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Abstract Background Long-lasting insecticidal nets (LLINs) are an important tool for controlling malaria. Much attention has been devoted to determine both the effect of LLINs on the reduction of Plasmodium infection rate and on clinically-confirmed malaria cases in sub-Saharan Africa. We carried out an epidemiological study to investigate whether LLINs impact on Plasmodium prevalence rate and the proportion of clinically-confirmed malaria cases, in five villages in the district of Toumodi, central Côte d'Ivoire. Methods From April 2007 to November 2008, a community-based malaria control programme was implemented in the study villages, which involved large-scale distribution of LLINs, and training and sensitization activities within the community. We determined the effect of this programme on Plasmodium prevalence rate, clinically-confirmed malaria cases and proportion of high parasitaemia rates in children aged 6-59 months through a series of cross-sectional surveys starting in April 2007 and repeated once every 6 months. Results We observed a significant decrease in the mean P. falciparum prevalence rate from April 2007 to April 2008 (p = 0.029). An opposite trend was observed from November 2007 to November 2008 when P. falciparum prevalence rate increased significantly (p = 0.003). Highly significant decreases in the proportions of clinical malaria cases were observed between April 2007 and April 2008 (p < 0.001), and between November 2007 and November 2008 (p = 0.001). Conclusions Large-scale distribution of LLINs, accompanied by training and sensitization activities, significantly reduced Plasmodium prevalence rates among young children in the first year of the project, whereas overall clinical malaria rates dropped over the entire 18-month project period. A decrease in community motivation to sleep under bed nets, perhaps along with changing patterns of malaria transmission, might explain the observed increase in the Plasmodium prevalence rate between November 2007 and November 2008.

The aim of this paper is to investigate the impact of 'negative behaviours' and 'bullying' in the workplace on the health and well-being of employees, to what extent the effects remain beyond the period of the experience as well as the extent to which they affect third-parties or witnesses. The paper also raises the question whether some behaviours associated with bullying may be more damaging than others. Potential sex differences and differences between occupational contexts are considered. To achieve these aims, a national cross-sectional study (N =5,388) was carried out. In absolute terms those who labelled their experience as bullying had substantially worse health than those who were not bullied. However, counter to what was expected, stronger associations were found between negative behaviour and adverse health effects than for self-reported (self-labelled) bullying and health. Previous targets as well as witnesses also reported worse health than those who were neither bullied nor had witnessed bullying. The findings also imply that some negative behaviours were more difficult to deal with than others. In all cases differences between the sexes and between occupational contexts emerged.

Objective To document the prevalence of multidrug resistance among people newly diagnosed with - and those retreated for-tuberculosis in Malawi. Methods We conducted a nationally representative survey of people with sputum-smear-positive tuberculosis between 2010 and 2011. For all consenting participants, we collected demographic and clinical data, two sputum samples and tested for human Immunodeficiency virus (HIV).The samples underwent resistance testing at the Central Reference Laboratory in Lilongwe, Malawi. All Mycobacterium tuberculosis isolates found to be multidrug-resistant were retested for resistance to first-line drugs--and tested for resistance to second-line drugs--at a Supranational Tuberculosis Reference Laboratory in South Africa. Findings Overall, M. tuberculosis was Isolated from 1777 (83.8%) of the 2120 smear-positive tuberculosis patients. Multidrug resistance was identified in five (0.4%) of 1196 isolates from new cases and 28 (4.8%) of 581 Isolates from people undergoing retreatment. Of the 31 Isolates from retreatment cases who had previously failed treatment, nine (29.0%) showed multidrug resistance. Although resistance to second-line drugs was found, no cases of extensive drug-resistant tuberculosis were detected. HIV testing of people from whom M. tuberculosis Isolates were obtained showed that 577 (48.2%) of people newly diagnosed and 386 (66.4%) of people undergoing retreatment were positive. Conclusion The prevalence of multidrug resistance among people with smear-positive tuberculosis was low for sub-Saharan Africa probably reflecting the strength of Malawi's tuberculosis control programme. The relatively high prevalence of such resistance observed among those with previous treatment failure may highlight a need for a change in the national policy for retreating this subgroup of people with tuberculosis. Objectif Documenter la prevalence de la resistance polymedicamenteuse de latuberculose parmiles personnes nouvellement diagnostiquees et les personnes traitees a nouveau au Malawi. Methodes Nous avons mene une enquete nationale representative des personnes atteintes de tuberculose a frottis d'expectoration posltlf entre 201 Oet 2011. Pour tous les participants consentants, nous avons recueilli les donnees demographlques et cliniques, deux echantillons d'expectoration et effectue le deplstage du virus de l'immunodeficience humaine (VIH). Les echantillons ont subi des tests de resistance au Laboratoire central de reference de Lilongwe, au Malawi. Tous les isolats de Mycobacterium tuberculosis qui ont presente une resistance polymedicamenteuse ont ete retestes pour la resistance aux medicaments de premiere Intention--et testes pour la resistance aux medlcaments de deuxleme Intention--dans un laboratoire de reference supranational pour la tuberculose en Afrique du Sud. Resultats Dans l'ensemble, M. tuberculosisM. tuberculosis a ete isole chez 1777 (83,8%) des 2120 patients atteints de tuberculose a frottis positlf. La resistance polymedicamenteuse a ete identifiee dans 5 (0,4%) des 1196 Isolats obtenus a partir des nouveaux cas et dans 28 (4,8%) des 581 isolats obtenus a partir des personnes qui recevaient a nouveau un traitement. Parmi les 31 Isolats issus des cas retraites qui ont connu un echec de traitement, 9 (29%) isolats ont presente une resistance polymedicamenteuse. Bien que la resistance aux medicaments donnes en deuxieme Intention alt ete identifiee, aucun cas de tuberculose ultrareslstante aux medlcaments n'a ete detecte. Les depistages du VIH des personnes a partir desquelles les Isolats de M. tuberculosisM. tuberculosis ont ete obtenus ont montre que 577 (48,2%) des personnes nouvellement dlagnostiquees et 386 (66,4%) des personnes recevant a nouveau le traitement etalent seropositives. Conclusion La prevalence de la resistance polymedlcamenteuse chez les personnes atteintes de tuberculose a frottis positif etalt falble en Afrlque subsaharlenne-refletantprobablement la force du programme de controle de la tuberculose du Malawi. La prevalence relativement elevee de cette resistance observee chez les personnes pour lesquelles le traitement precedent a echoue peut mettre en evldence un besoin de changement dans la politique nationale en matiere de retraitement de ce sous-groupe de personnes atteintes de tuberculose. Objetivo Documentar la prevalencia de la resistencia a medicamentos multiples entre pacientes a quienes se ha diagnosticado recientemente o han vuelto a recibir tratamiento para la tuberculosis en Malawi. Metodos Llevamos a cabo una encuesta representativa a nivel nacional de pacientes con tuberculosis que dieron positivo en el analisis de esputo entre 2010 y 2011. Para todos los participantes adultos, se recogieron datos demograficos y clinicos, dos muestras de esputo y realizamos pruebas del virus de immunodeficiencia humana (VIH). Las muestras se sometieron a pruebas de resistencia en el Laboratorio Central de Referencia en Lilongwe (Malawi). Se volvieron a examinar todas las cepas de Mycobacterium tuberculosis muitirresistentes para propar la resistencia a los medicamentos de primera linea y se probo su resistencia a los medicamentos de segunda linea en un laboratorio de referencia supranaclonal para la tuberculosis en Sudafrica. Resultados En general, la M. tuberculosisM. tuberculosis se aislo en 1777 (83,8%) de los 2120 pacientes de tuberculosis con baclloscopla positiva. Se detecto multlrreslstencla a medicamentos en cinco (0,4%) de las 1196 cepas de casos nuevos y en 28 (4,8%) de las 581 cepas de pacientes que se volvieron a someter al tratamiento. De las 31 cepas de casos de repeticion del tratamiento que no habian respondido previamente al tratamiento, nueve (29,0%) mostraron multirresistencia a medicamentos. Pese a que se hallo resistencia a los medicamentos de segunda linea, no se detectaron casos de tuberculosis con resistencia extendida ajnedicamentos. Las pruebas del VIH de quienes se obtuvieron cepas de M. tuberculosisM. tuberculosis mostraron que 577 (48,2%) de los pacientes con diagnostico reciente y 386 (66,4%) de los pacientes que se volvieron a someter al tratamiento dieron positivo. Conclusion La prevalencia de la multirresistencia a medicamentos entre los pacientes con tuberculosis que dieron positivo en la baciloscopia positiva fue baja en el Africa subsahariana, lo cual probablemente refleja la eficacia del programa de control de la tuberculosis de Malawi. La prevalencia relativamente alta de dicha resistencia observada entre los pacientes que no respondieron al tratamiento anterior puede poner de manifiesto la necesidad de un cambio en la politica nacional para volver a tratar a este subgrupo de pacientes con tuberculosis., Introduction Although the World Health Organization (WHO) has monitored the emergence of drug resistance of Mycobacterium tuberculosis since 1994, (1) there have been few national surveys of such resistance in [...]

Malaria is a leading cause of illness and death among children in countries in which it is endemic (1). An increasing number of countries in sub-Saharan Africa are rapidly scaling [...]

Objective To develop a simple tool for assessing the severity of disability resulting from Japanese encephalitis and whether, as a result, a child is likely to be dependent. Methods A new outcome score based on a 15-item questionnaire was developed after a literature review, examination of current assessment tools, discussion with experts and a pilot study. The score was used to evaluate 100 children in Malaysia (56 Japanese encephalitis patients, 2 patients with encephalitis of unknown etiology and 42 controls) and 95 in India (36 Japanese encephalitis patients, 41 patients with encephalitis of unknown etiology and 18 controls). Inter- and intra-observer variability in the outcome score was determined and the score was compared with full clinical assessment. Findings There was good inter-observer agreement on using the new score to identify likely dependency (K = 0.942 for Malaysian children; K = 0.786 for Indian children)and good intra-observer agreement (K = 1.000 and 0.902, respectively). In addition, agreement between the new score and clinical assessment was also good (K = 0.906 and 0.762, respectively). The sensitivity and specificity of the new score for identifying children likely to be dependent were 100% and 98.4% in Malaysia and 100% and 93.8% in India. Positive and negative predictive values were 84.2% and 100% in Malaysia and 65.6% and 100% in India. Conclusion The new tool for assessing disability in children after Japanese encephalitis was simple to use and scores correlated well with clinical assessment. Objectif Developper un outil simple pour evaluer la gravite de l'invalidite resultant de l'encephalite japonaise et, en consequence, la probabilite de dependance de l'enfant. Methodes Une nouvelle echelle d'evaluation basee sur un questionnaire de 15 questions a ete developpee apres une analyse de la litterature, l'examen des outils d'evaluation actueis, une discussion avec les experts et une etude pilote. L'echelle a ete utilisee pour evaluer 100 enfants en Malaisie (56 patients atteints d'encephalite japonaise, 2 patients atteints d'encephalite d'etiologie inconnue et 42 controles) et 95 en Inde (36 patients atteints d'encephalite, 41 patients atteints d'encephalite d'etiologie inconnue et 18 controles). La variabilite inter et intra-observateurs dans l'echelle d'evaluation a ete determinee et l'echelle a ete comparee avec une evaluation clinique complete. Resulfats II a ete observe une bonne correspondance inter-observateurs dans l'utilisation de la nouvelle echelle pour identifier la dependance probable (K = 0,942 pour les enfants malais; K = 0,786 pour les enfants indiens), ainsi qu'une bonne correspondance intra-observateurs (K = 1,000 et 0,902, respectivement). De plus, la correspondance entre la nouvelle echelle et l'evaluation clinique a ete bonne (K = 0,906 et 0,762, respectivement). La sensibilite et la specificite de la nouvelle echelle d'evaluation de la probabilite de dependance des enfants ont ete de 100 % et de 98,4 % en Malaisie et de 100 % et de 93,8 % en Inde. Les valeurs predictives positives et negatives ont ete de 84,2 % et de 100 % en Malaisie et de 65,6 % et de 100 % en Inde. Conclusion Le nouvel outil pour l'evaluation de l'invalidite des enfants apres encephalite japonaise a ete simple a utiliser et les resultats presentent une bonne correlation avec l'evaluation clinique. Objetivos Disenar una herramienta sencilla para valorar la gravedad de la incapacidad causada por la encefalitis japonesa y la posibilidad de que un nino sea dependiente como consecuencia de la misma. Metodos Se ha elaborado una nueva escala de resultados, basada en un cuestionario de 15 puntos, realizado tras una revision bibliografica, en el estudio de las herramientas de valoracion actuales, en el debate con expertos y en un estudio preliminar. La escala se empleo para evaluar a 100 ninos en Malasia (56 pacientes con encefalitis japonesa, 2 pacientes con encefalitis de etiologIa desconocida y 42 controles) y 95 en India (36 pacientes con encefalitis japonesa, 41 pacientes con encefalitis de etiologia desconocida y 18 controles). Se determino la variabilidad interobservador e intraobservador en la escala de resultados y se comparo la escala con una valoracion clinica completa. Resultados Hubo un consenso interobservador tavorable respecto a la utilizacion de la nueva escala para identificar la posible dependencia K = 0,942 en el caso de los hinos malasios; K = 0,786 para los ninos indios) y un consenso intraobservador favorable (K = 1,000 y 0,902, respectivamente). Ademas, el consenso entre la nueva escala y la valoracion clinica tambien fue bueno (K = 0,906 y 0,762, respectivamente). La sensibilidad y la especificidad de la nueva escala para identificar a los ninos que pueden ser dependientes fue del 100% y del 98,4% en Malasia, y del 100% y dei 93,8% en India. Los valores predictivos positivos y negativos fueron dei 84,2% y dei 100% en Malasia, y dei 65,6% y dei 100% en India. Conclusiones La nueva herramienta de valoracion de la incapacidad infantil tras la encefalitis japonesa fue facil de usar y los resultados estaban relacionados con la valoracion clinica., Introduction Neurological disability is a major problem among children in resource-poor countries but the true burden of disability is unknown because there is no simple and reliable way of measuring [...]

Background Sepsis protocols in sub-Saharan Africa are typically extrapolated from high-income settings, yet sepsis in sub-Saharan Africa is likely caused by distinct pathogens and may require novel treatment strategies. Data to guide such strategies are lacking. We aimed to define causes and modifiable factors associated with sepsis outcomes in Blantyre, Malawi, in order to inform the design of treatment strategies tailored to sub-Saharan Africa. Methods We recruited 225 adults who met a sepsis case definition defined by fever and organ dysfunction in an observational cohort study at a single tertiary center. Etiology was defined using culture, antigen detection, serology, and polymerase chain reaction. The effect of treatment on 28-day outcomes was assessed using Bayesian logistic regression. Results There were 143 of 213 (67%) participants living with human immunodeficiency virus (HIV). We identified a diagnosis in 145 of 225 (64%) participants, most commonly tuberculosis (TB; 34%) followed by invasive bacterial infections (17%), arboviral infections (13%), and malaria (9%). TB was associated with HIV infection, whereas malaria and arboviruses with the absence of HIV infection. Antituberculous chemotherapy was associated with survival (adjusted odds ratio for 28-day death, 0.17; 95% credible interval, 0.05–0.49 for receipt of antituberculous therapy). Of those with confirmed etiology, 83% received the broad-spectrum antibacterial ceftriaxone, but it would be expected to be active in only 24%. Conclusions Sepsis in Blantyre, Malawi, is caused by a range of pathogens; the majority are not susceptible to the broad-spectrum antibacterials that most patients receive. HIV status is a key determinant of etiology. Novel antimicrobial strategies for sepsis tailored to sub-Saharan Africa, including consideration of empiric antituberculous therapy in individuals living with HIV, should be developed and trialed. [ABSTRACT FROM AUTHOR]

Over the last 40 years, major changes have taken place in the workplace. The growth in the use of information technology at work, the globalization of many industries, organizational restructuring, changes in work contracts and work-time scheduling have radically transformed the nature of work in many organizations. The workforce itself is also diversifying, with an increase in female participation, a growing number of dual-earner couples and older workers. The present paper discusses the impact of these workplace transitions on employee well-being. We focus on four issues that are current concerns for organizations and the workforce; job insecurity, work hours, control at work, and managerial style. For each topic, recent research is presented, with suggestions for future research and recommendations for practitioners working in the organizations of today. The paper concludes with some final considerations for researchers and practitioners that may benefit both employee well-being and organizational effectiveness., Over the last four decades of the 20th century, the nature of work has changed dramatically for some people. The 1960s and 1970s saw the introduction of new technology, particularly [...]

Research examines four potential psycholinguistic markers for specific language impairment in children, including a sentence repetition task, a third person singular task, a nonword repetition task, and a past tense task. Findings suggest that sentence repetition is the most useful for identifying language impairment.