Intestinal parasites among young children in the interior of Guyana

Intestinal parasites contribute greatly to morbidity in developing countries. While there have been several studies of the problem in the Caribbean, including the implementation of control programmes, this has not been done for Guyana. The aim of this study was to determine the prevalence of intestinal parasites among young children in a town located in the interior of Guyana. Eighty-five children under the age of 12 years were studied prospectively for intestinal parasites in Mahdia, Guyana. Stool samples were transported in formalin to the Department of Microbiology, The University of the West Indies, Jamaica, for analysis using the formalin-ether concentration and Ziehl-Neelsen techniques. Data on age and gender of the children were recorded on field data sheets. At least one intestinal parasite was detected in 43.5% (37/85) of the children studied and multiple parasitic infections were recorded in 21.2% (18/85). The most common intestinal helminth parasite was hookworm (28.2%; 24/85), followed by Ascaris lumbricoides (18.8%; 16/85) and then Trichuris trichuria (14.1%; 12/85). Among the protozoan infections Giardia lamblia was detected in 10.5% (9/85) of the study population while Entamoeba histolytica appeared rarely. All stool samples were negative for Cryptosporidium and other intestinal Coccidia. There was no predilection for gender with any of the parasites. The pattern of distribution of worms in this area of Guyana was unlike that seen in other studies. Hookworm infection was the most common among the children and a large proportion had multiple infections. The study established the occurrence and prevalence of a number of intestinal parasites in the population of Guyana. This sets the stage for the design and implementation of more detailed epidemiological studies.     

The first 10 years of the dialysis-transplantation program at The Hospital for Sick Children, Toronto. 1: Predialysis and dialysis.

Renal dialysis and transplantation have been used for many years for adults with kidney failure but only recently for children. In May 1967 a renal-dialysis-transplantation program was established at The Hospital for Sick Children, Toronto for patients aged 6 to 18 years living within 240 km of Toronto. In 1973, children aged 1 to 5 years began to be accepted into the program, and by August 1977, 90 children (mean age 11 years) from all parts of Canada had been admitted to the program. The creation of vascular access in very small patients is difficult; the most successful types of access have been central shunts (established above the knee or the elbow) and bovine grafts. Specially made dialysis equipment is necessary for young patients. Young children should only be accepted in a dialysis-transplantation program that has a medical staff expert in meeting the specific needs of such children.     

Poisoning and poison control centres in Canada.

Poisoning is a major and increasing health problem in the Western world. In 1972 the 310 poison control centres in Canada reported 53 531 enquiries about poisoning, 40% in adults. In 1964 the numbers of hospital admissions and deaths due to poisoning in this country were 2446 and 38, respectively, but in 1972 the figures were 6263 and 319, respectively. Most of the hospitalizations and deaths were among adults. Of 100 Canadian poison control centres two thirds were staffed by "any nurse in the emergency room", most of whom had received no training to answer the phone enquiries. However, two thirds agreed a training program is needed. Only 6.7% of 223 parents surveyed stated they would call a poison control centre if their child had accidentally swallowed a large amount of a poisonous substance. Regionalization of centres, a training program for personnel answering telephone enquiries, the need for crisis intervention as part of poison control programs, and public education about poisoning and poison control centres are the new challenges facing those providing health services.     

Person-to-person transmission of Giardia lamblia in day-care nurseries.

In an outbreak of giardiasis at two day-care nurseries in metropolitan Toranto Giardia lamblia appeared to be transmitted person to person. No common source of infection could be found. The proportions of children infected in the two nurseries were 39% and 17%; infection was spread to 7% and 23% of their household contacts. Of the infected children and household contacts 26% and 30% respectively of those for whom detailed information could be obtained were symptomatic. Canadian children were more likely to be infected and symptomatic than were immigrant children attending the nurseries. The most susceptible ages for infection were 1 to 3 years. The results of this study suggest that all children in day-care nurseries who are infected with G. lamblia should be treated, regardless of whether they are symptomatic.     

Viral hepatitis associated with day-care centers.

From September 1976 through March 1978, we investigated 11 outbreaks of non-B viral hepatitis associated with Louisiana day-care centers. The outbreaks included 168 cases, most of which were erroneously considered "sporadic" cases of non-B viral hepatitis prior to the investigations. Thirteen percent of all non-B viral hepatitis cases reported in the New Orleans metropolitan area during 1977 were associated with one of the outbreaks. Most of the cases in each outbreak and 85% overall were in older, usually adult, contacts of children attending the day-care centers. Within the household, parents appeared to be at greatest risk, particularly those who had 1- to 2-year-old children in the day-care center. Day-care center outbreaks of non-B hepatitis are easily overlooked and may be more widespread than is currently appreciated.     

集安县乡村儿童少年肠道寄生虫调查报告

本文作者在集安县乡村初中、小学和幼儿园调查了501人,蛔虫感染率为79.2％,其他尚有鞭虫、蛲虫、钩虫、东方毛圆线虫、猪肉绦虫和溶组织内阿米巴,其中尚有2.4％受检者同时感染两种以上肠道寄生虫。提出了乡村儿少肠道寄生虫流行因素和防治原则,并比较了饱和盐水浮聚法在粪检中提高检出率的优点。     

Day-care versus inpatient pediatric surgery: a comparison of costs incurred by parents.

The cost-effectiveness for parents of day-care pediatric surgery was assessed by comparing time and financial costs associated with two surgical procedures, one (squint repair) performed exclusively as a day-care procedure, the other (adenoidectomy) performed exclusively as an inpatient procedure. All but 1 of 165 eligible families participated. The children underwent surgery between February and July 1981. The day-care surgery group (59 families) incurred average total time costs of 16.1 hours, compared with 37.1 hours for the inpatient surgery group (105 families), as parents in the latter group remained with their child during the longer hospital stay. Parents from out of town incurred the greater time and financial costs. In both groups parents of younger children tended to spend more time at the hospital than parents of older children. Type of surgical management was not a significant factor in out-of-pocket expenses. Loss of income was associated with employment of the mother as a professional or a manager and may reflect inequalities in access to compassionate leave between men and women in equivalent positions. Opening day-care surgery facilities on weekends might reduce the financial burden on working mothers. Overall, day-care surgery was found to be cost-effective for families.     

A hepatitis B vaccination programme for inner metropolitan Sydney neonates.

OBJECTIVE; To review the effectiveness of a hepatitis B vaccination programme for high risk infants within a mobile urban population. DESIGN: A follow-up study of 1429 infants enrolled consecutively in the programme from September 1987 to December 1988. SETTING: The programme was established in early childhood centres within inner metropolitan Sydney, an area where 30% of residents were born in non-English speaking countries and where doubts had previously been expressed about the efficacy of vaccination. PARTICIPANTS: Neonates born to mothers who were surface antigen positive, born in selected countries with a 5% prevalence of surface antigen carriage, Aboriginal or intravenous drug users. OUTCOME MEASURES: Documented vaccination given by early childhood centre nurses. Some adjustment was made for parents' reports of vaccination given elsewhere. RESULTS: Two vaccinations were given to 87% and three to 73% of these infants. If we include vaccinations apparently given elsewhere we estimate that 92% may have been fully protected. CONCLUSION: The programme produced high rates of compliance with vaccinations within a population where the delivery of such a service was thought to be difficult. Experience with the current State policy for hepatitis B vaccination indicates that it may not optimally reduce the pool of surface antigen carriers within our community.     

一起幼儿园的乙型肝炎流行

报告一起幼儿园乙型肝炎流行,工作人员的罹患率为18.2％;儿童中HBV感染率49.6％。5例儿童的血清学结果呈现乙肝急性感染的动态变化。随访发现,1例成人转为HBsAg携带者。表明,乙型肝炎在地方性流行区只要条件适宜,也能发生流行。     

Use of interventions for reducing mother-to-child transmission of HIV in Australia

OBJECTIVE: To describe the extent and outcome of use of interventions for reducing the risk of HIV transmission from mother to child in Australia. DESIGN: National surveillance for perinatal exposure to HIV. PARTICIPANTS AND SETTING: Notified cases of HIV infection in women in Australia and their perinatally exposed children, 1982-1999. OUTCOME MEASURES: Trends over time in use of interventions (antiretroviral therapy in pregnancy, elective caesarean delivery and avoidance of breastfeeding) and perinatally acquired HIV infection. RESULTS: By 31 March 2000, 204 children were reported as having been born in 1982-1999 to 162 women whose HIV infection had been diagnosed by 31 December 1999. The child's HIV infection status was established for 182 (89.2%); the mother's HIV infection was diagnosed antenatally in 91 of these cases (50%). Among women diagnosed antenatally, use of elective caesarean delivery and antiretroviral therapy in pregnancy increased significantly, from 3% and 14% by women whose children were born in 1982-1993, to 21% (P=0.01) and 88% (P<0.001), respectively, by women whose children were born in 1994-1999. Most women (95%) diagnosed antenatally avoided breastfeeding their children. The percentage of infected children born to women diagnosed antenatally declined from 26% among children born in 1982-1993 to 19% among those born in 1994-1999. The percentage of infected children was significantly lower among those whose mothers used antiretroviral therapy in pregnancy (11% versus 36%; P=0.03). CONCLUSION: Antiretroviral use in pregnancy, elective caesarean delivery and avoidance of breastfeeding have been effective interventions for reducing the risk of mother-to-child HIV transmission in Australia. While the rate of perinatal HIV transmission has declined, it remains high in comparison with rates reported from other industrialised countries.     

HIV infection among women undergoing abortion in Montreal.

OBJECTIVE: To determine the seroprevalence and correlates of HIV infection in a subpopulation of women of childbearing age in Montreal. DESIGN: Anonymous unlinked seroprevalence study. SETTING: Pregnancy termination unit in a teaching hospital in Montreal. PARTICIPANTS: Women presenting for abortion from July 1989 to June 1993 who resided in Quebec and were not known to have HIV infection; 12,017 (99.6%) of 12,068 eligible women were included in the study. INTERVENTION: HIV antibody testing of serum left over from samples obtained for routine Rh typing; the same algorithm as for serodiagnostic testing, namely enzyme immunoassay (EIA) followed by confirmatory testing of repeatedly EIA-reactive samples, was used. OUTCOME MEASURES: HIV serostatus by age, marital status, region of residence (metropolitan Montreal versus other), country of birth and number of living children. RESULTS: Most (84.7%) of the subjects resided in metropolitan Montreal. The median age was 27.0 (range 13 to 50) years. The serum samples of 22 women were confirmed to be HIV positive, for an overall seroprevalence rate of 1.8 per 1000 (95% confidence interval 1.1 to 2.8). The seroprevalence rate did not vary significantly by age, marital status, region of residence or study year. However, it was strongly correlated with country of birth: Canada 0.16, Haiti 23.5, HIV-endemic countries other than Haiti 5.3 and non-HIV-endemic countries other than Canada 0.0 per 1000. The seroprevalence rate among women born in Haiti was 147 times higher than that among women born in Canada (p < 0.0001). Of the women born in Haiti the rate was 3.0 times greater among those who immigrated to Canada in 1985 or later than among those who immigrated earlier (p = 0.047). CONCLUSIONS: The results of this study indicate that the HIV seroprevalence rate among women in Montreal is strongly associated with country of birth, women born in HIV-endemic countries, especially Haiti, having the highest rate. These results will help in the development of policies regarding HIV antibody testing and prevention of HIV transmission in Quebec.     

2019冠状病毒病疫情期间湖北省医务人员未成年子女心理行为研究

目的: 调查2019冠状病毒病（COVID-19）疫情期间湖北省医务人员未成年子女心理行为状态。方法: 采取横断面调查方法,于2020年3月13至15日通过问卷星在微信群及朋友圈中发放调查问卷,包括一般资料调查表及Conners父母症状问卷（PSQ）。问卷全部填写完毕方可提交,通过IP地址剔除湖北省外的问卷,同时剔除答题时间过短（答题时间少于150 s）的问卷。分析父母职业状态对不同年龄组儿童心理行为状态的影响。结果: 本次调查共回收有效问卷391份,其中男性207名（52.9%）,女性184名（47.1%）;3~ < 6岁91名（23.3%）,6~ < 10岁183名（46.8%）,10~16岁117名（29.9%）;父母均为医务人员87名（22.3%）,父母一方为医务人员139名（35.5%）,父母均非医务人员165名（42.2%）。无论父母是否为医务人员,3~ < 6岁儿童的PSQ得分在各因子水平差异均无统计学意义（均P>0.05）;父母均为医务人员的6~ < 10岁儿童的多动-冲动因子得分、学习问题因子得分和总分均高于父母均非医务人员的同龄儿童（均P < 0.05）,学习问题因子得分高于父母一方为医务人员的同龄儿童（P < 0.05）,父母一方或均为医务人员的子女焦虑因子得分高于父母均非医务人员的子女（均P < 0.05）;父母一方为医务人员的10~16岁儿童的品行问题、学习问题、多动-冲动、多动指数及总分均低于父母均为医务人员或父母均非医务人员的同龄儿童（P < 0.05或P < 0.01）,而身心问题、焦虑因子得分与其他两组差异无统计学意义（均P>0.05）。结论: COVID-19疫情期间,湖北省医务人员与非医务人员未成年子女心理行为状态随着年龄段不同而表现出差异,3~ < 6岁学龄前儿童心理行为状态无明显差异,而6~ < 10岁和10~16岁医务人员子女心理行为状态差于非医务人员子女心理行为状态,需对该年龄段医务人员子女心理行为状态予以关注。     

晋北肠道寄生虫病普查

目的 了解肠道寄生虫病在本地区的感染率。方法 选出有代表性的村落，作人群粪便普查和透明胶纸肛检。结果 共调查粪便3055份，查出11种肠道寄生虫，阳性人数为275，阳性率为9％。其中，几种重要的肠道寄生虫感染率分别为：蛔虫(2．2％)；钩虫(0％)；蛲虫(25．9％)。结论 肠道寄生虫病随着人民生活水平提高和医疗卫生条件改善而呈下降趋势，但要在晋北三地区控制和消灭肠道寄生虫病，仍需继续努力。     

Clinical utility of HIV-IgA immunoblot assay in the early diagnosis of perinatal HIV infection.

OBJECTIVE--To ascertain the sensitivity, specificity, predictive value, and clinical use of a human immunodeficiency virus (HIV)-IgA immunoblot assay for diagnosing perinatal HIV infection in infants tested at birth to 1 month, 3 months, and 6 months of age. DESIGN--Prospective, longitudinal cohort study of children born to HIV-infected and noninfected women. The HIV-IgA immunoblot assays were performed at birth to 1 month, 3 months, and 6 months of age and compared with the Centers for Disease Control's classification system of HIV infection in the children. Children were followed up for at least 15 months to ensure accuracy of infection status. SETTING--Municipal hospital in central Brooklyn, NY, where the prevalence of HIV infection is high. PATIENTS--Serum samples from 58 children, 22 with documented HIV infection, 18 noninfected children born to seropositive women, and 18 children born to noninfected women, were studied. MAIN OUTCOME MEASURE--Diagnosis of HIV infection using the Centers for Disease Control's classification scheme was compared with diagnosis using the HIV-IgA immunoblot assay for children 6 months of age or younger. RESULTS--The HIV-IgA immunoblot assay yielded negative results at 3 and 6 months of age for all 18 infants born to seronegative women; for the 18 seroreverting, noninfected children born to infected women, the assay yielded negative results at 1 month, 3 months, and 6 months of age. The positive predictive value of the assay was 100%--no false-positive results were identified in the 88 serum samples obtained from noninfected infants. For the HIV-infected children, sensitivity was a function of age: one (5.9%) of 17 infants had an assay that yielded positive results at birth to 1 month of age, 13 (62%) of 21 infants had assays that yielded positive results at 3 months of age, and 17 (77%) of 22 infants had assays that yielded positive results at 6 months of age. The presence or absence of symptoms did not affect the sensitivity. CONCLUSION--The HIV-IgA immunoblot assay can detect a significant proportion of infected children during an early asymptomatic period of their life. This relatively inexpensive, easily standardized assay may allow for institution of therapy before the onset of clinical symptoms.     

Diagnostic differences in psychogeriatric patients in Toronto, New York and London, England.

National statistics on psychiatric illness in the elderly patient from Canada, the United States and the United Kingdom suggest great differences in morbidity in these three centres. The present study shows that these differences stem mainly from different diagnostic habits in the three countries, but also there were more alcoholics in the Canadian sample. In particular, the diagnostic bias of the New York psychiatrists towards diagnosing most elderly patients as senile was not shared by their Toronto colleagues. Some patients were psychiatrically well, in spite of receiving a psychiatric diagnosis, and could have been helped without hospitalization. In addition, some depressed patients were labelled senile. Recommendations include improvement of catchment and treatment facilities for the elderly alcoholic and the provision of psychogeriatric diagnostic centres.     

杭州市幼儿肠道蠕虫感染的现状及其影响因素的调查

目的调查杭州市幼儿肠道蠕虫感染的现状及其影响因素。方法按杭州市区不同方位,随机抽取18所幼儿园,共2576名3～6岁幼儿作为调查对象。采用0.9%氯化钠溶液直接涂片法和饱和盐水浮聚法粪便检查蛔虫卵、钩虫卵和鞭虫卵,用透明胶纸肛拭法检查蛲虫卵。结果2576名受检者中,肠道蠕虫总感染率为11.96%,蛲虫、蛔虫、鞭虫和钩虫感染率分别为4.15%、7.69%、0.19%和0.39%。调查影响蠕虫感染的各种因素发现,不同级别的幼儿园、不同的卫生习惯及父母不同的教育程度对儿童肠道蠕虫感染率的影响有统计学意义（P〈0.05或0.01）;而幼儿性别、季节对幼儿肠道蠕虫感染率的影响无统计学意义（P〉0.05）。结论杭州市幼儿肠道蠕虫总感染率为11.96%,幼儿园环境和儿童自身卫生等因素与肠道蠕虫感染有着密切的联系。     

Prevalence of anaemia and worm infestation in tribal areas of Madhya Pradesh

The study was conducted among school going children (6-14 years) of Baiga, Abuihmadia and Bharia tribes of Madhya Pradesh to assess the prevalence of anaemia and intestinal parasitic infestation among themselves. A total of 776 school going children were included in the study of whom blood samples of all and stool samples of 409 were collected. Their haemoglobin was measured and stool samples were examined under microscope for ova and cysts. The results revealed that 30.3% of the children had severe anaemia (Hb < 7g/dl) and 50% children had intestinal parasites. The most common parasites were hookworn (16.3%) and A lumbricoides (18.5%). Though hookworm ova loads indicated mild to moderate infestation in most of the children, the continued presence of worms in marginally nourished children could contribute significantly to blood loss in the intestine with resultant anaemia.     

Q fever: hazard from sheep used in research

The recent recognition that Q fever is endemic in Ontario and the known occupational risk of Q fever to research personnel working with sheep prompted a study to determine the prevalence of antibodies to the causative organism, Coxiella burnetti, in animals and staff at a Toronto animal research institute. Of 37 sheep 34 (92%) were found to be seropositive--that is, to have a titre of complement-fixing antibody to the phase II antigen of 1:8 or greater. Of 331 staff members tested, 18% were found to be seropositive, compared with 0.6% of a random sample of Toronto blood donors. The highest rate of seropositivity, 68%, was in the 28 animal attendants tested. Seropositivity was associated with working with sheep or fetal lamb tissue (p less than 0.0001) and with visiting the animal facility (p less than 0.001). Of the 59 seropositive staff members 63% had had no direct contact with sheep. There were 12 clinically apparent cases of Q fever, 2 of which required admission to hospital. Q fever remains a serious occupational hazard to staff working in research laboratories using sheep, even to those with indirect exposure to infected animals.     

Prevalence and risk factors for giardiasis among primary school children in Damascus, Syria

OBJECTIVE: To evaluate the prevalence of giardiasis in primary school children in Damascus city and the countryside, and to investigate the possible risk factors for giardiasis infection. METHODS: A cross-sectional study was carried out on school children from 23 primary schools in Damascus, between March and June 2006. Data were collected from 1469 children of both genders from urban and rural regions using structured questionnaires, anthropometric measurements, and laboratory analysis of fecal samples. The parasites were detected using a single-stool sample by direct wet examination under light microscope. RESULTS: Two hundred and six (14%) of 1469 children were infected with Giardia lamblia, while 119 (8.1%) were found infected with other sorts of intestinal parasites. No correlation was found between giardiasis and age, gender, residence in urban or rural areas, availability of piped water or sewage system. In contrast, both mother's (p=0.003) and father's (p=0.018) levels of education, and the number of siblings in-home (p=0.014) were found significant predictors of giardiasis. As for children's nutritional status, 6.6% were found to have significant stunting, 1.8% had underweight, and 4.7% had wasting. Giardiasis, however, was not found a predictor of these conditions. CONCLUSION: The Damascus region could be classified as medium-prevalence area for Giardia infections. Thus, the local administrators need to pay more attention to the prevention of parasitic infections along with improvement in education, environmental, and sanitary conditions.     

The occupational risk of cytomegalovirus infection among day-care providers.

We prospectively studied day-care providers at six day-care centers in south-eastern Iowa to determine their occupational risk for primary cytomegalovirus infection and to define epidemiologic risk factors. Ninety-six (38%) of 252 day-care providers were seropositive for cytomegalovirus by latex agglutination at entry into the study. Among 82 seronegative providers available for follow-up, seven seroconversions occurred at only two of the six participating centers, yielding an annualized seroconversion rate of 7.9%. Median time to seroconversion among these providers was 13 months. Using Kaplan-Meier estimates of risk, we determined that the overall risk of seroconversion among providers at various centers ranged from 0% to 22% by 12 months and from 0% to 40% by 16 months. Risk of cytomegalovirus acquisition by providers was independent of race, age, education, the presence of a child at home, or caring for children younger than 2 or 3 years in the day-care center. However, the risk of seroconversion among day-care providers appeared to parallel rates of cytomegalovirus excretion and acquisition among children at each center.