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Influenza epidemic surveillance and prediction based on electronic health record data from an out-of-hours general practitioner cooperative: model development and validation on 2003\u20132015 data
No full textAbstract
Background
Annual influenza epidemics significantly burden health care. Anticipating them allows for timely preparation. The Scientific Institute of Public Health in Belgium (WIV-ISP) monitors the incidence of influenza and influenza-like illnesses (ILIs) and reports on a weekly basis. General practitioners working in out-of-hour cooperatives (OOH GPCs) register diagnoses of ILIs in an instantly accessible electronic health record (EHR) system.
This article has two objectives: to explore the possibility of modelling seasonal influenza epidemics using EHR ILI data from the OOH GPC Deurne-Borgerhout, Belgium, and to attempt to develop a model accurately predicting new epidemics to complement the national influenza surveillance by WIV-ISP.
Method
Validity of the OOH GPC data was assessed by comparing OOH GPC ILI data with WIV-ISP ILI data for the period 2003\u20132012 and using Pearson\u2019s correlation. The best fitting prediction model based on OOH GPC data was developed on 2003\u20132012 data and validated on 2012\u20132015 data. A comparison of this model with other well-established surveillance methods was performed. A 1-week and one-season ahead prediction was formulated.
Results
In the OOH GPC, 72,792 contacts were recorded from 2003 to 2012 and 31,844 from 2012 to 2015. The mean ILI diagnosis/week was 4.77 (IQR 3.00) and 3.44 (IQR 3.00) for the two periods respectively. Correlation between OOHs and WIV-ISP ILI incidence is high ranging from 0.83 up to 0.97. Adding a secular trend (5\ua0year\ua0cycle) and using a first-order autoregressive modelling for the epidemic component together with the use of Poisson likelihood produced the best prediction results. The selected model had the best 1-week ahead prediction performance compared to existing surveillance methods. The prediction of the starting week was less accurate (\ub13\ua0weeks) than the predicted duration of the next season.
Conclusion
OOH GPC data can be used to predict influenza epidemics both accurately and fast 1-week and one-season ahead. It can also be used to complement the national influenza surveillance to anticipate optimal preparation
Diagnostic dilemma of pulmonary tuberculosis among adults with severe mental illness in Beijing, China
No full textAbstract
Background
Although the prevalence of tuberculosis has decreased significantly over the past decades, the certain populations with mental illness are at increased risk for tuberculosis infection and transmission. However, no studies have examined the performance of different laboratory examination methods among people with severe mental illness in China.
Methods
In this study, we firstly performed a retrospective study to evaluate the feasibility of three routine laboratory methods, including sputum microscopy, solid culture and GeneXpert, to diagnose tuberculosis patients with mental illness.
Results
During August 2010 and March 2013, a total of 251\ua0TB patients based on clinical and radiographic criteria with severe mental illness were enrolled in this study. The majority of patients was homeless (97/251, 38.6%), and the other 62 (24.7%) and 92 (36.7%) were from urban and rural region, respectively. The most frequently diagnosed mental illness was schizophrenia, accounting for 84.1% (211/251) of patients available for analysis. In addition, the laboratory received 753 sputum samples collected from these 251\ua0TB patients, of which 76.0% (572/753) of samples were classified as salivary sputum, which were unqualified for microscopy and culture. When the test results were analyzed by patients, the positive numbers of TB patients detected by sputum microscopy, solid culture and GeneXpert were 3 (1.2%), 5 (2.0%) and 5 (2.0%), respectively.
Conclusions
In conclusion, our findings reveal that the current laboratory examinations based on sputum samples seem not to be suitable for the diagnosis of active TB in the persons with severe mental illness. The products using a non-invasive specimen such as urine deserve further evaluation, which may generate benefit for the early diagnosis of TB in this special population
Gestational age and 1-year hospital admission or mortality: a nation-wide population-based study
No full textAbstract
Background
Describe the 1-year hospitalization and in-hospital mortality rates, in infants born after 31\ua0weeks of gestational age (GA).
Methods
This nation-wide population-based study used the French medico-administrative database to assess the following outcomes in singleton live-born infants (32\u201343\ua0weeks) without congenital anomalies (year 2011): neonatal hospitalization (day of life 1 \u2013 28), post-neonatal hospitalization (day of life 29 \u2013 365), and 1-year in-hospital mortality rates. Marginal models and negative binomial regressions were used.
Results
The study included 696,698 live-born babies. The neonatal hospitalization rate was 9.8%. Up to 40\ua0weeks, the lower the GA, the higher the hospitalization rate and the greater the likelihood of requiring the highest level of neonatal care (both p \u2009<\u20090.001). The relative risk adjusted for sex and pregnancy-related diseases (aRR) reached 21.1 (95% confidence interval [CI]: 19.2-23.3) at 32\ua0weeks. The post-neonatal hospitalization rate was 12.1%. The raw rates for post-neonatal hospitalization fell significantly from 32 \u2013 40 and increased at 43\ua0weeks and this persisted after adjustment (aRR\u2009=\u20093.6 [95% CI: 3.3\u20133.9] at 32 and 1.5 [95% CI: 1.1\u20131.9] at 43 compared to 40\ua0weeks). The main causes of post-neonatal hospitalization were bronchiolitis (17.2%), gastroenteritis (10.4%) ENT diseases (5.4%) and accidents (6.2%). The in-hospital mortality rate was 0.85\u2030, with a significant decrease ( p \u2009<\u20090.001) according to GA at birth (aRR\u2009=\u20093.8 [95% CI: 2.4\u20135.8] at 32 and 6.6 [95% CI: 2.1\u201320.9] at 43, compared to 40\ua0weeks.
Conclusion
There\u2019s a continuous change in outcome in hospitalized infants born above 31\ua0weeks. Birth at 40\ua0weeks gestation is associated with the lowest 1-year morbidity and mortality
More than eight in every nineteen inmates were living with depression at prisons of Northwest Amhara Regional State, Ethiopia, a cross sectional study design
No full textAbstract
Background
Mental health is the greatest challenges for the current and future generations. Worldwide, out of the 66 million people suffering from depression; majority (85%) were from low and middle income countries. The prevalence was more common among the prisons population than the community. However, a worldwide consideration given to the problems is very low, particularly for prisoners.
Methods
To assess level of depression and associated factors among prisoners in prisons of Northwest Amhara Regional State, Ethiopia, Institutional based cross sectional study was employed on 727 prisoners selected by multistage random sampling from three prisons of northwest Amhara. Patient Health Questionnaire (PHQ-9) was used to assess an individuals\u2019 depression level. The reliability of the tool was checked by Cronbach\u2019s Alpha (yielding value of 0.841). Multivariable logistic regression was done to identify factors associated with depression after Hosmer and lemeshow goodness of fit test was used for model fitness.
Results
Of the total prisoners participated (649), 284 (43.8%; 95% CI: 39.90, 47.67%) had symptoms of depression. Detainees\u2019 satisfaction level about life before imprisonment, belief about their life after imprisonment, plan to commit suicide, social support and types of prisons were significantly associated with depression.
Conclusions
Depression level among detainees was found to be high. Thus, providing training to scale up satisfaction of prisoners, on how to cope up with environment just before imprisonment and release, and treating prisoners will improve the problem
Prevalence of attention deficit/hyperactivity disorder among children and adolescents in China: a systematic review and meta-analysis
No full textAbstract
Background
Attention deficit/hyperactivity disorder (ADHD), the most common childhood neurobehavioural disorder, can produce a series of negative effects on children, adolescents, and even adults as well as place a serious economic burden on families and society. However, the prevalence of ADHD is not well understood in China. The goal of this study was to estimate the pooled prevalence of ADHD among children and adolescents in China using a systematic review and meta-analysis.
Methods
A systematic literature search was conducted in PubMed, Web of Science, MEDLINE, CNKI, Wanfang, Weipu and CBM databases, and relevant articles published from inception to March 1, 2016, that provided the prevalence of ADHD among children and adolescents in China were reviewed. The risk of bias in individual studies was assessed using the Risk of Bias Tool for prevalence studies. Pooled-prevalence estimates were calculated with a random-effects model. Sources of heterogeneity were explored using subgroup analyses.
Results
Sixty-seven studies with a total of 275,502 individuals were included in this study. The overall pooled-prevalence of ADHD among children and adolescents in China was 6.26% (95% CI: 5.36\u20137.22%) with significant heterogeneity (I
2
\u2009=\u200999.0%, P \u2009<\u20090.001). The subgroup analyses showed that, the variables \u201cgeographic location\u201d and \u201csource of information\u201d partially explained of the heterogeneity in this study ( P \u2009<\u20090.05). The prevalence of ADHD-I was the highest of the subtypes, followed by ADHD-HI and ADHD-C.
Conclusions
The prevalence of ADHD among children and adolescents in China is generally consistent with the worldwide prevalence and shows that ADHD affects quite a large number of people under 18\ua0years old. However, a nationwide study is needed to provide more accurate estimations
Effectiveness of Aquatic Therapy vs Land-based Therapy for Balance and Pain in Women with Fibromyalgia: a study protocol for a randomised controlled trial
No full textAbstract
Background
Fibromyalgia is a disease with an increasing incidence. It impairs the quality of life of patients and decreases their functional capacity. Aquatic therapy has already been used for managing the symptoms of this syndrome. However, aquatic therapy has only recently been introduced as a treatment modality for improving proprioception in fibromyalgia. The main objective of this study is to determine the effectiveness of two physiotherapy protocols, one in and one out of water, for improving balance and decreasing pain in women with fibromyalgia.
Methods/Design
The study protocol will be a single-blind randomised controlled trial. Forty women diagnosed with fibromyalgia will be randomly assigned into 2 groups: Aquatic Therapy ( n \u2009=\u200920) or Land-based Therapy ( n \u2009=\u200920). Both interventions include 60-min therapy sessions, structured into 4 sections: Warm-up, Proprioceptive Exercises, Stretching and Relaxation. These sessions will be carried out 3 times a week for 3\ua0months. Primary outcomes are balance (static and dynamic) and pain (intensity and threshold). Secondary outcomes include functional balance, quality of life, quality of sleep, fatigue, self-confidence in balance and physical ability. Outcome measures will be evaluated at baseline, at the end of the 3-month intervention period, and 6-weeks post-treatment. Statistical analysis will be carried out using the SPSS 21.0 program for Windows and a significance level of p \u2009\u2264\u20090.05 will be used for all tests.
Discussion
This study protocol details two physiotherapy interventions in women with fibromyalgia to improve balance and decrease pain: aquatic therapy and land-based therapy. In current literature there is a lack of methodological rigour and a limited number of studies that describe physiotherapy protocols to manage fibromyalgia symptoms. High-quality scientific works are required to highlight physiotherapy as one of the most recommended treatment options for this syndrome.
Trial registration
Date of publication in ClinicalTrials.gov: 18/02/2016. ClinicalTrials.gov Identifier: NCT02695875
Assessing the progression of chronic periodontitis using subgingival pathogen levels: a 24-month prospective multicenter cohort study
No full textAbstract
Background
The diagnosis of the progression of periodontitis presently depends on the use of clinical symptoms (such as attachment loss) and radiographic imaging. The aim of the multicenter study described here was to evaluate the diagnostic use of the bacterial content of subgingival plaque recovered from the deepest pockets in assessing disease progression in chronic periodontitis patients.
Methods
This study consisted of a 24-month investigation of a total of 163 patients with chronic periodontitis who received trimonthly follow-up care. Subgingival plaque from the deepest pockets was recovered and assessed for bacterial content of Porphyromonas gingivalis , Prevotella intermedia , and Aggregatibacter actinomycetemcomitans using the modified Invader PLUS assay. The corresponding serum IgG titers were measured using ELISA. Changes in clinical parameters were evaluated over the course of 24 months. The sensitivity, specificity, and prediction values were calculated and used to determine cutoff points for prediction of the progression of chronic periodontitis.
Results
Of the 124 individuals who completed the 24-month monitoring phase, 62 exhibited progression of periodontitis, whereas 62 demonstrated stable disease. The P. gingivalis counts of subgingival plaque from the deepest pockets was significantly associated with the progression of periodontitis ( p \u2009<\u20090.001, positive predictive value\u2009=\u20090.708).
Conclusions
The ..
Sinularin induces DNA damage, G2/M phase arrest, and apoptosis in human hepatocellular carcinoma cells
No full textAbstract
Background
Sinularin isolated from the cultured soft coral Sinularia flexibilis has been reported to exert potent cytotoxic effects against particular types of cancer. This study was carried out to investigate the cytotoxic effects in sinularin-treated human hepatocellular carcinoma cells, HepG2, and to subsequently explore the underlying molecular mechanisms.
Methods
TheMTT (3-[4,5-dimethylthiazol-2-yl]-2, 5-diphenyl- tetrazolium bromide) method was used to evaluate the cytotoxicity of sinularin on HepG2 and Hep3B cell lines. Furthermore, the cell cycle distribution assay, apoptosis assay, and western blot analysis in vitro were used to explore the possible mechanisms of action.
Results
From the results of our study, cell viability was obviously inhibited by sinularin in a dose-dependent manner. In addition, our results suggested that sinularin triggered DNA damage and subsequently induced cell cycle G2/M arrest associated with up-regulation of p-ATM (Ser(1981)), p-Chk2 (Tyr(68)), p-cdc2 (Tyr(15)), and p53 coupled with increased expression of downstream proteins p21 and down-regulation of p-cdc25 (Ser(216)). Moreover, the results of the apoptosis assay and western blot analysis indicated that the cytotoxic activity could be related to mitochondrial apoptosis, characterized by decrease of Bcl-2 expression, disruption of mitochondrial membrane potential, and sequential activation of caspases and Poly (ADP-ribose) polymerase (PARP).
Conclusions
This study reveals for the first time the anti-HCC activities of sinularin, the active compound isolated from the cultured soft coral Sinularia flexibilis . We believe that our results warrant further evaluation of sinularin as a new anti-HCC chemotherapeutic agent
Medical complexity and time to lung cancer treatment \u2013 a three-year retrospective chart review
No full textAbstract
Background
The time from a referral for suspected lung cancer is received at a hospital until treatment start has been defined as a quality indicator. Current Norwegian recommendation is that \u226570% should start surgery or radiotherapy within 42 calendar days and systemic therapy within 35\ua0days. However, delays can occur due to medical complexity. The aim of this study was to quantify the proportion of patients who started treatment within the recommended timeframes; and to assess the proportion of non-complex patients for which there were no good reasons for delays.
Methods
We performed a retrospective chart review of all patients diagnosed with lung cancer at a university hospital during 2011\u20132013. We defined \u201cnon-complex\u201d patients as those who underwent \u22641 tissue diagnostic procedure and had no delays due to comorbidity, intercurrent disease or complications to diagnostic procedures (\u201cMedical delays\u201d) of more than three days.
Results
Four hundred forty-nine cases were analyzed; 142 (32%) had >1 tissue diagnostic procedures; 67 (15%) had medical delays >3\ua0days; 262 (58%) were non-complex and 363 (81%) received treatment for lung cancer. Median number of days until surgery or radiotherapy was 48 (overall) and 41 (non-complex patients). The proportions who started surgery or radiotherapy within 42\ua0days were 41% (overall) and 56% (non-complex). Corresponding numbers for systemic therapy were 29\ua0days (overall) and 25\ua0days (non-complex), and 64% (overall) and 80% (non-complex).
Conclusion
Fewer lung cancer patients than desired started treatment within the recommended timeframes. Even among the least complex patients, too few patients received timely treatment. The reasons need to be identified and understood, and changes in the organization appear to be necessary in order to offer timely treatment to more patients
Developing a framework to guide the de-adoption of low-value clinical practices in acute care medicine: a study protocol
No full textAbstract
Background
Healthcare systems have difficulty incorporating scientific evidence into clinical practice, especially when science suggests that existing clinical practices are of low-value (e.g. ineffective or harmful to patients). While a number of lists outlining low-value practices in acute care medicine currently exist, less is known about how best to initiate and sustain the removal of low-value clinical practices (i.e. de-adoption). This study will develop a comprehensive list of barriers and facilitators to the de-adoption of low-value clinical practices in acute care facilities to inform the development of a framework to guide the de-adoption process.
Methods
The proposed project is a multi-stage mixed methods study to develop a framework to guide the de-adoption of low-value clinical practices in acute care medicine that will be tested in a representative sample of acute care settings in Alberta, Canada. Specifically, we will: 1) conduct a systematic review of the de-adoption literature to identify published barriers and facilitators to the de-adoption of low-value clinical practices in acute care medicine and any associated interventions proposed ( Phase one ); 2) conduct focus groups with acute care stakeholders to identify important themes not published in the literature and obtain a comprehensive appreciation of stakeholder perspectives ( Phase two ); 3) extend the generalizability of focus group findings by conducting individual stakeholder surveys with a representative sample of acute care providers throughout the province to determine which barriers and facilitators identified in Phases one and two are most relevant in their clinical setting ( Phase three ). Identified barriers and facilitators will be catalogued and integrated with targeted interventions in a framework to guide the process of de-adoption in each of four targeted areas of acute care medicine (Emergency Medicine, Cardiovascular Health and Stroke, Surgery and Critical Care Medicine). Analyses will be descriptive using a combination of qualitative and quantitative analyses.
Discussion
There is a growing body of literature suggesting that the de-adoption of ineffective or harmful practices from patient care is integral to the delivery of high quality care and healthcare sustainability. The framework developed in this study will map barriers and facilitators to de-adoption to the most appropriate interventions, allowing stakeholders to effectively initiate, execute and sustain this process in an evidence-based manner