Ebola Surveillance - Guinea, Liberia, and Sierra Leone McNamara, Lucy A; Schafer, Ilana J; Nolen, Leisha D ...
Morbidity and mortality weekly report. Supplement,
2016-Jul-08, 2016-07-08, 20160708, Letnik:
65, Številka:
3
Journal Article
Odprti dostop
Developing a surveillance system during a public health emergency is always challenging but is especially so in countries with limited public health infrastructure. Surveillance for Ebola virus ...disease (Ebola) in the West African countries heavily affected by Ebola (Guinea, Liberia, and Sierra Leone) faced numerous impediments, including insufficient numbers of trained staff, community reticence to report cases and contacts, limited information technology resources, limited telephone and Internet service, and overwhelming numbers of infected persons. Through the work of CDC and numerous partners, including the countries' ministries of health, the World Health Organization, and other government and nongovernment organizations, functional Ebola surveillance was established and maintained in these countries. CDC staff were heavily involved in implementing case-based surveillance systems, sustaining case surveillance and contact tracing, and interpreting surveillance data. In addition to helping the ministries of health and other partners understand and manage the epidemic, CDC's activities strengthened epidemiologic and data management capacity to improve routine surveillance in the countries affected, even after the Ebola epidemic ended, and enhanced local capacity to respond quickly to future public health emergencies. However, the many obstacles overcome during development of these Ebola surveillance systems highlight the need to have strong public health, surveillance, and information technology infrastructure in place before a public health emergency occurs. Intense, long-term focus on strengthening public health surveillance systems in developing countries, as described in the Global Health Security Agenda, is needed.The activities summarized in this report would not have been possible without collaboration with many U.S and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html).
Medication adherence with urgency urinary incontinence (UUI) treatment is challenging and the best assessment methodology is uncertain. We sought to describe adherence with anticholinergic (AC) ...versus placebo (P) by comparing pill counts and MEMSCAP event data and to identify factors associated with adherence.
The randomized controlled AC versus Botox Comparison trial of women with moderate to severe idiopathic UUI included 126 participants initiating AC plus P bladder injection and 121 receiving P pills plus Botox injection. Adherence data on 243 participants (124 AC and 119 P) were calculated by pill count and MEMSCAP data for each 2-month interval during the 6-month study that allowed for dose escalation/drug change. Overall composite adherence estimates were calculated using the average of both methods and weighted by the duration of each 2-month interval.
Treatment groups had no significant differences in dosing duration (P = 0.76) or mean adherence (AC, 83.3% 16.8 vs. P, 84.8% 13.8). Only 53% of women met the dichotomous outcome of more than 80% adherence during all intervals. Correlation between adherence by pill counts versus MEMSCAP decreased over time with pill counts demonstrating higher adherence than MEMSCAP (r = 0.53, 0.50, and 0.36 for each 2-month interval). Lower adherence was associated with higher baseline incontinence severity and better UUI quality of life for the AC group and with current smoking status in both groups.
Adherence using pill counts and MEMSCAP was reasonably correlated and similar in both the AC and P groups. In the AC group, higher baseline incontinence severity and better UUI Quality of Life were associated with decreased adherence. Smokers were less adherent.
OBJECTIVES: To evaluate tolerability and course of adverse effects of antidepressants in elderly patients and to study the association between number and severity of adverse effects and age, physical ...comorbidity, antidepressant dose. and depression severity.
DESIGN: Double‐blind, randomized controlled trial followed by an open treatment phase of 3 years.
SETTING: Psychiatric hospital in the Netherlands.
PARTICIPANTS: Eighty‐one elderly depressed inpatients.
INTERVENTION: Patients were treated with venlafaxine or nortriptyline.
MEASUREMENTS: Frequency and severity of 43 individual adverse effects were assessed using the Symptom, Sign, Side‐Effect Checklist. Severity of depression was assessed using the Montgomery Åsberg Depression Rating Scale.
RESULTS: Both antidepressants were tolerated well, with no differences in clinical effectiveness, and most adverse effects decreased with time. The number and severity of adverse effects was not related to age or physical comorbidities. There was a significant relationship between the severity of depression and the severity of adverse effects, although the relationship between the dose of the antidepressant and the severity of the adverse effects was of only borderline statistical significance.
CONCLUSION: Elderly patients tolerated venlafaxine and nortriptyline well, and most adverse effects decreased with time as the depression improved. Age and physical comorbidities were not related to number and severity of adverse effects.
The risk of developing schizophrenia is increased for immigrants to the Netherlands from Surinam, the Netherlands Antilles and Morocco, but not for immigrants from Turkey. We examined, in these ...groups, the risks of a first admission for manic-depressive psychosis.
The Dutch Psychiatric Registry provided two datasets. The first referred to first admissions for manic-depressive psychosis (MDP), manic or circular type, in the period 1990-1996, the second to first admissions for MDP, depressed type. MDP, depressed type, corresponds (broadly) to the DSM-IV category of major depressive disorder and MDP, manic or circular type, to the DSM-IV category of bipolar I disorder. The Dutch Central Bureau for Statistics provided yearly population figures.
There were only small increases in the risks of a first admission for MDP, manic or circular type, for immigrants from Surinam (age- and sex-adjusted RR = 1.14; 95% CI: 0.97-1.33) and the Netherlands Antilles (RR = 1.41; 1.10-1.80). This risk was not clearly increased for immigrants from Morocco. The risks for MDP, depressed type, were increased for males from Morocco (age-adjusted RR = 2.17; 1.72-2.72) and Turkey (RR = 1.83; 1.46-2.30), and significantly decreased for females in all of the immigrant groups.
We found no evidence for a large increase in the incidence of MDP, manic or circular type, in the immigrant groups, whereas an increase in MDP, depressed type, was observed only in selected groups. Female immigrants suffering from MDP, depressed type, may be underserved.
Integrating gene expression profiles with certain proteins can improve our understanding of the fundamental mechanisms in protein-ligand binding. This paper spotlights the integration of gene ...expression data and target prediction scores, providing insight into mechanism of action (MoA). Compounds are clustered based upon the similarity of their predicted protein targets and each cluster is linked to gene sets using Linear Models for Microarray Data. MLP analysis is used to generate gene sets based upon their biological processes and a qualitative search is performed on the homogeneous target-based compound clusters to identify pathways. Genes and proteins were linked through pathways for 6 of the 8 MCF7 and 6 of the 11 PC3 clusters. Three compound clusters are studied; (i) the target-driven cluster involving HSP90 inhibitors, geldanamycin and tanespimycin induces differential expression for HSP90-related genes and overlap with pathway response to unfolded protein. Gene expression results are in agreement with target prediction and pathway annotations add information to enable understanding of MoA. (ii) The antipsychotic cluster shows differential expression for genes LDLR and INSIG-1 and is predicted to target CYP2D6. Pathway steroid metabolic process links the protein and respective genes, hypothesizing the MoA for antipsychotics. A sub-cluster (verepamil and dexverepamil), although sharing similar protein targets with the antipsychotic drug cluster, has a lower intensity of expression profile on related genes, indicating that this method distinguishes close sub-clusters and suggests differences in their MoA. Lastly, (iii) the thiazolidinediones drug cluster predicted peroxisome proliferator activated receptor (PPAR) PPAR-alpha, PPAR-gamma, acyl CoA desaturase and significant differential expression of genes ANGPTL4, FABP4 and PRKCD. The targets and genes are linked via PPAR signalling pathway and induction of apoptosis, generating a hypothesis for the MoA of thiazolidinediones. Our analysis show one or more underlying MoA for compounds and were well-substantiated with literature.
Levetiracetam is a recently approved, well-tolerated anticonvulsant with a unique mechanism of action yielding efficacy in treatment-refractory seizure disorders and positive effects in an animal ...model of mania. Given the effectiveness of a range of other anticonvulsants in bipolar disorder, we sought to evaluate levetiracetam in patients with treatment-resistant illness.
Thirty-four patients received 500 to 1000 mg of levetiracetam titrated to a target dose of 2000 mg/day (maximum dose = 3000 mg/day) as open, adjunctive treatment for clinically significant symptoms of depression (N = 13), mania (N = 7), or cycling (N = 14) despite ongoing treatment with mood stabilizers. Inventory for Depressive Symptomatology-Clinician version (IDS-C), Young Mania Rating Scale (YMRS), and Clinical Global Impressions scale for use in Bipolar Illness ratings were completed at each visit for 8 weeks, and partial responders were offered continuation treatment. Data were collected from July 2001 to December 2002.
Five of 16 (31%; 13 depressed, 3 cycling) patients with initial depressive symptoms met the criterion for remission (IDS-C score of < or = 13) at last observation. All of these patients were less severely ill at baseline, whereas none of those more severely depressed at baseline responded. The majority of the 16 patients (7 manic, 9 cycling) with manic symptoms at baseline showed improvement in the YMRS in the first 2 weeks. While 7 of the 16 (44%) patients met the criterion for manic response and remission at last observation, 4 showed intervening periods of moderate to marked exacerbation. Levetiracetam was weight neutral.
Other pilot trials should explore possible areas of psychotropic action of levetiracetam prior to the conduct of more controlled clinical trials.
Previous research that atypical antipsychotics were switched less often compared to typical antipsychotics, suggesting overall better treatment satisfaction. The objective of this study was to ...investigate the reasons for switching antipsychotics after initiating oral treatment with either typical or atypical antipsychotics in a clinical setting.
A total of 123 patients that switched antipsychotic therapy were recruited from 17 psychiatric hospitals, of which 46 % switched because of lack of effect and 45 % because of adverse effects.
No significant differences were found between users of atypical versus typical antipsychotics in reasons for switching, both for overall adverse events, and lack of effect. In users of atypical antipsychotics extrapyramidal effects were reported less often as reason for switching (adjusted OR = 0.18 (95 % CI = (0.07 - 0.51)). Patients on atypical antipsychotics switched more often because of weight gain (adjusted OR = 12.8 (95 % CI = (1.50 - 109)).
In conclusion, when switching occurred, no difference was found in the frequency of general tolerability or reported lack of effectiveness. However, the type of adverse event as a reason for switching differed between atypical and typical antipsychotics.
Objective: A relative resistance of immune cells to steroids has been established in patients with major depression (MD). In this study, we investigated the in vitro responsiveness of T cells to ...dexamethasone (DEX) of patients with bipolar disorder (BD).
Methods: T cells of outpatients with DSM‐IV BD (n = 54) and of healthy control subjects (HC; n = 29) were isolated, cultured and stimulated with phytohemagglutinin (PHA) for 72 h. The suppressive effect of graded concentrations of DEX (5 × 10−9–10−5 M) on PHA‐induced CD25 (IL‐2R) expression was measured by fluorescence‐activated cell sorting (FACS) analysis. Data were correlated to the T‐cell activation status in the peripheral blood of the same patients and to their diagnosis, current mood state, ultradian cycling pattern and current use of medication, including lithium.
Results: T cells of patients with BD were less sensitive to DEX‐induced suppressive effects as compared with T cells of HC. These data were particularly evident at 10−7 M DEX (mean % suppression ± SEM BD: 18.9% ± 3.5 versus HC: 35.8% ± 4.7, p = 0.001). We found no correlations of this relative in vitro DEX resistance of T cells neither with the previously mentioned clinical characteristics nor with the actual activation status of the T cells in the BD patients.
Conclusion: A relative T‐cell resistance to steroids, as has been observed in MD previously, may be a trait phenomenon of BD, independent of mood state.
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