Reemergence of Oropouche fever, northern Brazil

Oropouche fever has reemerged in Parauapebas and Porto de Moz municipalities, Pará State, Brazil. Serologic analysis (immunoglobulin M-ELISA) and virus isolation confirmed Oropouche virus (OROV) in both municipalities. Nucleotide sequencing of 2 OROV isolates from each location indicated genotypes I (Parauapebas) and II (Porto de Moz) in Brazil.     

Molecular epidemiology of Oropouche virus, Brazil

Oropouche virus (OROV) is the causative agent of Oropouche fever, an urban febrile arboviral disease widespread in South America, with >30 epidemics reported in Brazil and other Latin American countries during 1960-2009. To describe the molecular epidemiology of OROV, we analyzed the entire N gene sequences (small RNA) of 66 strains and 35 partial Gn (medium RNA) and large RNA gene sequences. Distinct patterns of OROV strain clustered according to N, Gn, and large gene sequences, which suggests that each RNA segment had a different evolutionary history and that the classification in genotypes must consider the genetic information for all genetic segments. Finally, time-scale analysis based on the N gene showed that OROV emerged in Brazil ≈223 years ago and that genotype I (based on N gene data) was responsible for the emergence of all other genotypes and for virus dispersal.     

Outbreak of Oropouche Virus in French Guiana

Oropouche fever is a zoonotic dengue-like syndrome caused by Oropouche virus. In August–September 2020, dengue-like syndrome developed in 41 patients in a remote rainforest village in French Guiana. By PCR or microneutralization, 23 (82.1%) of 28 tested patients were positive for Oropouche virus, documenting its emergence in French Guiana.     

Gender,play, language,and creativity in preschoolers

This study explored the effects of a child's gender and school setting on preschoolers' language abilities (receptive vocabulary), creativity, and social play. The participants were primarily European-American children who spoke English as a primary language (nine children were bilingual), and were from middle income socioeconomic backgrounds. There were 20 girls and 33 boys. Ages ranged from 3.11 to 6.60 years with a mean age of 4.66 years. On separate occasions, children individually completed the Goodenough-Harris Draw-a-Person Test and the Peabody Picture Vocabulary Test-IV. We also recorded the children's social play using Howes and Matheson's [1992. Sequences in the development of competent play with peers: Social and social pretend play. Developmental Psychology, 28, 961–974] scale. We employed a time sampling approach and also notated the area in which the child was playing. We found that gender and school setting influenced children's language abilities and social play. For example, children in the preschool that engaged in pretend play with greater frequency performed well on the receptive vocabulary test. We also found that certain classroom areas generated different types of social play. We discuss the applied value of our findings as these relate to future research.     

Characteristics and Risk Factors of Hospitalized and Nonhospitalized COVID-19 Patients,Atlanta, Georgia,USA, March–April 2020

We compared the characteristics of hospitalized and nonhospitalized patients who had coronavirus disease in Atlanta, Georgia, USA. We found that risk for hospitalization increased with a patient’s age and number of concurrent conditions. We also found a potential association between hospitalization and high hemoglobin A1c levels in persons with diabetes.     

Chikungunya outbreak, South India, 2006

We investigated chikungunya outbreaks in South India and observed a high attack rate, particularly among adults and women. Transmission was facilitated by Aedes aegypti mosquitoes in peridomestic water containers, as indicated by a high Breteau index. We recommended vector control measures and health education to promote safe water storage practices.     

Balance, balancing, and health

In this article we explore the concept of balance in the context of health. We became interested in balance during a grounded theory study of lay conceptualizations of cancer risk in which participants were concerned with having a good life, which relied heavily on balancing processes. This led us to the qualitative literature about balance in the context of health, which was large and in need of synthesis. We identified 170 relevant studies and used Thomas and Harden's technique of thematic synthesis to identify key balance-related themes and develop these into more abstract analytic categories. We found that balance and balancing were salient to people in three health-related contexts: health maintenance, disease or disability management, and lay or professional caregiving. In each of these contexts, balance or imbalance could be a state or a process. In addition, those using the word balance had either an internally or externally focused orientation to the world around them. Clinicians and public health practitioners might benefit from using these insights in their research and communication.     

Drug innovation,price controls,and parallel trade

We study the long-run welfare effects of parallel trade (PT) in pharmaceuticals. We develop a two-country model of PT with endogenous quality, where the pharmaceutical firm negotiates the price of the drug with the government in the foreign country. We show that, even though the foreign government does not consider global R&D costs, (the threat of) PT improves the quality of the drug as long as the foreign consumers’ valuation of quality is high enough. We find that the firm’s short-run profit may be higher when PT is allowed. Nonetheless, this is neither necessary nor sufficient for improving drug quality in the long run. We also show that improving drug quality is a sufficient condition for PT to increase global welfare. Finally, we show that, when PT is allowed, drug quality may be higher with than without price controls.     

Fetal, infant, and childhood growth are predictors of coronary heart disease, diabetes, and hypertension in adult men and women

Many human fetuses have to adapt to a limited supply of nutrients. In doing so they permanently change their structure and metabolism. These programmed changes may be the origins of a number of diseases in later life, including coronary heart disease, hypertension, and noninsulin- dependent diabetes. We review epidemiologic studies in which the incidence of these diseases has been related to the recorded, early growth of individuals, while considering factors in the adult lifestyle, such as obesity and socioeconomic status. We discuss possible mechanisms. For hypertension these mechanisms include placentation, maternal blood pressure, fetal undernutrition; childhood growth, activation of the renin-angiotensin system, renal structure, programming of the hypothalamic-pituitary-adrenal axis, vascular structure, and sympathetic nervous activity. For noninsulin-dependent diabetes we discuss mechanisms concerning both insulin resistance and insulin deficiency. We include a review of evidence for the programming of serum cholesterol and clotting factor concentrations. We address the timing of critical windows for coronary heart disease, reviewing studies that allow assessment of the relative importance of fetal, infant, and childhood growth. We argue for a research strategy that combines clinical, animal, and epidemiological studies.     

Lymphocytic Choriomeningitis Virus Meningitis, New York, NY, USA, 2009

We describe a case of lymphocytic choriomeningitis virus (LCMV) meningitis in a New York, NY, resident who had no apparent risk factors. Clues leading to the diagnosis included aseptic meningitis during winter and the finding of hypoglycorrachia and lymphocytosis in the cerebrospinal fluid. LCMV continues to be an underdiagnosed zoonotic disease.     

Influenza epidemics in the United States, France, and Australia, 1972-1997

Influenza epidemics occur once a year during the winter in temperate areas. Little is known about the similarities between epidemics at different locations. We have analyzed pneumonia and influenza deaths from 1972 to 1997 in the United States, France, and Australia to examine the correlation over space and time between the three countries. We found a high correlation in both areas between France and the United States (correlation in impact, Spearman's r= 0.76, p < 0.001, and test for synchrony in timing of epidemics, p < 0.001). We did not find a similar correlation between the United States and Australia or between France and Australia, when considering a systematic half-year lead or delay of influenza epidemics in Australia as compared with those in the United States or France. These results support a high correlation at the hemisphere level and suggest that the global interhemispheric circulation of epidemics follows an irregular pathway with recurrent changes in the leading hemisphere.     

Outbreak of Gastroenteritis in Tibetan Transit School, Dharamshala, Himachal Pradesh, India, 2006

Background:

On 28^th June, 2006, 55 cases of the gastroenteritis were reported among the hostellers of the Tibetan Transit School, Dharamshala. We investigated the outbreak to identify the source, propose control and preventive measures.

Materials and Methods:

We defined a case of the gastroenteritis as the occurrence of more than three smelly loose motions between 28^th June to 2^nd July, 2006 among some sections of the resident hostellers. We determined age and sex specific attack rate. We hypothesized it as a food borne beef meat outbreak. We conducted the case control study and collected the information about the food items consumed inside and outside the hostel at dinner using the standardized questionnaire. We calculated floor wise incidences of four hostels, odds ratios and attributable fractions. We interviewed food handlers. We lifted the seven rectal stool, four water and three samples from floor, kitchen and meat chopper room for culture and sensitivity.

Results:

116 cases patients of 802 hostellers met the case definition. The maximum attack rate (16%) was in the youngest group (15-20yrs) and nil in staff and 31-40 years age group with 5 overall attack rate as 14%. Sex specific attack rate was more (18%) in females. The floor wise incidences of the case patients were the highest in 2nd and 3rd floors, occupied by the youngest group. The median age was 20 yrs (Range 17-40 yrs). The most common symptoms were watery diarrhea (71/116, 61%) and bloody diarrhea-(45/116, 39%); abdominal pains-(87/116, 75%). Of the six food/water items examined, the food specific attack rate was highly statistically significant in the beef meat eaters (82% with PAF 71%), and Odds Ratio 19.19 (95% C.I. as 9.3-140). The food handlers & their cooking conditions in the kitchen were unhygienic. The food was not available for testing. Escherichia coli were detected in the samples from rectal stools, kitchen and meat chopper room. No fatality was reported.

Conclusion/Recommendation:

The beef meat purchased from outside was implicated for the explosive common source outbreak. The school authorities were counseled for hygienic food handling.     

The impact of pharmaceutical marketing on market access,treatment coverage,pricing, and social welfare

Pharmaceutical spending in the United States, Canada, and the EU is growing. Public payers cover a large portion of these costs and have responded by instituting various pricing and access policies to limit their expenditure. One challenge that public payers face is additional demand induced by a manufacturer's marketing effort. We use a game theoretic approach to study the impact of pharmaceutical marketing on six practical pricing and access policies: negotiated pricing, open pricing, controlled pricing, a listing process, a risk‐sharing arrangement, and a value‐based pricing with risk‐sharing arrangement. We find that all non‐value‐based policies result in either restricted access or suboptimal treatment coverage. We find that marketing is the highest in the first‐best setting where all decisions are made by a social planner. We also find that the value‐based pricing with risk‐sharing arrangement is preferred by the manufacturer and from a societal perspective whereas no policy is universally preferred by a health care payer. A value‐based pricing with risk‐sharing arrangement always results in zero net monetary benefit for a health care payer. Therefore, considering non‐value‐based arrangements, we find that a negotiated pricing policy, a controlled pricing policy, or a risk‐sharing arrangement may be socially preferred.     

Advanced anorexia nervosa, associated with pneumomediastinum, pneumothorax, and soft-tissue emphysema without esophageal lesion

OBJECTIVE: We describe the case of a 20-year-old female patient suffering from anorexia nervosa since the age 15 of years. When admitted, she was 168 cm tall with a weight of 35 kg (body mass index [BMI] = 12.4). A week after admission, the patient complained of retrosternal pain, and a few hours later she developed extensive soft-tissue emphysema. METHODS: The X-ray picture of her thorax showed left-hand supraclavicular and infraclavicular emphysema, extensive emphysema in both sides of the soft tissue of the throat, a left-hand apical pneumothorax (4 mm), and a pneumomediastinum. RESULTS: We discuss the extent to which these symptoms are interrelated in the sense of a causal nexus. CONCLUSION: We ruled out any other differential-diagnostic etiopathogenic factors and concluded that the cause of our patient's soft-tissue emphysema, pneumothorax, and pneumomediastinum might well be autodestructive behavior.     

Health insurance,endogenous medical progress,health expenditure growth,and welfare

We study the impact of health insurance expansion on medical spending, longevity and welfare in an OLG economy in which individuals purchase health care to lower mortality and medical progress is profit-driven. Three sectors are considered: final goods production; a health care sector, selling medical services to individuals; and an R&D sector, selling increasingly effective medical technology to the health care sector. We calibrate the model to the development of the US economy/health care system from 1965 to 2005 and study numerically the impact of the insurance expansion. We find that more extensive health insurance accounts for a large share of the rise in US health spending but also boosts the rate of medical progress. A welfare analysis shows that while the subsidization of health care through health insurance creates excessive health care spending, the gains in life expectancy brought about by induced medical progress more than compensate for this.     

Nonparametric regression of state occupation,entry, exit,and waiting times with multistate right‐censored data

We construct nonparametric regression estimators of a number of temporal functions in a multistate system based on a continuous univariate baseline covariate. These estimators include state occupation probabilities, state entry, exit, and waiting (sojourn) time distribution functions of a general progressive (e.g., acyclic) multistate model. We subject the data to right censoring, and the censoring mechanism is explainable by observable covariates that could be time dependent. The resulting estimators are valid even if the multistate process is non‐Markov. We study the performance of the estimators in two simulation settings. We establish large sample consistency of these estimators. We illustrate our estimators using a data set on bone marrow transplant recipients. Copyright © 2012 John Wiley & Sons, Ltd.