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A study was conducted to evaluate the outbreak of pneumonia and compare the age patterns with related morbidity and mortality with patterns from recent A (H1N1) influenza virus in Mexico. Results indicated that there was a sudden increase in the rate of severe pneumonia as well as an age shift that suggest a rationale for focusing prevention efforts on younger populations.

A study was conducted to evaluate the significant mortality and nosocomial transmission associated in patients with oseltamivir-resistant influenza A(H1N1) virus. Results indicated that seasonal oseltamivir-resistant influenza A(H1N1) viruses are transmitted and present a high-risk of mortality among high-risk patients.

A comprehensive control strategy was implemented in two Chinese villages from 2005 to 2007 with an aim to reduce the rate of transmission of 'Schistosoma japonicum' infection from cattle and humans to snails. The strategy was found to be highly effective and was adopted as the national strategy to control schistosomiasis in China.

Byline: Yasser Sakr (1), Christian Madl (2), Daniela Filipescu (3), Rui Moreno (4), Johan Groeneveld (5), Antonio Artigas (6), Konrad Reinhart (1), Jean-Louis Vincent (7) Keywords: Body mass index; Multicentre; Outcome; Intensive care; Nosocomial infection Abstract: Objective To investigate the possible impact of obesity on morbidity and mortality in intensive care unit (ICU) patients included in the European observational sepsis occurrence in acutely ill patients (SOAP) study. Design Planned substudy from the SOAP database. Setting One hundred and ninety-eight ICUs in 24 European countries. Patients All patients admitted to one of the participating ICUs. Patients were classified, according to their body mass index (BMI), as underweight ( Measurements and results The BMI was available in 2,878 (91%) of the 3,147 patients included in the SOAP study 120 patients (4.2%) were underweight, 1,206 (41.9%) had a normal BMI, 1,047 (36.4%) were overweight, 424 (14.7%) were obese, and 81 (2.8%) were very obese. Obese and very obese patients more frequently developed ICU-acquired infections than patients in lower BMI categories. Very obese patients showed a trend towards longer ICU [median (IQ): 4.1 (1.8--12.1) vs. 3.1 (1.7--7.2) days, P = 0.056) and hospital lengths of stay [14.3 (8.4--27.4) vs. 12.3 (5.1--24.4), days P = 0.077] compared to those with a normal BMI. However, there were no significant differences among the groups in ICU or hospital mortality rates. In a multivariate Cox regression analysis, none of the BMI categories was associated with an increased risk of 60-day in-hospital death. Conclusion BMI did not have a significant impact on mortality in this mixed population of ICU patients. Author Affiliation: (1) Department of Anaesthesiology and Intensive Care, Friedrich-Schiller-University Jena, Jena, Germany (2) Intensive Care Unit 13H1, Department of Internal Medicine IV, Medical University of Vienna, Vienna, Austria (3) Department of Anesthesiology and Cardiac Intensive Care, Institute of Cardiovascular Diseases, Bucharest, Romania (4) Department of Intensive Care, Hospital de St Antonio dos Capuchos, Lisbon, Portugal (5) Department of Intensive Care, VU University Medical Center, Amsterdam, The Netherlands (6) Department of Intensive Care, Sabadell Hospital, Sabadell, Spain (7) Department of Intensive Care, Hopital Erasme, Universite libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium Article History: Registration Date: 18/07/2008 Received Date: 09/11/2007 Accepted Date: 01/06/2008 Online Date: 01/08/2008 Article note: This article is discussed in the editorial available at doi: 10.1007/s00134-008-1244-z

Background. Summer 2003 witnessed an excess in heat-related mortality in the elderly population. The Argento Project was planned to define risk factors for heat-related death in Modena, Italy, during the hottest month of 2003 (August). Methods. We performed a retrospective, case-control study of a cohort of 394 older persons living in Modena, 197 dead (cases) and 197 survivors (controls). A questionnaire to collect information about demographic, social, environmental, and clinical characteristics and about causes of death was completed. Results. Cases were more likely to be living in a nursing home and needing assistance (p = .024, and p < .001, respectively). Survivors were living on higher level floors (p = .046). Spending the summer in Modena was significantly related to poor outcomes (p < .01). A higher number of cases were using public health services (p < .001). Individuals who died had a greater degree of comorbidity and dependence (p < .001); they were cognitively impaired (p < .001), took a larger number of drugs (p < .001), and had a greater number of hospital admissions (p < .001). Multivariate analysis showed that patients who spent the summer in Modena had a higher mortality. Other predictors of death were the use of home public-integrated assistance, a higher comorbidity and a higher degree of disability; the loss of at least 1 Activity of Daily Living (ADL) represents the strongest risk factor of heat-related death. Conclusions. Our study identifies the major risk factors of heat-related death in the elderly population. With the creation of an up-to-date database, when a new heat wave will come, it will be possible to identify frail persons for preventive targeted strategies.

Polygenic autoimmune diseases, such as systemic lupus erythematosus (SLE), are a significant cause of morbidity and mortality worldwide. In recent years, functionally important genetic polymorphisms conferring susceptibility to SLE have been identified, but the evolutionary pressures driving their retention in the gene pool remain elusive. A defunctioning, SLE-associated polymorphism of the inhibitory receptor Fc[gamma]RIIb is found at an increased frequency in African and Asian populations, broadly corresponding to areas where malaria is endemic. Here, we show that Fc[gamma]RIIb-deficient mice have increased clearance of malarial parasites (Plasmodium chabaudi chabaudi) and develop less severe disease. In vitro, the human lupus associated Fc[gamma]RIIb polymorphism enhances phagocytosis of Plasmodium falciparum-infected erythrocytes. These results demonstrate that FcyRIIb is important in controlling the immune response to malarial parasites and suggests that the higher frequency of human Fc[gamma]RIIb polymorphisms predisposing to SLE in Asians and Africans may be maintained because these variants reduce susceptibility to malaria. autoimmunity | evolution | Fc[gamma] receptors

Objective To assess injury-related mortality, disability and disability-adjusted life years (DALYs) in six European countries. Methods Epidemiological data (hospital discharge registers, emergency department registers, mortality databases) were obtained for Austria, Denmark, Ireland, Netherlands, Norway, and the United Kingdom (England and Wales). For each country, the burden of injury was estimated in years lost due to premature mortality (YLL), years lived with disability (YLD), and DALYs (per 1000 persons). Findings We observed marked differences in the burden of injury between countries. Austria lost the largest number of DALYs (25 per 1000 persons), followed by Denmark, Norway and Ireland (17-20 per 1000 persons). In the Netherlands and United Kingdom, the total burden due to injuries was relatively low (12 per 1000 persons). The variation between countries was attributable to a high variation in premature mortality (YLL varied from 9-17 per 1000 persons) and disability (YLD varied from 2-8 per 1000 persons). In all countries, males aged 25-44 years represented one third of the total injury burden, mainly due to traffic and intentional injuries. Spinal cord injury and skull-brain injury resulted in the highest burden due to permanent disability. Conclusion The burden of injury varies considerably among the six participating European countries, but males aged 15-24 years are responsible for a disproportionate share of the assessed burden of injury in all countries. Consistent injury control policy is supported by high-quality summary measures of population health. There is an urgent need for standardized data on the incidence and functional consequences of injury. Objectif Evaluer la mortalite, l&apos;incapacite et les annees de vie perdues ajustees sur l&apos;incapacite (DALY) dues aux traumatismes dans six pays europeens. Methodes Les donnees epidemiologiques (registres de sortie d&apos;etablissements hospitaliers, registres des services d&apos;urgence, bases de donnees sur la mortalite) ont ete obtenues pour l&apos;Autriche, le Danemark, l&apos;Irlande, la Norvege, les Pays-Bas et le Royaume-Uni (Angleterre et Pays de Galles). Pour chaque pays, la charge des traumatismes a ete estimee en annees de vie perdues du fait de la mortalite prematuree (YLL), en annees vecues avec une incapacite (YLD) et en DALY pour 1000 personnes. Resultats Des differences marquees ont ete constatees entre les pays concernant la charge des traumatismes. C&apos;est l&apos;Autriche qui a perdu le plus grand nombre de DALY (25 pour 1000 personnes) suivie du Danemark, de la Norvege et de l&apos;Irlande (17 a 20 pour 1000 personnes). Aux Pays-Bas et au Royaume-Uni, la charge totale des traumatismes etait relativement faible (12 pour 1000 personnes). La difference entre les pays etait imputable a une forte variation de la mortalite prematuree (YLL entre 9 et 17 pour 1000 personnes) et de l&apos;incapacite (YLD entre 2 et 8 pour 1000 personnes). Dans tous les pays, les hommes ages de 25 a 44 ans supportaient un tiers de la charge totale des traumatismes--constitues principalement d&apos;accidents de la circulation et de traumatismes intentionnels. Les incapacites permanentes etaient dues avant tout a des lesions de la moelle epiniere et a des traumatismes craniens. Conclusion La charge des traumatismes varie considerablement entre les six pays europeens consideres, mais les hommes ages de 15 a 24 ans supportent une part disproportionnee de la charge evaluee des traumatismes dans tous les pays consideres. Une politique coherente de lutte contre les traumatismes s&apos;appuie sur des indicateurs generaux de qualite de l&apos;etat de sante de la population. Il faut d&apos;urgence obtenir des donnees standardisees sur l&apos;incidence et les consequences fonctionnelles des traumatismes. Objetivo Evaluar la mortalidad, la discapacidad y los anos de vida ajustados en funcion de la discapacidad (AVAD) relacionados con los traumatismos en seis paises europeos. Metodos Se obtuvieron datos epidemiologicos (registros de alta de los hospitales, registros de urgencias y bases de datos sobre la mortalidad) en Austria, Dinamarca, Irlanda, Noruega, los Paises Bajos y el Reino Unido (Inglaterra y Gales). La carga de traumatismos en cada pais se estimo en anos perdidos por muerte prematura, anos vividos con discapacidad y AVAD (por 1000 personas). Resultados La carga de traumatismos presento grandes diferencias entre los paises. La mayor perdida de AVAD correspondio a Austria (25 por 1000), seguida de Dinamarca, Noruega e Irlanda (17-20 por 1000). En los Paises Bajos y el Reino Unido, la carga total de traumatismos fue relativamente baja (12 por 1000). Las variaciones entre los paises fueron atribuibles a una gran variacion de la mortalidad prematura (los anos perdidos por muerte prematura oscilaron entre 9 y 17 por 1000) y de la discapacidad (los anos vividos con discapacidad oscilaron entre 2 y 8 por 1000). En todos los paises estudiados, los varones de 25 a 44 anos sufrieron un tercio de la carga total de traumatismos, debida principalmente a los traumatismos intencionados o causados por el trafico. Los traumatismos craneoencefalicos y medulares fueron la causa de mayor carga de discapacidad permanente. Conclusion La carga de traumatismos presento una variacion considerable entre los seis paises europeos participantes, pero los varones de 15-24 anos son los que soportan la mayor carga en todos los paises. Los indicadores de buena calidad que resumen la salud de la poblacion respaldan una politica coherente de control de los traumatismos. Hay una necesidad urgente de datos normalizados sobre la incidencia y las consecuencias funcionales de los traumatismos. [TEXT NOT REPRODUCIBLE IN ASCII.], Introduction Injuries are a major cause of morbidity and mortality in developing and in industrialized regions. (1,2) Rational choices for injury prevention need to rely on comparable indicators relating the [...]

Objectives: This research identifies the level of specificity of cause-of-injury morbidity data in Australia. The research explores reasons for poor-quality data across different causes-of-injury areas, including a lack of clinical documentation and insufficient detail in the classification system. Methods: The 2002/03 hospital morbidity dataset of 593,079 injury-related hospital admissions was analysed to examine the specificity of coded external cause-of-injury data. Results: While overall specificity appeared high, the cause of 47,660 injuries was not specifically defined according to the code assigned. Only 56% of cases for whom injury was the result of an accidental fall were assigned a specific code to identify the causal detail; 19% were assigned an 'Other Specified' fall code, suggesting a lack of specific code availability; and 25% were assigned an 'Unspecified Fall' code, suggesting a lack of clinical documentation to facilitate code selection. Conclusions: To improve the quality of injury-related hospital morbidity data, two main areas to focus resources are: 1) the development of more specific cause-of-injury codes; and 2) the provision of more detailed documentation from clinicians. Implications: Clinicians and clinical coders need to work together to improve the quality of injury-related coded data through the provision of specific codes and improved clinical documentation. Accurate and comprehensive data pertaining to the circumstances surrounding hospitalised injury events will benefit injury prevention and surveillance initiatives, provide justification for resources related to injury hospitalisation, and assist in external cause research in Australia.

The authors examined the validity of a method commonly used to test alternative hypotheses regarding the causes of comorbidity: the examination of underlying deficits of comorbid disorders. The authors simulated data in which the true causes of comorbidity were known, then compared the patterns of underlying deficits of the comorbid disorders found in the simulated data with the predicted results. The method of examining the underlying deficits of comorbid disorders could distinguish between several comorbidity models, including those that could not be distinguished well using other methods. The ability to distinguish the correct model decreased as the sample size and the correlation between the underlying deficits and the symptom scores decreased, suggesting that the issue of power should be considered carefully. Keywords: comorbidity, comorbidity models, comorbid disorders, underlying deficits, simulations