Infectious diseases in a Nicaraguan refugee camp in Costa Rica

Artículo científico -- Universidad de Costa Rica. Instituto de Investigaciones en Salud, 1989Some Nicaraguans living in Costa Rica are in refugee camps. The types and rates of infectious diseases in the Pueblo Nuevo refugee camp were measured by examining medical records for 1985 and performing stool and blood testing. The incidence of infections was 320 episodes per 1000 persons per year. Respiratory infections represented 63% of all illnesses and pulmonary tuberculosis was high. Malaria was not found in blood samples and no childhood illnesses preventable by immunizations were recorded in the records. intestinal parasites were found in 565 of the persons examined, considerably higher than the 153/4 prevalence noted in surveys of Costa Rica as a whole. Trichuris trichlura was found in 40 To of the positive stool samples. The deficient hygienic conditions and overcrowding in the camp are responsible for the high rates of infections and the continued presence of infections many of which probably were acquired in Nicaragua. Improvement of hygienic conditions can be accomplished by involving the refugees in education, cleaning and identifying problem areas. Adequate sanitation and improved water supply, and reducing overcrowding are also recommended.Universidad de Costa Rica. Instituto de Investigaciones en Salud.Columbia University College of Physicians and Surgeons. New YorkUCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Instituto de Investigaciones en Salud (INISA

Public Health Forward: Modernizing the U.S. Public Health System

Public Health Forward: Modernizing the U.S. Public Health System defines a vision for a modernized public health system in the 21st century and provides a framework of practical, prioritized, and bipartisan actions for policymakers and public health officials to guide strategic investments and decision-making to help translate the vision into a reality with a focus on equity. The federal government continues to provide critical leadership and funding to navigate the current pandemic and has a responsibility to make significant investments and changes in public health for the post-pandemic future. Long-term, increased, sustainable funding and policy leadership from the federal government will be crucial to support this five-year vision, framework, and set of actions, as most public health departments are concerned over their funding levels, notwithstanding the recent infusion of money

Teaching Matters: Essays by UMF Faculty

Essays by faculty at the University of Maine at Farmington.https://scholarworks.umf.maine.edu/publications/1086/thumbnail.jp

MICE or NICE? An economic evaluation of clinical decision rules in the diagnosis of heart failure in primary care.

BACKGROUND: Detection and treatment of heart failure (HF) can improve quality of life and reduce premature mortality. However, symptoms such as breathlessness are common in primary care, have a variety of causes and not all patients require cardiac imaging. In systems where healthcare resources are limited, ensuring those patients who are likely to have HF undergo appropriate and timely investigation is vital. DESIGN: A decision tree was developed to assess the cost-effectiveness of using the MICE (Male, Infarction, Crepitations, Edema) decision rule compared to other diagnostic strategies to identify HF patients presenting to primary care. METHODS: Data from REFER (REFer for EchocaRdiogram), a HF diagnostic accuracy study, was used to determine which patients received the correct diagnosis decision. The model adopted a UK National Health Service (NHS) perspective. RESULTS: The current recommended National Institute for Health and Care Excellence (NICE) guidelines for identifying patients with HF was the most cost-effective option with a cost of £4400 per quality adjusted life year (QALY) gained compared to a "do nothing" strategy. That is, patients presenting with symptoms suggestive of HF should be referred straight for echocardiography if they had a history of myocardial infarction or if their NT-proBNP level was ≥400pg/ml. The MICE rule was more expensive and less effective than the other comparators. Base-case results were robust to sensitivity analyses. CONCLUSIONS: This represents the first cost-utility analysis comparing HF diagnostic strategies for symptomatic patients. Current guidelines in England were the most cost-effective option for identifying patients for confirmatory HF diagnosis. The low number of HF with Reduced Ejection Fraction patients (12%) in the REFER patient population limited the benefits of early detection

Time, the Written Record, and Professional Practice: The Case of Contemporary Social Work

Drawing on a three year ethnographically-oriented study exploring contemporary professional social work writing, this paper focuses on a key concern: the amount of time taken up with writing, or ‘paperwork’. We explore the relationship between time and professional social work writing in three key ways. Firstly, as a discrete, measurable phenomenon - how much time is spent on writing? Secondly, as a textual dimension to social work writing – how do institutional documents drive particular entextualisations of time and how do social worker texts entextualise time? Thirdly, as a particular timespace configuration of lived experience - how is time experienced by professional social workers? Findings indicate that a dominant institutional chronotope is governing social work textual practice underpinned by an ideology of writing which is at odds with social workers’ desired practice and professional goals. Methodologically, the paper illustrates the value of combining a range of data and analytic tools, using textual and contextual data, as well as qualitative and quantitative frames of analysis

Asymmetrical Gene Flow in a Hybrid Zone of Hawaiian Schiedea (Caryophyllaceae) Species with Contrasting Mating Systems

Asymmetrical gene flow, which has frequently been documented in naturally occurring hybrid zones, can result from various genetic and demographic factors. Understanding these factors is important for determining the ecological conditions that permitted hybridization and the evolutionary potential inherent in hybrids. Here, we characterized morphological, nuclear, and chloroplast variation in a putative hybrid zone between Schiedea menziesii and S. salicaria, endemic Hawaiian species with contrasting breeding systems. Schiedea menziesii is hermaphroditic with moderate selfing; S. salicaria is gynodioecious and wind-pollinated, with partially selfing hermaphrodites and largely outcrossed females. We tested three hypotheses: 1) putative hybrids were derived from natural crosses between S. menziesii and S. salicaria, 2) gene flow via pollen is unidirectional from S. salicaria to S. menziesii and 3) in the hybrid zone, traits associated with wind pollination would be favored as a result of pollen-swamping by S. salicaria. Schiedea menziesii and S. salicaria have distinct morphologies and chloroplast genomes but are less differentiated at the nuclear loci. Hybrids are most similar to S. menziesii at chloroplast loci, exhibit nuclear allele frequencies in common with both parental species, and resemble S. salicaria in pollen production and pollen size, traits important to wind pollination. Additionally, unlike S. menziesii, the hybrid zone contains many females, suggesting that the nuclear gene responsible for male sterility in S. salicaria has been transferred to hybrid plants. Continued selection of nuclear genes in the hybrid zone may result in a population that resembles S. salicaria, but retains chloroplast lineage(s) of S. menziesii