Burden of visceral leishmaniasis in villages of eastern gedaref state, Sudan: an exhaustive cross-sectional survey.

Since December 2009, Médecins Sans Frontières has diagnosed and treated patients with visceral leishmaniasis (VL) in Tabarak Allah Hospital, eastern Gedaref State, one of the main endemic foci of VL in Sudan. A survey was conducted to estimate the VL incidence in villages around Tabarak Allah

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Ecoconception du cabinet de médecine de famille ::concepts et vision d’avenir

L’éco-conception est un terme relativement nouveau pour les cabinets de médecine de famille. Il s’agit d’une démarche pro-active visant à réduire les impacts environnementaux nuisibles engendrés par une organisation ou un produit. Ces impacts environnementaux, comme le dérèglement climatique, représentent clairement des problèmes majeurs de santé publique, il semble donc légitime que le milieu médical s’interroge sur son rôle à « prévenir » plutôt que « guérir », également via sa contribution à la protection de l’environnement. Après avoir posé quelques éléments de définitions et de situations, cette revue dresse un état des lieux global de la pratique éco-conception dans le domaine médical ambulatoire. Enfin, des pistes de réflexions et de progrès sont présentées, avec un focus sur le contexte suisse

Determinants of Visceral Leishmaniasis: A Case-Control Study in Gedaref State, Sudan

<div><p>Background</p><p>Improving knowledge on local determinants of visceral leishmaniasis (VL) is crucial to guide the development of relevant control strategies. This study aimed to identify individual and household level determinants of primary VL in 24 highly endemic villages of Tabarak Allah hospital’s catchment area, Gedaref State, Sudan.</p><p>Methods</p><p>From September 2012 to July 2013, in an unmatched case-control design, 198 patients with primary VL were compared to 801 controls free of VL symptoms and with a negative VL rapid test. Using random spatial sampling, controls were selected with a distribution of age, sex and village of residence proportionate to the distribution of the target population. Data were collected using a structured questionnaire.</p><p>Results</p><p>Children and men were at higher risk of VL. Reporting VL patient(s) in the household in the previous year was the strongest VL risk factor. In a multivariate analysis, VL risk increased with household size, sleep location (outside the yard, not in the farm), evening outdoor activities in the rainy season (playing, watching TV, radio listening), use of ground nut oil as animal repellent and of smoke of Acacia seyal as indoor repellent, presence of dogs in the yard at night, Acacia nilotica in the yard’s immediate surroundings and of a forest at eye range. VL risk appeared to decrease with the use of drinking water sources other than the village water tank, a buffer distance from the adjacent house yard, and with the presence of animals other than dogs in the yard at night. In contrast with previous studies, housing factors, mosquito-net use, black cotton soil, ethnicity, socioeconomic index, presence of Balanites aegyptica and Azadirachta indica in the yard were not independent VL determinants.</p><p>Discussion and conclusion</p><p>Although these results do not provide evidence of causality, they provide useful suggestions for guiding further intervention studies on VL preventive measures.</p></div

Study area, case-control study on determinants of visceral leishmaniasis, Gedaref State, Sudan, 2012–2013.

<p>Left map: Annual incidence of visceral leishmaniasis (VL) in Sudan (2011) from < 5 cases /100,000 inhabitants (yellow) to ≥ 15 cases /100,000 inhabitants (red) (Source: Annual Report, Federal Ministry of Health, Sudan). Right map: Annual incidence of VL in Sudan (2011) proportionate to the size and colour of the circles (from 0 to ≥ 20 cases /1,000 inhabitants). The black circle includes the 24 study villages.</p

Individual level determinants associated (p<0.20) with VL after adjustment: crude and adjusted analysis.

<p>LR: Likelihood ratio; VL: visceral leishmaniasis; OR: Odds Ratio; 95%CI: 95% Confidence Interval;</p><p>* Adjusted for age, sex, their interaction, and village as random effect;</p><p>**Housework, too young, attending school, unemployed.</p><p>*** In the rainy season as a proxy of the whole year (trend of association being similar in both seasons though some factors less frequent in the dry season).</p><p>Gedaref State, Sudan, 2012–2013.</p

Socio-demographic characteristics, case-control study on determinants of visceral leishmaniasis, Gedaref State, Sudan, 2012–2013.

<p>Socio-demographic characteristics, case-control study on determinants of visceral leishmaniasis, Gedaref State, Sudan, 2012–2013.</p

Multivariate logistic regression mixed model of individual and household determinants for visceral leishmaniasis, with village as a random effect.

<p>OR: Odds Ratio; 95%CI: 95% Confidence Interval;</p><p>*Adjusted for village as a random effect (14% of variance, 95%CI 5–35%);</p><p>** During the rainy season; The level of education of the participant was not included in the model due to collinearity with age.</p><p>Gedaref, Sudan, 2012–2013.</p