Accurate data on West Nile virus (WNV) cases help guide public health education and control activities, and impact regional WNV blood product screening procedures. During an outbreak of WNV disease in Arizona, records from patients with meningitis or encephalitis were reviewed to determine the proportion tested for WNV. Of 60 patients identified with meningitis or encephalitis, 24 (40%) were tested for WNV. Only 12 (28%) of 43 patients aged <50 years were tested for WNV compared to 12 (71%) of 17 patients aged ≥50 years (P<0·01). Patients with clinical signs of weakness or paralysis, elevated CSF protein, admitted to an inpatient facility, or discharged to a rehabilitation facility were also more likely to have WNV testing performed. The lack of testing in younger age groups and in those with less severe disease probably resulted in substantial underestimates of WNV neuroinvasive disease burden.

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Abstract. West Nile virus (WNV) is the leading cause of mosquito-borne disease in the United States; however, risk factors for infection are poorly defined. We performed a case-control study to identify modifiable risk factors for WNV infection. Case-patients (N = 49) had laboratory evidence of recent WNV infection, whereas control-subjects (N = 74) had negative WNV serology. We interviewed participants, surveyed households, and assessed environmental data. WNV infection was associated with living in or near Water District X within Gilbert Township (adjusted odds ratio [aOR] 5.2; 95% confidence interval [95% CI] = 1.5-18.1), having water-holding containers in their yard (aOR 5.0; 95% CI = 1.5-17.3), and not working or attending school outside the home (aOR 2.4; 95% CI = 1.1-5.5). During this outbreak, WNV infection was likely primarily acquired peri-domestically with increased risk associated with potential mosquito larval habitats around the home and neighborhood.

Therapeutic inertia in the management of type 2 diabetes mellitus is common, with causes at the patient, health-care professional and health-care system levels. The majority of recent strategies to address therapeutic inertia usually consisted of multiple interventions, but rarely targeted more than 1 level. Most strategies used educational interventions among patients or health-care professionals, but gaps were found in addressing determinants of behaviour change.

Health professionals have a need to continually maintain their competencies and a range of knowledge as new research, techniques, information, or ideas are exchanged or discovered. There are several barriers to obtaining required continuing education (CE), which can include the time spent and/or travel expenses incurred to participate in traditional CE courses (Garrison, Schardt, & Kochi, 2000). However, distance-based education, which refers to the formal method of study where students and instructors do not meet in an instructional space but use the Internet or other electronic-mediated methods, is increasingly being used to 768329P HPXXX10.