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Duval D, Evans B, Sanders A, Hill J, Simbo A, Kavoi T, Lyell I, Simmons Z, Qureshi M, Pearce-Smith N, Arevalo CR, Beck CR, Bindra R, Oliver I. Non-pharmaceutical interventions to reduce COVID-19 transmission in the UK: a rapid mapping review and interactive evidence gap map. J Public Health (Oxf) 2024:fdae025. [PMID: 38426578 DOI: 10.1093/pubmed/fdae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/15/2024] [Accepted: 01/23/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Non-pharmaceutical interventions (NPIs) were crucial in the response to the COVID-19 pandemic, although uncertainties about their effectiveness remain. This work aimed to better understand the evidence generated during the pandemic on the effectiveness of NPIs implemented in the UK. METHODS We conducted a rapid mapping review (search date: 1 March 2023) to identify primary studies reporting on the effectiveness of NPIs to reduce COVID-19 transmission. Included studies were displayed in an interactive evidence gap map. RESULTS After removal of duplicates, 11 752 records were screened. Of these, 151 were included, including 100 modelling studies but only 2 randomized controlled trials and 10 longitudinal observational studies.Most studies reported on NPIs to identify and isolate those who are or may become infectious, and on NPIs to reduce the number of contacts. There was an evidence gap for hand and respiratory hygiene, ventilation and cleaning. CONCLUSIONS Our findings show that despite the large number of studies published, there is still a lack of robust evaluations of the NPIs implemented in the UK. There is a need to build evaluation into the design and implementation of public health interventions and policies from the start of any future pandemic or other public health emergency.
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Affiliation(s)
- D Duval
- Research, Evidence and Knowledge Division, UK Health Security Agency (UKHSA), London E14 5EA, UK
| | - B Evans
- Research, Evidence and Knowledge Division, UK Health Security Agency (UKHSA), London E14 5EA, UK
| | - A Sanders
- Research, Evidence and Knowledge Division, UK Health Security Agency (UKHSA), London E14 5EA, UK
| | - J Hill
- Clinical and Public Health Response Division, UKHSA, London E14 5EA, UK
| | - A Simbo
- Evaluation and Epidemiological Science Division, UKHSA, Colindale NW9 5EQ, UK
| | - T Kavoi
- Cheshire and Merseyside Health Protection Team, UKHSA, Liverpool L3 1DS, UK
| | - I Lyell
- Greater Manchester Health Protection Team, UKHSA, Manchester M1 3BN, UK
| | - Z Simmons
- Research, Evidence and Knowledge Division, UK Health Security Agency (UKHSA), London E14 5EA, UK
| | - M Qureshi
- Clinical and Public Health Response Division, UKHSA, London E14 5EA, UK
| | - N Pearce-Smith
- Research, Evidence and Knowledge Division, UK Health Security Agency (UKHSA), London E14 5EA, UK
| | - C R Arevalo
- Research, Evidence and Knowledge Division, UK Health Security Agency (UKHSA), London E14 5EA, UK
| | - C R Beck
- Evaluation and Epidemiological Science Division, UKHSA, Salisbury SP4 0JG, UK
| | - R Bindra
- Clinical and Public Health Response Division, UKHSA, London E14 5EA, UK
| | - I Oliver
- Director General Science and Research and Chief Scientific Officer, UKHSA, London E14 5EA, UK
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Lambert H, Shen X, Chai J, Cheng J, Feng R, Chen M, Cabral C, Oliver I, Shen J, MacGowan A, Bowker K, Hickman M, Kadetz P, Zhao L, Pan Y, Kwiatkowska R, Hu X, Wang D. Prevalence, drivers and surveillance of antibiotic resistance and antibiotic use in rural China: Interdisciplinary study. PLOS Glob Public Health 2023; 3:e0001232. [PMID: 37556412 PMCID: PMC10411760 DOI: 10.1371/journal.pgph.0001232] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 05/22/2023] [Indexed: 08/11/2023]
Abstract
This study aimed to characterise antibiotic prescribing and dispensing patterns in rural health facilities in China and determine the community prevalence of antibiotic resistance. We investigated patterns and drivers of antibiotic use for common respiratory and urinary tract infections (RTI/UTI) in community settings, examined relationships between presenting symptoms, clinical diagnosis and microbiological results in rural outpatient clinics, and assessed potential for using patient records to monitor antibiotic use. This interdisciplinary mixed methods study included: (i) Observations and exit interviews in eight village clinics and township health centres and 15 retail pharmacies; (ii) Urine, throat swab and sputum samples from patients to identify potential pathogens and test susceptibility; (iii) 103 semi-structured interviews with doctors, patients, pharmacy workers and antibiotic-purchasing customers; (iv) Assessment of completeness and accuracy of electronic patient records through comparison with observational data. 87.9% of 1123 recruited clinic patients were prescribed antibiotics (of which 35.5% contained antibiotic combinations and >40% were for intravenous administration), most of whom had RTIs. Antibiotic prescribing for RTIs was not associated with presence of bacterial pathogens but was correlated with longer duration of infection (OR = 3.33) and presence of sore throat (OR = 1.64). Fever strongly predicted prescription of intravenous antibiotics (OR = 2.87). Resistance rates in bacterial pathogens isolated were low compared with national data. 25.8% of patients reported antibiotics use prior to their clinic visit, but only 56.2% of clinic patients and 53% of pharmacy customers could confirm their prescription or purchase included antibiotics. Diagnostic uncertainty, financial incentives, understanding of antibiotics as anti-inflammatory and limited doctor-patient communication were identified as key drivers of antibiotic use. Completion and accuracy of electronic patient records were highly variable. Prevalence of antibiotic resistance in this rural population is relatively low despite high levels of antibiotic prescribing and self-medication. More systematic use of e-records and in-service training could improve antibiotic surveillance and stewardship in rural facilities. Combining qualitative and observational anthropological methods and concepts with microbiological and epidemiological investigation of antibiotic resistance at both research design and analytic synthesis stages substantially increases the validity of research findings and their utility in informing future intervention development.
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Affiliation(s)
- H. Lambert
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - X. Shen
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - J. Chai
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - J. Cheng
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - R. Feng
- Library Department of Literature Retrieval and Analysis, Anhui Medical University, Hefei, China
| | - M. Chen
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - C. Cabral
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - I. Oliver
- Field Service, National Infection Service, UK Health Security Agency, Bristol, United Kingdom
| | - J. Shen
- Fourth Affiliated Hospital of Anhui Medical University, Hefei, China
| | - A. MacGowan
- Severn Pathology, North Bristol NHS Trust, Bristol, United Kingdom
| | - K. Bowker
- Severn Pathology, North Bristol NHS Trust, Bristol, United Kingdom
| | - M. Hickman
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - P. Kadetz
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, United Kingdom
| | - L. Zhao
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - Y. Pan
- First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - R. Kwiatkowska
- Field Service, National Infection Service, UK Health Security Agency, Bristol, United Kingdom
| | - X. Hu
- Anhui Provincial Hospital, Hefei, China
| | - D. Wang
- School of Health Services Management, Anhui Medical University, Hefei, China
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Pringle JK, Jeffery AJ, Ruffell A, Stimpson IG, Pirrie D, Bergslien E, Madden C, Oliver I, Wisniewski KD, Cassella JP, Lamont N, Gormley S, Partridge J. The use of portable XRF as a forensic geoscience non-destructive trace evidence tool for environmental and criminal investigations. Forensic Sci Int 2022; 332:111175. [PMID: 35026699 DOI: 10.1016/j.forsciint.2022.111175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/16/2021] [Accepted: 01/01/2022] [Indexed: 01/09/2023]
Abstract
Hand-held, portable X-Ray fluorescence instruments (pXRF) provide a means of rapid, in-situ chemical characterisation that has considerable application as a rapid trace evidence characterisation tool in forensic geoscience. This study presents both a control test study which demonstrates optimisation of the data collection process, alongside a range of individual forensic case studies, including heavy metal contamination, conflict archaeology, forensic soil characterisation, and verification of human remains, which together validate the technique and provide some comparison between field-based and laboratory-based pXRF applications. Results highlight the time-efficiency and cost-effectiveness of in-situ, field-based pXRF analyses for material characterisation when compared with other trace evidence methods. Analytical precision of various analytes during in-situ analysis was sufficient to demonstrate considerable application of field-based pXRF as a tool for rapid identification of specific areas of interest to be further investigated. Laboratory-based pXRF analyses yielded greater accuracy which could provide an efficient compromise between field-based pXRF and traditional laboratory-based analytical techniques (e.g. WD-XRF, ICP-MS). Further studies should collect more advanced datasets in more diverse locations to further validate the techniques capability to rapidly conduct geochemical surveys in a range of environments.
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Affiliation(s)
- J K Pringle
- School of Geography, Geology & Environment, Keele University, Keele, Staffordshire ST5 5BG, UK.
| | - A J Jeffery
- School of Geography, Geology & Environment, Keele University, Keele, Staffordshire ST5 5BG, UK.
| | - A Ruffell
- School of the Natural Built Environment, Queens University, Belfast, Northern Ireland BT7 1NN, UK.
| | - I G Stimpson
- School of Geography, Geology & Environment, Keele University, Keele, Staffordshire ST5 5BG, UK.
| | - D Pirrie
- School of Applied Science, University of South Wales, Pontypridd, Rhondda Cynon Taff CF37 4AT, UK.
| | - E Bergslien
- Earth Sciences and Science Education, 165 Science Building, 1300 Elmwood Ave., Buffalo, NY 14222, USA.
| | - C Madden
- School of Geography, Geology & Environment, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - I Oliver
- School of Geography, Geology & Environment, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - K D Wisniewski
- School of Chemical & Physical Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - J P Cassella
- Department of Criminal Justice and Forensics, School of Law, Policing & Forensics, Science Centre, Staffordshire University, Leek Road, Stoke on-Trent, Staffordshire ST4 2DF, UK; Department of Life Sciences, School of Science, Institute of Technology Sligo, Ash Lane, Ballinode, Sligo F91 YW50, Ireland.
| | - N Lamont
- Department of Criminal Justice and Forensics, School of Law, Policing & Forensics, Science Centre, Staffordshire University, Leek Road, Stoke on-Trent, Staffordshire ST4 2DF, UK.
| | - S Gormley
- School of the Natural Built Environment, Queens University, Belfast, Northern Ireland BT7 1NN, UK.
| | - J Partridge
- Department of Criminal Justice and Forensics, School of Law, Policing & Forensics, Science Centre, Staffordshire University, Leek Road, Stoke on-Trent, Staffordshire ST4 2DF, UK.
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Villodre C, Taccogna L, Zapater P, Cantó M, Mena L, Ramia JM, Lluís F, Afonso N, Aguilella V, Aguiló J, Alados JC, Alberich M, Apio AB, Balongo R, Bra E, Bravo-Gutiérrez A, Briceño FJ, Cabañas J, Cánovas G, Caravaca I, Carbonell S, Carrera-Dacosta E, Castro EE, Caula C, Choolani-Bhojwani E, Codina A, Corral S, Cuenca C, Curbelo-Peña Y, Delgado-Morales MM, Delgado-Plasencia L, Doménech E, Estévez AM, Feria AM, Gascón-Domínguez MA, Gianchandani R, González C, Hevia RJ, González MA, Hidalgo JM, Lainez M, Lluís N, López F, López-Fernández J, López-Ruíz JA, Lora-Cumplido P, Madrazo Z, Marchena J, de la Cuadra MB, Martín S, Casas MI, Martínez P, Mena-Mateos A, Morales-García D, Mulas C, Muñoz-Forner E, Naranjo A, Navarro-Sánchez A, Oliver I, Ortega I, Ortega-Higueruelo R, Ortega-Ruiz S, Osorio J, Padín MH, Pamies JJ, Paredes M, Pareja-Ciuró F, Parra J, Pérez-Guarinós CV, Pérez-Saborido B, Pintor-Tortolero J, Plua-Muñiz K, Rey M, Rodríguez I, Ruiz C, Ruíz R, Ruiz S, Sánchez A, Sánchez D, Sánchez R, Sánchez-Cabezudo F, Sánchez-Santos R, Santos J, Serrano-Paz MP, Soria-Aledo V, Tallón-Aguilar L, Valdivia-Risco JH, Vallverdú-Cartié H, Varela C, Villar-Del-Moral J, Zambudio N. Simplified risk-prediction for benchmarking and quality improvement in emergency general surgery. Prospective, multicenter, observational cohort study. Int J Surg 2022; 97:106168. [PMID: 34785344 DOI: 10.1016/j.ijsu.2021.106168] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/24/2021] [Accepted: 11/03/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Emergency General Surgery (EGS) conditions account for millions of deaths worldwide, yet it is practiced without benchmarking-based quality improvement programs. The aim of this observational, prospective, multicenter, nationwide study was to determine the best benchmark cutoff points in EGS, as a reference to guide improvement measures. METHODS Over a 6-month period, 38 centers (5% of all public hospitals) attending EGS patients on a 24-h, 7-days a week basis, enrolled consecutive patients requiring an emergent/urgent surgical procedure. Patients were stratified into cohorts of low (i.e., expected morbidity risk <33%), middle and high risk using the novel m-LUCENTUM calculator. RESULTS A total of 7258 patients were included; age (mean ± SD) was 51.1 ± 21.5 years, 43.2% were female. Benchmark cutoffs in the low-risk cohort (5639 patients, 77.7% of total) were: use of laparoscopy ≥40.9%, length of hospital stays ≤3 days, any complication within 30 days ≤ 17.7%, and 30-day mortality ≤1.1%. The variables with the greatest impact were septicemia on length of hospital stay (21 days; adjusted beta coefficient 16.8; 95% CI: 15.3 to 18.3; P < .001), and respiratory failure on mortality (risk-adjusted population attributable fraction 44.6%, 95% CI 29.6 to 59.6, P < .001). Use of laparoscopy (odds ratio 0.764, 95% CI 0.678 to 0.861; P < .001), and intraoperative blood loss (101-500 mL: odds ratio 2.699, 95% CI 2.152 to 3.380; P < .001; and 500-1000 mL: odds ratio 2.875, 95% CI 1.403 to 5.858; P = .013) were associated with increased morbidity. CONCLUSIONS This study offers, for the first time, clinically-based benchmark values in EGS and identifies measures for improvement.
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Affiliation(s)
- C Villodre
- Hospital Gran Canaria Doctor Negrín, Las Palmas de Gran Canarias, Spain Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain Hospital Lluís Alcanyís de Xàtiva, Valencia, Spain Hospital Universitario de Badajoz, Badajoz, Spain Hospital Universitario de Bellvitge, Barcelona, Spain Hospital Marina Baixa, Alicante, Spain Hospital Juan Ramón Jiménez, Infanta Elena, Huelva, Spain Hospital Infanta Cristina, Parla, Madrid, Spain Hospital Universitario de Canarias, Tenerife, Spain Hospital Reina Sofía de Córdoba, Córdoba, Spain H. Ramón y Cajal, Madrid, Spain Hospital Parc Taulí de Sabadell, Barcelona, Spain Hospital General Universitario de Alicante, Alicante, Spain Complejo Hospitalario Universitario de Vigo, Hospital Pontevedra, Spain Hospital Trueta de Girona, Girona, Spain Hospital Universitario Rio Hortega, Valladolid, Spain Hospital Mutua Terrassa, Barcelona, Spain Consorci Hospitalari de Vic, Barcelona, Spain POVISA, Pontevedra, Spain Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain Hospital Universitario Basurto, Bizkaia, Spain Hospital Universitario Marqués de Valdecilla, Santander, Spain Hospital de Viladecans, Barcelona, Spain Hospital Clínico de Valencia, Valencia, Spain Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain Hospital Vírgen de la Macarena, Sevilla, Spain Hospital Cabueñes, Gijón, Spain Complejo Hospitalario de Jaén, Jaén, Spain Hospital Universitari Sant Joan de Reus, Tarragona, Spain Hospital Universitario Infanta Sofía, Madrid, Spain Complejo Hospitalario Torrecárdenas, Almería, Spain Hospital Sant Pau i Santa Tecla, Tarragona, Spain Hospital General Rafael Méndez de Lorca, Murcia, Spain Hospital Vírgen del Rocío, Sevilla, Spain Hospital Morales Meseguer, Murcia, Spain Hospital del Vinalopó, Alicante, Spain Hospital Universitario del Vinalopó, Alicante, Spain Hospital Universitario Virgen de las Nieves, Granada, Spain Department of Surgery, General University Hospital of Alicante, Alicante, Spain Department of Clinical Pharmacology, General University Hospital of Alicante, Alicante, Spain Computing, BomhardIP, Alicante, Spain Department of Clinical Documentation, General University Hospital of Alicante, Alicante, Spain Institute of Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
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Zhang T, Robin C, Cai S, Sawyer C, Rice W, Smith LE, Amlôt R, Rubin GJ, Reynolds R, Yardley L, Hickman M, Oliver I, Lambert H. Public health information on COVID-19 for international travellers: lessons learned from a mixed-method evaluation. Public Health 2021; 193:116-123. [PMID: 33780897 PMCID: PMC7874910 DOI: 10.1016/j.puhe.2021.01.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES In the containment phase of the response to the COVID-19 outbreak, Public Health England (PHE) delivered advice to travellers arriving at major UK ports. We aimed to rapidly evaluate the impact and effectiveness of these communication materials for passengers in the early stages of the pandemic. STUDY DESIGN The study design used is the mixed-methods evaluation. METHODS A questionnaire survey and follow-up interviews with passengers arriving at London Heathrow Airport on scheduled flights from China and Singapore. The survey assessed passengers' knowledge of symptoms, actions to take, and attitudes towards PHE COVID-19 public health information; interviews explored their views of official public health information and self-isolation. RESULTS One hundred and twenty-one passengers participated in the survey and 15 in follow-up interviews. Eighty three percentage of surveyed passengers correctly identified all three COVID-19 associated symptoms listed in PHE information at that time. Most could identify the recommended actions and found the advice understandable and trustworthy. Interviews revealed that passengers shared concerns about the lack of wider official action, and that passengers' knowledge had been acquired elsewhere as much from PHE. Respondents also noted their own agency in choosing to self-isolate, partially as a self-protective measure. CONCLUSION PHE COVID-19 public health information was perceived as clear and acceptable, but we found that passengers acquired knowledge from various sources and they saw the provision of information alone on arrival as an insufficient official response. Our study provides fresh insights into the importance of taking greater account of diverse information sources and of the need for public assurance in creating public health information materials to address global health threats.
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Affiliation(s)
- T Zhang
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - C Robin
- Field Epidemiology, Field Service, National Infection Service, Public Health England, Bristol, UK; NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK; NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - S Cai
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - C Sawyer
- UK Field Epidemiology Training Programme, Global Public Health Division, Public Health England, London, UK; Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, UK
| | - W Rice
- Field Epidemiology, Field Service, National Infection Service, Public Health England, Bristol, UK
| | - L E Smith
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, UK
| | - R Amlôt
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, UK; Behavioural Science Team, Emergency Response Department Science and Technology, Public Health England, UK
| | - G J Rubin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, UK
| | - R Reynolds
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Bristol Medical School, University of Bristol, Bristol, UK
| | - L Yardley
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Bristol Medical School, University of Bristol, Bristol, UK; School of Psychological Sciences, University of Bristol, Bristol, UK; Department of Psychology, University of Southampton, Southampton, UK
| | - M Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Bristol Medical School, University of Bristol, Bristol, UK
| | - I Oliver
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Field Epidemiology, Field Service, National Infection Service, Public Health England, Bristol, UK; NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Bristol Medical School, University of Bristol, Bristol, UK
| | - H Lambert
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Bristol Medical School, University of Bristol, Bristol, UK.
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6
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Marchant E, Ready D, Wimbury G, Smithson R, Charlett A, Oliver I. Determining the acceptability of testing contacts of confirmed COVID-19 cases to improve secondary case ascertainment. J Public Health (Oxf) 2021; 43:e446-e452. [PMID: 33782705 PMCID: PMC8083708 DOI: 10.1093/pubmed/fdab079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 02/22/2021] [Accepted: 02/27/2021] [Indexed: 12/02/2022] Open
Abstract
Background UK asymptomatic contacts of confirmed COVID-19 cases are not routinely tested for SARS-CoV-2. Testing contacts may improve case ascertainment and reduce onward transmission. This study investigated the acceptability of SARS-CoV-2 testing among contacts of confirmed cases as an integral part of the contact-tracing process. Methods A cross-sectional descriptive survey of case contacts was conducted in the UK. All contacts who completed a telephone call with the NHS Test and Trace Agile Lighthouse team were eligible for inclusion and were offered a molecular test. Consenting participants were sent a self-swab kit. Results Of the 1523 individuals contacted, 602 (39.5%) accepted the test offer. Of the 240 (39.9%) samples returned for testing, 16.3% tested polymerase chain reaction-positive for SARS-CoV-2. Most individuals who declined with a reason (638/905; 70.5%) reported they had already taken or booked a SARS-CoV-2 test, or were part of a testing programme. Matched laboratory records confirmed 73.1% of those who declined were tested by another route. Conclusions Most case contacts were tested, either through arranging a test by themselves or by accepting the study offer. Results demonstrate high acceptability, with substantial test positivity, indicating that there is public health benefit in offering tests to contacts as a routine part of the contact-tracing process.
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Affiliation(s)
- E Marchant
- UK Field Epidemiology Training Programme, Global Public Health Division, Public Health England, London NW9 5EQ, UK
| | - D Ready
- Field Services, South West England, Public Health England, Bristol BS1 6EH, UK.,NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, BS8 1QU, UK
| | - G Wimbury
- NHS Test & Trace Programme, Department of Health and Social Care, London SW1H 0TL, UK
| | - R Smithson
- NHS Test & Trace Programme, Department of Health and Social Care, London SW1H 0TL, UK
| | - A Charlett
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, BS8 1QU, UK.,Statistics, Modelling, and Economics, National Infection Service, Public Health England, London, NW9 5EQ, UK
| | - I Oliver
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, BS8 1QU, UK.,National Infection Service, Public Health England, London SE1 8UG, UK
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7
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Smith LE, Amlȏt R, Lambert H, Oliver I, Robin C, Yardley L, Rubin GJ. Factors associated with adherence to self-isolation and lockdown measures in the UK: a cross-sectional survey. Public Health 2020; 187:41-52. [PMID: 32898760 PMCID: PMC7474581 DOI: 10.1016/j.puhe.2020.07.024] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To investigate factors associated with adherence to self-isolation and lockdown measures due to COVID-19 in the UK. STUDY DESIGN Online cross-sectional survey. METHODS Data were collected between 6th and 7th May 2020. A total of 2240 participants living in the UK aged 18 years or older were recruited from YouGov's online research panel. RESULTS A total of 217 people (9.7%) reported that they or someone in their household had symptoms of COVID-19 (cough or high temperature/fever) in the last 7 days. Of these people, 75.1% had left the home in the last 24 h (defined as non-adherent). Men were more likely to be non-adherent, as were people who were less worried about COVID-19, and who perceived a smaller risk of catching COVID-19. Adherence was associated with having received help from someone outside your household. Results should be taken with caution as there was no evidence for associations when controlling for multiple analyses. Of people reporting no symptoms in the household, 24.5% had gone out shopping for non-essentials in the last week (defined as non-adherent). Factors associated with non-adherence and with a higher total number of outings in the last week included decreased perceived effectiveness of government 'lockdown' measures, decreased perceived severity of COVID-19 and decreased estimates of how many other people were following lockdown rules. Having received help was associated with better adherence. CONCLUSIONS Adherence to self-isolation is poor. As we move into a new phase of contact tracing and self-isolation, it is essential that adherence is improved. Communications should aim to increase knowledge about actions to take when symptomatic or if you have been in contact with a possible COVID-19 case. They should also emphasise the risk of catching and spreading COVID-19 when out and about and the effectiveness of preventative measures. Using volunteer networks effectively to support people in isolation may promote adherence.
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Affiliation(s)
- L E Smith
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK.
| | - R Amlȏt
- Public Health England, Behavioural Science Team, Emergency Response Department Science and Technology, UK
| | - H Lambert
- University of Bristol, Department of Population Health Sciences, Bristol Medical School, UK
| | - I Oliver
- Public Health England, Field Epidemiology, Field Service, National Infection Service, Bristol, UK
| | - C Robin
- Public Health England, Field Epidemiology, Field Service, National Infection Service, Liverpool, UK
| | - L Yardley
- University of Bristol, School of Psychological Sciences, UK
| | - G J Rubin
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
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Jermacane D, Coope CM, Ironmonger D, Cleary P, Muller-Pebody B, Hope R, Hopkins S, Puleston R, Freeman R, Hopkins KL, Johnson AP, Woodford N, Oliver I. An evaluation of the electronic reporting system for the enhanced surveillance of carbapenemase-producing Gram-negative bacteria in England. J Hosp Infect 2019; 102:17-24. [PMID: 30641097 DOI: 10.1016/j.jhin.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/03/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND An electronic reporting system (ERS) for the enhanced surveillance of carbapenemase-producing Gram-negative bacteria (CPGNB) was launched by Public Health England in May 2015. AIM This evaluation aimed to assess uptake, timeliness and completeness of data provided and explore potential barriers and facilitators to adopting the system. METHODS The evaluation comprised a retrospective analysis of surveillance data and semi-structured interviews with ERS users. FINDINGS The proportion of organisms referred for investigation of carbapenem resistance via ERS increased over the first 12 months post-implementation from 35% to 73%; uptake varied widely across regions of England. Completeness of enhanced data fields was poor in 78% of submitted isolates. The median number of days to report confirmatory test results via ERS was 1 day for the regional service and nine days for the national reference laboratory, which additionally conducts phenotypic testing to confirm carbapenemase negativity. Hindrances to ERS utility included: a lack of designated, ongoing resource for system maintenance, technical support and development; uncertainty about how and when to use ERS and workload. Incomplete data prevented gaining a better understanding of important risk factors and transmission routes of CPGNB in England. CONCLUSION The ERS is the only surveillance system in England with the potential to gather intelligence on important risk factors for CPGNB to inform public health measures to control their spread. Although the ERS captures more information on CPGNB than other surveillance systems, timeliness and completeness of the enhanced data require substantial improvements in order to deliver the desired health benefits.
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Affiliation(s)
- D Jermacane
- Field Service, National Infection Service, Public Health England, UK
| | - C M Coope
- Field Service, National Infection Service, Public Health England, UK; NIHR Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, UK.
| | - D Ironmonger
- Field Service, National Infection Service, Public Health England, UK
| | - P Cleary
- Field Service, National Infection Service, Public Health England, UK
| | - B Muller-Pebody
- Division of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - R Hope
- Division of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - S Hopkins
- Division of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - R Puleston
- Field Service, National Infection Service, Public Health England, UK
| | - R Freeman
- Division of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - K L Hopkins
- Division of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - A P Johnson
- Division of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - N Woodford
- National Infection Service Laboratories, Public Health England, London, UK
| | - I Oliver
- Field Service, National Infection Service, Public Health England, UK; NIHR Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, UK
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9
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Coope CM, Verlander NQ, Schneider A, Hopkins S, Welfare W, Johnson AP, Patel B, Oliver I. An evaluation of a toolkit for the early detection, management, and control of carbapenemase-producing Enterobacteriaceae: a survey of acute hospital trusts in England. J Hosp Infect 2018. [PMID: 29530741 DOI: 10.1016/j.jhin.2018.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Following hospital outbreaks of carbapenemase-producing Enterobacteriaceae (CPE), Public Health England published a toolkit in December 2013 to promote the early detection, management, and control of CPE colonization and infection in acute hospital settings. AIM To examine awareness, uptake, implementation and usefulness of the CPE toolkit and identify potential barriers and facilitators to its adoption in order to inform future guidance. METHODS A cross-sectional survey of National Health Service (NHS) acute trusts was conducted in May 2016. Descriptive analysis and multivariable regression models were conducted, and narrative responses were analysed thematically and informed using behaviour change theory. FINDINGS Most (92%) acute trusts had a written CPE plan. Fewer (75%) reported consistent compliance with screening and isolation of CPE risk patients. Lower prioritization and weaker senior management support for CPE prevention were associated with poorer compliance. Awareness of the CPE toolkit was high and all trusts with patients infected or colonized with CPE had used the toolkit either as provided (32%), or to inform (65%) their own local CPE plan. Despite this, many respondents (80%) did not believe that the CPE toolkit guidance offered an effective means to prevent CPE or was practical to follow. CONCLUSION CPE prevention and control requires robust IPC measures. Successful implementation can be hindered by a complex set of factors related to their practical execution, insufficient resources and a lack of confidence in the effectiveness of the guidance. Future CPE guidance would benefit from substantive user involvement, processes for ongoing feedback, and regular guidance updates.
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Affiliation(s)
- C M Coope
- NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK; Public Health England, UK; University of Bristol, Bristol, UK.
| | | | - A Schneider
- NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK; University College London, London, UK
| | | | | | | | | | - I Oliver
- NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK; Public Health England, UK; University of Bristol, Bristol, UK
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10
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French CE, Coope C, Conway L, Higgins JPT, McCulloch J, Okoli G, Patel BC, Oliver I. Control of carbapenemase-producing Enterobacteriaceae outbreaks in acute settings: an evidence review. J Hosp Infect 2016; 95:3-45. [PMID: 27890334 DOI: 10.1016/j.jhin.2016.10.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/08/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND In recent years, infections with carbapenemase-producing Enterobacteriaceae (CPE) have been increasing globally and present a major public health challenge. AIM To review the international literature: (i) to describe CPE outbreaks in acute hospital settings globally; and (ii) to identify the control measures used during these outbreaks and report on their effectiveness. METHODS A systematic search of MEDLINE and EMBASE databases, abstract lists for key conferences and reference lists of key reviews was undertaken, and information on unpublished outbreaks was sought for 2000-2015. Where relevant, risk of bias was assessed using the Newcastle-Ottawa scale. A narrative synthesis of the evidence was conducted. FINDINGS Ninety-eight outbreaks were eligible. These occurred worldwide, with 53 reports from Europe. The number of cases (CPE infection or colonization) involved in outbreaks varied widely, from two to 803. In the vast majority of outbreaks, multi-component infection control measures were used, commonly including: patient screening; contact precautions (e.g. gowns, gloves); handwashing interventions; staff education or monitoring; enhanced environmental cleaning/decontamination; cohorting of patients and/or staff; and patient isolation. Seven studies were identified as providing the best-available evidence on the effectiveness of control measures. These demonstrated that CPE outbreaks can be controlled successfully using a range of appropriate, commonly used, infection control measures. However, risk of bias was considered relatively high for these studies. CONCLUSION The findings indicate that CPE outbreaks can be controlled using combinations of existing measures. However, the quality of the evidence base is weak and further high-quality research is needed, particularly on the effectiveness of individual infection control measures.
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Affiliation(s)
- C E French
- University of Bristol, Bristol, UK; NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK
| | - C Coope
- NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK; Public Health England, Bristol, UK.
| | - L Conway
- NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK; Public Health England, Bristol, UK
| | - J P T Higgins
- University of Bristol, Bristol, UK; NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK
| | | | - G Okoli
- University of Bristol, Bristol, UK
| | | | - I Oliver
- NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK; Public Health England, Bristol, UK
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11
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Freeman R, Ironmonger D, Puleston R, Hopkins K, Welfare W, Hope R, Staves P, Shemko M, Hopkins S, Cleary P, Patel B, Muller-Pebody B, Li X, Alvarez-Buylla A, Hawkey P, Johnson A, Woodford N, Oliver I. Enhanced surveillance of carbapenemase-producing Gram-negative bacteria to support national and international prevention and control efforts. Clin Microbiol Infect 2016; 22:896-897. [DOI: 10.1016/j.cmi.2016.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/15/2016] [Accepted: 07/16/2016] [Indexed: 11/29/2022]
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12
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Gilbart VL, Simms I, Jenkins C, Furegato M, Gobin M, Oliver I, Hart G, Gill ON, Hughes G. Sex, drugs and smart phone applications: findings from semistructured interviews with men who have sex with men diagnosed withShigella flexneri3a in England and Wales: Table 1. Sex Transm Infect 2015; 91:598-602. [DOI: 10.1136/sextrans-2015-052014] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 04/11/2015] [Indexed: 11/03/2022] Open
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13
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van de Venter EC, Oliver I, Stuart JM. Timeliness of epidemiological outbreak investigations in peer-reviewed European publications, January 2003 to August 2013. Euro Surveill 2015; 20. [DOI: 10.2807/1560-7917.es2015.20.6.21035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- E C van de Venter
- Public Health England, Bristol, United Kingdom
- South West Public Health Training Programme, Health Education South West, Bristol, United Kingdom
| | - I Oliver
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- Field Epidemiology Service, Public Health England, Bristol, United Kingdom
| | - J M Stuart
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
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14
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Lamagni TL, Oliver I, Stuart JM. Global Assessment of Invasive Group A Streptococcus Infection Risk in Household Contacts. Clin Infect Dis 2014; 60:166-7. [DOI: 10.1093/cid/ciu752] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Oilleau-Barral L, Giraudon A, Barat P, Oliver I, Coutant R. SFP PC-02 - Complications post-thyroïdectomie préventive chez les enfants porteurs de NEM2. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)72152-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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16
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Close R, Gray S, Bennett S, Appleby S, Khan F, Payne C, Oliver I. What are the costs and benefits of patient notification exercises following poor infection control practices in dentistry? Public Health 2013; 127:1021-7. [DOI: 10.1016/j.puhe.2013.04.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 02/13/2013] [Accepted: 04/24/2013] [Indexed: 11/16/2022]
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17
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Gilbart VL, Simms I, Gobin M, Jenkins C, Oliver I, Hughes G. P3.149 High-Risk Drug Practises Associated withShigella FlexneriSerotype 3A Infections Amongst Men Who Have Sex with Men (MSM) in England. Sex Transm Infect 2013. [DOI: 10.1136/sextrans-2013-051184.0608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Borg ML, Modi A, Tostmann A, Gobin M, Cartwright J, Quigley C, Crook PD, Boxall N, Paul J, Cheasty T, Gill N, Hughes G, Simms I, Oliver I. Ongoing outbreak of Shigella flexneri serotype 3a in men who have sex with men in England and Wales, data from 2009–2011. Euro Surveill 2012. [DOI: 10.2807/ese.17.13.20137-en] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Diagnoses of Shigella flexneri in the United Kingdom (UK) are usually travel-related. However, since 2009, there has been an overall increase in UK-acquired cases. The Health Protection Agency has been investigating a national outbreak of S. flexneri detected in 2011 and which is still ongoing. Cases occurred mostly in men who have sex with men and were of serotype 3a. The investigation aimed at obtaining epidemiological data to inform targeted outbreak management and control.
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Affiliation(s)
- M L Borg
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- Health Protection Agency, South West Region, United Kingdom
| | - A Modi
- Health Protection Agency, North West Region, United Kingdom
| | - A Tostmann
- Health Protection Agency, South West Region, United Kingdom
| | - M Gobin
- Health Protection Agency, South West Region, United Kingdom
| | - J Cartwright
- Health Protection Agency, North West Region, United Kingdom
| | - C Quigley
- Health Protection Agency, North West Region, United Kingdom
| | - P D Crook
- Health Protection Agency, South East Region, United Kingdom
| | - N Boxall
- Health Protection Agency, South East Region, United Kingdom
| | - J Paul
- Health Protection Agency, South East Region, United Kingdom
| | - T Cheasty
- Gastro-Intestinal Infections Reference Unit, Health Protection Agency - Colindale, London, United Kingdom
| | - N Gill
- HIV & STI Department, Health Protection Agency - Colindale, London, United Kingdom
| | - G Hughes
- HIV & STI Department, Health Protection Agency - Colindale, London, United Kingdom
| | - I Simms
- HIV & STI Department, Health Protection Agency - Colindale, London, United Kingdom
| | - I Oliver
- University of Bristol, Bristol, United Kingdom
- Health Protection Agency, South West Region, United Kingdom
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19
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Borg ML, Modi A, Tostmann A, Gobin M, Cartwright J, Quigley C, Crook P, Boxall N, Paul J, Cheasty T, Gill N, Hughes G, Simms I, Oliver I. Ongoing outbreak of Shigella flexneri serotype 3a in men who have sex with men in England and Wales, data from 2009-2011. Euro Surveill 2012; 17:20137. [PMID: 22490381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Diagnoses of Shigella flexneri in the United Kingdom (UK) are usually travel-related. However, since 2009, there has been an overall increase in UK-acquired cases. The Health Protection Agency has been investigating a national outbreak of S. flexneri detected in 2011 and which is still ongoing. Cases occurred mostly in men who have sex with men and were of serotype 3a. The investigation aimed at obtaining epidemiological data to inform targeted outbreak management and control.
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Affiliation(s)
- M L Borg
- Health Protection Agency, South West Region, United Kingdom.
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20
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Horner P, Loaring J, Matthew H, Oliver I, Campbell R, Trotter C, Macleod J, Pye K. P1-S6.27 Could a peer driven intervention increase uptake of chlamydia screening? Proof of principle. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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21
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Wallensten A, Moore P, Webster H, Johnson C, van der Burgt G, Pritchard G, Ellis-Iversen J, Oliver I. Q fever outbreak in Cheltenham, United Kingdom, in 2007 and the use of dispersion modelling to investigate the possibility of airborne spread. Euro Surveill 2010; 15:19521. [PMID: 20350497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
We describe the investigation of an outbreak of Q fever in the town of Cheltenham, England. The outbreak was detected in June 2007, and prospective and retrospective case finding identified 30 confirmed or probable human cases. The investigation identified windborne spread of Coxiella burnetii from nearby sheep farms as the most likely source of infection. A telephone survey was conducted to identify risk practices at local farms. Subsequently the atmospheric dispersion model NAME was used to identify whether air from the identified farms with high risk practices had been carried into Cheltenham town centre during the risk period. Three high risk farms were identified and the modelling showed that air from all of these farms was carried over Cheltenham in the estimated risk period. The investigation resulted in an information campaign to farmers and production of improved advice for livestock farmers on reducing the risks of transmitting Q fever to humans.
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Affiliation(s)
- A Wallensten
- Health Protection Agency South West, Stonehouse, United Kingdom
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22
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Wallensten A, Moore P, Webster H, Johnson C, van der Burgt G, Pritchard G, Ellis-Iversen J, Oliver I. Q fever outbreak in Cheltenham, United Kingdom, in 2007 and the use of dispersion modelling to investigate the possibility of airborne spread. Euro Surveill 2010. [DOI: 10.2807/ese.15.12.19521-en] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We describe the investigation of an outbreak of Q fever in the town of Cheltenham, England. The outbreak was detected in June 2007, and prospective and retrospective case finding identified 30 confirmed or probable human cases. The investigation identified windborne spread of Coxiella burnetii from nearby sheep farms as the most likely source of infection. A telephone survey was conducted to identify risk practices at local farms. Subsequently the atmospheric dispersion model NAME was used to identify whether air from the identified farms with high risk practices had been carried into Cheltenham town centre during the risk period. Three high risk farms were identified and the modelling showed that air from all of these farms was carried over Cheltenham in the estimated risk period. The investigation resulted in an information campaign to farmers and production of improved advice for livestock farmers on reducing the risks of transmitting Q fever to humans.
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Affiliation(s)
- A Wallensten
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden
- Health Protection Agency South West, Stonehouse, United Kingdom
| | - P Moore
- Gloucestershire Hospitals NHS Foundation Trust, United Kingdom
| | | | - C Johnson
- Health Protection Agency South West, Stonehouse, United Kingdom
| | | | - G Pritchard
- Veterinary Laboratories Agency, Bury St Edmunds, United Kingdom
| | - J Ellis-Iversen
- Centre for Epidemiology and Risk Analysis, Veterinary Laboratories Agency, Weybridge, United Kingdom
| | - I Oliver
- Bristol University, Department of Social Medicine, Bristol, United Kingdom
- Health Protection Agency South West, Stonehouse, United Kingdom
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Wallensten A, Oliver I, Lewis D, Harrison S. Compliance and side effects of prophylactic oseltamivir treatment in a school in South West England. ACTA ACUST UNITED AC 2009; 14:19285. [PMID: 19643061 DOI: 10.2807/ese.14.30.19285-en] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
School closure along with mass prophylactic oseltamivir treatment of pupils have been used in England and elsewhere to contain school outbreaks of influenza A(H1N1)v. We evaluated the protective effect, compliance with and side effects of oseltamivir chemoprophylactic treatment with a ten-day course of 1x 75mg given to 11-12-year-old pupils in one school year in a secondary school in South West England closed for ten days in response to a symptomatic laboratory-confirmed pupil. We distributed a questionnaire to pupils in the affected school year in class after the school had re-opened. Questions included symptoms of flu-like illness, compliance with chemoprophylaxis and side effects. All present on the day, 248 (93.2%) participated. Compliance with chemoprophylaxis was high, 77% took the full course, 91% took at least seven days. Fifty-one percent experienced symptoms such as feeling sick (31.2%), headaches (24.3%) and stomach ache (21.1%). Although some children were ill with flu-like symptoms, those tested did not have A(H1N1)v infection. Compliance with oseltamivir chemoprophylaxis was high, although likely side effects were common. The burden of side effects needs to be considered when deciding on mass oseltamivir chemoprophylaxis in children especially given that the symptoms of A(H1N1)v influenza are generally mild.
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Affiliation(s)
- A Wallensten
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
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25
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Edouard T, Stafford D, Oliver I, Jesuran M, Bertozzi A, Cances C, Boetto S, Guilbeau-Frugier C, Delisle B, Tauber M. Isolated Lymphocytic Infiltration of Pituitary Stalk Preceding the Diagnosis of Germinoma in 2 Prepubertal Children Treated with Growth Hormone. Horm Res 2009; 72:57-62. [DOI: 10.1159/000224342] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Accepted: 09/01/2008] [Indexed: 11/19/2022]
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26
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Hoek MR, Oliver I, Barlow M, Heard L, Chalmers R, Paynter S. Outbreak of Cryptosporidium parvum among children after a school excursion to an adventure farm, south west England. J Water Health 2008; 6:333-338. [PMID: 19108553 DOI: 10.2166/wh.2008.060] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We present the results of an outbreak investigation on a Cryptosporidium parvum outbreak among 35 people, (27 students and 8 teachers), who participated in a school excursion to an outdoor adventure farm in South West England, from 22 to 26 May 2006. A cohort study was implemented to investigate possible sources of infection during the farm visit. The most likely transmission route was contact with faecally contaminated surface water following heavy rainfall, or consumption of water from the private well. Disinfection of the water reservoir was by chlorination, to which cryptosporidium is resistant. Supplemental disinfection or filtration methods of private water supplies on livestock farms may be needed. This study highlights the fact that epidemiological investigations of outbreaks as a result of environmental exposures are complex but important to inform the public and health professionals of the risks posed by private water supplies and outdoor activities. This is particularly so after heavy rainfall, as this may result in an increased effluent from faecally contaminated land, causing a wide variety of pathogens to wash into surface water and potentially, private wells. This poses risks for public health.
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Affiliation(s)
- M R Hoek
- Health Protection Agency, The Wheelhouse, Bond's Mill, Stonehouse, Glos GL10 3RF, UK.
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27
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McNulty CAM, Freeman E, Oliver I, Ford-Young W, Randall S. Strategies used to increase chlamydia screening in general practice: a qualitative study. Public Health 2008; 122:845-56. [PMID: 18620715 DOI: 10.1016/j.puhe.2007.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Revised: 08/01/2007] [Accepted: 10/26/2007] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To explore strategies used by chlamydia screening co-ordinators and practice staff to implement genital chlamydia screening within general practices. METHODS Qualitative phenomenological study using individual semi-structured telephone interviews. Screening co-ordinators were selected purposively in Phase 1 and 2 areas of the Department of Health National Chlamydia Screening Programme in England, where there was significant screening in general practice. Open questions were asked about: the factors that determined high chlamydia screening rates; maintaining motivation for screening; and strategies to increase screening in general practices. RESULTS Co-ordinators reported that successful screening practices had a champion who drove the screening process forward. These practices had normalized screening, so all at-risk patients were offered opportunistic screening whenever they attended. This was facilitated by a variety of time-saving methods including computer prompts, test kits in the reception area, youth clinics and receptionist involvement. Chlamydia screening was sustained through frequent reminders, newsletters containing chlamydia screening rates, and advertising to the 'at-risk' population from the screening team. Co-ordinators' enthusiasm and project management skills were as important as sexual health experience. Co-ordinators reported that to facilitate chlamydia screening across all practices, screening could be included in the General Medical Services (GMS) contract, and a higher national profile was needed amongst health professionals and the public. CONCLUSIONS All practice staff need to be encouraged to become champions of the chlamydia screening programme through education, especially aimed at older clinicians and receptionists. The National Health Service should consider including chlamydia screening in the GMS contract. Increased public awareness will allow screening to be undertaken more quickly and by non-medical staff.
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Affiliation(s)
- C A M McNulty
- Microbiology Department, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK.
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Edouard T, Oliver I, Jouret B, Lounis N, Moulin P, Pienkowski C, Elefterion M, Salles JP, Tauber M. Suivi de la croissance chez les enfants de petite taille de naissance après 3 ans de traitement par hormone de croissance : l’expérience d’un centre français. Arch Pediatr 2008; 15:115-21. [DOI: 10.1016/j.arcped.2007.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Revised: 09/05/2007] [Accepted: 10/15/2007] [Indexed: 11/25/2022]
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Hoek MR, Bracebridge S, Oliver I. Health impact of the Buncefield oil depot fire, December 2005: Study of accident and emergency case records. J Public Health (Oxf) 2007; 29:298-302. [PMID: 17586846 DOI: 10.1093/pubmed/fdm036] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND On Sunday 11th of December 2005, an explosion occurred at the Buncefield oil depot, Hertfordshire, resulting in a large fire that blazed for several days. Two Accident and Emergency (A&E) departments were placed on stand-by to receive casualties. A simple surveillance system was put in place during the acute phase of the incident, but this was not adequate to fully examine the health impact of the fire. METHODS Retrospective study of A&E records at Hemel Hempstead and Watford A&E departments for the period that the fire burnt. RESULTS Two hundred and forty-four people attended A&E as a result of the fire: 187 were members of the emergency services; 17 were oil depot workers; and 40 were members of the public. The most common presenting complaints were respiratory symptoms (n = 66) and injuries (n = 38). Twenty-five (21%) individuals were referred for medical follow-up. There were no fatalities. CONCLUSION There was a significant impact on local health services, with many emergency service personnel attending A&E asymptomatically. Alternative health service provision for these individuals, possibly near to the scene of the incident, should be considered. This incident has also highlighted an urgent need to develop surveillance systems that enable real-time monitoring of the acute public health impact of major incidents.
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Affiliation(s)
- M R Hoek
- EPIET, European Programme for Intervention Epidemiology Training, The Wheelhouse, Bond's Mill, Stonehouse GLOS GL10 3RF, UK.
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Ihekweazu C, Maxwell N, Organ S, Oliver I. Is STI surveillance in England meeting the requirements of the 21st century? An evaluation of data from the South West Region. Euro Surveill 2007; 12:E9-10. [PMID: 17991398 DOI: 10.2807/esm.12.05.00708-en] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- C Ihekweazu
- Health Protection Agency South West, Stroud, England
- European Programme for Intervention Epidemiology Training (EPIET)
| | - N Maxwell
- Health Protection Agency South West, Stroud, England
| | - S Organ
- Health Protection Agency South West, Stroud, England
| | - I Oliver
- Health Protection Agency South West, Stroud, England
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Fernández-Frías AM, Pérez-Vicente F, Arroyo A, Sánchez-Romero AM, Navarro JM, Serrano P, Oliver I, Costa D, Candela F, Calpena R. Is anal endosonography useful in the study of recurrent complex fistula-in-ano? Rev esp enferm dig 2006; 98:573-81. [PMID: 17048993 DOI: 10.4321/s1130-01082006000800002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION performing anal endosonography in complex fistula-in-ano allows us to design a personalized surgical strategy in each case, thereby improving results. However, there are doubts in the literature as to its utility in recurrent complex fistulas. The aim of this study was to compare the utility of anal ultrasonography in the study of primary versus recurrent complex fistula-in-ano. PATIENTS AND METHOD prospective study of patients diagnosed and treated for complex fistula-in-ano. Physical examination and anal ultrasonography provided data on primary track, internal opening, horseshoe extension and the presence of secondary tracks or cavities in a protocol designed specifically for the study. These assessments were subsequently contrasted with operative findings. RESULTS we included 35 patients, 19 (54.3%) with primary complex anal fistulas and 16 (45.7%) with recurrent fistulas. According to the operative findings, fistulas were classified as high transsphincteric in 28 patients (80%), suprasphincteric in 6 (17.1%) and extrasphincteric in one patient (2.9%), with no differences between groups. Physical examination correctly classified 28 of the 35 fistulous tracks, in contrast to the 32 (91.4%) correctly described on ultrasonography (80%). We did not find any statistically significant differences between the primary and the recurrent fistula groups with regard to sensibility, positive predictive value and accuracy of the anal ultrasonography for any of the parameters studied. CONCLUSION the accuracy of anal ultrasonography does not decrease in recurrent complex fistula-in-ano.
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Affiliation(s)
- A M Fernández-Frías
- Coloproctology Unit, Service of General and Gastrointestinal Surgery, Hospital General Universitario, Elche, Alicante, Spain.
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Lacueva FJ, Oliver I, Costa D, Calpena R. To perform or not D2 extended lymphadenectomy in patients with gastric cancer in the West. Effectiveness and limits. Clin Transl Oncol 2006; 8:139-41. [PMID: 16648110 DOI: 10.1007/s12094-006-0001-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Boulard S, Diene G, Barat R, Oliver I, Pienkowski C, Lacombe D, Vincent MC, Bourrouillou G, Tauber M. A case of trisomy 12 mosaicism with pituitary malformation and polycystic ovary syndrome. Genet Couns 2006; 17:173-83. [PMID: 16970035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
We report the case of a patient (followed from birth to 15 years) presenting with trisomy 12 mosaicism, and focus on the endocrine phenotype associating a pituitary malformation and ovarian abnormalities. We describe the dysmorphic features and their evolution, the growth retardation and ovarian symptoms. Complete growth hormone deficiency was confirmed on auxological data, stimulation test and was related to pituitary stalk interruption, diagnosed by magnetic resonance imaging. Effect of growth hormone treatment was satisfactory resulting in a normal adult height. She also presented premature thelarche associated with right ovarian hypertrophy (4 to 5 fold the volume of the left ovary) which remained constant until 15 years of age. Diagnosis of trisomy 12 mosaicism was made on skin and ovarian karyotypes. The possible relation between these endocine findings and some genes located on chromosome 12 involved in pituitary and ovarian development is discussed.
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Affiliation(s)
- S Boulard
- Division of Paediatrics, Hôpital Pellegrin, place Amélie Raba-Léon, 33076 Bordeaux, France
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Smith A, Lamagni TL, Oliver I, Efstratiou A, George RC, Stuart JM. Invasive group A streptococcal disease: should close contacts routinely receive antibiotic prophylaxis? Lancet Infect Dis 2005; 5:494-500. [PMID: 16048718 DOI: 10.1016/s1473-3099(05)70190-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Group A streptococci (Streptococcus pyogenes) causes a wide range of illnesses from non-invasive disease--eg, pharyngitis--to more severe invasive infections--eg, necrotising fasciitis and toxic shock-like syndrome. There remains uncertainty about the risk of secondary cases of invasive disease occurring among close contacts of an index case and how best to manage that risk. We do not consider that currently available evidence justifies the routine administration of chemoprophylaxis to close contacts. We suggest that the appropriate response should be to routinely inform all household contacts of a patient with invasive group A streptococcal disease about the clinical manifestations of invasive disease and to seek immediate medical attention if they develop such symptoms.
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Affiliation(s)
- A Smith
- Health Protection Agency, Centre for Infections, London, UK.
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Lacueva J, Perez-Ramos M, Soto JL, Oliver I, Andrada E, Medrano J, Perez-Vazquez T, Arroyo A, Carrato A, Ferragut JA, Calpena R. Multidrug resistance-associated protein (MRP1) gene is strongly expressed in gastric carcinomas. Analysis by immunohistochemistry and real-time quantitative RT-PCR. Histopathology 2005; 46:389-95. [PMID: 15810950 DOI: 10.1111/j.1365-2559.2005.02100.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIMS To assess MRP1 protein and MRP1 mRNA levels in gastric carcinomas and in non-neoplastic mucosa remote from the tumours. MRP1 gene expression may play a role in the complex pattern of chemoresistance present in gastric carcinomas. METHODS AND RESULTS A total of 57 carcinomas and respective gastric tissues were included for immunohistochemical assessment with the anti-MRP1 monoclonal antibodies MRPr1 and QCRL-1. Of these, 35 tumour and gastric mucosa tissues were also assessed by real-time quantitative reverse transcriptase-polymerase chain reaction. Medium or high MRP1 protein expression was detected in 89% and 77% of carcinomas and in 96% and 93% of non-neoplastic gastric mucosa by MRPr1and QCRL-1, respectively. No difference in MRP1 mRNA levels was detected between carcinomas and non-neoplastic gastric mucosa tissues in 77% of the patients. A significant correlation was found between MRP1 mRNA level and protein expression detected in carcinomas related to non-neoplastic gastric mucosa, although they were non-concordant in 29% of the patients. CONCLUSIONS MRP1 gene is usually expressed in most gastric carcinomas and does not differ substantially from that observed in non-neoplastic gastric mucosa remote from the tumour. However, a decrease in MRP1 gene expression is found in some carcinomas. For accurate assessment of changes in MRP1 expression between tumour and normal tissues both protein and mRNA detection are necessary.
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Affiliation(s)
- J Lacueva
- Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain.
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Oliver I, Costa D, Lacueva J, Calpena R. An upper abdominal swelling causing nausea and vomiting. Gut 2005; 54:813, 842. [PMID: 15888790 PMCID: PMC1774526 DOI: 10.1136/gut.2004.058644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- I Oliver
- Department of Pathology and Surgery, Elche University General Hospital, Camí de ĺAlmazara, # 11, 03202 Elche (Alicante), Spain.
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Affiliation(s)
- I Oliver
- Department of Pathology and Surgery, Elche University General Hospital, Elche (Alicante), Spain.
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Abstract
BRIANHUNTLEYA, A NEW GENUS ENDEMIC TO THE WORCESTER-ROBERTSON KAROO, SOUTH AFRICA
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Tauber M, Berro B, Delagnes V, Lounis N, Jouret B, Pienkowski C, Oliver I, Rochiccioli P. Can some growth hormone (GH)-deficient children benefit from combined therapy with gonadotropin-releasing hormone analogs and GH? Results of a retrospective study. J Clin Endocrinol Metab 2003; 88:1179-83. [PMID: 12629103 DOI: 10.1210/jc.2002-020974] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Recombinant GH (rGH) treatment does not invariably correct height deficits in GH-deficient children once puberty has begun. The addition of GnRH analogs (GnRHa) to delay puberty has been advocated, but published results are few and sometimes conflicting. We retrospectively compared GH-deficient children treated with rGH and GnRHa for at least 1 yr after entering puberty and having attained their final height (n = 23) with a matched control group treated only with rGH. Overall, combined therapy did not significantly increase final height relative to rGH alone. However, the shortest girls at the onset of puberty (<25th percentile) benefited more than the tallest (>75th percentile) in both final height relative to predicted height and pubertal catch-up growth. In the control group, patients having experienced intrauterine growth retardation (IUGR) attained a lower mean final height than patients without IUGR (difference significant in boys, but not in girls). In the combined therapy group, IUGR did not affect the final height of either sex. Our results suggest that two populations might benefit most from combined GnRHa and rGH therapy: girls particularly short at the onset of puberty and patients who had experienced IUGR. Further prospective studies are required to confirm these preliminary hypothesis.
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Affiliation(s)
- M Tauber
- Unité d'Endocrinologie, Hôpital des Enfants, 31026 Toulouse, France.
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Oliver I, Lacueva FJ, Pérez Vicente F, Arroyo A, Ferrer R, Cansado P, Candela F, Calpena R. Randomized clinical trial comparing simple drainage of anorectal abscess with and without fistula track treatment. Int J Colorectal Dis 2003; 18:107-10. [PMID: 12548410 DOI: 10.1007/s00384-002-0429-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2002] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Anal abscess is a frequent acute proctological disorder and whether the underlying fistula should be treated at the same time when the abscess is drained remains controversial. We examined indications for drainage alone versus drainage plus fistulotomy in terms of recurrence and continence. PATIENTS AND METHODS We carried out a randomized prospective study of 200 consecutive patients with anal abscess. One group received drainage alone, while in the other group drainage plus fistulotomy was performed when a subcutaneous-mucosa, low transsphincteral, or intersphincteral fistula was found. Delayed progressive fistulotomy with suture threads was performed in cases of high transsphincteric or suprasphincteric fistula. RESULTS The internal opening of the fistula track was found in 83% of the patients. The recurrence rate was related to the surgical technique employed: 29% in the group with drainage alone and 5% in the group for which treatment of the fistula track was attempted. The incontinence rate was also related to the surgical option. In those receiving drainage and treatment of the fistula track incontinence was restricted mostly to patients with delayed fistulotomy (36.7%), compared to 2.8% of patients when simple fistulotomy was performed. There was no incontinence in the drainage alone group. CONCLUSION Drainage of anal abscess with fistulotomy can be safely performed in cases of subcutaneous, intersphincteral, or low transsphincteral fistulae with a minimal recurrence rate. However, drainage alone and posterior treatment of the fistula track is recommended for high transsphincteral or suprasphincteral fistulae.
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Arroyo Sebastián A, Pérez F, Serrano P, Costa D, Oliver I, Ferrer R, Lacueva J, Calpena R. Is prosthetic umbilical hernia repair bound to replace primary herniorrhaphy in the adult patient? Hernia 2002; 6:175-7. [PMID: 12424596 DOI: 10.1007/s10029-002-0076-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2001] [Accepted: 07/02/2002] [Indexed: 10/27/2022]
Abstract
Given the outstanding outcome that prosthetic repair has recently achieved in the repair of inguinal hernia, we wonder whether it should be implemented as the gold-standard technique for umbilical hernia repair. We report on 213 adult patients who underwent surgery for umbilical hernia at our Day Surgery Unit from June 1992 to January 1998. Criteria for exclusion included problematic social and family environment and ASA IV status. A polypropylene plug was placed in small umbilical defects, whereas large defects (> 3 cm in diameter) were repaired with a polypropylene mesh. The mean follow-up was 64 months. The mean age was 57.1 years, with females accounting for the majority (57.8%). Most patients (88.3%) were classified as ASA I-II. With regard to the hernia size, 143 patients (67.1%) presented with small defects (< 3 cm). The anaesthetic technique of choice was local plus sedation. Reported complications included seroma (5.6%), haematoma (2.3%), wound infection (1.4%), and intolerance to prosthesis (0.95%), the last causing recurrence. The overall recurrence rate at a mean follow-up of 64 months was 0.95%. Prosthetic umbilical hernia repair can safely be performed in adults, and the rate of recurrence in this study is low in comparison to primary tissue repair.
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Affiliation(s)
- A Arroyo Sebastián
- Abdominal Wall Surgery Unit, Department of Surgery, University Hospital of Elche, Alicante, Spain.
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Abstract
Pioneering work in the 1940s and 1950s suggested that the concept of 'chunking' might be important in many processes of perception, learning and cognition in humans and animals. We summarize here the major sources of evidence for chunking mechanisms, and consider how such mechanisms have been implemented in computational models of the learning process. We distinguish two forms of chunking: the first deliberate, under strategic control, and goal-oriented; the second automatic, continuous, and linked to perceptual processes. Recent work with discrimination-network computational models of long- and short-term memory (EPAM/CHREST) has produced a diverse range of applications of perceptual chunking. We focus on recent successes in verbal learning, expert memory, language acquisition and learning multiple representations, to illustrate the implementation and use of chunking mechanisms within contemporary models of human learning.
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Affiliation(s)
- F Gobet
- ESRC Centre for Research in Development, Instruction and Training, School of Psychology, University Park, NG7 2RD, Nottingham, UK
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Arroyo A, Costa D, Lacueva J, Serrano P, Candela F, Oliver I, Pérez F, Ferrer R, García P, Calpena R. Hernia inguinal como causa de íleo biliar colónico. Cir Esp 2001. [DOI: 10.1016/s0009-739x(01)71796-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ferrer R, Medrano J, Calpena R, Diego M, Moltó M, Graells M, Pérez M, Cansado P, Oliver I, Pérez F, Arroyo A. Interacción hormonal endoexocrina pancreática: modelo in vivo sin filtro hepático en la rata. Cir Esp 2001. [DOI: 10.1016/s0009-739x(01)71778-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Arroyo A, Andreu J, García P, Jover S, Arroyo M, Fernández A, Costa D, Oliver I, Hernández H, Schwartz H, Reillo M, Calpena R, Arenas C. [Analysis of a programme of direct referral between primary and specialist care in potential surgery patients]. Aten Primaria 2001; 28:381-5. [PMID: 11602117 PMCID: PMC7684138 DOI: 10.1016/s0212-6567(01)70399-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To describe the results of a programme of direct referral of potential surgery patients between primary and specialist care, designed to lessen waiting-times.Design. Prospective, longitudinal and descriptive study. SETTING Health Area N. masculine 19 (Valencian Health Service): Surgery Service of Elche Hospital and 6 Health Centres. PARTICIPANTS Patients with pathologies that do not need special techniques for diagnosis except examination and who have a clear irrefutable indication of surgery without risk factors (ASA I-II).Intervention. The referral protocol consists of: a) diagnosis of pathology and pre-operative study in primary care (PC); b) appointment made by phone for the surgery clinic at the hospital, where diagnosis and pre-operative study are confirmed; c) referral and operation in the unit of non-hospital major surgery (UCMA); d) monitoring post-operation by the home hospitalisation unit (HHU) or preferably by the health centre, and e) check-up at the surgery clinic. Main measurements. The degree of agreement between PC and the specialist, assessment of the pre-operative study, and waiting time. RESULTS 86 patients were referred (average age, 35; 76% male) by 28 doctors. The most common pathologies were hernia (36%), pilonidal sinus (23.2%) and miscellaneous (32.5%). There was general agreement in diagnosis in 90.7% of cases. 89.5% of patients brought the proper pre-operative study. Mean waiting time between the primary care consultation in the different procedures and the first hospital consultation was 19 days; with 44 more days elapsing till the surgical operation. CONCLUSIONS This new programme is effective and economic, in that there is <<adequate referral>> of patients, waiting time is reduced by over 7 months for pilonidal sinus and by over 2 years for hernia pathology, and the procedure can be used for a large number of patients, as the pathologies involved are very common.
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Affiliation(s)
- A Arroyo
- Servicio de Cirugía General y Aparato Digestivo, Hospital General Universitario, Elche.
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Cance-Rouzaud A, Arnaud C, Oliver I, Barbeau C, Tauber MT, Grandjean H. [Modelization of growth between 0 and 3 years of age in children born in Toulouse in 1993-1994 and comparison with Sempé's growth curves]. Arch Pediatr 1999; 6:145-50. [PMID: 10079882 DOI: 10.1016/s0929-693x(99)80201-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIM The growth charts usually used in France were established by Sempé et al from the study of children born in 1953-1955. The aim of our study was to construct longitudinal growth charts from 0 to 3-year-old children born in 1993-1994, and to compare those with the charts made 40 years ago. POPULATION AND METHODS One hundred forty-five term neonates (75 boys and 70 girls) born in Toulouse in 1993-1994 were included in our study. Their heights were noted every 3 months during the first year of life, then every 6 months until the age of 3. A two-stage model to modelize growth curves was used for the available data (66 boys and 61 girls). RESULTS Mean heights were higher in our study than in Sempé's. In each sex, the mean curve was 0.6 to 0.8 SD far from Sempé's mean curve. Standard deviations rose from 2.0 to 4.0 cm between the ages of 2 months and 3 years. At the age of 3, boys and girls were respectively 2.7 cm and 2.3 cm taller than in the Sempé's study. Differences could not be explained by sample bias. DISCUSSION Constructions and publication of recent French growth charts seem necessary in order to be able to compare one child's growth to the growth of same age and sex children.
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Lacueva FJ, Calpena R, Medrano J, Oliver I, Carvajal R. Failure to detect early recurrence of gastric cancer. J Clin Gastroenterol 1998; 26:219-21. [PMID: 9600374 DOI: 10.1097/00004836-199804000-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Early gastric cancer recurrence is sometimes difficult to diagnose even by protocols using imaging techniques and tumor markers. We report a gastric cancer recurrence diagnosed by the appearance of a Sister Mary Joseph's nodule that illustrates the lack of sensitivity of these methods. We also discuss the protocol we currently follow for these patients.
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Affiliation(s)
- F J Lacueva
- Pathology and Surgery Department, Miguel Hernandez University School of Medicine, Elche University General Hospital, Spain
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Abstract
BACKGROUND Pituitary stalk transection is a non-negligible cause of growth hormone (GH) deficiency. POPULATION AND METHODS We studied 22 children (13 boys, nine girls) aged at the first clinical manifestations from 2 days to 10 years (average = 5.33 +/- 2 years). Pituitary stalk transection was assessed by the means of magnetic resonance imaging (MRI). The children's past history showed fetal distress in 12 cases (54.5%), cranial trauma in three (13%) and a midline anomaly in three (13%). The first clinical manifestations were neonatal hypoglycemia (two cases), decreased growth velocity (18 cases) and diabetes insipidus (two cases). RESULTS GH deficiency was complete, present from the onset in 19 of 22 cases and isolated in four. Fifteen of 22 cases had adreno-corticotrophic hormone (ACTH) and thyroid stimulating hormone (TSH) deficiency. Diabetes insipidus was present in six cases and revealed the syndrome in two. All children older than normal age of puberty (n = 10) had gonadotropin deficiency. In our study, these hormonal anomalies progressed from isolated GH deficiency to multiple hormonal deficiencies. CONCLUSION The recently described stalk transection syndrome is relatively frequent and should be suspected after cranial trauma or fetal distress syndrome. The outcome is progressive evolution towards panhypopituitarism and these patients require regular clinical survey and hormonal controls.
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Affiliation(s)
- C Barbeau
- Service d'endocrinologie pédiatrique, CHU Purpan, Toulouse, France
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Cunningham D, Zalcberg J, Rath U, Oliver I, van Cutsem E, Svensson C, Seitz J, Harper P, Kerr D, Perez-Manga G. Corrigenda. Ann Oncol 1997. [DOI: 10.1093/oxfordjournals.annonc.a010875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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