The province of Brescia faces a relevant epidemiological situation, with the prevalence of HCV and HBV infection reaching up to 3.0% in some areas. After the COVID-19 pandemic, the increase in HCV-related hepatocellular carcinomas has been overall in migrants. [In Brescia and its province], there is a high number of migrants originating from countries with a high prevalence of viral hepatitis. The epidemiological context has led the MISI Foundation and the non-profit organization "Il Filo della Salute" to undertake a project aimed at identifying infections of HBV and HCV in a settled migrant population from Eastern Europe employed as caregivers. Through the analysis of the most suitable methodologies to engage the target population, which is generally reluctant to undergo medical analyses and tests in the host country, communication strategies have been identified using social web channels and disseminated by influencers to promote the project. The project attracted 350 participants (300 women and 50 men), mainly originating from Moldova. Following pre-test counseling, a self-test for HCVAb was administered, resulting in a positive outcome for 18 (5,1%). Among these, 4.2% tested positive for HCV RNA. In 300 subjects, the HBsAg test was offered, yielding a positive result in 8,3% of cases. All infected individuals were offered linkage to the nearest hepatological or infectious disease care facility based on their residence. The project has allowed the identification of a high number of migrants residing in the province of Brescia infected with HCV or HBV, with percentages consistent with the epidemiology of their country of origin. Within public health projects, it would be crucial to invest in dedicated screening campaigns for the settled migrant population, also considering the role as a caregiver, which is important for both minimizing the risk of transmission and reducing the progression of the infection.
Introduction: Degenerative Lumbar spinal stenosis (DLSS) is the most common cause of spine surgery for patients above 55 years. Surgery options include decompression alone or with spinal fusion. The DRG system uses classification algorithms that categorize patients into groups with similar clinical and resource consumption characteristics, using ICD-10 nomenclature for diagnoses and ICD-9-CM for procedures. Objective: Identify clinical and epidemiological variables of DLSS surgery patients based on Chile’s DRG system data and define factors associated with arthrodesis as a complement to decompression. Study Design: Retrospective observational study. Methods: This study used the national DRG database to analyze factors predicting the need for fusion in patients with DLSS. Data from 31 public hospitals in Chile were analyzed for patients discharged between 2020 and 2022. Variables considered included age, gender, presence of other spinal pathologies, and attending physician specialty. For the descriptive analysis of qualitative variables, frequencies and percentages were used.The study used univariate and multivariate logistic regression analysis. A statistical significance level of less than 0.05 was considered. Results: We analyzed 1024 patients with lumbar spinal stenosis and found that 54.6% were female and 45.4% were male (p= 0.0034). The majority of the patients (57.4%) were aged between 60 and 79 years. 75% of orthopedic surgeons opted for decompression plus arthrodesis, while neurosurgeons preferred decompression alone in 73% of cases. The most significant predictors for decompression with fusion were the physician’s specialty in orthopedic surgery, female sex, and the presence of other spinal pathologies such as scoliosis, herniated disc, and spondylolisthesis. Patients treated by an Orthopedic Surgeon had an 8.2 times greater probability of undergoing decompression plus arthrodesis as compared to those treated by a Neurosurgeon. Additionally, the presence of spondylolisthesis increased the probability of decompression with fusion by 6.2 times, and the presence of scoliosis increased it by 6.6 times. Neurosurgeons opted for decompression alone in 89.7% of the cases with DLSS stenosis and herniated disc, while only 48.9% of orthopedic surgeons opted for the same option (p=0.0000). Conclusion: Our study based on DRG records from public hospitals in Chile has identified certain factors linked to a higher frequency of spinal arthrodesis. These factors include the surgery being performed by orthopedic surgeons, patients aged between 40 and 60 years old, the presence of degenerative spondylolisthesis and degenerative scoliosis, and the absence of a
Introduction: Surprisingly, multivariate multilevel analyses, which is often used to analyse longitudinal data, is seldom used to analyse multiple, correlated outcomes, such as questionnaire subscales or biological risk factors. Therefore, the aim of the study was to compare multivariate multilevel analysis with separate, per outcome, analyses in data with correlated outcomes retrieved from the same individual, in both cross sectional and longitudinal studies. Method: To compare the results of multivariate multilevel analysis with the separate analyses of each outcome, both real life example datasets and simulated data in which various characteristics are systematically varied, were used. Results: Multivariate multilevel analyses produced substantially more accurate estimates and standard errors than separate analyses for each outcome in incomplete datasets and when analysing longitudinal relations with time-dependent covariates. In complete datasets, for time-independent covariates (e.g., baseline characteristics) and when the development over time is analysed, results of the two analytical approaches were highly similar. It was also found that similarity of standard deviations between the outcomes is needed for a proper estimation of the standard error of the regression coefficient in a multivariate multilevel analysis. Similarity of standard deviations can be obtained by using z-scores. Furthermore, before using longitudinal multivariate multilevel analyses it has to be evaluated which type of clustering provides the best model fit. Conclusion: Multivariate multilevel analysis is an elegant way to analyse multiple correlated outcomes, which is superior to separate analyses for each outcome in case of missing data and/or when timedependent covariates are analysed. Keywords: Multivariate Multilevel Modelling; Cross-sectional data; Longitudinal data; Correlated outcomes; Real life data; Simulated data. List of abbreviations
The COVID-19 pandemic was a public health emergency between 2020 and 2022 with a direct impact on the lives of health professionals. The objective of the study was to identify the prevalence of contamination of the disease in primary care professionals in Salvador-Ba, Brazil, work activities changed by the pandemic, and the impacts on the mental health of these professionals. A cross-sectional study was carried out, and the reference population was the universe of professionals with higher and secondary education (N=1675) who worked in the network. An electronic form was applied from December 2021 to April 2022, including socioeconomic and demographic issues, health history and comorbidities, routine and working hours, contamination by COVID-19, and evaluation of the emotional aspects of these professionals through the application of the Anxiety Scale (GAD-7) and Burnout Syndrome (Maslach Burnout Inventory) questionnaire. A descriptive analysis of the variables of interest was performed using central tendency and dispersion measures and absolute and relative frequencies. 321 workers participated in the study, 97.20% with a workload of 40 hours per week. The female gender was the majority - 83.18%, married marital status with 57.94% and having a postgraduate degree was the most present level of education (48.50%). Among the comorbidities, hypertension had the highest occurrence (10.59%). 80.7% of health professionals revealed that they participated in the screening team (reception) of patients with or suspected of COVID-19 and in the organization of vaccination. Contamination by COVID-19 was 64.79%, and 41.83% attributed it to work activity. Of the total, 67.28% of workers had some type of anxiety intensity. Regarding the Burnout indices, it was observed that 47.06% had a high level of emotional exhaustion, 68.84% had a high level of depersonalization, and 99.06% considered their professional fulfillment to be low.
Managing coronavirus disease-2019 (COVID-19) pandemic, as an unprecedented public health emergency is considered to be one of the most burdensome cases of Public Health Management (PHM) in the 21st century.
Aim:To compare the prevalence of poor glycemic control in probability samples of Japanese and American adults, and to determine the association with their somatic phenotypes.Material and Methods:Blood samples and anthropometric measures were obtained from 382 Japanese, 32-79 years of age, randomly selected to reflect the 23 wards of Tokyo. HA1c values were compared to 1215 Americans, 35-86 years of age, from a national study across the 48 continental states, along with an over-sampling of African-Americans from one city (www.midus.wisc.edu). Body Mass Index (BMI) and Waist-hip ratio (WHR) were also assessed.Results:Many Japanese now have high HA1c approaching Caucasian-American levels, although elevated HA1c (>6.5%, 48 mmol/mol) is not nearly as prevalent as among African-Americans. Significant age-related trends were evident in both countries, with poor glycemic control occurring at younger ages in males and rarely found until old age in Japanese women. Japanese had higher HA1c levels at BMIs of 23-25, in contrast to Americans with Type 2 diabetes who more typically had a BMI over 30. Central adiposity predicted HA1c levels better than BMI, a relationship also apparent at a smaller WHR in Japan.Conclusion:The prevalence of high HA1c in Tokyo almost rivals white Americans, but those statistics are dwarfed by the 37% of Afr-Amer adults identified with Type 2 diabetes. Elevated HA1c was more common in men, reflecting central adiposity, but poor glycemic control was also widespread among overweight Afr-Amer women. Type 2 diabetes was higher among older Japanese, when more women succumb. Overall, the findings highlight the societal and clinical challenges posed by demographic trends in both countries.
Population-level serologic testing has demonstrated groundbreaking results in monitoring the prevalence and case-fatality of COVID-19 within a population. In Pakistan, Getz Pharma conducted a sero-prevalence survey on a sample of 24,210 individuals using the IgG/IgM Test Kit (Colloidal gold) with follow-up and sequential testing after every 15-20 days on a sub-sample. This is the first of its kind, large scale census conducted on a dense, urban, working population in Pakistan. The study results reveal that from 24,210 individuals screened, 17.5% tested positive, with 7% IgM positive, 6.0% IgG positive and 4.5% combined IgM and IgG positive. These findings have been extrapolated to the rest of the urban, adult, working population of Pakistan, and as of 6th July, 2020, 4.11 million people in Pakistan have been infected with COVID-19, which is 17.7 times higher than the current number of 231,818 symptom-based PCR cases reported by the government which exclude asymptomatic cases.
Context: Although Iraqis were exposed to very severe conditions during the 1991 Gulf War, we have very little information on the effect of distance from the war zone on the outcomes of pregnancy and congenital anomalies in children. Aim:To determine if pregnancy outcomes vary by distance from the 1991Gulf War battle zone. Methods:The study sample consisted of men between the ages 18-45 years and residents within 360 kilometres in Iraqi providences of Basra & Messan at time of 1991 Gulf War.During 2002, 720 out of 1150 participant were enrolled in the study because they were married and had at least one child.We divided the population study into two main groups: battle and non-battle zone and studied the effects of war on pregnancy outcomes. Results:Congenital anomalies in the non-battle zones appear to be significantly higher, which implies that the impact of war was not restricted to the war zone. Conclusion:There is no relationship between geographical closeness to Kuwait and adverse pregnancy outcome.
Introduction: Sri Guru Ram Das Institute of Medical Sciences and Research is a tertiary health care institution
Due to the paucity of remaining antibiotics for treating infections caused by carbapenem-resistant Enterobacteriaceae, polymyxins have become the last resort antibiotics.As a consequence, colistin resistance is increasingly reported worldwide.The aim of this study was to analyze colistin-resistant E. coli clinical isolates, recovered between 2014 and 2016 at the University Hospital of Buenos Aires, Argentina.Nine clinical colistin resistant E. coli isolates were studied.These isolates were recovered from urine samples of 5 inpatients and 4 outpatients.Whole genome sequencing was performed using Illumina technology.Plasmid characterization and mating-out assay was done using E. coli J53 as receptor strain.Antibiotic susceptibility (MIC) of clinical isolates and their transconjugants was determined using broth microdilution method.WGS analysis revealed the presence of mcr-1 gene in six out of the 9 isolates: 4 isolates carried mcr-1 and 2 carried mcr-1.5 alleles.All the clinical isolates had MIC values for colistin in the range of 4-16 mg/L.The three isolates lacking any mcr variant, presented point mutations in the chromosomal pmrA or pmrB genes.The mcr-1 gene were located on plasmids similar to the prototypical Incl2-type (KY471308, pMCR-M15049) differing only by little deletions.Until this date mcr-1.5 allele was reported once in Argentina and in Japan, suggested a transcontinental dissemination of this variant.
Drinking water sources can be contaminated by toxic metals and metalloids such As arsenic (s), which occurs naturally in the earth’s crust. Exposure to high levels of arsenic may cause adverse health effects because it provides a favourable environment for harmful microorganisms to grow. Buruli ulcer (Bu), a skin disease caused by Mycobacterium ulcerans MU infection is common in the Bomfa sub-district Ashanti region, Ghana. This study investigated the possible link between Buruli ulcer incidence and drinking water arsenic in the Bomfa subdistrict of Ghana. Drinking water sources in the study area were sampled and analyzed for arsenic. Surface map of arsenic concentration overlaid with locality map of BU incidents show localities with high incidents falling into regions of relatively high arsenic concentration. The exposure response relationship model showed a positive relationship between BU and drinking water arsenic. (i.e. R2=0.54, p=0.1). Statistical analysis of the data reveal that a high proportion of settlements with high BU prevalence utilize arsenic contaminated water sources. It was therefore concluded that arsenic likely contributes to MU infections in the study area.
Background: Despite its importance, the rate of exclusive breastfeeding for the first 6 months of life in Indonesia was only 42% as recently as 2012. Objective: This study examines determinants of breastfeeding behaviors in rural Indonesia. Methods: We conducted a cross-sectional survey among 2086 women 14-55 years of age, living in seven regions of Indonesia. Results: Participating mothers had an average age of 28 years old and had 1.9 children on average. Girls (64% vs. 58.2%) were more likely to be breastfed in the first hour of birth than boys (OR=1.268; 95% CI 1.062-1.515). Boys breastfed for an average of 6.4 months, compared to 9.2 months for girls. Nearly half (48.9%, 500/1023) of boys received foods other than breastmilk within the first three days of life, compared to 40.0% (425/1063) of girls. The belief that boys need better nutrition than girls (OR=0.706; 95% CI 0.572-0.872) was associated with lack of exclusive breastfeeding in the first 3 days of life. Conclusions: Our findings indicate differential exclusive breastfeeding behaviors for male and female children. Health communication strategies promoting optimal breastfeeding behaviors, attitudes and beliefs related to gender and breastfeeding are needed. Addressing cultural practices that contribute to non-exclusive breastfeeding for the first 6 months of life is essential for stainable behavior change.
Physical inactivity and obesity may increase risk of poor prognosis in breast cancer through effects on insulin or insulin-like growth factors or their binding proteins, insulin resistance, glucose metabolism, sex hormones, leptin and other adipokines, immunologic or inflammatory factors, oxidative stress, and Deoxyribonucleic acid (DNA) damage or repair capacity. The present review is based upon bibliographic searches in PubMed and relevant search terms. Articles published in English from January 1, 1980 through October 1, 2018 were identified using the following MeSH search terms and Boolean algebra commands: breast cancer survivors AND (insulin-like growth factor OR insulin resistance OR glucose metabolism OR sex hormones OR leptin OR adipokines OR immunologic OR inflammatory factors OR oxidative stress OR DNA repair capacity). After screening the abstracts or full texts of these articles and reviewing the references of previous review articles, a total of 66 studies met the eligibility criteria. Based upon published studies, it is difficult to determine the type or dose of exercise that affects inflammatory markers among breast cancer survivors. The optimal type of exercise, dose, and timing of physical activity needed to improve the inflammatory profile following a breast cancer diagnosis is unknown. Studies have used a range of physical activity types including aerobic, resistance training, yoga, and Tai Chi. A further issue is that existing studies of physical activity and biomarkers have included a range of disease stages. There is a need for a better understanding of the biological pathways through which physical activity and weight management increase survival in order to design targeted weight loss and exercise interventions for breast cancer survivors.
Aims:To investigate the association of childhood vaccinations with the risk of Type 1 diabetes in children less than 5 years of age. Methods:During 1992-95 a nation-wide population-based case-control study was performed in Germany including 760 incident cases (71% of eligible) and 1871 controls (43% of eligible), individually matched for age, sex, and place of residence.Information on childhood vaccinations and potential confounding factors were collected by a mailed questionnaire.Data were analysed by conditional logistic regression analyses.Results: Completed primary immunisation (≥3 doses) against pertussis, Haemophilus influenzae type b, poliomyelitis and diphtheria/tetanus were significantly associated with a decreased risk for Type 1 diabetes.Adjusted for potential confounders, respective odds ratios were 0.70 (0.55; 0.89), 0.63 (0.49; 0.91), 0.74 (0.55; 0.999) and 0.65 (0.46; 0.73).A measles/mumps/ rubella vaccination was associated with the T1D risk only by trend (odds ratio: 0.71 (0.51-1.01), while a BCG vaccination was not associated with the T1D risk. Conclusions:The findings of this large nation-wide population-based case-control study indicate that childhood vaccinations, in particular the Haemophilus influenzae type b vaccination, may be protective against the development of Type 1 diabetes.
It is well known that prevalence of a sensitive attribute may be underestimated based on direct inquiry of subjects. A non-randomized response model has thus been proposed and shown to be efficient in estimating the prevalence of sensitive attributes in surveys. Since most surveys are conducted to obtain precise estimates, herein we derive a sample size formula for this model based on confidence interval estimation rather than hypothesis testing as estimation is of most relevance in this context. In contrast to the conventional approach to sample size estimation, which does not explicitly consider the chance of achieving the precision, we incorporate an assurance probability into the formula by treating confidence interval width as random. Exact evaluation demonstrates that our formula performs well. Keywords : Confidence Interval; Prevalence; Proportion; Random Response
To characterize the epidemiology of pulmonary tuberculosis in Yangpu district of Shanghai, China, from 2006 to 2015.Methods: Descriptive analysis was mainly used to summarize the trends and epidemiologic features.The trend of incidence was examined using annual percentage change model.All statistical analyses were conducted using SAS 9.4 and a P value of <0.05 was considered as statistically significant.Results: A total of 4,408 tuberculosis cases were reported during 2006-2015, with an average annual crude incidence rate of 40.59/10 5 and an Age-Adjusted Incidence Rate (ASIRW) of 28.64/10 5 .The incidence was highest in 2008, with a crude incidence rate of 99.04/10 5 .The crude incidence rate in males was 56.13/10 5 , which was significantly higher than that in female (24.59/10 5 , P<0.001).Annual percentage change model showed a general decrease trend in the incidence during this period, with 2 join points observed in 2008 and 2011.The average age of death and onset of the disease were 71.86±13.22 and 50.15±19.63years, respectively.The proportion of tuberculosis was higher in retired and unemployed populations than in other groups. Conclusion:A general decrease trend of incidence of tuberculosis from 2006 to 2015 in Yangpu district was observed.Populations of male in gender, relatively low age, and the occupations of retirement and migrant workers or farmers were all more susceptible towards tuberculosis.These findings might provide a comprehensive guide for surveillance and treatment of tuberculosis in Yangpu district of Shanghai.
Breastfeeding is an important public health strategy for improving infant and child morbidity and mortality, improving maternal morbidity, and helping to control health care costs.The study aimed to assess knowledge, attitudes and key Breast Feeding (BF) promotion and counselling indicators among pregnant mothers in the Gaza Strip.Cross-sectional study among250 pregnant mothers in primary health care centers in the Gaza Strip.The results could be utilized to promote breastfeeding.The results indicated that less than fifty percent (48.4%) of pregnant mothers received BF counselling.Most of there spondents (88%) knew that breast milk was the best infant food.Almost all of the respondents agreed that complementary feeding should be introduced to the baby after 6 months of age (94.8%), and they also knew that Exclusive Breastfeeding extended through 6 months of age (87.2%).When assessing pregnant mothers attitude, 144 (57.6%) of pregnant mothers believed that their families will support them to breastfed.The majority of respondents (98%) will start breastfeeding directly after delivery and 96% of them will avoid milk formula and other liquids after delivery at the hospital.More than ninety percent (90.8%) of the respondents believe that complementary feeding should be started after six months of age.Mothers' knowledge about breastfeeding needs to be increased, especially in some aspects of breastfeeding such as Colostrum use, the age of weaning, optimum duration of breastfeeding episode and formula milk.The misconception and negative attitudes had been identified and should be addressed.Health system should include all mothers into educational in-terventional programs.
The aim of this study was to determine the effect of depression on the functional status and quality of life of patients with stroke, with a review on their cognitive and neurological status.Prospective study included 60 patients treated for the first stroke events, of which 30 patients with diagnosed Post-Stroke Depression (PSD) and 30 patients without depression.Tests were conducted two and six weeks after a stroke.Depression was diagnosed by Mini International Neuropsychiatric Interview, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV diagnostic criteria), the severity of depression quantified by Hamilton's Depression Scale (HDRS), the functional status was assessed by the Barthel Index (BI), quality of life was assessed by the Short Form 36 questionnaires (SF-36), cognitive status is evaluated by the Mini Mental State Examination (MINI), and neurological status of the record Stroke scales of the National Institute of Health, USA (NIH).Although the potential for functional recovery in depressive patients is not less, more severe neurological deficit, and so significantly more severe functional disability, was registered in the group of patients with post-stroke depression, initially, as well as after completion rehabilitation treatment.The mean scores on all quality of life domains were higher in patients without post-stroke depression.These differences were statistically highly significant except for the domain of bodily pain.Patients with post-stroke depression have significantly more severe cognitive impairment in relative to non-depressant patients.
