Mineralogy of a mudstone at Yellowknife Bay, Gale crater, Mars

Sedimentary rocks at Yellowknife Bay (Gale crater) on Mars include mudstone sampled by the Curiosity rover. The samples, John Klein and Cumberland, contain detrital basaltic minerals, calcium sulfates, iron oxide or hydroxides, iron sulfides, amorphous material, and trioctahedral smectites. The John Klein smectite has basal spacing of ~10 angstroms, indicating little interlayer hydration. The Cumberland smectite has basal spacing at both ~13.2 and ~10 angstroms. The larger spacing suggests a partially chloritized interlayer or interlayer magnesium or calcium facilitating H2O retention. Basaltic minerals in the mudstone are similar to those in nearby eolian deposits. However, the mudstone has far less Fe-forsterite, possibly lost with formation of smectite plus magnetite. Late Noachian/Early Hesperian or younger age indicates that clay mineral formation on Mars extended beyond Noachian time.

Rotavirus-associated hospitalization and emergency department costs and rotavirus vaccine program impact

OBJECTIVES

To determine the medical costs of laboratory-confirmed rotavirus hospitalizations and emergency department (ED) visits and estimate the economic impact of the rotavirus vaccine program.

PATIENTS AND METHODS

During 4 rotavirus seasons (2006-2009), children <3 years of age hospitalized or seen in the ED with laboratory-confirmed rotavirus were identified through active population-based rotavirus surveillance in three US counties. Medical costs were obtained from hospital and physician billing data, and factors associated with increased costs were examined. Annual national costs were estimated using rotavirus hospitalization and ED visit rates and medical costs for rotavirus hospitalizations and ED visits from our surveillance program for pre- (2006-2007) and post-vaccine (2008-2009) time periods.

RESULTS

Pre-vaccine, for hospitalizations, the median medical cost per child was $3581, the rotavirus hospitalization rate was 22.1/10,000, with an estimated annual national cost of $91 million. Post-vaccine, the median medical cost was $4304, the hospitalization rate was 6.3/10,000 and the estimated annual national cost was $31 million. Increased costs were associated with study site, age <3 months, underlying medical conditions and an atypical acute gastroenteritis presentation. For ED visits, the pre-vaccine median medical cost per child was $574, the ED visit rate was 291/10,000 resulting in an estimated annual national cost of $192 million. Post-vaccine, the median medical cost was $794, the ED visit rate was 71/10,000 with an estimated annual national cost of $65 million.

CONCLUSIONS

After implementation of rotavirus immunization, the total annual medical costs decreased from $283 million to $96 million, an annual reduction of $187 million.

Cardiopulmonary manifestations of portovenous shunts from congenital absence of the portal vein: pulmonary hypertension and pulmonary vascular dilatation

HPS and PPHTN are unusual and challenging pulmonary manifestations of liver disease. We report two pediatric cases in association with heterotaxy polysplenia syndrome and congenital absence of the portal vein. Both patients were symptomatic and hemodynamically compromised and required aggressive medical therapy. One patient with PPHTN alone achieved a successful liver transplant. The second child presented with combined HPS and PPHTN and exhibited a different evolution of pulmonary vascular disease. These cases illustrate associations that must be entertained in the setting of heterotaxy syndrome, cyanosis, or pulmonary hypertension and how strategic medical combined with surgical management can provide a good outcome.

Rights, knowledge, and governance for improved health equity in urban settings

All three of the interacting aspects of daily urban life (physical environment, social conditions, and the added pressure of climate change) that affect health inequities are nested within the concept of urban governance, which has the task of understanding and managing the interactions among these different factors so that all three can be improved together and coherently. Governance is defined as: "the process of collective decision making and processes by which decisions are implemented or not implemented": it is concerned with the distribution, exercise, and consequences of power. Although there appears to be general agreement that the quality of governance is important for development, much less agreement appears to exist on what the concept really implies and how it should be used. Our review of the literature confirmed significant variation in meaning as well as in the practice of urban governance arrangements. The review found that the linkage between governance practices and health equity is under-researched and/or has been neglected. Reconnecting the fields of urban planning, social sciences, and public health are essential "not only for improving local governance, but also for understanding and addressing global political change" for enhanced urban health equity. Social mobilization, empowering governance, and improved knowledge for sustainable and equitable development in urban settings is urgently needed. A set of strategic research questions are suggested.

Intestinal parasite screening in internationally adopted children: importance of multiple stool specimens

OBJECTIVE

Our goal was to determine the prevalence of intestinal parasites in internationally adopted children, to examine factors associated with infection, and to determine if evaluating multiple stool specimens increases the yield of parasite identification.

METHODS

We evaluated internationally adopted children with at least 1 stool specimen submitted for ova and parasite testing within 120 days after arrival to the United States. In children submitting 3 stool specimens, in which at least 1 specimen was positive for the pathogen studied, we examined whether multiple stool specimens increased the likelihood of pathogen identification.

RESULTS

Of the 1042 children studied, 27% had at least 1 pathogen identified; with pathogen-specific prevalence of Giardia intestinalis (19%), Blastocystis hominis (10%), Dientamoeba fragilis (5%), Entamoeba histolytica (1%), Ascaris lumbricoides (1%), and Hymenolepsis species (1%). The lowest prevalence occurred in South Korean (0%), Guatemalan (9%), and Chinese (13%) children, and the highest prevalence occurred in Ethiopian (55%) and Ukrainian (74%) children. Increasing age was significantly associated with parasite identification, whereas malnutrition and gastrointestinal symptoms were not. Overall, the yield of 1 stool specimen was 79% with pathogen recovery significantly increasing for 2 (92%) and 3 (100%) specimens, respectively (P < .0001). Pathogen identification also significantly increased with evaluation of additional stool specimens for children with and without gastrointestinal symptoms.

CONCLUSIONS

We provide data for evidence-based guidelines for intestinal parasite screening in internationally adopted children. Gastrointestinal symptoms were not predictive of pathogen recovery, and multiple stool specimens increased pathogen identification in this high-risk group of children.

Factors associated with protective antibody levels to vaccine preventable diseases in internationally adopted children

To determine which factors are predictive of protective antibody against vaccine-preventable diseases in internationally adopted children, we evaluated 562 children with serologic testing for at least one vaccine antigen before receiving a US vaccination. Vaccination status was defined as the number-of-doses recorded and as the presence of an up-to-date and valid record according to the American Academy of Pediatrics and the Advisory Committee on Immunization Practices guidelines. The number-of-doses recorded was the best predictor of protective antibody. These findings suggest that other options for immunization verification guidelines for internationally adopted children should be considered by policy makers.

Serologic testing to verify the immune status of internationally adopted children against vaccine preventable diseases

Definitive immunization guidelines for internationally adopted children are lacking. We examined whether these children had serologic evidence of protection against vaccine-preventable diseases. For children with ≥3 vaccine doses, overall protection was high for diphtheria (85%), tetanus (95%), polio (93%), hepatitis B (77%), and Hib (67%). For children ≥12 months of age with ≥1 dose of measles, mumps, or rubella vaccines, 95%, 72%, and 94% were immune, respectively. Children without immunization documentation had lower immunity. Serologic testing was useful in verifying the immunization status in internationally adopted children with and without documentation of immunizations.

Contributions for repositioning a regional strategy for Healthy Municipalities, Cities and Communities (HM&C): results of a pan-American survey

This article presents the results of the 1st Regional Survey of Healthy Municipalities, Cities and Communities (HM&C) carried out in 2008 by the Pan American Health Organization (PAHO) and ISALUD University of Argentina. It discusses the responses obtained from 12 countries in the Americas Region. Key informants in Argentina, Brazil, Chile, Colombia, Costa Rica, Cuba, Mexico, Paraguay, Peru, and Uruguay were selected and encouraged to answer the survey, while informants from Canada and Honduras answered voluntarily and were included in this analysis. The discussion of the results of the Survey provides insight into the current status of HM&C in the Region and suggests key topics for repositioning the Regional strategy relative to: (1) the conceptual identity and tools for HM&C; (2) challenging areas in the implementation process (scale, legal framework, and development of capacities); (3) related strategies and participatory processes such as the ways citizen empowerment in governance is supported; (4) the need to monitor and assess the impact of the HM&C strategy on the health and quality of life of the populations involved; and (5) the need for developing a strategic research and training agenda. The analysis and discussion of these results aims to provide useful input for repositioning the strategy in the Region and contributing to the emergence of a second generation of concepts and tools capable of meeting the developing priorities and needs currently faced by the HM&C strategy.

Risk factors for chronic hepatitis B virus infection among blood donors in Bangalore, India

OBJECTIVES AND AIM

We performed a study of hepatitis B virus (HBV) risk factors among blood donors in Bangalore, India.

BACKGROUND

HBV infection is prevalent in India and poses a potential risk of transmission by blood transfusion, but studies of risk factors for hepatitis B surface antigen (HBsAg) carriage among Indian blood donors are lacking.

METHODS/MATERIALS

Using a case-cohort design, we enrolled 71 cases with repeatedly reactive HBsAg results and a cohort of 212 contemporaneous blood donors with unknown HBsAg status. Questionnaire data were analysed using multivariable logistic regression.

RESULTS

In our multivariate analysis controlling for age, HBsAg positivity was associated with repeat donor status (OR = 0·34, 95% CI 0·17-0·71 vs first-time donor status), residence outside Bangalore and Hosur (rural areas) (OR = 15·66, 95% CI 3·60-68·07vs Bangalore residence), having been a customer at a local barber shop (OR = 4·07, 95% CI 2·06-8·03), close contact with a person who had jaundice (OR = 13·64, 95% CI 3·71-50·24) and cigarette smoking (OR = 3·25, 95% CI 1·39-7·60).

CONCLUSION

In addition to recognised demographic risk factors, associations with patronage of local barbers and contact with jaundiced individuals suggest behavioural risk factors that could be adopted as exclusionary criteria for blood donation in India.

Documenting the Current State of the Healthy Municipalities, Cities and Communities Initiative in the Americas

The objective of this study was to document the challenges, achievements, and lessons learned in municipalities where the Healthy Municipalities, Cities and Communities (HMC) strategy has been implemented in the Americas. A general survey was distributed through the HMC online network and through the Pan American Health Organization country offices. Municipalities answered questions regarding the planning, implementation, and evaluation phases of the strategy. Fifty-seven municipalities answered the survey. Ninety-three percent of the municipalities had signed a written agreement of political commitment to the HMC strategy. While 60% of the surveyed municipalities reported having a local health and well being situational analysis, 70% had an HMC Action Plan and only 58% had a follow-up and evaluation plan. The activities in which municipalities are engaged under the banner of the HMC strategy vary greatly in the Americas Region with varying degrees of success. Intersectorial collaboration and evaluation continues to be a challenge for the HMC initiative.

Glomus tumour in a child

Glomus tumours are uncommon neoplasms. Very rarely do they present in the paediatric age group. We describe a case of bilateral glomus tumours in a 13-year-old girl that were successfully treated with radiotherapy. The patient remains well 8 years after completion of treatment.

Detection of astrovirus in the faeces of cats with diarrhoea

Examination by electron microscopy of faeces from two separate cases of young cats with diarrhoea revealed the presence of 28 nm viral particles morphologically consistent with an astrovirus. No visible cytopathic effect was observed when the virus was inoculated into a feline kidney cell culture.

Isolation of a reovirus from a broiler chicken flock with high early mortality

A reovirus was isolated from a flock of 12,000 broiler chickens which experienced a total mortality of 6.3% up to 35 days. The reovirus produced large syncytia in primary chicken kidney cell cultures with eosinophilic intracytoplasmic inclusion body formation. Infected cells reacted with fluorescein conjugated specific anti-reovirus serum. Negatively strained virions had a double shelled appearance with overall diameter of 65 to 70 nm. The nucleic acid had ten discrete segments with electrophoretic mobilities as would be expected for a reovirus.

Primary Health Care and Aging

From 21-25 February 2000, in San Jose, Costa Rica, a WHO Consultative Group was held on the topic of Primary Health Care for Older Persons, with representatives from 13 countries from around the world, as well as Headquarters and Regional offices of WHO and the private sector. In the policy statement that emerged from the meeting four basic principles were highlighted: universal accessibility and coverage on the basis of need, community and individual involvement, intersectoral action for health, and appropriate use of cost effective technologies in relation to the available resources. Three complementary integration functions are mentioned: functional with an integrated approach to the health needs of individuals over their life course taking precedence over episodic management of disease; organizational, with a focus on how health centers should function with interdisciplinary teams; and educational which addresses the knowledge and skills and attitudes needed by health professionals that will facilitate communication, networking, advocacy and mediation of resources. The proceedings go on to outline the objectives to be included in national plans on health of older people, as well as the extended benefits and outcomes to be expected from PHC strategies for older people. In promoting quality of care for older persons, positive and negative factors are mentioned, as are strategies to: stimulate interest in geriatric care, motivate general practitioners to focus on the care of elders, encourage teamwork among PHC staff, and encourage multi-sectoral collaboration in promoting the health of older persons. An example is provided of healthy ageing from Canada. The recommendations include defining and measuring an ageing friendly health center (with specific indicators for the latter), defining the role of the PHC team in promoting healthy ageing, characteristics that programs should have to promote “age friendly” services in the primary care setting, and outcome indicators for quality of care of elders at the PHC level.