Search

Background: To support malaria control strategies, prior knowledge of disease risk is necessary. Developing a model to explain the transmission of malaria, in endemic and epidemic regions, is of high priority in developing health system interventions. We develop, fit and validate a non-spatial dynamic model driven by meteorological conditions that can capture seasonal malaria transmission dynamics at the village level in a malaria holoendemic area of north-western Burkina Faso. Methods: A total of 676 children aged 6-59 months took part in this study. Trained interviewers visited children at home weekly from December 2003 to November 2004 for Plasmodium falciparum malaria infection detection. Anopheles daily biting rate, mortality rate and growth rate were evaluated. Digital meteorological stations measured ambient temperature, humidity and rainfall in each site. Results: The overall P. falciparum malaria infection incidence was 1.1 episodes per person year. There was strong seasonal variation in P. falciparum malaria infection incidence with a peak observed in August and September, corresponding to the rainy season and a high number of mosquitoes. The model estimates of monthly mosquito abundance and the incidence of malaria infection correlated well with observed values. The fit was sensitive to daily mosquito survival and daily human parasite clearance. Conclusion: The model has demonstrated potential for local scale seasonal prediction of P. falciparum malaria infection. It could therefore be used to understand malaria transmission dynamics using meteorological parameters as the driving force and to help district health managers in identifying high-risk periods for more focused interventions. [ABSTRACT FROM AUTHOR]

Background: The development and propagation of malaria parasites in their vertebrate host is a complex process in which various host and parasite factors are involved. Sometimes the evolution of parasitaemia seems to be quelled by parasite load. In order to understand the typical dynamics of evolution of parasitaemia, various mathematical models have been developed. The basic premise ingrained in most models is that the availability of uninfected red blood cells (RBC) in which the parasite develops is a limiting factor in the propagation of the parasite population. Presentation of the hypothesis: We would like to propose that except in extreme cases of severe malaria, there is no limitation in the supply of uninfected RBC for the increase of parasite population. Testing the hypothesis: In this analysis we examine the biological attributes of the parasite-infected RBC such as cytoadherence and rosette formation, and the rheological properties of infected RBC, and evaluate their effects on blood flow and clogging of capillaries. We argue that there should be no restriction in the availability of uninfected RBC in patients. Implication of the hypothesis: There is no justification for the insertion of RBC supply as a factor in mathematical models that describe the evolution of parasitaemia in the infected host. Indeed, more recent models, that have not inserted this factor, successfully describe the evolution of parasitaemia in the infected host. [ABSTRACT FROM AUTHOR]

The objective of this investigation was to identify risk factors for carbapenem-resistant Acinetobacter baumannii (CRAB) and its association with mortality. A population-based matched case-control study using the computerized database of Clalit Health Services (CHS) in the period between 2007 and 2012 was conducted. Hospitalized patients with CRAB colonization or infection were compared to hospitalized patients without evidence of A. baumannii, matched by age, ward of hospitalization, season, Charlson score, and length of hospitalization. Risk factors for CRAB isolation were searched for using multivariate analysis. Association of CRAB and other risk factors with mortality were assessed in the cohort. A total of 1190 patients with CRAB were matched to 1190 patients without CRAB. Low socioeconomic status was independently associated with CRAB isolation and CRAB bacteremia [odds ratio 2.18, 95 % confidence interval (CI) 1.02-5]. Other risk factors were invasive procedures and bacteremia with other pathogens prior to CRAB isolation, and various comorbidities. Among all patients, CRAB isolation was independently associated with increased mortality (hazard ratio 2.33, 95 % CI 2.08-2.6). Socioeconomic status is associated with health outcomes. Our population-based study revealed an almost doubled risk for CRAB in patients at lower socioeconomic status and an association with healthcare exposure. CRAB was associated with mortality and might become a risk indicator for complex morbidity and mortality. [ABSTRACT FROM AUTHOR]

Documentation of primary care teams' involvement in disparity reduction efforts exists, yet little is known about how teams interact or perceive their effectiveness. We investigated how the social network and structural ties among primary-care-clinic team members relate to their perceived team effectiveness (TE), in a large-scale disparity reduction intervention in Israel's largest insurer and provider of services. A mixed-method design of Social Network Analysis and qualitative data collection was employed. 108 interviews with medical, nursing, and administrative teams of 26 clinics and their respective managerial units were performed and information on the organizational ties, analyzing density and centrality, collected. Pearson correlations examined association between network measures and perceived TE. Clinics with strong intra-clinic density and high clinic–subregional-management density were positively correlated with perceived TE. Clinic in-degree centrality was also positively associated with perceived TE. Qualitative analyses support these findings with teamwork emerging as a factor which can impede or facilitate teams' ability to design and implement disparity reduction interventions. The study demonstrates that in an organization-wide disparity reduction initiative, cohesive intra-network structure and close relations with mid-level management increase the likelihood that teams perceive themselves as possessing the skills and resources needed to lead and implement disparity reduction efforts. List of abbreviations Team Effectiveness (TE); Clalit Health Services (Clalit); Social Network Analysis (SNA); Quality Improvement (QI); National Health Care Collaborative (NHPC); Tampa Bay Community Cancer Network (TBCCN) [ABSTRACT FROM AUTHOR]

Carbapenem-resistant Acinetobacter baumannii ( CRAB) is an increasingly common nosocomial pathogen. We sought to identify clinical and microbiological predictors of 14-day mortality among patients with CRAB bacteraemia. This case-control study included all adult patients in one Israeli hospital with CRAB on blood culture between July 2008 and June 2011. Cases were defined as patients who died within 14 days of bacteraemia onset and controls as patients who survived over 14 days. Sequence-typing of the bla OXA-51-like gene and REP- PCR identified CRAB clone groups. Logistic regression was performed to analyze predictors of 14-day all-cause mortality. To correct for differences in treatment onset, Cox regression was used to examine the effect of receiving an active antibiotic. Eighty-three cases and 89 controls were included. Six major CRAB clone groups were identified, with 14-day mortality ranging from 17 to 66%. Independent predictors of 14-day mortality were severity of illness ( OR = 1.38 for each 1-point increase in Sequential Organ Failure Assessment ( SOFA) score; 95% CI, 1.21, 1.56), independence in activities of daily living ( ADL) on admission ( OR = 3.40; 95% CI, 1.20, 9.67, for fully dependent vs. independent), surgery before bacteraemia ( OR = 0.25; 95% CI, 0.11, 0.59) and clone group ( OR = 7.76; 95% CI, 2.52, 23.85, for the most virulent group vs. the reference group). In the multivariate Cox model using a propensity score to adjust for SOFA, clone, ADL and surgery, active antibiotic treatment was protective ( HR = 0.30; 95% CI, 0.15, 0.60). Differences in virulence between CRAB clones may partly explain heterogeneous results in previous studies of mortality following CRAB infection. [ABSTRACT FROM AUTHOR]

Purpose Few studies have investigated the association between religiosity and self-injurious thoughts and behaviors specifically in adolescents, yielding inconsistent results. To date, no study has examined this relationship in a Jewish adolescent cohort. Methods Self-injurious thoughts and behaviors, as well as depression, were assessed in a nationally representative sample of Jewish adolescents ( n = 620) and their mothers, using the Development and Well-Being Assessment Inventory (DAWBA) structured interview. Degree of religiosity was obtained by a self-report measure. Results Using multivariate analysis, level of religiosity was inversely associated with self-injurious thoughts and behaviors (Wald χ 2 = 3.95, P = 0.047), decreasing the likelihood of occurrence by 55% (OR = 0.45, 95% CI 0.2–0.99), after adjusting for depression and socio-demographic factors. This model (adjusted R 2 = 0.164; likelihood ratio χ 2 = 7.59; df = 1; P < 0.047) was able to correctly classify 95.6% of the patients as belonging either to the high or low risk groups. Conclusion This is the first study demonstrating religiosity to have a direct independent protective effect against self-injurious thoughts and behaviors in Jewish adolescents. This finding has clinical implications regarding risk assessment and suicide prevention. Further research can potentially elucidate the complex relationship between religiosity, self-injury and suicide in this population. [ABSTRACT FROM AUTHOR]

Mathematical modelling has been used to assess the level of malarial transmission, during the dry season, in Nouna province, in north–western Burkina Faso. The data used were collected, at four sites (one semi-urban and three rural), from 867 children aged 6–60 months who were randomly selected. Almost all of the children (850) completed the follow-up, which involved the active detection of malaria (i.e. febrile, smear-positive malarial infection) throughout a single dry season (December 2003–May 2004). Light traps were used to sample the local populations of Anopheles vectors, in order to estimate the daily biting rate. The mathematical model was then used to simulate the incidence of malaria, which was compared with the observed incidence. At all four study sites, new cases of malaria were observed throughout the dry season, although the level of transmission was low. The monthly incidence of malaria estimated using the mathematical model was very close to the observed incidence. The fit was sensitive to daily mosquito survival and daily human parasite clearance. In Nouna province, effective interventions to prevent malaria should not be confined to the rainy season but must continue throughout the year. The focus should be on the clearance of parasitaemias, by the use of effective drugs, and on decreasing vector survival, by the use of vector-control methods. [ABSTRACT FROM AUTHOR]

A multi-model ensemble-based system for seasonal-to-interannual prediction has been developed in a joint European project known as DEMETER (Development of a European Multimodel Ensemble Prediction System for Seasonal to Interannual Prediction). The DEMETER system comprises seven global atmosphere–ocean coupled models, each running from an ensemble of initial conditions. Comprehensive hindcast evaluation demonstrates the enhanced reliability and skill of the multimodel ensemble over a more conventional single-model ensemble approach. In addition, innovative examples of the application of seasonal ensemble forecasts in malaria and crop yield prediction are discussed. The strategy followed in DEMETER deals with important problems such as communication across disciplines, downscaling of climate simulations, and use of probabilistic forecast information in the applications sector, illustrating the economic value of seasonal-to-interannual prediction for society as a whole. [ABSTRACT FROM AUTHOR]