In recent years, large mumps outbreaks, involving mainly adolescents and young adults, have re-emerged in several countries. We investigated a large mumps outbreak, evaluated the association between mumps clinical severity (complications, hospitalization) and vaccination status (number of previous measles, mumps and rubella -MMR vaccine doses), and assessed vaccine effectiveness. The first mumps cases emerged in an ultra-orthodox boys' school in Jerusalem and were epidemiologically linked to the mumps outbreak in New York. Overall, 3130 mumps cases were notified in the Jerusalem district during September 2009-August 2011 (median age 13y, 64% males). Most cases were reported from community clinics. Patients with systemic symptoms and/or complications (419, 13.4%) were either hospitalized (n D 79) or treated in an emergency medical center (n D 340). The main complications included orchitis (3.8% males> age 12y) and meningoencephalitis (0.5%). The mumps virus genotype was G5. The distribution of previous MMR vaccine doses (n D 0,1,2) was: 24.8%, 28.3% and 46.9%, respectively. The number of previous vaccine doses was inversely associated with clinical severity. Adjusted values for MMR vaccine effectiveness against complications were estimated as 52.1% (95% CI ¡4 ¡78%) for one vaccine dose and 62.7% (95% CI 25.7-81.3%) for 2 doses. The outbreak was characterized by predominance of male students; the majority of whom had been previously vaccinated. The reported complication rate was relatively low. Vaccination status was associated with age and disease severity. The combination of limited mumps vaccine effectiveness and the specific school setting (dense learning and living conditions) probably contributed to the disease spread.
Hip-fractures (HF) in older adults are associated with poor outcomes and high costs. Measuring quality-of-care of HF patients has focused on clinical definitions rather than on measuring outcomes that are meaningful to the patient. Healthcare systems worldwide are increasingly interested in patient-reported outcome measures (PROs). The Short-form (SF36) questionnaire is a recommended measure among older adults however it’s comprehensiveness and uniqueness for specific patients after a HF is not clear. The aims of this study were to: understand the perspective of the older adults experience following HF, to assess the suitability of the SF36 as a PRO for HF and to determine the best timing for questioning. A qualitative description approach was used. This took place in 2 large academic medical-centers in Israel. The inquiry was done in 2 parts by semi-structured interview. A total 15 HF patients were interviewed. Categories and themes emerging from their responses were similar to the 8 domains of the SF36 questionnaire, but the participants added clarity regarding their own needs for setting goals. In the second part, participants agreed that the SF36 reflected common issues and served as an adequate measure for personal-goal setting. The study encourages patient-centered care in older adults recovering from HF, providing evidence that the SF36 is a suitable tool for measuring PROs in HF patients. Healthcare systems focus on clinical-outcome indicators and do not reflect how the patient views his outcomes. This study provides evidence that care should be customized for each person.
This paper focuses on the establishment and immediate impact of the national program for protection of residents of long-term care facilities (LTCF). More than a year and half into the pandemic, this approach is still having positive impact. Wide PCR testing and vaccination were integrated into the program as they became available.
Introduction: Understanding ” what is most important” to
medical-students can help improve residence learning and working
conditions. Such information is needed to facilitate policy planning
that will encourage the next generation of physicians to specialize in
medical-fields that are experiencing shortages. The hypothesis was,
there are significant changes in medical students’ preferences,
regarding the considerations for choosing a medical specialty in 2020 as
compared to students a decade earlier. Methods: A time comparison
cross-sectional study of 5 -year medical students
from two universities took place in 2010 and 2020. A questionnaire was
used to examine various aspects of the specialty selection process.
Results: 335 medical-students answered the survey (237
and 98 in 2010 and 2020, respectively). Medical students in 2020 in
comparison to 2010, were 2.26 time less likely to choose a residency
because of its potential for a high income (P<0.05), had
significantly more interest in residencies with greater teaching (98.8%
vs 82.9%, P<0.05) and increased responsibility/chance to
make clinical decisions on their own (67.9% vs 51.6%,
P<0.05). There were criteria which were important to both the
2010 and 2020 students, such as, choosing a bedside specialty (70.2%vs
67.9%, NS), an interesting and challenging residency (95.2%v s 91.3%,
NS) and interest in a specialty that involved working in the operating
room (29.8% vs 32.6%, NS). Conclusions: These results reinforce
the idea of avoiding stereotypes based on the generational cohort and
the importance of exploring the needs and motivations of medical
students. Notably, we found that the 2020 medical-students were more
interested than their predecessors in residencies with much resident
teaching and more responsibility/making clinical decisions on their own.
In addition, we found that selection criteria such as, importance of
choosing a specialty that one finds interesting and challenging, are
universal over time.
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