Collecting injury surveillance data in low- and middle-income countries: The Cape Town Trauma Registry pilot

Abstract

Injury is a major public health issue, responsible for 5 million deaths each year, equivalent to the total mortality caused by HIV, malaria and tuberculosis combined. The World Health Organisation estimates that of the total worldwide deaths due to injury, more than 90% occur in low- and middle-income countries (LMIC). Despite the burden of injury sustained by LMIC, there are few continuing injury surveillance systems for collection and analysis of injury data. We describe a hospital-based trauma surveillance instrument for collection of a minimum data-set for calculating common injury scoring metrics including the Abbreviated Injury Scale and the Injury Severity Score. The Cape Town Trauma Registry (CTTR) is designed for injury surveillance in low-resource settings. A pilot at Groote Schuur Hospital in Cape Town was conducted for one month to demonstrate the feasibility of systematic data collection and analysis, and to explore challenges of implementing a trauma registry in a LMIC. Key characteristics of the CTTR include: ability to calculate injury severity, key minimal data elements, expansion to include quality indicators and minimal drain on human resources based on few fields. The CTTR provides a strategy to describe the distribution and consequences of injury in a high trauma volume, low-resource environment.     

一步法Real-time RT-PCR检测结直肠癌前哨淋巴结CK20 mRNA的表达

目的 探讨结直肠癌前哨淋巴结定位和检测CK20 mRNA的意义.方法 对49例结直肠癌患者术中注射美蓝定位前哨淋巴结,用一步法Real-time RT-PCR检测前哨淋巴结CK20 mRNA表达以确定转移病灶.结果 49例结直肠癌患者中成功确定了前哨淋巴结47例,共115枚,每例1～5枚,平均2.4枚/例,检出成功率为95.92％.47例患者前哨淋巴结中,常规病理学证实有11例为肿瘤细胞所浸润,阳性检出率为23.40％；一步法Real-time RT-PCR检测有20例CK20呈阳性表达,阳性检出率为42.55％.两种方法的阳性检出率有显著差异（P＜0.05）.结论 利用一步法Real-time RT-PcR技术检测CK20 mRNA表达可明显提高结直肠癌前哨淋巴结转移病灶的检出率.     

Estimating primary care attendance rates for fever in infants after meningococcal B vaccination in England using national syndromic surveillance data

BackgroundIn September 2015, the United Kingdom became the first country to introduce the multicomponent group B meningococcal vaccine (4CMenB) into a national infant immunisation programme. In early clinical trials 51–61% of infants developed a fever when 4CMenB was administered with other routine vaccines. Whilst administration of prophylactic paracetamol is advised, up to 3% of parents may seek medical advice for fever following vaccination. We used research-level general practitioner consultations to identify any increase in attendances for all-cause fever in vaccine-eligible infants following 4CMenB introduction in England.MethodsConsultations for infant all-cause fever in the year following the vaccine introduction were identified from The Phoenix Partnership (TPP) ResearchOne general practice database using Read (CTV3) codes. Average daily consultation rates and incidence rate ratios (IRRs) were calculated for vaccine-eligible age groups and compared to the two years preceding vaccine introduction. The difference between pre- and post-vaccine all-cause fever consultations was estimated.ResultsAll-cause fever consultations in vaccine-eligible 7–10 week olds were 1.6-fold higher (IRR, 1.58; 95% CI, 1.22–2.05) compared to the two previous years and 1.5-fold higher (IRR 1.47; 95% CI, 1.17–1.86) in 15–18 week-olds. There were no significant differences in 0–6 or 11–14 week-olds. Applying the difference between pre- and post-vaccine consultation rates to the 4CMenB vaccine-eligible age groups across England estimated 1825 additional fever consultations in the year following 4CMenB introduction.ConclusionsWe found a small but significant difference in all-cause fever consultation rates in vaccine-eligible infants who would have received 4CMenB with other vaccines.     

Monitoring Emerging Diseases of Fish and Shellfish Using Electronic Sources

New and emerging fish and shellfish diseases represent an important constraint to the growth and sustainability of many aquaculture sectors and have also caused substantial economic and environmental impacts in wild stocks. This paper details the results of 8 years of a monitoring programme for emerging aquatic animal diseases reported around the world. The objectives were to track global occurrences and, more specifically, to identify and provide advanced warning of disease threats that may affect wild and farmed fish stocks in the UK. A range of electronic information sources, including Internet newsletters, alerting services and news agency releases, was systematically searched for reports of new diseases, new presentations of known pathogens and known diseases occurring in new geographic locations or new host species. A database was established to log the details of key findings, and 250 emerging disease events in 52 countries were recorded during the period of study. These included 14 new diseases and a further 16 known diseases in new species. Viruses and parasites accounted for the majority of reports (55% and 24%, respectively), and known diseases occurring in new locations were the most important emerging disease category (in which viruses were dominant). Emerging diseases were reported disproportionally in salmonid species (33%), in farmed populations (62%) and in Europe and North America (80%). The lack of reports from some regions with significant aquaculture or fishery production may indicate that emerging diseases are not being recognized in these areas owing to insufficient surveillance or testing or that these events are being under‐reported. The results are discussed in relation to processes underpinning disease emergence in the aquatic environment.     

Capture–Recapture Method for Estimating Annual Incidence of Imported Dengue,France, 2007–2010

Imported dengue cases pose the public health risk for local circulation in European areas, especially southeast France, where the Aedes mosquito is established. Using a capture–recapture method with Chao’s estimator, we estimated the annual incidence of dengue fever and the completeness of existing mandatory notification and laboratory network surveillance systems. During 2007–2010, >8,300 cases with laboratory evidence of recent dengue infection were diagnosed. Of these cases, 4,500 occurred in 2010, coinciding with intense epidemics in the French West Indies. Over this 4-year period, 327 cases occurred in southeast France during the vector activity period. Of these, 234 cases occurred in 2010, most of them potentially viremic. Completeness of the mandatory notification and laboratory network systems were ≈10% and 40%, respectively, but higher in southeast areas during May–November (32% and 69%, respectively). Dengue surveillance systems in France provide complementary information that is essential to the implementation of control measures.     

Disease insight and treatment perception of men on active surveillance for early prostate cancer

Study Type – Survey (prospective cohort)
Level of Evidence 1b

OBJECTIVE

To investigate the levels of knowledge of prostate cancer and the perception of active surveillance (AS) in men on AS, as AS for early prostate cancer instead of radical treatment might partly solve the over‐treatment dilemma in this disease, but might be experienced as a complex and contradictory strategy by patients.

PATIENTS AND METHODS

In all, 150 Dutch men recently diagnosed with early prostate cancer participating in a prospective protocol‐based AS programme (PRIAS study) received questionnaires, including a 15‐item measure on their general knowledge of prostate cancer, and open‐ended questions on the most important disadvantages and advantages of AS, and on the specific perception of AS. We assessed knowledge scores and explored potentially associated factors, the stated (dis)advantages and specific perceptions.

RESULTS

The questionnaire response rate was 86% (129/150). Participants provided correct answers to a median (interquartile range) of 13 (12–14) of 15 (87%) knowledge items. Younger and higher educated men had higher knowledge scores. In line with a priori hypotheses, the most frequently reported advantage and disadvantage of AS were the delay of side‐effects and the risk of disease progression, respectively. Specific negative experiences included the feeling of losing control over treatment decisions, distress at follow‐up visits, and the desire for a more active participation in disease management. No conceptually wrong understandings or expectations of AS were identified.

CONCLUSIONS

We found adequate knowledge of prostate cancer levels and realistic perceptions of the AS strategy in patients with early prostate cancer and on AS. These findings suggest adequate counselling by the physician or patient self‐education.     

北京市西城区1985～1995年百日咳发病与预防接种效果综合分析

北京市西城区１９８５～１９９５年百日咳疫苗的基础免疫和加强免疫接种率始终保持在９８％的高水平，百日咳报告发病率逐年下降。至１９８９年使用的是非吸附百白破混合制剂（ＤＰＴ），１９９０年换用吸附ＤＰＴ，两者的抗体阳性率相似，但抗体保护率不同，后者明显高于前者，差异有显著的统计学意义。吸附ＤＰＴ的抗体几何平均滴度（ＧＭＴ）比非吸附ＤＰＴ高６．７倍。北京市西城区１９９２～１９９５年百日咳发病为０。分析认为，在保持高接种率的基础上，提高百日咳抗体保护率和ＧＭＴ水平，是控制和消除百日咳的关键。     

归国劳务人员传染病监测模式的探讨

目的 了解归国劳务人员患传染病状况，探讨其监测模式的防治对策；方法 选择某劳务工司，对归国劳务人员实施了HIV抗体、RPR抗体、HBsAg检测和胸部透视检查，根据结果作原因分析，寻找适合归国劳务人员传染病监测的途径；结果 某劳务公司1996年至2000年底派往新加坡、牙买加、毛里求斯等国归国劳务人员960名，健康检查680名，检出RPR抗体阳性3例、HBsAg阳性29例；结论 提示要加大加强对归国劳务人员的传染病监测工作，防止传染病的传入和传播，在加强出境劳务人员传染病防治知识宣传教育的同时，认真履行归国劳务人员传染病监测的法律法规，建议政府尽快制定劳务人员归国后自觉接受体检的管理办法和具体措施。     

关于胃镜清洗与消毒后的细菌学监测和维护

比较四槽法(含酶洗涤剂)与三槽法清洗消毒对细菌学监测的影响。采用四槽分步法彻底清洗、消毒胃镜。60支胃镜经四槽清洗、消毒后和60支胃镜经三槽清洗、消毒后对照 ,其细菌数分别为9.3±3.8与22.6±6.5(cfu/件)。含酶洗涤剂是使用戊二醛前的清洁洗涤剂 ,能提高消毒效果 ,经统计学处理 ,P<0.05。     

乳腺癌前哨淋巴结活检中亚甲蓝与亚甲蓝、同位素联合示踪的比较研究

目的比较单用亚甲蓝或联合亚甲蓝及同位素示踪剂在乳腺癌前哨淋巴结活检中的价值及研究影响前哨淋巴结活检准确性的因素。方法收集2005年3月至2006年7月期间行前哨淋巴结活检的164例乳腺癌患者,单用亚甲蓝示踪剂组104例,活检前乳晕旁皮下注射亚甲蓝2ml;亚甲蓝和同位素联合示踪剂组60例,术前肿瘤周围实质中4点注射^99m锝-硫胶体2mCi/4ml,经淋巴显像,术中在γ探测仪引导下行腋窝前哨淋巴结活检。结果前哨淋巴结总的检出率为97.0%（159/164）,准确性为95.0%（151/159）,假阴性率为14.0%（8/57）;联合组检出率、准确率、敏感性、阴性预测值高于亚甲蓝组,联合组的假阴性率为8.7%（2/23）,较亚甲蓝组17.7%的假阴性率为低（6/34）,但差异均无统计学意义（P=0.453）。亚甲蓝组平均每例检测出2.2枚前哨淋巴结,联合组为平均2.5枚（P=0.223）。前哨淋巴结数目≥3和〈3枚的患者假阴性率分别为0%和24.2%（8/33）（P=0.016）。联合组中发现73枚无蓝染仅有热点的前哨淋巴结,故同位素的应用将本组患者的检出率从85.0%（51/60）提高至98.3%（59/60）,假阴性率从21.7%（5/23）降低至8.7% （2/23）。结论在取得一定经验的情况下,亚甲蓝示踪与联合染料、同位素示踪可获得相似的前哨淋巴结检出率、准确率;同位素示踪剂的应用对亚甲蓝示踪起到很好的补充作用;前哨淋巴结检出越多,假阴性率越低。