ISRN Epidemiology The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Identifying Vulnerable Populations in Subtropical Brisbane, Australia: A Guide for Heatwave Preparedness and Health Promotion Tue, 18 Feb 2014 12:50:41 +0000 Building healthy societies is a key step towards climate resilient communities. Ill health is related to increased risk during heat events and is disproportionally distributed within and between communities. To understand the differences in the spatial distribution of climate related health risks and how this will change in the future we have undertaken a spatiotemporal analysis of heatwave risks in urban populations in Brisbane, Australia. The aim of this was to advise emergency managers and public health authorities of high-risk areas during extreme heat events (EHEs). The spatial distribution of heat related morbidity identified areas of high healthcare service demand during EHEs. An index of risk was developed based on social and environmental determinants of vulnerability. Regression analysis was used to determine the key drivers of heat related morbidity from the index. A weighted map of population vulnerability was produced which identified the high risk areas and provided key information to target public health interventions and heat stress prevention policy. The predicted changes in high risk populations such as the proportion of elderly people living in urban areas were also mapped to support longer term adaptation and develop health care infrastructure and health promotion strategies. Margaret Loughnan, Nigel Tapper, and Thu Phan Copyright © 2014 Margaret Loughnan et al. All rights reserved. Vaginal Delivery and Maternal Knowledge on Correct Breastfeeding Initiation Time as Predictors of Early Breastfeeding Initiation: Lesson from a Community-Based Cross-Sectional Study Tue, 21 Jan 2014 13:52:30 +0000 Background. Early initiation of breastfeeding is a recommended practice by the World Health Organization (WHO), but in Ethiopia only 52% of the mothers practiced early initiation of breastfeeding. Hence, this study aimed to assess prevalence of early initiation of breastfeeding and the associated factors among mothers in Bahir Dar City, northwest Ethiopia. Methods. A community-based cross-sectional study was conducted among mothers who delivered 12 months before the study began in Bahir Dar City, northwest Ethiopia. A cluster sampling technique was used to select a sample of 819 participants. Bivariate and multivariate analyses were performed. Results. In this study, the prevalence of early initiation was found to be 87.0%. On multivariate logistic regression, delivering vaginally (AOR = 7.37, 95% CI = 4.24, 13.82) and being knowledgeable on correct initiation time (AOR = 6.08, 95% CI = 3.71, 9.95) were found to be independent predictors of early initiation. Conclusions. Prevalence of early initiation of breastfeeding in Bahir Dar city is relatively good but still lower than the national plan. Delivering vaginally and being knowledgeable on correct initiation time were significantly associated with early initiation. Increasing maternal knowledge on correct initiation and providing adequate pain relief and early assistance for mothers who gave birth by C/S were recommended. Abdulbasit Musa Seid Copyright © 2014 Abdulbasit Musa Seid. All rights reserved. Newcastle Disease in Local Chickens of Live Bird Markets and Households in Zamfara State, Nigeria Thu, 16 Jan 2014 12:47:42 +0000 Newcastle disease constitutes a major constraint to rural poultry production system in Nigeria. This study used serological method to estimate the level of circulating antibodies against ND in nonvaccinated village chickens, raised under traditional management system in Zamfara State, Nigeria. Competitive Enzyme Linked Immunosorbent Assay was used to analyze 504 chicken sera for Newcastle disease virus antibodies from randomly selected households and live bird markets. Higher seroprevalence rate of Newcastle disease virus antibodies was detected in both household and live bird markets. Overall, seropositive rate was found to be 32.5% (164/504). About 35.8% (115/321) sero-positive rate was obtained from live bird markets while 26.8% (49/183) seropositive rate was found in households. Comparison was made between the sero prevalence of house hold and live bird markets as well as between sexes. Live bird markets show a statistically significant higher prevalence rate () when compared with chickens sampled from households (OR 1.53; 95% CI, 1.024–2.275). The prevalence of ND indicated the presence of the virus amongst the population, and hence there should be an improvement in the vaccine campaign against ND for rural poultry especially the use of thermostable vaccine to reduce the chances of vaccine failure. A. H. Jibril, J. U. Umoh, J. Kabir, L. Saidu, A. A. Magaji, M. B. Bello, and A. A. Raji Copyright © 2014 A. H. Jibril et al. All rights reserved. Grade 2 and 3 Obesity and Diagnosed Prostate Cancer in Middle-Aged and Elderly Men: An Epidemiologic Study with Stratified Multistage Sampling Design Wed, 08 Jan 2014 08:03:00 +0000 Background. The association of obesity with the odds of diagnosed prostate cancer (DPC) is inconclusive. Whether grade 2 or grade 3 obesity is associated with increased odds of DPC has not been investigated. Design and Methods. Cross-sectional data of 7,974 subjects aged ≥40 years were collected from the National Health and Nutrition Examination Survey 2001–2010. Odds ratios (ORs) of DPC associated with grade 2 or grade 3 obesity were estimated by conducting weighted logistic regression models. Results. The unadjusted rates of DPC did not differ significantly over grades of BMI (). After adjustment for different groups of potential confounding factors, grade 2 or grade 3 obesity was not significantly associated with the odds of DPC with ORs changing from 0.62 to 0.69 for grade 2 obesity and from 0.81 to 1.09 for grade 3 obesity. Moreover, morbid obesity (grade 2 and 3 obesity combined) was not linked to the odds of DPC. Conclusion. Grade 2 or grade 3 obesity was not associated with the odds of DPC. Whether they are associated with a substantially increased risk of high-grade DPC needs to be further investigated as accumulating evidence has shown that obesity increases the risk of high-grade disease. Xuefeng Liu, Amal Khoury, Joshua Longcoy, and Joseph Ikekwere Copyright © 2014 Xuefeng Liu et al. All rights reserved. Some Epidemiologic Aspects of Common Warts in Rural Primary School Children Sun, 08 Dec 2013 14:08:49 +0000 Cutaneous warts are common in children worldwide, although the prevalence figures are conflicting. There are few publications on that issue, particularly in rural Egypt. The present cross-sectional study aimed to assess the prevalence of warts of hands in rural primary school children and to examine some risk factors associated with warts in these children. The study examined 1833 children from 15 rural primary schools in Dakahlia governorate, Egypt, for the presence of warts. Data about sociodemographic, lifestyle, and environmental factors were collected. Prevalence of warts was estimated. Appropriate statistical analyses including multivariate logistic regression were done. The prevalence of warts of hands in the studied children was 2.3% (1.3–3.3%) with no significant sex difference. The risk of warts increased significantly in children reported swimming in Nile channels (adjusted odds ratio (OR) = 5.6; 95% confidence interval (CI) = 2.9–10.6) and child labor (adjusted OR = 4.5; 95% CI = 2.3–8.8). A ninety percent risk reduction was observed in children with educated parents. The study findings demonstrated a significant increase in the risk of warts among rural children reported swimming in Nile channels and child labor. Parents’ education, on the other hand, was found to play an important role in risk reduction. Khaled Kasim, Soliman Amer, Mohamed Mosaad, Alaa Abdel-Wahed, and Hazem Allam Copyright © 2013 Khaled Kasim et al. All rights reserved. Risk Factors for Fracture in Diabetes: The Canadian Multicentre Osteoporosis Study Mon, 02 Dec 2013 16:04:45 +0000 Objective. Individuals with diabetes have been found to be at increased risk of nontraumatic fracture. However, within the diabetic population, how to distinguish who is at the highest risk and warranting therapy has remained elusive. Design. Cross-sectional analysis of a national population-based cohort study. Patients. Men and women over the age of 50 with diabetes from across Canada. Measurements. Logistic regression analysis to identify diabetes specific factors associated with a history of one or more non-traumatic fractures. Results. Six hundred and six individuals with diabetes with a mean age of 69 years were examined. Thirty percent had a history of non-traumatic fracture. Macrovascular diseases in the form of stroke or TIA, as well as hypertension, were found to be independently associated with fragility fracture. Other, more traditional, clinical risk factors were also associated with fracture, including increased age, female gender, rheumatoid arthritis, family history of osteoporosis, and decreased bone mineral density. Conclusions. In this cohort of Canadians with diabetes, those with rheumatoid arthritis, a family history of osteoporosis, female gender, increased age, decreased BMD, cerebrovascular disease, or hypertension were more likely to have had a non-traumatic fracture. These risk factors may be important to clinicians when identifying which of their diabetic patients are at highest risk of fracture and in need of preventative therapies. Lisa-Ann Fraser, Alexandra Papaioannou, Jonathan D. Adachi, Jinhui Ma, and Lehana Thabane Copyright © 2013 Lisa-Ann Fraser et al. All rights reserved. Personal Health Practices and Patient Counseling of German Physicians in Private Practice Thu, 01 Aug 2013 09:17:40 +0000 We examined physicians' personal health behaviors and the influence on their patient counseling practices in a representative sample () of physicians in private practice in Schleswig-Holstein, Germany. Physicians reported significantly better physical but poorer mental health compared to the general population (GP; ). The majority presented with normal weight (47.9% male, 73.1% female physicians versus 24.5/41.0% GP) or overweight (47.5% male, 20.0% female versus 52.9/35.6% GP). Frequency of exercise and fruit and vegetable consumption was higher than in the GP. About 70% drank coffee or tea more than once a day, but only 13.2% of female and 21.8% of male physicians were current smokers (GP 20.1/30.5%). More than half (56.1%) usually or always counseled a typical patient on exercise versus nutrition (47.0%), weight (45.8%), smoking (39.9%), and alcohol (30.0%). Doctors with better personal exercise, nutrition, smoking, and alcohol behaviors counseled their patients significantly more often on related topics. Despite better physical health and health behaviors in these German doctors compared to the GP, there is room for improvement (smoking, overweight), which could be expected to positively influence the counseling practice and impact of doctors' role modeling on patients. Edgar Voltmer, Erica Frank, and Claudia Spahn Copyright © 2013 Edgar Voltmer et al. All rights reserved. The Epidemiology of Fractures Caused by Falls Down Stairs Mon, 17 Jun 2013 19:03:04 +0000 Fractures sustained from a fall down stairs have received little attention in the orthopaedic literature. We have undertaken a study of these fractures to determine their epidemiology and to compare it to that of fractures caused by a standing fall. All new patients presenting with a fracture between July 2007 and June 2008 were prospectively identified. Falls down stairs caused 261 fractures and were the fifth commonest mode of injury in all ages but the second commonest in those aged 65 years or over. Patients in this category were significantly younger than those with a fracture from a standing fall (54.6 yrs versus 64.9 yrs, ). Fractures of the ankle (odds ratio (OR) 1.9, ), talus (OR 3.0, ), calcaneus (OR 9.7, ), midfoot (OR 6.9, ), toe phalanges (OR 12.0, ), scapula (OR 4.6, ), and proximal ulna (OR 2.4, ) were significantly more likely to result from a fall involving stairs. When grouped together, the odds of any foot or ankle fracture resulting from a fall down stairs were approximately double when compared with a fall from standing (OR 2.1, ). There was a trend towards increased fracture incidence from falls down stairs with worsening social deprivation (, ). A fall down stairs poses a substantial risk of fractures of the foot, ankle, and scapula. When examining patients with this mechanism of injury, these fracture types should be excluded. Sarah E. Mitchell, Stuart A. Aitken, and Charles M. Court-Brown Copyright © 2013 Sarah E. Mitchell et al. All rights reserved. Leptospira spp. Prevalence in Small Mammal Populations in Cotonou, Benin Wed, 27 Mar 2013 13:50:29 +0000 The aim of this study was to assess the Leptospira prevalence in small animals in Cotonou, the capital of Benin. Rodents and shrews were captured in urban and periurban settings and determined as species of the genera Rattus, Mastomys, and Crocidura. Kidney specimens of 90 animals were examined using a real-time PCR assay specific for leptospires that belong to pathogenic species. Leptospiral DNA was amplified from kidney tissues ranging from 13.3% (8/60) in Rattus rattus to 100.0% (1/1) in Crocidura spp. with an average of 18.9% (17/90) of the animals caught at 15 locations. Clade-specific Taqman PCR on 10 samples placed six of these within clade 1 comprising the species L. kirschneri, L. interrogans, L. meyeri, and L. noguchii and four within clade 2 consisting of species L. weilii, L. alexanderi, L. borgpetersenii, and L. santarosai. Phylogenetic analysis of partial sequences of the amplicons of seven samples of these 10 samples revealed that four of the clade 1 samples could equally be assigned to L. interrogans and L. kirschneri and three samples from clade 2 belonged to L. borgpetersenii. Results presented in the paper indicate that small mammals present a major public health risk for acquiring leptospirosis in Cotonou, Benin and will contribute to a raised awareness amongst health care workers and decision makers and hence promote appropriate clinical management of cases. G. Houemenou, A. Ahmed, R. Libois, and R. A. Hartskeerl Copyright © 2013 G. Houemenou et al. All rights reserved. Maternal Age at First Delivery and Risk of Cardiovascular Disease Later in Life Thu, 07 Mar 2013 09:15:14 +0000 Background. To elucidate the association between maternal age at first delivery and cardiovascular health in women. Material and Method. A nationally representative survey, comprising 3,937 Finnish women aged 30–99 years with information on most of the potential cardiovascular disease (CVD) risk factors. Weighting survey analyses and logistic regression were performed. Results. Women who had their first delivery at age 25 or less had about five times higher odds ratio for myocardial infarction (fully adjusted OR: 4.82; 95% CI: 1.39–16.75) and about 2-fold higher odds ratio of arrhythmia (fully adjusted OR: 1.82; 95% CI: 1.13–2.92) compared to those who were 31–35 years at their first delivery. Each one year younger maternal age at first delivery predicted a higher risk of myocardial infarction (age-adjusted ; 95% CI: 1.06–1.18), hypertension (age-adjusted ; 95% CI: 1.03–1.07), arrhythmia (age-adjusted OR = 1.03; 95% CI: 1.01–1.05), angina pectoris (age-adjusted OR = 1.06; 95% CI: 1.02–1.10), and heart failure (age-adjusted ; 95% CI: 1.01–1.10). Conclusion. Maternal earlier age at first delivery is related to subsequent development of CVD, especially myocardial infarction. Our findings suggest a need for additional care and monitoring for CVD and its risk factors in women who had their first delivery at young ages. Elham Kharazmi, Mahdi Fallah, and Riitta Luoto Copyright © 2013 Elham Kharazmi et al. All rights reserved. Risk Factors of Hypertension at UNRWA Primary Health Care Centers in Gaza Governorates Mon, 04 Mar 2013 09:26:32 +0000 Universally, hypertension is a major public health problem. Identification of risk factors for hypertension supports intervention policies to minimize the disease morbidity and mortality. The main objective is to fill a gap in research literature by establishing baseline information for hypertension risk factors among Palestinians. Methods. A case control study was conducted at UNRWA health care services in Gaza Strip. A proportional systematic random sample of 120 cases matched with sex, and locality to 120 controls were chosen. Data was collected using a questionnaire which included socio-demographic data, lifestyle, and health profile. Collected data was analyzed using SPSS V13. Results. The most common modifiable risk factors of hypertension were physical inactivity (76.7% versus 15.9%), obesity (67.5% versus 29.2%), diabetes mellitus (19.2% versus 7.5%), and ex-smoking (15.5% versus 1%). Cases and controls show statistical significant differences in values for the lipid profile. Hypertension was significantly associated with low socio economic status, education, and employment. The most common non-modifiable risk factors were age, and family history (85.8% versus 71.7%). Multiple logistic analysis controlling for age showed that significant predictors of hypertension were obesity, physical inactivity, low monthly income and family history. Conclusion. Most of the identified hypertension risk factors are preventable. Y. Abed and S. Abu-Haddaf Copyright © 2013 Y. Abed and S. Abu-Haddaf. All rights reserved. SEIR Epidemic Dynamics in Random Networks Tue, 12 Feb 2013 08:54:54 +0000 Predicting disease transmission on complex networks has attracted considerable recent attention in the epidemiology community. In this paper, we develop a low-dimensional system of nonlinear ordinary differential equations to model the susceptible-exposed-infectious-recovered (SEIR) epidemics on random network with arbitrary degree distributions. Both the final size of epidemics and the time-dependent behaviors are derived within our simple framework. The underlying network is represented by the configuration model, which appropriately accounts for the heterogeneity and finiteness of the degree observed in a variety of real contact networks. Moreover, a generalized model where the infectious state of individual can be skipped is treated in brief. Yilun Shang Copyright © 2013 Yilun Shang. All rights reserved. Nonlinear Analysis of Guillain Barré Time Series to Elucidate Its Epidemiology Mon, 24 Dec 2012 13:00:56 +0000 The etiology of Guillain Barré Syndrome (GBS) is not fully clarified, and there is a lack of agreement concerning its putative epidemic character. The low incidence rate of this disease is a disadvantage for employing the traditional statistical methods used in the analysis of epidemics. The objective of this paper is to clarify the GBS epidemic behavior applying a nonlinear time series identification approach. The authors obtained one time series of GBS and nine series of classical infectious epidemics (5 national and 4 international). These data were processed with advanced techniques of statistical time series analysis. This paper shows that GBS behaves similar to the other time series of classical epidemic studied. It corresponds to a nonlinear dynamics, with a point attractor. The spectral analysis pointed to an annual periodicity, and preference for the warmest month of the year was found. These results might suggest that Guillain Barré Syndrome has an epidemic behavior. The adequacy of nonlinear methods for analyzing the dynamics of epidemics, particularly those with low incidence rate, such as GBS was revealed. Zurina Lestayo O'Farrill, José Luís Hernández Cáceres, and Esperanza O'Farrill Mons Copyright © 2012 Zurina Lestayo O'Farrill et al. All rights reserved. Developing a Weibull Model Extension to Estimate Cancer Latency Tue, 04 Dec 2012 11:37:31 +0000 The mathematical model discussed in this paper presents a technique to estimate the length of the cancer’s silent growth period. The methodology described utilizes information obtained from observed cancer incidence to reconstruct what is cautiously believed to be the period of time from malignant cancer initiation to diagnosis. Analyses show a decreasing hazard for cancer indicating that the longer a patient survives, the more likely they are to reach the upper limit of their natural lifespan. Based on previous research, the Weibull distribution has been used to describe the mechanisms of cancer development. In contrast to the memoryless exponential distribution which assumes a constant failure rate, the shape of the Weibull distribution is dependent on past events and preserves a memory of prior survival. This provides a simple but powerful way to characterize how the unobserved experience of cancer relates to the observed as a function to estimate the time between onset and diagnosis. The results indicate a window of opportunity for early intervention when cancer is most treatable. The method presented provides useful information to identify cancers with high mortality and prolonged periods of undetected growth to distinguish types of dire public health concern. Diana L. Nadler and Igor G. Zurbenko Copyright © 2013 Diana L. Nadler and Igor G. Zurbenko. All rights reserved. The Epidemiological Implications of Deer Fly Nuisance Biting and Transmission of Loiasis in an Endemic Area in Southeastern Nigeria Mon, 26 Nov 2012 14:50:12 +0000 This work was aimed at determining the epidemiological implications of deer fly biting in Southeastern Nigeria and ascertaining the circadian and monthly biting pattern and the transmission potential of Chrysops in the area. Human-landing catches were carried out for 52 weeks by a catching team of four. A total of 930 female Chrysops sp. was caught; biting peaked during the months of June through August. The highest monthly biting rate (MBR) was 353 bites per person per month in July 2006. The annual biting rate (ABR) was 3,317 bites per person per year. The overall infective rate was 3.8%. A total of 314 L3s was recorded with a mean of 9.8 L3s per infective Chrysops. The highest monthly transmission potential (MTP) was 389 infective bites per month observed in July 2006. The annual transmission potential (ATP) was 1,265 infective bites per person per year. Parous rate was 29.3% and was higher during dry months of October through February. The circadian biting activities showed two peaks: between 07:00 and 10:00 hours and between 15:00 and 17:00 hours. The epidemiological implications of deer fly biting in the area are multifaceted. Resources must not be spared in bringing an end to their menace. Emmanuel Chukwunenye Uttah Copyright © 2013 Emmanuel Chukwunenye Uttah. All rights reserved. Disease Control in Age Structure Population Mon, 26 Nov 2012 14:35:44 +0000 We combine the Leslie model and its derivatives with the classical compartmental SIRS models to build a model of transmission of infected diseases, in a population of hosts, whether opened or closed systems. We calculate the basic reproductive rate R0. Under certain conditions, when , there is a disease-free equilibrium that is locally asymptotically stable. In contrast, when , this equilibrium is unstable. Then, through an example, we show how we can define public health strategies to tackle an endemic. Finally we carry a global sensitivity analysis based on this basic reproduction rate to exhibit the most influential parameters of our model that are applied to influenza. Etienne Kouokam, Jean-Daniel Zucker, Franklin Fondjo, and Marc Choisy Copyright © 2013 Etienne Kouokam et al. All rights reserved. Multiple Congenital Anomalies after Assisted Reproductive Technology in Japan (between 2004 and 2009) Mon, 26 Nov 2012 14:14:17 +0000 Multiple congenital anomalies (MCAs) are defined as two or more unrelated major structural malformations that cannot be explained by an underlying syndrome or sequence. The percentage and combination patterns of MCAs were analyzed using the European surveillance of congenital anomalies computer algorithms for nationwide data on congenital anomalies after assisted reproductive technology between 2004 and 2009 in Japan. There were a total of 177,548 pregnancies and 124,846 live births. About 7% (96/1,324) were MCAs. Although most maternal/neonatal outcomes between the isolated cases group and the MCAs group were similar, higher early neonatal death rate was observed in the MCAs group than in the isolated cases group (9.8% versus 3.7%, resp.). Regarding the major organ system subcategory in ICD-10, the rate of MCAs was around 30% in “congenital malformations of eye, ear, face, and neck,” “congenital malformations of the respiratory system,” and “congenital malformations of genital organs.” On the other hand, the rate of MCAs was less than 10% in “congenital malformations of the circulatory system.” The combination patterns of diseases were widely varied. Of them, two or three diseases of the circulatory system, the digestive system, and the musculoskeletal system tended to co-occur in the same individuals. Syuichi Ooki Copyright © 2013 Syuichi Ooki. All rights reserved. Distribution and Bionomic of Sand Flies in Five Ecologically Different Cutaneous Leishmaniasis Foci in Morocco Mon, 17 Sep 2012 11:22:11 +0000 Cutaneous and visceral leishmaniases are endemic in Morocco. Their geographical distribution is well known. It has been related to bioclimatic factors. However, in 2008, two new cutaneous leishmaniasis foci appeared out of the known risk areas. Hence, we have undertaken this entomological survey in five foci situated in different bioclimatic areas to better understand the distribution and the epidemiology of this disease. Results of this study, undertaken during 2011, showed the predominance of Phlebotomus sergenti (55.8%) followed by Ph. perniciosus (12.9%), Ph. longicuspis (12.3%), and Ph. papatasi (12.0%). Ph. sergenti was active during 6 months in subhumid area and 8 months in arid, semiarid, and Saharan areas. Compared to previous studies, our results show a rise in Ph. sergenti abundance and an extension of its activity period. These results could explain the increase in anthroponotic cutaneous leishmaniasis incidence in Morocco and its extension to new nonendemic regions. Ph. perniciosus and Ph. longicuspis have also displayed a large distribution and a long activity period indicating a high potential risk of Leishmania infantum transmission in the studied areas. Chafika Faraj, El Bachir Adlaoui, Souad Ouahabi, Mohamed El Kohli, Mohamed El Rhazi, Lhoussine Lakraa, and Btissam Ameur Copyright © 2013 Chafika Faraj et al. All rights reserved. Prenatal Exposure to Maternal Cigarette Smoke and Offspring Risk of Excess Weight Is Independent of Both Birth Weight and Catch-Up Growth Mon, 27 Aug 2012 07:51:53 +0000 Prenatal exposure to maternal cigarette smoke (PEMCS) is one of the most common insults to the developing fetus and has consistently emerged as an important risk factor for excess weight in the offspring. However, no consensus exists on the mechanism of action or duration of impact. This study seeks to further examine the role of PEMCS on overweight status of children up to age 10. Mother and child pairs (𝑛=1183) were analysed from the Québec Longitudinal Study of Child Development (QLSCD) (1998–2010). Multivariable logistic regression models were used to control for confounders and assess mediation. PEMCS was associated with overweight status at age 10 (OR: 1.70; 95% CI: 1.20–2.43) after adjustment for early life exposures and childhood behaviours. This relationship remained robust after adjustment for birth weight and catch-up growth. Other significant predictors included APGAR score, mother’s immigrant and weight status, family type and child energy intake. The elevated risk of excess weight among the offspring of smoking mothers was not accounted for by other known determinants, and PEMCS appears to play a role independent of birth weight and catch-up growth. Our research suggests that young mothers may be an important audience for targeting preventive strategies. Jonathan Gravel, Beth Potter, and Lise Dubois Copyright © 2013 Jonathan Gravel et al. All rights reserved. Incidence and Prognostic Factors for Legionnaires' Disease in Denmark 1993–2006 Tue, 14 Aug 2012 13:37:19 +0000 Objectives. To describe the incidence of Legionnaires’ disease and factors affecting survival in Denmark from 1993 to 2006. Methods. Retrospective register study using data on episodes of Legionnaires’ disease from notification forms and the National Reference Laboratory, and information on comorbidity from national registers on discharge diagnoses and mortality. Results. The average annual incidence of laboratory confirmed cases was 1.5 per 100000 people. The 30-day case fatality was 19%, ranging from 7% in travellers to 37% in hospital-acquired cases. Patients older than 60 years and patients with underlying disease were more likely-to die, as were patients infected with L. pneumophila serogroup 6. The lowest mortality was seen for L. pneumophila serogroup 1. Conclusion. Increased awareness of the disease, better diagnostics, and appropriate testing and treatment strategies are needed to improve survival. In particular, we focus on the relevance of diagnostic methods, such as polymerase chain reaction (PCR), that detect other serogroups than the urinary antigen tests used that will only reliably detect antigen from L. pneumophila serogroup 1. PCR is faster and more sensitive than culture. G. St-Martin, S. Uldum, and K. Mølbak Copyright © 2013 G. St-Martin et al. All rights reserved.