Utility of the Tourniquet Test and the White Blood Cell Count to Differentiate Dengue among Acute Febrile Illnesses in the Emergency Room

Dengue often presents with non-specific clinical signs, and given the current paucity of accurate, rapid diagnostic laboratory tests, identifying easily obtainable bedside markers of dengue remains a priority. Previous studies in febrile Asian children have suggested that the combination of a positive tourniquet test (TT) and leucopenia can distinguish dengue from other febrile illnesses, but little data exists on the usefulness of these tests in adults or in the Americas. We evaluated the diagnostic accuracy of the TT and leucopenia (white blood cell count <5000/mm3) in identifying dengue as part of an acute febrile illness (AFI) surveillance study conducted in the Emergency Department of Saint Luke's Hospital in Ponce, Puerto Rico. From September to December 2009, 284 patients presenting to the ED with fever for 2–7 days and no identified source were enrolled. Participants were tested for influenza, dengue, leptospirosis and enteroviruses. Thirty-three (12%) patients were confirmed as having dengue; 2 had dengue co-infection with influenza and leptospirosis, respectively. An infectious etiology was determined for 141 others (136 influenza, 3 enterovirus, 2 urinary tract infections), and 110 patients had no infectious etiology identified. Fifty-two percent of laboratory-positive dengue cases had a positive TT versus 18% of patients without dengue (P<0.001), 87% of dengue cases compared to 28% of non-dengue cases had leucopenia (P<0.001). The presence of either a positive TT or leucopenia correctly identified 94% of dengue patients. The specificity and positive predictive values of these tests was significantly higher in the subset of patients without pandemic influenza A H1N1, suggesting improved discriminatory performance of these tests in the absence of concurrent dengue and influenza outbreaks. However, even during simultaneous AFI outbreaks, the absence of leucopenia combined with a negative tourniquet test may be useful to rule out dengue

Identifying priorities within the health budget

Keynote panelConference Theme: Adding value in careGovernments are faced with a myriad of growing demands for healthcare services, from preventive services to more hospitals and clinics and new technologies. How do Health Ministries determine priorities within healthcare? How do they ensure that their finite budgets generate the best outcomes for their population? • How does value play a role in the setting of healthcare priorities? • How are outcomes used to shape how the healthcare budget is spent? • To what extent is health economics likely to inform not only funding decisions on new technologies but also broader healthcare policy decisions

Adaptação e avaliação de uma intervenção cognitivo-comportamental para meninos vítimas de violência sexual

Objetivou-se adaptar e avaliar um modelo de intervenção cognitivo-comportamental para meninos vítimas de Violência Sexual (VS), derivado de um modelo avaliado com meninas. A dissertação é composta por um artigo teórico sobre VS contra meninos, um capítulo que descreve o processo de adaptação do modelo, um relato de experiência sobre a produção e utilização de um documentário sobre VS contra meninos utilizado na aplicação do modelo adaptado e um artigo com os resultados dessa aplicação. Três meninos vítimas de VS com idades entre oito e 16 anos foram avaliados antes e após a intervenção por meio de instrumentos psicológicos quanto a sintomas comumente presentes em vítimas de VS. A aplicação do modelo adaptado foi avaliada por três juízes independentes por meio de seis indicadores. As avaliações sintomatológicas dos participantes e a da aplicação do modelo adaptado se constituem como evidências iniciais sobre sua ação terapêutica.This work aimed to adapt and assess a cognitive-behavioral intervention model for boys who are victims of sexual violence that was derived from a model that evaluated girls. The master thesis consists of a theoretical article about sexual violence against boys; a chapter describing the process of adapting the model; a report on the experience of producing and using the documentary about sexual violence against boys while applying the adapted model; and an article with the results from this application. Three boys between the ages of eight and 16 who had been victims of sexual violence were evaluated, through psychological instruments before and after the intervention, in terms of symptoms common to sexual violence victims. Three independent judges evaluated the application of the adapted model through six indicators. The evaluations of the participants’ symptoms as well as of the adapted model’s application provide initial proof of therapeutic effectiveness

The prevalence of anemia and iron deficiency is more common in breastfed infants than their mothers in Bhaktapur, Nepal

Background/Objectives: Iron deficiency anemia is a widespread public health problem, particularly in low- and middle-income countries. Maternal iron status around and during pregnancy may influence infant iron status. We examined multiple biomarkers to determine the prevalence of iron deficiency and anemia among breastfed infants and explored its relationship with maternal and infant characteristics in Bhaktapur, Nepal. Subjects/Methods: In a cross-sectional survey, we randomly selected 500 mother–infant pairs from Bhaktapur municipality. Blood was analyzed for hemoglobin, ferritin, total iron-binding capacity, transferrin receptors and C-reactive protein. Results: The altitude-adjusted prevalence of anemia was 49% among infants 2–6-month-old (hemaglobin (Hb) <10.8 g/dl) and 72% among infants 7–12-month-old (Hb <11.3 g/dl). Iron deficiency anemia, defined as anemia and serum ferritin <20 or <12 μg/l, affected 9 and 26% of infants of these same age groups. Twenty percent of mothers had anemia (Hb <12.3 g/dl), but only one-fifth was explained by depletion of iron stores. Significant predictors of infant iron status and anemia were infant age, sex and duration of exclusive breastfeeding and maternal ferritin concentrations. Conclusions: Our findings suggest that iron supplementation in pregnancy is likely to have resulted in a low prevalence of postpartum anemia. The higher prevalence of anemia and iron deficiency among breastfed infants compared with their mothers suggests calls for intervention targeting newborns and infants