ResearchPad - environmental-health https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[The improved and the unimproved: Factors influencing sanitation and diarrhoea in a peri-urban settlement of Lusaka, Zambia]]> https://www.researchpad.co/article/elastic_article_14479 Accounting for peri-urban sanitation poses a unique challenge due to its high density, unplanned stature, with limited space and funding for conventional sanitation instalment. To better understand users, needs and inform peri-urban sanitation policy, our study used multivariate stepwise logistic regression to assess the factors associated with use of improved (toilet) and unimproved (chamber) sanitation facilities among peri-urban residents. We analysed data from 205 household heads in 1 peri-urban settlement of Lusaka, Zambia on socio-demographics (economic status, education level, marital status, etc.), household sanitation characteristics (toilet facility, ownership and management) and household diarrhoea prevalence. Household water, sanitation and hygiene (WASH) facilities were assessed based on WHO-UNICEF criteria. Of particular interest was the simultaneous use of toilet facilities and chambers, an alternative form of unimproved sanitation with focus towards all-in-one suitable alternatives. Findings revealed that having a regular income, private toilet facility, improved drinking water and handwashing facility were all positively correlated to having an improved toilet facility. Interestingly, both improved toilets and chambers indicated increased odds for diarrhoea prevalence. Odds of chamber usage were also higher for females and users of unimproved toilet facilities. Moreover, when toilets were owned by residents, and hygiene was managed externally, use of chambers was more likely. Findings finally revealed higher diarrhoea prevalence for toilets with more users. Results highlight the need for a holistic, simultaneous approach to WASH for overall success in sanitation. To better access and increase peri-urban sanitation, this study recommends a separate sanitation ladder for high density areas which considers improved private and shared facilities, toilet management and all-inclusive usage (cancelling unimproved alternatives). It further calls for financial plans supporting urban poor access to basic sanitation and increased education on toilet facility models, hygiene, management and risk to help with choice and proper facility use to maximize toilet use benefit.

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<![CDATA[Evaluation of C-C Chemokine Ligand 5 (CCL5) Chemokine, Interleukin 5 (IL-5) Cytokine, and Eosinophil Counts as Potential Biomarkers in Saudi Patients with Chronic Asthma During Sandstorms]]> https://www.researchpad.co/article/elastic_article_10542 Background and objectives

Asthma is a common chronic inflammatory disorder of the lung that can be exacerbated by environmental triggers during sandstorms. This study aimed to evaluate the usefulness of C-C chemokine ligand 5 (CCL5) chemokine and interleukin 5 (IL-5) cytokine and determine the total eosinophil count in blood and sputum for use as biomarkers in Saudi patients with chronic asthma who visited emergency departments during sandstorms.

Methods

The study included 42 Saudi patients with chronic asthma and 20 healthy controls. Plasma levels of CCL5, IL-5, and total immunoglobulin E (IgE) were measured using a specific enzyme-linked immunosorbent assay (ELISA). Total eosinophils in peripheral blood were counted using a hematology analyzer (CELL-DYN Ruby System; Abbott Diagnostics, Chicago, Illinois); in sputum, eosinophils stained with Giemsa were examined under a microscope, counted, and expressed as a percentage of the total cells.

Results

Total IgE levels were significantly higher in patients with asthma (mean 433 IU/ml, P = 0.0001) as compared to normal controls (139 IU/ml). There was no significant difference in the levels of CCL5 in patients with asthma (625 pg/ml) as compared to normal controls (663 pg/ml, P = 0. 57). No correlation was found between total IgE and CCL5 levels. IL-5 was not detected in patients with asthma or in controls. Moreover, the total counts of eosinophils in the blood did not increase in patients with asthma as compared to controls while eosinophils in sputum samples were increased in the former (mean =3.128%).

Conclusion

Plasma levels of CCL5 and IL-5 or eosinophil counts in the peripheral blood may not be useful diagnostic biomarkers to evaluate airway inflammation and monitor asthma severity. Conversely, the sputum eosinophil count may represent a useful diagnostic marker for assessing the magnitude of asthma exacerbation during sandstorms.

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<![CDATA[Using the Pillars of Infection Prevention to Build an Effective Program for Reducing the Transmission of Emerging and Reemerging Infections]]> https://www.researchpad.co/article/Nd5355bc0-75b8-4761-b25c-1d2f8a19790e

Preventing transmission of emerging infectious diseases remains a challenge for infection prevention and occupational safety programs. The recent Ebola and measles outbreaks highlight the need for pre-epidemic planning, early identification, and appropriate isolation of infected individuals and health care personnel protection. To optimally allocate limited infection control resources, careful consideration of major modes of transmission, the relative infectiousness of the agent, and severity of the pathogen-specific disease are considered. A framework to strategically approach pathogens proposed for health care settings includes generic principles (1) elimination of potential exposure, (2) implementation of administrative controls, (3) facilitation of engineering and environmental controls, and (4) protection of the health care worker and patient using hand hygiene and personal protective equipment. Additional considerations are pre-epidemic vaccination and incremental costs and benefits of infection prevention interventions. Here, major strategies for preventing health-care-associated transmissions are reviewed, including reducing exposure; vaccination; administrative, engineering, and environmental controls; and personal protective equipment. Examples from recent outbreaks are used to highlight key infection prevention aspects and controversies.

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<![CDATA[Impact of a New Portable Air Purification Technology Device in the Pediatric Hospital Setting – A Pre-post Assessment Study]]> https://www.researchpad.co/article/N65be58ae-850a-4d73-b9f6-047fb7e52aa9

Introduction

We assessed whether portable photo-electrochemical oxidation (PECO) air purification in the pediatric hospital room setting could improve health outcomes for patients admitted with respiratory distress. 

Methods

We performed a prospective study evaluating the use of a portable air purifier with PECO technology. The historical control group comprised matched patients. Twenty-seven PECO-equipped portable air filtration devices were placed in the rooms. Clinical endpoints included length of stay in the hospital, length of stay in the intensive care unit (ICU), rates of intubation, non-invasive ventilation, and nebulizer use.

Results

The mean length of ICU stay was 0.7 days in the pre-intervention period and decreased to 0.4 days post-intervention. The mean length of overall hospitalization reduced by 0.3 days. The rate of non-invasive ventilation use was 77% in the pre-intervention period and decreased to 23% in the post-intervention period. The rate of nebulizer use was 59% in the pre-intervention period and 41% in the post-intervention period. The rate of intubation was 57.1% in the pre-intervention period and 43% in the post-intervention period. 

Conclusion 

Portable PECO air purification may reduce hospital length of stay, rates of intubation, and need for non-invasive intervention and nebulizers for pediatric patients admitted with respiratory distress. 

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<![CDATA[Identification of cholera hotspots in Zambia: A spatiotemporal analysis of cholera data from 2008 to 2017]]> https://www.researchpad.co/article/Nb4ea4681-5c5d-42bd-a1ce-642b56a34f03

The global burden of cholera is increasing, with the majority (60%) of the cases occurring in sub-Saharan Africa. In Zambia, widespread cholera outbreaks have occurred since 1977, predominantly in the capital city of Lusaka. During both the 2016 and 2018 outbreaks, the Ministry of Health implemented cholera vaccination in addition to other preventative and control measures, to stop the spread and control the outbreak. Given the limitations in vaccine availability and the logistical support required for vaccination, oral cholera vaccine (OCV) is now recommended for use in the high risk areas (“hotspots”) for cholera. Hence, the aim of this study was to identify areas with an increased risk of cholera in Zambia. Retrospective cholera case data from 2008 to 2017 was obtained from the Ministry of Health, Department of Public Health and Disease Surveillance. The Zambian Central Statistical Office provided district-level population data, socioeconomic and water, sanitation and hygiene (WaSH) indicators. To identify districts at high risk, we performed a discrete Poisson-based space-time scan statistic to account for variations in cholera risk across both space and time over a 10-year study period. A zero-inflated negative binomial regression model was employed to identify the district level risk factors for cholera. The risk map was generated by classifying the relative risk of cholera in each district, as obtained from the space-scan test statistic. In total, 34,950 cases of cholera were reported in Zambia between 2008 and 2017. Cholera cases varied spatially by year. During the study period, Lusaka District had the highest burden of cholera, with 29,080 reported cases. The space-time scan statistic identified 16 districts to be at a significantly higher risk of having cholera. The relative risk of having cholera in these districts was significantly higher and ranged from 1.25 to 78.87 times higher when compared to elsewhere in the country. Proximity to waterbodies was the only factor associated with the increased risk for cholera (P<0.05). This study provides a basis for the cholera elimination program in Zambia. Outside Lusaka, the majority of high risk districts identified were near the border with the DRC, Tanzania, Mozambique, and Zimbabwe. This suggests that cholera in Zambia may be linked to movement of people from neighboring areas of cholera endemicity. A collaborative intervention program implemented in concert with neighboring countries could be an effective strategy for elimination of cholera in Zambia, while also reducing rates at a regional level.

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<![CDATA[Aspergillus fumigatus Mitochondrial Acetyl Coenzyme A Acetyltransferase as an Antifungal Target]]> https://www.researchpad.co/article/N5346d4c5-b82a-43c9-80e8-d095e6f7e668

A growing number of people worldwide are suffering from invasive aspergillosis caused by the human opportunistic fungal pathogen A. fumigatus. Current therapeutic options rely on a limited repertoire of antifungals. Ergosterol is an essential component of the fungal cell membrane as well as a target of current antifungals. Approximately 20 enzymes are involved in ergosterol biosynthesis, of which acetyl-CoA acetyltransferase (ACAT) is the first enzyme. Two ACATs in A. fumigatus are AfErg10A and AfErg10B. However, the biological function of AfErg10A is yet to be investigated. In this study, we showed that AfErg10A is localized in the mitochondria and is essential for A. fumigatus survival and morphological development. In combination with structural studies, we validated AfErg10A as a potential drug target that will facilitate the development of novel antifungals and improve the efficiency of existing drugs.

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<![CDATA[Association Between Maternal Exposure to Magnetic Field Nonionizing Radiation During Pregnancy and Risk of Attention-Deficit/Hyperactivity Disorder in Offspring in a Longitudinal Birth Cohort]]> https://www.researchpad.co/article/Nd97e0a2b-69f6-4bdc-a7d8-63cef575efdf

Key Points

Question

Could human exposure to magnetic field nonionizing radiation be associated with increased risk of attention-deficit/hyperactivity disorder in children?

Findings

This birth cohort study found a statistically significant association between a high level of maternal exposure to magnetic field nonionizing radiation, as captured with a monitoring meter, during pregnancy and an increased risk of attention-deficit/hyperactivity disorder in offspring. The association was stronger for children who received a diagnosis of attention-deficit/hyperactivity disorder in adolescence (≥12 years of age) than for those without such a diagnosis in adolescence, and primarily for children with attention-deficit/hyperactivity disorder with immune-related comorbidities.

Meaning

The findings should spur more research to examine the biological association of in utero magnetic field exposure with risk of attention-deficit/hyperactivity disorder in offspring.

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<![CDATA[Comparison of Bone Turnover Markers between Young Adult Male Smokers and Nonsmokers]]> https://www.researchpad.co/article/Nb1bafece-b5d2-48d2-9ca8-f56d238d29d4

Background

This study aims to compare the differences in the means of bone formation and resorption markers between young adult male smokers and nonsmokers.

Methods

This study employed a cross-sectional, descriptive design. Thirty-five smokers and 38 nonsmokers were recruited. All participants completed self-reported questionnaires about demographics, physical activity, and smoking status. In addition, blood specimens were collected to determine serum levels of bone turnover markers.

Results

Regarding bone formation markers, the least square means (LSM) for osteoprotegerin (OPG) and procollagen type I N-terminal propeptide (PINP) were similar for smoking and nonsmoking groups. Regarding bone resorption markers, the LSM serum carboxyl-terminal telopeptide of collagen type I (CTXI) level was found to be significantly lower in smokers than nonsmokers [0.82 ± 0.83 vs. 1.30 ± 0.82 ng/mL, F (1, 66) = 5.73, p = 0.020]. The LSM for soluble-receptor activator of nuclear factor-kappa B ligand (sRANKL) [1.64 ± 0.60 vs. 1.69 ± 0.62 ng/mL, F (1,64) = 10.74, p = 0.002] and RANKL/OPG [2.62 ± 1.09 vs. 2.81 ± 1.10 ng/mL, F (1,65) = 5.88, p = 0.018] were different for smoking and nonsmoking groups. Exploration of the moderating influence of physical activity on smoking effects revealed significant effect for the interaction between smoking status and physical activity on sRANKL [F (2, 64) = 8.63, p = 0.001] and RANKL/OPG ratio [F (2, 65) = 5.49, p = 0.006].

Conclusion

Our study provides evidence for the effect of smoking on bone resorption markers in young adult males. Such effects should be carefully considered side by side with other lifestyles that may lead to poor bone health and increased risk for osteoporosis.

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<![CDATA[Diffuse Alveolar Hemorrhage: An Uncommon Manifestation of Vaping-associated Lung Injury]]> https://www.researchpad.co/article/N18405920-1eb1-40d1-86d2-1299db4ac4c4

Vaping involves the use of a device to deliver aerosolized nicotine and tetrahydrocannabinol (THC) oils to the lungs. Vaping continues to increase in popularity; however, because it is a novel drug delivery system there is little evidence regarding its safety and long-term consequences. Here, we present a 22-year-old Caucasian male who was admitted with acute hypoxic respiratory failure and massive hemoptysis. Contrasted computed tomography of the chest demonstrated ground glass opacities throughout all lung fields and bilateral pulmonary emboli. Bronchoalveolar lavage revealed increased red blood cell counts in serial aliquots, consistent with the diagnosis of diffuse alveolar hemorrhage (DAH). An extensive workup did not reveal an etiology for the DAH. However, further history was obtained, and the patient divulged daily vaping of THC. E-cigarette, or vaping, product use associated lung injury (EVALI) consists of a myriad of different lung injury patterns. Our case illustrates an uncommon presentation of EVALI with DAH and multiple pulmonary emboli. 

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<![CDATA[Limb Preservation Using Edetate Disodium-based Chelation in Patients with Diabetes and Critical Limb Ischemia: An Open-label Pilot Study]]> https://www.researchpad.co/article/N50f7fd3b-ad79-4795-a89f-f35596d20094

Background

In 2015, there were 30.3 million patients with diabetes in the US, including 25.2% of people ages 65 or older and 108,000 hospitalizations for non-traumatic amputations. Severe diabetic limb disease includes critical limb ischemia (CLI ) due to an infrapopliteal disease with foot pain and ischemic ulcerations including gangrene. Environmentally acquired toxic metals, such as lead and cadmium, have been associated with cardiovascular disease. Thus, we designed the present unblinded pilot study to determine whether there was a signal of benefit for edetate disodium-based infusions in patients with critical limb ischemia.

Methods

This was an open-label pilot study in 10 patients with diabetes and critical limb ischemia. Each patient received up to 50 edetate disodium-based infusions and was assessed for safety, clinical efficacy, metal excretion, and quality of life. The primary endpoint was to assess the effect of edetate disodium-based therapy plus vitamins in patients with diabetes and infra-popliteal peripheral artery disease presenting with severe CLI and determine if there were improvements in vascular flow parameters.

Results

We enrolled 10 (60% male) predominantly Caucasian (90%) subjects. The mean age was 75.3 (8.0) years. Smoking was reported by 30%. There were 70% with coronary artery disease (30% had prior coronary artery bypass grafting) and 50% had a prior lower-extremity amputation, three having previous minor amputations and two major amputations. There were no major adverse cardiovascular events during the infusion phase through the one-year follow-up. Patients completing 40 infusions demonstrated complete wound healing and improvement in the quality of life.

Conclusion

Patients with diabetes and CLI treated with a regimen of edetate disodium-based infusions demonstrated a potential signal of benefit and preliminary evidence of safety. The Trial to Assess Chelation Therapy in Critical Limb Ischemia (TACT3a), a randomized double-blind, placebo-controlled clinical trial now in progress, will further test these findings.

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<![CDATA[Carriage and Subtypes of Foodborne Pathogens Identified in Wild Birds Residing near Agricultural Lands in California: a Repeated Cross-Sectional Study]]> https://www.researchpad.co/article/N06fc250b-227f-4ed3-8c65-7b5ae332eebd

The shedding dynamics of foodborne pathogens by wild birds on farmland are not well characterized. This yearlong study sampled wild birds for foodborne pathogens within agricultural lands in northern California. There was a low prevalence of Salmonella spp., Escherichia coli O157:H7, and non-O157 Shiga-toxin producing E. coli (prevalence, 0.34% to 0.50%) identified in bird populations in this study. However, pathogens of public health importance (such as Salmonella Newport, E. coli O157:H7, and STEC O103 and O26) were identified in fecal samples, and two birds carried STEC on their feet or feathers. Identical pathogen strains were shared episodically among birds and between wild geese and free-range cattle. This result suggests a common source of contamination in the environment and potential transmission between species. These findings can be used to assess the risk posed by bird intrusions in produce fields and enhance policy decisions toward the comanagement of food safety and farmland habitat conservation.

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<![CDATA[Awareness Among Healthcare Professionals Regarding Contaminated Stethoscopes as a Source of Nosocomial Infections]]> https://www.researchpad.co/article/Na971e23c-60f0-4bd6-b031-80ef9cb5ccf2

Objectives

The objective of this study was to determine the awareness among healthcare professionals regarding stethoscopes as a source of nosocomial infections, their cleaning practices in this regard before or after examination, and to find out about the existence of any guidelines and accountability criteria issued by the hospitals in this regard.

Methodology

A descriptive cross-sectional study of 243 healthcare professionals using non-probability convenience sampling was done to include consultants, residents, final-year medical students, and nursing staff and excluding medical students from pre-clinical years as well as doctors of those departments with infrequent use of a stethoscope. The study was conducted for a period of nine months at tertiary health care facilities of Rawalpindi and Islamabad. A self-administered structured questionnaire was used for data collection.

Results

Participants from both genders included 54 participants (22.2%) from the final year, 48 (19.8%) house officers, 106 (43.6%) postgraduate trainees, nine (3.7%) specialists, and 26 (10.7%) nurses. A total of 210 (86.4%) were aware of stethoscopes as a source of nosocomial infections. Among participants, 23 (9.5%) cleaned their stethoscope per patient, 50 (20.6%) did it daily, 48 (19.8%) did it weekly, 41 (16.9%) did it monthly, 12 (4.9%) participants cleaned it six-monthly while 69 (28.4%) respondents had never cleaned their stethoscope. Almost 127 participants (52.3%) used alcohol wipes to clean their stethoscopes, 11 (4.5%) used a wet cloth, six (2.5%) used tissue paper. Sixty-one (24.9%) agreed that the hospital issued protocols for the decontamination of stethoscopes while 189 (77.8%) did not. A total of 241 (99.2%) believed that there were no accountability criteria set for the assessment of the cleanliness of stethoscopes in their hospitals.

Conclusion

A majority of the participants were aware of stethoscopes being a source of nosocomial infections and believed in cleaning stethoscopes regularly. However, a majority of the participants believed that their hospital did not issue any protocols for the decontamination of stethoscopes. Further research can expand our recommendations.

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<![CDATA[Iron deficiency anemia, population health and frailty in a modern Portuguese skeletal sample]]> https://www.researchpad.co/article/5c8accd9d5eed0c484990155

Introduction

Portugal underwent significant political, demographic and epidemiological transitions during the 20th century resulting in migration to urban areas with subsequent overcrowding and issues with water sanitation. This study investigates population health during these transitions and interprets results within a framework of recent history and present-day public health information. We investigate skeletal evidence for anemia (cribra orbitalia and porotic hyperostosis) as indicators of stress and frailty–i.e., whether the lesions contribute to susceptibility for disease or increased risk of death.

Methods

The presence and severity of skeletal lesions were compared against known sex and cause of death data to investigate potential heterogeneity in frailty and the relationship between lesions and risk of dying over time. Additionally, we tested for the presence of selective mortality in our data (i.e., whether or not the sample is biased for individuals with higher frailty). Our sample derives from a large, documented, modern Portuguese collection from Lisbon and is the first study of its kind using a documented collection. The collection represents primarily middle-class individuals.

Results and conclusions

Analyses indicated that porotic hyperostosis became more common and severe over time, while cribra orbitalia severity increased over time. Neither process was linked to cause of death. However, there was a significant relationship to sex; males exhibited a higher prevalence and severity of lesions and increased mortality. A Gompertz function showed decreased survivorship in early life but increased survivorship over age 60. Using comorbidities of anemia, we were unable to detect selective mortality–i.e., in our sample, lesions do not represent a sign of poor health or increased frailty and are not significantly linked with a decreased mean age-at-death. However, lesion prevalence and severity do reflect the socioeconomic processes in urban Lisbon during the 1800s and 1900s and the possibility of water-borne parasites as the contributing factor for iron deficiency anemia.

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<![CDATA[Knowledge, attitudes and practices with regard to schistosomiasis prevention and control: Two cross-sectional household surveys before and after a Community Dialogue intervention in Nampula province, Mozambique]]> https://www.researchpad.co/article/5c65dce7d5eed0c484dec4db

Background

The Community Dialogue Approach is a promising social and behaviour change intervention, which has shown potential for improving health seeking behaviour. To test if this approach can strengthen prevention and control of schistosomiasis at community level, Malaria Consortium implemented a Community Dialogue intervention in four districts of Nampula province, Mozambique, between August 2014 and September 2015.

Methodology/Principal findings

Cross-sectional household surveys were conducted before (N = 791) and after (N = 792) implementation of the intervention to assess its impact on knowledge, attitudes and practices at population level. At both baseline and endline, awareness of schistosomiasis was high at over 90%. After the intervention, respondents were almost twice as likely to correctly name a risk behaviour associated with schistosomiasis (baseline: 18.02%; endline: 30.11%; adjusted odds ratio: 1.91; 95% confidence interval: 1.14–2.58). Increases were also seen in the proportion of people who knew that schistosomiasis can be spread by infected persons and who could name at least one correct transmission route (baseline: 25.74%; endline: 32.20%; adjusted odds ratio: 1.36; 95% confidence interval: 1.01–1.84), those who knew that there is a drug that treats the disease (baseline: 29.20%, endline: 47.55%; adjusted odds ratio: 2.19; 95% confidence interval: 1.67–2.87) and those who stated that they actively protect themselves from the disease and cited an effective behaviour (baseline: 40.09%, endline: 59.30%; adjusted odds ratio: 2.14; 95% confidence interval: 1.40–3.28). The intervention did not appear to lead to a reduction in misconceptions. In particular, the belief that the disease is sexually transmitted continued to be widespread.

Conclusions/Significance

Given its overall positive impact on knowledge and behaviour at population level, Community Dialogue can play an important role in schistosomiasis prevention and control. The intervention could be further strengthened by better enabling communities to take suitable action and linking more closely with community governance structures and health system programmes.

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<![CDATA[“If you will counsel properly with love, they will listen”: A qualitative analysis of leprosy affected patients’ educational needs and caregiver perceptions in Nepal]]> https://www.researchpad.co/article/5c648cc8d5eed0c484c817a0

Background

Leprosy remains a disease of concern in many countries including Nepal. To achieve the target of elimination, the WHO strategy promotes comprehensive education of patients, healthcare workers (HCWs), and the public on leprosy-related issues. However most educational programs are based on the concerns of HCWs and not on patients’ needs. The objective of this paper is to explore the educational needs of leprosy affected patients in Nepal and compare them to the needs perceived by HCWs.

Methodology/principal findings

Semi directive interviews were conducted with patients and HCWs. The data was analyzed using the basic interpretative qualitative framework. The study was conducted in two leprosy referral centers, one university hospital and one primary health care center: Lalgadh Leprosy Hospital and Services Centre, Anandaban Hospital and its satellite clinic in Patan, B. P. Koirala Institute of Health Sciences in Dharan, and the Itahari primary health care centre.

The results show that there remains a lack of knowledge regarding the disease (origins, manifestations, prevention and treatment) contributing to late care seeking behavior and high levels of stigma, with an important psychological and financial stress for patients. All of the HCWs displayed a good understanding of patients’ difficulties and needs and acknowledged the key role of patient education. However, they expressed several challenges in managing patients due to lack of time, human resources and training in patient education.

Conclusions/significance

Further efforts need to be made to increase patients’ general knowledge of the disease in order to motivate them to seek healthcare earlier and change their perception of the disease to reduce stigma. HCWs need proper training in patient education and counseling for them to acquire the necessary skills required to address the different educational needs of their patients. The use of lay and peer counselors would be an option to address the workload and lack of time expressed by HCWs.

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<![CDATA[Optimal threshold of three-dimensional echocardiographic fully automated software for quantification of left ventricular volumes and ejection fraction: Comparison with cardiac magnetic resonance disk-area summation method and feature tracking method]]> https://www.researchpad.co/article/5c58d637d5eed0c4840318e4

Aims

Novel fully automated left chamber quantification software for three-dimensional echocardiography (3DE) has a potential for reliable measurement of left ventricular (LV) volumes and ejection fraction (LVEF). However, the optimal setting of global LV endocardial border threshold has not been settled.

Methods and results

We performed LV volumes and LVEF analysis using fully automated left chamber quantification software (Dynamic HeartModelA.I., Philips Medical Systems) in 65 patients who had undergone both 3DE and cardiac magnetic resonance (CMR) examinations on the same day. We recorded LV end-diastolic volume (LVEDV) and LV end-systolic volume (LVESV) according to the change in LV global border threshold settings from 0-point to 100-point with each increment of 10-point. These values were compared to the corresponding values of CMR with disk-area summation method and feature tracking (FT) method. Coverage probability (CP) was calculated as an index of accuracy and reliability. Fully automated software provided LV volumes and LVEF in 57 patients (Feasibility: 88%). LVEDV and LVESV increased steadily according to the increase in border threshold and reached minimal bias when border threshold setting was 80 against CMR disk-summation method and 90 against CMR FT method. Corresponding CP of LVEF was 0.74 and 0.84 against disk-area summation method and FT method.

Conclusions

With CMR values as a reference, LV endocardial border threshold value can be set around 80 to 90 with the same number of LV end-diastole and end-systole threshold to approximate LVEDV, LVESV and LVEF with clinically acceptable CP values of LVEF.

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<![CDATA[Integrated delivery of school health interventions through the school platform: Investing for the future]]> https://www.researchpad.co/article/5c5ca2c3d5eed0c48441ea70

School health and nutrition (SHN) programmes are recognized as a significant contributor to both health and education sector goals. The school system offers an ideal platform from which to deliver basic health interventions that target the most common health conditions affecting school-age children (SAC) in low-income countries, leading to improved participation and learning outcomes. However, governments require evidence to cost, design, and implement these programmes. In Ethiopia, prevalent health conditions affecting SAC's education participation and learning outcomes include infection with soil-transmitted helminths (STHs), hunger, and malnutrition. In recognition of the multiple issues affecting the health and education of SAC, the government has taken a proactive approach, coordinating an integrated SHN programme designed to be implemented in partnership and monitored and financed through a single, integrated mechanism. The programme, known as the Enhanced School Health Initiative (ESHI), integrates three complimentary health interventions: deworming; school feeding; and provision of a water, sanitation, and hygiene (WASH) package in schools, which in delivery aim to maximize the benefits of each of the individual components. Operational research surrounding the ESHI programme includes both qualitative and quantitative analyses. Here, we present an overview of the ESHI programme and its genesis. We also introduce three additional supporting papers that provide in-depth analyses of key findings, including the baseline situational analysis, the costs, and community perceptions of the programme. The findings from ESHI provide initial evidence to develop an understanding of the related costs and synergies of integrating multiple health interventions onto a single platform. The work has translated into strengthened institutional capacity and improved cross-sectoral coordination. The government is now committed to supporting 25 million school children in Ethiopia through SHN. The ESHI model serves as a reference point for other countries looking to scale up targeted SHN interventions.

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<![CDATA[Context for layering women’s nutrition interventions on a large scale poverty alleviation program: Evidence from three eastern Indian states]]> https://www.researchpad.co/article/5c50c47dd5eed0c4845e881d

Over 70 million women of reproductive age are undernourished in India. Most poverty alleviation programs have not been systematically evaluated to assess impact on women’s empowerment and nutrition outcomes. National Rural Livelihoods Mission’s poverty alleviation and livelihoods generation initiative is an opportune platform to layer women’s nutrition interventions being tapped by project Swabhimaan in three eastern Indian states—Bihar, Chhattisgarh and Odisha. A cross-sectional baseline survey covering 8755 mothers of children under-two years of age, one of the three primary target groups of program are presented. Standardized questionnaire was administered and anthropometric measurements were undertaken from October 2016 to January 2017. 21 indicators on women’s empowerment, Body Mass Index and Mid-upper Arm Circumference for nutrition status, food insecurity indicators as per the Food Insecurity Experience Scale and selected indicators for assessing women’s access to basic health services were included. National Rural Livelihoods Mission operates in contexts with stark social and gender inequalities. Self-help group members exhibited better control on financial resources and participation in community activities than non-members. Using Body Mass Index, at least 45% mothers were undernourished irrespective of their enrolment in self-help groups. Higher proportion of self-help group members (77%-87%) belonged to food insecure households than non-members (66%-83%). Proportion of mothers reporting receipt of various components of antenatal care service package varied from over 90% for tetanus toxoid vaccination to less than 10% for height measurement. Current use of family planning methods was excruciatingly low (8.2%-32.4%) in all states but positively skewed towards self-help group members. Participation in monthly fixed day health camps was a concern in Bihar. Layering women’s nutrition interventions as stipulated under Swabhimaan may yield better results for women’s empowerment and nutrition status under National Rural Livelihoods Mission. While this opportunity exists in all three states, Bihar with a higher proportion of matured self-help groups offers more readiness for Swabhimaan implementation.

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<![CDATA[Association of Prenatal Exposure to Ambient and Traffic-Related Air Pollution With Newborn Thyroid Function]]> https://www.researchpad.co/article/5c50f5ffd5eed0c48462bbde

Key Points

Question

Are prenatal ambient and traffic-related air pollutant exposures associated with newborn total thyroxine concentrations, and are there critical windows of exposure?

Findings

In a cohort study of a subset of 2050 newborns from the Children’s Health Study in southern California, an increase of 2 standard deviations in prenatal exposure to particulate matter in air pollution was associated with higher newborn total thyroxine measures. Months 3 to 7 and 1 to 8 of pregnancy were identified as critical windows of exposure to particulate matter and associated higher thyroxine levels.

Meaning

The fetal thyroid gland may be susceptible to particulate matter air pollution toxicity, especially during early pregnancy and midpregnancy.

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<![CDATA[Effects of improved drinking water quality on early childhood growth in rural Uttar Pradesh, India: A propensity-score analysis]]> https://www.researchpad.co/article/5c3e4f27d5eed0c484d724a1

Context

Recent randomised controlled trials in Bangladesh and Kenya concluded that household water treatment, alone or in combination with upgraded sanitation and handwashing, did not reduce linear growth faltering or improve other child growth outcomes. Whether these results are applicable in areas with distinct constellations of water, sanitation and hygiene (WaSH) risks is unknown. Analysis of observational data offers an efficient means to assess the external validity of trial findings. We studied whether a water quality intervention could improve child growth in a rural Indian setting with higher levels of circulating pathogens than the original trial sites.

Methods

We analysed a cross-sectional dataset including a microbiological measure of household water quality. All households accessed water from an improved source. We applied propensity score methods to emulate a randomised trial investigating the hypothesis that receipt of drinking water meeting Sustainable Development Goal (SDG) 6.1 quality standards for absence of faecal contamination leads to improved growth. Growth outcomes (stunting, underweight, wasting, and their corresponding Z-scores) were assessed in children 12–23 months of age. For each outcome, we estimated the mean and 95% confidence interval of the absolute risk difference between treatment groups.

Findings

Of 1088 households, 442 (40.62%) received drinking water meeting SDG 6.1 standards. The adjusted risk of child underweight was 7.4% (1.3% to 13.4%) lower among those drinking water satisfying SDG 6.1 norms than among controls. Evidence concerning the relationship of drinking water meeting SDG 6.1 norms to length-for-age and weight-for-age was inconclusive, and there was no apparent relationship with stunting or wasting.

Conclusions

In contexts characterised by high pathogen transmission, water quality improvements have the potential to reduce the proportion of underweight children, but are unlikely to impact stunting or wasting. Further research is required to assess how these modelled benefits can best be achieved in real world settings.

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