bluuebunny/crossref_metadata_2025 huggingface dataset:
Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study
Authors: Strege Rainer J. , Kiefer Reinhard , Herrmann Manfred
Published: December 2019

Background

Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. The aim of this study was the multimodal analysis of patient characteristics after VAD to identify contributing factors.

Methods

In an exploratory study, 34 consecutive patients with first-ever spontaneous VAD were prospectively examined in comparison to 38 patients with cerebral ischemia without dissection and 25 stroke mimics as control groups. Multimodal assessment was performed for clinical, neurological, cognitive, psychological and radiological data at baseline and for QOL, functional outcome, and stress symptoms by questionnaire at six months follow-up. Subgroup analysis stratified for QOL by Stroke Specific Quality of Life Scale (SS-QOL) were done for patients with good functional outcome (modified Ranking Scale (mRS) scoring 0–2). Predictors for QOL at follow-up were analyzed by regression model.

Results

88.2% of patients with VAD suffered from acute cerebral ischemia. Thirteen of 32 VAD patients (40.6%) rated QOL at follow-up as bad (SS-QOL score ≤ 3.9) despite of good functional outcome (mRS score 0–2). Subgroup analysis yielded significantly higher scores for posttraumatic stress symptoms (p = 0.002) in this subgroup. Posttraumatic stress symptoms, severity of neurological disorders, and impaired neuropsychological baseline performance proved to be independent predictors for reduced QOL at follow-up according to regression analysis.

Conclusion

VAD leads to impaired QOL at 6 months follow-up due to multiple factors. The data suggest that posttraumatic stress symptoms are of significant importance for the QOL after VAD. Clinical monitoring should address this topic to make timely treatment possible.
Correlation study between increased fetal movement during the third trimester and neonatal outcome
Authors: Huang Cuiqin , Han Wei , Fan Yajing
Published: December 2019

Background

We aimed to analyze the correlation between increased fetal movements in the third trimester and neonatal outcomes.

Methods

We enrolled pregnant women (n = 219) who reported increased/excessive fetal movements in the third trimester in our hospital. A control group of healthy women (n = 278) who had undergone regular childbirth and delivery in our hospital during the same period and did not report abnormal fetal movements were also recruited. All pregnant women underwent fetal non-stress test. We analyzed the neonatal weight, appearance, pulse, grimace, activity, and respiration score, degrees of amniotic fluid contamination, amniotic fluid volume, conditions of umbilical cord around the neck and cord length, and incidence of small for gestational age. In addition, the incidence of preterm delivery, cesarean section rate, postpartum hemorrhage, and other postpartum complications were also analyzed. We then analyzed the correlation between increased/excessive fetal activity and neonatal outcomes.

Results

Women with complaints of increased/excessive fetal movements exhibited increased fetal movements mainly around 31 and 39 weeks of gestation. Several pregnancy variables, including number of previous delivery, gestational age (less than 34 weeks and more than 37 weeks) and vaginal birth rate, were associated with increased/excessive fetal movements. In addition, women who reported increased/excessive fetal movements had higher odds of large for gestational age (LGA), particularly those with gestational age over 37 weeks.

Conclusion

Increased/excessive fetal movements may be used to predict adverse neonatal outcome such as LGA.
Metabolic consequences of perioperative oral carbohydrates in breast cancer patients — an explorative study
Authors: Lende Tone Hoel , Austdal Marie , Bathen Tone Frost , Varhaugvik Anne Elin , Skaland Ivar , Gudlaugsson Einar , Egeland Nina G. , Lunde Siri , Akslen Lars A. , Jonsdottir Kristin , Janssen Emiel A. M. , Søiland Håvard , Baak Jan P. A.
Published: December 2019

Background

The metabolic consequences of preoperative carbohydrate load in breast cancer patients are not known. The present explorative study investigated the systemic and tumor metabolic changes after preoperative per-oral carbohydrate load and their influence on tumor characteristics and survival.

Methods

The study setting was on university hospital level with primary and secondary care functions in south-west Norway. Serum and tumor tissue were sampled from a population-based cohort of 60 patients with operable breast cancer who were randomized to either per-oral carbohydrate load (preOp™; n = 25) or standard pre-operative fasting (n = 35) before surgery. Magnetic resonance (MR) metabolomics was performed on serum samples from all patients and high-resolution magic angle spinning (HR-MAS) MR analysis on 13 tumor samples available from the fasting group and 16 tumor samples from the carbohydrate group.

Results

Fourteen of 28 metabolites were differently expressed between fasting and carbohydrate groups. Partial least squares discriminant analysis showed a significant difference in the metabolic profile between the fasting and carbohydrate groups, compatible with the endocrine effects of insulin (i.e., increased serum-lactate and pyruvate and decreased ketone bodies and amino acids in the carbohydrate group). Among ER-positive tumors (n = 18), glutathione was significantly elevated in the carbohydrate group compared to the fasting group (p = 0.002), with a positive correlation between preoperative S-insulin levels and the glutathione content in tumors (r = 0.680; p = 0.002). In all tumors (n = 29), glutamate was increased in tumors with high proliferation (t-test; p = 0.009), independent of intervention group. Moreover, there was a positive correlation between tumor size and proliferation markers in the carbohydrate group only. Patients with ER-positive / T2 tumors and high tumor glutathione (≥1.09), high S-lactate (≥56.9), and high S-pyruvate (≥12.5) had inferior clinical outcomes regarding relapse-free survival, breast cancer-specific survival, and overall survival. Moreover, Integrated Pathway Analysis (IPA) in serum revealed activation of five major anabolic metabolic networks contributing to proliferation and growth.

Conclusions

Preoperative carbohydrate load increases systemic levels of lactate and pyruvate and tumor levels of glutathione and glutamate in ER-positive patients. These biological changes may contribute to the inferior clinical outcomes observed in luminal T2 breast cancer patients.

Trial of registration

ClinicalTrials.gov; NCT03886389. Retrospectively registered March 22, 2019.
Malnutrition as predictor of survival from anti-retroviral treatment among children living with HIV/AIDS in Southwest Ethiopia: survival analysis
Authors: Oumer Abdu , Kubsa Mina Edo , Mekonnen Berhanu Abebaw
Published: December 2019

Background

Approximately 70% of HIV positive people live in Africa where food insecurity and under nutrition are endemic. However the impact of malnutrition on treatment outcome is not clear. This study assessed the effect of under nutrition on Anti-Retroviral Therapy treatment outcome among pediatric age group living with HIV/AIDS in Public Hospitals, Southwest Ethiopia.

Method

A retrospective cohort study was conducted on records of 242 pediatric children in Guraghe zone Public Hospitals. Also median, mean, standard deviation and interquartile range were calculated. Life table, hazard function and survival function were plotted. Log rank test with 95% confidence interval of mean survival time was done. The nutritional status data were managed via WHO Anthros plus and BMI for age Z score was calculated. To assess effects of nutritional status on mortality, both Bivariate and multivariate cox proportional hazard regression was conducted with crude (CHR) and adjusted hazard ratio (AHR) (95% confidence interval and p value). P value of less than 0.05 was used as cut off point to declare statistical significance.

Results

A total of 243 records of pediatric ART records with mean age of 11.6 (± 3.8 years) were reviewed. About 178 (73.3%) have got therapeutic feeding on the course of ART treatment. Whereas significant number of children, 163 (67.1%) reported to had eating problems. A total of 13 (5.3%) children were dead with incidence density of 11.2 deaths per 1000 person years. There is significantly higher survival time among well nourished (11.1 years with 95% CI: 10.8 to 11.4) as compared to underweight children (9.76 with 95% CI: 9.19 to 10.32 years). Underweight children had almost three fold increase incidence of death (AHR = 3.01; 95% CI: 0.80–11.4). Similarly children with anemia had higher incidence of death than children without anemia (AHR = 1.55; 95% CI: 0.49–4.84).

Conclusions

Low nutritional status at the start of ART evidenced by underweight and anemia were found to be predictors of survival among HIV positive children. There should be improved, sustained and focused nutritional screening, care and treatment for children on ART follow up.
Knowledge, attitudes, practices about HIV and implications in risk and stigma prevention among French Guianese and Brazilian border inhabitants
Authors: Mosnier E. , Nacher M. , Parriault M. C. , Dao C. , Bidaud B. , Brousse P. , Gaillet M. , Epelboin L. , Mendes A. M. , Montenegro L. , Daniel C. Nakano , Botreau R. , Rouseliere A. , Rhodes S. , Carbunar A.
Published: December 2019

Background

The border area between French Guiana and Brazil is an active HIV-transmission zone. The aim of the present study was to describe HIV knowledge, risk and the level of stigma among inhabitants of this border area.

Methods

A cross-sectional study was conducted among 621 inhabitants over 18 years of age in the border cities of Saint-Georges-de-l’Oyapock in French Guiana and Oiapoque in Brazil. It was conducted between October 2017 and February 2018. An anonymous standardized questionnaire was filled out by culturally-trained mediators, then analyzed using STATA 12.

Results

Almost half (45.9%) of the individuals had a low education level. Participants whose native language was Portuguese or French demonstrated better HIV knowledge than other populations, notably native Amerindian and creole-speaking people. HIV risk behavior was more frequent in men and in younger age groups. People with good HIV knowledge reported having performed more HIV tests in the last year than participants with poor knowledge. The stigma level was high and reported in 74.8% of respondents.

Conclusions

These results illustrate the need for initiatives to improve HIV prevention among autochthonous populations on both sides of this border area. Cross-border collaboration on health policies could produce common key messages adapted to the education level and multi-linguistic populations who live in this area.
Comparison of the prevalence rates of HIV infection between men who have sex with men (MSM) and men in the general population in sub-Saharan Africa: a systematic review and meta-analysis
Authors: Hessou P. H. Septime , Glele-Ahanhanzo Yolaine , Adekpedjou Rheda , Ahouada Carin , Johnson R. Christian , Boko Michel , Zomahoun Hervé Tchala Vignon , Alary Michel
Published: December 2019

Background

According to the 2015 report of the Joint United Nations Program on Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS), the prevalence rates of HIV infection among men who have sex with men (MSM) varied from 6 to 37% depending on the country, far exceeding the national prevalence rates. The present study on HIV infection among men who have sex with men in sub-Saharan Africa was conducted to describe the different sampling methods used to identify this target population and compare the prevalence rates of HIV infection among MSM to that of men in the general population.

Methods

The selection of studies to be included was carried out in the principal electronic databases. The 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) directives were used throughout the entire process. Bias evaluation was performed using the Mixed Methods Appraisal Tool. For each country, HIV prevalence values in both groups were calculated. A prevalence ratio was also calculated to compare the prevalence rates of the two groups.

Results

Seventeen articles were selected. Most of the studies (82.35%) used the Respondent-Driven Sampling method. The average prevalence rate was 17.81% (range: 3.7–33.46) for MSM and 6.15% (range: 0.5–19.7) for men in the general population. Overall, the human HIV prevalence rate was 4.94 times higher among MSM than among men in the general population (95%CI: 2.91–8.37). The western and central regions of Africa, as well as low-prevalence countries (prevalence < 1%), had very high prevalence ratios: 14.47 (95% CI: 9.90–21.13) and 28.49 (95% CI: 11.47–72.71), respectively.

Conclusion

MSM are at higher risk of HIV infection than men in the general population. The prevalence ratios are particularly elevated in West and Central Africa as well as in low-prevalence countries. Close monitoring of the situation, research and preventive measures are essential to control the epidemic amongst MSM.
Prevalence of tuberculosis, HIV/AIDS, and hepatitis; in a prison of Balochistan: a cross-sectional survey
Authors: Wali Ahmad , Khan Dawood , Safdar Nauman , Shawani Zeenat , Fatima Razia , Yaqoob Aashifa , Qadir Aurangzeb , Ahmed Sultan , Rashid Hamayun , Ahmed Bashir , Khan Shereen
Published: December 2019

Background

Human Immunodeficiency Virus (HIV), Hepatitis, and Tuberculosis (TB) are three primary communicable infections have the likely potential to cause severe morbidity in prison settings. The prison has the most favorable environment for the transmission of infections. We conducted this survey to determine the prevalence and feasibility of rapid diagnostic tests in an active screening of these infectious diseases in prison.

Methods

This cross-sectional survey conducted in central Jail Gaddani, one of the largest prisons in the Balochistan province of Pakistan. All prisoners, jail staffs, and staff’s family members participated. Informed consent obtained from each participant before the screening. Van equipped with digital X-ray linked with Computer-Aided Detection for TB (CAD4TB) software used for testing. Sputum samples tested on Xpert for MTB/RIF assay and blood specimens collected for HIV and hepatitis serology. Diagnosed TB patients enrolled for treatment at Basic Management Unit (BMU), reactive on hepatitis Rapid Diagnostic Tools (RDTs) were referred for further testing and management, while HIV reactive referred to Anti Retro Viral (ARV) center for Anti Retro Viral Treatment (ART).

Results

A total of 567 participants offered screening, 63% (356) prisoners, 23% (129) staff’s family members, and 14% (82) jail staffs. Among tested 10.3% (58/562) were hepatitis seropositive (Hepatitis-C 41 [7.29%] Hepatitis-B, 16 [2.84%] Hepatitis B&C both, 01 [0.17%]). In reactive participants, 49 were prisoners, 08 were jail staffs, and 01 was the staff’s family member. HIV seropositive was 4% (24/566), and all were prisoners. Almost 99% (565/567) screened by digital X-ray, 172 (30%) were with abnormal CAD4TB suggestion (score > 50), out of them sputum of 26% (148) tested on Xpert, and 2% (03) found Mycobacterium tuberculosis Positive (MTB+). A total of five TB patients were detected; out of two were diagnosed clinically. Co-morbidities observed in 15 patients, (01 TB/HIV co-infected, 12 HIV/HCV, 01 HIV/HBV, and 01 HBV/HCV).

Conclusion

The high frequency of infectious diseases in prison is alarming. For limiting the transmission of infections among prison and community, immediate steps are needed to be taken for improvement of prisons condition by application of recommended screening protocols at the time of the first entry of prisoners in prisons.
Descriptive epidemiology of measles surveillance data, Osun state, Nigeria, 2016–2018
Authors: Shorunke Folajimi O. , Adeola-Musa Oluwatoyin , Usman Aisha , Ameh Celestine , Waziri Endie , Adebowale Stephen A.
Published: December 2019

Background

Globally, an estimate of 254,928 measles cases in 2015 and 89,780 deaths in 2016 occur annually. In Nigeria, measles is the fifth leading causes of under-five child mortality with 342 confirmed cases found in the first 9 epidemic weeks in some states including Osun State. We described the distribution, trend and make projection of measles cases in Osun State.

Methods

The Osun State surveillance weekly reporting data on measles cases from all its 30 Local Government Area (LGA) were reviewed, from January 2016 to December 2018 (n = 1205). Data were analyzed using descriptive statistics and a multiplicative time series model (MTSM). The MTSM was used to determine the trend, seasonality in the data and make projections for 2019 and 2020.

Results

Cases of measles were reported across the 30 LGAs of the state between January 2016 and December 2018. The rate of reported cases of measles was 20.2, 34.4 and 28.8 per 100,000 populations in 2016, 2017 and 2018 respectively in Ede south LGA where the highest rates were reported in the 3-year period. Out of the three studied years, year 2017, recorded the highest number of reported cases of measles in Osun State. The trend line for the 3-year period showed a positive correlation (r = + 0.4979, p = 0.056). The computed quarterly variation for the studied years was 1.094 for the 1st quarter, 1.162 for the 2nd quarter, 0.861 for the 3rd quarter and 0.888 for the 4th quarter. A quarterly projection for 2019 and 2020 showed an increasing trend with the second quarter of each year likely to have the highest reported cases of measles.

Conclusions

Ede south LGA has the highest proportion of reported measles cases in Osun State. Measles cases may increase in years ahead, but the second quarter of a year has the highest number. Government should strengthen the existing framework on measles reduction and more attention should be given to the second quarter of each year.
Differences in radiographic and clinical outcomes of oblique lateral interbody fusion and lateral lumbar interbody fusion for degenerative lumbar disease: a meta-analysis
Authors: Li Hui-Min , Zhang Ren-Jie , Shen Cai-Liang
Published: December 2019

Background

In the current surgical therapeutic regimen for the degenerative lumbar disease, both oblique lateral interbody fusion (OLIF) and lateral lumbar interbody fusion (LLIF) are gradually accepted. Thus, the objective of this study is to compare the radiographic and clinical outcomes of OLIF and LLIF for the degenerative lumbar disease.

Methods

We conducted an exhaustive literature search of MEDLINE, EMBASE, and the Cochrane Library to find the relevant studies about OLIF and LLIF for the degenerative lumbar disease. Random-effects model was performed to pool the outcomes about disc height (DH), fusion, operative blood loss, operative time, length of hospital stays, complications, visual analog scale (VAS), and Oswestry disability index (ODI).

Results

56 studies were included in this study. The two groups of patients had similar changes in terms of DH, operative blood loss, operative time, hospital stay and the fusion rate (over 90%). The OLIF group showed slightly better VAS and ODI scores improvement. The incidence of perioperative complications of OLIF and LLIF was 26.7 and 27.8% respectively. Higher rates of nerve injury and psoas weakness (21.2%) were reported for LLIF, while higher rates of cage subsidence (5.1%), endplate damage (5.2%) and vascular injury (1.7%) were reported for OLIF.

Conclusions

The two groups are similar in terms of radiographic outcomes, operative blood loss, operative time and the length of hospital stay. The OLIF group shows advantages in VAS and ODI scores improvement. Though the incidence of perioperative complications of OLIF and LLIF is similar, the incidence of main complications is significantly different.
Prevalence of dental caries and its association with body mass index among school-age children in Shenzhen, China
Authors: Cheng Yi-hong , Liao Yi , Chen Ding-yan , Wang Yun , Wu Yu
Published: December 2019

Background

Dental caries and overweight/obesity are health problems with shared risk factors, but the relationships between caries and BMI need to be further explored. The objective was to evaluate the current status of dental caries and the association between dental caries and Body Mass Index (BMI) among primary and secondary school students in Shenzhen, China, during the 2016–2017 academic year.

Methods

A population-based, cross-sectional study that enrolled a total of 1,196,004 students was conducted in Shenzhen. Physical and dental examinations were given to all primary and secondary school students by certified physicians and dentists following the national specification for student health examinations, and dental caries was diagnosed using WHO criteria. Descriptive analysis was applied to assess current oral health status and a multifactorial, logistic regression model was employed to evaluate the relationship between dental caries and obesity.

Results

A total of 1,196,004 students participated in the census. Mean age of the participants was 10.3 years, ranging from 6 to 20 years. The prevalence of dental caries was 41.15% in the present study, which was higher among girls (42.88%) than that in boys (39.77%) with a p-value of < 0.001. Students in public schools showed a significantly lower (p < 0.001) caries prevalence (37.36%) compared with those in private schools (47.96%). The caries restoration rate of students in Shenzhen was only 10.30%, which means only one out of ten students with caries received restorations. The mean dmft and DMFT scores were 0.97 and 0.33, respectively. More girls (10.96%) had their teeth filled than boys (9.78%). The restoration rate was higher (p < 0.001) in public schools (11.73%) than in private ones (8.35%). Children who were overweight or obese had a lower risk of experiencing caries compared to those who were within a normal weight (OR = 0.74/0.64). Caries was inversely associated with BMI among primary and secondary school students in Shenzhen.

Conclusions

The prevalence of dental caries among primary and secondary school children was found to be related to sex, type of schools, region, and BMI. Further studies and more government support are required to confirm the findings of this study and to address current oral health problems.
Microhardness of glass carbomer and high-viscous glass Ionomer cement in different thickness and thermo-light curing durations after thermocycling aging
Authors: Buldur Mehmet , Sirin Karaarslan Emine
Published: December 2019

Background

The objective of our study was to compare the upper and lower surface microhardness and surface changes of Glass Carbomer Cement (GCP) and EQUIA Forte (EF) in different thickness after thermo-light curing durations and aging.

Methods

A total of 504 samples (5 mm-diameter) were prepared by using GCP-252 (GCP Dental, and Vianen, Netherlands) and EF-252 (EQUIA Forte, GC, Tokyo, Japan). Three different thickness samples (2, 4, and 6 mm) were prepared with 84 samples in each subgroup. The samples were prepared by three curing procedures (Non-exposed, 60s, 90s). Their varnishes were applied to the upper surfaces of half of each subgroup (n = 7). The upper microhardness measurements were evaluated before and after aging. To compare the effect of different thicknesses, the bottom surfaces of the samples were evaluated before aging in terms of microhardness measurements. Also, the upper surfaces were analyzed in the SEM before and after aging.

Results

The upper surface values of all the samples were higher than the bottom values (p < 0.05). There were no significant differences between the varnished and non-varnished samples in both materials (p > 0.05). Although this increase was not significant in some groups, temperature variations increased the surface microhardness values of both materials except for the non-exposed-varnished EF samples. The highest microhardnesses values were recorded in the non-exposed-varnished EF (125.6 ± 6.79) and unvarnished GCP (88.1 ± 7.59) samples which were thermo-light cured for 90 s before aging. The bottom hardness values were affected by thickness variations in both GCP and EF materials (p < 0.05). The sample deformations and microcracks after aging were greater than before in all the materials. Thermo-light curing in 90 s to the samples reduced the cracks in both the materials before and after aging.

Conclusions

Thermal aging adversely affected the microhardness of the materials, which is important for clinical success. The thermo-light curing process improved the microhardness of the GCP group without varnish application. Varnish application increased the microhardness of the EF group without applying thermo-light curing. The microhardness of the bottom surfaces decreased with increasing thickness. The thermo-light curing did not increase the bottom surface microhardness of all the samples.
Virtual patients versus small-group teaching in the training of oral and maxillofacial surgery: a randomized controlled trial
Authors: Seifert Lukas B. , Socolan Octavian , Sader Robert , Rüsseler Miriam , Sterz Jasmina
Published: December 2019

Background

Computerized virtual patients (VP) have spread into many areas of healthcare delivery and medical education. They provide various advantages like flexibility in pace and space of learning, a high degree of teaching reproducibility and a cost effectiveness. However, the educational benefit of VP as an additive or also as an alternative to traditional teaching formats remains unclear. Moreover, there are no randomized-controlled studies that investigated the use of VP in a dental curriculum. Therefore, this study investigates VP as an alternative to lecturer-led small-group teaching in a curricular, randomized and controlled setting.

Methods

Randomized and controlled cohort study. Four VP cases were created according to previously published design principles and compared with lecturer-led small group teaching (SGT) within the Oral and Maxillofacial Surgery clerkship for dental students at the Department for Cranio-, Oral and Maxillofacial Plastic Surgery, Goethe University, Frankfurt, Germany. Clinical competence was measured prior (T0), directly (T1) and 6 weeks (T2) after the intervention using theoretical tests and a self-assessment questionnaire. Furthermore, VP design was evaluated using a validated toolkit.

Results

Fifty-seven students (VP = 32; SGT = 25) agreed to participate in the study. No competence differences were found at T0 (p = 0.56). The VP group outperformed (p < .0001) the SGT group at T1. At T2 there was no difference between both groups (p = 0.55). Both interventions led to a significant growth in self-assessed competence. The VP group felt better prepared to diagnose and treat real patients and regarded VP cases as a rewarding learning experience.

Conclusions

VP cases are an effective alternative to lecture-led SGT in terms of learning efficacy in the short and long-term as well as self-assessed competence growth and student satisfaction. Furthermore, integrating VP cases within a curricular Oral and Maxillofacial Surgery Clerkship is feasible and leads to substantial growth of clinical competence in undergraduate dental students.
Factors associated with using alternative sources of primary care: a cross-sectional study
Authors: Reed Charlie , Rabito Felicia A. , Werthmann Derek , Smith Shannon , Carlson John C.
Published: December 2019

Background

Mobile (MHCs), Community (CHCs), and School-based health clinics (SBHCs) are understudied alternative sources of health care delivery used to provide more accessible primary care to disenfranchised populations. However, providing access does not guarantee utilization. This study explored the utilization of these alternative sources of health care and assessed factors associated with residential segregation that may influence their utilization.

Methods

A cross-sectional study design assessed the associations between travel distance, perceived quality of care, satisfaction-adjusted distance (SAD) and patient utilization of alternative health care clinics. Adults (n = 165), child caregivers (n = 124), and adult caregivers (n = 7) residing in New Orleans, Louisiana between 2014 and 2015 were conveniently sampled. Data were obtained via face-to face interviews using standardized questionnaires and geospatial data geocoded using GIS mapping tools. Multivariate regression models were used to predict alternative care utilization.

Results

Overall 49.4% of respondents reported ever using a MCH, CHC, or SBHC. Travel distance was not significantly associated with using either MCH, CHC, or SBHC (OR = 0.91, 0.74–1.11 p > .05). Controlling for covariates, higher perceived quality of care (OR = 1.02, 1.01–1.04 p < .01) and lower SAD (OR = 0.81, 0.73–0.91 p < .01) were significantly associated with utilization.

Conclusions

Provision of primary care via alternative health clinics may overcome some barriers to care but have yet to be fully integrated as regular sources of care. Perceived quality and mixed-methods measures are useful indicators of access to care. Future health delivery research is needed to understand the multiple mechanisms by which residential segregation influences health-seeking behavior.
The heterogeneous health state profiles of high-risk healthcare utilizers and their longitudinal hospital readmission and mortality patterns
Authors: Ng Shawn Choon Wee , Kwan Yu Heng , Yan Shi , Tan Chuen Seng , Low Lian Leng
Published: December 2019

Background

High-risk patients are most vulnerable during transitions of care. Due to the high burden of resource allocation for such patients, we propose that segmentation of this heterogeneous population into distinct subgroups will enable improved healthcare resource planning. In this study, we segmented a high-risk population with the aim to identify and characterize a patient subgroup with the highest 30-day and 90-day hospital readmission and mortality.

Methods

We extracted data from our transitional care program (TCP), a Hospital-to-Home program launched by the Singapore Ministry of Health, from June to November 2018. Latent class analysis (LCA) was used to determine the optimal number and characteristics of latent subgroups, assessed based on model fit and clinical interpretability. Regression analysis was performed to assess the association of class membership on 30- and 90-day all-cause readmission and mortality.

Results

Among 752 patients, a 3-class best fit model was selected: Class 1 “Frail, cognitively impaired and physically dependent”, Class 2 “Pre-frail, but largely physically independent” and Class 3 “Physically independent”. The 3 classes have distinct demographics, medical and socioeconomic characteristics (p <  0.05), 30- and 90-day readmission (p <  0.05) and mortality (p <  0.01). Class 1 patients have the highest age-adjusted 90-day readmission (OR = 2.04, 95%CI: 1.21–3.46,p = 0.008), 30- (OR = 6.92, 95%CI: 1.76–27.21,p = 0.006) and 90-day mortality (OR = 11.51, 95%CI: 4.57–29.02,p <  0.001).

Conclusions

We identified a subgroup with the highest readmission and mortality risk amongst high-risk patients. We also found a lack of interventions in our TCP that specifically addresses increased frailty and poor cognition, which are prominent features in this subgroup. These findings will help to inform future program modifications and strengthen existing transitional healthcare structures currently utilized in this patient cohort.
Determination of rheology and surface tension of airway surface liquid: a review of clinical relevance and measurement techniques
Authors: Chen Zhenglong , Zhong Ming , Luo Yuzhou , Deng Linhong , Hu Zhaoyan , Song Yuanlin
Published: December 2019

By airway surface liquid, we mean a thin fluid continuum consisting of the airway lining layer and the alveolar lining layer, which not only serves as a protective barrier against foreign particles but also contributes to maintaining normal respiratory mechanics. In recent years, measurements of the rheological properties of airway surface liquid have attracted considerable clinical attention due to new advances in microrheology instruments and methods. This article reviews the clinical relevance of measurements of airway surface liquid viscoelasticity and surface tension from four main aspects: maintaining the stability of the airways and alveoli, preventing ventilator-induced lung injury, optimizing surfactant replacement therapy for respiratory syndrome distress, and characterizing the barrier properties of airway mucus to improve drug and gene delivery. Primary measuring techniques and methods suitable for determining the viscoelasticity and surface tension of airway surface liquid are then introduced with respect to principles, advantages and limitations. Cone and plate viscometers and particle tracking microrheometers are the most commonly used instruments for measuring the bulk viscosity and microviscosity of airway surface liquid, respectively, and pendant drop methods are particularly suitable for the measurement of airway surface liquid surface tension in vitro. Currently, in vivo and in situ measurements of the viscoelasticity and surface tension of the airway surface liquid in humans still presents many challenges.
Primary immunodeficiency-related bronchiectasis in adults: comparison with bronchiectasis of other etiologies in a French reference center
Authors: Goussault Hélène , Salvator Hélène , Catherinot Emilie , Chabi Marie-Laure , Tcherakian Colas , Chabrol Alexandre , Didier Morgane , Rivaud Elisabeth , Fischer Alain , Suarez Felipe , Hermine Olivier , Lanternier Fanny , Lortholary Olivier , Mahlaoui Nizar , Devillier Philippe , Couderc Louis-Jean
Published: December 2019

Background

Bronchiectasis is a heterogeneous disease depending on etiology. It represents the most frequent non-infectious pulmonary complication of primary immunodeficiencies (PID). We investigated whether bronchiectasis associated with PID had a distinct course in comparison to bronchiectasis of other causes.

Methods

Retrospective single-center study of adult patients diagnosed with non-cystic fibrosis bronchiectasis with more than 5 years of follow-up and at least 4 pulmonary functional tests available at one year apart. They were divided into three groups: PID- related bronchiectasis, idiopathic/post infectious-related bronchiectasis and other causes of bronchiectasis. Respiratory functional data and clinical outcomes were compared.

Results

Of 329 patients with bronchiectasis diagnosed in Foch Hospital (Suresnes, France), 98 patients fulfilled the selected criteria (20 PID-related cases, 39 idiopathic or post-infectious cases, and 39 cases with other causes). Median time of follow-up was 9.5 years. Groups were similar concerning initial characteristics (female 70.4%, never smokers 59.2%, mild severity bronchiectasis according to the FACED score and median FEV1 at diagnosis 73.5% predicted values [Q1–Q3: 53.75–90.5]), except PID patients who were younger (median age of 51.5 vs 62 years, p = 0.02). Eighty-five percent of PID patients received immunoglobulin substitution (median trough level was measured at 10.5 g/dl [10;10.92]). Global median FEV1 annual decline was 25.03 ml/year [8.16;43.9] and 19.82 ml/year [16.08;48.02] in the PID patients group. Forty-five percent of patients had bacterial colonization, pneumoniae occurred in 56% of patients and median exacerbation annual rate was 0.8 [0.3–1.4]. Hemoptysis occurred in 31.6% of patients. Global mortality rate was 11.2%. We did not record any significant difference for all clinical and functional outcomes between patients with PID and other etiologies. The median decline in FEV1 was similar in the three groups.

Conclusions

The course of PID-related bronchiectasis was similar to bronchiectasis of other causes. Provided that patients receive immunoglobulin replacement, the course of PID-related bronchiectasis seems to be independent of the underlying immune disorder.
Inhaled corticosteroids and FEV1 decline in chronic obstructive pulmonary disease: a systematic review
Authors: Whittaker Hannah R. , Jarvis Debbie , Sheikh Mohamed R. , Kiddle Steven J. , Quint Jennifer K.
Published: December 2019

Rate of FEV1 decline in COPD is heterogeneous and the extent to which inhaled corticosteroids (ICS) influence the rate of decline is unclear. The majority of previous reviews have investigated specific ICS and non-ICS inhalers and have consisted of randomised control trials (RCTs), which have specific inclusion and exclusion criteria and short follow up times. We aimed to investigate the association between change in FEV1 and ICS-containing medications in COPD patients over longer follow up times.

MEDLINE and EMBASE were searched and literature comparing change in FEV1 in COPD patients taking ICS-containing medications with patients taking non-ICS-containing medications were identified. Titles, abstract, and full texts were screened and information extracted using the PICO checklist. Risk of bias was assessed using the Cochrane Risk of Bias tool and a descriptive synthesis of the literature was carried out due to high heterogeneity of included studies.

Seventeen studies met our inclusion criteria. We found that the difference in change in FEV1 in people using ICS and non-ICS containing medications depended on the study follow-up time. Shorter follow-up studies (1 year or less) were more likely to report an increase in FEV1 from baseline in both patients on ICS and in patients on non-ICS-containing medications, with the majority of these studies showing a greater increase in FEV1 in patients on ICS-containing medications. Longer follow-up studies (greater than 1 year) were more likely to report a decline in FEV1 from baseline in patients on ICS and in patients on non-ICS containing medications but rates of FEV1 decline were similar.

Further studies are needed to better understand changes in FEV1 when ICS-containing medications are prescribed and to determine whether ICS-containing medications influence rate of decline in FEV1 in the long term. Results from inclusive trials and observational patient cohorts may provide information more generalisable to a population of COPD patients.
Who buys nets? Factors associated with ownership and use of purchased mosquito nets in sub-Saharan Africa
Authors: Olapeju Bolanle , Choiriyyah Ifta , Bertram Kathryn , Piccinini Danielle , Harig Hunter , Selby Richmond Ato , Lynch Matthew , Koenker Hannah
Published: December 2019

Background

Public sector strategies to promote insecticide-treated net (ITN) access have resulted in increased ITN ownership across sub-Saharan Africa. However, the current status of the private sector distribution channel for nets has not been fully explored. This multi-country study explored the prevalence of net purchases and the characteristics of households that had purchased nets and used such nets in sub-Saharan Africa.

Methods

Data from recent Malaria Indicator Survey (MIS) or Demographic and Health Survey (DHS) in 16 countries were analysed to explore the prevalence of purchased nets. Purchased nets were defined as nets obtained from shops/markets or pharmacies. Additional sub-analysis of factors associated with ownership and use of purchased nets was conducted in seven countries with over 10% of nets reported as purchased. Key outcomes included: prevalence of purchased nets out of all nets, household ownership of a purchased net, and whether a purchased net was used the previous night. Analytical methods included country level tests of association and multivariable logistic regressions.

Results

Among all nets, the proportion of purchased nets in the study countries ranged from 0.8 to 32.7% and most (median = 77%) of these purchased nets were ITNs. Although the private nets are presumed to be from the retail, non-public sector, the prevalence of treated purchased nets suggests that some purchased nets may be “leaked” ITNs from public sector distributions, and thus, may be an informal sector rather than part of the formal “private sector”. Urban, wealthier households as well as those with educated heads were more likely to own purchased nets. Use of such nets was, however, lower in wealthier households. In addition, net use was higher in households owning insufficient nets for their family size, and when the nets were newer than 24 months.

Conclusion

The formal and informal private sector have played a role in bolstering net access rates in some settings. Study findings can help relevant malaria control stakeholders gain insight on the contribution of purchased nets on their overall ITN strategy, identify potential target populations for private sector nets as well as inform the design and distribution of private sector insecticide-treated nets that appeal to their target groups.
High Plasmodium falciparum genetic diversity and temporal stability despite control efforts in high transmission settings along the international border between Zambia and the Democratic Republic of the Congo
Authors: Pringle Julia C. , Wesolowski Amy , Berube Sophie , Kobayashi Tamaki , Gebhardt Mary E. , Mulenga Modest , Chaponda Mike , Bobanga Thierry , Juliano Jonathan J. , Meshnick Steven , Moss William J. , Carpi Giovanna , Norris Douglas E.
Published: December 2019

Background

While the utility of parasite genotyping for malaria elimination has been extensively documented in low to moderate transmission settings, it has been less well-characterized in holoendemic regions. High malaria burden settings have received renewed attention acknowledging their critical role in malaria elimination. Defining the role for parasite genomics in driving these high burden settings towards elimination will enhance future control programme planning.

Methods

Amplicon deep sequencing was used to characterize parasite population genetic diversity at polymorphic Plasmodium falciparum loci, Pfama1 and Pfcsp, at two timepoints in June–July 2016 and January–March 2017 in a high transmission region along the international border between Luapula Province, Zambia and Haut-Katanga Province, the Democratic Republic of the Congo (DRC).

Results

High genetic diversity was observed across both seasons and in both countries. No evidence of population structure was observed between parasite populations on either side of the border, suggesting that this region may be one contiguous transmission zone. Despite a decline in parasite prevalence at the sampling locations in Haut-Katanga Province, no genetic signatures of a population bottleneck were detected, suggesting that larger declines in transmission may be required to reduce parasite genetic diversity. Analysing rare variants may be a suitable alternative approach for detecting epidemiologically important genetic signatures in highly diverse populations; however, the challenge is distinguishing true signals from potential artifacts introduced by small sample sizes.

Conclusions

Continuing to explore and document the utility of various parasite genotyping approaches for understanding malaria transmission in holoendemic settings will be valuable to future control and elimination programmes, empowering evidence-based selection of tools and methods to address pertinent questions, thus enabling more efficient resource allocation.
A global analysis of National Malaria Control Programme vector surveillance by elimination and control status in 2018
Authors: Burkot Thomas R. , Farlow Robert , Min Myo , Espino Effie , Mnzava Abraham , Russell Tanya L.
Published: December 2019

Background

Maintaining the effectiveness of the currently recommended malaria vector control interventions while integrating new interventions will require monitoring key recommended indicators to identify threats to effectiveness including physiological and behavioural resistance to insecticides.

Methods

Country metadata on vector surveillance and control activities was collected using an online survey by National Malaria Control Programmes or partner organization officials. Country and regional surveillance activities were analysed for alignment with indicators for priority vector surveillance objectives recommended by the World Health Organization. Surveillance activities were also compared for countries in the E2020 (eliminating countries) and countries with more intense transmission.

Results

Significant differences in monitoring priority vector indicators between Africa and Asia-Pacific country programmes were found as well as differences between countries approaching elimination and those controlling malaria. Gaps were found between vector data collected and country management strategies (i.e., for insecticide resistance management and integrated vector control strategies) and for making programmatic decisions on surveillance and control using vector surveillance data.

Conclusions

Significant opportunities exist for increasing vector data collection on priority indicators and using these data for national programmatic decisions for both proactive insecticide resistance management and enhancing vector control.
What is the role of cultural competence in ethnic minority consumer engagement? An analysis in community healthcare
Authors: Harrison Reema , Walton Merrilyn , Chauhan Ashfaq , Manias Elizabeth , Chitkara Upma , Latanik Monika , Leone Desiree
Published: December 2019

Background

Effective patient engagement has been associated with high quality health care. There is a dearth of evidence around effective engagement with consumers from ethnic minority backgrounds; specifically in relation to the role of cultural competence amongst healthcare professionals in effective engagement with consumers from ethnic minority backgrounds. To address this knowledge gap, we analysed the role of cultural competence in the consumer engagement approaches taken by community healthcare professionals working with consumers from ethnic minority backgrounds.

Methods

Semi-structured individual interviews were conducted with 21 healthcare professionals employed across four community healthcare and affiliated services in four local government areas in Australia.

Results

Adopting patient-centric approaches (that seek to understand and be responsive to the patient as an individual) featured as an underpinning theme that transcended other emerging themes. Recognition of diversity within communities and individuals in those communities, all with their own story, was described as pivotal to effective engagement. This was encapsulated in the theme of Cultural standpoints and personal context that contained four further themes of: (1) Build foundations of trust and respect; (2) Diversify communication channels; (3) Generate system, service and community partnerships; (4) Take the time.

Conclusion

Our findings indicate that cultural competence and effective consumer engagement are closely linked in ethnic minority populations. Embedding cultural competence as a health system, service and professional capability is therefore critical to ensure equitable healthcare quality for consumers from all ethnic backgrounds.