Search

Background: Legionnaires' disease is under-diagnosed because of inconsistent use of diagnostic tests and uncertainty about whom to test. We assessed the increase in case detection following large-scale introduction of routine PCR testing of respiratory specimens in New Zealand., Methods: LegiNZ was a national surveillance study done over 1-year in which active case-finding was used to maximise the identification of cases of Legionnaires' disease in hospitals. Respiratory specimens from patients of any age with pneumonia, who could provide an eligible lower respiratory specimen, admitted to one of 20 participating hospitals, covering a catchment area of 96% of New Zealand's population, were routinely tested for legionella by PCR. Additional cases of Legionnaires' disease in hospital were identified through mandatory notification., Findings: Between May 21, 2015, and May 20, 2016, 5622 eligible specimens from 4862 patients were tested by PCR. From these, 197 cases of Legionnaires' disease were detected. An additional 41 cases were identified from notification data, giving 238 cases requiring hospitalisation. The overall incidence of Legionnaires' disease cases in hospital in the study area was 5·4 per 100 000 people per year, and Legionella longbeachae was the predominant cause, found in 150 (63%) of 238 cases., Interpretation: The rate of notified disease during the study period was three-times the average over the preceding 3 years. Active case-finding through systematic PCR testing better clarified the regional epidemiology of Legionnaires' disease and uncovered an otherwise hidden burden of disease. These data inform local Legionnaires' disease testing strategies, allow targeted antibiotic therapy, and help identify outbreaks and effective prevention strategies. The same approach might have similar benefits if applied elsewhere in the world., Funding: Health Research Council of New Zealand., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objectives: to determine the correlation between a scale measuring the amount of care required by people in rest homes and two scales, the Booth scale and the composite scale which measure dependency. To examine the scales for retest reliability., Subjects: one hundred and twenty-five people aged 47 to 98 years, median age 84 years, living in seven rest homes in Dunedin., Method: subjects were assessed using the care, Booth and composite scales and the assessment repeated after four weeks., Results: the care scale test-retest reliability based on rank order correlates was 0.86. For the physical care items retest reliability was high but supervision and the management of behavioural problems showed poor retest reliability. Correlation between the care scale and the two dependency scales was only moderate (composite scale 0.64, Booth scale 0.55). Behavioural problems and the time for supervision were assessed on the care scale only and it was these components which accounted for most of the poor correlation between the care and dependency scales., Conclusion: the time required for the management of behavioural problems and supervision for some people in rest homes was considerable. Measurement of this was difficult and made assessment of individual residents in homes unreliable.