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pages 16

It is estimated that 190 million individuals are at risk of blindness from trachoma, and that control by mass drug administration (MDA) is reducing this risk in many populations. Programs are monitored using prevalence of follicular trachoma disease (TF) in children. However, as programs progress to low prevalence there are challenges interpreting this indirect measure of infection. PCR and sero-surveillance are being considered as complementary tools to monitor low-level transmission, but there are questions on how they can be most effectively used. We use a previously-published, mathematical model to explore the dynamic relationship between TF and PCR throughout a control program and a sero-catalytic model to evaluate the utility of two cross-sectional sero-surveys for estimating sero-conversion rates. The simulations show that whilst PCR is more sensitive than TF at detecting infection, the probability of detecting at least one positive individual declines during an MDA program more quickly for PCR than for TF (for the same sample size). Towards the end of a program there is a moderate chance of a random sample showing both low PCR prevalence and higher TF prevalence, which may contribute to the lack of correlation observed in epidemiological studies. We also show that conducting two cross-sectional sero-surveys 10 years apart can provide more precise and accurate estimation of epidemiological parameters than a single survey, supporting previous findings that whilst serology holds great promise, multiple cross-sections from the same community are needed to generate the most valuable information about transmission. These results highlight that the quantitative dynamics of infection and disease should be included alongside the many logistical and practical factors to be considered in designing a monitoring and evaluation strategy at the operational research level, in order to help subsequently inform data collection for individual country programs. Whilst our simulations provide some insight, they also highlight that some level of longitudinal, individual-level data on reinfection and disease may be needed to monitor elimination progress. [ABSTRACT FROM AUTHOR]


Malaria in rural Mozambique. Part I: Children attending the outpatient clinic.

by Guinovart, Caterina, Bassat, Quique, Sigaúque, Betuel, Aide, Pedro, Sacarlal, Jahit, Nhampossa, Tacilta, Bardají, Azucena, Nhacolo, Ariel, Macete, Eusébio, Mandomando, Inácio, Aponte, John J., Menéndez, Clara, Alonso, Pedro L. [2008-01-01]

Academic Journal

pages 9

Background: Malaria represents a huge burden for the health care services across Africa. Describing malaria attending health services contributes to quantify the burden and describe the epidemiology and clinical presentation. Methods: Retrospective analysis of data collected through the Manhiça morbidity surveillance system (Mozambique) on all paediatric visits (


Malaria in rural Mozambique. Part II: children admitted to hospital.

by Bassat, Quique, Guinovart, Caterina, Sigaúque, Betuel, Aide, Pedro, Sacarlal, Jahit, Nhampossa, Tacilta, Bardají, Azucena, Nhacolo, Ariel, Macete, Eusébio, Mandomando, Inácio, Aponte, John J., Menéndez, Clara, Alonso, Pedro L. [2008-01-01]

Academic Journal

pages 13

Background: Characterization of severe malaria cases on arrival to hospital may lead to early recognition and improved management. Minimum community based-incidence rates (MCBIRs) complement hospital data, describing the malaria burden in the community. Methods: A retrospective analysis of all admitted malaria cases to a Mozambican rural hospital between June 2003 and May 2005 was conducted. Prevalence and case fatality rates (CFR) for each sign and symptom were calculated. Logistic regression was used to identify variables which were independent risk factors for death. MCBIRs for malaria and severe malaria were calculated using data from the Demographic Surveillance System. Results: Almost half of the 8,311 patients admitted during the study period had malaria and 13,2% had severe malaria. Children under two years accounted for almost 60% of all malaria cases. CFR for malaria was 1.6% and for severe malaria 4.4%. Almost 19% of all paediatric hospital deaths were due to malaria. Prostration (55.0%), respiratory distress (41.1%) and severe anaemia (17.3%) were the most prevalent signs among severe malaria cases. Severe anaemia and inability to look for mother's breast were independent risk factors for death in infants younger than eight months. For children aged eight months to four years, the risk factors were malnutrition, hypoglycaemia, chest indrawing, inability to sit and a history of vomiting. MCBIRs for severe malaria cases were highest in children aged six months to two years of age. MCBIRs for severe malaria per 1,000 child years at risk for the whole study period were 27 in infants, 23 in children aged 1 to


Do conflict management systems matter?

by Roche, William, Teague, Paul [2012-03-01]

Academic Journal

pages 28

The most influential current idea in the theory of conflict management concerns the design features and supposed superior outcomes of conflict management systems combining interest-based and rights-based practices for resolving conflict in organizations. Yet much of the literature in the area is highly prescriptive and draws heavily either on exemplary case studies or descriptive data. Using focus groups of HR practitioners and experts in conflict resolution to develop a questionnaire covering the main conflict management practices associated with the theory of conflict management systems, the study analyzes data from a survey of firms in the Republic of Ireland to examine quantitatively the effects of conflict management systems on organizational outcomes. While proactive line management and supervisory engagement in conflict resolution as a key dimension of conflict management systems is found to be positively associated with a range of organizational outcomes, no evidence is found for the kind of system effects proposed in the theoretical and prescriptive literature. © 2012 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]


Breast Cancer Research in the Caribbean: Analysis of Reports From 1975 to 2017.

by Ragin, Camille, Banydeen, Rishika, Zhang, Christine, Ben, Athena, Calabrese, Victoria, Villa, Nina N., Reville, Jade, Dasgupta, Shaoni, Bandyopadhyay, Mausumi, Louden, Delroy, Dasgupta, Subhajit [2018-11-27]

Academic Journal

pages 21

Purpose: Breast cancer is among the leading causes of death resulting from cancer in Caribbean women. Studies examining exogenous and genetically predetermined endogenous risk factors are critical to define breast cancer susceptibility in Caribbean women. The purpose of this systematic review is to assess the existing scientific literature in the last 42 years (1975 to 2017) to describe the body of research generated for the population of this region and determine future research directions. Methods: We selected published research articles using a combination of definite keyword searches in PubMed. Only articles presenting the Caribbean population as the focus of their research objectives were included in this analysis. Results: Studies on breast cancer in the Caribbean are limited. A majority of publications on Caribbean populations were descriptive, focusing on cancer trends and clinicopathologic factors. High incidence and mortality rates for breast cancer are reported for the region, and there seem to be some differences between countries in the frequency of cases according to age at presentation. A limited number of epidemiologic, behavioral, and genetic and molecular studies were conducted in more recent years. Conclusion: A regional strategy for cancer registration is needed for the Caribbean to address possible underestimates of breast cancer incidence. Furthermore, behavioral, molecular, genetic, and epidemiologic investigations of breast cancer are critical to address the concerns related to currently described high incidence and mortality rates in the Caribbean. [ABSTRACT FROM AUTHOR]


Communication of epidemiology study results by industry: The Dow Chemical Company approach.

by Collins, James J, Bodner, Kenneth M, Baase, Catherine M, Burns, Carol, Jammer, Brenda, Bloemen, Louis J [2004-11-15]

Academic Journal

pages 6

Communicating epidemiology study results to subjects, affected workers, and community members is an important part of compliance and alignment with our company's policies, industry's Responsible Care® Principles, and the doctrines of Good Epidemiology Practices. It is the responsibility of the investigators to interpret their research appropriately for each audience, and to assure that all who have a need or right to know get information in a form meaningful to them. We discuss study communication with examples from a recent evaluation of communication efforts within Dow and our experience with occupational and community studies on dioxin. We also discuss how we currently structure worker and community communication based on this experience. Since each Dow protocol must include a communication plan, when we agree to undertake a study, we are also agreeing to communicate study results. Depending upon the nature and type of the study, there may also be some prestudy communication. We encourage all investigators to share the results of their studies more broadly than just scientific publication and plan for the study communication before the study is initiated.Journal of Exposure Analysis and Environmental Epidemiology (2004) 14, 492-497. doi:10.1038/sj.jea.7500394 Published online 11 August 2004 [ABSTRACT FROM AUTHOR]


Perspectives of National Coordinators and Partners on the Work of the Global Trachoma Mapping Project.

by Heggen, Anne E., Solomon, Anthony W., Courtright, Paul [2016-12-01]

Academic Journal

pages 7

Purpose: Neglected tropical diseases (NTDs) affect people living in the poorest regions of the world and their debilitating effects perpetuate the poverty cycle. Understanding the distribution of NTDs is crucial for effective intervention delivery. In 2012, the Global Trachoma Mapping Project (GTMP) was initiated to map >1800 suspected trachoma endemic districts by March 2015. This research was carried out to better understand the implementation experience and identify lessons which might inform the GTMP and similar initiatives. Methods: Using grounded theory methodology, semi-structured interviews were conducted with key informants from six countries with 63% of the global mapping backlog (Ethiopia, Malawi, Mozambique, Nigeria, Solomon Islands, and Yemen). Interviews were transcribed, coded, and findings separated into categories. Results: Three themes were identified during the research; planning and operations, technical implementation, and governance. The project was felt to be most successful in countries where the Ministry of Health was actively engaged in setting standards, ensuring capacity building for government staff, and guiding the training, data collection, analysis, and interpretation of data. Standardized tools, training platforms, and the use of electronic data capture increased confidence in the reliability of the survey data, informed quality improvement efforts within survey implementation, and the immediate release of results empowered end-user decision-makers. Regional collaboration between endemic countries bolstered program manager competence and confidence, while reinforcing partnerships essential to the success of the GTMP. Conclusions: We depict how innovative characteristics of the GTMP, and lessons learned from its implementation, can strengthen similar initiatives to map disease prevalence and risk factors. [ABSTRACT FROM PUBLISHER]


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pages 4

Objective: To assess the impact on hospital admissions produced by trees and other falling objects, to examine these accidents' circumstances, and to investigate the degree of support provided by the data for tree-related accident prevention. Methods: Admissions to emergency departments in the Hunter Region for the period 2008-2012 allocated the International Classification of Disease 10 code W20 (struck by falling object) were analysed. Results: Of 620 admissions, 125 files were incorrectly coded leaving an eligible sample of 495 W20 admissions. Males made up 79.4% of admissions. Where recorded, the commonest accident locations were workplaces (63.2%) and homes (31.5%). Trees/branches caused only 24 (4.8%) of such accidents with an age-adjusted admission rate of 0.28 per 10,000 people compared with 6.84 per 10,000 for all falling objects combined. Most tree-related admissions (at least 62.5%) occurred to persons actively interacting with the tree. Being male ( p=0.04) and living in an outer regional area ( p=0.001) increased the incidence of tree injuries. Conclusions: Hospital admissions caused by falling objects especially trees are uncommon. Implications for public health: It is difficult to justify any major health promotion expenditure to reduce tree-related accidents, given their especial rarity. Any funds allocated should focus on preventing falling object injuries in workplaces and homes. [ABSTRACT FROM AUTHOR]


How Well Does the World Health Organization Definition of Domestic Violence Work for India?

by Kalokhe, Ameeta S., Potdar, Ratnaprabha R., Stephenson, Rob, Dunkle, Kristin L., Paranjape, Anuradha, del Rio, Carlos, Sahay, Seema [2015-03-01]

Academic Journal

pages 16

Domestic violence (DV) is reported by 40% of married women in India and associated with substantial morbidity. An operational research definition is therefore needed to enhance understanding of DV epidemiology in India and inform DV interventions and measures. To arrive at a culturally-tailored definition, we aimed to better understand how definitions provided by the World Health Organization and the 2005 India Protection of Women from Domestic Violence Act match the perceptions of behaviors constituting DV among the Indian community. Between September 2012 and January 2013, 16 key informant interviews with experts in DV and family counseling and 2 gender-concordant focus groups of lay community members were conducted in Pune, India to understand community perceptions of the definition of DV, perpetrators of DV, and examples of DV encountered by married women in Pune, India. Several key themes emerged regarding behaviors and acts constituting DV including 1) the exertion of control over a woman’s reproductive decision-making, mobility, socializing with family and friends, finances, and access to food and nutrition, 2) the widespread acceptance of sexual abuse and the influences of affluence on sexual DV manifestations, 3) the shaping of physical abuse experiences by readily-available tools and the presence of witnesses, 4) psychological abuse for infertility, dowry, and girl-children, and 5) the perpetration of DV by the husband and other members of his family. Findings support the need for a culturally-tailored operational definition that expands on the WHO surveillance definition to inform the development of more effective DV intervention strategies and measures. [ABSTRACT FROM AUTHOR]


Exploration of workforce changes in integrated chronic care: Findings from an interactive and emergent research design.

by Busetto, Loraine, Luijkx, Katrien, Calciolari, Stefano, González Ortiz, Laura Guadalupe, Vrijhoef, Hubertus Johannes Maria [2017-12-21]

Academic Journal

pages 21

Introduction: Integrated care interventions introduced in response to the increased demand for long-term care entail profound changes to the health workforce. This exploratory study aims to provide an overview of the workforce changes implemented as part of integrated chronic care interventions. Methods: An interactive and emergent research design was used consisting of a literature review, qualitative expert questionnaires and case reports. We defined integrated care as interventions targeting at least two of the six Chronic Care Model components. Workforce changes were defined as those changes experienced by clinical and non-clinical staff responsible for public and individual health intervention. Results: Seven workforce changes were identified: (1) nurse involvement, (2) multidisciplinary staff, (3) multidisciplinary protocols/pathways, (4) provider training, (5) case manager/care coordinator, (6) team meetings, and (7) new positions. Most interventions included more than one of these workforce changes. Conclusion: The results of this study provide detailed insights into the current implementation of workforce changes in integrated care interventions and thereby pave the way for further investigations into the relative effectiveness of different workforce changes within the scope of complex interventions. Advancing knowledge in this area is essential for fostering health systems’ capacity to cope with the challenges related to the current demographic and epidemiological trends. [ABSTRACT FROM AUTHOR]


Peste des Petits Ruminants serological survey in Karamoja sub region of Uganda by competitive ELISA.

by Mulindwa, Bonny, Ruhweza, Simon Petter, Ayebazibwe, Chrisostom, Mwiine, Frank Norbert, Muhanguzi, Dennis, Olaho-Mukani, William [2011-04-01]

Academic Journal

pages 4

Following the historical reports of mysterious illnesses and deaths in goats in the Karamoja sub-region in April, 2007 and subsequent confirmation of Pest des Petitis Ruminants in July, 2007; we carried out a serological survey to determine the indicative caprine PPRV exposure rate by 2009. We sampled 280 goats from Moroto, Nakapiripirit, Abim and Kotido Districts of North-eastern Uganda to detect antibodies against PPRV using competitive enzyme linked immunosorbent assay (cELISA). The prevalence of PPRV antibodies in the districts of Moroto, Nakapiripirit, Kotido and Abim was 63.2% (CI = 95%, 58.0 - 68.0%), 72.0% (CI = 95%, 65.6 - 78.4%), 85% (CI = 95%, 81.0 - 88.9%) and 1.6% (CI = 95%, -0.01 - 3.22%) respectively. The overall prevalence of antibodies against PPRV in Karamoja sub-region was found to be 57.6 % (CI = 95%, 48.8 - 66.4%). The high prevalence of antibodies against PPRV suggests that active infection may still be present and therefore the need to institute disease control measures. More studies should be undertaken to characterize the viruses involved and the epidemiology of PPR in Uganda. [ABSTRACT FROM AUTHOR]


Academic Journal

pages 9

Purpose The impact of programs, policies, and practices developed by professionals in the field of maternal and child health (MCH) epidemiology is highlighted biennially by 16 national MCH agencies and organizations, or the Coalition for Excellence in MCH Epidemiology. Description In September 2014, multiple leading agencies in the field of MCH partnered to host the national CityMatCH Leadership and MCH Epidemiology Conference in Phoenix, Arizona. The conference offered opportunities for peer exchange; presentation of new scientific methodologies, programs, and policies; dialogue on changes in the MCH field; and discussion of emerging MCH issues relevant to the work of local, state, and national MCH professionals. During the conference, the National MCH Epidemiology Awards were presented to individuals, teams, institutions, and leaders for significantly contributing to the improved health of women, children, and families. Assessment During the conference, the Coalition presented seven deserving health researchers and research groups with national awards in the areas of advancing knowledge, effective practice, outstanding leadership, young professional achievement, and lifetime achievement. The article highlights the accomplishments of these national-level awardees. Conclusion Recognition of deserving professionals strengthens the field of MCH epidemiology, and sets the standard for exceptional research, mentoring, and practice. [ABSTRACT FROM AUTHOR]


Importance of Performance Measurement and MCH Epidemiology Leadership to Quality Improvement Initiatives at the National, State and Local Levels.

by Rankin, Kristin, Gavin, Loretta, Moran, John, Kroelinger, Charlan, Vladutiu, Catherine, Goodman, David, Sappenfield, William [2016-11-01]

Academic Journal

pages 8

Purpose In recognition of the importance of performance measurement and MCH epidemiology leadership to quality improvement (QI) efforts, a plenary session dedicated to this topic was presented at the 2014 CityMatCH Leadership and MCH Epidemiology Conference. This paper summarizes the session and provides two applications of performance measurement to QI in MCH. Description Performance measures addressing processes of care are ubiquitous in the current health system landscape and the MCH community is increasingly applying QI processes, such as Plan-Do-Study-Act (PDSA) cycles, to improve the effectiveness and efficiency of systems impacting MCH populations. QI is maximally effective when well-defined performance measures are used to monitor change. Assessment MCH epidemiologists provide leadership to QI initiatives by identifying population-based outcomes that would benefit from QI, defining and implementing performance measures, assessing and improving data quality and timeliness, reporting variability in measures throughout PDSA cycles, evaluating QI initiative impact, and translating findings to stakeholders. MCH epidemiologists can also ensure that QI initiatives are aligned with MCH priorities at the local, state and federal levels. Two examples of this work, one highlighting use of a contraceptive service performance measure and another describing QI for peripartum hemorrhage prevention, demonstrate MCH epidemiologists' contributions throughout. Challenges remain in applying QI to complex community and systems-level interventions, including those aimed at improving access to quality care. Conclusion MCH epidemiologists provide leadership to QI initiatives by ensuring they are data-informed and supportive of a common MCH agenda, thereby optimizing the potential to improve MCH outcomes. [ABSTRACT FROM AUTHOR]


Histoplasmosis: a new endemic fungal infection in China? Review and analysis of cases.

by Pan, Bo, Chen, Min, Pan, Weihua, Liao, Wanqing [2013-05-01]

Academic Journal

pages 10

Histoplasmosis occurs in specific endemic areas, including the mid-western United States, Africa and most of Latin America. Sporadic cases have also been reported in China. The aim of this study was to summarise the epidemiological and clinical data of histoplasmosis in China. We searched the PubMed, CBMdisk and CNKI databases to identify publications related to histoplasmosis in China. Case reports/series on patients with histoplasmosis were included. A comprehensive literature review identified additional cases. The relevant material was evaluated and reviewed. Overall, 300 cases of histoplasmosis were reported in China from 1990 to 2011, and 75% were from regions through which the Yangtze River flows. Most of the patients were autochthonous infections. Of these, 43 patients had pulmonary histoplasmosis and 257 patients had disseminated histoplasmosis. Common underlying diseases included HIV infection, diabetes mellitus and liver diseases. Fever was the most frequently reported clinical feature in disseminated histoplasmosis, followed by splenomegaly and hepatomegaly. Cases of histoplasmosis had a prominent geographical distribution in China. Histoplasmosis should be considered in the diagnosis of patients with relevant symptoms and a history of travel to or residence in these areas. [ABSTRACT FROM AUTHOR]


Risky Music Listening, Permanent Tinnitus and Depression, Anxiety, Thoughts about Suicide and Adverse General Health.

by Vogel, Ineke, van de Looij-Jansen, Petra M., Mieloo, Cathelijne L., Burdorf, Alex, de Waart, Frouwkje [2014-06-01]

Academic Journal

pages 8

Objective: To estimate the extent to which exposure to music through earphones or headphones with MP3 players or at discotheques and pop/rock concerts exceeded current occupational safety standards for noise exposure, to examine the extent to which temporary and permanent hearing-related symptoms were reported, and to examine whether the experience of permanent symptoms was associated with adverse perceived general and mental health, symptoms of depression, and thoughts about suicide. Methods: A total of 943 students in Dutch inner-city senior-secondary vocational schools completed questionnaires about their sociodemographics, music listening behaviors and health. Multiple logistic regression analyses were used to examine associations. Results: About 60% exceeded safety standards for occupational noise exposure; about one third as a result of listening to MP3 players. About 10% of the participants experienced permanent hearing-related symptoms. Temporary hearing symptoms that occurred after using an MP3 player or going to a discotheque or pop/rock concert were associated with exposure to high-volume music. However, compared to participants not experiencing permanent hearing-related symptoms, those experiencing permanent symptoms were less often exposed to high volume music. Furthermore, they reported at least two times more often symptoms of depression, thoughts about suicide and adverse self-assessed general and mental health. Conclusions: Risky music-listening behaviors continue up to at least the age of 25 years. Permanent hearing-related symptoms are associated with people’s health and wellbeing. Participants experiencing such symptoms appeared to have changed their behavior to be less risky. In order to induce behavior change before permanent and irreversible hearing-related symptoms occur, preventive measurements concerning hearing health are needed. [ABSTRACT FROM AUTHOR]


The global burden of neonatal hypothermia: systematic review of a major challenge for newborn survival.

by Lunze, Karsten, Bloom, David E., Jamison, Dean T., Hamer, Davidson H. [2013-04-01]

Academic Journal

pages 11

Background: To provide evidence on the global epidemiological situation of neonatal hypothermia and to provide recommendations for future policy and research directions Methods: Using PubMed as our principal electronic reference library, we searched studies for prevalence and risk factor data on neonatal hypothermia in resource-limited environments globally. Studies specifying study location, setting (hospital or community based), sample size, case definition of body temperature for hypothermia, temperature measurement method, and point estimates for hypothermia prevalence were eligible for inclusion Results: Hypothermia is common in infants born at hospitals (prevalence range, 32% to 85%) and homes (prevalence range, 11% to 92%), even in tropical environments. The lack of thermal protection is still an underappreciated major challenge for newborn survival in developing countries. Although hypothermia is rarely a direct cause of death, it contributes to a substantial proportion of neonatal mortality globally, mostly as a comorbidity of severe neonatal infections, preterm birth, and asphyxia. Thresholds for the definition of hypothermia vary, and data on its prevalence in neonates is scarce, particularly on a community level in Africa. Conclusions: A standardized approach to the collection and analysis of hypothermia data in existing newborn programs and studies is needed to inform policy and program planners on optimal thermal protection interventions. Thermoprotective behavior changes such as skin-to-skin care or the use of appropriate devices have not yet been scaled up globally. The introduction of simple hypothermia prevention messages and interventions into evidence-based, cost-effective packages for maternal and newborn care has promising potential to decrease the heavy global burden of newborn deaths attributable to severe infections, prematurity, and asphyxia. Because preventing and treating newborn hypothermia in health institutions and communities is relatively easy, addressing this widespread challenge might play a substantial role in reaching Millennium Development Goal 4, a reduction of child mortality. [ABSTRACT FROM AUTHOR]


Avian Influenza Virus Surveillance in Wild Birds in Georgia: 2009–2011.

by Lewis, Nicola S., Javakhishvili, Zurab, Russell, Colin A., Machablishvili, Ann, Lexmond, Pascal, Verhagen, Josanne H., Vuong, Oanh, Onashvili, Tinatin, Donduashvili, Marina, Smith, Derek J., Fouchier, Ron A. M. [2013-03-01]

Academic Journal

pages 11

The Caucasus, at the border of Europe and Asia, is important for migration and over-wintering of wild waterbirds. Three flyways, the Central Asian, East Africa-West Asia, and Mediterranean/Black Sea flyways, converge in the Caucasus region. Thus, the Caucasus region might act as a migratory bridge for influenza virus transmission when birds aggregate in high concentrations in the post-breeding, migrating and overwintering periods. Since August 2009, we have established a surveillance network for influenza viruses in wild birds, using five sample areas geographically spread throughout suitable habitats in both eastern and western Georgia. We took paired tracheal and cloacal swabs and fresh feces samples. We collected 8343 swabs from 76 species belonging to 17 families in 11 orders of birds, of which 84 were real-time RT-PCR positive for avian influenza virus (AIV). No highly pathogenic AIV (HPAIV) H5 or H7 viruses were detected. The overall AIV prevalence was 1.6%. We observed peak prevalence in large gulls during the autumn migration (5.3–9.8%), but peak prevalence in Black-headed Gulls in spring (4.2–13%). In ducks, we observed increased AIV prevalence during the autumn post-moult aggregations and migration stop-over period (6.3%) but at lower levels to those observed in other more northerly post-moult areas in Eurasia. We observed another prevalence peak in the overwintering period (0.14–5.9%). Serological and virological monitoring of a breeding colony of Armenian Gulls showed that adult birds were seropositive on arrival at the breeding colony, but juveniles remained serologically and virologically negative for AIV throughout their time on the breeding grounds, in contrast to gull AIV data from other geographic regions. We show that close phylogenetic relatives of viruses isolated in Georgia are sourced from a wide geographic area throughout Western and Central Eurasia, and from areas that are represented by multiple different flyways, likely linking different host sub-populations. [ABSTRACT FROM AUTHOR]


Academic Journal

pages 12

This article tests the mediation effects of future orientation in the relationship between assets and perceived economic stability. The first model, proposed by Sherraden, presents the direct effects of assets on perceived economic stability without any intermediary role of future orientation. The second model presents a model of asset effects on perceived economic stability that is fully mediated by future orientation as proposed by Shobe and Page-Adams. The authors propose a third model with a partial mediation role of future orientation. Using structural equation modeling, the authors test these hypotheses and find that the full mediation hypothesis is a better fit. The authors present a discussion for the further development of asset theory. [ABSTRACT FROM AUTHOR]


Chinese herbal medicine reduced the risk of stroke in patients with Parkinson’s disease: A population-based retrospective cohort study from Taiwan.

by Lai, Ching-Yuan, Chiang, Jen-Huan, Lin, Jaung-Geng, Yen, Hung-Rong, Tu, Cheng-Hao, Chen, Yi-Hung [2018-09-07]

Academic Journal

pages 14

Parkinson’s disease (PD) is associated with a significantly increased risk of stroke. Traditional Chinese medicine (TCM) has long been used in Asia to treat stroke, but there are no large-scale clinical data to confirm its efficacy in protecting PD patients against stroke. Herein, we analyzed a cohort of 1,000,000 records from Taiwan’s National Health Insurance Research Database for the period 1997–2011, and identified 1,882 patients with new-onset PD. We matched 290 patients who received Chinese herbal medicine (CHM) by age, sex, year of CHM prescription, and year of PD diagnosis with 290 patients who did not use CHM as control. Both cohorts were followed until the end of 2013 for the incidence of new-onset stroke. In a multivariable Cox proportional hazard model adjusted for potential comorbidities, the incidence of stroke was lower among PD patients using CHM compared with non-CHM users (11.10 per 100 person-years vs 23.15 per 100 person-years; Hazard ratio: 0.56; 95% confidence interval:  0.44 to 0.72). The probability curve generated from our follow-up data showed that PD patients receiving CHM treatment had a decreased risk of stroke compared with those not receiving CHM treatment (P


Associations between health systems capacity and mother-to-child HIV prevention program outcomes in Zambia.

by Price, Joan T., Chi, Benjamin H., Phiri, Winifreda M., Ayles, Helen, Chintu, Namwinga, Chilengi, Roma, Stringer, Jeffrey S. A., Mutale, Wilbroad [2018-09-07]

Academic Journal

pages 13

Introduction: Zambia has made substantial investments in health systems capacity, yet it remains unclear whether improved service quality improves outcomes. We investigated the association between health system capacity and use of prevention of mother-to-child HIV transmission (PMTCT) services in Zambia. Materials and methods: We analyzed data from two studies conducted in rural and semi-urban Lusaka Province in 2014–2015. Health system capacity, our primary exposure, was measured with a validated balanced scorecard approach. Based on WHO building blocks for health systems strengthening, we derived overall and domain-specific facility scores (range: 0–100), with higher scores indicating greater capacity. Our outcome, community-level maternal antiretroviral drug use at 12 months postpartum, was measured via self-report in a large cohort study evaluating PMTCT program impact. Associations between health systems capacity and our outcome were analyzed via linear regression. Results: Among 29 facilities, median overall facility score was 72 (IQR:67–74). Median domain scores were: patient satisfaction 75 (IQR 71–78); human resources 85 (IQR:63–87); finance 50 (IQR:50–67); governance 82 (IQR:74–91); service capacity 77 (IQR:68–79); service provision 60 (IQR:52–76). Our programmatic outcome was measured from 804 HIV-infected mothers. Median community-level antiretroviral use at 12 months was 81% (IQR:69–89%). Patient satisfaction was the only domain score significantly associated with 12-month maternal antiretroviral use (β:0.22; p = 0.02). When we excluded the human resources and finance domains, we found a positive association between composite 4-domain facility score and 12-month maternal antiretroviral use in peri-urban but not rural facilities. Conclusions: In these Zambian health facilities, patient satisfaction was positively associated with maternal antiretroviral 12 months postpartum. The association between overall health system capacity and maternal antiretroviral drug use was stronger in peri-urban versus rural facilities. Additional work is needed to guide strategic investments for improved outcomes in HIV and broader maternal-child health region-wide. [ABSTRACT FROM AUTHOR]


Academic Journal

pages 9

Background Newspapers are an important means for the communication of medical research findings to policy-makers and the public, but may distort their views on the relative importance of research into, and burden from, different respiratory diseases. Methods A systematic search strategy based on respiratory-related keywords was developed and translated into 15 European languages to identify relevant stories in 26 newspapers from eight countries in 2002-2013. Details of the stories were recorded on Excel and coded based on the reported respiratory conditions (asthma, chronic obstructive pulmonary disease (COPD) and other) and research types. Each cited research study was identified on the Web of Science and downloaded for analysis. Findings There were far more stories about asthma than on COPD, although the amount of research was only modestly greater, and the disease burden far less. Epidemiology, lifestyle and genetics research received the most media attention but not in all newspapers, while means of diagnosis and quality of life were under-reported in all newspapers. Journalists tended to over-cite research from their country by a factor averaging four times more than other researchers. About 10% of stories included a quote from a commentator, especially those in the two UK newspapers, with most of the quotes from UK charities. Conclusions The balance between disease areas reported in European newspaper stories is very misleading. European policy-makers and public may perceive asthma as more burdensome than it is and COPD much less. The study also showed that UK charities, but not those in other European countries, gained significant publicity from their contributions to these stories. [ABSTRACT FROM AUTHOR]


A model to improve the accuracy of US Poison Center data collection.

by Krenzelok, E. P., Reynolds, K. M., Dart, R. C., Green, J. L. [2014-09-01]

Academic Journal

pages 8

Context. Over 2 million human exposure calls are reported annually to United States regional poison information centers. All exposures are documented electronically and submitted to the American Association of Poison Control Center's National Poison Data System. This database represents the largest data source available on the epidemiology of pharmaceutical and non-pharmaceutical poisoning exposures. The accuracy of these data is critical; however, research has demonstrated that inconsistencies and inaccuracies exist. Objective. This study outlines the methods and results of a training program that was developed and implemented to enhance the quality of data collection using acetaminophen exposures as a model. Methods. Eleven poison centers were assigned randomly to receive either passive or interactive education to improve medical record documentation. A task force provided recommendations on educational and training strategies and the development of a quality-measurement scorecard to serve as a data collection tool to assess poison center data quality. Poison centers were recruited to participate in the study. Clinical researchers scored the documentation of each exposure record for accuracy. Results. Two thousand two hundred cases were reviewed and assessed for accuracy of data collection. After training, the overall mean quality scores were higher for both the passive (95.3%; + 1.6% change) and interactive intervention groups (95.3%; + 0.9% change). Data collection accuracy improved modestly for the overall accuracy score and significantly for the substance identification component. There was little difference in accuracy measures between the different training methods. Conclusion. Despite the diversity of poison centers, data accuracy, specifically substance identification data fields, can be improved by developing a standardized, systematic, targeted, and mandatory training process. This process should be considered for training on other important topics, thus enhancing the value of these data in relation to public health safety. [ABSTRACT FROM AUTHOR]


Risk adjustment of heroin treatment outcomes for comparative performance assessment in England.

by Marsden, John, Eastwood, Brian, Jones, Hayley, Bradbury, Colin, Hickman, Matthew, Knight, Jonathan, Randhawa, Kulvir, White, Martin [2012-12-01]

Academic Journal

pages 12

Aims Variability in effectiveness of treatment for substance abuse disorder ( SUD) is an important and understudied issue. This study aimed to quantify the extent of outcome variability in the English SUD treatment system after adjusting for potential confounding variables. Design Prospective cohort study using data from the English national drug treatment outcome monitoring database. Setting All 149 administrative areas delivering publicly funded SUD services in the National Health Service and non-governmental sector. Participants New adult admissions between January 2008 and October 2010 with illicit heroin-related problems in all administrative areas, with an in-treatment review conducted between 5 and 26 weeks (mean = 129.5 days; SD = 40.0) up to 30 April 2011 ( n = 65 223; 75.6% of eligible clients). Individuals were divided randomly to form model developmental and internal validation samples. These were contrasted with an independent (external) sample of the same population admitted to treatment between November 2010 and April 2011 and followed to 31 October 2011 ( n = 13 797; 81.4% of those eligible). Measurements and analysis The outcome measure was self-reported illicit heroin use, categorized as abstinent or deteriorated (the latter by Reliable Change Index), each risk-adjusted by person-level (demographics, clinical severity and treatment complexity) and area-level ( SUD prevalence, social deprivation and severity averages) covariates by multivariable logistic regression using multiply imputed outcome and covariate data. Risk-adjusted models were assessed by information criteria and discrimination (c-index). Standardized outcome rates were compared by funnel plot with 95% and 99% control limits. Findings Models of heroin abstinence (48.4%) and deterioration (3.2%) were comparable across the developmental and validation samples (c-index = 0.70-0.71 and 0.82-0.87), with 79.2 and 94.0%, respectively, of the 149 treatment areas falling within 95% control limits. At the 99% limit, seven areas (4.7%) achieved abstinence rates above the national average, and eight had relatively poor abstinence rates (5.4%). At the 99% control limit, one area achieved very low deterioration outcomes and two (1.3%) were worse that the average. Risk adjustment served to increase abstinence rates in good performing areas by 0.63% and reduce abstinence rates by 0.37% in poor performing areas, and by 0.12% and 0.18%, respectively, for deterioration. Conclusion There is some exceptional variability in the apparent effectiveness of the English treatment system for substance use disorders. It is important to determine the source of this variability in order to inform drug treatment delivery and its evaluation both in England and overseas. [ABSTRACT FROM AUTHOR]


Academic Journal

pages 9

Background/purpose: One of the most common childhood diseases is Urinary Tract Infection (UTI). Without diagnosis and treatment, it can cause irreparable effects. Escherichia coli cause UTI in 75% of cases. Unlike diarrheagenic E. coli has certain pathotypes, E. coli causing UTI, are not well known. For further information, we considered pathogenicity determinants and epidemiology of uropathogenic E. coli (UPEC) strains isolated from children with Urinary Tract Infection (UTI) to define distinct pathotypes. Methods: One hundred E. coli strains (50 UPEC and 50 commensal) isolated from children with UTI were examined. Some virulence factors and specific genes were examined by PCR method. Genetic diversity was evaluated by phylogenetic typing groups. Results: Some pathogenicity determinants were more prevalent in UPEC strains rather than commensal E. coli strains, significantly. There were PAI IICFT073, PAI II J96, PAI I536, PAI ICFT073, PAIII536, PAI IV, gafD, focG, vat, usp, hlyD, sat, cnf1, picU, fliC(H7), kpsMTII, kpsMTIII. UPEC were mainly found in phylogenetic typing groups B2 and D, while in commensal isolates, phylogenetic groups A and D were the most common. Conclusion: We need a simple pathotypes screening test which can be used either as or could be beneficial to facilitate along with other experiments in establishing an UTI assessment. Unfortunately, due to the high variation in pathogenicity determinants of UPEC strains, pathotypes could not be determined using genotype and virulence factors. Knowledge of the molecular details of UPEC is mainstay of successful strategies development for treatment of UTI and prevention of its subsequent complications. [ABSTRACT FROM AUTHOR]