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1.
Pan Afr Med J ; 36: 330, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33193984

RESUMO

Bacteria of the Burkholderia cepacia complex cause frequent infections in immunocompromised and hospitalized patients, with a significant mortality rate. Phenotypic identification of those bacteria is difficult and therefore rarely reported from developing countries. This study presents the first ever reported case series of Burkholderia cenocepacia neonatal sepsis in Central African Republic. It demonstrates the superiority of molecular methods to accurately identify B. cenocepacia IIIA species compared to the phenotypic methods.

2.
Trop Med Infect Dis ; 5(2)2020 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-32408591

RESUMO

Hepatitis B vaccination (HBV) is recommended for high-risk groups, such as people who inject drugs (PWIDs). As part of a harm reduction program by a non-governmental organization, hepatitis B screening, vaccination and antibody (HBAb) testing after completion of the vaccination schedule were offered to PWIDS in Myanmar. We determined the proportions of HBV non-completion and sero-unprotection among PWIDs enrolled in the program and their association with socio-demographic and clinical characteristics. We conducted a descriptive study based on routine program data in five selected clinics in Hpakant Township, Myanmar. PWIDs who were Hepatitis B antigen negative at screening during January 2015-December 2018 were included. Among 5386 participants eligible for HBV, 9% refused vaccination. Among those who accepted vaccination (n = 3177 individuals), 65% completed vaccination. Of those tested for HBsAb (n = 2202), 30% were sero-unprotected. Young-adults (aged 18-44 years) and migrant workers had a higher risk of incomplete vaccination. However, participants who used methadone had a lower risk of incomplete vaccination. Migrant workers had higher risk of not returning for HBsAb testing and HIV-positive participants had a higher risk of being HBV sero-unprotected. Efforts to increase HBV vaccination in PWIDs for young adults and clients during methadone and anti-retroviral services should be prioritized.

3.
Int Health ; 2020 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-31927565

RESUMO

BACKGROUND: Recurrent measles outbreaks followed by mass vaccination campaigns (MVCs) occur in urban settings in sub-Saharan countries. An understanding of the reasons for this is needed to improve future vaccination strategies. The 2017 measles outbreak in Guinea provided an opportunity to qualitatively explore suboptimal vaccination coverage within an MVC among participants through their perceptions, experiences and challenges. METHODS: We conducted focus group discussions with caregivers (n=68) and key informant interviews (n=13) with health professionals and religious and community leaders in Conakry. Data were audio-recorded, transcribed verbatim from Susu and French, coded and thematically analysed. RESULTS: Vaccinations were widely regarded positively and their preventive benefits noted. Vaccine side effects and the subsequent cost of treatment were commonly reported concerns, with further knowledge requested. Community health workers (CHWs) play a pivotal role in MVCs. Caregivers suggested recruiting CHWs from local neighbourhoods and improving their attitude, knowledge and skills to provide information about vaccinations. Lack of trust in vaccines, CHWs and the healthcare system, particularly after the 2014-2016 Ebola epidemic, were also reported. CONCLUSIONS: Improving caregivers' knowledge of vaccines, potential side effects and their management are essential to increase MVC coverage in urban settings. Strengthening CHWs' capacities and appropriate recruitment are key to improving trust through a community involvement approach.

4.
J Infect ; 80(3): 326-332, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31958541

RESUMO

OBJECTIVE: To estimate the time-dependent measles effective reproduction number (Rt) as an indicator of the impact of three outbreak response vaccination (ORV) campaigns on measles transmission during a nationwide outbreak in Guinea. METHODS: Rt represents the average number of secondary cases generated by a single primary case in a partially immune population during a given time period. Measles Rt was estimated using daily incidence data for 3952 outbreak-associated measles cases in Guinea in 2017 for the time periods prior to, between, and following each of three ORV campaigns using a simple and extensible mathematical model. RESULTS: Rt was estimated to be above the threshold value of 1 during the initial growth period of the outbreak until the first ORV campaign began on March 13 (Rt = 1.60, 95% CI: 1.55-1.67). It subsequently dropped below 1 and remained <1 through the end of the year (range: 0.71-0.91), although low levels of transmission persisted. CONCLUSIONS: Reduction in Rt coincided with implementation of the ORV campaigns, indicating success of the campaigns at maintaining measles transmission intensity below epidemic growth levels. However, persistent measles transmission remains an issue in Guinea due to insufficient levels of herd immunity. Estimation of Rt should be further leveraged to help decision makers and field staff understand outbreak progress and the timing and type of vaccination efforts needed to halt transmission.

5.
Disaster Med Public Health Prep ; 14(1): 34-38, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31679549

RESUMO

INTRODUCTION AND OBJECTIVES: Typhoon Haiyan partially destroyed the Ormoc District Hospital in the Philippines. A field hospital was established to replace its outpatient department for 5 weeks. We investigated the reasons for medical consultation in the field hospital. METHODS: We described the consultations by sex, age, week, and diagnosis according to the Surveillance in Post-Extreme Emergencies and Disasters system. We compared the number and proportion of upper respiratory tract infections (URTIs) with a control season in 2014. RESULTS: We included 6785 consultations, 55.9% from women. The majority of consultations were communicable diseases (88.2%) followed by noncommunicable (7.1%) and injuries (5.6%). Males suffered more often from injuries than women (66.0% vs 34.0%). Consultations due to injuries decreased from 10.0% in the first to 2.9% in the last week. The most frequent diagnosis over the study period was acute respiratory infections (ARIs) (73.1%), of which 83.0% were children. The number of daily URTIs was higher than in a similar 2014 period. CONCLUSIONS: ARI was the most prevalent diagnosis. We recommend ARI treatments being fully accessible after such a disaster. During the first week, injury prevention should focus on adult men. Studies after natural disasters should include control periods to better understand disease distribution, ultimately improving the prioritization in disasters.


Assuntos
Tempestades Ciclônicas/estatística & dados numéricos , Unidades Móveis de Saúde/estatística & dados numéricos , Encaminhamento e Consulta/tendências , Adolescente , Adulto , Criança , Pré-Escolar , Defesa Civil/métodos , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Unidades Móveis de Saúde/organização & administração , Filipinas/epidemiologia , Vigilância da População/métodos , Encaminhamento e Consulta/estatística & dados numéricos
6.
PLoS One ; 14(3): e0213362, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30835777

RESUMO

INTRODUCTION: Delays in arrival and treatment at health facilities lead to negative health outcomes. Individual and external factors could be associated with these delays. This study aimed to assess common factors associated with arrival and treatment delays in the emergency departments (ED) of three hospitals in humanitarian settings. METHODOLOGY: This was a cross-sectional study based on routine data collected from three MSF-supported hospitals in Afghanistan, Haiti and Sierra Leone. We calculated the proportion of consultations with delay in arrival (>24 hours) and in treatment (based on target time according to triage categories). We used a multinomial logistic regression model (MLR) to analyse the association between age, sex, hospital and diagnosis (trauma and non-trauma) with these delays. RESULTS: We included 95,025 consultations. Males represented 65.2%, Delay in arrival was present in 27.8% of cases and delay in treatment in 27.2%. The MLR showed higher risk of delay in arrival for females (OR 1.2, 95% CI 1.2-1.3), children <5 (OR 1.4, 95% CI 1.4-1.5), patients attending to Gondama (OR 30.0, 95% CI 25.6-35.3) and non-trauma cases (OR 4.7, 95% CI 4.4-4.8). A higher risk of delay in treatment was observed for females (OR 1.1, 95% CI 1.0-1.1), children <5 (OR 2.0, 95% CI 1.9-2.1), patients attending to Martissant (OR 14.6, 95% CI 13.9-15.4) and non-trauma cases (OR 1.6, 95% CI 1.5-1.7). CONCLUSIONS: Women, children <5 and non-trauma cases suffered most from delays. These delays could relate to educational and cultural barriers, and severity perception of the disease. Treatment delay could be due to insufficient resources with consequent overcrowding, and severity perception from medical staff for non-trauma patients. Extended community outreach, health promotion and support to community health workers could improve emergency care in humanitarian settings.


Assuntos
Serviço Hospitalar de Emergência , Tratamento de Emergência , Tempo para o Tratamento , Adolescente , Adulto , Afeganistão , Idoso , Altruísmo , Criança , Pré-Escolar , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/estatística & dados numéricos , Feminino , Haiti , Hospitais , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta , Serra Leoa , Tempo para o Tratamento/estatística & dados numéricos , Triagem , Adulto Jovem
7.
Front Public Health ; 6: 208, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30234081

RESUMO

Background and objective: Understanding how natural disasters affect their victims is key to improve prevention and mitigation. Typhoon Haiyan strongly hit the Philippines in 2013. In Leyte, health staff of two hospitals had a key role as responders, but also as victims. Scarce literature is available on how health staff may be affected when being disasters' victims. We therefore aimed to understand Haiyan's impact for health staff at personal and work level. Methods: We conducted semi-structured interviews in the two hospitals with doctors, nurses, midwives, watchmen and administrative staff in September 2016. We used a thematic analysis. Results: The three main aspects reported as influencing staff were accessibility, safety and emotional aspects. Accessibility was a main difficulty, which prevented some staff from reaching the hospital, causing other staff staying longer on-call. Personal and family safety were affected, and due to remaining on-call immediately after Haiyan, staff members reported lack of information about their family situation. Faith was an emotional aspect repeatedly mentioned as a coping mechanism, and commitment to serve patients was for some respondents an essential argument to stay on duty. Conclusions: Conflict between personal and professional concerns was present in health staff, making it difficult for them to prioritize work. Feeling unsafe was a common experience among health staff which influenced attendance to the hospital. Including temporary housing for staff and relatives close by the hospital can improve the extensive disaster risk during the typhoon season. In addition, established communication channels should be prioritized for staff on duty to find out about family members' wellbeing. We recommend faith and commitment to serve patients to be included in the preparedness programs in this setting.

8.
PLoS One ; 13(1): e0191516, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29381720

RESUMO

OBJECTIVES: We investigated the short-term impact of Typhoon Haiyan, one of the strongest typhoons ever to make landfall, on the pattern of admissions in two hospitals in Eastern Visayas, the Philippines. METHODS: This study took place at Eastern Visayas Regional Medical Center (EVRMC) in Tacloban, and Ormoc District Hospital (ODH) in Ormoc. We determined whether there were differences in the pattern of admissions between the week before and the three weeks after Haiyan by using information on sex, age, diagnosis, ward and outcome at discharge from patient records. RESULTS: There was a drop in admissions in both hospitals after Haiyan as compared to before. Admissions climbed back to the baseline after ten days in EVRMC and after two weeks in ODH. When comparing the period after Haiyan to the period before, there was a relative increase in male versus female admissions in ODH (OR 2.8, 95%CI 1.7-4.3), but not in EVRMC. Patients aged ≥50 years and 0-14 years had the highest relative increase in admissions. There was a relative decrease in admissions for the ICD10 group 'Pregnancy, childbirth and the puerperium' (OR 0.4, 95%CI 0.3-0.6), and an increase in 'Certain infectious and parasitic diseases' (OR 2.1, 95%CI 1.2-3.5), mainly gastroenteritis, and 'Diseases of the respiratory system' (OR 1.8, 95%CI 1.0-3.0), mainly pneumonia, compared to all other diagnosis groups in ODH. Out of all reasons for admission within the study period, 66% belong to these three ICD-10 groups. Data on reasons for admission were not available for EVRMC. CONCLUSIONS: The observed reduction in patients after the Typhoon calls for ensuring that hospital accessibility should be protected and reinforced, especially for pregnant women, by trying to remove debris in the direct hospital vicinity. Hospitals in areas prone to tropical cyclones should be prepared to treat large numbers of patients with gastroenteritis and pneumonia, as part of their disaster plans.


Assuntos
Tempestades Ciclônicas , Hospitais , Admissão do Paciente , Humanos , Filipinas
9.
Artigo em Inglês | MEDLINE | ID: mdl-28757595

RESUMO

The Syrian conflict has displaced five million individuals outside their country with Lebanon hosting the largest numbers per capita. Around 24% of Syrian refugees fleeing to Lebanon are women of reproductive age (15-49). Yet, a better understanding of the sexual and reproductive health needs of Syrian refugee women in Lebanon is required to improve provided services. Eleven focus group discussions were conducted in four regions of Lebanon with 108 Syrian refugee women of reproductive age. Thematic analysis was used to examine the data. Interviewed women were mainly adults. They believed that, in Lebanon, they were subjected to early marriage compared to the norm in Syria due to their financial situation and uncertainty. Cost was reported as the main barrier to use contraception in Lebanon but some Syrian refugee women were not aware of free services covering sexual and reproductive health. In general, marriage, pregnancy, and family planning behavior of Syrian refugee women in Lebanon slightly differed from those in Syria pre-conflict in terms of age of marriage, conception subsequent to marriage, and contraception method. Hence, interventions to increase awareness of subsidized sexual and reproductive health services, including free contraceptives at primary health care centers, and those targeting protection from early marriage of Syrian refugee women in Lebanon are strongly recommended.


Assuntos
Anticoncepção/estatística & dados numéricos , Casamento/estatística & dados numéricos , Refugiados/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Líbano , Pessoa de Meia-Idade , Pesquisa Qualitativa , Saúde Reprodutiva/estatística & dados numéricos , Síria , Saúde da Mulher/estatística & dados numéricos , Adulto Jovem
10.
Artigo em Inglês | MEDLINE | ID: mdl-28075363

RESUMO

Due to the conflict that started in spring 2014 in Eastern Ukraine, a total of 1.75 million internally displaced persons (IDPs) fled the area and have been registered in government-controlled areas of the country. This paper explores perceived health, barriers to access to healthcare, caring practices, food security, and overall financial situation of mothers and young children displaced by the conflict in Ukraine. This is a qualitative study, which collected data through semi-structured in-depth interviews with nine IDP mothers via Skype and Viber with a convenience sample of participants selected through snowball technique. Contrary to the expectations, the perceived physical health of mothers and their children was found not to be affected by conflict and displacement, while psychological distress was often reported. A weak healthcare system, Ukraine's proneness to informal payments, and heavy bureaucracy to register as an IDP were reported in our study. A precarious social safety net to IDP mothers in Ukraine, poor dietary diversity, and a generalized rupture of vaccine stocks, with halted or delayed vaccinations in children were identified. Increasing social allowances and their timely delivery to IDP mothers might be the most efficient policy measure to improve health and nutrition security. Reestablishment and sustainability of vaccine stocks in Ukraine is urgent to avoid the risks of a public health crisis. Offering psychological support for IDP mothers is recommended.


Assuntos
Saúde da Criança/estatística & dados numéricos , Abastecimento de Alimentos/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Nível de Saúde , Saúde Materna/estatística & dados numéricos , Refugiados/psicologia , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Entrevistas como Assunto , Saúde Pública , Pesquisa Qualitativa , Ucrânia , Adulto Jovem
11.
BMC Health Serv Res ; 17(1): 72, 2017 01 23.
Artigo em Inglês | MEDLINE | ID: mdl-28114994

RESUMO

BACKGROUND: Various barriers exist that preclude individuals from undergoing surgical care in low-income countries. Our study assessed the main barriers in Nepal, and identified individuals most at risk for not receiving required surgical care. METHODS: A countrywide survey, using the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey tool, was carried out in 2014, surveying 2,695 individuals with a response rate of 97%. Our study used data from a subset, namely individuals who required surgical care in the last twelve months. Data were collected on individual characteristics, transport characteristics, and reasons why individuals did not undergo surgical care. RESULTS: Of the 2,695 individuals surveyed, 207 individuals needed surgical care at least once in the previous 12 months. The main reasons for not undergoing surgery were affordability (n = 42), accessibility (n = 42) and fear/no trust (n = 34). A factor significantly associated with affordability was having a low education (OR = 5.77 of having no education vs. having secondary education). Living in a rural area (OR = 2.59) and a long travel time to a secondary and tertiary health facility (OR = 1.17 and 1.09, respectively) were some of the factors significantly associated with accessibility. Being a woman was significantly associated with fear/no trust (OR = 3.54). CONCLUSIONS: More than half of the individuals who needed surgical care did not undergo surgery due to affordability, accessibility, or fear/no trust. Providing subsidised transport, introducing mobile surgical clinics or organising awareness raising campaigns are measures that could be implemented to overcome these barriers to surgical care.


Assuntos
Cirurgia Geral , Instalações de Saúde/provisão & distribução , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Cirurgiões/provisão & distribução , Adulto , Estudos Transversais , Países em Desenvolvimento/estatística & dados numéricos , Feminino , Pesquisas sobre Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Unidades Móveis de Saúde/estatística & dados numéricos , Nepal/epidemiologia , Pobreza/estatística & dados numéricos , Recursos Humanos
12.
Artigo em Inglês | MEDLINE | ID: mdl-28134849

RESUMO

Extreme heat is associated with an increased mortality and morbidity. National heat plans have been implemented to minimize the effect of extreme heat. The population's awareness and knowledge of national heat plans and extreme heat is essential to improve the community's behavior and adaptation. A general population survey was conducted in Lisbon and in Madrid to assess this knowledge. We used a questionnaire to interview passers-by. Results were compared between Lisbon and Madrid and between locals and foreigners, using Pearson Chi-square tests and Fisher's exact test. We conducted 260 interviews in six locations of different socio-economic backgrounds in each city. The most frequently mentioned extreme heat-related risk groups were the elderly (79.2%), children (49.6%) and babies (21.5%). The most frequently reported protective measures were increased fluid intake (73.1%) and avoiding exposure to the sun (50.8%). Knowledge about the heat plan was higher in Lisbon (37.2%) than in Madrid (25.2%) (p-value = 0.03). Foreigners had less knowledge of risk groups compared to locals. Heat plans were not widely known in Madrid and Lisbon. Nonetheless, knowledge of practical concepts to face extreme heat, such as certain risk groups and protective measures, was found. Our results were similar to comparable surveys where specific respondents' groups were identified as less knowledgeable. This highlighted the importance of addressing these groups when communicating public health messages on heat. Foreigners should be specifically targeted to increase their awareness.


Assuntos
Cidades , Calor Extremo/efeitos adversos , Educação em Saúde/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Saúde Pública/educação , Inquéritos e Questionários , Adaptação Fisiológica , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Portugal , Características de Residência , Espanha
13.
PLoS One ; 11(12): e0168820, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27992563

RESUMO

Hosting refugees may represent a drain on local resources, particularly since external aid is frequently insufficient. Between 2004 and 2011, over 100,000 refugees settled in the eastern border of Cameroon. With little known on how refugee influx affects health services of the hosting community, we investigated the impact of refugees on mother and child health (MCH) services in the host community in Cameroon. We used Cameroon's 2004 and 2011 Demographic and Health Surveys to evaluate changes in MCH indicators in the refugee hosting community. Our outcome variables were antenatal care (ANC) coverage, caesarean delivery rate, place of delivery and child vaccination coverage; whereas the exposure variable was residence in the refugee hosting community. We used a difference-in-differences analysis to compare indicators of the refugee hosting community to a control group selected through propensity score matching from the rest of the country. A total of 10,656 women were included in our 2004 analysis and 7.6% (n = 826) of them resided in the refugee hosting community. For 2011, 15,426 women were included and 5.8% (n = 902) of them resided in the hosting community. Between 2004 and 2011, both the proportion of women delivering outside health facilities and children not completing DPT3 vaccination in the refugee hosting community decreased by 9.0% (95% Confidence Interval (CI): 3.9-14.1%) and 9.6% (95% CI: 7.9-11.3%) respectively. However, ANC attendance and caesarean delivery did not show any significant change. Our findings demonstrate that none of the evaluated MCH service indicators deteriorated (in fact, two of them improved: delivery in health facilities and completing DPT3 vaccine) with the presence of refugees. This suggests evidence disproving the common belief that refugees always have a negative impact on their hosting community.


Assuntos
Cuidado da Criança/estatística & dados numéricos , Refugiados/estatística & dados numéricos , Adulto , Camarões , Cesárea/estatística & dados numéricos , Criança , Serviços de Saúde da Criança , Feminino , Acesso aos Serviços de Saúde , Humanos , Serviços de Saúde Materna , Cuidado Pré-Natal , Estudos Retrospectivos , Vacinação/estatística & dados numéricos , Serviços de Saúde da Mulher , Adulto Jovem
14.
PLoS Negl Trop Dis ; 10(10): e0005050, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27780199

RESUMO

In cases of Dengue fever, late hospital admission can lead to treatment delay and even death. In order to improve early disease notification and management, it is essential to investigate the factors affecting the time of admission of Dengue cases. This study determined the factors associated with the time of admission among notified Dengue cases. The study covered the period between 2008 and 2014 in Region VIII, Philippines. The factors assessed were age, sex, hospital sector, hospital level, disease severity based on the 1997 WHO Dengue classification, and period of admission (distinguishing between the 2010 Dengue epidemic and non-epidemic time). We analysed secondary data from the surveillance of notified Dengue cases. We calculated the association through chi-square test, ordinal logistic regression and linear regression at p value < 0.05. The study included 16,357 admitted Dengue cases. The reported cases included a majority of children (70.09%), mild cases of the disease (64.00%), patients from the public sector (69.82%), and non-tertiary hospitals (62.76%). Only 1.40% of cases had a laboratory confirmation. The epidemic period in 2010 comprised 48.68% of all the admitted cases during this period. Late admission was more likely among adults than children (p<0.05). The severe type of the disease was more likely to be admitted late than the mild type (p<0.05). Late admission was also more likely in public hospitals than in private hospitals (p<0.05); and within tertiary level hospitals than non-tertiary hospitals (p<0.05). Late admission was more likely during the non-epidemic period than the 2010 epidemic period (p<0.05). A case fatality rate of 1 or greater was significantly associated with children, severe diseases, tertiary hospitals and public hospitals when admitted late (p<0.05). Data suggests that early admission among child cases was common in Region VIII. This behavior is encouraging, and should be continued. However, further study is needed on the late admission among tertiary, public hospitals and non-epidemic period with reference to the quality of care, patient volume, out of pocket expense, and accessibility We recommend the consistent use of the 2009 WHO Dengue guidelines in order to standardize the admission criteria and time across hospitals.


Assuntos
Dengue/terapia , Admissão do Paciente , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Dengue/epidemiologia , Notificação de Doenças , Feminino , Hospitalização , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/estatística & dados numéricos , Filipinas/epidemiologia , Fatores de Tempo , Adulto Jovem
15.
Euro Surveill ; 21(16)2016 04 21.
Artigo em Inglês | MEDLINE | ID: mdl-27123691

RESUMO

During the 2009/10 influenza A(H1N1)pdm09 pandemic, the five Nordic countries adopted different approaches to pandemic vaccination. We compared pandemic vaccination strategies and severe influenza outcomes, in seasons 2009/10 and 2010/11 in these countries with similar influenza surveillance systems. We calculated the cumulative pandemic vaccination coverage in 2009/10 and cumulative incidence rates of laboratory confirmed A(H1N1)pdm09 infections, intensive care unit (ICU) admissions and deaths in 2009/10 and 2010/11. We estimated incidence risk ratios (IRR) in a Poisson regression model to compare those indicators between Denmark and the other countries. The vaccination coverage was lower in Denmark (6.1%) compared with Finland (48.2%), Iceland (44.1%), Norway (41.3%) and Sweden (60.0%). In 2009/10 Denmark had a similar cumulative incidence of A(H1N1)pdm09 ICU admissions and deaths compared with the other countries. In 2010/11 Denmark had a significantly higher cumulative incidence of A(H1N1)pdm09 ICU admissions (IRR: 2.4; 95% confidence interval (CI): 1.9-3.0) and deaths (IRR: 8.3; 95% CI: 5.1-13.5). Compared with Denmark, the other countries had higher pandemic vaccination coverage and experienced less A(H1N1)pdm09-related severe outcomes in 2010/11. Pandemic vaccination may have had an impact on severe influenza outcomes in the post-pandemic season. Surveillance of severe outcomes may be used to compare the impact of influenza between seasons and support different vaccination strategies.


Assuntos
Vírus da Influenza A Subtipo H1N1 , Influenza Humana/mortalidade , Influenza Humana/prevenção & controle , Vacinação em Massa/estatística & dados numéricos , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Vacinas contra Influenza/uso terapêutico , Influenza Humana/virologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Vacinação em Massa/métodos , Vacinação em Massa/mortalidade , Pessoa de Meia-Idade , Gravidez , Prevalência , Fatores de Risco , Países Escandinavos e Nórdicos/epidemiologia , Estações do Ano , Índice de Gravidade de Doença , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
16.
Papillomavirus Res ; 2: 78-84, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-29074189

RESUMO

AIM: We examined ethnicity-related differences in the uptake of a temporary free-of-charge HPV vaccine (HPVV) catch-up programme offered in Denmark from August 2012 to December 2013 to women born from 1985-1992 and compared it with the previous self-payment system in place. METHODS: We conducted a nationwide retrospective cohort study. We performed logistic regression analyses to examine the relationship between ethnic background and HPV vaccine (HPVV) programme initiation. RESULTS: The free programme increased the vaccination uptake from 16% to 75%. Descendants (Denmark-born women with both parents of foreign origin) and immigrants in Denmark for more than 5 years were less likely to initiate the free HPVV programme than Denmark-born women ((aOR=0.56; 95% CI: 0.54-0.59) and (aOR=0.39; 95% CI: 0.38-0.40), respectively). The likelihood of HPVV programme initiation among immigrants increased with time in Denmark ((aOR=2.28; 95% CI: 2.11-2.48) for immigrants living in Denmark for 16-20 years compared to 6-10 years)). CONCLUSION: The initiation of the free-of-charge HPVV programme was satisfactory. However, large differences in uptake were demonstrated, indicating that some target groups are harder to reach than others. The integration process (as related to use of health services) occurs over many years where differences between the different population groups seem to vanish.


Assuntos
Grupos Étnicos , Vacinas contra Papillomavirus/administração & dosagem , Vacinação/estatística & dados numéricos , Adulto , Dinamarca , Feminino , Humanos , Estudos Retrospectivos , Adulto Jovem
17.
Front Oncol ; 5: 141, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26157706

RESUMO

BACKGROUND: Cervical cancer is the fourth most common cancer affecting women worldwide. Since 2006, two human papillomavirus vaccines (HPVV) have been licensed to protect women against the virus that causes cervical cancer. However, worldwide coverage remains unequal. Studies from the USA found strong evidence for differences in HPVV uptake by ethnicity and healthcare coverage. As the profile of ethnic groups and the healthcare system in the USA differ from countries in Europe where HPVV is free in most of the countries, we conducted a systematic review in order to analyze the determinants of HPVV uptake in Europe. METHODS: We performed a systematic Pubmed, Scopus, and Science Direct search to find articles published from HPVV availability in European countries until April 2014. No age restriction was applied. We included all studies assessing factors associated with HPVV uptake. Uptake refers to either initiation and/or completion of the three dose vaccination program. RESULTS: Out of the 23 eligible studies, 14 were retrospective reviews of data, six were cross-sectional surveys, and three were prospective cohort studies. Higher HPVV uptake was associated with ethnic majority populations, higher socio-economic status, regular cervical screening participation by the mother, and having received previous childhood vaccinations. CONCLUSION: Since the vaccine is offered for free in most of the European countries, the findings suggest that ethno-cultural and educational factors play an important role when it comes to HPVV uptake. Girls who were undervaccinated had also a lower uptake of standard childhood vaccines and mothers who were less likely to attend cervical cancer screening. This may indicate that only few parents have specific concerns with HPVV, and that preventive health care should seek ways to target these vulnerable groups.

18.
PLoS Curr ; 72015 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-25713744

RESUMO

The Democratic Republic of Congo (DRC) has committed to eliminate measles by 2020. In 2013, in response to a large outbreak, Médecins Sans Frontières conducted a mass vaccination campaign (MVC) in Moba, Katanga, DRC. We estimated the measles vaccination coverage for the MVC, the Expanded Programme on Immunization routine measles vaccination (EPI) and assessed reasons for non-vaccination. We conducted a household-based survey among caretakers of children aged 6 months-15 years in Moba from November to December 2013. We used a two-stage-cluster-sampling, where clusters were allocated proportionally to village size and households were randomly selected from each cluster. The questionnaire included demographic variables, vaccination status (card or oral history) during MVC and EPI and reasons for non-vaccination. We estimated the coverage by gender, age and the reasons for non-vaccination and calculated 95% confidence intervals (95% CI). We recruited 4,768 children living in 1,684 households. The MVC coverage by vaccination card and oral history was 87% (95% CI 84-90) and 66% (95% CI 61-70) if documented by card. The EPI coverage was 76% (95% CI 72-81) and 3% (95% CI 1-4) respectively. The MVC coverage was significantly higher among children previously vaccinated during EPI 91% (95% CI 88-93), compared to 74% (95% CI 66-80) among those not previously vaccinated. Six percent (n=317) of children were never vaccinated. The main reason for non-vaccination was family absence 68% (95% CI 58-78). The MVC and EPI measles coverage was insufficient to prevent the recurrence of outbreaks in Moba. Lack of EPI vaccination and lack of accessibility by road were associated with lower MVC coverage. We recommend intensified social mobilization and extended EPI and MVCs to increase the coverage of absent residents and unreached children. Routine and MVCs need to be adapted accordingly to improve coverage in hard-to-reach populations in DRC.

19.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 31(4): 217-221, abr. 2013. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-112047

RESUMO

Introduction In order to assess the relationship between the concentrations of airborne fungi and particles, particle counting was combined with fungal air sampling in several rooms of a hospital. Methods Concentrations of ≥0.5μm particles (P05) and ≥1μm particles (P1) were measured using a particle counter; fungal air sampling was performed with volumetric air samplers, which impacted air on Rodac plates with Sabouraud chloramphenicol agar. Particle counts were categorised according to ISO 14644-1 standard cut-off points; their association with fungal detection was assessed with Fisher's exact test. Results Forty-two simultaneous samplings were carried out: 24 in operating rooms, 13 in rooms for burns or haematology patients, 3 in pharmacy clean rooms, and two in other procedure rooms. Filamentous fungi were recovered in 5 samples, which also had higher particle counts. No fungi were detected in 12 samplings with both P05 and P1 concentrations below the maximum for class 6 clean rooms; 4 of 7 samplings with both concentrations within the range for class 8 clean rooms were positive for fungi. The association between fungal detection and higher particle counts was statistically significant, both for P05 (p=.004) and P1 (p=.003). There was a partial overlap between the concentrations of particles of samplings which were positive or negative for fungi. Conclusions There is a relationship between the concentrations of P05 and P1 and airborne fungi in hospital rooms. When both P05 and P1 concentrations are below the maximum for class 6 clean rooms, a negative fungal detection can be predicted (AU)


Introducción Para evaluar la relación entre las concentraciones de esporas de hongos y de partículas vehiculados por aire, el recuento de partículas se añadió al estudio microbiológico del aire de varias salas de un hospital. Métodos Las concentraciones de partículas ≥0,5μm (P05) y ≥1μm (P1) se midieron con contador de partículas; el muestreo para estudio microbiológico se efectuó con aspiradores volumétricos que impactaban aire sobre placas Rodac con agar Sabouraud cloranfenicol. Los recuentos de partículas se categorizaron según puntos de corte de norma ISO 14644-1; su asociación con la detección de hongos se evaluó con la prueba exacta de Fisher. Resultados Se realizaron 42 muestreos simultáneos: 24 en quirófanos, 13 en habitaciones para pacientes quemados o hematológicos, 3 en salas blancas de farmacia y 2 en salas para otros procedimientos. Se aislaron hongos filamentosos en 5 muestreos, cuyas concentraciones de partículas fueron superiores. No se detectaron hongos en 12 muestreos con concentraciones de clase 6 de P05 y P1; sí se detectaron en 4 de 7 muestreos con concentraciones de ambas partículas de clase 8. La asociación entre detección de hongos y recuentos elevados de partículas fue estadísticamente significativa para P05 (p=0,004) y P1 (p=0,003). Hubo una superposición parcial de las concentraciones de partículas de los muestreos con y sin detección de hongos. Conclusiones En salas hospitalarias hay una asociación entre concentraciones de P05, P1 y hongos en aire. Concentraciones de P05 y P1 inferiores al máximo para salas de clase 6 pueden predecir ausencia de detección de hongos (AU)


Assuntos
Humanos , Material Particulado/análise , Infecção Hospitalar/microbiologia , Análise do Ar , Fungos/isolamento & purificação , /métodos , Carga Bacteriana/métodos , Poluição do Ar
20.
Enferm Infecc Microbiol Clin ; 31(4): 217-21, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22525830

RESUMO

INTRODUCTION: In order to assess the relationship between the concentrations of airborne fungi and particles, particle counting was combined with fungal air sampling in several rooms of a hospital. METHODS: Concentrations of ≥0.5µm particles (P05) and ≥1µm particles (P1) were measured using a particle counter; fungal air sampling was performed with volumetric air samplers, which impacted air on Rodac plates with Sabouraud chloramphenicol agar. Particle counts were categorised according to ISO 14644-1 standard cut-off points; their association with fungal detection was assessed with Fisher's exact test. RESULTS: Forty-two simultaneous samplings were carried out: 24 in operating rooms, 13 in rooms for burns or haematology patients, 3 in pharmacy clean rooms, and two in other procedure rooms. Filamentous fungi were recovered in 5 samples, which also had higher particle counts. No fungi were detected in 12 samplings with both P05 and P1 concentrations below the maximum for class 6 clean rooms; 4 of 7 samplings with both concentrations within the range for class 8 clean rooms were positive for fungi. The association between fungal detection and higher particle counts was statistically significant, both for P05 (p=.004) and P1 (p=.003). There was a partial overlap between the concentrations of particles of samplings which were positive or negative for fungi. CONCLUSIONS: There is a relationship between the concentrations of P05 and P1 and airborne fungi in hospital rooms. When both P05 and P1 concentrations are below the maximum for class 6 clean rooms, a negative fungal detection can be predicted.


Assuntos
Microbiologia do Ar , Poluição do Ar em Ambientes Fechados/análise , Fungos/isolamento & purificação , Unidades Hospitalares/estatística & dados numéricos , Salas Cirúrgicas/estatística & dados numéricos , Material Particulado/análise , Quartos de Pacientes/estatística & dados numéricos , Aerossóis , Unidades de Queimados/estatística & dados numéricos , Ambiente Controlado , Monitoramento Ambiental/instrumentação , Monitoramento Ambiental/métodos , Hematologia , Tamanho da Partícula , Quartos de Pacientes/classificação , Serviço de Farmácia Hospitalar , Espanha , Esporos Fúngicos , Leveduras/isolamento & purificação
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