bluuebunny/crossref_metadata_2025 huggingface dataset:
Estimated Number of Short-Stay Service Recipients in Hokkaido Prefecture, Japan, from 2020 to 2045: Estimation by Machine Learning and Review of Changing Trend by Cartogram
Authors: Ouchi Junko , Hattori Kanetoshi
Published: November 2020

Background: For effective allocations of limited human resources, it is significant to have accurate estimates of future elderly care demands at the regional level, especially in areas where aging and population decline vary by region, such as Hokkaido prefecture in Japan.Objectives: The present study aimed to estimate the numbers of short-stay service recipients in all administrative units in Hokkaido from 2020 to 2045 with the machine learning approaches and reviewed the changing trends of spatial distributions of the service recipients with cartograms.Methods: A machine learning approach was used for the estimation. To develop the model to estimate, population data in Japan from 2015 to 2017 were used as input signals, whereas data on the numbers of short-stay service recipients at each level of needs for long-term care (levels 1–5) from 2015 to 2017 were used as a supervisory signal. Three models were developed to avoid problems of repeatability. Then, data of the projected population in Hokkaido every 5 years from 2020 to 2045 were fed into each model to estimate the numbers of the service recipients for the 188 administrative units of Hokkaido. The medians of the estimations from the models were considered as the final results; the estimates for 188 administrative units were presented with continuous area cartograms on the map of Hokkaido.Results: The developed models predicted that the number of the service recipients in Hokkaido would peak at 18,016 in 2035 and the number of people at level 3 in particular would increase. The cartograms for levels 2 and 3 from 2020 to 2030 and level 3 for 2035 were heavily distorted in the populated areas in Hokkaido.Discussion: The large correlation coefficients indicated the accuracy of estimations by the developed models. The growing number of the service recipients especially at level 3 by 2035 was assumed to be related to aging of the first baby boomers in Japan. The distortions of the cartograms suggested that the majority of the service recipients would be concentrated in the populated areas in Hokkaido. Future allocations of human resources were discussed on the basis of the findings.
Increased Risk of Legionella Pneumonia as Community-acquired Pneumonia after Heavy Rainfall in 2018 in West Japan
Authors: Mitsui Miho , Ito Akihiro , Ishida Tadashi , Tachibana Hiromasa , Nakanishi Yosuke , Yamazaki Akio , Washio Yasuyoshi
Published: November 2020

Background: Japan experienced a heavy rainfall event from June 28 to July 8, 2018, and many casualties were caused by both heavy rainfall and flooding. Few studies have investigated patients’ characteristics and causative pathogens of community-acquired pneumonia before and after heavy rainfall events. The aim of the present study was to evaluate the causative pathogens and clinical characteristics of hospitalised patients with community-acquired pneumonia before and after the heavy rainfall event using prospective cohort data.Methods: The study was divided into two periods: July to November 2013-2017 (pre heavy rainfall) and July to November 2018 (post heavy rainfall). The patients’ clinical characteristic and causative pathogens before and after the heavy rainfall were investigated. Regarding the causative pathogens, precipitation and seasonal patterns were adjusted.Results: There were no significant differences in the number and clinical characteristics of patients pre and post heavy rainfall. However, the frequency of Legionella pneumonia was significantly higher after than before the heavy rainfall event (8.9% vs 3.0%, P = 0.02) and remained significant after adjusting for precipitation and season. Three of 7 Legionella pneumonia patients engaged in reconstruction work and 2 Legionella pneumonia patients had soil exposure.Conclusions: An increased risk of Legionella pneumonia after not only rainfall and serious flooding, but also following recovery work or soil exposure should be considered. Trial registration: A prospective epidemiological study for patients with pneumonia in a single center in Japan, UMIN000004353. Registered 7 October 2010,　https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000005195
Contrasting Smoking Behaviors of Non-daily Smokers – A Study based on Clustering of Repeated Daily Measures of Nicotine Exposure
Authors: Midya Vishal , Hobkirk Andréa L. , Krebs Nicolle M. , Allen Sophia I. , Reinhart Lisa , Sun Dongxiao , Stennett Andrea L. , Muscat Joshua E.
Published: November 2020

Background: Over one-quarter of all smokers in the U.S. identify as non-daily smokers and this number is projected to rise. Despite the negative health effects of non-daily smoking and high rates of unsuccessful quit attempts, we know little about the variability and correlates of nicotine exposure among non-daily smokers. Methods: A community sample of non-daily smokers (n=60) ages 21 to 60 completed baseline measures of nicotine dependence, a consecutive 7-day at-home protocol to log each smoking session, ecological momentary assessments of mood and activity during smoking, and daily saliva samples for cotinine and nicotine metabolite ratio analysis. Hierarchical cluster analysis categorized participants based on their mean cotinine levels across days. Clusters were compared on biological and behavioral smoking characteristics, nicotine dependence, and activities and emotions during smoking using linear mixed effect regression models.Results: Cluster analysis of cotinine revealed four distinct clusters of nicotine exposure, ranging from high levels (above 200 ng/ml) to very low levels (near 0 ng/ml). Compared to the other clusters, the cluster with the highest mean levels of cotinine also had the largest day-to-day variation in cotinine and was associated with significantly higher levels of nicotine dependence on the Fagerström Test of Nicotine Dependence and the Penn State Cigarette Dependence Index, lower rates of social smoking, and the highest frequency of negative emotions during smoking. Conclusions: Our findings highlight the variability in nicotine exposure across days among non-daily smokers and show that some are exposed to levels near those of daily smokers. The results point to individual differences and existence of several sub-groups of nondaily smokers based on their nicotine exposure, which varied considerably across days for some, but not all groups. The results highlight the need to better characterize non-daily smokers and the factors that maintain smoking behavior to inform personalized cessation treatments for this growing population of smokers.
Epidemiological Modeling Analysis Reveals the Transmission Potential of COVID-19 Asymptomatic Patients:A Prospective Study of Epidemiological Transmission in America
Authors: Zhao Yuhang , Ji Zhonglei , Wang Ping , Meng Xiangwei , Ma Zhixiang , Li Xiyuan , Sun Haihang , Li Wei
Published: November 2020

Background:The asymptomatic of COVID-2019 are getting more and more attention from all walks of life. Now, America has become the epicenter of the pandemic, with more reported cases and deaths than other regions of the world. Studying the development asymptomatic populations may play a key role in managing the outbreak effectively. Methods:We propose a new model to predict the course of the epidemic and simulate the transmission of the asymptomatic. The model considers seven stages of infection: susceptible (S), exposed (E), infected (I), asymptomatic (A), confirmed (C), recovered (R), dead (D), we named it as SEIACRD. We used a model to study the interaction between asymptomatic patients and viral transmission.Result:Our model confirms that about 12 million people will be infected with the virus. Changes in mortality rates will be volatile, first falling, then rising. Not only the number of patients, but also the spread of the epidemic will be affected by the ability to detect asymptomatic persons. Contact with asymptomatic infected patients also significantly promoted the spread of the virus. But these methods had no significant effect on changes in patient mortality.Conclusion:American Asymptomatic patients have a strong interaction with epidemic transmission. They are no less at risk of transmission than symptomatic patients. In terms of controlling the number of infections, efforts to improve detection capacity are more effective than simply suppressing the spread of the virus. Extensive testing and effective social distancing measures should be taken to protect more people from the virus.
Occurrence of Carcinogenic illudane Glycosides in Drinking Water Wells
Authors: Skrbic Natasa , Kisielius Vaidotas , Pedersen Ann-Katrin , Christensen Sarah C. B. , Hedegaard Mathilde J. , Hansen Hans Christian Bruun , Rasmussen Lars Holm
Published: November 2020

Background Ptaquiloside (PTA), caudatoside (CAU) and ptesculentoside (PTE) are carcinogenic illudane glycosides found in bracken ferns (Pteridium spp.) world-wide. The environmentally mobile PTA entails both acute and chronic toxicity and comparable risk might be associated with the structurally similar CAU and PTE. It is of great concern if these compounds are present in drinking water wells in bracken dominated regions, since they might pose a threat to human health. This study investigates the presence of PTA, CAU, PTE, and their corresponding hydrolysis products pterosins B (PtB), A (PtA) and G (PtG) in water wells in Denmark, Sweden and Spain. In total, 77 water samples from deep groundwater wells (40 – 100 m) and shallow water wells (8 – 40 m) were collected and preserved in the field, pre-concentrated in the laboratory and analysed by liquid chromatography-mass spectrometry (LC-MS). Results Deep groundwater wells contained neither illudane glycosides nor their pterosins. However, seven private shallow wells contained at least one of the illudane glycosides and/or pterosins at concentrations up to 0.27 µg L-1 (PTA), 0.75 µg L-1 (CAU), 0.05 µg L-1 (PtB), 0.03 µg L-1 (PtA) and 0.28 µg L-1 (PtG). Conclusions Detected concentrations of illudane glycosides in some of investigated wells exceeded the suggested maximum tolerable concentrations of PTA, although they were used for drinking water purpose. Contaminated wells were characterized by shallow depth, lower pH and electrical conductivity compared to deep groundwater wells where no illudane glycosides or pterosins were found.
Person Centered Antenatal Care and Associated Factors in Rwanda: A Secondary Analysis of Program Data
Authors: Miller Phoebe , Afulani Patience , Musange Sabine Furere , Sayingoza Felix , Walker Dilys
Published: November 2020

Background: Research suggests that person centered antenatal care (PCANC) provides an effective tool for addressing maternal deaths in Sub-Saharan Africa through the delivery of health care which is both respectful of, and responsive to, the preferences, needs, and values of women. Yet little is known in Rwanda about either the extent to which PCANC is practiced or the factors that might determine its use. This is the first study to quantitatively examine the extent of and the factors associated with PCANC in Rwanda.Methods: We used quantitative data from a pair-matched cluster randomized control trial (CRCT) in Rwanda. A total of 2,150 surveys were used from 36 health centers across five districts. Eligible women were 16 – 49 years old and were not referred to higher levels of care or had incomplete survey responses. Results: PCANC was found to be sub-optimal with 30% of women leaving antenatal care (ANC) either with questions or confused and 24% feeling disrespected. In bivariate analysis, factors that significantly predict high PCANC are better levels of cognitive maternal empowerment, greater parity, being in the traditional care (control group), and being from Burera district. The study group to which women were assigned and the district in which women received care were significantly associated with PCANC in the multivariate analysis.Conclusions: Given the benefits of PCANC, improvements in PCANC through provider training in Rwanda might promote an institutional culture shift towards a more person-centered model of care. We also found that better measurement tools are needed to more comprehensively measure PCANC and recommend wider use of these validated tools in national surveys to get a systematic understanding of PCANC in Rwanda. Additionally, we recommend thoughtful measures of empowerment during antenatal care to capture the social experiences of women in Rwanda. Trial registration: Not applicable
Evaluating the Effect of Dexmedetomidine Intravenous Infusion on Labor Pain Management in Primipar Term Pregnant Women
Authors: Delavari Abasali , Esmailzadeh Arezoo , Dehgan Mahdi , Lak Marzieh
Published: November 2020

Background: The pain of labor is very severe. Most women prefer painless labor to routine labor if they are aware of the methods of analgesia. The aim of this study was to evaluate the effect of Dexmedetomidine intravenous infusion on labor pain management in primipar term pregnant women. Methods: In this Non-randomized clinical trial with control group, all primipar term pregnant women were enrolled in the study. In the intervention group, after the active phase of labor, Dexmedetomidine was given according to the protocol and continued until phase two of labor. The control group received no intervention to reduce pain. Patients in both groups were evaluated for, fetal heart rate, Apgar scores, vital signs, pain intensity and sedation score. Results: There were no significant difference in primary fetal heart rate, primary maternal hemodynamics, and mean Apgar scores of 1 and 5 minutes, between the two groups (p>0.05). There was no significant difference in the mean of fetal heart rate in different stages between two groups. Intra-group analysis in the intervention group showed that mean systolic and diastolic blood pressure were significantly decreased after drug administration but were in normal range. The active phase of labor in the intervention group was significantly shorter than the control group (p = 0.002). The mean VAS score after Dexmedetomidine administration decreased significantly from 9.25 at baseline to 4.61 after drug administration, 3.88 during labor and 1.88 after placental expulsion. The mean RSS score after Dexmedetomidine administration increased significantly from 1 at baseline to 2.05 after drug administration, 2.22 during labor and 2.05 after placental expulsion. Conclusion: Based on results, it seems that administration of Dexmedetomidine to manage labor pain with careful monitoring of mother and fetus is recommended. Due to limited studies, further larger and multicenter studies are needed to be performed.Trial registration: This study was registered on Iranian registry of clinical trials, identification number IRCT20161022030421N5, registered on February 2, 2019, https://irct.ir/trial/40134.
Use and Quality of Cesarean Delivery in a Low and Middle Income Setting: National Results from Two Emergency Obstetric and Newborn Care Assessments
Authors: Beyene Misrak Getnet , Zemedu Theodros Getachew , Gebregiorgis Azmach Hadush , Ruano Ana Lorena , Bailey Patricia E
Published: November 2020

Background: Cesarean delivery (CD) rates have reached epidemic levels in many high and middle income countries while increasingly, low income countries are challenged both by high urban CD rates and high unmet need in rural areas. The managing authority of health care institutions often plays a role in these disparities. This paper shows changes between 2008 and 2016 in CD rates and the capacity of the Ethiopian health system to deliver quality CD services, highlighting the role of the management sector.Methods: We compare results from two national cross-sectional emergency obstetric and newborn care assessments using descriptive statistics. The sample includes 111 hospitals in 2008 and 316 hospitals in 2016, and 275 CD case reviews in 2008 and 568 in 2016. Our primary outcome measures include population- and institutional-based CD rates; hospital readiness to perform CD; quality of clinical management; and the relative size of Robson classification groupsResults: The national population-based rate increased (< 1% to 2.7%) as did all regional rates. Rates ranged from 24% in urban settings to less than 1% in several rural regions. The institutional rate was 54% in the private for-profit sector in 2016, up from 46% in 2008. Hospital readiness to perform CDs increased in public and for-profit hospitals. Only half of the women whose cases were reviewed received uterotonics after delivery of the baby, but use of prophylactic antibiotics was high. Partograph use increased from 9% to 42% in public hospitals, but was negligible or declined elsewhere. In 2016, a third of case reviews from the public sector were among low-risk nulliparous women (Robson group 1).Conclusions: Between 2008 and 2016, government increased the availability of CD services, improved public hospital readiness and some aspects of clinical quality. Strategies tailored to further reduce the high unmet need for CD and what appears to be an increasing number of unnecessary cesareans are discussed. Adherence to best practices and universal coverage of water and electricity will improve the quality of hospital services while the use of the Robson classification system may serve as a useful quality improvement tool.
A Remote Management System for Control and Surveillance of Echinococcosis: Design and Implementation Based on Internet of Things
Authors: Yang Shi-Jie , Xiao Ning , Li Jing-Zhong , Feng Yu , Ma Jun-Ying , Quzhen Gong-Sang , Yu Qing , Zhang Ting , Yi Shi-Cheng , Zhou Xiao-Nong
Published: November 2020

Background: As a neglected cross-species parasitic disease transmitted between canines and livestock, echinococcosis remains a global public health concern with a heavy disease burden. In China, especially in the epidemic pastoral communities on the Qinghai-Tibet Plateau, the harsh climate, low socio-economic status, poor overall hygiene, and remote and insufficient access to all owned dogs exacerbate the difficulty in implementing the ambitious control programme for echinococcosis. New methods and tools are urgently needed to increase the deworming coverage and frequency, promote real-time scientific surveillance, and prevent transmission of echinococcosis. Methods: We propose the remote management system (RMS) based on IoT as a novel tool to control smart deworming devices to deliver efficient PZQ baits to dogs regularly and automatically and also as a smart digital management platform to monitor, analyse, and display the epidemic trends of echinococcosis dynamically, in real time. The RMS is an excellent alternative to existing manual deworming methods and management for surveillance of echinococcosis.Results: The smart collars are fully capable of anti-collision, waterproof, and cold-proof performance, and the battery’s energy is sufficient. The RMS can accurately analyse the monitoring data and parameters including positive rates of canine faeces, and the prevalence of echinococcosis in the general population livestock, and children. The data of dogs deworming and surveillance for echinococcosis is able to be controlled using RMS and has expanded gradually in townships to the whole Hezuo region. A total of 48 administrators (3, 3, 8, 11, 23 at the provincial, municipal, county, township, village levels, respectively) participated in the questionnaire survey, with 93.8% of its overall satisfaction rate.Conclusion: The existing difficulties and challenges in the way of prevention and control for echinococcosis can partially be resolved using the innovative, IoT-based technologies and tools. The proposed RMS to advance the upgrade of existing manual prevention and control models for echinococcosis, especially in the current ongoing COVID-19 pandemic, as social distance and community blockade continue.
Seroprevalence and Molecular Diagnosis of Brucellosis Among Patients at Selected Hospitals of Abbottabad, Pakistan
Authors: Hassan Laiba , Ali Shahzad , Syed Muhammad Ali , Shah Asim Ali , Abbasi Shahid Ahmad , Tabassum Sadia , Saeed Usama , Melzer Falk , Khan Aman Ullah , El-Adawy Hosny , Neubauer Heinrich
Published: November 2020

Background: Brucellosis is a neglected disease of ruminants with zoonotic potential. It causes severe health problems in humans and economic loss. Only a limited number of studies have been conducted in Pakistan to determine the prevalence of human brucellosis and related risk factors. The objectives of the current cross-sectional study were to determine prevalence of Brucella infection in sera collected from patients at three hospitals of Abbottabad. Risk factors were investigated. Methods: A total of 500 blood samples were collected. A questionnaire was filled in for each patient to obtain information on age, gender, living area, brucellosis associated symptoms, associated risk factors, pregnancy and abortion history. Serum agglutination test (SAT) was performed to detect antibodies against brucellae. A genus specific BCSP-31 gene RT-PCR was used to detect Brucella DNA in the sample. Statistical analysis was done to determine odd ratios, risk ratios, 95% confidence intervals and p values. Results: A total of 13.6% (n=68) patients were found to be SAT positive. DNA was found in 11.4% (n=57) samples. The prevalence of brucellosis was reported to be higher in women (14.6%, n=44) than in man (12.1%, n=24). The age group of 25-50 years was found to be at higher risk for brucellosis (14.5%, n=50). “Animal contact” was reported as the main risk factor followed by “consumption of raw animal products”. About 9.9% pregnant women (n=13) were found brucellosis positive. Of these 23.8% (n=5) had an abortion history. Conclusions: The present study reports a striking prevalence of brucellosis among patients including pregnant women at three hospitals of Abbottabad. These findings must foster strategies for controlling human brucellosis at household level, raising of awareness about brucellosis in hospital and family doctors and finally in setting up an eradication program in the dairy industry.
Factors Associated With Delayed Diagnosis of Cervical Cancer in Tikur Anbesa Specialized Hospital, Ethiopia, 2019: Cross-Sectional Study
Authors: Zeleke Shegaw , Anley Mesfin , Kefale Demewoz
Published: November 2020

BackgroundCervical cancer is a preventable and curable disease if detected early enough. But, several numbers of women in Ethiopia strive for treatment when the disease has extended to last stage. Cervical cancer is the second most common cancer morbidity and the leading cause of women mortality related to cancer in Ethiopia. Delayed in diagnosis is the main reason for cervical cancer mortality in Ethiopia. The main objective of this study was to assess factors associated with delayed diagnoses of cervical cancer in Tikur Anbesa Specialized Hospital, Ethiopia. MethodsInstitution based cross-sectional study was conducted. Randomly selected 422 cervical cancer patients were interviewed and their medical records were reviewed. Data was entered using Epi data version 3.1 and analyzed using SPSS version 22. Bivariate and multivariate analysis was conducted to examine the association between independent and the outcome variables. ResultA total of 422 women were enrolled in our study yielding a response rate of 97.1%. The mean age of the women was 50 years (SD ±11.5). Half of the participants (50%) were can’t read and write, and 66.3% of participants income were <500 Ethiopian Birr (approximately 14 USD). Most (86.3%) of the women had delayed diagnosis of cervical cancer. Women who have <500 Ethiopian Birr (14 USD) income (adjusted OR=3.79, CI: 1.48, 9.67), haven’t awareness of cervical cancer disease (adjusted OR=1.33, CI: 1.05, 2.71) and haven’t awareness about cervical cancer screening (adjusted OR=1.64, CI: 1.16, 4.07) were more likely for delayed diagnosis of cervical cancer. ConclusionOur study reports a high prevalence of delayed diagnosis of women with cervical cancer. High level of illiteracy, low socioeconomic status, lack of awareness, traditional healers and absence of routine screening program, were accountable for delayed diagnosis of cervical cancer. Raising awareness, increasing access and improving health services for cancer should be promoted and advocated to decrease the usual delay of cervical cancer diagnosis.
Internet use and well-being during the COVID-19 outbreak: Examining the role of gender, age, motives for using the internet and relational resources in an Italian adult sample.
Authors: Venuleo Claudia , Marino Claudia , Ferrante Lucrezia , Rollo Simone , Schimmenti Adriano
Published: November 2020

The COVID-19 outbreak introduced self-isolation and social distancing as measures to reduce the spreading of the pandemic. As a consequence, internet usage has increased globally. The current study aims to show whether internet worked as a resource for well-being or as an amplifier of psychological distress and problematic internet use (PIU), considering the role of gender, age, motives for using the internet and online/offline relational resources. Five hundred and seventy-three adult participants (M: 40.28; SD: 16.43; 64% women) completed a form on sociodemographic characteristics and Internet use, and completed standardized measures on loneliness, online social support, well-being and PIU. A principal component analysis was computed to identify the main motives Internet use; ANOVA and Pearson’s r correlations were computed to examine (dis)similarities in motivational components with respect to gender, agegroup and psychosocial measures. A multivariate multiple regression analysis was performed to assess the contribution of the hypothesized predictors on overall well-being and PIU.Three principal motives for Internet use were detected: leisure and social interaction, knowledge, learning/working. Significant differences were found among them with respect to gender and age group and online/offline relational resources. Differences were found in the likelihood of PIU and well-being related to all the variables considered, with the exception of online social support for PIU and gender and age for well-being. These findings call for further research aimed to disentangle the correlates of PIU in a time of physical distancing, as well as for innovative efforts tailored to blunt the impacts of social isolation and bolster social connectivity.
ITRAQ-based quantitative proteomic analysis of Fusarium moniliforme (Fusarium verticillioides) in response to Phloridzin inducers
Authors: Zhang Rong , Jiang Weitao , Liu Xin , Duan Yanan , Xiang Li , Wang Yanfang , Jiang Yuanmao , Shen Xiang , Chen Xuesen , Yin Chengmiao , Mao zhiquan
Published: November 2020

Background: Apple replant disease (ARD) has been reported from all major fruit-growing regions of the world, and is often caused by biotic factors (pathogen fungi) and abiotic factors (phenolic compounds). In order to clarify the proteomic differences of Fusarium moniliforme under the action of phloridzin, and to explore the potential mechanism of F. moniliforme as the pathogen of ARD, the role of Fusarium spp in ARD was further clarified.Methods: In this paper, the quantitative proteomics method iTRAQ analysis technology was used to analyze the proteomic differences of F. moniliforme before and after phloridzin treatment. The differentially expressed protein was validated by qRT-PCR analysis.Results: A total of 4535 proteins were detected, and 293 proteins were found with more than 1.2 times (P<0.05) differences. In-depth data analysis revealed that 59 proteins were found with more than 1.5 times (P<0.05) differences, and most proteins were consistent with the result of qRT-PCR. Differentially expressed proteins were influenced a variety of cellular processes, particularly metabolic processes. Among these metabolic pathways, a total of 8 significantly enriched KEGG pathways were identified with at least 2 affiliated proteins with different abundance in conidia and mycelium. Functional pathway analysis indicated that up-regulated proteins were mainly distributed in amino sugar, nucleotide sugar metabolism, glycolysis/ gluconeogenesis and phagosome pathways.Conclusions: This study is the first to perform quantitative proteomic investigation by iTRAQ labeling and LC-MS/MS to identify differentially expressed proteins in F. moniliforme under phloridzin conditions. The results confirmed that F. moniliforme presented a unique protein profile that indicated the adaptive mechanisms of this species to phloridzin environments. The results deepened our understanding of the proteome in F. moniliforme in response to phloridzin inducers and provide a basis for further exploration for improving the efficiency of the fungi as biocontrol agents to control ARD.
Racial and ethnic patterns and differences in health care expenditures among Medicare beneficiaries with and without cognitive deficits or Alzheimer's disease and related dementias
Authors: Park Sungchul , Chen Jie
Published: November 2020

Background: Numerous studies have documented racial and ethnic differences in the prevalence and incidence of Alzheimer's disease and related dementias (ADRD). Less is known, however, about racial and ethnic differences in health care expenditures among older adults at risk for ADRD (cognitive deficits without ADRD) or with ADRD. In particular, there is limited evidence that racial and ethnic differences in health care expenditures change over the trajectory of ADRD or differ by types of service.Methods: We examined racial and ethnic patterns and differences in health care expenditures (total health care expenditures, out-of-pocket expenditures, and six service-specific expenditures) among Medicare beneficiaries without cognitive deficits, those with cognitive deficits without ADRD, and those with ADRD. Using the 1996-2017 Medical Expenditure Panel Survey, we performed multivariable regression models to estimate expenditure differences among racial and ethnic groups without cognitive deficits, those with cognitive deficits without ADRD, and those with ADRD. Models accounted for survey weights and adjusted for various demographic, socioeconomic, and health characteristics.Results: Black, Asians, and Latinos without cognitive deficits had lower total health care expenditures than whites without cognitive deficits ($10,236, $9,497, $9,597, and $11,541, respectively). There were no racial and ethnic differences in total health care expenditures among those with cognitive deficits without ADRD and those with ADRD. Across all three groups, however, Blacks, Asians, and Latinos consistently had lower out-of-pocket expenditures than whites (except for Asians with cognitive deficits without ADRD). Furthermore, service-specific health care expenditures varied by racial and ethnic groups.Conclusions: Our study did not find significant racial and ethnic differences in total health care expenditures among Medicare beneficiaries with cognitive deficits and/or ADRD. However, we documented significant differences in out-of-pocket expenditures and service-specific expenditures. We speculated that the differences may be attributable to racial and ethnic differences in access to care and/or preferences based on family structure and cultural/economic factors. Particularly, heterogeneous patterns of service-specific expenditures by racial and ethnic groups underscore the importance of future research in identifying determinants leading to variations in service-specific expenditures among racial and ethnic groups.
Near-Falls in Singapore Community-Dwelling Older Adults: A Feasibility Study
Authors: SOH SHAWN LENG-HSIEN , TAN CHEE-WEE , LANE JUDITH , YEH TING-TING , SOON BENJAMIN
Published: November 2020

BackgroundA near-fall is defined as a loss of balance that would result in a fall if sufficient balance recovery manoeuvres are not executed. Compared to falls, near-falls and its associated balance recovery manoeuvres have been understudied. Older adults may not recognise a near-fall or identify the use of their balance recovery manoeuvres to prevent a fall. The consensus on the methods to collect near-fall data is lacking. The primary objective of this study was to determine the feasibility of recruitment and retention. Secondary objectives were to establish evidence that Singapore community-dwelling older adults can identify near-falls and associated balance recovery manoeuvres. Texting and calling methods were explored as reporting methods.MethodsThis study took place in Singapore (September to October 2019). Participants were healthy, community-dwelling adults aged 65 or older. Recruitment was done through poster advertisement, and all participants gave informed consent. Participants attended a briefing session and reported their near-fall or fall incidence over 21 days using either daily texting or calling. The primary outcome measures were the recruitment rate, retention rate, preferred modes for data reporting and ability to report near-falls or falls. Secondary outcomes included the self-reported incidence of falls and near-falls.ResultsThirty older adults were recruited in five weeks. All participants completed the study. They understood near-fall concepts and were able to report the occurrence and relevant balance recovery manoeuvres used to prevent a fall. 87% (26/30) chose to text while 13% (4/30) selected calling as their reporting method. One actual fall (0.16%) out of 630 responses was reported. Thirty-six incidents (5.7%) of near-falls were recorded. Sixteen participants (53.3%) experienced near-falls and half of this group experienced two or more near-falls. Use of reach-to-grasp strategy (36%), compensatory stepping (52.8%), and other body regions (11.2%) were used to prevent the fall. ConclusionsThe study provided evidence that studying near-falls in Singapore community-dwelling older adults is feasible and can be applied to a large-scale study. Recruitment and retention rates were good. Older adults were able to identify near-falls and balance recovery manoeuvres. Both texting and calling were feasible reporting methods, but texting was preferred. Trial registrationClinicalTrials identifier: NCT04087551. Registered 12th September 2019
Risk factors for hospital-acquired influenza A and patient characteristics: A matched case-control study
Authors: Yang Kui , Zhang Ni , Gao Chunchen , Qin Hongyan , Wang Anhui , Song Liqiang
Published: November 2020

Background: While hospital-acquired influenza A results in an additional cost burden and considerable mortality in patients, its risk factors are unknown. We aimed to describe the characteristics of patients vulnerable to hospital-acquired influenza A and to identify its risk factors to assist clinicians control hospital-acquired infections and reduce the burden of treatment.Methods: A case-control study was conducted among hospitalized patients aged ≥18 years at a tertiary level teaching hospital during the 2018–2019 influenza A season. Patient data were retrieved from hospital-based electronic medical records. Hospital-acquired influenza A was defined as a case of influenza A diagnosed 7 days or more after admission, in a patient with no evidence of influenza A infection on admission. The controls without influenza A were selected among patients exposed to the same setting and time period. We identified risk factors using conditional logistic regression and described the characteristics of hospital-acquired influenza A by comparing the clinical data of infected patients and the controls.Results: Of the 412 hospitalized patients with influenza A from all the departments in the study hospital, 93 (22.6%) cases were classified as hospital-acquired. The most common comorbidities of the 93 cases were hypertension (41.9%), coronary heart disease (21.5%), and cerebrovascular disease (20.4%). Before the onset of hospital-acquired influenza A, patients presented more lymphocytopenia (51.6% vs 35.5%, P=0.027), hypoalbuminemia (78.5% vs 57.0%, P=0.002), and pleural effusion (26.9% vs 9.7%, P=0.002) than the matched controls. Infected patients also had longer hospital stays (18 days vs 14 days, P=0.002), and higher mortality rates (10.8% vs 2.2%, P=0.017) than the matched controls. Lymphocytopenia (odds ratio [OR]: 3.11; 95% confidence interval [CI]: 1.24–7.80; P=0.016), hypoalbuminemia (OR: 2.24; 95% CI: 1.10–4.57; P=0.027), and pleural effusion (OR: 3.09; 95% CI: 1.26–7.58; P=0.014) were independently associated with hospital-acquired influenza A.Conclusions: Lymphocytopenia, hypoalbuminemia and pleural effusion are independent risk factors that can help identify patients at high risk of hospital-acquired influenza A, which can extend hospital stay and is associated with a high mortality.
Hypertension prevalence, awareness, treatment, and control and predicted 10-year CVD risk: a cross-sectional study of Seven Communities in East and West Africa (SevenCEWA)
Authors: Okello Samson , Muhihi Alfa , Mohamed Shukri F , Ameh Soter , Ochimana Caleb , Oluwasanu Abayomi Olabayo , Bolarinwa Oladimeji Akeem , Sewankambo Nelson , Danaei Goodarz
Published: November 2020

Background: Few studies have characterized epidemiology and management of hypertension across several communities with comparable methodology in sub-Saharan Africa. We assessed prevalence, awareness, treatment, and control of hypertension and predicted 10-year cardiovascular disease risk across seven sites in East and West Africa. Methods: Between June and August 2018, we conducted household surveys among adults aged 18 years and above in 7 communities in Kenya, Nigeria, Tanzania, and Uganda. We collected data on socio-demographics, health insurance, and healthcare utilization. We measured blood pressure using digital blood pressure monitors and following a standardized protocol. We estimated 10-year cardiovascular disease (CVD) risk using a country-specific risk score and fitted hierarchical models to identify determinants of hypertension prevalence, awareness and treatment. Results: We analyzed data of 3549 participants. The mean age was 39·7 years (SD 15·4), 60·5% of whom were women, 9·6% had ever smoked, and 32·7% were overweight/obese. A quarter of the participants (25·1% had hypertension, half of whom (57·6%) were diagnosed. Among diagnosed, 50·5% were taking medication, and among those taking medication 47·3% had controlled blood pressure. After adjusting for other determinants, older age was associated with increased hypertension prevalence, awareness, and treatment whereas primary education was associated with lower hypertension prevalence. Health insurance was associated with lower hypertension prevalence and higher chances of treatment. Median predicted 10-yr CVD risk across sites was 4·9% Interquartile range, IQR (2·4%, 10·3%) and 13·2% had risk of 20% or greater while 7·1% had risk of >30%. Conclusion: In seven communities in east and west Africa, a quarter of adults had hypertension, about 40% were unaware, half of those aware were treated and half of those treated were controlled blood pressure. Access to health insurance is needed to improve awareness, treatment, and control of hypertension in sub-Saharan Africa.
Application of refrigerated and frozen sorghum malt slurries in preservation of starter cultures for Obushera from Uganda
Authors: Mukisa Ivan Muzira , Byakika Stellah , Serwanga Arnold
Published: November 2020

Industrial production of traditional fermented beverages is limited by lack of quality commercial starter cultures. Saccharomyces cerevisiae MNC21Y and Lactobacillus plantarum MNC21 can be used to ferment cereal beverages such as Obushera. These cultures are unavailable as commercial starters due to lack of appropriate propagating and distributing procedures. The purpose of this study was to evaluate the use of refrigerated and frozen sorghum slurries as carrier media for the starters. Starters were propagated in sorghum slurries (30°C for 24 h) and stored at 5°C and -18°C for 90 days. Viability of Saccharomyces cerevisiae and Lactobacillus plantarum was determined by cell counts after surface plating and pour plating, respectively. Fermentation ability was determined by inoculating sorghum slurries with starters and monitoring pH, acidity and flavor development. Viability was higher for starters stored at 5°C (S. cerevisiae: 6 log cfu.g-1 and Lb. plantarum: 7-9 log cfu.g-1 during 90 days) than those at -18°C (S. cerevisiae: 2 cfu.g-1 and Lb. plantarum: 4 log cfu.g-1 after 30 days). Refrigerated starters acidified Obushera (pH  4.5) faster (10-20 h) than frozen ones (18-24 h). Refrigerated or frozen S. cerevisiae + Lb. plantarum starters in sorghum malt slurries can remain viable for at least one or three months, respectively and produce Obushera with characteristic flavors.
Estimating transmission dynamics and serial interval of the first wave of COVID-19 infections under different control measures: A statistical analysis in Tunisia from February 29 to May 5, 2020 
Authors: Talmoudi Khouloud , Safer Mouna , Letaief Hejer , Hchaichi Aicha , Harizi Chahida , Dhaouadi Sonia , Derouiche Sondes , Bouaziz Ilhem , Gharbi Donia , Najar Nourhene , Osman Molka , Cherif Ines , Mlallekh Rym , Ben-Ayed Oumaima , Ayedi Yosr , Bouabid Leila , Bougatef Souha , Ben-Alaya Nissaf Bouafif ép , Chahed Mohamed Kouni
Published: November 2020

Background: Describing transmission dynamics of the outbreak and impact of intervention measures are critical to planning responses to future outbreaks and providing timely information to guide policy makers decision. We estimate serial interval (SI) and temporal reproduction number (Rt) of SARS-CoV-2 in Tunisia. Methods: We collected data of investigations and contact tracing between March 1, 2020 and May 5, 2020 as well as illness onset data during the period February 29-May 5, 2020 from National Observatory of New and Emerging Diseases of Tunisia. Maximum likelihood (ML) approach is used to estimate dynamics of Rt. Results: 491 of infector-infectee pairs were involved, with 14.46% reported pre-symptomatic transmission. SI follows Gamma distribution with mean 5.30 days [95% Confidence Interval (CI) 4.66-5.95] and standard deviation 0.26 [95% CI 0.23-0.30]. Also, we estimated large changes in Rt in response to the combined lockdown interventions. The Rt moves from 3.18 [95% Credible Interval (CrI) 2.73-3.69] to 1.77 [95% CrI 1.49-2.08] with curfew prevention measure, and under the epidemic threshold (0.89 [95% CrI 0.84-0.94]) by national lockdown measure.Conclusions: Overall, our findings highlight contribution of interventions to interrupt transmission of SARS-CoV-2 in Tunisia.
A modelling study highlights the power of detecting and isolating asymptomatic or very mildly affected individuals for COVID-19 epidemic management.
Authors: Mayorga Lia , Samartino Clara García , Flores Gabriel , Masuelli Sofía , Sánchez María V. , Mayorga Luis S. , Sánchez Cristián G.
Published: November 2020

Background: Mathematical modelling of infectious diseases is a powerful tool for the design of management policies and a fundamental part of the arsenal currently deployed to deal with the COVID-19 pandemic. Methods: We present a compartmental model for the disease where symptomatic and asymptomatic individuals move separately. We introduced healthcare burden parameters allowing to infer possible containment and suppression strategies. In addition, the model was scaled up to describe different interconnected areas, giving the possibility to trigger regionalized measures. It was specially adjusted to Mendoza-Argentina’s parameters, but is easily adaptable for elsewhere. Results: Overall, the simulations we carried out were notably more effective when mitigation measures were not relaxed in between the suppressive actions. Since asymptomatics or very mildly affected patients are the vast majority, we studied the impact of detecting and isolating them. The removal of asymptomatics from the infectious pool remarkably lowered the effective reproduction number, healthcare burden and overall fatality. Furthermore, different suppression triggers regarding ICU occupancy were attempted. The best scenario was found to be the combination of ICU occupancy triggers (on: 50%, off: 30%) with the detection and isolation of asymptomatic individuals. In the ideal assumption that 45% of the asymptomatics could be detected and isolated, there would be no need for complete lockdown, and Mendoza’s healthcare system would not collapse. Conclusions: Our model and its analysis inform that the detection and isolation of all infected individuals, without leaving aside the asymptomatic group is the key to surpass this pandemic.
Harmonization of medical products regulation: A key factor for improving regulatory capacity in the East African Community
Authors: Ndomondo-Sigonda Margareth , Miot Jacqueline , Naidoo Shan , Masota Nelson Enos , Ng'andu Brian , Ngum Nancy , Kaale Eliangiringa
Published: November 2020

AbstractBackground: Limited capacity to regulate medical products is associated with circulation of products which do not meet standards of quality, safety and efficacy with negative public health and economic outcomes. This study focused on assessing the effect of the East African Community (EAC) medicines regulatory harmonization initiative on the capacity of national medicines regulatory agencies, with a focus on registration and inspection systems. Methods: An exploratory mixed-method design using both qualitative and quantitative data was employed. Data was collected from six national medicines regulatory authorities (NMRAs) and the EAC Secretariat through a combination of semi-structured interviews, questionnaires, and checklists for the period 2010/11-2015/16 whereas 2010/11 data served as baseline. Interviews were conducted with heads of NMRAs, regulatory and monitoring and evaluation experts, and the EAC Secretariat Project Officer. A set of 14 indicators grouped into 6 categories were used to measure NMRAs performance. Results: Policy and legal frameworks provide a foundation for effective regulation. Collaboration, harmonization, joint dossier reviews and inspections of manufacturing sites, reliance and cooperation are key factors for building trust and capacity among NMRAs. Five out of six of the EAC Partner States have comprehensive medicines laws with autonomous NMRAs. All the NMRAs have functional registration and good manufacturing practice inspection systems supported by regional harmonised guidelines for registration, inspection, quality management and information management systems with four NMRAs attaining ISO 9001:2015 certification.Conclusions: The EAC regulatory harmonization initiative has contributed to improved capacity to regulate medical products. The indicators generated from this research can be replicated for evaluation of similar initiatives across and beyond the African continent and contribute to public health policy.