Bed Bug Infestations in an Urban Environment

Bed bug infestations adversely affect health and quality of life, particularly among persons living in homeless shelters

Pharmacological methods for induction of abortion in bitches

Prekid skotnosti je čest zahtjev u veterinarskoj maloj praksi, zbog niza zdravstvenih i kinoloških razloga. Za kontrolu populacije pasa svakako se preporuča kirurška sterilizacija, koja u rasplodnih kuja nije prihvatljiva zbog ireverzibilnosti postupka. Danas postoji mnoštvo farmakoloških metoda kojima se može izazvati pobačaj u kuja, ovisno o stadiju gravidnosti. U prvoj trećini gravidnost još nije moguće sa sigurnošću dijagnosticirati, a žuto tijelo je refraktoran na egzogenu primjenu luteolitika. Moguće je koristiti estrogene, prostaglandine i inhibitore progesterona. Međutim, zbog nemogućnosti točne dijagnoze, tretiraju se i kuje koje nisu gravidne, a većina pripravaka ima jake nuspojave ili nisu dostupni na tržištu. U drugoj trećini gravidnosti moguća je 100% točna dijagnoza te je indukcija pobačaja izvediva, bilo s resorpcijom ili ekspulzijom plodova, i ostaje dovoljno vremena za ponavljanje tretmana u slučaju izostanka učinka. Za indukciju se može koristiti više pripravaka: prostaglandini, dopaminski agonisti, njihove kombinacije, inhibitori progesterona. U zadnjoj trećini indukcija pobačaja završava ekspulzijom plodova, koji, s obzirom na varijacije u određivanju trajanja gravidnosti, mogu biti i živi. Kod odabira farmakološke metode za indukciju pobačaja, prednost svakako imaju one, tretman kojima počinje nakon sigurne dijagnostike skotnosti, kako bi se izbjeglo nepotrebno tretiranje negravidnih kuja. Stoga se preporuča indukcija porođaja u razdoblju 30 do 35 dana nakon početka diestrusa ili od zadnjeg parenja. Pobačaj se može izazvati primjenom samo jednog preparata ili kombinacijom dvaju ili više njih. Mnoge od metoda imaju nepoželjne učinke na opće zdravstveno stanje životinje te se ne koriste (npr. estrogeni, antiestrogeni), ili im učinak nije dovoljno istražen (npr. GnRH antagonisti). Unatoč pozitivnim iskustvima u literaturi, neki od u radu navedenih preparata nisu dostupni na hrvatskom tržištu (npr. aglepriston). U zdravih kuja s potvrđenom, ali neželjenom skotnošću, najuspješnijom se pokazala primjena prostaglandina F2α (prirodnog ili sintetičkog analoga) u kombinaciji s dopaminskim agonistom (bromokriptin ili kabergolin), posebice uz redovite ultrazvučne kontrole do potvrde pobačaja.Termination of unwanted pregnancy is a common requirement in veterinary small practice due to a series of health and breeding management reasons. In order to control the population of dogs, surgical sterilization is recommended, which in breeding bitches is not acceptable due to the irreversibility of the procedure. Today, pharmacological methods that can be used to induce abortion in the bitch are numerous, depending on the stage of pregnancy. In the first trimester, pregnancy cannot be diagnosed with certainty, and the CL is refractory to exogenous administration of luteolytic agents. It is possible to use estrogens, prostaglandins and progesterone inhibitors. However, due to the impossibility of accurate diagnosis, non-pregnant bitches are treated also, and most preparations have severe side effects, or are not available on the market. In the second trimester, 100% accurate diagnosis is possible and abortion induction is feasible, either by fetal resorption or expulsion, and there is enough time to repeat the treatment, if necessary in case of a failure. Multiple preparations may be used for induction: prostaglandins, dopamine agonists, their combinations, progesterone inhibitors. In the last trimester, induction of abortion ends with the expulsion of fetuses, which, due to variations in the determination of the pregnancy duration, may be alive. When choosing a pharmacological method for induction of abortion, treatments that begin after a definitive pregnancy diagnoses are more favorable, because of avoiding unnecessary treatment of non-pregnant bitches. Therefore, recommended period for starting the induction of abortion is between 30 to 35 days after the onset of dioestrus or from the last mating. Abortion may be caused by the use of only one preparation or a combination of two or more of them. Many of the methods have undesirable effects on the overall health of the animal and are not used (e.g. estrogen, antiestrogen); or their effect is not sufficiently explored (e.g. GnRH antagonists). Despite of good reported success in recent literature, some of the preparations are unavailable on the Croatian market (e.g. aglepriston). In healthy bitches with confirmed but undesired pregnancy, the most successful method for induction of abortion is a combination of prostaglandin F2α (natural or synthetic analogues) and dopamine agonist (bromocriptine or cabergoline), with the emphasis on regular ultrasound controls until abortion is confirmed

Population-Based Surveillance for Invasive Pneumococcal Disease in Homeless Adults in Toronto

BACKGROUND: Identification of high-risk populations for serious infection due to S. pneumoniae will permit appropriately targeted prevention programs. METHODS: We conducted prospective, population-based surveillance for invasive pneumococcal disease and laboratory confirmed pneumococcal pneumonia in homeless adults in Toronto, a Canadian city with a total population of 2.5 M, from January 1, 2002 to December 31, 2006. RESULTS: We identified 69 cases of invasive pneumococcal disease and 27 cases of laboratory confirmed pneumococcal pneumonia in an estimated population of 5050 homeless adults. The incidence of invasive pneumococcal disease in homeless adults was 273 infections per 100,000 persons per year, compared to 9 per 100,000 persons per year in the general adult population. Homeless persons with invasive pneumococcal disease were younger than other adults (median age 46 years vs 67 years, P<.001), and more likely than other adults to be smokers (95% vs. 31%, P<.001), to abuse alcohol (62% vs 15%, P<.001), and to use intravenous drugs (42% vs 4%, P<.001). Relative to age matched controls, they were more likely to have underlying lung disease (12/69, 17% vs 17/272, 6%, P = .006), but not more likely to be HIV infected (17/69, 25% vs 58/282, 21%, P = .73). The proportion of patients with recurrent disease was five fold higher for homeless than other adults (7/58, 12% vs. 24/943, 2.5%, P<.001). In homeless adults, 28 (32%) of pneumococcal isolates were of serotypes included in the 7-valent conjugate vaccine, 42 (48%) of serotypes included in the 13-valent conjugate vaccine, and 72 (83%) of serotypes included in the 23-valent polysaccharide vaccine. Although no outbreaks of disease were identified in shelters, there was evidence of clustering of serotypes suggestive of transmission of pathogenic strains within the homeless population. CONCLUSIONS: Homeless persons are at high risk of serious pneumococcal infection. Vaccination, physical structure changes or other program to reduce transmission in shelters, harm reduction programs to reduce rates of smoking, alcohol abuse and infection with bloodborne pathogens, and improved treatment programs for HIV infection may all be effective in reducing the risk

Difficult behaviors in the emergency department: a cohort study of housed, homeless and alcohol dependent individuals.

This study contrasted annual rates of difficult behaviours in emergency departments among cohorts of individuals who were homeless and low-income housed and examined predictors of these events.Interviews in 1999 with men who were chronically homeless with drinking problems (CHDP) (n = 50), men from the general homeless population (GH) (n = 61), and men residing in low-income housing (LIH) (n = 58) were linked to catchment area emergency department records (n = 2817) from 1994 to 1999. Interview and hospital data were linked to measures of difficult behaviours.Among the CHDP group, annual rates of visits with difficult behaviours were 5.46; this was 13.4 (95% CI 10.3-16.5) and 14.3 (95% CI 11.2-17.3) times higher than the GH and LIH groups. Difficult behaviour incidents included physical violence, verbal abuse, uncooperativeness, drug seeking, difficult histories and security involvement. Difficult behaviours made up 57.54% (95% CI 55.43-59.65%), 24% (95% CI 19-29%), and 20% (95% CI 16-24%) of CHDP, GH and LIH visits. Among GH and LIH groups, 87% to 95% were never involved in verbal abuse or violence. Intoxication increased all difficult behaviours while decreasing drug seeking and leaving without being seen. Verbal abuse and violence were less likely among those housed, with odds ratios of 0.24 (0.08, 0.72) and 0.32 (0.15, 0.69), respectively.Violence and difficult behaviours are much higher among chronically homeless men with drinking problems than general homeless and low-income housed populations. They are concentrated among subgroups of individuals. Intoxication is the strongest predictor of difficult behaviour incidents

Breakdown of types of difficult behaviour during emergency department visits among homeless and low-income housed men.

<p>All bracketed figures are 95% confidence intervals.</p><p>Breakdown of types of difficult behaviour during emergency department visits among homeless and low-income housed men.</p

Comparison of Demographic and Mental Health Measures between study subject cohorts.

<p>^* CI denotes confidence interval</p><p>^† After direct age standardized to the CHDP cohort.</p><p>^‡Alcohol dependence, Major Depressive Episode, Generalized Anxiety Disorder and Drug Dependence meeting DSM IIIR criteria using the WHO Composite International Diagnostic Interview Short Form instrumen</p><p>Comparison of Demographic and Mental Health Measures between study subject cohorts.</p

Odds ratios of factors impacts on rates of difficult behaviours in emergency departments based on a multivariate model that included all of these factors.

<p>Odds ratios of factors impacts on rates of difficult behaviours in emergency departments based on a multivariate model that included all of these factors.</p

Serotype distribution in patients with severe pneumococcal disease, Toronto, 2002–2006.

*<p>Serotypes listed are those which comprise >5% of isolates from any one category of disease. During the surveillance period, there 3 episodes of invasive disease due to serotype 1 (none in homeless persons), 10 episodes due to serotype 8 (1 in a homeless person), and no episodes of disease due to serotype 5.</p>†<p>Serotypes included in 7-valent conjugate and 23 valent polysaccharide vaccine.</p>‡<p>Serotypes included in 23-valent polysaccharide vaccine, but not the 7-valent conjugate vaccine.</p