, appropriate sneezing behaviors, and vaccinations. In total, 26 student focus groups were conducted. Body Busters was engaging and enjoyable, whereas Stop the Spread was fast-paced and challenging but increased vaccination and health behavior intentions. CONCLUSIONS: e-Bug games are an effective learning tool for students to enhance knowledge about microbes, infection prevention, and antibiotics. Game-suggested improvements should help increase enjoyment.

10.
Int J STD AIDS ; 30(1): 37-44, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-30170527

RESUMEN

In 2014, 42% of all HIV diagnoses in the East of England were diagnosed late. Individuals unaware of their HIV status will not benefit from lifesaving and infectious-limiting antiretroviral therapy, and they remain at risk of decreased life expectancy and onward transmission of HIV. We sought to identify risk factors associated with late HIV diagnosis in the East of England to inform future HIV testing and prevention strategies relevant to the local population. Data on all HIV infected individuals aged ≥16 years and diagnosed between 2008 and 2014 in the East of England were obtained from the national HIV and AIDS Reporting System. Late diagnosis was defined as CD4 cell count below 350 cells/mm3 within 91 days of diagnosis. Logistic regression investigated risk factors for late HIV diagnosis. A total of 2469 people were included; 1342 (54%) were late HIV diagnoses. In multivariable analysis risk factors for late diagnosis were: age ≥30 years, originating from WHO regions of South-East Asia or Europe (excluding UK), heterosexual orientation and being diagnosed as an inpatient or by a general practitioner. The odds of late diagnosis significantly reduced every year (OR 0.95, 95% CI 0.90-0.99, p = 0.042). Despite this year-on-year reduction continued high rates suggest future HIV testing and prevention strategies should be informed by local regional epidemiology to allow those at greatest risk to be targeted appropriately.


Asunto(s)
Diagnóstico Tardío/estadística & datos numéricos , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Heterosexualidad , Vigilancia de la Población/métodos , Adolescente , Adulto , Distribución por Edad , Anciano , Recuento de Linfocito CD4/estadística & datos numéricos , Bases de Datos Factuales , Inglaterra/epidemiología , Femenino , Infecciones por VIH/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Distribución por Sexo , Conducta Sexual
11.
Euro Surveill ; 23(26)2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-29970217

RESUMEN

Public Health England was alerted to a national outbreak of Shiga toxin-producing Escherichia coli O157 PT34 in July 2016. Early investigations suggested that the likely source was a salad item consumed outside of the home. A number of cases reported consuming meals at a staff canteen (Venue A) and a garden café (Venue B). Both venues shared a common salad supplier. An investigation was undertaken to measure associations between salad items and illness using an 'ingredient-based analysis'. A retrospective case-control study was conducted using an online questionnaire to collect information on menu items consumed at each venue. Chefs at both venues were interviewed to identify ingredients contained within each menu item. Both venues were pooled together for multivariable analysis measuring associations at the ingredient level. Among 203 responses, 24 cases were identified (13 confirmed, two probable and nine possible). Case onsets ranged between 7 and 25 June 2016. Multivariable analysis identified strong evidence that only baby mixed-leaf salad from the common supplier was a vehicle of infection (adjusted odds ratio = 13.1; 95% confidence interval: 1.6-106.5). Identifying the specific salad ingredient associated with illness was made possible by using an ingredient-based analysis. We recommend the increased use of ingredient-based analyses.


Asunto(s)
Brotes de Enfermedades , Infecciones por Escherichia coli/epidemiología , Escherichia coli O157/aislamiento & purificación , Enfermedades Transmitidas por los Alimentos/epidemiología , Lechuga/microbiología , Toxina Shiga/aislamiento & purificación , Adolescente , Adulto , Anciano , Estudios de Casos y Controles , Niño , Preescolar , Brotes de Enfermedades/estadística & datos numéricos , Infecciones por Escherichia coli/diagnóstico , Infecciones por Escherichia coli/microbiología , Femenino , Contaminación de Alimentos/análisis , Microbiología de Alimentos , Enfermedades Transmitidas por los Alimentos/microbiología , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Escherichia coli Shiga-Toxigénica/aislamiento & purificación , Reino Unido/epidemiología , Adulto Joven
12.
Epidemiol Infect ; 146(11): 1452-1460, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-29961436

RESUMEN

Since April 2014 all presumptive Salmonella isolates received by Public Health England (PHE) have been characterised using whole genome sequencing (WGS) and the genomic data generated used to identify clusters of infection. To inform the implementation and development of a national gastrointestinal infection surveillance system based on WGS we have retrospectively identified genetically related clusters of Salmonella Enteritidis and Salmonella Typhimurium infection over a one year period and determined the distribution of these clusters by PHE operational levels. Using a constrained WGS cluster definition based on single nucleotide polymorphism distance, case frequency and temporal spread we demonstrate that the majority of clusters spread to multiple PHE operational levels. The greatest investigative burden is on national level staff investigating small, geographically dispersed clusters. We also demonstrate that WGS identifies long-running, slowly developing clusters that may previously have remained undetected. This analysis also indicates likely increased workload for local health protection teams and will require an operational strategy to balance limited human resources with the public health importance of investigating small, geographically contained clusters of highly related cases. While there are operational challenges to its implementation, integrated cluster detection based on WGS from local to international level will provide further improvements in the identification of, response to and control of clusters of Salmonella spp. with public health significance.


Asunto(s)
Infecciones por Salmonella/epidemiología , Salmonella enteritidis/aislamiento & purificación , Salmonella typhimurium/aislamiento & purificación , Secuenciación Completa del Genoma , Análisis por Conglomerados , Inglaterra/epidemiología , Humanos , Análisis Multivariante , Polimorfismo de Nucleótido Simple , Análisis de Regresión , Estudios Retrospectivos , Infecciones por Salmonella/microbiología , Salmonella enteritidis/genética , Salmonella typhimurium/genética
13.
J Antimicrob Chemother ; 73(3): 787-794, 2018 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-29309593

RESUMEN

Objectives: To assess the effect of general practice characteristics and antibiotic prescribing on the number of non-susceptible Escherichia coli isolated from urine specimens submitted from community settings, we undertook an ecological study of the general practice population in the West Midlands. Methods: Descriptive analysis and multilevel modelling of temporal trends in antibiotic prescribing and non-susceptibility of E. coli urine isolates to a range of antibiotics prescribed in the community over a 4 year period. Results: Nine of the 16 antibiotic prescribing/non-susceptibility combinations demonstrated a significant statistical linear correlation with non-susceptibility either for prescribing in a quarter or for prescribing within the previous 12 months. The magnitude of the effect varied, from a 0.3% increase in the odds of non-susceptibility to ampicillin/amoxicillin (when prescribing ampicillin/amoxicillin) to a 6.3% increase in the odds of non-susceptibility to nitrofurantoin (when prescribing nitrofurantoin) for an increase of 50 DDDs per 1000 practice population within a quarter (equivalent to ∼10 courses of antibiotics). In all 16 models, single-handed general practices were shown to have a significant association with increased numbers of non-susceptible E. coli urine isolates (adjusted ORs 1.083-1.657). Increased prescribing of ampicillin/amoxicillin in winter periods was associated with increased non-susceptibility of E. coli isolated from urine specimens. Conclusions: Small increases in antibiotic prescribing in individual general practices reduce the number of susceptible bacteria in the practice population. To maintain the effectiveness of available treatment, antibiotic stewardship should be encouraged and supported within each practice.


Asunto(s)
Antibacterianos/farmacología , Escherichia coli/efectos de los fármacos , Medicina General/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adolescente , Adulto , Anciano , Ampicilina/farmacología , Programas de Optimización del Uso de los Antimicrobianos , Ciprofloxacino/farmacología , Farmacorresistencia Bacteriana , Fenómenos Ecológicos y Ambientales , Inglaterra , Infecciones por Escherichia coli/orina , Femenino , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Nitrofurantoína/farmacología , Estudios Retrospectivos , Estaciones del Año , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/microbiología , Adulto Joven
14.
Artículo en Inglés | MEDLINE | ID: mdl-29194429

RESUMEN

Approximately one million people in the UK are served by private water supplies (PWS) where main municipal water supply system connection is not practical or where PWS is the preferred option. Chronic exposure to contaminants in PWS may have adverse effects on health. South West England is an area with elevated arsenic concentrations in groundwater and over 9000 domestic dwellings here are supplied by PWS. There remains uncertainty as to the extent of the population exposed to arsenic (As), and the factors predicting such exposure. We describe a hazard assessment model based on simplified geology with the potential to predict exposure to As in PWS. Households with a recorded PWS in Cornwall were recruited to take part in a water sampling programme from 2011 to 2013. Bedrock geologies were aggregated and classified into nine Simplified Bedrock Geological Categories (SBGC), plus a cross-cutting "mineralized" area. PWS were sampled by random selection within SBGCs and some 508 households volunteered for the study. Transformations of the data were explored to estimate the distribution of As concentrations for PWS by SBGC. Using the distribution per SBGC, we predict the proportion of dwellings that would be affected by high concentrations and rank the geologies according to hazard. Within most SBGCs, As concentrations were found to have log-normal distributions. Across these areas, the proportion of dwellings predicted to have drinking water over the prescribed concentration value (PCV) for As ranged from 0% to 20%. From these results, a pilot predictive model was developed calculating the proportion of PWS above the PCV for As and hazard ranking supports local decision making and prioritization. With further development and testing, this can help local authorities predict the number of dwellings that might fail the PCV for As, based on bedrock geology. The model presented here for Cornwall could be applied in areas with similar geologies. Application of the method requires independent validation and further groundwater-derived PWS sampling on other geological formations.


Asunto(s)
Arsénico/análisis , Agua Potable/análisis , Agua Subterránea/análisis , Contaminantes Químicos del Agua/análisis , Pozos de Agua , Inglaterra , Monitoreo del Ambiente , Geología , Humanos , Medición de Riesgo
15.
BMC Res Notes ; 10(1): 701, 2017 Dec 06.
Artículo en Inglés | MEDLINE | ID: mdl-29208027

RESUMEN

OBJECTIVES: This study aimed to determine if patients recalled key messages from antibiotic animations shown on digital displays in General Practice waiting rooms, and if watching them changed patients' immediate intentions to consult their GP for upper respiratory tract infections, seek antibiotics and self-care. RESULTS: The pre intervention focus group found the animations intergenerational, informative and educational. 3119 patients were observed in 3 GP practices during project team visits; 145 (4.6%) were observed watching the animations; 132 (91%) remembered seeing them; the key messages were retained by 47-55% of patients. Significant positive differences were observed for questions related to intended antibiotic related behaviours.


Asunto(s)
Antibacterianos/administración & dosificación , Actitud Frente a la Salud , Concienciación , Pacientes/psicología , Comunicación Persuasiva , Grupos Focales , Medicina General , Humanos
16.
J Med Microbiol ; 66(11): 1650-1655, 2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-29039305

RESUMEN

PURPOSE: There is a lack of consensus about which non-human immunodeficiency virus (HIV) patient groups would benefit from prophylaxis. Here, we analysed an enhanced Pneumocystis jirovecii database to describe the epidemiology of Pneumocystis pneumonia (PCP) and P. jirovecii colonizations in Northern Ireland (NI) with a view to identifying risk groups who may benefit from prophylaxis. METHODOLOGY: We prospectively collected information on demographics, clinical severity and clinical features for all hospital inpatients in NI aged ≥18 years with P. jirovecii confirmed in any respiratory tract sample. We defined P. jirovecii colonization or PCP according to clinical symptoms and radiological findings. We compared P. jirovecii colonization to PCP using exact logistic regression and presented the odds ratios (OR), 95 % confidence intervals (CI) and likelihood ratio test P-values.Results/Key findings. Overall, 36/49 (73 %) of P. jirovecii detections were categorized as PCP. A total of 28/36 (78 %) were in non-HIV patients, of which 18 (64 %) had cancer. The odds of PCP compared to P. jirovecii colonization were eight times higher in those with current exposure to chemotherapy (OR 8.73; 95 % CI 0.84, ∞), 16 times higher for those diagnosed with HIV (OR 16.2; 95 % CI 1.71, ∞) and 12 times higher for those ever exposed to another immunosuppressive drug (OR 12.1; 95 % CI 1.94, ∞). CONCLUSION: The greatest burden of PCP is now in the non-HIV group, particularly cancer patients. We recommend increasing clinician awareness of PCP risk and strengthening prevention guidelines in non-HIV patients, and promoting the consideration of prophylaxis on a case-by-case basis.


Asunto(s)
Neumonía por Pneumocystis/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Análisis Multivariante , Irlanda del Norte/epidemiología , Oportunidad Relativa , Factores de Riesgo , Adulto Joven
17.
Euro Surveill ; 22(29)2017 Jul 20.
Artículo en Inglés | MEDLINE | ID: mdl-28749334

RESUMEN

In the United Kingdom, pertussis guidance recommends prophylaxis for household contacts within 21 days of case symptom onset if the household includes a vulnerable contact. The aim of our study was to identify characteristics associated with cases reported late for public health action. We reviewed the epidemiology of cases reported in London and South East England for the period 2010 to 2015. We characterised risk factors associated with late reporting of cases and described public health actions taken on timely reported cases. From 2010 to 2015, 9,163 cases of pertussis were reported to health protection teams. Only 11% of cases were reported within 21 days of onset, limiting opportunities for secondary prevention. Timely reporting was associated with younger age groups, pregnancy, being a healthcare worker and being reported by schools or hospital clinicians. Late reporting was associated with older age groups and general practitioner or laboratory reporting. Delays, such as those due to insidious onset and late presentation to healthcare, may be unavoidable; however, delay in reporting once a patient presents can be reduced since cases can be reported before laboratory confirmation. Thus we recommend working with clinicians and laboratories to determine causes and improve early reporting to public health.


Asunto(s)
Notificación de Enfermedades/estadística & datos numéricos , Salud Pública , Tos Ferina/diagnóstico , Niño , Preescolar , Inglaterra/epidemiología , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Londres , Masculino , Análisis Multivariante , Estudios Retrospectivos , Factores de Tiempo , Tos Ferina/epidemiología , Tos Ferina/prevención & control
18.
J Antimicrob Chemother ; 72(7): 2119-2126, 2017 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-28333334

RESUMEN

Background: Delivering health topics in schools through peer education is known to be beneficial for all students involved. In this study, we have evaluated a peer-education workshop that aims to educate primary and secondary school students on hygiene, the spread of infection and antibiotics. Methods: Four schools in south-west England, in a range of localities, took part in peer-education workshops, with students completing before, after and knowledge-retention questionnaires. Mixed-effect logistic regression and mixed-effect linear regression were used to analyse the data. Data were analysed by topic, region and peer/non-peer-educator status. Qualitative interviews and focus groups with students and educators were conducted to assess changes in participants' skills, confidence and behaviour. Results: Qualitative data indicated improvements in peer-educator skills and behaviour, including confidence, team-working and communication. There was a significant improvement in knowledge for all topics covered in the intervention, although this varied by region. In the antibiotics topic, peer-educators' knowledge increased in the retention questionnaire, whereas non-peer-educators' knowledge decreased. Knowledge declined in the retention questionnaires for the other topics, although this was mostly not significant. Conclusions: This study indicates that peer education is an effective way to educate young people on important topics around health and hygiene, and to concurrently improve communication skills. Its use should be encouraged across schools to help in the implementation of the National Institute for Health and Care Excellence (NICE) guidance that recommends children are taught in an age-appropriate manner about hygiene and antibiotics.


Asunto(s)
Educación en Salud/normas , Higiene/educación , Grupo Paritario , Instituciones Académicas , Adolescente , Antibacterianos , Niño , Inglaterra , Femenino , Educación en Salud/métodos , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Encuestas y Cuestionarios
19.
Ophthalmic Epidemiol ; 24(2): 116-129, 2017 04.
Artículo en Inglés | MEDLINE | ID: mdl-28107088

RESUMEN

PURPOSE: This paper describes the rationale, study design and procedures of the National Eye Survey of Trinidad and Tobago (NESTT). The main objective of this survey is to obtain prevalence estimates of vision impairment and blindness for planning and policy development. METHODS: A population-based, cross-sectional survey was undertaken using random multistage cluster sampling, with probability-proportionate-to-size methods. Eligible participants aged 5 years and older were sampled from the non-institutional population in each of 120 cluster segments. Presenting distance and near visual acuity were screened in their communities. People aged 40 years and older, and selected younger people, were invited for comprehensive clinic assessment. The interview included information on potential risk factors for vision loss, associated costs and quality of life. The examination included measurement of anthropometrics, blood glucose, refraction, ocular biometry, corneal hysteresis, and detailed assessment of the anterior and posterior segments, with photography and optical coherence tomography imaging. Adult participants were invited to donate saliva samples for DNA extraction and storage. RESULTS: The fieldwork was conducted over 13 months in 2013-2014. A representative sample of 10,651 individuals in 3410 households within 120 cluster segments identified 9913 people who were eligible for recruitment. CONCLUSION: The study methodology was robust and adequate to provide the first population-based estimates of the prevalence and causes of visual impairment and blindness in Trinidad and Tobago. Information was also gathered on risk factors, costs and quality of life associated with vision loss, and on normal ocular parameters for the population aged 40 years and older.


Asunto(s)
Ceguera/epidemiología , Baja Visión/epidemiología , Personas con Daño Visual/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Ceguera/economía , Niño , Preescolar , Análisis por Conglomerados , Estudios Transversales , Femenino , Costos de la Atención en Salud , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Calidad de Vida , Factores de Riesgo , Distribución por Sexo , Trinidad y Tobago/epidemiología , Baja Visión/economía , Adulto Joven
20.
BMC Infect Dis ; 16: 311, 2016 06 24.
Artículo en Inglés | MEDLINE | ID: mdl-27341796

RESUMEN

BACKGROUND: Listeriosis is an opportunistic bacterial infection caused by Listeria monocytogenes and predominantly affects people who are immunocompromised. Due to its severity and the population at risk, prompt clinical diagnosis and treatment of listeriosis is essential. A major step to making a clinical diagnosis is the collection of the appropriate specimen(s) for testing. This study explores factors that may influence the time between onset of illness and collection of specimen in order to inform clinical policy and develop necessary interventions. METHODS: Enhanced surveillance data on non-pregnancy associated listeriosis in England and Wales between 2004 and 2013 were collected and analysed. The difference in days between onset of symptoms and collection of specimen was calculated and factors influencing the time difference were identified using a gamma regression model. RESULTS: The median number of days between onset of symptoms and collection of specimen was two days with 27.1 % of cases reporting one day between onset of symptoms and collection of specimen and 18.8 % of cases reporting more than seven days before collection of specimen. The median number of days between onset of symptoms and collection of specimen was shorter for cases infected with Listeria monocytogenes serogroup 1/2b (one day) and cases with an underlying condition (one day) compared with cases infected with serotype 4 (two days) and cases without underlying conditions (two days). CONCLUSIONS: Our study has shown that Listeria monocytogenes serotype and the presence of an underlying condition may influence the time between onset of symptoms and collection of specimen.


Asunto(s)
Listeria monocytogenes/aislamiento & purificación , Listeriosis/epidemiología , Manejo de Especímenes , Adolescente , Adulto , Anciano , Niño , Preescolar , Inglaterra/epidemiología , Femenino , Humanos , Huésped Inmunocomprometido , Lactante , Recién Nacido , Listeria monocytogenes/clasificación , Listeriosis/diagnóstico , Listeriosis/patología , Persona de Mediana Edad , Manejo de Especímenes/métodos , Manejo de Especímenes/normas , Factores de Tiempo , Gales/epidemiología
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