Detection of foodborne disease outbreaks relies on health care practitioners (HCPs), infection control practitioners (ICPs), and clinical laboratorians to report notifiable diseases to state or local health departments.To examine knowledge and practices about notifiable foodborne disease reporting among HCPs and ICPs in western North Carolina and among clinical laboratorians statewide, participants responded to a self-administered questionnaire about foodborne pathogen testing and reporting, referencing Campylobacter, shiga-toxin producing Escherichia coli, and other organisms.Three hundred seventy-two of 1442 health care providers participated in this survey. Of 372 study participants, fewer than 20% knew that both the clinician and the laboratorian were legally responsible for reporting the study pathogens. Most laboratorians identified the ICP (57%) as responsible for reporting. There was a lack of understanding about which infections and test results were reportable.The response rate was very low, particularly among HCPs; participants may have been biased towards those with a particular interest in foodborne disease or surveillance. This descriptive study cannot be used to determine rates of reporting among the medical community.Although not legally obliged to report, ICPs were found to play a significant role in disease reporting. Dissemination of surveillance information and training through the established network of North Carolina ICPs may be ideal for improving foodborne disease surveillance in this state.
The effect that vaginal lactobacilli have on trichomoniasis is not known. At 3 clinics for treatment of sexually transmitted disease, we recruited 521 female patients with trichomoniasis and 176 control subjects. All participants underwent physical examinations and testing for sexually transmitted infection and completed questionnaires. Low levels of vaginal lactobacilli were associated with trichomoniasis (odds ratio [OR], 2.2 [95% confidence interval {CI}, 1.4–3.2]). After adjustment for covariables, this association remained in women with a higher educational level (OR, 4.6 [95% CI, 2.2–9.5]) but not in women with a lower educational level (OR, 1.6 [95% CI, 0.7–3.4]). Vaginal lactobacilli may be associated with trichomoniasis in women with higher levels of education or a related behavioral factor.
Digital mental health interventions (DMHIs) present a promising way to address gaps in mental health service provision. However, the relationship between user engagement and outcomes in the context of these interventions has not been established. This study addressed the current state of evidence on the relationship between engagement with DMHIs and mental health outcomes. MEDLINE, PsycINFO, and EmBASE databases were searched from inception to August 1, 2021. Original or secondary analyses of randomized controlled trials (RCTs) were included if they examined the relationship between DMHI engagement and post-intervention outcome(s). Thirty-five studies were eligible for inclusion in the narrative review and 25 studies had sufficient data for meta-analysis. Random-effects meta-analyses indicated that greater engagement was significantly associated with post-intervention mental health improvements, regardless of whether this relationship was explored using correlational [r = 0.24, 95% CI (0.17, 0.32), Z = 6.29, p < 0.001] or between-groups designs [Hedges' g = 0.40, 95% CI (0.097, 0.705), p = 0.010]. This association was also consistent regardless of intervention type (unguided/guided), diagnostic status, or mental health condition targeted. This is the first review providing empirical evidence that engagement with DMHIs is associated with therapeutic gains. Implications and future directions are discussed. Systematic Review Registration: PROSPERO, identifier: CRD 42020184706.
<b><i>Background:</i></b> Initial therapy for craniopharyngioma remains controversial. Population-based datasets indicate that traditional algorithms [gross total resection (GTR) vs. subtotal resection (STR) +/- radiation therapy (XRT)] are often not employed. We investigated neurosurgical practice patterns. <b><i>Methods:</i></b> A ten-question survey was electronically distributed to members of the American Association of Neurological Surgeons. Responses were analyzed using standard statistical techniques. <b><i>Results:</i></b> 102 responses were collected, with a median of 25 craniopharyngiomas managed per respondent. 36% estimated that their practice included ≥75% pediatric patients and 61% had an academic practice. 36% would recommend observation or XRT for a suspected craniopharyngioma in the absence of a tissue diagnosis, with 46% of these indicating this recommendation in ≥10% of the cases. Following STR, 35% always recommend XRT and 59% recommend it in over half of the cases. However, following STR or biopsy alone, 18 and 11% never recommend XRT. There was no association between the type of practice (i.e. academic or ≥75% pediatric patients) and practice patterns. <b><i>Conclusions:</i></b> This survey verifies that a deviation from established algorithms is common, underscoring the clinical complexity of these patients and recent secondary data analyses. This should influence clinical researchers to investigate outcomes for patients treated using alternative methods. It will lend insight into appropriate treatment options and contribute to quality of life outcomes studies for craniopharyngioma.
Depression and anxiety are often first experienced during childhood and adolescence, and interest in the prevention of these disorders is growing. The focus of this review was to assess the effectiveness of psychological prevention programs delivered in schools, and to provide an update to our previous review from five years ago (Werner-Seidler, Perry, Calear, Newby, & Christensen, 2017). Three electronic databases were systematically searched for published articles of randomised controlled trials (RCTs) evaluating the efficacy of school-based prevention programs until October 2020. There were 130 articles that met inclusion criteria, representing 118 unique trials and 45,924 participants. Small between-group effect sizes for depression (g = 0.21) and anxiety (g = 0.18) were detected immediately post-intervention. Subgroup analyses suggested that targeted prevention programs (for young people with risk factors or symptoms) were associated with significantly greater effect sizes relative to universal programs for depression, which was confirmed by meta-regression. There was also some evidence that external providers conferred some benefit over school-staff delivered programs. Overall, study quality was moderate and no association between risk of bias and effect size was detected. School-delivered psychological prevention programs have small effects in reducing symptoms of depression and anxiety. Refinement of these programs, and knowledge about how they can be sustainably delivered in schools beyond the trial period is now needed for population-level preventive effects. Systematic Review Registration Number: PROPSERO - CRD42020188323.
In 35 cases, the attempt is made to present hemodilution as an appropriate means of hepatitis prophylaxis and blood sparing in patients having to undergo selective orthopedic or oral surgery. Especially in hospitals which cannot afford the expensive methods of autotransfusion, this method which is easy to perform from the technical and practical point of view offers a possibility of markedly reducing the transfusion rate of whole blood. Taking into account possible contraindications, this method is to be considered in all patients undergoing selective surgery where the general condition of the patient is sufficient and a blood loss of 1000-1500 ml is not exceeded.
Relationships among attempted suicide, nonsuicidal self-harm, and physical assault were examined in 400 regular users of heroin and/or psychostimulants. Twenty-eight percent had episodes of nonsuicidal self-harm, 32% had attempted suicide, and 95% had been violently assaulted. The number of suicide attempts and nonsuicidal self-harm incidents were correlated (ρ = 0.44). There were also significant correlations between the number of assaults and nonsuicidal self-harm incidents (ρ = 0.17), and suicide attempts (ρ = 0.27). The mean age onset for non-suicidal self-harm (18.9 yrs) was significantly younger than that of initial suicide (22.3 yrs). The age at initial physical assault (16.0yrs) was significantly younger than that of nonsuicidal self-harm and initial suicide attempt. Screening for all forms of violence appears warranted when determining suicide risk for this population.
There have been concerns about the increased use of helium and nitrogen gas as a suicide mechanism in Australia. National Coronial Information System data were used to investigate gas‐specific suicides in Australia over the period 2006–2017. Characteristics were compared between helium or nitrogen, carbon monoxide and seven other gases. Gas inhalation accounted for 10% (3,103/31,002) of all suicide deaths in Australia between 2006 and 2017. The mean age of individuals who died by suicide was 47.6 years (SD 16.9, R 14‐97) and 83.3% were male. The number of gas suicides declined over the study period (IRR=0.96). The fall was associated with a 47% decline in carbon monoxide suicides (IRR=0.93). There was an increase in deaths due to argon (IRR=1.60) and nitrogen (IRR=1.27). Compared to individuals using other non‐carbon monoxide gases, individuals who died by suicide from helium or nitrogen were significantly more likely to be older, have a physical illness and/or disability, have contacted a euthanasia group and have accessed instructional material and purchased gas online. Suicides by carbon monoxide decreased between 2006 and 2017 alongside an increase in argon and nitrogen gas use – particularly among older adults. The ease of access to these gases points to new targets for means restriction. Identifying the types of gases used in suicide deaths and emerging trends may enable targeted interventions that could potentially reduce access.
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