Impact of positive chest X-ray findings and blood cultures on adverse outcomes following hospitalized pneumococcal lower respiratory tract infection: a population-based cohort study.

BACKGROUND: Little is known about the clinical presentation and outcome of pneumococcal lower respiratory tract infection (LRTI) without positive chest X-ray findings and blood cultures. We investigated the prognostic impact of a pulmonary infiltrate and bacteraemia on the clinical course of hospitalized patients with confirmed pneumococcal LRTI. METHODS: We studied a population-based multi-centre cohort of 705 adults hospitalized with LRTI and Streptococcus pneumoniae in LRT specimens or blood: 193 without pulmonary infiltrate or bacteraemia, 250 with X-ray confirmed pneumonia, and 262 with bacteraemia. We compared adverse outcomes in the three groups and used multiple regression analyses to adjust for differences in age, sex, comorbidity, and lifestyle factors. RESULTS: Patients with no infiltrate and no bacteraemia were of similar age but had more comorbidity than the other groups (Charlson index score ≥1: no infiltrate and no bacteraemia 81% vs. infiltrate without bacteraemia 72% vs. bacteraemia 61%), smoked more tobacco, and had more respiratory symptoms. In contrast, patients with a pulmonary infiltrate or bacteraemia had more inflammation (median C-reactive protein: no infiltrate and no bacteraemia 82 mg/L vs. infiltrate without bacteraemia 163 mg/L vs. bacteraemia 316 mg/L) and higher acute disease severity scores. All adverse outcomes increased from patients with no infiltrate and no bacteraemia to those with an infiltrate and to those with bacteraemia: Length of hospital stay (5 vs. 6 vs. 8 days); intensive care admission (7% vs. 20% vs. 23%); pulmonary complications (1% vs. 5% vs. 14%); and 30-day mortality (5% vs. 11% vs. 21%). Compared with patients with no infiltrate and no bacteraemia, the adjusted 30-day mortality rate ratio was 1.9 (95% confidence interval (CI) 0.9-4.1) in patients with an infiltrate without bacteraemia and 4.1 (95% CI 2.0-8.5) in bacteraemia patients. Adjustment for acute disease severity and inflammatory markers weakened these associations. CONCLUSIONS: Hospitalization with confirmed pneumococcal LRTI is associated with substantial morbidity and mortality even without positive chest X-ray findings and blood cultures. Still, there is a clinically important outcome gradient from LRTI patients with pneumococcal isolation only to those with detected pulmonary infiltrate or bacteraemia which is partly mediated by higher acute disease severity and inflammation.

Management of Empty Pesticide Containers-A Study of Practices in Santa Cruz, Bolivia.

AIMS: The mismanagement of empty containers of pesticides, posing a risk to the environment and the health of people, has motivated the promotion of international policies and guidelines to mitigate such problems. Despite these guidelines, attention to this problem is inadequate in Bolivia. The objective was to study the knowledge and practical management of the containers and to implement a responsible management plan for empty pesticide containers. METHODS: This study implemented the project from 2014 to 2016 in 2 municipalities of the Department of Santa Cruz. Integral and participatory processes of information, education, and training were used. A questionnaire study among pesticide users was used to investigate knowledge and management of the empty pesticide containers. RESULTS: The authorities and the population responded to the program by taking a critical and active approach to the problem, improving their responsible practices, and 5500 kg of empty containers were collected. The cross-sectional study showed that 93% of the empty containers were disposed of in vulnerable places; 62% of the population did not know what triple washing is; 60% felt discomfort, headache, and/or dizziness while using pesticides; and 31% of the empty containers had pesticide residue inside them. CONCLUSIONS: The study illustrates a complex situation, mainly caused by lack of knowledge and clear guidelines. We recommend documentation of the social, economic, and productive characteristics of the region before any municipal program action is undertaken. The key element to sustainable change is an informed and coordinated participation of all actors.

Pesticide Residues in Commercial Lettuce, Onion, and Potato Samples From Bolivia-A Threat to Public Health?

Bolivia does not have a surveillance program for pesticide residues in food. The few published studies have suggested that pesticide contamination in food may present a public health problem. Data are lacking for all foods except tomatoes and breast milk. In this study 10 potato, 10 onion, and 10 lettuce samples from La Paz were sampled on August 15, 2015 at a local market and screened for 283 pesticides. Residues of cypermethrin, chlorpyrifos, difenoconazol, or/and λ-cyhalothrin were detected in 50% of the lettuce samples, whereas no pesticides were found in potatoes and onions. In 20% of the lettuce samples, the measurements were above the maximum residue limits, and 2 or 3 pesticides were identified simultaneously. Washing almost halved the pesticide levels, but still 20% of the samples showed measurements above the limits. No samples contained concentrations of pesticides which alone or together would lead to exposures that exceeded the acceptable daily intake or the acute reference dose. To protect consumers from pesticide poisonings and chronic effects, the development of measures for prevention, control, and monitoring of food contamination by pesticides in Bolivia is suggested.

Publication rate and PhD enrolment following a medical pre-graduate research programme.

INTRODUCTION: In the 1990s, the publication and PhD recruitment rates following the Danish pre-graduate research programme (PGRP) in medicine were 54% and 33%, respectively. Updated estimates are unknown. METHODS: All medical students enrolled in the PGRP at the Faculty of Medicine, Aarhus University (Health), Denmark, during 2003-2012 were included (n = 687). The PGRP files were merged with PhD students' files at Health. A systematic literature search was completed for research students who had enrolled during the 2006-2009 period (n = 227). The factors investigated were student age, sex, PGRP completion time and years in medical school at the time of PGRP initiation. Supervisors were described by sex, title, position and affiliation. Calculations were tested by the chi-squared test; p < 0.05 was considered significant. RESULTS: A larger proportion of male medical students conducted a PGRP compared to female medical students (28% versus 19%; p < 0.01). Within three and a half years from PGRP initiation, 13% of the research students had enrolled in a PhD programme at Health, and 52% had published ≥ 1 paper with ≥ 1 supervisor. The research student was the first author on 43% of the overall 224 papers, and 90% were original articles. Publication was positively associated with completion of the PGRP in < 18 months and with embarking on a PhD and with having a male main supervisor. PhD recruitment was related to enrolment in the PGRP after fewer years in medical school. CONCLUSIONS: Fast completion of the PGRP and early enrolment in the programme were associated with scientific publishing and PhD recruitment. The publication rate has remained stable over time.

Serotype distribution in non-bacteremic pneumococcal pneumonia: association with disease severity and implications for pneumococcal conjugate vaccines.

BACKGROUND: There is limited knowledge of serotypes that cause non-bacteremic pneumococcal pneumonia (NBP). Here we report serotypes, their associated disease potential and coverage of pneumococcal conjugate vaccines (PCV) in adults with NBP and compare these to bacteremic pneumonia (BP). METHODS: Adults with pneumonia and Streptococcus pneumoniae isolated from the lower respiratory tract or blood were included 1 year in a population-based design in Denmark. Pneumonia was defined as a new infiltrate on chest radiograph in combination with clinical symptoms or elevated white blood count or plasma C-reactive protein. All isolates were serotyped using type-specific pneumococcal rabbit antisera. All values are medians with interquartile ranges. RESULTS: There were 272 cases of NBP and 192 cases of BP. Ninety-nine percent were hospitalized. NBP and BP cases were of comparable age and sex but NBP cases had more respiratory symptoms and less severe disease compared to BP cases. In total, 46 different serotypes were identified. Among NBP cases, 5 serotypes accounted for nearly a third of isolates. PCV10 and -13 types covered 17% (95% confidence interval (CI): 11-23%) and 34% (95% CI: 25-43%) of NBP isolates, respectively. In contrast, the five most frequent serotypes accounted for two-thirds of BP isolates. PCV10 and -13 types covered 39% (95% CI: 30-48%) and 64% (95% CI: 48-79) of BP isolates, respectively. More severe NBP disease was associated with infection with invasive serotypes while there was an inverse relationship for BP. CONCLUSIONS: Only a third of cases of adult non-bacteremic pneumococcal pneumonia would potentially be preventable with the use of PCV13 and just one sixth of cases with the use of PCV10 indicating that PCVs with increased valency are needed to increase vaccine coverage for NBP in adults. PCV13 could potentially prevent two-thirds of adult bacteremic pneumococcal pneumonia.