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Biomedical subjects

J S Nguyen-Van-Tam

Publications and source records attributed to J S Nguyen-Van-Tam.

At least 19 recordsLinked to original sources
PubMed2006

Timing of monoclonal antibody for seasonal RSV prophylaxis in the United Kingdom.

Respiratory syncytial virus (RSV) infection produces more severe disease and increased hospitalization rates in high-risk babies. The monoclonal antibody palivizumab offers protection against complications, and the first of five monthly doses should be administered before the onset of community RSV activity. However, the required real-time prediction of this onset is problematic. We attempted to identify seasonal RSV patterns by retrospectively examining 10 years of laboratory reports for RSV and clinical episode reports for certain respiratory presentations in both primary and secondary care. Analysis of hospital laboratory reports, incidence of acute bronchitis in primary care, and hospital admissions for acute bronchitis and bronchiolitis in young children revealed a consistent increase in RSV activity during week 43 each year. Promptly commencing prophylaxis during the second week of each October (week 42) would precede the onset of the RSV season in the United Kingdom, and provide coverage until its decline in mid-March.

Antibodies, Monoclonal↗
PubMed2005

Costs of running a universal adolescent hepatitis B vaccination programme.

In the first UK study to examine feasibility and acceptability of universal adolescent hepatitis B vaccination, the costs associated with the administration and uptake (80.2 and 89.3% for three doses and at least two doses, respectively), of a three-dose regimen in pupils in Glasgow schools (2001/2002) were measured. These data were used to estimate the economic outlay for the delivery of a routine, ongoing three-dose and two-dose hepatitis B vaccine programme in schools. Vaccine, accounting for almost 70% of the overall costs, was the largest cost item for both the pilot and routine programmes, using either regimen. However, the ongoing, two-dose regimen was the cheapest option in this analysis, irrespective of vaccine price. Cost data from this study may be useful for other countries wishing to implement a similar programme.

Adolescent↗
PubMed2005

Influenza burden of illness, diagnosis, treatment, and prevention: what is the evidence in children and where are the gaps?

Influenza is a disease of global public health significance. Traditionally the emphasis has been on adult disease because of the impact of influenza related mortality in the elderly and other high risk groups. However, it is becoming increasingly better recognised that young children suffer considerable morbidity from influenza. There are also potential consequences for siblings, parents, other carers, and extended family members in terms of secondary infections and carer leave. Influenza infection in childhood could be effectively prevented through vaccination. However, the United States is the only industrialised country currently recommending universal influenza vaccination for young children (between the ages of 6 and 23 months), as opposed to vaccinating only those with high risk conditions.

Adolescent↗
PubMed2002

Emergency (999) calls to the ambulance service that do not result in the patient being transported to hospital: an epidemiological study.

OBJECTIVE: To describe the demographic and clinical characteristics of patients who are not transported to hospital after an emergency (999) call to the East Midlands Ambulance Service, the reason for non-transportation, and the priority assigned when the ambulance is dispatched. METHODS: The first 500 consecutive non-transported patients from 1 March 2000 were identified from the ambulance service command and control data. Epidemiological and clinical data were then obtained from the patient report form completed by the attending ambulance crew and compared with the initial priority dispatch (AMPDS) code that determined the urgency of the ambulance response. RESULTS: Data were obtained for 498 patients. Twenty six per cent of these calls were assigned an AMPDS delta code (the most urgent category) at the time the call was received. Falls accounted for 34% of all non-transported calls. This group of patients were predominantly elderly people (over 70 years old) and the majority (89%) were identified as less urgent (coded AMPDS alpha or bravo) at telephone triage. The mean time that an ambulance was committed to each non-transported call was 34 minutes. CONCLUSIONS: This study shows that falls in elderly people account for a significant proportion of non-transported 999 calls and are often assigned a low priority when the call is first received. There could be major gains if some of these patients could be triaged to an alternative response, both in terms of increasing the ability of the ambulance service to respond faster to clinically more urgent calls and improving the cost effectiveness of the health service. The AMPDS priority dispatch system has been shown to be sensitive but this study suggests that its specificity may be poor, resulting in rapid responses to relatively minor problems. More research is required to determine whether AMPDS prioritisation can reliably and safely identify 999 calls where an alternative to an emergency ambulance would be a more appropriate response.

Accidental Falls↗
PubMed2002

Results of inguinal canal repair in athletes with sports hernia.

AIMS: To evaluate the role of surgical exploration and repair of the inguinal canal in athletes suspected of having a sports hernia. METHODS: Thirty-five (34 males, 1 female) athletes with a suspected sports hernia underwent surgical exploration and inguinal hernia repair. After six months, all athletes were sent questionnaires to assess any improvement in analogue pain scores, return to sport, recurrence of symptoms and the overall result of surgery. RESULTS: Operative findings revealed a tear in the external oblique aponeurosis with or without a significant posterior bulge (n=20), a lone significant posterior bulge (n=10), a tear in the conjoint tendon with dilated superficial ring (n=3), small direct hernial sac (n=1) and lipoma of the spermatic cord (n=1). Surgery consisted of repair of external oblique tear (when present) and prolene darn or lichtenstein mesh repair of the posterior inguinal canal. Twenty-seven patients replied to the questionnaire giving a response rate of 78%; of these, 25 patients (93%: 95% CI 83-100) had returned to normal athletic activities at pre-injury level. There was a marked improvement in level of pain (median pain level=8 pre-operative vs 2 post-operative, p<0.001). Eleven patients (41%) rated the results as excellent, eleven (41%) as good and five (18%) as fair and none worse. Six patients complained of occasional discomfort related to the scar. Three patients complained of recurrence of their symptoms after 4 to 5 months following strenuous exercise. CONCLUSION: Sports hernia presents with a spectrum of surgical findings. Athletes with sports hernia should be considered for routine hernia repair, as the majority of the patients benefit from surgery. It is important to offer a structured rehabilitation programme to maximise the benefits of surgery.

Adult↗
PubMed2002

Doncaster: the public health response to a local cluster of heterosexually acquired HIV infection.

In recent years, clusters of sexually transmitted HIV infection have attracted some media prominence in the UK. We describe our response to a local HIV cluster of five cases that acquired a high media profile. Practical difficulties encountered included: ensuring medical confidentiality in an outbreak control team which included many professional groups; handling a large volume of helpline calls; differing views on how specific health promotion should be; and the impact of summer leave on the control team's continuity. Following publicity, two further cases of HIV infection were found, bringing the total cluster to seven. Both later cases named the man at the centre of the cluster as a sexual partner. Of these two cases, one was local, identified as a direct result of the campaign. The other, living 170 miles distant in London, was identified as a result of increased media awareness. Eventually, the press named the man they thought to be the source case, which the outbreak control team had avoided doing. Good inter-disciplinary working made a co-ordinated public health response possible, and the 1,600 helpline calls dealt with served to reassure the public. Over 1,000 of the callers were advised to contact the Genito Urinary Medicine (GUM) department of their local hospital for counselling and testing of whom 772 took the advice. However, the longer-term effect on sexual behaviour was minimal as evidence by a subsequent survey.

Adult↗
PubMed2001

Excess hospital admissions for pneumonia and influenza in persons > or = 65 years associated with influenza epidemics in three English health districts: 1987-95.

OBJECTIVES: To study the association between community influenza activity and acute hospital admissions for pneumonia and influenza among elderly persons. DESIGN: Multiple regression analysis of acute hospital admissions against community influenza activity, air temperature and seasonal and long-term trends. SETTING: Three English health districts: 1987-95. SUBJECTS: Persons aged > or = 65 years. OUTCOME MEASURES: Acute hospital admissions for pneumonia and influenza (ICD9: 480-487); excess hospital admissions during epidemic periods. RESULTS: The final regression model explained 70% of the total variation in hospital admissions for pneumonia and influenza, including 14% due to community influenza activity. However, most variation was explained by long-term and seasonal changes unrelated to influenza. In the large influenza epidemic of 1989/90 a typical health district (500,000 total population) experienced 56 excess admissions for pneumonia and influenza attributable to epidemic influenza among persons aged > or = 65 years, requiring 672 additional bed-days. However the figure varied widely between seasons and over the whole study period, the average winter excess was 17.5 admissions per health district, requiring an additional 210 bed-days. CONCLUSIONS: Influenza epidemics exert a variable impact on acute hospital admissions for pneumonia and influenza among elderly persons, which in the past have been poorly quantified. Although the absolute numbers of excess admissions is modest, their impact on bed availability may be considerable because of the duration of hospital stay in elderly persons.

Age Factors↗
PubMed2001

What happens to medical students who complete an honours year in public health and epidemiology?

BACKGROUND: Around one-third of medical students in the UK take an intercalated honours degree in addition to their basic undergraduate course. The honours year has been reported to have a major influence on subsequent career choice; honours students show greater interest in research and laboratory medicine careers and less in general practice and public health.1,2 AIMS: To examine the career choice of Nottingham medical students who completed an honours year in public health and epidemiology (including general practice). METHODS: Postal questionnaire and telephone follow-up of a cohort of 266 students who entered the honours year in Public Health and Epidemiology between 1973 and 1993. RESULTS: Career information was available on 203 students; 78% (195) of those are currently employed in medicine. 44% were working in general practice (expected 40-45%) and 8% in public health medicine (expected 2%). Overall 19% (expected 4-11%) had chosen academic careers including nine of the 15 choosing an academic career in public health. The majority (60%) reported that the honours year had influenced their career choice, while 55% reported that the year had increased their likelihood of choosing an academic career. CONCLUSIONS: The honours year does encourage entry into academic and research careers in general and the type of honours year department strongly influences the subsequent choice of specialty.

Career Choice↗
PubMed2000

Changing carriage rate of Neisseria meningitidis among university students during the first week of term: cross sectional study.

OBJECTIVE: To determine the rates of, and risk factors for, meningococcal carriage and acquisition among university students. DESIGN: Repeated cross sectional study. PARTICIPANTS: 2,507 students in their first year at university. MAIN OUTCOME MEASURES: Prevalence of carriage of meningococci and risk factors for carriage and acquisition of meningococci. RESULTS: Carriage rates for meningoccoci increased rapidly in the first week of term from 6.9% on day 1, to 11.2% on day 2, to 19.0% on day 3, and to 23.1% on day 4. The average carriage rate during the first week of term in October among students living in catered halls was 13.9%. By November this had risen to 31.0% and in December it had reached 34. 2%. Independent associations for acquisition of meningococci in the autumn term were frequency of visits to a hall bar (5-7 visits: odds ratio 2.7, 95% confidence interval 1.5 to 4.8), active smoking (1.6, 1.0 to 2.6), being male (1.6, 1.2 to 2.2), visits to night clubs (1. 3, 1.0 to 1.6), and intimate kissing (1.4, 1.0 to 1.8). Lower rates of acquisition were found in female only halls (0.5, 0.3 to 0.9). The most commonly acquired meningococcal strain was C2a P1.5 (P1.2), which has been implicated in clusters of invasive meningococcal disease at other UK universities. CONCLUSIONS: Carriage rates of meningococci among university students increase rapidly in the first week of term, with further increases during the term. The rapid rate of acquisition may explain the increased risk of invasive meningococcal disease and the timing of cases and outbreaks in university students.

Activities of Daily Living↗
PubMed2000

Outbreaks of influenza A in nursing homes in Sheffield during the 1997-1998 season: implications for diagnosis and control.

Three recent outbreaks of influenza A in nursing and residential homes in Sheffield were characterized by high attack rates among both residents and staff, and a high mortality rate among residents. The epidemiology of the outbreaks was unusual in that all three occurred towards the end of a quiet influenza season, against a generally low level of community activity, and involved strains of influenza that were not included in the current season's vaccine. The outbreak investigation was aided by the use of a novel rapid diagnostic technique. In future the combination of vaccination, surveillance, rapid diagnosis and new antineuraminidase drugs should improve prospects for control of influenza within closed communities.

Aged↗
PubMed2000

Prevalence of Helicobacter pylori infection in Kenyan schoolchildren aged 3-15 years and risk factors for infection.

OBJECTIVES: To determine the prevalence of Helicobacter pylori (Hp) infection in Kenyan schoolchildren aged 3-15 years and the risk factors for infection. DESIGN: A cross-sectional survey and study of risk factors. SUBJECTS: Primary-school children in Trans Nzoia district, Kenya. METHODS: Hp status was determined using the 13C-urea breath test. Risk factors were assessed using a structured interview schedule. RESULTS: Of 205 children interviewed, valid breath test results were obtained for 192 (93.7%), of whom 155 (80.7% (95% CI 75.2-86.3)) were infected. Univariate analysis showed weak associations between Hp infection and rural areas (location of home, Relative Risk (RR)= 1.2 (1.0-1.4); location of school, RR = 1.2 (1.0-1.3)) and lower socio-economic status (RR = 1.2 (1.0-1.4)). Access to only a pit-latrine in the home (RR = 1.2 (1.0-1.4)) and plate-sharing with other family members in the home also increased the likelihood of Hp infection (RR = 1.3 (1.1 -1.6)). However, after logistic regression modelling only plate-sharing in the home remained as an independent risk factor (odds ratio (OR) = 2.8 (1.3-6.3)). CONCLUSIONS: The prevalence of Hp infection in Kenyan schoolchildren aged 3-15 years is already high, suggesting that most acquisition occurs before age 3 years. Children who normally shared a plate with other family members during meals in the home had a higher prevalence of infection, suggesting that oro-oral transmission may be important in this population. Future studies in developing countries should focus on younger children (before age 3 years), and consider the possibility of adult-child, oro-oral transmission in order to establish likely modes of transmission.

Activities of Daily Living↗
PubMed2000

Dynamics of meningococcal long-term carriage among university students and their implications for mass vaccination.

In the 1997-98 academic year, we conducted a longitudinal study of meningococcal carriage and acquisition among first-year students at Nottingham University, Nottingham, United Kingdom. We examined the dynamics of long-term meningococcal carriage with detailed characterization of the isolates. Pharyngeal swabs were obtained from 2,453 first-year students at the start of the academic year (October), later on during the autumn term, and again in March. Swabs were immediately cultured on selective media, and meningococci were identified and serologically characterized. Nongroupable strains were genetically grouped using a PCR-based assay. Pulsed-field gel electrophoresis was used to determine the link between sequential isolates. Of the carriers initially identified in October, 44.1% (98 of 222) were still positive later on in the autumn (November or December); 57.1% of these remained persistent carriers at 6 months. Of the index carriers who lost carriage during the autumn, 16% were recolonized at 6 months. Of 344 index noncarriers followed up, 22.1% acquired carriage during the autumn term and another 13.7% acquired carriage by March. Overall, 43.9% (397 of 904) of the isolates were noncapsulated (serologically nongroupable); by PCR-based genogrouping, a quarter of these belonged to the capsular groups B and C. The ratio of capsulated to noncapsulated forms for group B and C strains was 2.9 and 0.95, respectively. Sequential isolates of persistent carriers revealed that individuals may carry the same or entirely different organisms at different times. We identified three strains that clearly switched their capsular expression on and off at different times in vivo. One student developed invasive meningococcal disease after carrying the same organism for over 7 weeks. The study revealed a high rate of turnover of meningococcal carriage among students. Noncapsulated organisms are capable of switching their capsular expression on and off (both ways) in the nasopharynx, and group C strains are more likely to be noncapsulated than group B strains. Carriage of a particular meningococcal strain does not necessarily protect against colonization or invasion by a homologous or heterologous strain.

Carrier State↗
PubMed1999

Clinical effectiveness, policies, and practices for influenza and pneumococcal vaccines.

Pneumococcal disease and influenza impact public health considerably. S pneumoniae probably accounts for almost 14,000 deaths and more than 23,000 admissions to National Health Service hospitals per annum. Influenza epidemics occur frequently and unpredictably with the potential to inflict morbidity and mortality on a massive scale. Both diseases pose maximum risks to persons with underlying chronic illnesses. Assessing the effectiveness of pneumococcal and influenza vaccines presents complex methodological problems. However, despite these difficulties, a body of evidence has accumulated suggesting that pneumococcal vaccines offer substantial protection against both bacteremia and pneumonia among healthy low-risk adults, but only against bacteremia in those considered high-risk. There is now strong evidence that the influenza vaccine protects high-risk patients from both hospitalization and death. Although most European countries now have national guidelines for vaccination of high-risk patients, both vaccines remain underused in modern clinical practice mainly due to poor organization.

Adult↗