Limited transmission of SARS-CoV-2 in schools in Ireland during the 2020-2021 school year

BackgroundThe role of schools in SARS-CoV-2 transmission has been a debated topic since the beginning of the COVID-19 pandemic.AimTo examine SARS-CoV-2 transmission in all schools in Ireland during the 2020-21 school year.MethodsIn a national descriptive cross-sectional study, we investigated PCR-confirmed cases of COVID-19 among students (aged < 20 years) and staff (aged ≥ 20 years) who attended school during their infectious period to identify school close contacts. SARS-CoV-2 PCR test results of all school close contacts were pooled to obtain an overall positivity rate and to stratify positivity rate by school setting and role (i.e. student or staff).ResultsIn total, 100,474 individuals were tested as close contacts in 1,771 schools during the 2020-21 school year. An overall close contact positivity rate of 2.4% was observed across all schools (n = 2,373 secondary cases). The highest positivity rate was seen in special schools (3.4%), followed by primary (2.5%) and post-primary schools (1.8%) (p < 0.001). Of the close contacts identified, 90.5% (n = 90,953) were students and 9.5% (n = 9,521) were staff. Overall, students had a significantly higher positivity rate than staff (2.4% vs 1.8%, p < 0.001).ConclusionThis study demonstrated that a low level of SARS-CoV-2 transmission occurred in Irish schools during the 2020-21 academic year. In the event of future pandemics, and as the COVID-19 pandemic continues, there is a need to carefully weigh up the harms and benefits associated with disrupted education to mitigate infectious disease transmission before reflexively closing classes or schools.

The use of the IAEA MARIS database in determining the variability of sediment distribution coefficients in the marine environment and potential implications for marine dispersion modelling

A prototype tool has been developed for deriving sediment distribution coefficients,K_d, in the marine environment by harvesting simultaneous measurements of activity concentrations of radionuclides in seawater and sediments based on the International Atomic Energy Agency's Marine Radioactivity Information System (MARIS). As a case study, theK_dvariability in the Baltic Sea was investigated as this region has been extensively monitored by HELCOM since 1984 resulting in a comprehensive dataset with good spatial and temporal coverage and required ancillary parameters. The prototype tool was used to derive a dataset ofin-situapparentK_d(a)values derived from measurements of seawater and sediment in quasi-equilibrium conditions from the Baltic Sea over a period of approximately 35 years. For Cs, a comprehensive analysis of the Baltic SeaK_d(a)dataset was undertaken, focusing on the temporal trend ofK_d(a)and comparing the results toK_dvalues derived elsewhere. For Sr and Pu, for which there were fewer data records available a more rudimentary analysis was carried out. The CsK_d(a)median values derived from¹³⁷Cs data in this study were estimated to be 2154 l kg^-1for seabed sediment and 10 000 l kg^-1for suspended sediment. The value derived for seabed sediment is in good agreement with the previously recommended ocean margin CsK_dvalue of 4000 l kg^-1. The analysis demonstrated the important distinction in the Baltic Sea betweenK_dvalues for seabed sediment and suspended sediments, which differed by an order of magnitude. The analysis also highlighted the dependence ofK_dvalues on the variation in both the salinity of seawater and the type of seabed sediment. Such variability can significantly influence outcomes when modelling the behaviour of radionuclides in marine dispersion modelling.

222Rn and 226Ra Concentrations in Spring Water and Their Dose Assessment Due to Ingestion Intake

²²²Rn and ²²⁶Ra concentrations of less than a few to several thousands of Bq L⁻¹ have been observed in several underground bodies of water around the world. Although regulations for these concentrations in water have been implemented internationally, there are currently no regulations in place in Japan. However, concentrations that exceed these internationally recognized regulatory values have also been observed in Japan. In this study, concentrations in spring water in the northern part of Japan were measured and the effective dose from intake of the water was evaluated. ²²²Rn concentrations were measured using a liquid scintillation counter, and ²²⁶Ra concentrations were measured using a high purity germanium detector after chemical preparation. The measured ²²²Rn concentrations (=12.7 ± 6.1 Bq L⁻¹) and ²²⁶Ra concentrations (<0.019–0.022 Bq L⁻¹) did not exceed the reference values set by international and European/American organizations. A conservative estimate of the annual effective ingestion dose of 8 μSv for ²²²Rn and ²²⁶Ra obtained in this study is much smaller than the estimated overall annual effective dose of 2.2 mSv from natural radiation to the Japanese population. However, this dosage accounts for 8% of the WHO individual dosing criteria of 0.1 mSv/year for drinking water.

A unique high natural background radiation area - Dose assessment and perspectives

The biological effects of low dose-rate radiation exposures on humans remains unknown. In fact, the Japanese nation still struggles with this issue after the Fukushima Dai-ichi Nuclear Power Plant accident. Recently, we have found a unique area in Indonesia where naturally high radiation levels are present, resulting in chronic low dose-rate radiation exposures. We aimed to estimate the comprehensive dose due to internal and external exposures at the particularly high natural radiation area, and to discuss the enhancement mechanism of radon. A car-borne survey was conducted to estimate the external doses from terrestrial radiation. Indoor radon measurements were made in 47 dwellings over three to five months, covering the two typical seasons, to estimate the internal doses. Atmospheric radon gases were simultaneously collected at several heights to evaluate the vertical distribution. The absorbed dose rates in air in the study area vary widely between 50 nGy h^-1 and 1109 nGy h^-1. Indoor radon concentrations ranged from 124 Bq m^-3 to 1015 Bq m^-3. That is, the indoor radon concentrations measured exceed the reference levels of 100 Bq m^-3 recommended by the World Health Organization. Furthermore, the outdoor radon concentrations measured were comparable to the high indoor radon concentrations. The annual effective dose due to external and internal exposures in the study area was estimated to be 27 mSv using the median values. It was found that many residents are receiving radiation exposure from natural radionuclides over the dose limit for occupational exposure to radiation workers. This enhanced outdoor radon concentration might be as a result of the stable atmospheric conditions generated at an exceptionally low altitude. Our findings suggest that this area provides a unique opportunity to conduct an epidemiological study related to health effects due to chronic low dose-rate radiation exposure.

Ongoing mumps outbreak among adolescents and young adults, Ireland, August 2018 to January 2020

Between 18 August 2018 and 24 January 2020, 3,736 mumps cases were notified in Ireland. The highest numbers of notifications were observed in the age group 15–24 years. Vaccination status was reported for 32% (n = 1,199) of cases: 72% of these had received two doses of measles-mumps-rubella (MMR) vaccine. Vaccination uptake after free MMR vaccination targeting colleges and universities since early 2019 was low. Therefore, a national media campaign began in January 2020.

Assessment of Radiation Dose from the Consumption of Bottled Drinking Water in Japan

Activity concentrations of ²³⁴U, ²³⁵U, ²³⁸U, ²²⁶Ra, ²²⁸Ra, ²²²Rn, ²¹⁰Po, ²¹⁰Pb, ⁴⁰K, ³H, ¹⁴C, ¹³⁴Cs and ¹³⁷Cs were determined in 20 different Japanese bottled drinking water commercially available in Japan. The origins of the mineral water samples were geographically distributed across different regions of Japan. Activity concentrations above detection limits were measured for the radionuclides ²³⁴U, ²³⁵U, ²³⁸U, ²²⁶Ra, ²²⁸Ra and ²¹⁰Po. An average total annual effective dose due to ingestion was estimated for adults, based on the average annual volume of bottled water consumed in Japan in 2019, reported to be 31.7 L/y per capita. The estimated dose was found to be below the recommended World Health Organisation (WHO) guidance level of 0.1 mSv/y for drinking water quality. The most significant contributor to the estimated dose was ²²⁸Ra.

EVALUATIONS OF INVENTORY AND ACTIVITY CONCENTRATION OF RADIOCESIUM IN SOIL AT A RESIDENTIAL HOUSE 3 YEARS AFTER THE FUKUSHIMA NUCLEAR ACCIDENT

Soil samples from the surface to a 5 cm depth were collected at a residential house in Koriyama City, Fukushima Prefecture using a scraper plate every three months from March 2014 to September 2014 to evaluate the vertical distribution profiles and inventories of 134Cs and 137Cs in soil. The vertical distribution profiles of radiocesium (134Cs and 137Cs) in soil showed that greater than 86% of the total radiocesium was absorbed in the upper 2 cm 3 years after the accident. Radiocesium in the surface layer seems to move to the lower layer over time. The migration of radiocesium in surface layer might be influenced by the ground surface runoff by rainfall. Radiocesium inventories in June increased significantly over the short period between March and June. In contrast, the radiocesium inventories in September did not increase significantly compared to the values in June. Radiocesium resuspension and deposition caused by decontamination work and meteorological events might be one possible reason for the increased radiocesium inventories observed in June.

A Single-arm, Practical Application Assessment of User Experience and Peristomal Skin Condition Among Persons With an Ileostomy Using a New Barrier Seal With Assisted Flow

Peristomal skin complications are a common problem for persons with an ileostomy.

PURPOSE

The purpose of this pilot study was to solicit user feedback and perform an initial assessment of the performance of a new barrier seal designed to decrease the risk of chemical-induced dermatitis.

METHODS

Seven (7) potential participants who were at least 18 years of age, >6 months post surgery, with an end or loop ileostomy and unbroken peristomal skin, and who were capable of changing their appliance themselves or had the availability of care assistance were identified and recruited by the stoma care nurse at the University Hospital, Limerick, Ireland. At the initial visit and after 1 and 2 weeks, participants were asked to rate device comfort, security, and handling; skin condition was assessed by the research nurse using the Ostomy Skin Tool. Descriptive statistics were used to tabulate the results.

RESULTS

Five (5) participants completed the study. Discoloration, erosion, and tissue overgrowth scores improved in 3 of 5 patients, and the mean Ostomy Skin Tool score decreased from 5.4 ± 2.19 at the initial assessment to 4 ± 1.87 at the week 2 visit. Comfort, handling, and security ratings increased from a median of 8 at the beginning of the study to 10 at week 2.

CONCLUSION

Initial patient feedback regarding the new product was positive, and skin assessment results suggest the new seal may help improve peristomal skin condition. Larger studies with longer patient follow-up are needed to confirm the results of this pilot evaluation.

International Rn-222 in drinking water interlaboratory comparison

A radon in drinking water interlaboratory comparison (ILC) was conducted between eight laboratories in Europe. The majority of the measurement results submitted were in agreement with the assigned value, with a single result deemed questionable. The questionable result does not deviate significantly from the assigned value but the measurement uncertainties associated with this result could be too small. The results from this ILC indicate that there is good agreement between participating laboratories for radon in water measurements.

Investigation and management of an outbreak of Salmonella Typhimurium DT8 associated with duck eggs, Ireland 2009 to 2011

Salmonella Typhimurium DT8 was a very rare cause of human illness in Ireland between 2000 and 2008, with only four human isolates from three patients being identified. Over a 19-month period between August 2009 and February 2011, 34 confirmed cases and one probable case of Salmonella Typhimurium DT8 were detected, all of which had an MLVA pattern 2-10-NA-12-212 or a closely related pattern. The epidemiological investigations strongly supported a linkbetween illness and exposure to duck eggs. Moreover, S. Typhimurium with an MLVA pattern indistinguishable (or closely related) to the isolates from human cases, was identified in 22 commercial and backyard duck flocks, twelve of which were linked with known human cases. A range of control measures were taken at farm level, and advice was provided to consumers on the hygienic handling and cooking of duck eggs. Although no definitive link was established with a concurrent duck egg-related outbreak of S. Typhimurium DT8 in the United Kingdom, it seems likely that the two events were related. It may be appropriate for other countries with a tradition of consuming duck eggs to consider the need for measures to reduce the risk of similar outbreaks.

Investigation and management of an outbreak of Salmonella Typhimurium DT8 associated with duck eggs, Ireland 2009 to 2011

>Salmonella Typhimurium DT8 was a very rare cause of human illness in Ireland between 2000 and 2008, with only four human isolates from three patients being identified. Over a 19-month period between August 2009 and February 2011, 34 confirmed cases and one probable case of Salmonella Typhimurium DT8 were detected, all of which had an MLVA pattern 2-10-NA-12-212 or a closely related pattern. The epidemiological investigations strongly supported a link between illness and exposure to duck eggs. Moreover, S. Typhimurium with an MLVA pattern indistinguishable (or closely related) to the isolates from human cases, was identified in 22 commercial and backyard duck flocks, twelve of which were linked with known human cases. A range of control measures were taken at farm level, and advice was provided to consumers on the hygienic handling and cooking of duck eggs. Although no definitive link was established with a concurrent duck egg-related outbreak of S. Typhimurium DT8 in the United Kingdom, it seems likely that the two events were related. It may be appropriate for other countries with a tradition of consuming duck eggs to consider the need for measures to reduce the risk of similar outbreaks.

Effects of complex hydrodynamic processes on the horizontal and vertical distribution of Tc-99 in the Irish Sea

The increased discharge of Tc-99 from the Sellafield plant following the commissioning of the Enhance Actinide Removal Plant in 1994 was reflected in higher Tc-99 activity concentrations over much of the Irish Sea. The presence of this radionuclide in the marine environment is of concern not only because of its long half life but also high bio-concentration factor in commercially valuable species, such Norway lobster (Nephrops norvegicus) and common lobster (Homarus gammarus). Accurate predictions of the transport, and spatial and temporal distributions of Tc-99 in the Irish Sea have important environmental and commercial implications. In this study, transport of the Tc-99 material was simulated in order to develop an increased understanding of long-term horizontal and vertical distributions. In particular, impact of seasonal hydrodynamic features such as the summer stratification on the surface-to-bottom Tc-99 ratio was of interest. Also, material retention mechanisms within the western Irish Sea were explored and flushing rates under various release conditions and meteorological forcing were estimated. The results show that highest vertical gradients are observed between June and July in the deepest regions of the North Channel and the western Irish Sea where radionuclide-rich saline-poor water overlays radionuclide-poor saline-rich Atlantic water masses. Strong correlation between top-to-bottom ratio of Tc-99 and strength of stratification was found. Flushing studies demonstrate that as the stratification intensifies, residence times within the western Irish Sea increase. In stratified waters of the gyre Tc-99 material is flushed out from the upper layer much quicker than from the bottom zone. The research also shows that in the gyre the biologically active upper layers above the thermocline are likely to contain higher concentrations than the near-bed region. Long-term horizontal and vertical distributions as determined in this study provide a basis for assessment of a potential biota exposure to Tc-99.

Comparison of retrospective and contemporary indoor radon measurements in a high-radon area of Serbia

In Niska Banja, Serbia, which is a high-radon area, a comparison was made between two retrospective radon measuring methods and contemporary radon measurements. The two retrospective methods derive the radon concentrations that occurred in dwellings over longer periods in the past, based on the amount of trapped (210)Po on the surface of glass objects (surface traps, ST) or in the bulk of porous materials (volume traps, VT). Both surface implanted (210)Po in glass objects and contemporary radon in air were measured in 46 rooms, distributed in 32 houses of this radon spa-town, using a dual alpha track detector configuration (CR-39 and LR115) and CR-39 track etched detectors, respectively. In addition to the use of surface trap measurements, in 18 rooms (distributed in 15 houses) VT samples of suitable material were also collected, allowing to compare ST and VT retrospective radon concentration estimates. For each room, contemporary annual radon concentrations (CONT) were measured or estimated using seasonal correction factors. The distribution of the radon concentration in all data sets was found to be close to lognormal (Chi-square test>0.05). Geometric means (GM) are similar, ranging from 1040 to 1380 Bq m(-3), whereas geometric standard deviations (GSD) for both the retrospective methods are greater than for the CONT method, showing reasonable agreement between VT, ST and CONT measurements. A regression analysis, with respect to the lognormal distribution of each data set, shows that for VT-ST the correlation coefficient r is 0.85, for VT-CONT r is 0.82 and for ST-CONT r is 0.73. Comparison of retrospective and contemporary radon concentrations with regard to supposed long-term indoor radon changes further supports the principal agreement between the retrospective and conventional methods.

The lakes of Titan

The surface of Saturn's haze-shrouded moon Titan has long been proposed to have oceans or lakes, on the basis of the stability of liquid methane at the surface. Initial visible and radar imaging failed to find any evidence of an ocean, although abundant evidence was found that flowing liquids have existed on the surface. Here we provide definitive evidence for the presence of lakes on the surface of Titan, obtained during the Cassini Radar flyby of Titan on 22 July 2006 (T16). The radar imaging polewards of 70 degrees north shows more than 75 circular to irregular radar-dark patches, in a region where liquid methane and ethane are expected to be abundant and stable on the surface. The radar-dark patches are interpreted as lakes on the basis of their very low radar reflectivity and morphological similarities to lakes, including associated channels and location in topographic depressions. Some of the lakes do not completely fill the depressions in which they lie, and apparently dry depressions are present. We interpret this to indicate that lakes are present in a number of states, including partly dry and liquid-filled. These northern-hemisphere lakes constitute the strongest evidence yet that a condensable-liquid hydrological cycle is active in Titan's surface and atmosphere, in which the lakes are filled through rainfall and/or intersection with the subsurface 'liquid methane' table.

Titan Radar Mapper observations from Cassini's T3 fly-by

Cassini's Titan Radar Mapper imaged the surface of Saturn's moon Titan on its February 2005 fly-by (denoted T3), collecting high-resolution synthetic-aperture radar and larger-scale radiometry and scatterometry data. These data provide the first definitive identification of impact craters on the surface of Titan, networks of fluvial channels and surficial dark streaks that may be longitudinal dunes. Here we describe this great diversity of landforms. We conclude that much of the surface thus far imaged by radar of the haze-shrouded Titan is very young, with persistent geologic activity.

Smoking, occupancy and staffing levels in a selection of Dublin pubs pre and post a national smoking ban, lessons for all

BACKGROUND

On the 29th March 2004 the Irish government introduced a comprehensive workplace smoking ban to protect the health of workers. This study evaluates the impact the ban had on staffing levels, customer numbers and smoking rates in a sample of 38 public houses in Dublin.

METHODS

A total of 38 public houses were visited prior to the introduction of the ban, each visit lasted at least three hours, and the number of staff, customers and the number of people smoking was recorded each hour. Follow-up visits were conducted exactly one year later, on the same day of the week and at the same time of day, allowing controlling for seasonal and weekday effects.

RESULTS

There was a decrease (8.82%) in average staff levels while customer numbers increased by 11% and there was a dramatic reduction in numbers smoking on a visit to a pub (77.8%).

CONCLUSIONS

The hospitality industry predicted major job losses as a consequence of the introduction of the smoking ban; this work has shown that there was no significant decrease in the number of staff employed or in customer numbers. There was full compliance, with no customers smoking inside the public houses following the introduction of the ban. The ban has been good for the industry, staff, and customers.

The Sand Seas of Titan: Cassini RADAR Observations of Longitudinal Dunes

The most recent Cassini RADAR images of Titan show widespread regions (up to 1500 kilometers by 200 kilometers) of near-parallel radar-dark linear features that appear to be seas of longitudinal dunes similar to those seen in the Namib desert on Earth. The Ku-band (2.17-centimeter wavelength) images show approximately 100-meter ridges consistent with duneforms and reveal flow interactions with underlying hills. The distribution and orientation of the dunes support a model of fluctuating surface winds of approximately 0.5 meter per second resulting from the combination of an eastward flow with a variable tidal wind. The existence of dunes also requires geological processes that create sand-sized (100- to 300-micrometer) particulates and a lack of persistent equatorial surface liquids to act as sand traps.

Psychological symptoms and nonfatal unintentional injuries among Chinese adolescents: a prospective study

PURPOSE

To describe patterns of nonfatal unintentional injuries and investigate the association of psychological symptoms with injury risk among adolescents in Guangxi, China.

METHODS

Adolescents were selected from middle and high school students in Baise City, Guangxi, China. Psychological symptoms at baseline were measured using SCL-90-R and nonfatal unintentional injuries that occurred among participants were recorded using a standardized injury surveillance questionnaire. Annual injury rates per 100 adolescents by adolescents' demographic and family characteristics were calculated. Student's t-test and the Chi-square test were used to test differences in mean raw scores of SCL-90-R subscales and injury rates. Relative risks and odds ratios of injury with 95% confidence intervals were calculated in univariate analyses and multivariate logistic models.

RESULTS

A total of 1474 middle and high school students finished the study. Of them, 442 reported nonfatal unintentional injuries during the study period, resulting in an annual injury rate of 30.3 per 100 adolescents. Boys had a significantly higher injury rate than girls (32.6% vs. 27.4%). Injury rate decreased as the adolescents' age increased. Compared with adolescents who were not injured, the injured adolescents had higher average raw scores of all subscales of SCL-90-R, with an exception of the subscale for hostility. All SCL-90-R subscales factors, except those for hostility and phobia, were associated with injury risk. After confounding effects of age, gender, and ethnicity were controlled using logistic regression models, SCL-90-R subscales for somatization (OR = 2.00, 95% CI 1.52-2.63), obsessive-compulsiveness (OR = 2.10, 95% CI 1.71-2.58), interpersonal-sensitivity (OR = 1.66, 95% CI 1.34-2.06), depression (OR = 2.00, 95% CI 1.59-2.51), anxiety (OR = 2.08, 95% CI 1.62-2.66), and psychoticism (OR = 1.60, 95% CI 1.26-2.03) were significantly associated with an elevated injury risk.

CONCLUSION

Psychological symptoms are associated with an elevated risk of nonfatal unintentional injury among middle and high school students. Mental health services, such as psychological counseling, may help reduce the risk of nonfatal unintentional injuries among Chinese adolescents.

Human brucellosis in the Mid-West 2002-3

Human brucellosis remains a serious public health issue in Ireland. Clinical notifications in the Mid-Western Area (HSE-MWA) underestimate the burden of illness and attendant morbidity in the region. The diagnosis of acute and chronic human brucellosis depends on the clinical evidence and the results from laboratory serological testing or culture on rare occasion. This study examined the clinical evidence behind locally defined serological "positives" in the HSE-MWA from 2002 to 2003. Ninety cases were detected in 2002 and 31 in 2003. While sampling bias is likely to be present, aspects of brucellosis in Ireland were confirmed. Middle-aged males were most commonly affected. The majority of cases were linked to farming or veterinary practice. Symptoms such as sweats, fever and weight loss were commonly associated with acute brucellosis infection while malaise was common in acute and chronic brucellosis. A clear definition of what is notifiable is needed. Surveillance systems must appreciate the importance of both clinical and laboratory evidence to classify confirmed or probable brucellosis as paired sera were not common. Public health authorities must follow-up the clinical aspects for accurate national statistics. General practitioners in the Mid-West appear to be vigilant regarding brucellosis in their patients. Regional zoonoses committees are useful in monitoring disease prevalence in human and animal populations without compromising confidentiality.

Cassini Radar Views the Surface of Titan

The Cassini Titan Radar Mapper imaged about 1% of Titan's surface at a resolution of approximately 0.5 kilometer, and larger areas of the globe in lower resolution modes. The images reveal a complex surface, with areas of low relief and a variety of geologic features suggestive of dome-like volcanic constructs, flows, and sinuous channels. The surface appears to be young, with few impact craters. Scattering and dielectric properties are consistent with porous ice or organics. Dark patches in the radar images show high brightness temperatures and high emissivity and are consistent with frozen hydrocarbons.

The incidence of S. aureus bacteraemia in acute hospitals of the Mid-Western Area, Ireland, 2002-2004

Concerns about healthcare-associated infections and the global crisis in antimicrobial resistance has combined to accentuate the fears around so-called &quot;superbugs&quot;. In Ireland there is no single agreed indicator regarded as a true measure of the level of methicillin resistant Staphylococcus aureus (MRSA) in hospitals. The objective of this study was to compare two crude measures of MRSA - the percentage of bacteraemia caused by MRSA and the incidence rate (per 1000 bed days used) of MRSA bacteraemia in six acute hospitals. We examined all blood cultures positive for S. aureus (methicillin sensitive and resistant) from 2002 to 2004 in the Health Service Executive (HSE) Mid-Western Area of Ireland. Hospital In-Patient Enquiry (HIPE) data was used to determine monthly in-patient bed days used. Of 245 patient episodes of bacteraemia, 119 were MRSA. The trends in the percentage of isolates that were MRSA and the incidence rate calculated were compared. The incidence rate appears to be a more reliable and robust indicator of MRSA in hospitals than the percentage. Despite many difficulties in interpreting indicators of MRSA they should not preclude the regular publication of data at least at regional level in Ireland.

The incidence of S. aureus bacteraemia in acute hospitals of the Mid-Western Area, Ireland, 2002-2004

Concerns about healthcare-associated infections and the global crisis in antimicrobial resistance has combined to accentuate the fears around so-called "superbugs". In Ireland there is no single agreed indicator regarded as a true measure of the level of methicillin resistant Staphylococcus aureus (MRSA) in hospitals. The objective of this study was to compare two crude measures of MRSA--the percentage of bacteraemia caused by MRSA and the incidence rate (per 1000 bed days used) of MRSA bacteraemia in six acute hospitals. We examined all blood cultures positive for S. aureus (methicillin sensitive and resistant) from 2002 to 2004 in the Health Service Executive (HSE) Mid-Western Area of Ireland. Hospital In-Patient Enquiry (HIPE) data was used to determine monthly in-patient bed days used. Of 245 patient episodes of bacteraemia, 119 were MRSA. The trends in the percentage of isolates that were MRSA and the incidence rate calculated were compared. The incidence rate appears to be a more reliable and robust indicator of MRSA in hospitals than the percentage. Despite many difficulties in interpreting indicators of MRSA they should not preclude the regular publication of data at least at regional level in Ireland.

The use of primary/national school absenteeism as a proxy retrospective child health status measure in an environmental pollution investigation

As a result of community concerns over animal and human ill health centred around a rural town in the Republic of Ireland, a series of epidemiological studies were conducted. The absence of adequate health-information systems forced researchers to investigate alternative methods of assessing child health in the 'at-risk' area. This study aimed to examine annual primary/national school attendance data over a 10 year period as a proxy health status measure. Data from six geographical areas were analysed; one of these six areas was designated the 'high-risk' area on the basis of reports of animal ill health. Significantly higher absenteeism rates were noted in the 'high-risk' area in nine of the 10 years examined. Although caution is urged in the interpretation of these results, this study demonstrates that primary/national school absenteeism data can act as a useful, albeit crude, proxy measure of health status.

Dead cattle, lead and child health

This study was carried out as part of a larger interagency investigation in response to concerns about human health following the death of three cattle from lead poisoning in an old lead mining area in Silvermines, Tipperary. Its aim was to screen for lead toxicity in the local child population. Screening consisted of measurement of blood lead concentrations and the completion of questionnaires regarding exposure to lead and general health. Pre-school and primary school children resident in four surrounding district electoral divisions (DEDs) were specifically targeted. One out of 334 (0.3%) children screened had an elevated blood lead concentration. The geometric mean lead concentration was 2.6 microg/dl which is below the intervention lead concentration of 10 microg/dl recommended by the CDC. The mean lead concentration in those aged under three years was statistically significantly higher than in those aged three years and over (3.4 microg/dl vs 2.5 microg/dl; p=0.000581). No specific health problems were identified by the questionnaires. This study concluded that the elevated environmental lead levels which were demonstrated by other agencies involved in this investigation are not currently being transferred to children. It recommends further blood screening of children in the area and ongoing education to minimise the risk of lead toxicity in the area in the future.

Functional limitations of school-aged children seen in primary care

OBJECTIVE

The purpose of the present study was to assess the prevalence of functional limitations in children seen in a large paediatric practice network and to identify sociodemographic, family and psychosocial factors related to functional limitations.

STUDY DESIGN

Cross-sectional analysis.

POPULATION

Children were recruited from two large, practice-based primary care research networks during their paediatric office visits. For the present study, participants included 14 630 school-aged children (ages 6-15 years) and their caregivers.

OUTCOMES MEASURED

Parents completed written questionnaires including the Pediatric Symptom Checklist, the Family Apgar and the Functional Limitations Index.

RESULTS

Findings indicated that 15% of children surveyed had some limitation in their daily functioning. More children had schoolwork and physical function limitations than limitations in personal and self-care. Logistic regression equations predicted functional limitations and health status in children from a model of sociodemographic factors, psychosocial symptoms and family functioning.

CONCLUSIONS

A low but significant number of school-age children seen in the primary care setting experience functional limitations. Children with any psychosocial symptoms were at increased risk for functional limitations, indicating the critical need to screen for functional impairment in children with suspected behavioural or emotional problems. A screening tool of functional limitations may be useful for assessing the presence or absence of such limitations in children's daily function and warrants further investigation.

Monitoring and enforcing cultural competence in Medicaid managed behavioral health care

In recent years cultural competence has expanded beyond language provisions to include understanding and factoring into services provision the cultural perspectives clients may have that are different from the majority culture. The federal government requires state Medicaid programs to offer culturally competent services, but little is known about how states implement such mandates and monitor and enforce them. We reviewed the origins and implications of cultural competence mandates and conducted a brief case study of 5 states to learn about the implementation of cultural competence provisions in behavioral managed care contracts. We found that states and managed behavioral health organizations (MBHOs) vary in their definitions and implementation of standards to ensure mental health care access for vulnerable populations. Although states had a variety of oversight mechanisms, varying contractual requirements ranging from optional to required, vague contract language, no existing standardized indicators or definitions, and scant data on the cultural characteristics of the populations enrolled in Medicaid managed care hamper monitoring and enforcement of cultural competence by states. Implications for MBHOs, states, and the federal government, as well as services researchers, follow.

Physician gender and psychosocial care for children: attitudes, practice characteristics, identification, and treatment

OBJECTIVE

To examine differences by physician gender in the identification and treatment of childhood psychosocial problems.

DESIGN

Survey of patients (n = 19,963) and physicians (n = 366) in primary care offices in 2 large, practice-based research networks. Multivariate regressions were used to control for patient, physician, and visit characteristics, with a correction for the clustered sample.

SUBJECTS

Children ages 4 to 15 years seen consecutively for nonemergent care.

MEASURES

Physician report of attitudes, training, practice factors, and identification and treatment of psychosocial problems. Parental report of demographics and behavioral symptoms.

RESULTS

Compared with male physicians, female physicians were less likely to view care for psychosocial problems as burdensome. They were more likely to see children who were female, younger, black or Hispanic, in single-parent households, enrolled in public or managed health plans, and with physical health limitations. Children seen by male physicians had higher symptom counts. Male physicians were more likely to report having primary care responsibility for their patient and that parents agree with their care plan. Female physicians spent more time with patients. After controlling for these differences, female physicians did not differ from male physicians in identification or treatment of childhood psychosocial problems.

CONCLUSIONS

Male and female physicians see different kinds of children for different visit purposes and have different kinds of relationships with their patients. After controlling for these factors, management of childhood psychosocial problems does not differ by physician gender. Improving management of psychosocial conditions depends on identifying modifiable factors that affect diagnosis and treatment; our work suggests that characteristics of the practice environment, physician-patient relationship, and patient self-selection deserve more research.

A case of haemophagocytic syndrome and Kikuchi-Fujimoto disease occurring concurrently in a 17-year-old female

An unusual case in which a young Asian female presenting with fever, lymphadenopathy and cytopaenia was found to have distinct histological features of both haemophagocytic syndrome (HS) and histiocytic necrotising lymphadenitis (Kikuchi-Fujimoto disease, KFD) is presented. We review the clinical features of each of these rare, but important, diagnoses and propose the hypothesis that they may form part of a disease continuum, rather than representing separate entities.

Prospective study of displaced children's symptoms in wartime Bosnia

BACKGROUND

This study examines the psychological symptoms of Bosnian children exposed to war and trauma, and detects changes in these symptoms over time.

METHOD

A total of 147 displaced children residing in refugee centers in Bosnia completed self-report assessments of anxiety, depressive, and posttraumatic stress symptoms at two time points.

RESULTS

Symptoms of posttraumatic stress, anxiety, and depression showed a greater decrease in boys relative to girls over time.

CONCLUSION

Gender may be an important factor in the natural course of trauma-related symptoms among war traumatized children. Further research is needed to better understand the psychological effects of war trauma on children, and the natural course of posttraumatic symptoms, so as to improve interventions targeted to this vulnerable population.