Abstract: Historically, Shigella sonnei has dominated other Shigella species infection in men who have sex with men (MSM) in Montreal. In early 2010, Toronto reported increased proportions of the more pathogenic S. flexneri, HIV co-infection and MSM in shigellosis cases since 2009. Analytical methods were used to assess whether S. flexneri had dominated Montreal’s MSM cases since 2009 and whether changes had occurred in notifications in MSM and HIV-co-infected MSM. S. flexneri increased by 6.7% per month since 2007 and predominated in MSM since 2009 without changes in HIV co-infection or similar shifts in the general population. The results suggest that the surveillance of Shigella species in order to detect species shifts is beneficial for surveillance, given the potential for increased transmission and severity of S. flexneri in HIV-positive MSM.
Abstract: Humanitarian emergencies resulting from armed conflicts and natural disasters necessitate the most rapid of public health responses. During 2009 and 2010, practitioners highlighted two critical opportunities in such settings: (1) to respond to the changing needs for health assessment and healthcare delivery for conflict-affected communities and (2) to strengthen operational research capacity for disease control programmes that serve vulnerable populations.1 2 Both ideas signal the need for reinforcement of training for health workers in crises and they also resonate with the aims of field epidemiology.
Field epidemiology encompasses the investigation of infectious diseases and other health events and the conduct of succinct research studies using surveillance data. These tools are applied to derive evidence rapidly for intervention and policy change. Epidemiologists working for non-governmental organisations, ministries of health and international organisations use this approach to assess disease burden and to plan and evaluate interventions, sometimes in very challenging circumstances.3 4 This approach can flexibly contend with the changing demographics of crisis-affected populations who may be living longer, who …
Abstract: Debarati Guha-Sapir and Ruwan Ratnayake use field data to demonstrate the severe vulnerability faced by much of the Somalian population due to ongoing conflict, and call for concerted public health interventions and access to food aid especially in southern Somalia.
Abstract: PRIMARY OBJECTIVE: To explore the experiences of health care practitioners working with Aboriginal clients recovering from acquired brain injury (ABI). RESEARCH DESIGN: Participatory research design using qualitative methods. METHODS: Fourteen in-depth, semi-structured interviews were conducted. The Framework Method of analysis was used to uncover emerging themes. FINDINGS: Five main categories emerged: practitioners' experience with brain injury, practitioners' experience with Aboriginal clients, specialized needs of Aboriginal clients recovering from brain injury, culturally sensitive care and traditional healing methods. These categories were then further divided into emergent themes and sub-themes where applicable, with particular emphasis on the specialized needs of Aboriginal clients. DISCUSSION: Each emergent theme highlighted key challenges experienced by Aboriginal peoples recovering from ABI. A key challenge was that protocols for rehabilitation and discharge planning are often lacking for clients living on reserves or in remote communities. Other challenges included lack of social support; difficulty of travel and socio-cultural factors associated with post-acute care; and concurrent disorders. CONCLUSIONS: Results suggest that developing reasonable protocols for discharge planning of Aboriginal clients living on reserves and/or remote communities should be considered a priority.
Abstract: ABSTRACT: The use of epidemiology in documenting the mortality experience in complex emergencies has become pervasive in humanitarian practice. Recent assessments in Iraq and Darfur have provoked much discussion on the assessment of mortality in scientific and policy spheres. In this context, the Centre for Research on the Epidemiology of Disasters and the Harvard Humanitarian Initiative held an inter-disciplinary symposium to examine the topic among epidemiologists, demographers, forensic scientists and legal and human rights investigators. We aimed to strengthen the scientific understanding of mortality estimation by reviewing progress across fields and building inter-disciplinary bridges. We report on the presentations and discussions here.
Abstract: Background: Suicidal behaviour, primarily through self-poisoning, is a major public health problem among youth in Sri Lanka.
Methods: This article describes a qualitative study of student perspectives on suicidal behaviour and its prevention. Focus groups were held with students 17—20 years of age. A discussion of the perceived causes of suicidal behaviour provided the context for discussing prevention efforts.
Conclusion: Participants identified pathways to suicidal behaviour and emphasized experiential aspects and the variability of fatal intent. Suggestions for prevention tended to emphasize the strengthening of community-oriented actions in order to better realize lethal means restrictions.
Abstract: If you mention the phenomenon of pesticide poisoning in developing countries to well-informed health advocates, it is likely that the 1984 industrial disaster in Bhopal, India, will come to mind. In Bhopal, a Union Carbide pesticide plant leaked 40 tonnes of methyl isocyanate gas into the environment, leading to at least 15 000 deaths over the next 20 years. What is not so well known is that intentional self-poisoning by pesticide ingestion has become an enduring epidemic that is estimated to result in 250 000 to 370 000 deaths annually, predominantly in Asia. This means that in some areas of the developing world, pesticide poisoning, including self-poisoning, is responsible for more deaths than infectious diseases.
Abstract: As members of the most recent cohort of interns who have returned from international health–related placements through the Government of Canada’s Youth Employment Strategy (YES), we are writing to voice our concerns about potential budget cuts to the Canadian International Development Agency’s (CIDA) International Youth Internship Program. It was recently announced that Government’s funding cuts have suspended the Department of Foreign Affairs’ Young Professionals International Program and we are apprehensive that further downsizing of CIDA’s counterpart program will deprive Canadian graduates of important entry points into the field of international health.
Abstract: Suicide on subway systems is a public health challenge that has been reported in urban centers worldwide. Our objective was to analyze studies of suicide on subway systems, develop a profile of characteristics that are suggestive of association with suicides or attempts, and show how this profile can inform prevention. A literature review involving epidemiology studies and studies relating to subway suicide was conducted. Twenty-eight studies were included in this review. Across studies, characteristics were not often assessed for risk factor status, although several characteristics were remarkably similar. Those attempting suicide on the subway appear to be affected by serious mental illness and have contact with mental health services before the suicidal behavior. Several characteristics may be shared among this population, emphasizing the potential for prevention in clinical and public health domains. Well-designed studies that utilize robust data collection and statistical methods are needed to establish the risk status associated with these characteristics.
Abstract: OBJECTIVE: This paper has 3 objectives. First, we review the epidemiologic evidence for the association between suicidal behaviour and suicide in individuals diagnosed with antisocial, borderline, or narcissistic personality disorder. Second, we examine whether any potentially modifiable risk factors are associated with these diagnoses, based on existing empirical evidence. Last, we discuss clinical approaches to assessing youth with antisocial, borderline, or narcissistic personality disorder presenting at risk for suicide. METHOD: We reviewed the English-language literature for the last 12 years (from January 1, 1991, to December 31, 2002), using as search terms the names of the 3 disorders, as well as the key words suicide, suicidal behaviour, youth, and adolescents. RESULTS: Patients with antisocial or borderline personality disorder are likely to be at increased risk for suicidal behaviour when they demonstrate such comorbid disorders as major depressive episodes or substance abuse disorders, when they experience recent negative life events, or when they have a history of childhood sexual abuse. CONCLUSIONS: For patients with antisocial personality disorder, the risk of violence has to be judged in addition to the risk of suicide or self-harm. For patients with borderline personality disorder, interventions are determined by differentiating acute-on-chronic from chronic risk of suicidal behaviour. Finally, patients with narcissistic personality disorder can be at high risk for suicide during periods when they are not suffering from clinical depression. These episodes can seem to be unpredictable.
Abstract: Recent surveys have stimulated debate and awareness on the way indirect deaths almost always exceed direct deaths in war zones. For this report, research on indirect conflict deaths was led by Debarati Guha-Sapir, Olivier Degomme, Chiara Altare, and Ruwan Ratnayake, all members of a team of epidemiologists at the Centre for Research on the Epidemiology of Disasters (CRED) in Brussels. On the basis of a systematic review of dozens of population-based surveys undertaken in conflict affected countries, these experts established a series of estimates of the indirect costs of armed conflict. Their work was supported with case studies on mortality in Sierra Leone and South Sudan compiled by, among others, Catrien Bijleveld, Lotte Hoex, and Shanna Mehlbaum of the VU University Amsterdam. Jorge Restrepo and Olivier Degomme carried out critical research for the box on armed violence in Iraq. The editors thank Richard Garfield, Colin Mathers, and Alex Butchart at WHO, who also provided input into the estimates produced in this report.
Notes: This chapter was an edited version of the CRED occasional paper no. 237. It was presented at the Review Summit of the Geneva Declaration on Armed Violence and Development, September 9, 2008.
