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Biomedical subjects

M Fearon

Publications and source records attributed to M Fearon.

At least 19 recordsLinked to original sources
PubMed2000

Hospitalization for community-acquired, rotavirus-associated diarrhea: a prospective, longitudinal, population-based study during the seasonal outbreak. The Greater Toronto Area/Peel Region PRESI Study Group. Pediatric Rotavirus Epidemiology Study for Immunization.

OBJECTIVES: To determine the age-specific hospitalization rate for rotavirus-associated diarrhea in Canadian children during the seasonal outbreak, and to characterize children and their households, for assessment of the need for a rotavirus vaccine. DESIGN: Prospective multisite cohort study. SETTINGS AND PARTICIPANTS: Children with an admission diagnosis of diarrhea admitted to 18 hospitals serving 132 study census tracts of a major urban region, from November 1, 1997, through June 30, 1998. Prospective centralized testing of stools was performed; research nurses administered a follow-up questionnaire to parents. MAIN OUTCOME MEASURE: Age-specific diarrhea and rotavirus-associated hospitalization rates. RESULTS: Of 224160 children younger than 5 years, the diarrhea hospitalization rate was 4.8 in 1000 (n = 1086) during the seasonal epidemic. Based on testing of 65% of the hospitalized children, the rotavirus-associated diarrhea hospitalization rate was 1.3 in 1000; the cumulative incidence to 5 years of age was 1 in 160. Rotavirus-associated diarrhea was reported in 37% of the 1001 hospitalized children undergoing testing inside and outside of the census tracts; in children aged 6 to 35 months, this rose to more than 70% during April and May. Ages of children with rotavirus-associated diarrhea were 0 to 2 months (2%), 3 to 5 months (5%), 6 to 23 months (60%), 24 to 35 months (15%), and 36 months or older (19%). Of children aged 0 to 5 and 6 to 11 months, 4 (19%) of 21 and 6 (10%) of 59, respectively, had been born prematurely; 20 (24%) of 83 younger than 1 year were breastfed at the time of illness. Of children younger than 36 months, 77% were cared for in their homes; 13%, in family day care homes; and 8%, in child care centers. The mean (+/- SD) duration of rotavirus hospitalization based on hospital records and parental questioning was 2.4 +/- 1.7 and 3.1 +/- 1.6 days, respectively; it was significantly longer (P < or = .001) in children with an underlying medical condition. One child required intensive care unit hospitalization. Diarrhea occurred concurrently in 74% of household contacts younger than 3 years; 38%, aged 3 to 18 years; and 29%, older than 18 years. Seventy-six percent of parents were married. Household incomes in Canadian dollars in the 81% reporting were less than $20000 in 20%, $20000 to $60000 in 44%, and greater than $60000 in 36%. Ethnicity was reported as 53% white, 15% black, 10% Asian, 12% East Indian, and 11% other. CONCLUSIONS: Based on testing of 65% of children with diarrhea, rotavirus resulted in hospitalization in a minimum of 1 in 160 children by 5 years of age during the seasonal outbreak. Had 100% of young children with diarrhea undergone testing, the extrapolated cumulative incidence of rotavirus-associated diarrhea by 5 years of age may have been 1 in 106.

Acute Disease↗
PubMed2000

Rotavirus-associated diarrhea in outpatient settings and child care centers. The Greater Toronto Area/Peel Region PRESI Study Group. Pediatric Rotavirus Epidemiology Study for Immunization.

OBJECTIVES: To determine the prevalence of rotavirus infection in outpatient and child care center (CCC) settings during the seasonal rotavirus outbreak and to describe associated health care utilization. DESIGN: Prospective, multisite cohort study in various ambulatory settings. SETTINGS AND PARTICIPANTS: Participants were children with diarrhea (1) presenting to hospital emergency departments (EDs) and receiving intravenous (IV; n = 8) or oral (n = 1) hydration, (2) seen in pediatric practices (n=4), or (3) attending CCCs (n = 19) between November 1, 1997, and June 30, 1998. Prospective centralized testing of stool samples for rotavirus was performed using enzyme-linked immunosorbent assay and electron microscopy. Study nurses administered follow-up parent questionnaires for rotavirus-positive children. MAIN OUTCOME MEASURE: Prevalence of rotavirus-associated diarrhea. RESULTS: During the 8-month study, rotavirus was identified in 92 children with diarrhea: ED-IV, 20 (44%) of 45; ED-oral, 9 (47%) of 19; pediatric practices, 30 (20%) of 147; and CCCs, 33 (18%) of 186. Of 226 children with diarrhea in pediatric practices, all 5 who progressed to ED-IV hydration or hospitalization were tested, and 3 (60%) were rotavirus positive. Of 211 children in CCCs with diarrhea, 84% who required no health care visits were tested, and of these 10% were positive; of 56 who went on to require a health care visit and 8 who required ED-IV hydration or hospitalization, all were tested, and 27% and 75%, respectively, were rotavirus positive. Among 16 children with rotavirus followed up with ED-IV hydration, 4 (25%) returned and were hospitalized. Maximal health care intervention among 29 children with rotavirus enrolled in pediatric practices included 22 (76%) seeing the pediatrician only, 5 (17%) seeking further care in the ED, 1 (3%) receiving further ED-IV hydration, and 1 (3%) being hospitalized briefly. Maximal health care intervention for 33 children with rotavirus enrolled in CCCs included 13 (39%) who did not visit a physician, 11 (33%) who did, 3 (9%) who sought care in the ED, 1 (3%) who received ED-IV hydration, and 5 (15%) who were hospitalized. In CCCs, rates of diarrhea per 100 child-months of observation were as follows: ages 0 to 23 months, 6.6 episodes; ages 24 to 35 months, 1.9 episodes; and 3 years and older, 0.07 episodes; rates of rotavirus-associated diarrhea were as follows: ages 0 to 23 months, 1.1 episodes (28 of 2547); ages 24 to 35 months, 0.23 episodes (5 of 2185); and 3 years and older, 0 episodes (0 of 4124). CONCLUSION: Across a variety of outpatient and CCC settings, rotavirus is an important cause of diarrhea and a major cause of health care utilization.

Child↗
PubMed2000

Zanamivir use during transmission of amantadine-resistant influenza A in a nursing home.

OBJECTIVE: To describe the use of zanamivir during an influenza A outbreak. POPULATION: Residents of a 176-bed long-term-care facility for the elderly in Newmarket, Ontario, Canada, 90% of whom received influenza vaccine in the fall of 1998. OUTBREAK: When respiratory illness due to influenza A was confirmed, infection control measures and amantadine prophylaxis were initiated. Despite these measures, transmission of influenza A continued. INTERVENTION: Zanamivir inhalations, 10 mg daily for prophylaxis and 10 mg twice daily for treatment of influenza. RESULTS: There were 13 definite and 66 probable outbreak-associated cases of influenza A. Twelve (15%) cases developed pneumonia, 7 (9%) were hospitalized, and 2 (2.6%) died. All 12 culture-positive cases yielded influenza A/Sydney/H3N2/05/97-like virus, a 1998/99 vaccine component. The three isolates obtained prior to the initiation of amantadine were amantadine-susceptible; all nine obtained after prophylaxis was instituted were amantadine-resistant. One hundred twenty-nine (92%) of 140 residents who were offered zanamivir accepted it and were able to attempt inhalations. Of these 129, 78% (100) had no difficulty in complying with inhalations. Difficulty with inhalations was associated with decreased functional and mental status. Fifteen (58%) of 26 residents fully dependent in activities of daily living had difficulty compared to 14 (14%) of 100 others (P<.001). Twenty-two (45%) of 49 residents not oriented to person, place, or time had difficulty compared to 7 (10%) of 77 others (P<.001). In the 2 weeks after zanamivir prophylaxis, only 2 new cases of respiratory illness occurred, neither confirmed as influenza. No side effects were identified in 128 zanamivir-treated residents. CONCLUSION: A minority of nursing home residents have difficulty following instructions for zanamivir inhalations. Zanamivir was well tolerated, and its use was temporally associated with termination of an outbreak that amantadine had failed to control.

Activities of Daily Living↗
PubMed2000

Etiology of community-acquired pediatric viral diarrhea: a prospective longitudinal study in hospitals, emergency departments, pediatric practices and child care centers during the winter rotavirus outbreak, 1997 to 1998. The Pediatric Rotavirus Epidemiology Study for Immunization Study Group.

OBJECTIVE: To determine the viral etiology of community-acquired diarrhea in children admitted to hospitals and presenting in emergency departments, pediatric practices and child care centers from November 1, 1997, to June 30, 1998. STUDY DESIGN: Children with diarrhea were identified in a prospective multisite cohort study and analyzed according to age, gender and duration of hospitalization. Stools were tested for rotavirus by enzyme immunoassay and for all other enteric viruses by electron microscopy. RESULTS: Of the 2524 children identified with diarrhea, stools of 1386 (55%) were tested by enzyme immunoassay for rotavirus, and of these 1365 (54%) were screened by electron microscopy for all identifiable enteric viruses. Rotavirus was found in 32% (n = 437), adenovirus in 4% (n = 55), torovirus in 3% (n = 44), Norwalk-like viruses in 2% (n = 25) and astrovirus (n = 14) and calicivirus (n = 7) in fewer than 1% of the specimens tested. The proportion of rotavirus was significantly higher in children 12 to 23 months of age (43% of tested stools, n = 159) and 24 to 35 months of age (38% of tested stools, n = 64) (P < 0.001) than in any other age group. Toroviruses were found to approximately the same extent in children > or =36 months of age (6% of tested stools, n = 19) as those <36 months of age. Rotavirus (36% of tested stools, n = 375, P < 0.0005) and torovirus (4% of tested stools, n = 43, P < 0.004) were most often found in hospitalized patients. In contrast Norwalk-like viruses (P < 0.001) and astroviruses (P < 0.01) were more commonly detected in specimens from patients who presented to physicians' offices and who were symptomatic for gastroenteritis in child care centers. CONCLUSION: This study demonstrates that although all known gastroenteritis viruses were diagnosed in symptomatic children, rotavirus was the etiologic agent in most cases of diarrhea managed in the community and in the hospital.

Child Day Care Centers↗
PubMed2000

Performance of indirect immunoglobulin M (IgM) serology tests and IgM capture assays for laboratory diagnosis of measles.

As progress is made toward elimination of measles, the laboratory confirmation of measles becomes increasingly important. However, both false-positive and false-negative results can occur with the routinely used indirect measles immunoglobulin M (IgM) serology tests. The measles IgM capture assay is considered to be more specific, and therefore, its use is indicated for confirmatory testing, but its relative performance has not been fully assessed. Four commercial indirect measles IgM serology test kits (the Behring, Clark, Gull, and PanBio assays) and a commercial IgM capture assay (the Light Diagnostics assay) were evaluated for their abilities to detect measles virus-specific IgM antibody with a total of 308 serum samples from patients involved in a measles outbreak and with confirmed cases of measles and 454 samples from subjects without measles. The Centers for Disease Control and Prevention (CDC) IgM capture assay was also used in a part of the evaluation. Among the indirect assays, the overall sensitivities ranged from 82.8% (Clark assay) to 88.6% (Behring assay) and specificity ranged from 86.6% (PanBio assay) to 99.6% (Gull assay). These rates were 92.2 and 86. 6%, respectively, for the Light Diagnostics capture assay and 87.0 and 94.8%, respectively, for the CDC capture assay. While the Light Diagnostics capture assay had the best detection rate (80%) with the acute-phase samples compared with those for the rest of the tests (CDC capture assay, 77%; Behring assay, 70%; Gull assay, 69%; PanBio assay, 58%; and Clark assay, 57%), all tests showed a significantly improved sensitivity in the range of 92% (Clark and PanBio assays) to 97% (Light Diagnostics and CDC capture assays) with the convalescent-phase samples, as expected. The best seropositivity rates (in the range of 92 to 100%) were observed with samples collected 6 to 14 days after the onset of symptoms. The Gull assay showed the highest positive predictive value (99.6%), followed by the Behring assay (97.8%) and the CDC capture assay (96.1%). Overall, the Gull and Behring assays were found to be as good as or better than the capture assays. In conclusion, laboratory diagnosis of measles based on IgM serology varies depending on the timing of specimen collection and the test used, and the case for the use of the IgM capture assay as the confirmatory test appears to be uncertain.

Antibodies, Viral↗
PubMed1999

Toronto street youth and HIV/AIDS: prevalence, demographics, and risks.

PURPOSE: The purposes of this study were: (a) to identify human immunodeficiency virus (HIV) prevalence in Toronto street youth through paired blood and saliva specimens; (b) to identify the HIV risk and prevention behaviors of street involved youth; and (c) to identify demographic or other factors that may contribute to the risk of street youth becoming infected with HIV/acquired immunodeficiency syndrome (AIDS) in the future. METHODS: This was a cross-sectional convenience study of street-involved youth aged 14-25 years. The youth participated in interviews to identify HIV-related knowledge and personal risk and preventive behaviors. Following interviews, they were asked to provide a saliva sample, blood spot, or both. They could refuse one or both samples without jeopardizing their involvement or receiving an honorarium. Two males were the only participants who declined to provide a sample. RESULTS: Fifteen of 695 (2.2%) youth tested positive for HIV infection. All were male, ranging in age from 18 to 25 years. Same and opposite sex, intravenous (IV) drug use, prostitution, and incarceration were risk factors associated with positive HIV test results. The rate of HIV infection was seven times greater for the group 20 years of age and older (20-25) compared to the younger group aged 14-9 years. The proportion testing positive for HIV from small cities, towns, and rural communities in Ontario was 40%; yet, they represented 21% of the study population. Most (57%) youth had been on their own for no more than 3 years and had moved frequently. Nearly two thirds (60%) had stayed in hostels or homeless shelters in the previous 6 months. CONCLUSION: Street youth in Canada are at high risk of HIV infection with their risk increasing with age. Unprotected (same and opposite) sex, IV drug use, prostitution and incarceration were linked to their HIV infections. The high level of mobility identified by street youth challenges governments, communities, and public health officials to develop appropriate prevention strategies and to carefully monitor the spread of HIV infection in this vulnerable population.

Adolescent↗
PubMed1999

Measles inclusion-body encephalitis caused by the vaccine strain of measles virus.

We report a case of measles inclusion-body encephalitis (MIBE) occurring in an apparently healthy 21-month-old boy 8.5 months after measles-mumps-rubella vaccination. He had no prior evidence of immune deficiency and no history of measles exposure or clinical disease. During hospitalization, a primary immunodeficiency characterized by a profoundly depressed CD8 cell count and dysgammaglobulinemia was demonstrated. A brain biopsy revealed histopathologic features consistent with MIBE, and measles antigens were detected by immunohistochemical staining. Electron microscopy revealed inclusions characteristic of paramyxovirus nucleocapsids within neurons, oligodendroglia, and astrocytes. The presence of measles virus in the brain tissue was confirmed by reverse transcription polymerase chain reaction. The nucleotide sequence in the nucleoprotein and fusion gene regions was identical to that of the Moraten and Schwarz vaccine strains; the fusion gene differed from known genotype A wild-type viruses.

Encephalitis, Viral↗
PubMed1998

Intimacy as a determinant of expressed emotion in carers of people with Alzheimer's disease.

BACKGROUND: Although high expressed emotion (EE) has been found to be an important predictor of poor prognosis in a wide range of conditions such as schizophrenia, anorexia and depression no complete explanation exists for individual differences in EE responses. The aim of this paper is to investigate the role of intimacy in determining the level of EE in carers of people with dementia. METHODS: Ninety-nine carers of people with dementia who presented to Old Age Psychiatry Services in South and Central Manchester completed questionnaires to ascertain past and current levels of intimacy. Camberwell Family Interviews (CFIs) were carried out to ascertain levels of EE. RESULTS: Current intimacy was found to be strongly related to EE such that low current intimacy was associated with high EE and there was a significant difference between high and low intimacy groups on measures of criticism and hostility, though not warmth. CONCLUSIONS: The association found between intimacy and EE indicates that high EE may be a characteristic of low intimacy relationships between the carer and the cared-for-person. Since the assessment of EE is time intensive, perhaps a measure of intimacy will provide a short-hand screen for identifying critical and hostile caring environments.

Aged↗
PubMed1996

Performance characteristics of recombinant enzyme immunoassay to detect antibodies to human immunodeficiency virus type 1 (HIV-1) and HIV-2 and to measure early antibody responses in seroconverting patients.

We investigated the performance of a double-antigen sandwich recombinant enzyme immunoassay (EIA; Abbott Laboratories, North Chicago, Ill.) and compared it with that of a synthetic-peptide-based EIA (Biochem Immunosystems, Montreal, Quebec, Canada) for the detection of human immunodeficiency type 1 (HIV-1) and HIV-2 antibodies in 2,321 clinical serum samples. The results of both EIA methods and Western blot (immunoblot) were in agreement for 1,046 HIV-1 and 10 HIV-2 specimens from a panel of known positives. From a prospective panel of 1,085 specimens, 38 proved to be positive by both EIAs and Western blot, 3 were positive by the recombinant EIA only, and 9 were positive by the peptide EIA only, for calculated specificities of 99.71 and 99.04%, respectively. Of 180 specimens from a seroconversion panel collected from 77 patients, the results for 170 were in agreement by all antibody testing methods and 10 were found to be repeat reactive for HIV antibodies by the recombinant EIA only. All 10 were initial specimens of seroconverting patients; 7 were also reactive for HIV p24 antigen. An examination of four of these sera by radioimmunoprecipitation assay showed gp120 and gp160 bands in each. Analysis of the anti-Env antibody class in three of these samples showed that one consisted of immunoglobulin M (IgM) only and two contained both IgG and IgM antibodies. Although both EIA procedures were sensitive and specific in the detection of antibodies to HIV-1 and HIV-2 and both were capable of detecting early antibodies, the recombinant assay was more sensitive for antibody detection during early seroconversion.

Evaluation Studies as Topic↗
PubMed1996

Longitudinal study of molecular epidemiology of small round-structured viruses in a pediatric population.

Small round-structured viruses (SRSV), recently designated members of the family Caliciviridae, can now be readily subtyped by amplification of a defined portion of their genome by reverse transcription-PCR and then by identification of the amplicons with specific probes by Southern blotting. A longitudinal survey (from 1991 to 1995) was conducted to determine the genotypes of the SRSV present in pediatric stool specimens from patients with sporadic cases of gastroenteritis. It was found that almost all viruses were of the G-2 genotype, and on probing, the subtype P2-B was predominant but the frequencies of the different subtypes varied from year to year. A survey of the genotypes of SRSV from community outbreaks from 1995 showed that the G-2 genotype was also predominant and that the distribution of its subtypes was similar to that seen in sporadic cases of diarrhea in pediatric patients over the same time period. It was concluded that there is a succession of subtypes of SRSV in our pediatric population over time. This distribution of genotypes in sporadic cases of pediatric gastroenteritis may reflect the distribution in community outbreaks occurring at the same time.

Caliciviridae Infections↗
PubMed1995

The HIV information project for transfusion recipients a decade after transfusion.

OBJECTIVE: To gather information on which to base decisions about a general notification program for pediatric patients a decade after their receiving transfusions. DESIGN: The physicians of a cohort of 1793 patients who underwent cardiac surgery were sent letters asking them to contact and counsel patients identified from cardiovascular surgery and blood bank databases about their risk for human immunodeficiency virus (HIV) infection. Questionnaires were used to collect data about physicians' HIV practices; telephone interviews were conducted to collect information about patients' and parents' knowledge and attitudes about HIV and transfusions. Because of unexpected media interest, questionnaires and interviews were modified to include questions about the source of information. The HIV-testing status of patients reported by physicians was anonymously cross-referenced with specimens received by the Laboratory Services Branch, Ontario Ministry of Health, Toronto. SETTING: A large Canadian pediatric tertiary care hospital in Toronto. PARTICIPANTS: Seven hundred ninety-three patients undergoing cardiopulmonary bypass between 1980 and 1985. RESULTS: The HIV Information Project successfully reached most (approximately 75%) of this cohort and, with the help of the media, many other at-risk transfusion recipients. The information was new for many; almost all informed wanted to undergo testing. The seroprevalence of this group that received multiple transfusions was, at minimum, 8.5 patients in 1000. Six previously unsuspected HIV-seropositive cases were diagnosed. CONCLUSIONS: Although we had assumed that most patients receiving transfusions would be aware of their risk for HIV infection, our results indicate that, even a decade after the transfusion, many recipients were not aware of the risk and wanted to undergo testing. Testing identified asymptomatic infected patients.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Reducing volunteer bias: using left-over specimens to estimate rates of HIV infection among inmates in Ontario, Canada.

OBJECTIVE: To estimate the prevalence of HIV-1 infection among adult and young offenders admitted to remand facilities in the province of Ontario, Canada, by using a design that reduces volunteer bias. METHODS: A study using a modified anonymous HIV-surveillance design was conducted with urine specimens routinely collected from male and female entrants to all Ontario jails, detention and youth centres between February and August 1993. Information on sex, age, and history of injecting drug use was also collected. Urine was screened using a modified commercial HIV enzyme-linked immunosorbent assay kit and confirmed using a modified in-house Western blot assay. RESULTS: Data were obtained on 10,530 adult men, 1518 adult women, 1480 young male offenders, and 92 young female offenders. Urine specimens were available for 88% of new entrants. Of the entrants, 1% (n = 163) refused to have their urine used for research. Refusals were not associated with history of injecting drug use. Overall rates of HIV-1 infection were 1% for adult men, 1.2% for adult women, and 0% for young offenders. Both the rates of infection and prevalence of injecting drug use varied across facilities and geographic regions. Overall, 13% of adult men, 20% of adult women, 3% of young male offenders, and 2% of young female offenders reported a history of injecting drug use. Rates of infection were highest among self-reported injecting drug users. Rates of HIV were 3.6% for adult men and 4.2% for adult women who injected compared with 0.6 and 0.5%, respectively, for non-injecting drug users. CONCLUSIONS: The use of unlinked left-over specimens is an important tool for measuring HIV-prevalence rates and should be encouraged. The results indicate that HIV rates are much higher among those entering prisons than in the general population. The pattern of HIV in Ontario prisons is similar to that reported in Europe and the United States. We are optimistic that these data will stimulate much needed efforts towards education and health promotion, and open the door to further research in Canadian prisons.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Differential bacteriology in adenoid disease.

In order to define the differential bacteriology in adenoid disease, adenoids were obtained from 10 children with adenoid hypertrophy and 29 children with chronic adenoiditis. The patients' ages ranged from 18 months to 13 years. After removal of the adenoids, the surface organisms were destroyed by alcohol and flame disinfection. One gram of tissue was sampled for aerobic and anaerobic culture. There was an average of 4.8 isolates per specimen, with 4.2 aerobes and 0.6 anaerobes. The most common isolates were: Haemophilus influenzae (84%), diphtheroids (66%), non-pathogenic Neisseria species (66%), alpha-hemolytic streptococci (64%) and non-hemolytic streptococci (59%). Anaerobes were present in 56% of all cases. The distribution of organisms was similar, regardless of clinical diagnosis. Only eight (21%) of the 39 cases had 'significant' (> or = 10(5) organisms/gm) colony counts. Our study detected no difference in either organism distribution or in total colony counts in chronic adenoiditis vs. adenoid hypertrophy.

Adenoids↗