Substance Abuse and Dependence Treatment in Outpatient Physician Offices, 1997–2004

Objective: To examine patient, physician, and visit characteristics associated with treatment for substance abuse during outpatient physician visits. Methods: Secondary data was obtained from the 1997–2004 National Ambulatory Medical Care Survey. Results: A substance abuse diagnosis was recorded in. 9% of general and family practice visits,. 8% of internal medicine visits, and 5.1% of psychiatry visits. Multivariable logistic regression found that women, elderly, non-White, and established patients were less likely to be given a substance abuse diagnosis. Conclusion: Increased screening, particularly of existing patients, may lead to decreased gender, age, and racial disparities in diagnosis and treatment.     

Relapse typhoid fever in North–eastern state in Malaysia

ObjectiveTo discuss the prevalence, clinical and laboratory presentations of relapse typhoid fever.MethodsAll relapse cases were reviewed to identify the clinical and laboratory presentation of the relapse typhoid fever.ResultsTwo hundred and forty six patients were admitted to a teaching tertiary hospital in North-eastern state of Malaysia and fourteen (5.69%) relapse cases were identified. The duration of relapse after the patient was discharged was (25.0±9.9) d. The patients presented with fever, diarrhoea, headache, abdominal pain and constipation. The duration of fever before admission in the initial episode [(8.6±4.2) d] was significantly longer than the relapse episode [(5.0±2.5) d] (P=0.019). Four patients have hepatomegaly in initial episode and ten in relapse episode (P=0.852). The defervescence days of initial episodes was (3.2±2.2) d, comparing to relapse episode [(2.0±1.8) d] which was statistically not significant (P=0.124).ConclusionAssumption of the relapse typhoid fever is milder comparing to original episodes based on observation and is not supported by statistical analysis.     

The genetic match between vaccine strains and circulating seasonal influenza A viruses in Vietnam, 2001–2009

Please cite this paper as: Vuong et al. (2013). The genetic match between vaccine strains and circulating seasonal influenza A viruses in Vietnam, 2001–2009. Influenza and Other Respiratory Viruses 7(6), 1151–1157. Background  Vietnam is currently developing domestic capability to manufacture influenza vaccines but information on the genetic and antigenic characteristics of locally circulating seasonal influenza viruses is limited. To assess the relevance of WHO recommended vaccine strains to the situation in Vietnam, we analyzed the genetic relatedness of the hemagglutinin (HA) gene of seasonal influenza A viruses circulating in Vietnam from 2001 to 2009 to WHO recommended vaccine strains over the same period. Methods and Principal findings  We sequenced the HA gene of 32 H1N1 and 44 H3N2 seasonal influenza A isolates from laboratory‐based sentinel surveillance sites in Hanoi from 2001 to 2005 and from a national influenza surveillance system from 2005 to 2009. H1 and H3 HA phylogenetic trees rooted to vaccine strains A/Beijing/295/1995 (H1N1) and A/Moscow/10/1999 (H3N2), respectively, were constructed with contemporary HA sequences of isolates from neighboring countries. We found some genetic differences between seasonal influenza H3N2 viruses and three WHO influenza vaccine strains recommended for use in the Northern and Southern Hemispheres for the 2001–2004 and 2007–2008 seasons and close genetic identity of circulating H3N2 strains with the recommended WHO Southern Hemisphere vaccine strains for 2004 and 2009 seasons. The genetic similarity of circulating H1N1 strains with the WHO recommended vaccine strains are described for the study period 2001–2009. Conclusions  The HA gene of seasonal influenza virus strains in Vietnam (especially influenza A/H3N2) showed varying degrees of genetic identity compared with those of the Northern or Southern Hemisphere vaccine strains recommended by WHO. The close relatedness of the HA of Vietnamese strains and contemporary strains from nearby countries indicate a good genetic match of circulating strains during study period. Greater representation of virus isolates from South East Asia in the vaccine strain selection process is desirable of influenza vaccine development in Vietnam.     

National Trends in Ambulatory Asthma Treatment, 1997–2009

BACKGROUND  

Despite reductions in morbidity and mortality and changes in guidelines, little is known regarding changes in asthma treatment patterns.     

Molecular characterisation of β-globin gene mutations in Penang and Kedah,Malaysia

IntroductionBeta-thalassaemia is an autosomal recessive disorder and it is a public health problem in the Malaysian Malays and Chinese. This disorder mainly results from point mutations, small insertion or deletions in the β-globin gene complex. Beta-thalassaemia major patients require life-long monthly blood transfusions and iron-chelation therapies to sustain their lives. Mutation characterisation is necessary for affected couples at risk of having a β-thalassaemia major child.Objective1. To develop the TaqMan genotyping platform as a time- and cost-effective approach for characterisation of β-globin gene mutations. 2. To characterise the mutations using the developed assays in transfusion-dependent patients in Penang and Kedah.MethodsTen sets of primers and TaqMan probes were designed to identify the common mutations in Malaysian Malays and Chinese: −28 (A→G), CD17 (A→T), CD19 (A→G), HbE (G→A), IVS1-1 (G→T), IVS1-5 (G→C), CD 41/42 (-CTTT), CD71/72 (⁺A), IVS2-654 (C→T) and Poly A (AATAAAHAATAGA). Another 7 sets of TaqMan genotyping assays were designed to identify the rare mutations in Malays and Chinese: −29 (A→G), Cap (⁺1) (A→C), CD8/9 (⁺G), CD16 (-C), CD27/28 (⁺C), IVS1-1 (G→A) and CD43 (G→T). The developed assays were used to screen 54 and 62 transfusion-dependent patients in Penang and Kedah respectively.Results & DiscussionThe developed assays detected 92.9% of mutations in the β-thalassaemia major patients. The remaining mutations were detected by ARMS, gap-PCR and DNA sequencing. The most common mutation in β-thalassaemia major patients in Penang is CD41/42 with a frequency of 20.9%. The most common mutation in β-thalassaemia major patients in Kedah is HbE with a frequency of 30.8%.ConclusionThe simplicity and reproducibility of the TaqMan genotyping assays enable rapid and cost-effective analysis of the β-globin gene mutations in Malaysia.     

Prevalences of hepatitis A, B, C and E viruses in Behçet's disease

OBJECTIVE: To determine whether Beh?et's disease (BD), being a systemic vasculitis of unknown aetiology, is associated with hepatitis viruses (HAV, HBV, HCV and HEV). METHODS: In addition to 124 patients [male:female (M/F): 73/51], all fulfilling the diagnostic criteria of the International Study Group for BD (1991), 14 patients with systemic necrotizing vasculitis (M/F: 7/7), 47 patients with ankylosing spondylitis (M/F: 36/11) and 51 healthy controls (M/F: 22/29) were also included in this study. Serological markers of four different types of hepatitis (anti-HAV IgM, total anti-HAV, HBsAg, anti-HBs, total anti-HBc, anti-HBc IgM, anti-HCV and anti-HEV) were studied in all cases. RESULTS: There was no difference between the groups with respect to HAV, HCV and HEV serologies. Anti-HBs positivity was observed less frequently in BD compared with healthy controls and systemic vasculitis (P<0.05). CONCLUSION: Serological evidence of previous HAV, HCV and HEV infections was not significantly different between Beh?et's patients and other groups. However, previous HBV infection was found in a significantly lower number of BD patients as compared with healthy controls and systemic vasculitic patients.     

The frequency and seasonality of influenza and other respiratory viruses in Tennessee: two influenza seasons of surveillance data, 2010–2012

Background

In 2010, the Tennessee Department of Health, in collaboration with the Centers for Disease Control and Prevention (CDC), expanded influenza surveillance in Tennessee to include other respiratory viruses.

Objectives

To determine the prevalence and seasonality of influenza and other respiratory viruses during the influenza seasons of 2010–2012.

Methods

Nasal and nasopharangeal swabs/washings from persons with influenza‐like illness were collected across Tennessee. Influenza and other respiratory viruses were identified using a molecular‐based respiratory virus panel. Influenza A positives were subtyped using real‐time PCR according to the CDC protocol. Data were analyzed to describe frequency and seasonality of circulating strains.

Results

Of the 933 positive specimens, 60·3% were identified as influenza viruses, 19·8% rhinovirus/enterovirus, 8·6% respiratory syncytial virus (RSV), 5·8% metapneumovirus, 3·0% adenovirus, and 2·5% parainfluenza viruses. In the 2010–2011 season, influenza B was prominent during weeks 48–3, while influenza A(H1N1) was most frequently identified during weeks 4–10. Influenza A(H3N2) was present at lower levels during weeks 48–17. However, in the 2011–2012 season, overall numbers of influenza cases were reduced and influenza A (H3N2) was the most abundant influenza strain. The expanded surveillance for other respiratory viruses noted an increase in identified specimens from the first to the second season for adenovirus, metapneumovirus, RSV, and rhinovirus/enterovirus.

Conclusions

This study provides data of the influenza strains in circulation in Tennessee. It also establishes a baseline and time of year to expect other respiratory viruses that will aid in detecting outbreaks of non‐influenza respiratory viruses in Tennessee.     

Socioeconomic Position and Cardiovascular Disease in Adults with and Without Diabetes: United States Trends, 1997–2005

Background  Diabetes and its cardiovascular complications are more common in adults of low socioeconomic position (SEP). In the US, the past decade has seen the establishment of many programs to reduce cardiovascular risk in persons with diabetes, but their effect on socioeconomic disparities is uncertain. Objective  We sought to investigate recent time trends in socioeconomic disparities in cardiovascular disease (CVD) among persons with and without diabetes. Participants and Design   Two hundred fifty-five thousand nine hundred sixty-six individuals aged 25 years or older included in the National Health Interview Survey between 1997 and 2005. Measurements  Educational attainment was used as a marker for SEP and self-reported history of CVD as the main outcome. Educational disparities were measured using prevalence rate ratios (PRR) and the relative index of inequalities (RII). Main Results  Among adults with diabetes, CVD prevalence was persistently higher in those who did not complete high school (HS) than in college graduates (adjusted PRR [aPRR] 1.20, 95% confidence interval [95%CI] 1.05–1.38 in 1997–1999, and aPRR 1.12, 95% CI 1.00–1.25 in 2003–2005). However, the HS vs. college graduates disparity in CVD declined from 1997–1999 (aPRR 1.20, 95% CI 1.04–1.37) to 2003–2005 (aPRR 1.01, 95% CI 0.90–1.12). Among adults without diabetes educational disparities in CVD widened markedly over time. Conclusions  Concurrently with improvements in diabetes management, the widening of socioeconomic health disparities has remained limited in the diabetic population during the past decade. This provides evidence for the potential impact of improvements in disparities in health care access and process, such as experienced among persons with diabetes, in limiting socioeconomic health disparities.     

Socioeconomic characteristics and comorbidities of diverticular disease in Sweden 1997–2012

Purpose

This study aimed to evaluate the association of socioeconomic status and comorbidities with uncomplicated and complicated diverticular disease (DD) in Sweden.

Methods

We identified all individuals aged ≥30 years in Sweden diagnosed with DD between 1997 and 2012 using the Swedish National Population and Housing Census and the Hospital Discharge Register. Data were analyzed by multivariable logistic regression, with individual-level characteristics as covariates.

Results

A total of 79,481 patients (median age 66 [range 30–86] years) were hospitalized for DD, 15,878 (20%) of whom for complicated DD. Admissions for both uncomplicated and complicated DD were more common in women (p < 0.001). A low education level was identified as a risk factor for uncomplicated (unadjusted hazard ratio [HR] 1.79, 95% confidence interval [CI] 1.75–1.82; adjusted HR 1.22, 95% CI 1.19–1.24) and complicated DD (unadjusted HR 1.84, 95% CI 1.77–1.92; adjusted HR 1.26, 95% CI 1.21–1.32). Patients with the lowest income had a lower risk of hospitalization for uncomplicated (adjusted HR 0.94, 95% CI 0.91–0.96) and complicated DD (adjusted HR 0.87, 95% CI 0.83–0.92) than those with the highest income. The correlation coefficient between income and education was 0.25. Diabetes and cardiovascular disease were identified as protective factors against uncomplicated DD (adjusted HR 0.68, 95% CI 0.66–0.69 and HR 0.79, 95% CI 0.74–0.84, respectively).

Conclusions

Patients with the lowest education level had an increased risk of hospitalization for DD. Further studies are needed to explore the association of diabetes and cardiovascular disease with uncomplicated DD.

     

Colorectal Cancer in Denmark 1943–1997

PURPOSE: This article reports the incidence rates of colon and rectal cancer in Denmark during 55 years of data registration and estimates the number of cases identified attributable to four modifiable risk factors and potentially preventable.METHODS: On the basis of reports in the nationwide, population-based, Danish Cancer Registry, we calculated age-standardized, period-specific, incidence rates and age and birth cohort-specific incidence rates. To calculate the population attributable risk, relative risk estimates were obtained from meta-analyses, case-control, and prospective cohort studies, combined with data from surveys of the consumption of alcohol, red meat, vegetables, and level of physical activity.RESULTS: For both genders, the incidence rate of colon cancer increased, whereas the incidence rate for rectal cancer decreased during the period 1943 to 1997. The decrease in the incidence rate of rectal cancer was observed for both genders, but the incidence rate among males was higher than that among females. The proportion of cases that could have been prevented if the Danish population had not been exposed to the four known risk factors varied from 0 to 15 percent for each of the four risk factors.CONCLUSIONS: This study shows that the incidence rate of colon cancer has increased, whereas that of rectal cancer has decreased in Denmark during 55 years of observation. The potentially preventable proportions of incident cases are substantial but not as high as might have been expected.Supported by the Danish Cancer Society and the National Institute of Public Health, Denmark.     

Type 2 diabetes, socioeconomic status and risk of cancer in Scotland 2001–2007

Aims/hypothesis

The objective of this study was to use Scottish national data to assess the influence of type 2 diabetes on the risk of cancer at 16 different sites, while specifically investigating the role of confounding by socioeconomic status in the diabetes–cancer relationship.

Methods

All people in Scotland aged 55–79 years diagnosed with any of the cancers of interest during the period 2001–2007 were identified and classified by the presence/absence of co-morbid type 2 diabetes. The influence of diabetes on cancer risk for each site was assessed via Poisson regression, initially with adjustment for age only, then adjusted for both age and socioeconomic status.

Results

There were 4,285 incident cancers in people with type 2 diabetes. RR for any cancers (adjusted for age only) was 1.11 (95% CI 1.05, 1.17) for men and 1.33 (1.28, 1.40) for women. Corresponding values after additional adjustment for socioeconomic status were 1.10 (1.04, 1.15) and 1.31 (1.25, 1.38), respectively. RRs for individual cancer sites varied markedly.

Conclusions/interpretation

Socioeconomic status was found to have little influence on the association between type 2 diabetes and cancer.     

Trends in the epidemiology and care of diabetes mellitus-related end-stage renal disease in France, 2007–2011

Aims/hypothesis

The aim was to study geographic variations and recent trends in the incidence of end-stage renal disease (ESRD) by diabetes status and type, and in patient condition and modalities of care at initiation of renal replacement therapy.

Methods

Data from the French population-based dialysis and transplantation registry of all ESRD patients were used to study geographic variations in 5,857 patients without diabetes mellitus, 227 with type 1 diabetes mellitus, and 3,410 with type 2. Trends in incidence and patient care from 2007 to 2011 were estimated.

Results

Age- and sex-adjusted incidence rates were higher in the overseas territories than in continental France for ESRD unrelated to diabetes and related to type 2 diabetes, but quite similar for type 1 diabetes-related ESRD. ESRD incidence decreased significantly over time for patients with type 1 diabetes (?10% annually) and not significantly for non-diabetic patients (0.2%), but increased significantly for patients with type 2 diabetes (+7% annually until 2009 and seemingly stabilised thereafter). In type 2 diabetes, the net change in the absolute number was +21%, of which +3% can be attributed to population ageing, +2% to population growth and +16% to the residual effect of the disease. Patients with type 2 diabetes more often started dialysis as an emergency (32%) than those with type 1 (20%) or no diabetes.

Conclusions/interpretation

The major impact of diabetes on ESRD incidence is due to type 2 diabetes mellitus. Our data demonstrate the need to reinforce strategies for optimal management of patients with diabetes to improve prevention, or delay the onset, of diabetic nephropathy, ESRD and cardiovascular comorbidities, and to reduce the rate of emergency dialysis.     

Movements and home range of a common species of tree–shrew,Tupaia glis,surrounding houses of otoacariasis cases in Kuantan,Pahang, Malaysia

ObjectiveTo document movement patterns, home range, nesting behaviour and social organization of 5 individuals (3 males and 2 females) of a common species of tree-shrew, Tupaia glis (T. glis) surrounding houses of otoacariasis cases.MethodsEach shrew was fitted with a transmitter chip radio-collar which operates between the frequencies of 154.13 MHz to 154.21 MHz. Each transmitter was then tracked with a Portable Telemetry Receiver (Sirtrack, New Zealand) fitted with a 3-element Yagi antenna. Collared shrews were located using standard methods of ground-based triangulation. Each location was taken from at least 2 directional fixes and a minimum of 3 compass bearings. Fixes were taken hourly for each collared individual from the time of emergence from nest (beginning of activity) till time of entry into the nest (end of activity) every day for 5 to 7 continuous days. Three series of radio telemetry observations were carried out. The bearings, time and positions of an observer were recorded and later plotted on a graph paper in order to derive coordinates of the collared animal. [These coordinates then analyzed using Ecological Software Solutions (Biotas Version 1.03)].ResultsNests were found in a jack fruit tree, long bushes, and 2 houses. Daily telemetry detections demonstrated 2 individuals of different sex having nests (or a nest) in the same house. All shrews emerged from and returned to their nests between 0601 to 0659 hours and 1901 to 1959 hours, respectively. Both the time of exit from and entry into nest were the same between sexes (P>0.05). Their average total active period was 4.90 to 7.00 hours with a total daily travel distant of 270 m to 382 m. A male and a female shrew can move as far as 3 285 m and 4 591 m, respectively. Active movements of T. glis were during daytime. They regularly entered some houses in the area during day and night except for one individual which visited during daytime only. The sizes of home range and core area for the shrews were 2.00–3.40 ha and 0.05–0.42 ha, respectively. Generally, the mean home range size of females was 20.8% larger than that of males. Females covered a 15.4% slightly higher daily movement range compared to males.ConclusionsThis is the first radio telemetry study in Malaysia to monitor movements and home range of shrews carrying ticks on their body. It demonstrates that shrews are potential carriers of ticks from wild into the houses and their compounds based on their total active periods spent moving around from fruit orchards, secondary forest, plantations and other vegetations to trees in compound of 4 to 7 houses and vice versa. There are also evidences showing shrews have close contact with humans.