Puente la Reina, Spain
Puente la Reina, Spain

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Pezzoli L.,Epidemiology Consultant | Mathelin J.P.,Public Health Agency | Hennessey K.,World Health Organization | Eswara-Aratchige P.,World Health Organization | And 2 more authors.
American Journal of Tropical Medicine and Hygiene | Year: 2017

The prevalence of hepatitis B virus (HBV) in Wallis and Futuna (WAF) was one of the highest in the Pacific and was the driving factor for introducing hepatitis B (HepB) vaccination in 1992 and HepB birth dose (HepB-BD) in 2006. Using lymphatic filariasis (LF) transmission assessment survey (TAS) as a survey platform for eliminating LF, we assessed HBV surface antigen (HBsAg) seroprevalence, HepB vaccination coverage, and its timeliness among schoolchildren in WAF. From one finger prick of all registered fourth and fifth grade students, we tested HBsAg and filariasis antigen simultaneously, and estimated HepB vaccination coverage and timeliness by reviewing students' immunization cards. Since the children targeted were born when the three-dose HepB schedule was 2, 3, and 8 months, we defined timely vaccination if each dose was given by 3, 4, and 12 months. Of 476 targeted, 427 were enrolled. HBsAg prevalence was 0.9%. Estimated HepB vaccination coverage was 97%, 97%, and 96% for the first, second, and third doses, respectively, yielding coverage for all three doses of 96%. Proportion of timely vaccination was lower: 80%, 56%, and 65%, respectively, and less than 50% for all three doses combined. The seroprevalence of HBsAg among schoolchildren in WAF is less than 1%, close to the control goal. HepB vaccination coverage was high, but many children were vaccinated late. We recommend increasing the efforts for timely HepB vaccination. By combining an HBV seroprevalence survey and coverage assessment, we demonstrated the benefit of using TAS as a public health platform to access schoolchildren. Copyright © 2017 by The American Society of Tropical Medicine and Hygiene.


PubMed | University of British Columbia, University of Victoria, Thompson Rivers University and Epidemiology Consultant
Type: | Journal: BMC public health | Year: 2016

Disparities in injury rates between Aboriginal and non-Aboriginal populations in British Columbia (BC) are well established. Information regarding the influence of residence on disparities is scarce. We sought to fill these gaps by examining hospitalization rates for all injuries, unintentional injuries and intentional injuries across 24years among i) Aboriginal and total populations; ii) populations living in metropolitan and non-metropolitan areas; and iii) Aboriginal populations living on- and off-reserve.We used data spanning 1986 through 2010 from BCs universal health care insurance plan, linked to vital statistics databases. Aboriginal people were identified by insurance premium group and birth and death record notations, and their residence was determined by postal code. On-reserve residence was established by postal code areas associated with an Indian reserve or settlement. Health Service Delivery Areas (HSDAs) were classified as metropolitan if they contained a population of at least 100,000 with a density of 400 or more people per square kilometre. We calculated the crude hospitalization incidence rate and the Standardized Relative Risk (SRR) of hospitalization due to injury standardizing by gender, 5-year age group, and HSDA. We assessed cumulative change in SRR over time as the relative change between the first and last years of the observation period.Aboriginal metropolitan populations living off-reserve had the lowest SRR of injury (2.0), but this was 2.3 times greater than the general British Columbia metropolitan population (0.86). For intentional injuries, Aboriginal populations living on-reserve in non-metropolitan areas were at 5.9 times greater risk than the total BC population. In general, the largest injury disparities were evident for Aboriginal non-metropolitan populations living on-reserve (SRR 3.0); 2.5 times greater than the general BC non-metropolitan population (1.2). Time trends indicated decreasing disparities, with Aboriginal non-metropolitan populations experiencing the largest declines in injury rates.Metropolitan/non-metropolitan residence appears to be a more important predictor than on/off-reserve residence for all injuries and unintentional injuries, and the relationship was even more pronounced for intentional injuries. The persistent disparities highlight the need for culturally sensitive and geographically relevant injury prevention approaches.


PubMed | University of British Columbia, University of Victoria, Thompson Rivers University and Epidemiology Consultant
Type: | Journal: SpringerPlus | Year: 2016

The current study examines what factors contribute to higher injury risk among Aboriginal peoples, compared to the total British Columbia (BC) population. We explore socioeconomic, geographic, and cultural factors, and combinations of these factors, that contribute to increased injury risk for Aboriginal peoples. This follows from our previously reported findings of improvements in injury risk over time for both the total and Aboriginal populations.We use provincial population-based linked health care databases of hospital discharge records. We identify three population groups: total BC population, and Aboriginal populations living off-reserve, or on-reserve. For each group we calculate age and gender-standardized relative risks (SRR) of injury-related hospitalization, relative to the total population of BC, for two 5-year time periods (1999-2003, and 2004-2008). We use custom data from the 2001 and 2006 long-form Censuses that described income, education, employment, housing conditions, proportion of urban dwellers, proportion of rural dwellers, and prevalence of Aboriginal ethnicity. We use multivariable linear regression to examine the associations between the census characteristics and SRR of injury.The best-fitting model was an excellent fit (R(2)=0.905, p<0.001) among the three population groups within Health Service Delivery Areas of BC. We find indicators in all three categories (socioeconomic, geographic, and cultural) are associated with disparity in injury risk. While the socioeconomic indicators (income, education, housing, employment) were shown to be highly correlated, only living in housing that needs major repair and occupational hazardousness, along with rural residence and Aboriginal ethnicity, remained in the final model. Our data show that cultural density is not associated with injury risk for Aboriginal peoples, and that living off-reserve is associated with reduced injury by improving socioeconomic and geographic conditions (compared to living on-reserve). Finally, our analyses show that Aboriginal status itself is associated with injury risk.Our findings confirm previous research indicating that geographical differences differentiate injury risk, including for Aboriginal populations, and that socioeconomic determinants are associated with health risks. Our analyses showing that Aboriginal status itself contributes to injury risk is new, but we can only speculate about pathway, and whether the causes are direct or indirect.


Martin-Hernandez R.,Centro Apicola Regional | Martin-Hernandez R.,Institute Recursos Humanos para la Ciencia y la Tecnologia INCRECYT | Botias C.,Centro Apicola Regional | Bailon E.G.,Centro Apicola Regional | And 4 more authors.
Environmental Microbiology | Year: 2012

Nosema ceranae has been suggested to be replacing Nosema apis in some populations of Apis mellifera honeybees. However, this replacement from one to the other is not supported when studying the distribution and prevalence of both microsporidia in professional apiaries in Spanish territories (transverse study), their seasonal pattern in experimental hives with co-infection or their prevalence at individual level (either in worker bees or drones). Nevertheless, N. ceranae has shown to present a higher prevalence at all the studied levels that could indicate any advantage for its development over N. apis or that it is more adapted to Spanish conditions. Also, both microsporidia show a different pattern of preference for its development according to the prevalence in the different Spanish bioclimatic belts studied. Finally, the fact that all analyses were carried out using an Internal PCR Control (IPC) newly developed guarantees the confidence of the data extracted from the PCR analyses. This IPC provides a useful tool for laboratory detection of honeybee pathogens. © 2011 Society for Applied Microbiology and Blackwell Publishing Ltd.


Pellock J.M.,Virginia Commonwealth University | Faught E.,Emory University | Sergott R.C.,Thomas Jefferson University | Shields W.D.,University of California at Los Angeles | And 5 more authors.
Epilepsy and Behavior | Year: 2011

The vigabatrin patient registry was implemented in August 2009 in conjunction with Food and Drug Administration approval of vigabatrin. All US vigabatrin-treated patients must enroll in the registry. Data on prescriber specialty/location, patient demographics, and clinical characteristics are collected. Benefit-risk assessments are required early in the course of therapy. Vision assessments are required at baseline (≤ 4. weeks after therapy initiation), every 3. months during therapy, and 3 to 6. months after discontinuation. As of February 1, 2011, 2473 patients (1500 with infantile spasms, 846 with refractory complex partial seizures, 120 with other diagnoses) had enrolled; 30.4% were previously exposed to vigabatrin. Kaplan-Meier analysis of time in registry indicated that 83 and 97% of all enrolled patients with refractory complex partial seizures and infantile spasms remained beyond 3 and 1. month, respectively. The ongoing registry will provide visual status and other information on vigabatrin-treated patients for both the infantile spasm and refractory complex partial seizure indications. © 2011 Elsevier Inc.


Paton D.J.,Institute for Animal Health | Sinclair M.,Epidemiology consultant | Rodriguez R.,Instituto Nacional de Tecnologia Agropecuaria
Transboundary and Emerging Diseases | Year: 2010

The risk of importing foot-and-mouth disease virus (FMDV) restricts trade in livestock and their products from parts of the world where the virus is present. This reduces trade opportunities and investment in the livestock sector of many developing countries and constrains global food supply. This review focuses on the risks associated with trade in deboned beef (DB) from foot-and-mouth disease (FMD)-infected cattle, countries or zones. A definition of DB is provided along with a description of the procedures for its preparation within beef slaughtering operations. Evidence is reviewed for circumstances under which DB can be contaminated with FMDV, and a commodity risk factor approach is used to consider the mitigating efficacy of slaughterhouse procedures. A combination of pre-slaughter and slaughterhouse measures has enabled DB to be safely imported into FMD-free countries from countries that were not nationally or zonally FMD-free. Nevertheless, current evidence does not provide absolute assurance that abattoir procedures for producing DB can result, by themselves, in a commodity with a negligible risk of transmitting FMDV without complementary measures to reduce the likelihood of slaughtering infected cattle. The main areas of uncertainty are the amounts of residual FMDV-harbouring tissues within DB, and our understanding of what constitutes a safe level of contamination. More detailed guidance should be developed to specify the mitigating measures needed in support of the export of DB from regions that are not officially FMD-free. This will help to avoid differences in interpretation of what is needed that give rise to obstacles to trade. © 2010 Blackwell Verlag GmbH.


Pezzoli L.,Epidemiology Consultant | Andrews N.,Public Health England | Ronveaux O.,World Health Organization
Tropical Medicine and International Health | Year: 2010

Objective Vaccination programmes targeting disease elimination aim to achieve very high coverage levels (e.g. 95%). We calculated the precision of different clustered lot quality assurance sampling (LQAS) designs in computer-simulated surveys to provide local health officers in the field with preset LQAS plans to simply and rapidly assess programmes with high coverage targets. Methods We calculated sample size (N), decision value (d) and misclassification errors (alpha and beta) of several LQAS plans by running 10 000 simulations. We kept the upper coverage threshold (UT) at 90% or 95% and decreased the lower threshold (LT) progressively by 5%. We measured the proportion of simulations with ≤d individuals unvaccinated or lower if the coverage was set at the UT (pUT) to calculate beta (1-pUT) and the proportion of simulations with >d unvaccinated individuals if the coverage was LT% (pLT) to calculate alpha (1-pLT). We divided N in clusters (between 5 and 10) and recalculated the errors hypothesising that the coverage would vary in the clusters according to a binomial distribution with preset standard deviations of 0.05 and 0.1 from the mean lot coverage. We selected the plans fulfilling these criteria: alpha ≤ 5% beta ≤ 20% in the unclustered design; alpha ≤ 10% beta ≤ 25% when the lots were divided in five clusters. Result When the interval between UT and LT was larger than 10% (e.g. 15%), we were able to select precise LQAS plans dividing the lot in five clusters with N = 50 (5 × 10) and d = 4 to evaluate programmes with 95% coverage target and d = 7 to evaluate programmes with 90% target. Conclusion These plans will considerably increase the feasibility and the rapidity of conducting the LQAS in the field. © 2010 Blackwell Publishing Ltd.


PubMed | University of British Columbia, Seabird Island Band and Epidemiology consultant
Type: Journal Article | Journal: Canadian journal of diabetes | Year: 2016

1) How closely do capillary glycated hemoglobin (A1C) levels agree with venous A1C levels? 2) How well do venous A1C levels agree with plasma glucose for diagnosis of diabetes in this population?The Seabird Island mobile diabetes clinic screened people not known to have diabetes by using finger-prick capillary A1C levels with point-of-care analysis according to the Siemens/Bayer DCA 2000 system. Clients then went to a clinical laboratory for confirmatory testing for venous A1C levels, fasting plasma glucose (FPG) and plasma glucose 2 hours after 75g oral glucose load (2hPG). A reference laboratory compared the DCA 2000 and the clinical laboratorys Roche Integra 800CTS system to the National Glycohemoglobin Standardization Program Diabetes Control and Complications Trial (DCCT) reference.1) In the reference laboratory, DCA 2000 and Integra 800CTS both agreed very closely with the DCCT standard. In the field, capillary glycated hemoglobin percent (A1C) % was biased, underestimating venous A1C % by a mean of 0.19 (p<0.001). The margin of error of bias-adjusted capillary A1C % was 0.36 for 95% of the time, compared to 0.27 for venous A1C%. 2) By linear regression, we found FPG 7.0mmol/L and 2hPG 11.1mmol/L predicted mean venous A1C levels very close to 6.5%, with no significant bias.Point-of-care capillary A1C did not perform as well in the field as in the laboratory, but the bias is correctible, and the margin of error is small enough that the test is clinically useful. In this population, venous A1C levels 6.5% agree closely with the FPG and 2hPG thresholds to diagnose diabetes; ethnic-specific adjustment of the venous A1C threshold is not necessary.


Engler-Stringer R.,University of Saskatchewan | Stringer B.,Epidemiology Consultant | Haines T.,McMaster University
Canadian Journal of Dietetic Practice and Research | Year: 2011

Purpose: This study was conducted to explore whether preparing more complex meals was associated with higher food security status. Methods: This mixed-methods, community-based study involved the use of semistructured interviews to examine the cooking practices of a group of young, low-income women in Montreal. Fifty participants aged 18 to 35 were recruited at 10 locations in five low-income neighbourhoods. Food security status was the main outcome measure and the main exposure variable, "complex food preparation," combined the preparation of three specific food types (soups, sauces, and baked goods) using basic ingredients. Results: Low-income women preparing a variety of meals using basic ingredients at least three times a week were more than twice as likely to be food secure as were women preparing more complex meals less frequently. Conclusions: Women who prepared more complex meals more frequently had higher food security. Whether this means that preparing more complex foods results in greater food security remains unclear, as this was an exploratory study.


PubMed | World Health Organization, Public Health Agency and Epidemiology Consultant
Type: | Journal: The American journal of tropical medicine and hygiene | Year: 2017

The prevalence of hepatitis B virus (HBV) in Wallis and Futuna (WAF) was one of the highest in the Pacific and was the driving factor for introducing hepatitis B (HepB) vaccination in 1992 and HepB birth dose (HepB-BD) in 2006. Using transmission assessment survey (TAS) as a survey platform for eliminating lymphatic filariasis (LF), we assessed HBV surface antigen (HBsAg) seroprevalence, HepB vaccination coverage, and its timeliness among schoolchildren in WAF. From one finger prick of all registered fourth and fifth grade students, we tested HBsAg and filariasis antigen simultaneously, and estimated HepB vaccination coverage and timeliness by reviewing students immunization cards. Since the children targeted were born when the three-dose HepB schedule was 2, 3, and 8 months, we defined timely vaccination if each dose was given by 3, 4, and 12 months. Of 476 targeted, 427 were enrolled. HBsAg prevalence was 0.9%. Estimated HepB vaccination coverage was 97%, 97%, and 96% for the first, second, and third doses, respectively, yielding coverage for all three doses of 96%. Proportion of timely vaccination was lower: 80%, 56%, and 65%, respectively, and less than 50% for all three doses combined. The seroprevalence of HBsAg among schoolchildren in WAF is less than 1%, close to the control goal. HepB vaccination coverage was high, but many children were vaccinated late. We recommend increasing the efforts for timely HepB vaccination. By combining an HBV seroprevalence survey and coverage assessment, we demonstrated the benefit of using TAS as a public health platform to access schoolchildren.

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