Clinical Epidemiology and Global Health最新文献

Background

On January 30, 2023, 26 acute diarrheal disease (ADD) cases and a death were reported from a village in Dibrugarh, Assam, India. We investigated and described the outbreak by time, place and person, identified the potential exposures, and formulated recommendations.

Methods

We defined a case of ADD as the occurrence of loose stools (≥3 episodes) between January 27, 2023 and February 11, 2023. We conducted a door-to-door case search, calculated attack rates by age and gender, drew an epidemic curve, and plotted cases by residence. We performed a case-control study to identify possible exposure variables, calculated odds ratio (OR) with 95 % confidence interval (CI), and collected stool and water specimens from households and schools for laboratory testing.

Results

We identified a total of 55 cases, with an overall attack rate of 5.6 % and one death (case fatality rate of 1.8 %). School-going children exhibited a higher attack rate of 39 %. Shigella flexneri was isolated from one of the stool specimens. Furthermore, the water obtained from households' tube wells exceeded the permissible limits of E. coli for consumption. Consuming prasadam (Sacred food) at a school religious event (OR = 6.2, 95 % CI = 2.6–15.2) and not washing hands after defecation (OR = 8.2, 95 % CI = 1.7–38) were associated with ADD.

Conclusion

The results indicated that the food served during the school religious event could potentially be the source of the ADD outbreak. The food served during the event likely acted as a medium for community transmission, possibly due to unhygienic practices and contaminated drinking water.

Objectives

To evaluate the awareness and practices of patient's antibiotic usage and assess the perception of health providers with regard to antibiotic use and misuse in a tertiary hospital.

Methods

A cross sectional study was conducted in a tertiary care hospital in coastal Karnataka, India. The study participants included consenting volunteers of either gender, aged >18 years, including 384 patients, 25 nurses and 25 physicians.

Results

Knowledge about indications for antibiotic usage was found to be poor as 85.9 % believed that antibiotics were effective against viral diseases as well. It was found that about 71.6 % patients had self-medicated themselves for minor illnesses, but majority preferred tertiary health care facilities for major illnesses. Practice of the patients was found to be good with 78.1 % patients consulting a physician before consuming antibiotics and 96 % completing the course as advised. Among the 25 nurses interviewed, 92 % reported discussion with patients regarding their antibiotic prescription. About 21.4 % nurses reported to have prescribed antibiotics to other friends, neighbours and patients, on the basis of their clinical exposure. The causes of emerging Antimicrobial Resistance (AMR) as reported by the doctors were-inappropriate prescription, self-medication, and non-adherence to the course as prescribed.

Conclusion

Better doctor patient communication, educating both doctors and patients, antibiotic sensitivity-based prescription and practicing evidence-based medicine are required to combat antimicrobial resistance.

Objectives

Evaluating the physical health, mental health, and Quality of life (QoL) in relationship to body constitution (BC) types in students of the Faculty of Traditional Medicine (FTM) in the University of Medicine and Pharmacy at Ho Chi Minh City (UMP).

Methods

A cross-sectional descriptive study on 717 students of FTM through face-to-face interviews used three questionnaires to investigate the following sections: general demographic information questionnaire; physical health (PCS), mental health (MCS), and QoL (Vietnamese version of SF-36 questionnaire); BC types (Vietnamese version of the CCMQ questionnaire). We used multiple linear regression analyses to assess the associations between BC types and each of the QoL domains’ scores. The dependent variables are the scores of eight QoL domains and integration scores in PCS and MCS.

Results

Most students had Unbalanced BC types (87.03 %). Qi-depression, Qi-deficiency, and Blood-stasis had the three highest percentages (48.1 %, 33.2 %, 26.9 %). There were relationships between BC types and students’ physical health, mental health, and QoL. The SF-36 resulted in “high” scores in most of the Neutral-type students, while the majority of students with Unbalanced BC types had “poor” scores in both physical health, mental health, and QoL (p < 0.01). The estimated impact of 8 Unbalanced types on SF-36 scales was significantly negative. The impact was most remarkable for Qi-stagnation, followed by Blood-stasis.

Conclusion

87.03 % of students had Unbalanced BC types, which in turn can increase the likelihood of disease. Research results also initially showed that adjusting these types to the Neutral type can help improve FTM students’ health.

Background

Evidence-based assessment and management of dysphagia in neonates, especially those in the neonatal intensive care unit (NICU), are limited. Understanding existing clinical practices may be the first step toward developing a consensus. The current study aimed to identify clinical practice patterns of speech-language pathologists (SLPs) in India towards facilitating the development of feeding skills and assessment and management of dysphagia among neonates.

Method

An electronic survey questionnaire comprising 46 questions categorized into two main sections (demographics and a hypothetical case scenario) was emailed to 35 SLPs practicing in the NICU. The hypothetical clinical case was created to include considerations of assessment and management of dysphagia in the NICU, and the participants answered questions about clinical decision-making.

Results

As many as 22 individuals completed the survey. The responses were analyzed descriptively to identify themes and trends in practice patterns. Our results revealed varied practice patterns in the clinical swallowing assessment and management approaches for neonatal dysphagia.

Conclusion

There is a need to develop a consensus statement and standard guidelines for the assessment and intervention for dysphagia by the SLP in the NICU. Translation of current evidence-based research into clinical practice is critical to patient care.

Introduction

This study described the different stages of uncontrolled hypertension, and assessed independently of the socio-demographic parameters, the non-modifiable and modifiable factors associated with uncontrolled hypertension at ambulatory care, in urban and peri-urban primary health care centres (PHCCs) of Bobo–Dioulasso, Burkina Faso.

Methods

A sample of 380 hypertensive adults were consecutively interviewed from January to February 2022, in 20 public PHCCs, in Bobo-Dioulasso. Sociodemographic, non- and modifiable lifestyle, anthropometric and blood pressure parameters were collected. Descriptive, comparative and logistic regression tests were performed.

Results

The participants’ mean age was 56.2 ± 10.4 years and frequency of uncontrolled hypertension stage I, II and III was respectively 40.3 %, 23.3 % and 7.9 %. Those with family history of hypertension was 42.4 %. Participants with monotherapy, bi-therapy and tri-therapy represented 51.6 %, 42.6 % and 2.1 % respectively, while 38.2 % declared to be uncompliant with the therapy. About 36 % were current alcohol users, 29.7 % physically inactive, 23.7 % ate less than three servings of fruits and vegetables (FV), 15.3 % were obese, and 12.9 % current tobacco users. In logistic regression analysis, the presence of family history of hypertension [adjusted odds ratio (aOR) = 2.1; p = 0.005], use of bi-/tri-therapy (aOR = 1.7; p = 0.044), daily intake of less than three FV servings (aOR = 1.9; p = 0.025); non-adherence with therapy (aOR = 3.3, p = 0.0001) and obesity (aOR = 4.5; p = 0.003) were associated with uncontrolled hypertension.

Conclusion

Uncontrolled hypertension was high at ambulatory primary care. For its efficient management in secondary prevention, a tailored in-hospital strategy including permanent education for a healthier lifestyle practice is needed; and should be complementary strengthened with specific community-based interventions.

Despite the associated health risks of poor sleep quality during pregnancy, recent evidence suggests that its impact persists in most countries. However, poor sleep quality during pregnancy in Ethiopia is poorly understood because of the lack of comprehensive reviews. Hence, we aimed to assess the pooled prevalence of poor sleep quality and associated factors among pregnant women in Ethiopia.

Methods

A comprehensive search using electronic databases (PubMed, Cochrane Library, Google Scholar, and African Journal Online) was performed covering articles indexed before January 20, 2023. The quality of the included studies was evaluated using the Newcastle‒Ottawa Scale. Cochrane Q and I² test statistics were used to examine the heterogeneity of the studies. A random-effects meta-analysis was performed with Stats Direct statistical software and Open Meta [Analyst] to estimate the prevalence of the outcome variable, and the results are reported in a forest plot. Simple charts and tables were used to summarize the evidence on poor sleep quality during pregnancy and its associated factors.

Results

After 27,211 studies were reviewed, seven studies involving with 2689 study participants were included. The combined prevalence of poor sleep quality among pregnant women was 52.30 % (95 % CI: 42.39, 62.19). Depression (OR = 4.53; 95 % CI: 2.07, 9.89), perceived stress (OR = 3.42; 95 % CI: 2.46, 4.74), age greater than 35 years (OR = 3.47; 95 % CI: 1.01, 11.86), unplanned pregnancy (OR = 2.94; 95 % CI: 1.85, 4.68), anxiety (OR = 4.71; 95 % CI: 1.19, 18.65), and having poor sleep hygiene practices (OR = 4.32; 95 % CI: 1.48, 12.6) were significantly associated with poor sleep quality.

Conclusions

More than half of the pregnant women did not have adequate sleep quality at night. Being depressed, stressed, anxious, having poor hygiene practices, and being older than 35 years were influential factors for poor sleep quality. Therefore, healthcare providers’ regular early screening for poor sleep quality and its determinants is important for improving birth outcomes.

Background

The application of AI algorithms for the detection of the mandibular canal in Cone Beam Computed Tomography (CBCT) holds immense promise in dentistry.

Aim

This review aimed to identify the semi and fully automated algorithm to localize the mandibular canal. An extensive search was conducted and, out of which 12 articles are considered for review. The result revealed using various AI algorithms achieved better accuracy in localizing the mandibular canal with reporting sensitivity and specificity above 90 %. In conclusion, it is noted that the application of AI algorithms in dentistry can provide significant benefits like improving the accuracy of reporting.

Background

Metabolic adverse effects of second-generation antipsychotics (SGAs) have been well-documented in literature. This study aimed to develop, validate, and evaluate the usefulness of patient information leaflet (PIL) by user testing method to improve metabolic monitoring for psychiatric patients prescribed with SGAs.

Methods

The study included out-patients above 18 years of age diagnosed with schizophrenia, schizoaffective, bipolar disorders prescribed with SGAs. Database such as micromedex, guidelines on developing PIL and factsheets on antipsychotics were used to prepare the content of the leaflet and was given to experts for validation. The PIL covered information on definition of antipsychotic and its types, metabolic syndrome and its prevention such as lifestyle modifications and regular monitoring. Readability of the PIL was assessed using Flesch reading ease (FRE), Flesch Kincaid grade level (FK-GL) and user testing in 20 similar patient population.

Results

The BALD scores on layout and design of the PILs was found to be 29. The FRE readability test score was found to be 63.5 and FKGL test score was found to be 7.6. Among the 20 patients, 5 of them favoured English PILs, while 15 chose Kannada PILs. The overall pre and post user-testing mean scores for knowledge assessment significantly increased from 60.62 ± 23.39 to 91.25 ± 11.54. Overall, about 85 % of patients gave the PIL leaflets a good rating.

Conclusion

Patient education materials of high quality that are created with pictures may aid in a better knowledge of the treatment for psychiatric patients who are on long term SGA therapy.

On May 5, 2023, the World Health Organization announced the end of the coronavirus pandemic. Nonetheless, there are growing reports indicating that individuals who have contracted COVID-19, especially in its more severe manifestations, may endure medium-to long-term impacts of the condition.

The purpose of this study was to investigate the impact of the severity of COVID-19 on the subsequent health outcomes.

Methods

The prospective cohort study ran from March to October of 2021.482 study participants were divided into two cohorts: the first cohort encompassed 118 individuals who received hospital care, while the second cohort included 364 individuals receiving outpatient care. Propensity Score Analysis was used as the probability of being hospitalized for COVID-19 in logistic regression as a covariate, to account for the influence of intervening factors that were associated with the probability of being hospitalized for COVID-19. The odds ratio (OR) was the association metric that was applied.

Results

Patients with more severe COVID-19 are more prone to infectious and parasitic diseases ORadj 6.61 (with 95 % CI 1.84–23.75), p = 0.004, more likely to show complications from the respiratory system ORadj 2.37 (with 95 % CI 1.35–4.16), p = 0.003, more frequently diagnosed eye pathologies ORadj 5.60 (with 95 % CI 1.96–15.98), p = 0.001, susceptible to hospitalization, ORadj 3.49 (1.78–6.84), p < 0.001.

Conclusion

Our study's findings indicate that patient with more severe COVID-19 have a higher requirement for medical attention regardless of other factors that influence the need for medical care.

Background/objectives

Cardiovascular disease (CVD) is the leading cause of death worldwide, however little is known about the prevalence of risk factors in the Caribbean country of Trinidad and Tobago. This study investigates the prevalence of major cardiovascular risk factors in patients with CVD in Trinidad and Tobago between two age groups – <60 years and ≥60 years – and determines if the prevalence differed with sex.

Methods

Medical records of 151 patients with CVD admitted to a private hospital in Trinidad and Tobago between January 2015 and March 2021 were analyzed. Patients were divided by sex, and into two age groups: <60 years (young) and ≥60 years (elderly). Chi-squared and Mann-Whitney U tests were used to analyze five major cardiovascular risk factors: hypertension, diabetes, smoking, hypercholesterolaemia, and family history of coronary heart disease (CHD).

Results

It was found that the prevalence of hypertension was higher in the elderly group, while smoking, hypercholesterolaemia and family history of CHD were more common in males than in females. The prevalence of different risk factors varied with sex in the age groups: diabetes and family history of CHD in the <60 age group, and smoking and hypercholesterolaemia in the ≥60 age group. These risk factors were more prevalent in males than in females within the age groups. Additionally, the mean age of females in the ≥60 age group was found to be greater than that of males in the same age group.

Conclusions

Age and sex differences were observed in the prevalence of major CVD risk factors, which may influence the management of CVD in Trinidad and Tobago. Intervention strategies, such as health education and counselling programmes that are age- and sex-specific, are recommended.