Tag: pubmed

Health Policy Plan. 2021 Oct 26:czab120. doi: 10.1093/heapol/czab120. Online ahead of print.

ABSTRACT

Community health workers (CHWs) are a vital part of the health infrastructure in Uganda and in many other low- and middle-income countries. While the need for CHWs is clear, it is less clear how they should dispense health products to maximize the health benefits to their community. In this study, we assess the cost-effectiveness of several competing CHW distribution strategies in the context of treatment for child diarrhea. We used data from a 4-armed cluster-randomized controlled trial to assess the cost-effectiveness of 1) free distribution of oral rehydration salts (ORS) via home deliveries prior to diarrhea onset (free delivery arm), 2) free distribution via vouchers where households retrieved the treatment from a central location (voucher arm), 3) a door-to-door sales model (home sales arm), and 4) a control arm where CHWs carried out their activities as normal. We assessed the cost-effectiveness from the implementor’s perspective and a societal perspective, in terms of cost per case treated with ORS and cost per disability adjusted life-year (DALY) averted. Free delivery was the most effective strategy and the cheapest from a societal perspective. Although implementor costs were highest in this arm, cost savings comes from households using fewer resources to seek treatment outside the home (transport, doctor fees, and treatment costs). From the implementors’ perspective, free delivery costs $2.19 per additional case treated and $56 per DALY averted relative to the control. Free delivery was also extremely cost-effective relative to home sales and vouchers but there was a large degree of uncertainty around the comparison with vouchers. Free distribution of ORS by CHWs prior to diarrhea onset is extremely cost-effective compared to other CHW distribution models. Implementers of CHW programs should consider free home delivery of ORS.

PMID:34698342 | DOI:10.1093/heapol/czab120

Vision (Basel). 2021 Sep 28;5(4):44. doi: 10.3390/vision5040044.

ABSTRACT

Gastropod mollusks are convenient model organisms for studying the functioning of the visual system. The purpose of this work is to estimate the value of the optical sensitivity to white light for the camera-like eyes of gastropod mollusks and humans and analyze its effect on the spatial resolving power in two regions of the retina: in the center-for single photoreceptors of the first/second type in a mollusk and single cones in humans-and in the periphery-for single photoreceptors of the first/second type in a mollusk, as well as for single rods/cones and their groups, subject to spatial summation in humans. The methods of histology, light and transmission electron microscopy, morphometry, calculations and methods of statistical analysis are used in the work. In a mollusk, with a fixed pupil area, the value of the optical sensitivity of the eye to white light in the center of the retina for single photoreceptors of the first/second type is 0.5/0.006 μm²·sr and in the periphery of the retina, 0.9/0.009 μm²·sr. In humans, at the minimum and maximum pupil area, respectively, the value of the optical sensitivity of the eye to white light in the center of the retina (foveola) for single cones varies from 0.00053 to 0.028 μm²·sr, and in the periphery of the retina (far periphery) for single rods from 0.011 to 0.575 μm²·sr, for single cones from 0.025 to 1.319 μm²·sr, for the groups of rods from 3859 to 204,094 μm²·sr and for the groups of cones from 2.5 to 131 μm²·sr. The value of the optical sensitivity of the eyes to white light for single photoreceptors of the first/second type in both regions of the retina in a mollusk, as well as for single cones in the center and groups of rods/cones in the periphery of the retina in humans, corresponds to the ambient light conditions during periods of activity and does not affect the spatial resolving power.

PMID:34698309 | DOI:10.3390/vision5040044

Trop Med Infect Dis. 2021 Sep 29;6(4):177. doi: 10.3390/tropicalmed6040177.

ABSTRACT

While there has been a tremendous decline in malaria disease burden in the remote parts of Malaysia, little is known about malaria incidence in its urban localities. This study aimed to analyze trends of malaria cases in urban Kuala Lumpur, Malaysia. All suspected cases presented to a university hospital in Kuala Lumpur from January 2005 to December 2020 were examined by microscopy. Infection status was analyzed using descriptive statistics and curve estimation analysis. Of 3105 blood films examined, 92 (3%) were microscopically confirmed malaria cases. Plasmodium vivax infections accounted for the majority (36.9%) of all malaria cases. Nearly half (47.8%) of cases were found among foreign cases (p < 0.001). The majority of foreign cases were male (86.4%) and came from Southeast Asian countries (65.9%). The curve estimation analysis showed significant decreases in malaria cases due to P. vivax (R² = 0.598; p < 0.001) and Plasmodium falciparum (R² = 0.298, p = 0.029), but increases for Plasmodium knowlesi (R² = 0.325, p = 0.021) during the 16 years. This study showed that malaria incidence in urban Kuala Lumpur is low and has remained stable since 2005. However, P. knowlesi has played a significant role in the increase in overall malaria in the area, highlighting the importance of continued vigilance and improved surveillance.

PMID:34698312 | DOI:10.3390/tropicalmed6040177

Trop Med Infect Dis. 2021 Oct 20;6(4):189. doi: 10.3390/tropicalmed6040189.

ABSTRACT

In New Zealand (NZ), leptospirosis is a mostly occupational zoonosis, with >66% of the recently notified cases being farm or abattoir workers. Livestock species independently maintain Leptospira borgpetersenii serovar Hardjo and L. interrogans serovar Pomona, and both are included in livestock vaccines. The increasing importance in human cases of Ballum, a serovar associated with wildlife, suggests that wildlife may be an overlooked source of infection. Livestock could also act as bridge hosts for humans. Drawing from disease ecology frameworks, we chose five barriers to include in this review based on the hypothesis that cattle act as bridge hosts for Ballum. Using a narrative methodology, we collated published studies pertaining to (a) the distribution and abundance of potential wild maintenance hosts of Ballum, (b) the infection dynamics (prevalence and pathogenesis) in those same hosts, (c) Ballum shedding and survival in the environment, (d) the exposure and competency of cattle as a potential bridge host, and (e) exposure for humans as a target host of Ballum. Mice (Mus musculus), rats (Rattus rattus, R. norvegicus) and hedgehogs (Erinaceus europaeus) were suspected as maintenance hosts of Ballum in NZ in studies conducted in the 1970s-1980s. These introduced species are distributed throughout NZ, and are present on pastures. The role of other wildlife in Ballum (and more broadly Leptospira) transmission remains poorly defined, and has not been thoroughly investigated in NZ. The experimental and natural Ballum infection of cattle suggest a low pathogenicity and the possibility of shedding. The seroprevalence in cattle appears higher in recent serosurveys (3 to 14%) compared with studies from the 1970s (0 to 3%). This review identifies gaps in the knowledge of Ballum, and highlights cattle as a potential spillover host. Further studies are required to ascertain the role that wild and domestic species may play in the eco-epidemiology of Ballum in order to understand its survival in the environment, and to inform control strategies.

PMID:34698305 | DOI:10.3390/tropicalmed6040189

Sci Rep. 2021 Oct 25;11(1):20956. doi: 10.1038/s41598-021-00351-1.

ABSTRACT

The vagina plays a critical role in supporting the pelvic organs and loss of support leads to pelvic organ prolapse. It is unknown what microstructural changes influence prolapse progression nor how decreased elastic fibers contributes to vaginal remodeling and smooth muscle contractility. The objective for this study was to evaluate the effect of fibulin-5 haploinsufficiency, and deficiency with progressive prolapse on the biaxial contractile and biomechanical function of the murine vagina. Vaginas from wildtype (n = 13), haploinsufficient (n = 13), and deficient mice with grade 1 (n = 9) and grade 2 or 3 (n = 9) prolapse were explanted for biaxial contractile and biomechanical testing. Multiaxial histology (n = 3/group) evaluated elastic and collagen fiber microstructure. Western blotting quantified protein expression (n = 6/group). A one-way ANOVA or Kruskal-Wallis test evaluated statistical significance. Pearson’s or Spearman’s test determined correlations with prolapse grade. Axial contractility decreased with fibulin-5 deficiency and POP (p < 0.001), negatively correlated with prolapse grade (ρ = – 0.80; p < 0.001), and positively correlated with muscularis elastin area fraction (ρ = – 0.78; p = 0.004). Circumferential (ρ = 0.71; p < 0.001) and axial (ρ = 0.69; p < 0.001) vaginal wall stresses positively correlated with prolapse grade. These findings demonstrated that fibulin-5 deficiency and prolapse progression decreased vaginal contractility and increased vaginal wall stress. Future work is needed to better understand the processes that contribute to prolapse progression in order to guide diagnostic, preventative, and treatment strategies.

PMID:34697337 | DOI:10.1038/s41598-021-00351-1

Nat Commun. 2021 Oct 25;12(1):6162. doi: 10.1038/s41467-021-26465-8.

ABSTRACT

Single-particle tracking offers detailed information about the motion of molecules in complex environments such as those encountered in live cells, but the interpretation of experimental data is challenging. One of the most powerful tools in the characterization of random processes is the power spectral density. However, because anomalous diffusion processes in complex systems are usually not stationary, the traditional Wiener-Khinchin theorem for the analysis of power spectral densities is invalid. Here, we employ a recently developed tool named aging Wiener-Khinchin theorem to derive the power spectral density of fractional Brownian motion coexisting with a scale-free continuous time random walk, the two most typical anomalous diffusion processes. Using this analysis, we characterize the motion of voltage-gated sodium channels on the surface of hippocampal neurons. Our results show aging where the power spectral density can either increase or decrease with observation time depending on the specific parameters of both underlying processes.

PMID:34697310 | DOI:10.1038/s41467-021-26465-8

Sci Rep. 2021 Oct 25;11(1):20955. doi: 10.1038/s41598-021-00379-3.

ABSTRACT

This study aimed to examine the reliabilities (test-retest reliability and measurement error), construct validity, and the interpretability (minimal clinically important difference) of the Box and Block Test (BBT) to interpret test scores precisely for children with UCP. A total of 100 children with UCP were recruited and 50 children from the whole sample assessed the BBT twice within 2-week interval. The BBT, the Melbourne Assessment 2, the Bruininks-Oseretsky Test of Motor Proficiency, 2nd Edition, and the Pediatric Motor Activity Log Revised were measured before and immediately after a 36-h intensive neurorehabilitation intervention. Measurement properties of the BBT were performed according to the COnsensus-based Standards for the selection of health Measurement INstruments checklist. The test-retest reliability of the BBT was high (intraclass correlation coefficient = 0.98). The measurement error estimated by the MDC₉₅ value was 5.95. Construct validity was considered good that 4 of 4 (100%) hypotheses were confirmed. The interpretability estimated by the MCID ranged from 5.29 to 6.46. The BBT is a reliable and valid tool for children with UCP. For research and clinical applications, an improvement of seven blocks on the BBT is recommended as an indicator of statistically significant and clinically important change.

PMID:34697312 | DOI:10.1038/s41598-021-00379-3

Cell Discov. 2021 Oct 26;7(1):99. doi: 10.1038/s41421-021-00329-3.

ABSTRACT

Large-scale COVID-19 vaccinations are currently underway in many countries in response to the COVID-19 pandemic. Here, we report, besides generation of neutralizing antibodies, consistent alterations in hemoglobin A1c, serum sodium and potassium levels, coagulation profiles, and renal functions in healthy volunteers after vaccination with an inactivated SARS-CoV-2 vaccine. Similar changes had also been reported in COVID-19 patients, suggesting that vaccination mimicked an infection. Single-cell mRNA sequencing (scRNA-seq) of peripheral blood mononuclear cells (PBMCs) before and 28 days after the first inoculation also revealed consistent alterations in gene expression of many different immune cell types. Reduction of CD8⁺ T cells and increase in classic monocyte contents were exemplary. Moreover, scRNA-seq revealed increased NF-κB signaling and reduced type I interferon responses, which were confirmed by biological assays and also had been reported to occur after SARS-CoV-2 infection with aggravating symptoms. Altogether, our study recommends additional caution when vaccinating people with pre-existing clinical conditions, including diabetes, electrolyte imbalances, renal dysfunction, and coagulation disorders.

PMID:34697287 | DOI:10.1038/s41421-021-00329-3

Proc Natl Acad Sci U S A. 2021 Nov 2;118(44):e2107306118. doi: 10.1073/pnas.2107306118.

ABSTRACT

Snow is highly sensitive to atmospheric warming. However, because of the lack of sufficiently long snow avalanche time series and statistical techniques capable of accounting for the numerous biases inherent to sparse and incomplete avalanche records, the evolution of process activity in a warming climate remains little known. Filling this gap requires innovative approaches that put avalanche activity into a long-term context. Here, we combine extensive historical records and Bayesian techniques to construct a 240-y chronicle of snow avalanching in the Vosges Mountains (France). We show evidence that the transition from the late Little Ice Age to the early twentieth century (i.e., 1850 to 1920 CE) was not only characterized by local winter warming in the order of +1.35 °C but that this warming also resulted in a more than sevenfold reduction in yearly avalanche numbers, a severe shrinkage of avalanche size, and shorter avalanche seasons as well as in a reduction of the extent of avalanche-prone terrain. Using a substantial corpus of snow and climate proxy sources, we explain this abrupt shift with increasingly scarcer snow conditions with the low-to-medium elevations of the Vosges Mountains (600 to 1,200 m above sea level [a.s.l.]). As a result, avalanches migrated upslope, with only a relict activity persisting at the highest elevations (release areas >1,200 m a.s.l.). This abrupt, unambiguous response of snow avalanche activity to warming provides valuable information to anticipate likely changes in avalanche behavior in higher mountain environments under ongoing and future warming.

PMID:34697237 | DOI:10.1073/pnas.2107306118

Rev Esp Salud Publica. 2021 Oct 25;95:e202110182.

ABSTRACT

OBJECTIVE: The COVID-19 pandemic caused by the SARS-CoV-2 virus has generated a great burden on health systems, and healthcare workers have been the most affected. In Spain, the Health Ministry issued common protocols regarding the return-to-work of healthcare workers presenting a negative PCR (Polymerase Chain Reaction) test result and complete resolution of symptoms. Some autonomous communities decided to include a CT (Cycle Threshold) value criterion as well. The aim of this paper was to compare the time intervals required to obtain a negative PCR result by means of both criteria.

METHODS: A multicenter, cross-sectional study was performed from March to September of 2020, in the health areas of Navarra, La Rioja and Vigo (Galicia), managed by their own Occupational Risk Prevention Units. The PCR negativization time intervals were analyzed according to gender, age, professional category and the PCR repetition criteria used (clinical or defined by CT). Mean difference calculation by Student’s t-test and Kaplan-Meier survival analyzes were conducted.

RESULTS: The sample amounted to a total of 1,052 workers: 673 from Navarra, 335 from La Rioja and 44 from Vigo, with an average age of 46 years, and of which 81% were women, 35.48% nursing personnel and 23.65% physicians. No statistically significant differences were found between the PCR negativization time periods with any of the variables, except with the CT criterion, which presented a mean of 6.49 days (95% CI, 4.96-8.02), longer and displaying positively displaced survival curves.

CONCLUSIONS: The CT criterion for carrying out the control PCR test lengthened the reincorporation of essential personnel in the fight against the pandemic.

PMID:34697284