Hepatitis A immunity and region-of-origin in a Swiss prison.

Purpose - The environmental and demographic characteristics of closed institutions, particularly prisons, precipitate morbidity during hepatitis A virus (HAV) outbreaks. Given the high prevalence of chronic liver disease and other risk factors in the prison setting, the purpose of this paper is to examine HAV-immunity and its associated factors in this population. Design/methodology/approach - The cross-sectional study was conducted in 2009: a serology screening for HAV IgG was carried out among 116 inmates in Switzerland's largest pre-trial prison. Other participant characteristics were collected through a structured face-to-face questionnaire with a physician. Findings - In terms of significant demographics, Africa (53.5 percent) and the Balkans/Eastern Europe (36.2 percent) were the main regions of origin; a minority of inmates were from Western Europe (6.9 percent), Latin America (2.6 percent) or Asia (0.9 percent). The authors identified hepatitis A antibody-negative serology (lack of immunity) in five out of 116 prisoners (4.3 percent, 95 percent CI 1.4-9.7). Among participants of European origin alone, five out of 50 inmates were hepatitis A antibody-negative (10 percent, 95 percent CI 3.3-21.8), whereas the 66 inmates from other all continents were hepatitis A antibody-positive (immune) (p=0.026). Originality/value - In this prison population composed of mostly African migrants, hepatitis A immunity was high. This reaffirms that region of origin is highly associated with childhood immunity against HAV. HAV vaccination should take into account a patient's area of origin and his/her risk factors for systemic complications, if ever infected. This targeted strategy would offer herd immunity, and seek out the most vulnerable individuals who are potentially at risk of new exposure in this precarious setting.

Patterns of malaria indices across three consecutive seasons in children in a highly endemic area of West Africa: a three times-repeated cross-sectional study.

OBJECTIVES: To study the manifestations of Plasmodium infection, and its relations with the malaria disease, especially when comparing dry and rainy seasons in a hyperendemic area of West Africa. METHODS: The study was carried out in an area where malaria transmission is high, showing important seasonal variations. One thousand children, representing the total child population (1-12 year old), were observed transversally at the end of three consecutive seasons (dry/rainy/dry). The usual indicators, such as parasite density, splenomegaly, anaemia, or febrile disease were recorded and analysed. RESULTS: The prevalence of Plasmodium falciparum was high in all age groups and seasons, constantly around 60%. The high transmission season (rainy) showed higher rates of anaemia and spleen enlargement and, in the youngest children only, higher parasite densities. There were also differences between the two dry seasons: in the first one, there was a higher rate of fever than in the second one (p < 0.001). Low parasite density (<2,000 p/µl) was never associated with fever during any season, raising some concern with regard to the usefulness of parasite detection. The possible origins of fever are discussed, together with the potential usefulness of analyzing these indices on a population sample, at a time when fever incidence rises and malaria is one potential cause among others. The distinction to be made between the Plasmodium infection and the malaria disease is highlighted. CONCLUSIONS: These data confirm previous hypotheses of a strong difference in malaria infection and disease between dry and rainy seasons. The most relevant seasonal indicator was not mainly parasite rate and density but anaemia, spleen enlargement, prevalence and possible origin of fever. RECOMMENDATIONS: In any situation (i.e. fever or not) and especially during the dry season, one must consider that detection of parasites in the blood is only evidence of a Plasmodium infection and not necessarily of a malaria disease. In such a situation, it seems suitable to obtain, through national malaria teams, a well-defined situation of transmission and prevalence of Plasmodium infection following zones and seasons, in order to adapt control strategies. For researchers, a systematic management of data separately for dry and rainy season appears mandatory.

[What is new in ambulatory general internal medicine in 2013?]. / Médecine interne générale ambulatoire.

This article provides an overview of 10 important articles published in year 2013 in the field of ambulatory general internal medicine. The newest guidelines about glaucoma screening are detailed. In the midst of the lung cancer screening controversy, an article summarizes new guidelines for the management of solitary pulmonary nodules. Cohort studies are detailed, which have shown association between high calcium intake and cardiovascular mortality, grade 2 or 3 obesity and mortality, aspirin use and lower melanoma incidence, and a reduction of the prevalence of dementia in last 20 years. Finally, 2 publications clarify the optimal length of corticoid treatment for COPD exacerbations and the most appropriate treatment regimen for Helicobacter Pylori eradication.

The protective effect of taking care of grandchildren on elders' mental health? Associations between changing patterns of intergenerational exchanges and the reduction of elders' loneliness and depression between 1993 and 2007 in Taiwan.

BACKGROUND: The 20th century's rapid industrialization and urbanization brought important social changes to Taiwan, including an increased number of elders living alone, which has increased risk of depression for the elderly. This study aimed to evaluate the changing pattern regarding the effect of intergenerational exchanges on elders' depressive symptoms from 1993 to 2007. METHODS: Data from the second-, fourth- and sixth-wave surveys of the Study of Health and Living Status of the Middle-Aged and Elderly in Taiwan were analyzed. This study collected elders' individual sociodemographic characteristics, their self-reported health status and their intergenerational exchanges, including living with partners or with their children and their provision of care for their grandchildren. Information about elders' depression was evaluated using the 5-item Epidemiological Studies Depression Scale (CES-D).Changes in elders' intergenerational exchanges and depressive symptoms were compared during these study periods (chi-square test). Then, logistic regression was performed to determine how significantly elders' intergenerational exchanges were associated with their depressive symptoms across the three years 1993, 1999 and 2007. RESULTS: The prevalence of elders living with partners decreased from 1993 to 2007 by 19%, and that of living with their children decreased from 1993 to 2007 by 7%. Conversely, the percentage of elders providing care for grandchildren dramatically increased, from 9% in 1993 to 21% in 2007. Elderly people had significantly fewer depressive symptoms in 2007 than in 1993.After adjusting for confounders, those living without a partner, living without children or providing no grandchild care had a greater risk of feeling lonely and being depressed. However, during the period 1993 to 2007, the impact on elders' depression and loneliness of co-residing with a partner or with children decreased at the same time that the impact of their provision of grandchild care increased. In 2007, elders who provided no grandchild care were significantly more likely to feel lonely and sad as well as to have high CES-D scores; these strong associations were not found in 1993 and 1999. CONCLUSIONS: This study illustrates how taking care of grandchildren protects against depression and loneliness in elderly Taiwanese. We argue the need, in an aging society, for improving intergenerational interaction and recommend careful evaluation of the interaction between population policies and those of social welfare, such as child care.

Is the reporting timeliness gap for avian flu and H1N1 outbreaks in global health surveillance systems associated with country transparency?

BACKGROUND: This study aims to evaluate the length of time elapsed between reports of the same incidents related to avian flu and H1N1 outbreaks published by the WHO and ProMED-mail, the two major global health surveillance systems, before and after the amendment of the International Health Regulations in 2005 (IHR 2005) and to explore the association between country transparency and this timeliness gap. METHODS: We recorded the initial release dates of each report related to avian flu or H1N1 listed on the WHO Disease Outbreak News site and the matching outbreak report from ProMED-mail, a non-governmental program for monitoring emerging diseases, from 2003 to the end of June 2009. The timeliness gap was calculated as the difference in days between the report release dates of the matching outbreaks in the WHO and ProMED-mail systems. Civil liberties scores were collected as indicators of the transparency of each country. The Human Development Index and data indicating the density of physicians and nurses were collected to reflect countries' development and health workforce statuses. Then, logistic regression was performed to determine the correlation between the timeliness gap and civil liberties, human development, and health workforce status, controlling for year. RESULTS: The reporting timeliness gap for avian flu and H1N1 outbreaks significantly decreased after 2003. On average, reports were posted 4.09 (SD = 7.99) days earlier by ProMED-mail than by the WHO. Countries with partly free (OR = 5.77) and free civil liberties scores (OR = 10.57) had significantly higher likelihoods of longer timeliness gaps than non-free countries. Similarly, countries with very high human development status had significantly higher likelihoods of longer timeliness gaps than countries with middle or low human development status (OR = 5.30). However, no association between the timeliness gap and health workforce density was found. CONCLUSION: The study found that the adoption of IHR 2005, which contributed to countries' awareness of the importance of timely reporting, had a significant impact in improving the reporting timeliness gap. In addition, the greater the civil liberties in a country (e.g., importance of freedom of the media), the longer the timeliness gap.

Evolution in intergenerational exchanges between elderly people and their grandchildren in Taiwan; data from a multiple round cross-sectional study from 1993 to 2007.

BACKGROUND: This study aimed to evaluate social evolution in Taiwan in recent decades using the changing pattern of care provided by grandparents for their grandchildren as an indicator. METHODS: Data from the second, fourth and sixth wave surveys of the Study of Health and Living Status of the Middle-Aged and Elderly in Taiwan were used for the analysis. This survey collected individual characteristics, including age, gender, education, ethnicity, dwelling place, living with partners, co-resident with children, employment status, self-reported health status and their provision of care for their grandchildren. Information about the attitudes toward National Health Insurance (NHI) was further collected in a questionnaire of 1999 following the implementation of NHI in 1995. By elders, we mean persons 60 or more years old. By grandchildren, we mean persons under 16 years of age. First, changes in individual characteristics were compared during these study periods (chi-square test). Then the logistic regression was performed to determine how significantly elders' grandchild-care behavior was associated with their individual characteristics. RESULTS: The percentage of elders providing grandchild care increased from 7.7% in 1993 to 13.6% in 1999, and then to 19.4% in 2007. By analysis, significant association was found between behavior in taking care of grandchildren and individuals of lower age, grandmothers, those living with partners or co-residing with children, those unemployed and those with better self-reported health status. And the effect of year was confirmed in the multivariable analysis. CONCLUSIONS: This study pointed out the changing pattern of elders' behavior in taking care of their grandchildren as the main indicator and their related individual characteristics. We argue the need for improving social security policies in an ageing society. We suggest that the interaction between population policies and those of social welfare, including policies for health care and childcare, should be carefully evaluated.

[Proposals to clarify the term "network" applied in the field of the health sector]. / Propositions pour clarifier le terme réseau appliqué au domaine de la santé.

In many technical domains the term "network" is well defined in terms of structures and functions. This is not the case in the social and health sectors where numbers of groupings called themselves networks, suggesting a certain level of interactions, lots of independence, even a will to escape a more restrictive outline-law (foundation, association, federation). However that might be, the concept seems to embrace several dimensions: actors, structures and types of interactions. We would like to bring here a few thoughts aiming to reach a more precise definition, and in particular to formulate some conditions in order to enable the distinction between "network" and others types of functional structures.