The effect of meteorological variables on the transmission of hand, foot and mouth disease in four major cities of shanxi province, China: a time series data analysis (2009-2013).

Increased incidence of hand, foot and mouth disease (HFMD) has been recognized as a critical challenge to communicable disease control and public health response. This study aimed to quantify the association between climate variation and notified cases of HFMD in selected cities of Shanxi Province, and to provide evidence for disease control and prevention. Meteorological variables and HFMD cases data in 4 major cities (Datong, Taiyuan, Changzhi and Yuncheng) of Shanxi province, China, were obtained from the China Meteorology Administration and China CDC respectively over the period 1 January 2009 to 31 December 2013. Correlations analyses and Seasonal Autoregressive Integrated Moving Average (SARIMA) models were used to identify and quantify the relationship between the meteorological variables and HFMD. HFMD incidence varied seasonally with the majority of cases in the 4 cities occurring from May to July. Temperatures could play important roles in the incidence of HFMD in these regions. The SARIMA models indicate that a 1° C rise in average, maximum and minimum temperatures may lead to a similar relative increase in the number of cases in the 4 cities. The lag times for the effects of temperatures were identified in Taiyuan, Changzhi and Yuncheng. The numbers of cases were positively associated with average and minimum temperatures at a lag of 1 week in Taiyuan, Changzhi and Yuncheng, and with maximum temperature at a lag of 2 weeks in Yuncheng. Positive association between the temperature and HFMD has been identified from the 4 cities in Shanxi Province, although the role of weather variables on the transmission of HFMD varied in the 4 cities. Relevant prevention measures and public health action are required to reduce future risks of climate change with consideration of local climatic conditions.

Surgical site infections in spine surgery: identification of microbiologic and surgical characteristics in 239 cases.

STUDY DESIGN: Retrospective analysis. OBJECTIVE: The objective of this study was to describe the microbiology of surgical site infection (SSI) in spine surgery and relationship with surgical management characteristics. SUMMARY OF BACKGROUND DATA: SSI is an important complication of spine surgery that results in significant morbidity. A comprehensive and contemporary understanding of the microbiology of postoperative spine infections is valuable to direct empiric antimicrobial treatment and prophylaxis and other infection prevention strategies. METHODS: All cases of spinal surgery associated with SSI between July 2005 and November 2010 were identified by the hospital infection control surveillance program using Centers for Disease Control National Health Safety Network criteria. Surgical characteristics and microbiologic data for each case were gathered by direct medical record review. RESULTS: Of 7529 operative spine cases performed between July 2005 and November 2010, 239 cases of SSI were identified. The most commonly isolated pathogen was Staphylococcus aureus (45.2%), followed by Staphylococcus epidermidis (31.4%). Methicillin-resistant organisms accounted for 34.3% of all SSIs and were more common in revision than in primary surgical procedures (47.4% vs. 28.0%, P = 0.003). Gram-negative organisms were identified in 30.5% of the cases. Spine surgical procedures involving the sacrum were significantly associated with gram-negative organisms (P < 0.001) and polymicrobial infections (P = 0.020). Infections due to gram-negative organisms (P = 0.002) and Enterococcus spp. (P = 0.038) were less common in surgical procedures involving the cervical spine. Cefazolin-resistant gram-negative organisms accounted for 61.6% of all gram-negative infections and 18.8% of all SSIs. CONCLUSION: Although gram-positive organisms predominated, gram-negative organisms accounted for a sizeable portion of SSI, particularly among lower lumbar and sacral spine surgical procedures. Nearly half of infections in revision surgery were due to a methicillin-resistant organism. These findings may help guide choice of empiric antibiotics while awaiting culture data and antimicrobial prophylaxis strategies in specific spine surgical procedures. LEVEL OF EVIDENCE: 3.

Motivational interviewing concepts and the relationship to risk management and patient counseling.

A brief version of motivational interviewing, a patient-centered counseling technique, has been found to be effective in reducing caries in high-risk young children. Motivational interviewing principles are discussed, examples of motivational interviewing interactions are provided, and the concept of readiness is presented in this paper. Dental professionals using caries management by risk assessment can readily use motivational interviewing strategies to reduce risks.

Early life environment, life history and risk of endometrial cancer.

Endometrial cancer risk is influenced by reproductive behaviours, including parity and breastfeeding, and timing of life history events such as age at menarche and menopause. One potential mechanism by which altered reproductive strategies may influence endometrial cancer risk is through exposure to reproductive hormones. Current theory suggests that high lifetime exposure to oestrogen, unopposed by progesterone, increases endometrial cancer risk; here we suggest that progesterone deficiency itself may also play a significant role. Additionally, given that reproductive profile variables are themselves influenced by early childhood conditions, we hypothesise that endometrial cancer risk may be influenced by the childhood psychosocial environment as mediated through changes to adolescent and adult reproductive behaviours and hormone exposures. Investigating reproductive cancers, including endometrial cancer, using a life history approach may help to increase understanding of why these cancers occur and potentially help implementation of early detection and screening processes in the future.

The status of water and sanitation among Pacific Rim nations.

Analysis of relationships among national wealth, access to improved water supply and sanitation facilities, and population health indices suggests that the adequacy of water resources at the national level is a poor predictor of economic development--namely, that low water stress is neither necessary nor sufficient for economic development at the present state of water stress among Pacific Rim nations. Although nations differ dramatically in terms of priority provided to improved water and sanitation, there is some level of wealth (per capita GNP) at which all nations promote the development of essential environmental services. Among the Pacific Rim countries for which there are data, no nation with a per capita GNP > US$18,000 per year has failed to provide near universal access to improved water supply and sanitation. Below US$18,000/person-year, however, there are decided differences in the provision of sanitary services (improved water supply and sanitation) among nations with similar economic success. There is a fairly strong relationship between child mortality/life expectancy and access to improved sanitation, as expected from the experiences of developed nations. Here no attempt is made to produce causal relationships among these data. Failure to meet Millennium Development Goals for the extension of improved sanitation is frequently evident in nations with large rural populations. Under those circumstances, capital intensive water and sanitation facilities are infeasible, and process selection for water/wastewater treatment requires an adaptation to local conditions, the use of appropriate materials, etc., constraints that are mostly absent in the developed world. Exceptions to these general ideas exist in water-stressed parts of developed countries, where water supplies are frequently augmented by water harvesting, water reclamation/reuse, and the desalination of brackish water resources. Each of these processes involves public acceptance of water resources that are at least initially of inferior quality. Despite predictions of looming increases in water stress throughout the world, adaptation and resourcefulness generally allow us to meet water demand while pursuing rational economic development, even in the most water-stressed areas of the Pacific Rim.

Dryland salinity and vector-borne disease emergence in southwestern Australia.

Broad-scale clearing of native vegetation for agriculture in southwestern Australia has resulted in severe ecosystem degradation, which has been compounded by the subsequent development of large areas of dryland salinity; decreased transevaporation allows the water table to rise, dissolving ancient aeolian salt deposits and creating saline surface pools. The mosquito-borne disease Ross River virus has been noted as a potential adverse human health outcome in salinity-affected regions because the principal vector, Aedes camptorhynchus, is salt tolerant and thrives preferentially in such systems. To understand the geology and ecology underlying the relationship between land clearing and disease emergence, we examine the relationship between dryland salinity processes that determine the dissolved solids profile of saline pools in affected areas, the mosquito vectors and interactions with the human population within the disease cycle. Aedes camptorhynchus is able to survive in a wide range of salinities in pools created by dryland salinity processes. The link with disease emergence is achieved where population distribution and activity overlaps with the convergence of environmental and ecological conditions that enhance disease transmission.

Pan-European Chikungunya surveillance: designing risk stratified surveillance zones.

The first documented transmission of Chikungunya within Europe took place in Italy during the summer of 2007. Chikungunya, a viral infection affecting millions of people across Africa and Asia, can be debilitating and no prophylactic treatment exists. Although imported cases are reported frequently across Europe, 2007 was the first confirmed European outbreak and available evidence suggests that Aedes albopictus was the vector responsible and the index case was a visitor from India. This paper proposed pan-European surveillance zones for Chikungunya, based on the climatic conditions necessary for vector activity and viral transmission. Pan-European surveillance provides the best hope for an early-warning of outbreaks, because national boundaries do not play a role in defining the risk of this new vector borne disease threat. A review of climates, where Chikungunya has been active, was used to inform the delineation of three pan-European surveillance zones. These vary in size each month across the June-September period of greatest risk. The zones stretch across southern Europe from Portugal to Turkey. Although the focus of this study was to define the geography of potential surveillance zones based on the climatic limits on the vector and virus, a preliminary examination of inward bound airline passengers was also undertaken. This indicated that France and Italy are likely to be at greater risk due to the number of visitors they receive from Chikungunya active regions, principally viraemic visitors from India. Therefore this study represents a first attempt at creating risk stratified surveillance zones, which we believe could be usefully refined with the use of higher resolution climate data and more complete air travel data.

Split-volume treatment planning of multiple consecutive vertebral body metastases for cyberknife image-guided robotic radiosurgery.

Cyberknife treatment planning of multiple consecutive vertebral body metastases is challenging due to large target volumes adjacent to critical normal tissues. A split-volume treatment planning technique was developed to improve the treatment plan quality of such lesions. Treatment plans were generated for 1 to 5 consecutive thoracic vertebral bodies (CVBM) prescribing a total dose of 24 Gy in 3 fractions. The planning target volume (PTV) consisted of the entire vertebral body(ies). Treatment plans were generated considering both the de novo clinical scenario (no prior radiation), imposing a dose limit of 8 Gy to 1 cc of spinal cord, and the retreatment scenario (prior radiation) with a dose limit of 3 Gy to 1 cc of spinal cord. The split-volume planning technique was compared with the standard full-volume technique only for targets ranging from 2 to 5 CVBM in length. The primary endpoint was to obtain best PTV coverage by the 24 Gy prescription isodose line. A total of 18 treatment plans were generated (10 standard and 8 split-volume). PTV coverage by the 24-Gy isodose line worsened consistently as the number of CVBM increased for both the de novo and retreatment scenario. Split-volume planning was achieved by introducing a 0.5-cm gap, splitting the standard full-volume PTV into 2 equal length PTVs. In every case, split-volume planning resulted in improved PTV coverage by the 24-Gy isodose line ranging from 4% to 12% for the de novo scenario and, 8% to 17% for the retreatment scenario. We did not observe a significant trend for increased monitor units required, or higher doses to spinal cord or esophagus, with split-volume planning. Split-volume treatment planning significantly improves Cyberknife treatment plan quality for CVBM, as compared to the standard technique. This technique may be of particular importance in clinical situations where stringent spinal cord dose limits are required.

Effect of motivational interviewing on rates of early childhood caries: a randomized trial.

PURPOSE: The purposes of this randomized controlled trial were to: (1) test motivational interviewing (MI) to prevent early childhood caries; and (2) use Poisson regression for data analysis. METHODS: A total of 240 South Asian children 6 to 18 months old were enrolled and randomly assigned to either the MI or control condition. Children had a dental exam, and their mothers completed pretested instruments at baseline and 1 and 2 years postintervention. Other covariates that might explain outcomes over and above treatment differences were modeled using Poisson regression. Hazard ratios were produced. RESULTS: Analyses included all participants whenever possible. Poisson regression supported a protective effect of MI (hazard ratio [HR]=0.54 (95%CI=035-0.84)-that is, the M/ group had about a 46% lower rate of dmfs at 2 years than did control children. Similar treatment effect estimates were obtained from models that included, as alternative outcomes, ds, dms, and dmfs, including "white spot lesions." Exploratory analyses revealed that rates of dmfs were higher in children whose mothers had: (1) prechewed their food; (2) been raised in a rural environment; and (3) a higher family income (P<.05). CONCLUSIONS: A motivational interviewing-style intervention shows promise to promote preventive behaviors in mothers of young children at high risk for caries.

Laboratory determination of efficacy of a Santalum spicatum extract for mosquito control.

The activity of QN50, a sequiterpene alcohol derived from Australian sandalwood (Santalum spicatum), was tested for its effectiveness against larvae of 2 mosquito species (Culex molestus and Aedes camptorhynchus [Diptera: Culicidael), nymphs of 2 species of water boatmen (Micronecta robusta and Agraptocorixa [Hemiptera: Corixidae]), immature Daphnia sp. (Crustacea), and mosquito eggs (Cx. molestus). In a series of laboratory bioassays, field-collected mosquito larvae, eggs, and immature corixids and daphnids were placed in beakers with either QN50, methoprene or source water only (control). The mosquito larvae exposed to QN50 had reduced survivorship and average longevity relative to the control and to methoprene at most concentrations used in this study. The hatching rate of mosquito eggs was unaffected by methoprene or QN50. Corixid nymphs and daphnids experienced high mortality in both methoprene and QN50 relative to the control, but there was no difference in the effect between the compounds. The results of this preliminary study suggest that further research into the mode of action and efficacy of QN50 as a potential alternative to methoprene for mosquito abatement is warranted.

Rural Puerto Rican women's views on children's oral health: a qualitative community-based study.

PURPOSE: The purpose of this study was to examine women's views on beliefs, preferences, and behaviors relevant to children's oral health. METHODS: Women of childbearing age and mothers of women of childbearing age were recruited from 2 rural Puerto Rican communities to participate in 24 focus groups. One hundred fifty women participated. Participants were asked about their awareness and knowledge of childhood decay and their child-feeding and oral care attitudes and practices. Analysis consisted of a comprehensive content review of participant's responses. RESULTS: Participants used a variety of infant and toddler feeding practices, including breastfeeding and prolonged bottle use. Children progressed through feeding stages based on mother's experience, older relatives' advice, and child readiness. Grandmothers were considered trusted and reliable sources of information. Many believed that dental disease did not affect infants and were unaware of el síndrome del biberón (baby bottle tooth decay, SIB). Participants believed that decay was caused by too much sugar and prolonged bottle use and only affected children. Dental visits were rare in very young children, unless conspicuous decay or pain was present. Mothers' dental experiences influenced seeking children's preventive and treatment visits. CONCLUSIONS: This study highlights caregivers' perceptions, which are inconsistent with maximizing children's oral health. This information can be used to develop culturally appropriate, community based oral health programs.

Effect of volcanic gas exposure on urine, blood, and serum chemistry.

AIMS: This pilot study tested the hypothesis that aluminium (Al), rubidium (Rb), arsenic (As), lead (Pb), mercury (Hg), fluorine (F), and chlorine (Cl), which are all known to be present in volcanic emissions, may be useful biological markers for occupational gas exposure in volcanologists. METHODS: Ten human subjects were exposed to fumarole gases on White Island, New Zealand, for approximately 20 minutes. Sulphur dioxide (SO2) exposure was recorded by personal monitoring tubes. Pre- and post-exposure urine, blood and serum samples (collected using standard protocols) were analysed in the pathology laboratory for trace element and halogen content. RESULTS: Average personal exposure was measured at <75 ppm SO2 and calculated at approximately 25 ppm HCl, approximately 8 ppm hydrogen fluoride (HF), approximately 1 ppm Al, approximately 0.1 ppb Rb and approximately 4 ppb Pb. These concentrations almost certainly exceed those usually found in occupational exposure settings. Advanced levels of urinary Al and Rb were found following gas exposure and were statistically significant in the population at p<0.005 and p<0.001, respectively. The other chemical elements that were analysed (urinary Cl, F, and Hg; blood Pb, and serum Al) did not show such patterns. CONCLUSIONS: It is possible that urinary Al and Rb may be useful markers for exposure, a hypothesis which should be followed up in future work.

Pathogen survival trajectories: an eco-environmental approach to the modeling of human campylobacteriosis ecology.

Campylobacteriosis, like many human diseases, has its own ecology in which the propagation of human infection and disease depends on pathogen survival and finding new hosts in order to replicate and sustain the pathogen population. The complexity of this process, a process common to other enteric pathogens, has hampered control efforts. Many unknowns remain, resulting in a poorly understood disease ecology. To provide structure to these unknowns and help direct further research and intervention, we propose an eco-environmental modeling approach for campylobacteriosis. This modeling approach follows the pathogen population as it moves through the environments that define the physical structure of its ecology. In this paper, we term the ecologic processes and environments through which these populations move "pathogen survival trajectories." Although such a modeling approach could have veterinary applications, our emphasis is on human campylobacteriosis and focuses on human exposures to Campylobacter through feces, food, and aquatic environments. The pathogen survival trajectories that lead to human exposure include ecologic filters that limit population size, e.g., cooking food to kill Campylobacter. Environmental factors that influence the size of the pathogen reservoirs include temperature, nutrient availability, and moisture availability during the period of time the pathogen population is moving through the environment between infected and susceptible hosts. We anticipate that the modeling approach proposed here will work symbiotically with traditional epidemiologic and microbiologic research to help guide and evaluate the acquisition of new knowledge about the ecology, eventual intervention, and control of campylobacteriosis.

Disease surveillance in rural communities is compromised by address geocoding uncertainty: a case study of campylobacteriosis.

This study illustrates the impact of address geocoding uncertainty on rural estimates of reportable disease incidence using campylobacteriosis as an example. After all cases of campylobacteriosis notified from 1993 to 1997 had been geocoded, the minimum and maximum disease notification rates were calculated for rural and urban areas of New Zealand. The estimated maximum rural rates were four times higher than estimated minimum rural rates, whereas estimated minimum and maximum urban rates varied minimally. The impact of address geocoding on the estimation of disease notification rates across Public Health Service Regions showed considerable variation. The relative proportions of ungeocoded notifications to rural notifications ranged from 1.3:1 to 10.2:1, reflecting the range of uncertainty in estimated rural rates of campylobacteriosis. Unless the reliability of captured rural address data is improved significantly, disease surveillance systems will underestimate rural rates of disease and limit small area analyses.