Pelvic inflammatory disease during the post-partum year.

OBJECTIVE: To investigate the occurrence of, and risk factors for, pelvic inflammatory disease (PID) occurring during the post-partum year. METHODS: Demographic and clinical data for women who delivered a term infant with 5-minute Apgar score > or = 8 from 1992 through 1999 at a large urban hospital were extracted from an electronic medical record system. RESULTS: During the study period, 15 206 deliveries occurred among 12 549 women. PID was diagnosed during the post-partum year of 148 (1.0%) deliveries. In univariate analysis, young age, black race, and both pre-delivery history and post-partum diagnosis of chlamydial and gonococcal infection were associated with PID. In multivariate analysis, only young age and a positive test for gonorrhea before delivery or post-partum were independent predictors of PID. CONCLUSIONS: Pelvic inflammatory disease was diagnosed during the post-partum year in 1% of women studied. Young maternal age was an important demographic risk factor. Further investigation of post-partum STD acquisition and progression to PID is needed to determine whether women are at increased risk following delivery

La comunicación electrónica facilita la investigación de un brote de alta dispersión: salmonella en la super carretera

Los brotes ampliamente dispersos de enfermedades de origen alimenticio son un problema emergente de salud pública. El aumento de la movilidad de la población y la amplia distribución de los alimentos producidos centralmente significan que cuando un brote de enfermedad alimenticia ocurre, las personas afectadas pueden distribuirse a través de el país o aún del mundo. Los brotes ampliamente dispersos desafían los limitados recursos de salud pública; pueden ser difíciles detectar, laboriosos, y consumir mucho tiempo para investigarlos. Nosotros informamos la rápida y eficiente investigación de un brote ampliamente disperso interestatal mediante la comunicación electrónica entre los pacientes posibles y trabajadores de salud pública.Facultad de Ciencias Veterinaria

La comunicación electrónica facilita la investigación de un brote de alta dispersión: salmonella en la super carretera

Los brotes ampliamente dispersos de enfermedades de origen alimenticio son un problema emergente de salud pública. El aumento de la movilidad de la población y la amplia distribución de los alimentos producidos centralmente significan que cuando un brote de enfermedad alimenticia ocurre, las personas afectadas pueden distribuirse a través de el país o aún del mundo. Los brotes ampliamente dispersos desafían los limitados recursos de salud pública; pueden ser difíciles detectar, laboriosos, y consumir mucho tiempo para investigarlos. Nosotros informamos la rápida y eficiente investigación de un brote ampliamente disperso interestatal mediante la comunicación electrónica entre los pacientes posibles y trabajadores de salud pública.Facultad de Ciencias Veterinaria

La comunicación electrónica facilita la investigación de un brote de alta dispersión: salmonella en la super carretera

Los brotes ampliamente dispersos de enfermedades de origen alimenticio son un problema emergente de salud pública. El aumento de la movilidad de la población y la amplia distribución de los alimentos producidos centralmente significan que cuando un brote de enfermedad alimenticia ocurre, las personas afectadas pueden distribuirse a través de el país o aún del mundo. Los brotes ampliamente dispersos desafían los limitados recursos de salud pública; pueden ser difíciles detectar, laboriosos, y consumir mucho tiempo para investigarlos. Nosotros informamos la rápida y eficiente investigación de un brote ampliamente disperso interestatal mediante la comunicación electrónica entre los pacientes posibles y trabajadores de salud pública.Facultad de Ciencias Veterinaria

Recommendations of the Advisory Committee on Immunization Practices for Use of Cholera Vaccine

Cholera, caused by infection with toxigenic Vibrio cholerae bacteria of serogroup O1 (>99% of global cases) or O139, is characterized by watery diarrhea that can be severe and rapidly fatal without prompt rehydration. Cholera is endemic in approximately 60 countries and causes epidemics as well. Globally, cholera results in an estimated 2.9 million cases of disease and 95,000 deaths annually (1). Cholera is rare in the United States, and most U.S. cases occur among travelers to countries where cholera is endemic or epidemic. Forty-two U.S. cases were reported in 2011 after a cholera epidemic began in Haiti (2); however, <25 cases per year have been reported in the United States since 2012

Feasibility and acceptability of a patient-reported outcome intervention in chronic heart failure

Patients with chronic heart failure (CHF) have symptoms and concerns which are inadequately addressed. Patient-reported outcome measures (PROMs) can potentially improve the identification and management of advanced symptoms and palliative concerns. However, these have not been used in CHF.OBJECTIVES: To examine the feasibility and acceptability of using a PROM-the Integrated Palliative care Outcome Scale (IPOS)-together with heart failure nurse education and training to improve the identification and management of symptoms and concerns among patients with CHF.METHODS: A parallel, mixed methods design with an embedded qualitative component was used to examine the feasibility of recruitment, retention, intervention adherence/compliance and follow-up assessment completion (symptom burden, quality of life, psychological well-being). Patient and nurse qualitative semistructured interviews explored intervention and study design feasibility and its acceptability.RESULTS: Conversion to consent was 46.9% (372 screened, 81 approached, 38 recruited). 66% of patient participants completed the IPOS; 6% of IPOS questionnaire items were missing (non-response). Over two-thirds (65.6%) of these missing items related to three patients. No item was consistently missing; appetite was the most frequent missing item (1.4%). 92% of participants who completed the IPOS completed all follow-up assessments (1-2 days, 1-2 weeks and 4-6 weeks post-IPOS completion) with no missing data. The a priori feasibility objectives were met. Patients and nurses reported the intervention and study design feasible and acceptable.CONCLUSIONS: A palliative-specific PROM-based intervention is feasible and acceptable to both patients with CHF and nurses in nurse-led disease management clinics for the purposes of both clinical care and research.</p

An online decision tree for vaccine efficacy trial design during infectious disease epidemics: The InterVax-Tool.

BACKGROUND: Licensed vaccines are urgently needed for emerging infectious diseases, but the nature of these epidemics causes challenges for the design of phase III trials to evaluate vaccine efficacy. Designing and executing rigorous, fast, and ethical, vaccine efficacy trials is difficult, and the decisions and limitations in the design of these trials encompass epidemiological, logistical, regulatory, statistical, and ethical dimensions. RESULTS: Trial design decisions are complex and interrelated, but current guidance documents do not lend themselves to efficient decision-making. We created InterVax-Tool (http://vaxeval.com), an online, interactive decision-support tool, to help diverse stakeholders navigate the decisions in the design of phase III vaccine trials. InterVax-Tool offers high-level visual and interactive assistance through a set of four decision trees, guiding users through selection of the: (1) Primary Endpoint, (2) Target Population, (3) Randomization Scheme, and, (4) Comparator. We provide guidance on how key considerations - grouped as Epidemiological, Vaccine-related, Infrastructural, or Sociocultural - inform each decision in the trial design process. CONCLUSIONS: InterVax-Tool facilitates structured, transparent, and collaborative discussion of trial design, while recording the decision-making process. Users can save and share their decisions, which is useful both for comparing proposed trial designs, and for justifying particular design choices. Here, we describe the goals and features of InterVax-Tool as well as its application to the design of a Zika vaccine efficacy trial

Estimating the Attack Rate of Pregnancy-Associated Listeriosis during a Large Outbreak

Background. In 2011, a multistate outbreak of listeriosis linked to contaminated cantaloupes raised concerns that many pregnant women might have been exposed to Listeria monocytogenes. Listeriosis during pregnancy can cause fetal death, premature delivery, and neonatal sepsis and meningitis. Little information is available to guide healthcare providers who care for asymptomatic pregnant women with suspected L. monocytogenes exposure. Methods. We tracked pregnancy-associated listeriosis cases using reportable diseases surveillance and enhanced surveillance for fetal death using vital records and inpatient fetal deaths data in Colorado. We surveyed 1,060 pregnant women about symptoms and exposures. We developed three methods to estimate how many pregnant women in Colorado ate the implicated cantaloupes, and we calculated attack rates. Results. One laboratory-confirmed case of listeriosis was associated with pregnancy. The fetal death rate did not increase significantly compared to preoutbreak periods. Approximately 6,500–12,000 pregnant women in Colorado might have eaten the contaminated cantaloupes, an attack rate of ~1 per 10,000 exposed pregnant women. Conclusions. Despite many exposures, the risk of pregnancy-associated listeriosis was low. Our methods for estimating attack rates may help during future outbreaks and product recalls. Our findings offer relevant considerations for management of asymptomatic pregnant women with possible L. monocytogenes exposure

Implications for registry-based vaccine effectiveness studies from an evaluation of an immunization registry: A cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Population-based electronic immunization registries create the possibility of using registry data to conduct vaccine effectiveness studies which could have methodological advantages over traditional observational studies. For study validity, the base population would have to be clearly defined and the immunization status of members of the population accurately recorded in the registry. We evaluated a city-wide immunization registry, focusing on its potential as a tool to study pertussis vaccine effectiveness, especially in adolescents.</p> <p>Methods</p> <p>We conducted two evaluations – one in sites that were active registry participants and one in sites that had implemented an electronic medical record with plans for future direct data transfer to the registry – of the ability to match patients' medical records to registry records and the accuracy of immunization records in the registry. For each site, records from current pediatric patients were chosen randomly. Data regarding pertussis-related immunizations, clinic usage, and demographic and identifying information were recorded; for 11–17-year-old subjects, information on MMR, hepatitis B, and varicella immunizations was also collected. Records were then matched, when possible, to registry records. For records with a registry match, immunization data were compared.</p> <p>Results</p> <p>Among 350 subjects from sites that were current registry users, 307 (87.7%) matched a registry record. Discrepancies in pertussis-related data were common for up-to-date status (22.6%), number of immunizations (34.7%), dates (10.2%), and formulation (34.4%). Among 442 subjects from sites that planned direct electronic transfer of immunization data to the registry, 393 (88.9%) would have matched a registry record; discrepancies occurred frequently in number of immunizations (11.9%), formulation (29.1%), manufacturer (94.4%), and lot number (95.1%.) Inability to match and immunization discrepancies were both more common in subjects who were older at their first visit to the provider site. For 11–17-year-old subjects, discrepancies were also common for MMR, hepatitis B, and varicella vaccination data.</p> <p>Conclusion</p> <p>Provider records frequently could not be matched to registry records or had discrepancies in key immunization data. These issues were more common for older children and were present even with electronic data transfer. These results highlight general challenges that may face investigators wishing to use registry-based immunization data for vaccine effectiveness studies, especially in adolescents.</p