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C J Hospedales

Publications and source records attributed to C J Hospedales.

17 recordsLinked to original sources
PubMed1998

Epidemic of pediatric deaths from acute renal failure caused by diethylene glycol poisoning. Acute Renal Failure Investigation Team.

CONTEXT: Contaminated pharmaceutical products can result in substantial morbidity and mortality and should be included in the differential diagnosis of deaths of unknown origin. OBJECTIVE: To investigate an outbreak of deaths among children from acute renal failure in Haiti to determine the etiology and institute control measures. DESIGN: Case-control study, cohort study, and laboratory toxicologic evaluation. SETTING: Pediatric population of Haiti. PARTICIPANTS: Cases were defined as Haitian residents younger than 18 years with idiopathic anuria or severe oliguria for 24 hours or longer. Febrile hospitalized children without renal failure were enrolled as control subjects. MAIN OUTCOME MEASURE: The odds of exposure to suspected etiologic agents among cases and controls. RESULTS: We identified 109 cases of acute renal failure among children. The clinical syndrome included renal failure, hepatitis, pancreatitis, central nervous system impairment, coma, and death. Of 87 patients with follow-up information who remained in Haiti for treatment, 85 (98%) died; 3 (27%) of 11 patients transported to the United States for intensive care unit management died before hospital discharge. A locally manufactured acetaminophen syrup was highly associated with disease (odds ratio, 52.7; 95% confidence interval, 15.2-197.2). Diethylene glycol (DEG) was found in patients' bottles in a median concentration of 14.4%. The median estimated toxic dose of DEG was 1.34 mL/kg (range, 0.22-4.42 mL/kg). Glycerin, a raw material imported to Haiti and used in the acetaminophen formulation, was contaminated with 24% DEG. CONCLUSIONS: An epidemic of severe systemic toxicity and deaths from DEG-contaminated acetaminophen syrup occurred in Haiti. Good manufacturing practice regulations should be used by all pharmaceutical manufacturers to prevent such tragedies.

Acetaminophen↗
PubMed1996

Outbreak of histoplasmosis among employees in a paper factory--Michigan, 1993.

In December 1993, four reported cases of histoplasmosis among employees in a Michigan pulp paper factory prompted an investigation. A cohort of employees was surveyed to identify additional cases. A case of acute histoplasmosis was defined as an influenza-like illness in a plant employee with the onset of illness during October or November 1993 and laboratory evidence of recent infection with Histoplasma capsulatum. Among the 96 employees surveyed, 18 persons met the case definition; all of these had illness onset during the last week of October in 1993. The attack rate among maintenance employees (16 of 53 [30%]) was much greater than that among nonmaintenance employees (2 of 43 [5%]) (relative risk = 6.5; 95% confidence interval = 1.6 to 26.7; P = 0.003). On October 22, a dry, windy day, one maintenance worker swept bird guano, approximately 10 cm deep, from an adjacent roof < 20 m from the maintenance building. The disturbance of the bird guano was the likely event which caused this outbreak. H. capsulatum remains an important pathogen among immunocompetent hosts. We recommended that the plant authorities (i) discourage birds from roosting at the facility and (ii) use safe procedures for the cleanup and disposal of soil contaminated with bird droppings.

Adult↗
PubMed1994

A survey of hepatitis B among health workers in Jamaica.

One thousand, five hundred and thirty-seven health staff, presenting for hepatitis B vaccination in Jamaica, were surveyed in 1990/91 for hepatitis B markers and/or exposure to blood or hepatitis. Antibodies to either hepatitis B surface antigen (HBsAg) or hepatitis B core (HBc) were found in 19.8% of 817 persons tested. Males were more likely to have antibodies to Hepatitis B Virus (HBV) than females (29% compared with 18%, Odds Ratio 1.6; 95% CI 0.98-2.9). HBsAg was found in 5.3% of 562 persons tested compared with 1% of blood donors. One or more needlestick accidents were reported by 60% of the sample, and blood or liquor splashing on the face was reported by 48%. Jaundice and hepatitis were reported by 1.2% and 3.5% of health staff, respectively. HBsAg carrier status was associated with years of service (p = 0.039). Prevalence of antibodies to HBV increased with age (p = 0.004) and years of service (p = 0.028). The effect of age and years of service appears to be largely independent (r = 0.44). This survey reaffirms the importance of health workers being immunized with hepatitis B vaccine, and adhering rigorously to universal precautions in patient care and laboratory practice.

Adolescent↗
PubMed1993

Attitudes and practices of pesticide users in Saint Lucia, West Indies.

This article reports the results of a Saint Lucia survey, part of a larger program, that was the first to document the prevalence of suboptimal safety practices among vector control and farm workers using pesticides in the English-speaking Caribbean. Among other things, the survey found that many of 130 pesticide users surveyed were unaware that the skin and eyes were important potential routes of absorption. Over a quarter said they had felt ill at some point as a result of pesticide use. About half the respondents said they had received more than "introductory" training in safe pesticide use, and most said they always found labels or directions affixed to pesticide containers. However, about half said they never or only sometimes understood the labels, and many of those who said they understood did not always follow the instructions. About a quarter of the smokers said they smoked while using pesticides; about a sixth of the survey subjects said they ate food while using pesticides; and over 60% said they never wore protective clothing.

Adolescent↗
PubMed1992

Epidemiological indicators and the epidemiology of measles in the English-speaking Caribbean and Suriname.

The main purpose of this article is to discuss the definitions and limitations of the indicators used to study the epidemiology of measles in the English-speaking Caribbean and Suriname. In addition, the epidemiology of measles over the past ten years is briefly reviewed, with a focus on recent epidemics. The predicted epidemiological picture of measles over the next few years is also discussed and, finally, the difference between elimination and eradication of measles is explained.

Adolescent↗
PubMed1990

A three-year evaluation of the quality of diabetes care in the Norwich community care scheme.

The care of patients with diabetes was assessed in eight general practices intending to establish mini-clinics. Seven of these practices subsequently participated in a mini-clinic scheme incorporating continuing education and audit. After 3 years further data were collected and compared with the baseline assessment. Seven other local practices which had not set up mini-clinics were also studied. During the time between the baseline survey and the 3-year assessment the proportion of non-insulin-treated patients registered with the mini-clinic practices and receiving regular review in general practice increased from 54 to 84%. The proportions of patients with a record of body weight, blood pressure, urinary glucose, urinary protein, blood glucose, HbA1, visual acuity, examination of the fundus through dilated pupils, examination of the feet, and a consultation with a dietitian within the previous year increased significantly and were higher in mini-clinic than in comparison practices although, for a substantial number of patients in both groups of practices, these remained unrecorded. This study shows that organized and audited general practice mini-clinics can improve the process of care for diabetic patients.

Adult↗
PubMed1989

Epidemiology of AIDS and HIV infection in the Caribbean.

A review of surveillance data on AIDS and HIV infection in the 18 English-speaking Caribbean countries and Suriname suggests that the epidemiologic pattern of AIDS in the Caribbean is evolving from an epidemic that began in 1983 among homosexual and bisexual males to one in which cases are increasingly resulting from heterosexual contact, with different countries at various stages of transition. Overall, there has been a decline in the male to female case ratio. Perinatal transmission is already a major problem in many countries--19% of cases in the Bahamas are among children under 15 years of age. Serosurveys conducted in Trinidad and Tobago, Jamaica, Antigua, St. Vincent and the Grenadines, and other countries show high HIV seroprevalence among homosexuals (15-40%), prisoners (4-10%), prostitutes (up to 13%), and cocaine users (2%); at present, prevalence in the general population continues to be low.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Clinical audit.

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Humans↗