HPV vaccination coverage within 3years of program launching (2008-2011) at Geneva State, Switzerland

Objective: The objective of this study is to assess the HPV vaccination coverage of 11-19-year-old girls during a state-coordinated HPV vaccination program in Geneva, Switzerland, from September 2008 to June 2011. Methods: State Medical Office coordinated the HPV vaccination program. Each service provider transmitted the list of the persons who had received their first, second, or third shot. Results: The global coverage rates, 3years after the program had been launched, were 63.72% for one dose, 63.22% for two doses, and 61.40% for three doses of the HPV vaccine. Conclusion: This study shows that it is possible to obtain a good coverage rates after 3years of a state-coordinated HPV vaccination progra

Prophylaxis Failure Is Associated with a Specific Pneumocystis carinii Genotype

To investigate the possible association between Pneumocystis carinii types and various clinical and demographic parameters, we used molecular typing to analyze 93 bronchoalveolar lavage specimens from patients with P. carinii pneumonia (PCP). Multivariate regression analysis revealed an association between being infected with a specific P. carinii genotype and receiving anti-PCP prophylaxis (odds ratio, 4.4; 95% confidence interval, 1.0-18.6; P = .05), although no association with a specific drug was detecte

Outbreak of Enterobacter cloacae Related to Understaffing, Overcrowding, and Poor Hygiene Practices

Abstract Objective: To determine the cause and mode of transmission of a cluster of infections due to Enterobacter cloacae. Design and Setting: Retrospective cohort study in a neonatal intensive-care unit (NICU) from December 1996 to January 1997; environmental and laboratory investigations. Subjects: 60 infants hospitalized in the NICU during the outbreak period. Main Outcome Measures: Odds ratios (OR) linking E cloacae colonization or infection and various exposures. All available E cloacae isolates were typed and characterized by contour-clamped homogenous electric-field electrophoresis to confirm possible cross-transmission. Results: Of eight case-patients, two had bacteremia; one, pneumonia; one, soft-tissue infection; and four, respiratory colonization. Infants weighing <2,000 g and born before week 33 of gestation were more likely to become cases (P<.001). Multivariate analysis indicated that the use of multidose vials was independently associated with E cloacae carriage (OR, 16.3; 95% confidence interval [CI95], 1.8-∞ P=011). Molecular studies demonstrated three epidemic clones. Cross-transmission was facilitated by understaffing and overcrowding (up to 25 neonates in a unit designed for 15), with an increased risk of E cloacae carriage during the outbreak compared to periods without understaffing and overcrowding (relative risk, 5.97; CI95, 2.2-16.4). Concurrent observation of healthcare worker (HCW) handwashing practices indicated poor compliance. The outbreak was terminated after decrease of work load, increase of hand antisepsis, and reinforcement of single-dose medication. Conclusions: Several factors caused and aggravated this outbreak: (1) introduction of E cloacae into the NICU, likely by two previously colonized infants; (2) further transmission by HCWs' hands, facilitated by substantial overcrowding and understaffing in the unit; (3) possible contamination of multidose vials with E cloacae. Overcrowding and understaffing in periods of increased work load may result in outbreaks of nosocomial infections and should be avoide

Evaluation de la qualité de vie chez les personnes infectées par le VIH

[Table des matières] I. Patients et méthodes. 1. Enquête auprès de personnes infectées par le VIH : participation et caractéristiques des participants. 2. Modalités de l'enquête. 3. Patients séropositifs hospitalisés. 4. Questionnaire. 5. Calcul des scores du SF-36 et du SF-36+CF. - II. Résultats commentés de l'enquête auprès de personnes infectées par le VIH et des autres groupes comparatifs de patients. 1. Comparaison entre le groupe de patients séropositifs et le groupe Consultation anonyme sida (PMU). 2. Comparaison entre le groupe des patients séropositifs et la population générale vaudoise. 3. Auto-évaluation de l'état de santé par rapport à l'année précédente. 4. Evolution des variables cliniques à 12 mois. 5. Analyse factorielle et scores synthétiques du SF-36. 6. Relation entre les scores des dimensions du SF-36+CF et la survenue du décès. - III. Evaluation du questionnaire. 1. Mesure de la qualité de vie liée à l'état de santé. 2. Adjonction de la dimension "fonctionnement cognitif". 3. Conclusions et recommandations

Prevalence and Risk Factors for Nosocomial Infections in Four University Hospitals in Switzerland

Abstract Objective: To determine the prevalence and risk factors for nosocomial infections (NIs) in four Swiss university hospitals. Design and Setting: A 1-week period-prevalence survey conducted in May 1996 in medical, surgical, and intensive-care wards of four Swiss university hospitals (900-1,500 beds). Centers for Disease Control and Prevention definitions were used, except that asymptomatic bacteriuria was not categorized as NI. Study variables included patient demographics, primary diagnosis, comorbidities, exposure to medical and surgical risk factors, and use of antimicrobials. Risk factors for NIs were determined using logistic regression with adjustment for length of hospital stay, study center, device use, and patients' comorbidities. Results: 176 NI were recorded in 156 of 1,349 screened patients (11.6%; interhospital range, 9.8%-13.5%). The most frequent NI was surgical-site infection (53; 30%), followed by urinary tract infection (39; 22%), lower respiratory tract infection (27; 15%), and bloodstream infection (23; 13%). Prevalence of NI was higher in critical-care units (25%) than in medical (9%) and surgical wards (12%). Overall, 65% of NIs were culture-proven; the leading pathogens were Enterobacteriaceae (44; 28%), Staphylococcus aureus (20; 13%), Pseudomonas aeruginosa (17; 11%), and Candida species (16; 10%). Independent risk factors for NI were central venous catheter (CVC) use (odds ratio [OR], 3.35; 95% confidence interval [CI95], 2.91-3.80), admission to intensive care (OR, 1.75; CI95, 1.30-2.21), emergency admission (OR, 1.57; CI95, 1.15-2.00), impaired functional status (Karnofsky index 1-4: OR, 2.56; CI95, 1.95-3.17), and McCabe classification of ultimately fatal (OR, 2.50; CI95, 2.04-2.96) or rapidly fatal (OR 2.25; CI95,1.52-2.98) underlying condition. Conclusions: According to the results of this survey, NIs are frequent in Swiss university hospitals. This investigation confirms the importance of CVCs as a major risk factor for NI. Patient comorbidities must be taken into account to adjust for case mix in any study comparing interhospital or intrahospital infection rate

Prevalence and Risk Factors for Nosocomial Infections in Four University Hospitals in Switzerland

Abstract Objective: To determine the prevalence and risk factors for nosocomial infections (NIs) in four Swiss university hospitals. Design and Setting: A 1-week period-prevalence survey conducted in May 1996 in medical, surgical, and intensive-care wards of four Swiss university hospitals (900-1,500 beds). Centers for Disease Control and Prevention definitions were used, except that asymptomatic bacteriuria was not categorized as NI. Study variables included patient demographics, primary diagnosis, comorbidities, exposure to medical and surgical risk factors, and use of antimicrobials. Risk factors for NIs were determined using logistic regression with adjustment for length of hospital stay, study center, device use, and patients' comorbidities. Results: 176 NI were recorded in 156 of 1,349 screened patients (11.6%; interhospital range, 9.8%-13.5%). The most frequent NI was surgical-site infection (53; 30%), followed by urinary tract infection (39; 22%), lower respiratory tract infection (27; 15%), and bloodstream infection (23; 13%). Prevalence of NI was higher in critical-care units (25%) than in medical (9%) and surgical wards (12%). Overall, 65% of NIs were culture-proven; the leading pathogens were Enterobacteriaceae (44; 28%), Staphylococcus aureus (20; 13%), Pseudomonas aeruginosa (17; 11%), and Candida species (16; 10%). Independent risk factors for NI were central venous catheter (CVC) use (odds ratio [OR], 3.35; 95% confidence interval [CI95], 2.91-3.80), admission to intensive care (OR, 1.75; CI95, 1.30-2.21), emergency admission (OR, 1.57; CI95, 1.15-2.00), impaired functional status (Karnofsky index 1-4: OR, 2.56; CI95, 1.95-3.17), and McCabe classification of ultimately fatal (OR, 2.50; CI95, 2.04-2.96) or rapidly fatal (OR 2.25; CI95,1.52-2.98) underlying condition. Conclusions: According to the results of this survey, NIs are frequent in Swiss university hospitals. This investigation confirms the importance of CVCs as a major risk factor for NI. Patient comorbidities must be taken into account to adjust for case mix in any study comparing interhospital or intrahospital infection rate

Cytomegalovirus Retinitis: Decreased Risk of Bilaterality with Increased Use of Systemic Treatment

Cytomegalovirus (CMV) retinitis may be treated systemically or intravitreally. We reviewed retrospectively patients with CMV retinitis, in order to determine whether systemic treatment was associated with less spread of CMV retinitis from one eye to the other. Of 222 cases, 92 patients had bilateral disease at onset of CMV retinitis, leaving 130 for analysis. Bilaterality occurred in 10 patients during 12,687 days of systemic treatment and in 34 during 14,791 days without systemic treatment (odds ratio [OR] = 2.92; confidence interval [CI], 1.44-5.90). Patients who had received systemic treatment for <50% of the follow-up period had a greater risk of bilaterality (OR = 3.7; CI, 2.79-4.54) than did the more intensively treated patients. CD4 cell levels also contributed to increased risk, but multivariate analysis showed that CD4 cell counts and treatment intensity were independent risk factors. CMV retinitis was more likely to become bilateral in patients who received less intravenous therapy. Local treatment can complete but does not replace systemically administered therap

Impact on construction project planning council of aqueduct Fruticas Chipaque

En los últimos años Colombia ha tenido un papel destacado en el escenario internacional por ser un país emergente económicamente, fortaleciendo significativamente los aspectos más relevantes para el desarrollo de un país. Dentro de estos factores relevantes se encuentra la construcción de infraestructurapública, que aporta grandes beneficios y brinda bienestar a la comunidad en general. Sin embargo muchas de estas obras se han visto afectadas por la mala planeación con la que se programan, incurriendo en sobrecostos que han llevado en el mejor de los casos a tiempos más largos de ejecución y en los casos más críticos al abandono de los proyectos, causando un notorio detrimento en el patrimonio de la nación y de los colombianos. Una vez revisada la información concerniente a la construcción del acueducto Fruticas del municipio de Chipaque se pudo determinar que son varios los factores que intervinieron para que su ejecución no se realizara dentro de los tiempos establecidos, siendo los más relevantes una pésima planeación de la obra dentro de su parte inicial y una gestión del riesgo inadecuada e inoportuna. El propósito fundamental de este artículo es hacer un análisis de un caso específico de un mal proyecto de construcción de infraestructura pública en Colombia, con el fin emitir algunas conclusiones, que de ser tenidas en cuenta, contribuyan a evitar que nuevos casos similares a este se presenten, afectando directamente a la economía del país y al mejoramiento de la calidad de vida de todos los colombianos.In recent years Colombia has had a prominent role on the international stage for being an economically emerging country, significantly strengthening the most important for a country's development issues. These relevant factors are the construction of public infrastructure, which provides great benefits and provides welfare to the community. However many of these works have been affected by the poor planning that are programmed with, incurring cost overruns that led to the best at longer runtimes and the most critical project abandonment cases causing a noticeable detriment to the heritage of the nation and Colombians. After reviewing the information concerning the construction of Fruticas aqueduct Township Chipaque it was determined that several factors intervened to your execution is not carried out within the established time, the most important being a lousy planning of the work within part of their initial management and inadequate and inappropriate risk. The main purpose of this paper is to analyze a specific case of a bad project to build public infrastructure in Colombia, to issue some conclusions, which if taken into account, help prevent new cases similar to this one submit, directly affecting the economy and improving the quality of life for all Colombians

Prevalence and Associated Factors for Chlamydia trachomatis Infection Among Undocumented Immigrants in a Primary Care Facility in Geneva, Switzerland: A Cross-Sectional Study

Chlamydia trachomatis infection (CTI) is the most frequent sexually transmitted infection in western countries. Its prevalence in undocumented immigrants, a rapidly growing vulnerable population, remains unknown. We aimed to document the prevalence of CTI and associated factors at the primary health care level. This cross-sectional study included all undocumented immigrants attending a health care facility in Geneva, Switzerland. Participants completed a questionnaire and were tested for CTI by PCR assay. Three-hundred thirteen undocumented immigrants (68.4% female, mean age 32.4 (SD 8) years) agreed to participate. CTI prevalence was 5.8% (95% CI 3.3-8.4). Factors associated with higher prevalence were age ≤25 (OR 3.9, 95% CI 1.3-12.2) and having had two or more sexual partners during the precedent year (OR 4.5, 95% CI 1.5-13.7). Prevalence and associated factors for infection in this vulnerable population were comparable with other populations in Western countries. Our findings support the importance of facilitating access to existing screening opportunities in particular to individuals at higher ris