bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative Study of the Effect of Macrolide Antibiotics Erythromycin, Clarithromycin, and Azithromycin on the ERG1 Gene Expression in H9c2 Cardiomyoblast Cells
Authors: Hajimirzaei Nima , Khalili Nazila Pour , Boroumand Behshad , Safari Fatemeh , Pourhosseini Armin , Tavakoli Fatemeh
Published: March 2020

Background Macrolides are clinically well-established class of antibiotics. Macrolides induce cardiotoxicity by blocking ether-a-go-go–related gene (ERG) potassium channels in cardiac myocytes. The aim of this study was to compare the effects of erythromycin, clarithromycin and azithromycin on cell viability and expression of ERG1 gene in H9c2 cells. Methods Cell viability and ERG1 gene expression of H9c2 cells in 3 different concentrations, 1, 10 and 25µg/ml, after 48 and 72 hours were determined by MTT test and Real time-PCR method respectively. Results After 48 hours, the growth of H9c2 cells treated with erythromycin, clarithromycin and Azithromycin (except two doses) were inhibited significantly compared to control group (p <0.05). All three groups of antibiotics showed toxic effects on cells after 72 hours in all concentrations. Azithromycin-inhibiting effects were significantly higher than two other groups after 72 hours of treatment. The expression of ERG1 gene increased in all three groups of antibiotics by increasing the concentration and duration of treatment. Azithromycin had the most pronounced effect on ERG1 expression in 48 and 72 hours. Conclusions This study indicated that these macrolides affect ERG1 expression due to their potential cardiac adverse effects. Further investigations are required to understand the exact mechanism of cardiotoxicity associated with macrolides.
Computational identification and characterization of glioma candidate biomarkers through multi-omics integrative profiling
Authors: Liu Lin , Wang Guangyu , Wang Liguo , Yu Chunlei , Li Mengwei , Song Shuhui , Hao Lili , Ma Lina , Zhang Zhang
Published: March 2020

Background: Glioma is one of the most common malignant brain tumors and exhibits low resection rate and high recurrence risk. Although a large number of glioma studies powered by high-throughput sequencing technologies have led to massive multi-omics datasets, there lacks of comprehensive integration of glioma datasets for uncovering candidate biomarker genes.Results: In this study, we collected a large-scale assemble of multi-omics multi-cohort datasets from worldwide public resources, involving a total of 16,939 samples across 19 independent studies. Through comprehensive molecular profiling across different datasets, we revealed that PRKCG (Protein Kinase C Gamma), a brain-specific gene detectable in cerebrospinal fluid, is closely associated with glioma. Specifically, it presents lower expression and higher methylation in glioma samples compared with normal samples. PRKCG expression/methylation change from high to low is indicative of glioma progression from low-grade to high-grade and high RNA expression is suggestive of good survival. Importantly, PRKCG in combination with MGMT is effective to predict survival outcomes in a more precise manner.Conclusions: PRKCG bears the great potential for glioma diagnosis, prognosis and therapy, and PRKCG-like genes may represent a set of important genes associated with different molecular mechanisms in glioma tumorigenesis. Our study indicates the importance of computational integrative multi-omics data analysis and represents a data-driven scheme toward precision tumor subtyping and accurate personalized healthcare.
Factors facilitating trained NIMART nurses’ adherence to treatment guidelines: A vital matter in the management of TB/HIV treatment in South Africa
Authors: Makhado Lufuno , Davhana-Maselesele Mashudu , Lebese Rachel Tsakani , Maputle Sonto Maria
Published: March 2020

Background: Globally the burden of tuberculosis or human immunodeficiency virus (TB/HIV) is at 24% with 3% global health workforce and this an alarming rate that World Health Organization (WHO) declared African region as critical workforce shortage area. To facilitate adherence to treatment guidelines, WHO recommended a strategy of task shifting for these countries with high health workforce shortages. The strategy aimed at redistribution of health care tasks to available workers. The purpose of the study was to determine factors facilitating trained NIMART nurses’ adherence to TB/HIV treatment guidelines in KwaZulu-Natal (KZN) and North West (NW) Provinces of South Africa.Design: The study was qualitative, explorative and descriptive in nature. Population comprised of 24 participants who were purposively selected. In-depth one-on-one interview was conducted. Data analysis was through the used of ATLAS T.I. software program (version 7.0) and followed the basic steps of notice-collect-think (NCT) analysis. Trustworthiness and ethical consideration were ensured.Results: The following one theme namely; marked identified needs to be met in order to promote adherence to treatment guidelines and sub-themes emerged from raw data: Expected positive attitudinal needs outlined and an outline of a positive behavioural change. Conclusion: Factors such as continuous training, support supervision and improved relationships with colleagues need to be enhanced to enable NIMART nurses to adhere to treatment guideline.
Multilevel resistive switching memory based on a CH3NH3PbI3-xClx film with potassium chloride additives
Authors: Lv Fengzhen , Ling Kang , Zhong Tingting , Liu Fuchi , Liang Xiaoguang , Zhu Changming , Liu Jun , Kong Wenjie
Published: March 2020

High-quality CH3NH3PbI3-xClx (MAPIC) films were prepared using potassium chloride (KCl) as an additive on indium tin oxide(ITO)-coated glass substrates using a simple one-step and low-temperature solution reaction. The Au/KCl-MAPIC/ITO/Glass devices exhibited obvious multilevel resistive switching behavior, moderate endurance, and good retention performance. Electrical conduction analysis indicated that the resistive switching behavior of the KCl-doped MAPIC films was primarily attributed to the trap-controlled space-charge-limited current conduction that was caused by the iodine vacancies in the films. Moreover, the modulations of the barrier in the Au/KCl-MAPIC interface under bias voltages were thought to be responsible for the resistive switching in the carrier injection trapping/detrapping process.
Use of traditional medicine for dental care by different ethnic groups in New Zealand
Authors: Guo Jun , Low Karson , Mei Li , Li JiaHui , Qu Wenwen , Guan Guangzhao
Published: March 2020

Objective To explore the views, use of and access to traditional medicine (TM) among different ethnicities living in New Zealand. Methods Qualitative study and in depth interviews were used. An individual semi-structured questionnaire was used to collect data. Interviews were recorded, transcribed, and analysed using an inductive approach to identify the main themes. Results Three main themes were extracted from interviews with 14 participants from diverse cultural backgrounds: (1) the perspectives of TM varied among different ethnic groups, and included the involvement of spirituality, the environment, knowledge and usage of TM. (2) The TM that was used by different ethnic groups included plants, herbs, massage, and other forms of healing. Reasons for choosing traditional or western medicines generally included family tradition, access to TM, and finding a competent traditional healer. (3) The barriers in accessing TM included the paucity of traditional healers, difficulty accessing plants and cost, therefore most would look for substitution or alternative treatment. Conclusion Even though the access to these TM in New Zealand was a challenge for the majority of the participants, they are still considered the first-line treatment for the majority. This study provided dental practitioners an insight into the different sort of TM used by the population. By understanding and acknowledging the use of TM, dental practitioners could create a supportive environment for patients to disclose their use of TM and allow them to educate patients on the use of TM.
Fasting Plasma Glucose Variability in Midlife and the Risk of Parkinson’s Disease: A Nationwide Population-Based Study
Authors: Chung Hye Soo , Lee Ji Sung , Kim Jung A , Roh Eun , Lee You-Bin , Hong So-Hyeon , Yoo Hye Jin , Baik Sei Hyun , Kim Nan Hee , Seo Ji A , Yu Ji Hee , Kim Sin Gon , Kim Nam Hoon , Choi Kyung Mook
Published: March 2020

Background — Athough an association exists between type 2 diabetes and Parkinson’s disease (PD), the implications of glycemic variability on PD are unknown. We assessed the future risk of incident PD according to visit-to-visit fasting plasma glucose (FPG) variability; this was calculated using standard deviation (FPG-SD), coefficient variance (FPG-CV), and variability independent of the mean (FPG-VIM). Methods — Using the Korean National Health Insurance Service–Health Screening Cohort, we followed 131,625 Korean adults without diabetes. This study population was divided into a midlife group (<65 years) and an elderly group (≥65 years), during a median follow-up of 8.4 years. Results — The adjusted hazard ratios (HRs) were calculated using a multivariable Cox proportional hazard analysis. In the midlife group, the HRs for incident PD in the highest quartile of FPG variability, as measured using SD, CV, and VIM, were 1.35 (95% confidence interval (CI), 1.07–1.70), 1.31 (95% CI, 1.04–1.65), and 1.33 (95% CI, 1.06–1.67), respectively, when compared to the lowest quartile group. However, the incident PD was not different depending on FPG variability in the elderly group. Kaplan–Meier curves of PD probability showed a progressively increasing risk of PD according to the higher FPG variability in the midlife group. According to a multivariable adjusted model, a 1-SD unit increment in glycemic variability was associated with a 9% higher risk for incident PD in the midlife group. Conclusions — Increased long-term glycemic variability is a preceding risk factor for developing PD in the midlife population without diabetes.
Effectiveness, Safety, and Major Adverse Limb Events in Atrial Fibrillation Patients with Concomitant Diabetes Mellitus Treated with Non-Vitamin K Antagonist Oral Anticoagulants
Authors: Chan Yi-Hsin , Lee Hsin-Fu , Li Pei-Ru , Liu Jia-Rou , Chao Tze-Fan , Wu Lung-Sheng , Chang Shang-Hung , Yeh Yung-Hsin , Kuo Chi-Tai , See Lai-Chu , Lip Gregory Y. H.
Published: March 2020

Background: Evidence of adverse clinical outcomes for non-vitamin K antagonist oral anticoagulant (NOACs) and warfarin in patients with atrial fibrillation (AF) and diabetes mellitus are limited. We investigated the effectiveness, safety, and major adverse limb events for NOACs versus warfarin among diabetic AF patients. Methods: In this nationwide retrospective cohort study collected from Taiwan National Health Insurance Research Database, we identified a total of 20,967 and 5,812 consecutive AF patients with diabetes taking NOACs and warfarin from June 1, 2012, to December 31, 2017, respectively. We used propensity-score stabilized weighting to balance covariates across study groups. Results: NOAC was associated with a lower risk of major adverse cardiovascular events (MACE) (adjusted hazard ratio (aHR):0.88; [95% confidential interval (CI):0.78-0.99]; P =0.0283), major adverse limb events (aHR:0.72;[95%CI:0.57-0.92]; P =0.0083), and major bleeding (aHR:0.67;[95%CI:0.59-0.76]; P <.0001) compared to warfarin. NOACs decreased MACE in patients of 75 but not in those aged <75 years ( P interaction=0.01), and in patients with ischemic heart disease (IHD) compared to those without IHD ( P interaction<0.01). For major adverse limb events, the advantage of risk reduction for NOAC over warfarin persisted in high risk subgroups including age 75 years, chronic kidney disease, IHD, peripheral artery disease, or use of concomitant antiplatelet drugs. Conclusion: NOACs were associated with a lower risk of effectiveness, safety, and major adverse limb events than warfarin among diabetic AF patients. Thromboprophylaxis with NOACs should be considered in the diabetic AF population with a high atherosclerotic burden.
From income inequality to social corrosion: impact on health levels in an international efficiency comparison panel
Authors: Schenkman Simone , Bousquat Aylene
Published: March 2020

Background Health equity, although addressed in several publications dealing with health efficiency analysis, usually does not usually remain as a relevant result in empirical studies, due to the difficulty in its operationalization. Some studies provide evidence that it does not influence health outcomes; others demonstrate that its effect is an indirect one, with the hegemony of material living conditions over its social connotation. The aim of this article is to evaluate the role of health equity in determining health outcomes, in an international comparative analysis of the effectiveness and efficiency of health systems. Method Fixed Effects Model Panel and Data Envelopment Analysis, a dynamic and network model, in addition to comparative analysis between methods and health impacts. The effect variables considered in the study were life expectancy at birth and infant mortality, in 2010 and 2015, according to the sociocultural regions of the selected countries. Inequality was assessed both economically and socially. The following dimensions were considered: physical and financial resources, health production (access, coverage and prevention) and intersectoral variables: demographic, socioeconomic, governance and health risks. Results Both methods demonstrated that countries with higher inequality levels (regarding income, education and health dimensions), associated or not with poverty, are the least efficient, not reaching the potential for effective health outcomes. The outcome life expectancy at birth showed inequality and per capita health expenditure in the final model. The variable linfant mortality comprehended education, in association with care seeking due to diarrhea, births attended by skilled health professionals and the reduction in the incidence of HIV. Conclusion The dissociation between the distribution of health outcomes and the overall level of health of the population characterizes a devastating political choice for society, as it increases the levels of segregation, disrespect and violence from within. Countries should prioritize health equity, adding value to its resources, since health inequalities affect society altogether, generating mistrust and reduced social cohesion.
Spillover Effect of Presence of Children on Parents Smoking Behavior among Chinese Couples: Empirical Evidence Based on China Family Panel Studies
Authors: LIN Haoxiang , Chang Chun , LIU Zhao , Tan Huaqing
Published: March 2020

Background: Previous studies found social-psychological factors affect smoking behaviors. However those studies mainly focused on marriage, family, education background and gender factors. Studies regarding the impact of children are lacking. This study explores how presence of children is associated with parents’ smoking behaviors. Methods: The data used in this study was from China Family Panel Studies. The method used for data analyses is panel regression with fixed effect. We firstly regressed the dependent variable on number of children with other covariates. Then, we divided our sample into several groups based on education attainment, occupation, age difference and urban or rural residents to examine heterogeneous effect. Results: Full sample regressions show that the number of children was significantly negatively associated with smoking behavior (OR=0.9292; P<0.01). Further subsample regression finds the spillover effect is only significant in the high-educated group (OR= 0.9151; P<0.01), high skilled workers (OR= 0.8891; P<0.05) and couples who had more than 2 years of age difference (OR=0.9148; P<0.01). Conclusions: This study confirmed that the presence of children indeed has an association with couple’s smoking behavior. Health promotional programs should take into account occupation, educational attainment and age difference of couples. For countries, stop smoking service is rare, if limited resources for cessation are to be used effectively then taking advantage of these ‘teachable moments’ becomes a necessity. Targeting cessation activities at those who presence children at early age is one such strategy.
Progress towards the 2020 Fast Track targets in Eastern sub-Sahara Africa region and in Ethiopia; using Global Burden of Disease 2017data
Authors: Mirkuzie Alemnesh H. , Ali Solomon , Abate Ebba , Worku Asnake , Misganaw Awoke
Published: March 2020

BackgroundSustainable Development Goal (SDG) 3.3, targets to eliminate HIV from being a public health threat by 2030. For better tracking of this target interim Fast Track millstones for 2020 and composite complementary measures have been indicated. This study measured the Fast Track progress in Eastern sub-Saharan Africa (ESSA) region and in Ethiopia across ages using Global Burden of Disease (GBD) 2017 data. Methods The National Data Management Center for health research team at Ethiopian Public Health Institute has analyzed the GBD 2017 data for the year 2010 to 2017 for Ethiopia and ESSA countries. GBD 2017 data sources were census, demographic and health surveys, prevention of mother-to-child HIV transmission and anti-retroviral treatment programs, sentinel surveillances and UNAIDS spectrum modeling. Age standardized and age specific HIV/AIDS incidence, prevalence, mortality, Disability Adjusted Life Years (DALYs), incidence:mortality ratio and incidence:prevalence ratio were calculated with corresponding 95% confidence limits. Results Slow progress has been recorded in reducing new HIV infection in ESSA since 2010; only Uganda would achieve the 75% target by 2020. Ethiopia, Tanzania and Uganda have already achieved 75% mortality reduction target set for 2020. With incidence: prevalence ratio of < 0.03, Ethiopia, Rwanda and Uganda are on track to end HIV by 2030. Ethiopia has an incidence: mortality ratio <1 due to high mortality; while Kenya, Rwanda, Tanzania and Uganda, have a ratio >1 due to high incidence. Ethiopia has reduced the HIV incidence rate by 76% among under 5 children and seem to be on track to attain the 2020 national target but far behind achieving the target among the 15-49 age group. Conclusion The ESSA countries have made remarkable progress towards achieving the 75% HIV/AIDS mortality reduction target by 2020 since 2010, although they progress poorly in reducing HIV incidence. Having an incidence:prevalence ratio of less than 0.03, Ethiopia, Rwanda and Uganda are well heading towards epidemic control. The high HIV/AIDS mortality rate in Ethiopia for its incidence requires innovative strategies to bring undiagnosed cases to treatment and care services across age. For sustainable epidemic control, Ethiopian needs to build strong institutional capacity to generate strong evidence to support policy decision.
Predictors of infant-survival practices among mothers attending paediatric clinics in Ijebu-Ode, Ogun State, Nigeria
Authors: Sokefun Eniolufolake Elizabeth , Atulomah Nnodimele Onuigbo
Published: March 2020

Background: Despite concerted global efforts towards achieving infant-survival, infant mortality lingers as a problem in developing countries. Environmental and personal-level factors are assumed to account for this situation. This study was undertaken to provide better understanding of the dynamics of predictors of infant-survival practices among mothers with infants attending paediatric clinics.Methods: A cross-sectional survey design was adopted. Data was collected from 386 consenting nursing mothers selected by stratified sampling technique. Interviewer-administered questionnaires were used for data collection. The questionnaire consisted of 38-items involving demographic information of respondents, health-literacy counsels received during antenatal care, social-support from significant others and self-efficacy to carry-out infant-survival instructions. Responses were transformed into rating scales for each variable and data analysis was conducted by linear regression analysis with test of hypotheses, at 5% level of significance.Results: The mean age of respondents was 29.79±5.84years. Majority (81.6%) were married. Yorubas (83.90%) were predominant. Participants had mean scores of 11.41±3.91, 10.61±3.67 and 16.61±4.56 respectively computed for levels of health-literacy, social-support and self-efficacy. The dependent variable measured was their level of infant-survival practices and respondents scored 16.53±4.71. The study found a significant association among variables. Self-efficacy was the major predictor variable of self-reported infant-survival practices (R=4.66; R2=0.217; P˂0.05).Conclusion: We conclude that participants had average levels of health-literacy, social-support, self-efficacy and infant-survival practices. Efforts should be made by healthcare providers to empower pregnant women on activities essential for infant-survival. Family members of nursing mothers should as well be knowledgeable about the advantages of supporting them.
Lack of Sexual Identity Disclosure in China May Distort Efforts to Combat STI Epidemics
Authors: Kumar Navin , Forastiere Laura , Zhang Tiange , Yang Fan , Li Katherine T , Tang Weiming , Tucker Joseph D , Christakis Nicholas A , Alexander Marcus
Published: March 2020

Background. To evaluate whether Chinese men who have sex with men (MSM) select an STI test (rectal vs urethral) appropriate for their sexual behavior (insertive and/or receptive role in anal sex). Methods. We studied uptake of gonorrhea and chlamydia testing among Chinese MSM (N=431) in a multi-site RCT (December 2018 to January 2019). We collected socio-demographics, relevant medical and sexual history, and disclosure of sexual identity (outness). We estimated the decision to test and test choice, and the extent to which disclosure plays a role in decision-making. Results. Among 431 MSM, mean age was 28 years (SD=7.10) and 65% were out to someone. MSM who indicated the versatile role and were out to someone had a 26.8% (95%CI=6.1, 47.5) increased likelihood for selecting the rectal test vs the urethral test, compared to those versatile and not out. Versatile MSM out to their health provider outside of the study context had a 29.4% (95%CI=6.3, 52.6) greater likelihood for selecting the rectal STI test vs the urethral test, compared to versatile MSM not out to their health provider. Conclusions. Anal sex role and identity disclosure may affect gonorrhea and chlamydia testing provision. Apart from clinicians, community-based efforts may reduce stigma-based barriers to testing.
The effect of government financial investment on the development of traditional medicine: Evidence from public Traditional Chinese Medicine hospitals (PTHs) of Henan Province, China
Authors: Ren Weicun , Fu Xiaoli , Tarimo Clifford Silver , Kasanga Maisa , Wang Yanqing , Wu Jian
Published: March 2020

Background Traditional medicine has long been used to address relatively common illness, and Chinese government has been continually increasing its investments on Public Traditional Chinese Medicine hospitals (PTHs) in recent years. Objectives This study aimed to assess the scales and structure of investments on PTHs in Henan Province, China, in order to analyze the contribution of Government Financial Investment (GFI) to the revenue growth of PTHs, as well as raising practical investment strategies for decision-makers. Methods This study was a panel data research, conducted in Henan Province, China. By collecting 143 PTHs’ operational data from 2005 to 2017, the authors computed data with Barrow Economic Growth Model (BEG), Stochastic Frontier Analysis (SFA) and Vector Autoregressive Model (VAR), respectively.Results The study observed that the contribution of GFI to PTHs’ revenue growth was positive (average MPG=2.84), which means the scale of GFI hadn’t reached an optimal level. The scales of GFI on Grade III, Grade II A, Grade II B PTHs need to be increased by -5.96%, 4.88% and 11.51% respectively in order to maximize the input-output efficiency. The third year after the investment year may be a more effective period for conducting an effect evaluation of GFI in Henan Province.Conclusions GFI on PTHs usually has a long-term impact on PTHs. Government needs to adjust its GFI policy to maximize the input-output efficiency.
Awareness, use and willingness to self-test for HIV: An analysis of cross-sectional population-based surveys in Malawi and Zimbabwe
Authors: Johnson Cheryl Case , Neuman Melissa , MacPherson Peter , Choko Augustine , Quinn Caitlin , Wong Vincent J , Hatzold Karin , Nyirenda Rose , Ncube Getrude , Baggaley Rachel , Terris-Prestholt Fern , Corbett Elizabeth
Published: March 2020

Background Many southern African countries are nearing the global goal to diagnose 90% of people with HIV by 2020. In 2016, 84% and 86% of people with HIV knew their status in Malawi and Zimbabwe respectively. Despite this progress, gaps remain, particularly among men (≥25 years). We investigated awareness, use and willingness to HIV self-test (HIVST) prior to large scale implementation and explored sociodemographic associations.Methods We pooled responses from two of the first cross-sectional Demographic Health Surveys to include HIVST questions: Malawi and Zimbabwe in 2015-16. Sociodemographic factors and sexual risk behaviours associated with never testing for HIV, and awareness, past use and future willingness to self-test were investigated using univariable and multivariable logistic regression, adjusting for the sample design and limiting analysis to participants with completed questionnaire and a valid HIV result. Analysis of willingness to self-test was restricted to Zimbabwean men as Malawians and women were not asked this question.Results Of 31 385 individuals, the proportion never-tested was higher for men (31.2%) than women (16.5%), p<0.001. For men, having ever tested increased with age. Past use and awareness of HIVST was very low, 1.2% and 12.6% respectively. Awareness was lower among women than men (9.1% vs 15.3%, adjusted odds ratio (aOR)=1.55; 95% confidence interval [CI]: 1.37-1.75), and at younger age, and lower education and literacy levels. Willingness to self-test among Zimbabwean men was high (84.5%), with having previously tested for HIV, high sexual risk, and being older (≥25 years) associated with greater willingness. Wealthy men had greater awareness of HIVST than poorer men (p<0.001). Men at higher sexual risk, compared to men at lower risk, had the greatest willingness to self-test (aOR=3.74; 95%CI: 1.39-10.03, p<0.009).Conclusions In 2015-16 many Malawian and Zimbabwean men had never tested for HIV. Despite low awareness and minimal HIVST experience at that time, willingness to self-test was high, especially in older men with moderate to high sexual risk. These data provide a valuable baseline against which to investigate population-level uptake of HIVST as programmes scale-up. Programmes introducing, or planning to introduce HIVST, should consider including questions in population-based surveys.
Presentation Intervals And The Impact Of Delay On Breast Cancer Progression In A Black African Population
Authors: Agodirin Olayide , Olatoke Samuel , Rahman Ganiyu , Olaogun Julius , Olasehinde Olalekan , Katung Aba , Kolawole Oladapo , Ayandipo Omobolaji , Etonyeaku Amarachukwu , Habeeb Olufemi , Adeyeye Ademola , Agboola John , Akande Halimat , Oguntola Soliu , Akanbi Olusola , Fatudimu Oluwafemi
Published: March 2020

BACKGROUND: The help-seeking interval or the primary-care interval are points of delays in breast cancer presentation. To inform future breast cancer down-staging intervention, we described the contribution of each interval to the delay and the impact of delay on tumor progression.METHOD: Multicentered survey from June 2017 to May 2018. We hypothesized that most patients visited the First Healthcare Provider within 60days of tumor detection. Inferential statistics were by t-test, chi-square test, and Wilcoxon-Signed Rank test at p-value 0.05 or 95% confidence limits. Time-to-event was by survival method. Multivariate analysis was by logistic regression.RESULTS: Respondents were females between 24 and 95 years (n=420). Most respondents visited FHP within 60 days of detecting symptoms (230(60%, 95% CI 53-63). Most had long primary-care(237 of 377(64% 95%CI 59-68) and detection-to-specialist(293 (73% (95%CI 68-77)) intervals. The primary care interval(median 106days) was longer than the help-seeking interval( median 42days )Wilcoxon signed-rank test p= 0.001. There was strong correlation between length of primary care interval and the detection-to-specialist interval(r= 0.9, 95%CI 0.88- 0.92). Patronizing the hospital, receiving the correct advice, and having a big tumor(>5cm) were associated with short intervals. Tumors were detected early, but most became advanced before arriving at the specialist clinic. The difference in tumor size between detection and arriving at a specialist clinic was 5.0±4.9cm(95%CI 4.0-5.0). The instantaneous hazard of progressing from early to locally advanced disease was least in the first 30days(3%). The hazard was 31% in 90days.CONCLUSION: Most respondents presented early to the first healthcare provider, but most arrived late at a specialist clinic. The primary care interval was longer than the help-seeking interval. Most tumors were early at detection but locally advanced before arriving in a specialist clinic. Interventions aiming to shorten the primary care interval will have the most impact on time to breast cancer presentation for specialist oncology care in Nigeria.
Efficacy of interventions to improve public support for evidence based public health and climate change policy measures: a systematic review.
Authors: Coleman Rachel , Clifford Rebecca , Hewitt Catherine , McCambridge Jim
Published: March 2020

Background Policies which reduce affordability and availability of alcohol are known to be effective in reducing alcohol harms. Public support is important in policy decision making and implementation, and it may be possible to intervene to improve public support for alcohol policy measures. This systematic review aims to explore the effects of interventions to increase public support for evidence based policy measures in relation to either public health or climate change, and to examine underpinning theory and content of effective interventions.Methods The electronic search strategy was built around the constructs "public support or opinion", "health or climate change policies" and "interventions". Backward and forward searching was conducted, and authors of included papers contacted. Studies were included if they aimed to intervene to improve public support for public health or climate change policy measures, were controlled trials, and targeted the general public.Results Sixteen studies were included in this review, of which 13 had sufficient data for inclusion in meta analyses. The pooled effect estimates for continuous and binary data both show improvements in public support for policy measures as a result of evaluated interventions. The pooled standardised mean difference (n=8 studies) is 0.13 (95% C.I. 0.08-0.17), and the pooled odds ratio (n=5 studies) is 1.72 (95% C.I. 1.33-2.21). Careful attention to message framing, with or without narrative persuasion, appears particularly important content for efficacious interventions.Conclusion This systematic review demonstrates the efficacy of interventions to improve public support for public health policies.
Risk Perception and Behavior in Egyptian Adolescent Pesticide Applicators: An Intervention Study
Authors: Rohlman Diane S , Davis Jonathan W , Ismail Ahmed , Rasoul Gaafar Abdel , Hendy Olfat , Olson James R , Bonner Matthew R
Published: March 2020

Background: Adolescents are engaged in agricultural work, including pesticide application, around the world. Adolescent pesticide applicators are more likely to be exposed to pesticides than their adult counterparts because of their application practice and hygiene habits surrounding pesticide use. There is a need for low-cost interventions to reduce pesticide exposure. We evaluated a theoretically-based educational intervention to change perceptions about the risk of pesticide use and hygiene habits during and after pesticide application for adolescent and young adult pesticide applicators in Egypt.Methods: Young adult and adolescent pesticide applicators were given an educational intervention to inform them on the risk of pesticide use and how to reduce pesticide exposure. Changes in perceived susceptibility and effectiveness were measured with a survey pre and post intervention. The same survey was given 8-month post intervention to identify sustained effects. Observational checklists of pesticide application practice were also completed during application seasons before and after the intervention.Results: There was an increase in the proportion of individuals who viewed pesticides as being a long-term health risk (74.7% pre-intervention to 97.9% post-intervention, McNemar test p<0.001). This change remained significant when surveyed at the 8-month follow-up (90.5%, p<0.001). There was also a sustained improvement in regards to participant’s view of proper hygiene practice surrounding pesticide application. Applicators where observed wearing googles, shoes, and mask more frequently post intervention.Conclusion: This theoretically-based intervention is an example of a low-cost solution that can improve adolescent and young adult’s practices regarding pesticide application and personal hygiene practice during and after pesticide application. The intervention can be applied in other countries with similar safety culture surrounding pesticide application.
Reunion, a sentinel island for multidrug-resistant bacteria surveillance in South-western Indian ocean: a retrospective survey using hospitalised patients screening, 2015-2017
Authors: Gay Noellie , Lugagne Nathalie , Miltgen Guillaume , Belmonte Olivier , Cardinale Eric
Published: March 2020

BackgroundSince 2015, antimicrobial resistance was identified as a public health priority for the Southwestern Indian ocean (SWIO) (Comoros, Madagascar, Mauritius, Mayotte (France), Reunion (France), and Seychelles). However, multidrug-resistant Bacteria (MRB) colonization rates in human populations from most islands of SWIO were still unknown in 2020 with neither hospital nor community baseline colonization rates estimated.MethodsBased on exhaustive hospital MRB screening laboratory data, we provided the first estimation of MRB colonization rates in hospitalized patients residing in SWIO (2015-2017). Using Reunion (European Union) MRB colonization rate as a baseline we identified at risk patients according to their territory of residence.ResultsThe survey pointed out significantly higher overall MRB colonization rates in patients from Comoros, Madagascar, Mayotte, and Seychelles when compared to Reunion (France) with extended-spectrum betalactamase producing Enterobacteriaceae as a generalized public health issue for these territories. Specific epidemiological dynamics were pointed out in Mayotte and Seychelles patients with significantly higher methicillin-resistant Staphylococcus aureus (MRSA) colonization rates; and in Mauritius patients with higher carbapenemase producing Enterobacteriaceae (CPE) colonization rate.ConclusionThese results could be the first step to set up a regional MRB surveillance in SWIO hospitals.
Clustering 46 Asian countries according to the trend of breast cancer incidence rate from 1990- 2016: An application of growth mixture model
Authors: Azadikhah Fariba , Mehrabani Kamran , Shahraki Hadi Raeisi
Published: March 2020

Breast cancer among Asian countries is the second cause of cancer death and remains as a challenging issue in woman health as 39% of all new cases of breast cancer have been diagnosed in Asia. The current study was devoted to recognize different patterns of breast cancer incidence rate among Asian countries. Information about the incidence rates of female breast cancer within 1990-2016 years was extracted from Gapminder web site and growth mixture model was developed to describe the growth patterns and provide a set of tools to investigate the individual differences in change. Our findings suggest an overall increasing trend throughout the continent, but individual trajectories show different behaviors among countries. Bayesian information creation showed that 3-cluster model was the best. Cluster one countries including: Bangladesh, Israel, Kyrgyz republic, Maldives, Nepal, North Korea, Tajikistan and Timor-Leste, the slope of -0.13 suggests a slight negative trend for the incidence rate of breast cancer. 17 countries including: Armenia, Bahrain, Brunei, Cyprus, Iraq, Japan, Jordan, Kazakhstan, Kuwait, Lebanon, Malaysia, Pakistan, Philippines, Qatar, Singapore, South Korea, United Arab Emirate which belongs to cluster 2, had not only a high intercept that means higher amounts of incidence rate in 1990 year, but also a slope of 0.96, indicating a sharp increase trajectory. Also slope of 0.38 showed a slow increase in the incidence rate of breast cancer over time for another 21 countries. In conclusion, increase of breast cancer incidence among cluster 2 countries is tremendous therefore effective strategies for prevention are urgently needed.
What does the American public know about 'child marriage'?
Authors: Lawson David W , Lynes Rachel , Morris Addison , Schaffnit Susan B
Published: March 2020

Background: A global campaign to eradicate ‘child marriage’ (<18 years) increasingly targets governments, the private sector and the general public as agents of change. Here, we measure the current state of public knowledge of child marriage, identifying potential misconceptions and inaccurate beliefs. We then consider the implications of our survey for global health initiatives addressing child marriage.Methods: We surveyed USA nationals via the online survey platform MTurk. Participants provided sociodemographic information and answered ten questions about their understanding of child marriage. To identify potential misconceptions and inaccurate beliefs we present descriptive statistics for participant responses paired with correct answers where available.Results: 609 participants provided data for analysis. 59% were women, with a mean age of 37 years, just over half (55%) were university educated, and the majority (79%) were currently employed. Half of those surveyed mistakenly believed that the cut-off for child marriage is younger than the legal threshold of 18 years, and nearly three-quarters incorrectly believed that most child marriages occur at 15 years or below (child marriage primarily takes place in later adolescence). The large majority of participants incorrectly believed that child marriage is illegal throughout the United States (it’s illegal in only two states), and mistakenly believed that child marriage primarily takes place among Muslim-majority regions of the Middle East and North Africa (it is most common in sub Saharan Africa and South Asia). Participants tended to substantially overestimate the prevalence of child marriage in both the USA and abroad.Conclusions: These findings suggest that public understanding of child marriage is not only poor, but also shaped by wider misperceptions of both relatively high and low-income nations. Organizations seeking to empower girls and young women by reducing child marriage need to be cautious of these misunderstandings, and wary of the potential for their own activities to seed misinformation. For example, we suggest the terminology ‘child marriage’, as opposed to ‘teen marriage’ or ‘adolescent marriage’, may contribute to widespread confusion about the typical ages at which child marriages occur.
Performance of India’s national publicly funded health insurance scheme, Pradhan Mantri Jan Arogaya Yojana (PMJAY), in improving access and financial protection for hospital care: findings from household surveys in Chhattisgarh state
Authors: Garg Samir , Bebarta Kirtti Kumar , Tripathi Narayan
Published: March 2020

Background:A national Publicly Funded Health Insurance (PFHI) scheme called Pradhan Mantri Jan Arogaya Yojana (PMJAY) was launched by government of India in 2018. PMJAY seeks to cover 500 million persons with an annual cover of around 7000 USD per household. PMJAY claims to be the largest government funded health scheme globally and has attracted an international debate as a policy for Universal Health Coverage. India’s decade-long experience of the earlier national and state-specific PFHI schemes had shown poor effectiveness in financial protection. Most states in India have completed a year of implementation of PMJAY but no evaluations are available of this important scheme.Methods:The study was designed to find out the effect of enrolment under PMJAY in improving utilisation of hospital services and financial protection in Chhattisgarh which has been a leading state in implementing PFHI in terms of enrolment and claims. The study analyses three repeated cross-sections. Two of the cross-sections are from National Sample Survey (NSS) health rounds – year 2004 when there was no PFHI and 2014 when the older PFHI scheme was in operation. Primary data was collected in 2019-end to cover the first year of PMJAY implementation and it formed the third cross-section. Multivariate analysis was carried out. In addition, Propensity Score Matching and Instrumental Variable method were applied to address the selection problem in insurance.Results:Enrollment under PMJAY or other PFHI schemes did not increase utilisation of hospital-care in Chhattisgarh. Out of Pocket Expenditure (OOPE) and incidence of Catastrophic Health Expenditure did not decrease with enrollment under PMJAY or other PFHI schemes. The size of OOPE was significantly greater for utilisation in private sector, irrespective of enrollment under PMJAY.Conclusion:PMJAY provided substantially larger vertical cover than earlier PFHI schemes in India but it has not been able to improve access or financial protection so far in the state. Though PMJAY is a relatively new scheme, the persistent failure of PFHI schemes over a decade raises doubts about suitability of publicly funded purchasing from private providers in the Indian context. Further research is recommended on such policies in LMIC contexts.
Inequalities in participation and time spent in moderate-to-vigorous physical activity: analysis using the Health Surveys for England 2008, 2012, and 2016
Authors: Scholes Shaun , Mindell Jennifer S
Published: March 2020

BackgroundEvidence is unclear on whether inequalities in average levels of moderate-to-vigorous physical activity (MVPA) reflect differences in participation, differences in the amount of time spent active, or both. Using self-reported data from 24 882 adults (Health Survey for England 2008, 2012, 2016), we examined gender-specific inequalities in these separate aspects for total and domain-specific MVPA.MethodsHurdle models can accommodate continuous data with excess zeros and positive skewness. Such models were used to assess differences between income groups in three aspects: (1) the probability of doing any MVPA, (2) the average hours/week spent in MVPA, and (3) the average hours/week spent in MVPA conditional on participation (MVPA-active). Inequalities were summarised on the absolute scale using average marginal effects (AMEs) after confounder adjustment.ResultsInequalities were robust to adjustment in each aspect for total MVPA and for sports/exercise. Differences between adults in high-income versus low-income households in sports/exercise MVPA were 2.2 hours/week among men (95% confidence interval (CI): 1.7, 2.6) and 1.7 hours/week among women (95% CI: 1.4, 2.1); differences in sports/exercise MVPA-active were 1.3 hours/week (95% CI: 0.7, 1.9) and 1.0 hours/week (95% CI: 0.5, 1.6) for men and women, respectively. Heterogeneity in associations was evident for the other domains. For example, adults in high-income versus low-income households were more likely to do any walking (men: 13.0% (95% CI: 11.0, 15.0%); women: 10.2% (95% CI: 7.5, 12.9%)), yet showed no difference in hours/week walking, whilst among those doing any walking, women in high-income households spent less time walking (-1.0 hours/week; 95% CI: -1.6, -0.4).ConclusionsMonitoring inequalities in MVPA requires assessing different aspects of the distribution within each domain.
Association between depression and the combination of lower socioeconomic status and metabolic syndrome: the Korean National Health and Nutrition Examination Survey (KNHANES)
Authors: Kim Byungmi , Park Eun Young
Published: March 2020

Background: Accumulating evidence supports the existence of a metabolic–mood syndrome. Lower socioeconomic status (SES) is correlated with a higher prevalence of both depression and metabolic syndrome (MS). However, the nature of this association remains poorly understood. The objective of this study was to examine whether the combination of MS and lower SES was associated with the prevalence of depression. Methods: We conducted a cross-sectional study of 24,102 adults (>19 years of age) who participated in the 2008–2013 Korean National Health and Nutrition Examination Survey and for whom MS and depression data were available. MS was defined using the diagnostic criteria of the modified National Cholesterol Education Program Adult Treatment Panel III. Depression was assessed using a questionnaire. Multiple logistic regression analysis was used to evaluate the association between depression and MS as well as SES (alone and in combination). Results: Overall, 622 of the 24,102 subjects (2.2%) met the criteria for depression. The prevalence of depression was associated with MS, a lower high-density lipoprotein cholesterol level, an elevated triglyceride level, a lower education level, and a lower household income. Participants with MS and a low SES had a higher likelihood of depression than those without MS and a high SES (odds ratio [OR]=4.180 for low education level and OR=3.994 for low household income level). Conclusions: This study suggests that the combination of SES and MS may play an important role in depression, which has implications for healthcare policy and depression management.
Health Literacy and its Effect on Chronic Disease Prevention: Evidences from China’s Data
Authors: Liu Lefan , Qian xujun , chen zhuo , He Tianfeng
Published: March 2020

Background: Improving health literacy is an important public health goal in many countries. Although many studies have suggested that low health literacy has adverse effects on an individual’s health outcomes, factors that may be confounding the relationship between health literacy and health outcomes are often not accounted. This paper examines the interplay between health literacy and chronic disease prevention.Methods: A sample of 2,835 residents aged 14-71 years old in Ningbo province of China were selected from China’s National Health Literacy Surveillance Survey in 2017. The multivariate regression analysis is used to untangle the relationship between health literacy and chronic disease prevention.Results: We find the association between health literacy and the occurrence of the first chronic condition is attenuated after we adjust the results for age and education. In contrast, we find having one or more chronic conditions leads to better knowledge about chronic diseases and thus improved health literacy on chronic disease prevention. Thus, when a respondent has one chronic disease, health literacy could reduce the incidence of a new chronic condition (comorbidities). However, the protective effect of health literacy is only found among our urban sample, suggesting health literacy might be a key factor explaining the rural-urban disparity in health outcomes.Conclusion: Our findings highlight that health literacy plays a more important role in helping individuals preventing comorbidity than preventing their first chronic disease. Moreover, family support could be a potential channel through which health literacy accumulates and results in beneficial effects on health.