Entering out-of-home care during childhood: Cumulative incidence study in Canada and Australia

Cumulative incidence provides a more accurate indicator than annual incidence rates of the number of children who experience out-of-home care during childhood. The study utilises a cohort of all children born in Western Australia (WA) 1994–2005 and Manitoba 1998–2008 using de-identified linked data. Life tables were used to calculate the age-specific cumulative incidence over time and for at-risk groups. Cox regression was used to compare risk factors for entry to care. Manitoba had a larger proportion of children entering care compared to WA (9.4% vs 1.5% by age 12). Over time children entered care at a younger age in both WA (HR = 1.5, CI:1.4–1.5) and Manitoba (HR = 1.5, CI:1.5–1.6). Similar factors were associated with earlier age care entries in both countries including: socioeconomic disadvantage, young maternal age, maternal hospital admissions for mental health issues, substance misuse and assault. Supplementary analysis for WA showed a time trend with young children (<3 years of age) who entered care spending an increasing proportion of their early years in care. Whilst Manitoba had a larger proportion of children entering care, over time in Western Australia children have been entering care at a younger age and spending more time in care. These latter factors contribute to an increased burden on the out-of-home care system. Manitoba had over five times greater cumulative incidence than WA, however risk factors for entry to out-of-home care were consistent in both countries. Knowledge of the risk factors for entry to out-of-home care can inform targeted support and prevention programs

SURVEILLANCE FOR VANCOMYCIN RESISTANT ENTEROCOCCI IN A TERTIARY INSTITUTION IN SOUTH WESTERN NIGERIA

Background. Enterococci are responsible for up to 12% of cases of healthcare associated infections worldwide and cause life threatening infections among critically ill patients. They show intrinsic and acquired resistance to a wide range of antimicrobial agents. Glycopeptide resistance is due to vanA, vanB, vanC, vanD, vanE, vanG and vanL genes. Objectives. To determine the carriage rate of VRE among patients on prolonged hospitalization in LUTH, assess the antimicrobial resistance pattern of VRE, identify factors associated with VRE colonization and describe the genetic determinants of enterococcal resistance to Vancomycin. Methods. VRE were isolated from rectal swabs collected from patients hospitalized for seven days or more in Lagos University Teaching Hospital and identified by Matrix Assisted Laser Desorption Ionization (MALDI) and Polymerase Chain Reaction (PCR). Antimicrobial susceptibility testing was performed by E-test. PCR assay for Vancomycin resistance genes was also performed. Data on demographic and risk factors collected by questionnaire was tested for significance using chi square. Results. Thirteen of 319 patients surveyed were colonized with VRE; one with vanA E. faecium, two with vanB E. faecium, ten with E. gallinarum and one with E. casseliflavus. Univariate analysis for risk factors associated with VRE colonization was only significant for the ward of admission. Only one VRE isolate showed full resistance to vancomycin and Teicoplanin. Three were resistant to Ampicillin and nine to Ciprofloxacin but all were susceptible to Linezolid. High-level resistance to Gentamicin was found in four VRE isolates. Conclusion. There is a low prevalence of VRE in Lagos University Teaching Hospital which may be spreading among patients in affected wards

Characteristics of a population-based multiple sclerosis cohort treated with disease-modifying drugs in a universal healthcare setting

BACKGROUND: Relatively little is known about the use of disease-modifying drugs (DMDs) for multiple sclerosis (MS) in the population-based universal healthcare setting. This study aimed to describe the characteristics of a population-based cohort with MS and their DMD exposure in four Canadian provinces. METHODS: We identified all adults (aged ≥18 years) with MS using linked population-based health administrative data. Individuals were followed from the most recent of their first MS or demyelinating event or 1 January 1996(study entry), to the earliest of death, emigration, or 31 March 2018(study end). Cohort characteristics examined included sex, age, socioeconomic status, and comorbidity burden. RESULTS: Overall, 10,418/35,894 (29%) of MS cases filled a DMD prescription during the 22-year study period. Most were women (n = 7,683/10,418;74%), and 17% (n = 1,745/10,418) had some comorbidity (Charlson Comorbidity Index≥1) at study entry. Nearly 20% (n = 1,745/10,418) were aged ≥50 when filling their first DMD; the mean age was 39.6 years. CONCLUSIONS: Almost 1 in 6 people with MS had at least some comorbidity, and nearly 1 in 6 were ≥50 years old at the time of their first DMD. As these individuals are typically excluded from clinical trials, findings illustrate the need to understand the harms and benefits of DMD use in these understudied groups

A framework for modelling differences in regional mortality over time

Study objective: To present a conceptual framework for testing differences in mortality for small geographical areas over time using the generalised linear model with generalised estimating equations. This framework can be used to test whether the magnitude of regional inequalities in health status has changed over time. Design: A Poisson regression model for correlated data is used to investigate the relation of population health status to demographic, geographical, and temporal explanatory variables. Differences between regions at one or more points in time are tested with linear contrasts. Setting and participants: A case example shows the application of the framework. All cause mortality and cause specific mortality were compared for three rural regions of Manitoba, Canada between 1985 and 1999. The data were obtained from Vital Statistics records and the provincial health registry. Main results: Tests of linear contrasts on the regression coefficients for time and region show an increase in the magnitude of the difference in the risk of all cause mortality and heart disease mortality between northern and southern regions of the province for the 1985–1989 and 1995–1999 time periods. No significant differences are identified for cancer, injury, or respiratory disease mortality. Conclusions: The proposed framework enables testing of a variety of hypotheses about differences between regions and time periods and can be applied to other measures of population health status

Empowering vocational educators instructional delivery through information and communication technology training in universities

&lt;p&gt;This paper explores ways of empowering vocational educators for effective instructional delivery through information and communication technology (ICT) training in tertiary institutions in Enugu State, Nigeria. A descriptive survey research design was used with a population of 63 respondents, comprising lecturers of computer education and business education from University of Nigeria, Enugu State University of Science and Technology, and Godfrey Okoye University. There was no sampling carried out due to the manageable size of the population. The researchers employed a structured questionnaire as a means of collecting data. The collected data were analysed using the mean ( ) and standard deviation. The findings of the study revealed that ICT training would help promote effective instructional delivery in universities in Enugu State. Also, various ICT skills are required by vocational educators for effective instructional delivery. Lastly, several challenges are constraining the ICT training for effective instructional delivery in universities in Enugu State. Based on the findings, the study recommends, among others, that universities should make provision for training and retraining of vocational educators on the u&lt;/p&gt

Fungal Quality of Fresh Shrimp Sold at Ndibe-Beach in Afikpo, Ebonyi State

Abstract: The Fungal quality of fresh shrimp collected from Ndibe-beach in Afikpo North Local Government Area of Ebonyi State, Nigeria was investigated using standard microbiological procedures. A total of 60g samples sourced from three vendors (A, B, and C

Measure of Investment Optimal Strategy

Abstract In this paper, we considered the different strategies that generate the optimal wealth on investment. The strategy examine depends on the utility function an investor is willing to adopt, say H * at time N in every 2n possible states; in an N period setting. Negative exponential, logarithm, square root and power utility functions were established, as the market structures changed according to a Markov chain through a martingale approach. The problem of maximization is solved via Lagrange method. The performance of the investment from day-to-day is driven by the ratio of the risk neutral probability and the probability of rising to falling