The end of the Australia antigen? An ecological study of the impact of universal newborn hepatitis B vaccination two decades on

Background

A universal newborn hepatitis B (HBV) vaccination program was introduced in the Northern Territory of Australia in 1990, followed by a school-based catch-up program. We evaluated the prevalence of hepatitis B infection in birthing women up to 20 years after vaccination and compared this to women born before the programs commenced.

Methods

A cohort of birthing mothers was defined from Northern Territory public hospital birth records between 2005 and 2010 and linked to laboratory confirmed notifications of chronic HBV, based principally on a record of hepatitis B surface antigen detection. Prevalence of HBV was compared between women born before or after implementation of the newborn and catch-up vaccination programs.

Findings

Among 10797 birthing mothers, 138 (1.3%) linked to a chronic HBV record. HBV prevalence was substantially higher in Aboriginal women compared to non-Indigenous women (2.4% versus 0.04%; p < 0.001). Among 5678 Aboriginal women, those eligible for catch-up and newborn HBV vaccination programs had a significantly lower HBV prevalence than older women born prior to the programs: HBV prevalence respectively 2.2% versus 3.5%, (OR 0.61, 95%CI 0.43–0.88) and 0.8% versus 3.5% (OR 0.21, 95%CI 0.11–0.43). This represents a risk reduction of respectively 40% and 80% compared to unvaccinated women.

Interpretation

The progressively greater reduction in the prevalence of chronic HBV in adult Aboriginal women co-inciding with eligibility for catch-up and newborn vaccination programs is consistent with a significant impact from both programs. The use of data derived from antenatal screening to track ongoing vaccine impact is applicable to a range of settings globally.     

How sharp is the short QuickDASH? A refined content and validity analysis of the short form of the disabilities of the shoulder, arm and hand questionnaire in the strata of symptoms and function and specific joint conditions

Purpose  

To assess and compare content, validity, and specificity of the QuickDASH (Disability of the arm, shoulder and hand questionnaire) as compared to the full-length DASH and other instruments to give a recommendation for its use depending on a specific clinical situation.     

Analysis of the cost-effectiveness of the implementation of Indoor Residual Spraying and distribution of Long-Lasting Insecticidal Nets in the municipality of Kouandé and municipality of Copargo in Benin

Background

In Benin, malaria was the leading cause of hospital consultation for children less than 5 years old (47.2%), and for all patients not hospitalized (42.3%). Its incidence among those who attended a health facility was respectively 42.9% and 17%. To address this problem, the National Program for the Fight against Malaria undertook, in 2011, a mass campaign of distribution of Long-Lasting Insecticidal Nets (LLINs). In addition to this strategy, the program decided to implement Indoor Residual Spraying in 7 of the 9 municipalities of Atacora department, which is one of the most malaria endemic areas. The objective of this study was to see if adding the IRS to the LLINs (municipality of Kouandé) strategy is cost-effective, as compared to the LLINs-only strategy (municipality of Copargo), in highly malaria endemic areas.

Method

This study was a cross-sectional study of the implementation of the IRS from June 2011 to July 2011. Regarding the selection of health workers, managers of the malaria program, and partners of implementation of the IRS, a reasoned choice was made. The data collection consisted mainly of a series of interviews with people responsible for resource management and the exploitation of documents provided by them.

Results

After the implementation of LLNs + IRS the annual incidence of malaria in health facilities decreased significantly at Kouandé-Centre and at Guilmaro. In the same period it increased significantly at Copargo- Centre, and decreased at Pabégou.The average cost per malaria case prevented (CE) was respectively 85,572.4 FCFA at Copargo Centre, 38,932.6 FCFA at Kouandé Centre, 15,940.6 FCFA at Pabégou and 174,728.5 FCFA at Guilmaro. According to the results, the CE ratio at Kouandé-Centre is lower than the CE ratio at Copargo- Centre and the CE ratio at Guilmaro is higher than the CE ratio at Pabégou.The LLINs?+?IRS strategy is more cost effective in urban areas than the LLINs-only strategy. The opposite result is observed in rural areas.

Conclusion

The LLINs?+?IRS strategy is cost effective in highly endemic areas both urban and rural, if communities sleep in sprayed structures and use LLINs even when it is hot.

     

Evaluation of the direct detection of group a β-hemolytic streptococcal antigen in a pediatric population: Comparison with the traditional culture technique

An evaluation of the Directigen Group A Strep Test (DGAST) in comparison witht the traditional culture technique, was carried out on 1907 throat specimens, obtained from pediatric patients suspected of having a group A -hemolytic streptococcal pharyngitis.Of the 344 specimens positive by culture, 277 were DGAST positive (sensitivity, 81%). Of the 1563 specimens negative by culture, 1511 were DGAST negative (specificity, 97%).Nineteen isolates of non-group A 3-hemolytic streptococci were recovered, primarily group G, B and G.The DGAST is easy to perform, rapid and very specific, but a lower sensitivity indicates that a back up traditional culture is still necessary, especially in pediatric patients.Corresponding author     

Characterization of phase I and phase II drug metabolism and the effect of Β-naphthoflavone in the liver and posterior kidney of the channel catfish,Ictalurs punctatus

Immature channel catfish (Ictalurus punctatus) were injected intraperitoneally with 50 mg/kg -naphthoflavone (BNF) and its effects on phase I and phase II xenobiotic metabolizing enzymes of liver and posterior kidney were evaluated. Microsomal monooxygenases in control animals exhibited higher specific activities in liver than in kidney although if data are expressed as turnover numbers, both organs have comparable activities, -naphthoflavone treatment resulted in increases in hepatic microsomal cytochrome P-450 content and ethoxyresorufin deethylase activity. Renal monooxygenases were not responsive to BNF injection. The phase II xenobiotic metabolizing systems of liver or kidney did not respond to BNF treatment. With the exception of epoxide hydrolase which was higher in renal microsomes, phase II drug metabolizing activity of liver cell fractions was about two-fold that observed in fractions isolated from posterior kidney.     

Organisation and financing of the health care systems of Bulgaria and Greece – what are the parallels?

Background  

The Bulgarian and Greek Medical Care systems have been reformated the last fifteen years. The aim of this study was an examination and comparison of the Bulgarian and Greek Medical Care Systems.     

Smoking and the Ø pattern; predictors of transitions through the stages of change

Pre-contemplators, contemplators and preparers have previously been described by distinct scores on pros, social influence and self-efficacy, the ? pattern. The objective of this study was to replicate this pattern in a sample of adult smokers (n = 554), to longitudinally observe stage sequence and identify predictors for forward and backward stage transition. Three hypotheses were formulated: (i) forward transition from pre-contemplation will be predicted by a higher perception of pros concerning smoking cessation, (ii) backward transition from contemplation will be predicted by a lower perception of pros of quitting smoking and (iii) forward transition from preparation will be predicted by a higher self-efficacy perception concerning smoking cessation. The ? pattern was replicated successfully. Smokers appeared to be more likely to transition to an adjacent stage than to skip a stage in the sequence. For prediction of stage transition, separate analyses were conducted for pre-contemplators, contemplators and preparers. Respondents transitioning forward were compared with respondents remaining in the same stage or transitioning backward and vice versa. Hypothesis (i) and (iii) were confirmed. Additionally, self-efficacy predicted forward transition from pre-contemplation. Implications towards improving interventions and research concerning stage transition are discussed.     

Velázquez and the representation of dignity

The purpose of this paper is to explore the visual representation of dignity, through the particular example of the seventeenth century Spanish painter Diego Velázquez. Velázquez works at a point in Western history when modern conceptions of dignity are beginning to be formed. It is argued that Velázquez' portraits of royalty and aristocracy articulate a tension between a feudal conception of majesty and a modern conception of the dignity of merit. On this level, modern conceptions of dignity of merit are understood in terms of a struggle to excel in particular activities, and thus to overcome the risk of failure. More radically, Velázquez' portraits of dwarfs and the mentally disabled are argued to be expressive of dignity, not by finding a positive representation of the sitter's dignity, or to find scales of activities by which they can be positively assessed, but rather by grounding their dignity, negatively, in a protest against indignity and humiliation. Drawing on Honneth's analysis of dignity in terms of a theory of recognition, it is argued that the indignity of the court dwarf lies in the fracturing of their communication with the rest of society. The task of repairing that fractured communication is achieved, not by representing a dignified ideal, but rather by drawing attention to the prejudices that serve to exclude the humiliated from full participation in society. In conclusion, it is suggested that the conceptualisation and representation of the elderly today finds effective exemplars in Velázquez' portraits of court dwarfs, rather than in his portraits of the elderly. This revised version was published online in July 2006 with corrections to the Cover Date.     

Analysis and Forecast of the Mortality of Diabetes Mellitus in China

[目的]分析1990～1999年我国城市和农村居民糖尿病死亡率的现况特点并预测未来5年的变化趋势.[方法]根据<全国卫生统计年报>资料,对我国1990至1999年糖尿病死亡率的现况进行流行病学分析,并利用灰色动态模型GM(1.1)预测我国2000至2005年城市和农村糖尿病死亡率趋势.[结果]城市1999年糖尿病死亡率为15.37/10万而农村为5.13/10万,分别是1990年死亡率的1.89倍和1.71倍;女性的死亡率高于男性,城市和农村男女死亡率之比分别为0.63∶1和0.76∶1;根据1990～1999死亡率所建立的城市的灰色模型预测方程为t=-106.481 7×(1-e0.074 58t)-Yt-1(t=1,2,...,N),而农村的方程为t=-33.605 3×(1-e0.075 37t)-Yt-1(t=1,2,...,N);预测到2005年我国城市和农村糖尿病死亡率将分别达到25.24/10万人和8.15/10万人;精度检验证明了城市和农村的预测模型拟合良好而外推测值可信.[结论]我国人群糖尿病死亡率上升趋势明显,提示有关部门应加强防治力度;灰色模型GM(1.1)能够较好地预测糖尿病死亡率的近期变化趋势.