A measles epidemic occurred in Romania with 32,915 cases and 21 deaths reported between November 1996 and June 1998, despite high vaccination coverage since the early 1980s. Most cases were unvaccinated children aged <2 years and vaccinated school-aged children. A case-control study among preschool children and a cohort study among primary-school children were conducted to estimate effectiveness of Romanian-produced measles vaccine, and to evaluate age at vaccination and waning immunity as risk factors for vaccine failure. Both studies indicated that measles vaccine was highly effective. One dose reduced the risk for measles by 89% (95% confidence interval (CI) 85, 91); two doses reduced the risk by 96% (95% CI 92, 98). Children vaccinated at <1 year of age were not at increased risk for measles compared with children vaccinated at > or =1 year. Waning immunity was not identified as a risk factor since vaccine effectiveness was similar for children vaccinated 6-8, 9-11, and 12-14 years in the past. Because specific groups were not at risk for vaccine failure, an immunization campaign that targets all school-aged children who lack two doses may be an effective strategy for preventing outbreaks. A mass campaign followed by increased first-dose coverage should provide the population immunity required to interrupt indigenous measles virus transmission in Romania.
Introduction:A First Manic Episode (FME) can evolve differently and some patients remain chronically ill (Poor Outcome Manic Syndrome = POMS). Even, the majority of subsequent episodes reoccur over the time; few studies have looked at the long-term course of a FME. The aim is therefore to look at the longitudinal clinical characteristics of FME in a hospital setting.Method:The subjects, developing POMS, were patients admitted to hospital with at least 2 hospitalizations for mania and having received continuing psychiatric care for ≥ 5 years. The control group subjects were FME patients with only one admission. The data was gathered from hospital discharge summaries for all 472 subjects with FME (age 14–64) admitted to a Quebec regional psychiatric hospital for the first time during a 30 year period (1980-2011).Results:Amongst all first admitted FME patients, 27% ended up with POMS. A logistic regression analysis indicates the subsequent development of POMS was correlated with younger age, male gender and alcohol misuse at the time of the initial admission to hospital. The historical data available (median=11 years) shows that the diagnosis evolved towards bipolar disorder (76%), schizoaffective disorder (17%) and schizophrenia (6%).Conclusion:The results indicate that development of POMS is an inevitable clinical reality. The influence of alcoholism on the evolution of FME is clearly adverse. It is particularly associated with more manic episodes. The results underline the necessity for concomitant intervention for alcoholism in the presence of FME.
BackgroundMultimorbidity (MM) refers to the coexistence of two or more chronic diseases in the same individual; it encompasses medical comorbidity (MC) and psychiatric comorbidity (PC). Hypothesis: MM is prevalent amongst in-patients suffering from affective disorders (AD) and also impacted on length of stay.AimsTo determine the prevalence of MM and its impact on duration of hospitalization in AD admissions.MethodThis cross-sectional study was conducted using secondary data taken from discharge records of 1056 adults admitted for AD to a Quebec-based facility, between 2006 and 2014. Distribution of AD cases: 47% depression, 53% bipolar disorders.ResultsThe prevalence rate of MM: 85%. PC was present in 70% of sample whereas MC was present in 62%. The median number of comorbid illnesses was 2.7 for each study subject. The rate of MM was not related to age or gender. Metabolic syndrome (54%), cardiovascular diseases and chronic pain syndrome (17%) were the most prevalent MC in both depressed and bipolar populations. Personality disorder (65%) was highest in the depression population, whereas substance misuse (55%) was the most prevalent PC in the bipolar subjects. A longer length of stay was correlated with MM. However, a logistic regression analysis indicated that duration of hospitalization was only correlated with MC.ConclusionsThe observation that MM is the norm, even in this relatively young population with AD. The results confirmed that MC prolongs hospital stay. These findings advocate strongly for integrated management of psychiatric and physical health problems in clinical practice.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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