45 research outputs found
Lessons from SARS: A retrospective study of outpatient care during an infectious disease outbreak
<p>Abstract</p> <p>Background</p> <p>During severe acute respiratory syndrome (SARS) outbreak in Toronto, outpatient clinics at SickKids Hospital were closed to prevent further disease transmission. In response, a decision was made by the neonatal neuro-developmental follow up (NNFU) clinic staff to select patients with scheduled appointments to have a mail/telephone assessment using Ages and Stages Questionnaire (ASQ) or to postpone/skip their visit. The objective of this study was to compare the developmental assessment and its outcome in two groups of NNFU clinic patients, SARS versus non-SARS, over three standard clinic appointments.</p> <p>Methods</p> <p>We compared the diagnostic accuracy (identification of developmental delay), and patient management (referral for therapy or communication of a new diagnosis) of the strategies used during SARS, April/May 2003, to the standard assessment methods used for patients seen in April/May 2005 (non-SARS). In all cases data were obtained for 3 patient visits: before, during and after these 2 months and were compared using descriptive statistics.</p> <p>Results</p> <p>There were 95 patients in the SARS group and 99 non-SARS patients. The gestational age, sex, entry diagnosis and age at the clinic visit was not different between the groups. The NNFU clinic staff mailed ASQ to 27 families during SARS, 17 (63%) were returned, and 8 of the 17 were then contacted by telephone. Criteria used to identify infants at risk selected for either mailed ASQ or phone interviews were not clearly defined in the patients' charts. There was a significant under identification of developmental delay during SARS (18% versus 45%). Of those who responded to the mailed questionnaire, referrals for therapy rates were similar to non-SARS group. The lost to follow up rate was 24% for the SARS group compared with 7% for non-SARS. There was no difference in the overall rate of developmental delay in the two groups as identified at the 'after' visit.</p> <p>Conclusions</p> <p>Poor advanced planning led to a haphazard assessment of patients during this infectious disease outbreak. Future pandemic plans should consider planning for outpatient care as well as in hospital management of patients.</p
Coastal Upwelling Supplies Oxygen-Depleted Water to the Columbia River Estuary
Low dissolved oxygen (DO) is a common feature of many estuarine and shallow-water
environments, and is often attributed to anthropogenic nutrient enrichment from
terrestrial-fluvial pathways. However, recent events in the U.S. Pacific
Northwest have highlighted that wind-forced upwelling can cause naturally
occurring low DO water to move onto the continental shelf, leading to
mortalities of benthic fish and invertebrates. Coastal estuaries in the Pacific
Northwest are strongly linked to ocean forcings, and here we report observations
on the spatial and temporal patterns of oxygen concentration in the Columbia
River estuary. Hydrographic measurements were made from transect (spatial
survey) or anchor station (temporal survey) deployments over a variety of wind
stresses and tidal states during the upwelling seasons of 2006 through 2008.
During this period, biologically stressful levels of dissolved oxygen were
observed to enter the Columbia River estuary from oceanic sources, with minimum
values close to the hypoxic threshold of 2.0 mg L−1. Riverine
water was consistently normoxic. Upwelling wind stress controlled the timing and
magnitude of low DO events, while tidal-modulated estuarine circulation patterns
influenced the spatial extent and duration of exposure to low DO water. Strong
upwelling during neap tides produced the largest impact on the estuary. The
observed oxygen concentrations likely had deleterious behavioral and
physiological consequences for migrating juvenile salmon and benthic crabs.
Based on a wind-forced supply mechanism, low DO events are probably common to
the Columbia River and other regional estuaries and if conditions on the shelf
deteriorate further, as observations and models predict, Pacific Northwest
estuarine habitats could experience a decrease in environmental quality
The first case of Brucella canis in Sweden: background, case report and recommendations from a northern European perspective
Infection with Brucella canis has been diagnosed in Sweden for the first time. It was diagnosed in a three-year-old breeding bitch with reproductive disturbances. Fifteen in-contact dogs were tested repeatedly and all of them were negative for B. canis. The source of infection could not be defined. The present article describes the case and the measures undertaken and gives a short review over B. canis. Recommendations on how to avoid the infection in non-endemic countries are given
Developmental delays and dental caries in low-income preschoolers in the USA: a pilot cross-sectional study and preliminary explanatory model
Abstract Background Anecdotal evidence suggests that low-income preschoolers with developmental delays are at increased risk for dental caries and poor oral health, but there are no published studies based on empirical data. The purpose of this pilot study was two-fold: to examine the relationship between developmental delays and dental caries in low-income preschoolers and to present a preliminary explanatory model on the determinants of caries for enrollees in Head Start, a U.S. school readiness program for low-income preschool-aged children. Methods Data were collected on preschoolers ages 3–5 years at two Head Start centers in Washington, USA (N = 115). The predictor variable was developmental delay status (no/yes). The outcome variable was the prevalence of decayed, missing, and filled surfaces (dmfs) on primary teeth. We used multiple variable Poisson regression models to test the hypothesis that within a population of low-income preschoolers, those with developmental delays would have increased dmfs prevalence than those without developmental delays. Results Seventeen percent of preschoolers had a developmental delay and 51.3% of preschoolers had ≥1 dmfs. Preschoolers with developmental delays had a dmfs prevalence ratio that was 1.26 times as high as preschoolers without developmental delays (95% CI: 1.01, 1.58; P < .04). Other factors associated with increased dmfs prevalence ratios included: not having a dental home (P = .01); low caregiver education (P < .001); and living in a non-fluoridated community (P < .001). Conclusions Our pilot data suggest that developmental delays among low-income preschoolers are associated with increased primary tooth dmfs. Additional research is needed to further examine this relationship. Future interventions and policies should focus on caries prevention strategies within settings like Head Start classrooms that serve low-income preschool-aged children with additional targeted home- and community-based interventions for those with developmental delays