Burden of disease from inadequate water,sanitation and hygiene for selected adverse health outcomes: An updated analysis with a focus on low- and middle-income countries

BackgroundTo develop updated estimates in response to new exposure and exposure-response data of the burden of diarrhoea, respiratory infections, malnutrition, schistosomiasis, malaria, soil-transmitted helminth infections and trachoma from exposure to inadequate drinking-water, sanitation and hygiene behaviours (WASH) with a focus on low- and middle-income countries.MethodsFor each of the analysed diseases, exposure levels with both sufficient global exposure data for 2016 and a matching exposure-response relationship were combined into population-attributable fractions. Attributable deaths and disability-adjusted life years (DALYs) were estimated for each disease and, for most of the diseases, by country, age and sex group separately for inadequate water, sanitation and hygiene behaviours and for the cluster of risk factors. Uncertainty estimates were computed on the basis of uncertainty surrounding exposure estimates and relative risks.FindingsAn estimated 829,000 WASH-attributable deaths and 49.8 million DALYs occurred from diarrhoeal diseases in 2016, equivalent to 60% of all diarrhoeal deaths. In children under 5 years, 297,000 WASH-attributable diarrhoea deaths occurred, representing 5.3% of all deaths in this age group. If the global disease burden from different diseases and several counterfactual exposure distributions was combined it would amount to 1.6 million deaths, representing 2.8% of all deaths, and 104.6 million DALYs in 2016.ConclusionsDespite recent declines in attributable mortality, inadequate WASH remains an important determinant of global disease burden, especially among young children. These estimates contribute to global monitoring such as for the Sustainable Development Goal indicator on mortality from inadequate WASH.     

Use of complementary and alternative medicine in children with asthma

BACKGROUND:

Because of the potential risk of interaction with, and underuse of, conventional medications, it is important to document the prevalence of the use of complementary and alternative medicines (CAMs) in asthmatic children.

OBJECTIVE:

To ascertain the prevalence and type of CAMs, and to identify factors associated with their use.

METHODS:

A cross-sectional survey of children who presented to the Asthma Centre of The Montreal Children’s Hospital (Montreal, Quebec) between 1999 and 2007 was conducted. At the initial consultation, parents completed a questionnaire inquiring, in part, about CAM use. Computerized health records provided information regarding patient characteristics and their condition.

RESULTS:

The median age of the 2027 children surveyed was 6.1 years (interquartile range 3.3 to 10.5 years); 58% were male and 59% of children had persistent asthma. The prevalence of CAM use was 13% (95% CI 12% to 15%). Supplemental vitamins (24%), homeopathy (18%) and acupuncture (11%) were the most commonly reported CAMs. Multivariable logistic regression analysis confirmed the association of CAM use with age younger than six years (OR 1.86; 95% CI 1.20 to 2.96), Asian ethnicity (OR 1.89; 95% CI 1.01 to 3.52), episodic asthma (OR 1.88; 95% CI 1.08 to 3.28) and poor asthma control (OR 1.98; 95% CI 1.80 to 3.31).

CONCLUSION:

The prevalence of reported CAM use among Quebec children with asthma remained modest (13%), with vitamins, homeopathy and acupuncture being the most popular modalities. CAM use was associated with preschool age, Asian ethnicity, episodic asthma and poor asthma control.     

我国城镇居民自我医疗相关因素分析

目的 探讨我国普遍存在的自我医疗行为的相关因素,特别关注与社会经济状况和健康保险可及性的关系.方法 通过采用全国典型抽样调研数据(2007年国务院城镇居民基本医疗保险试点评估入户调查),根据Andersen卫生服务利用模型建立logit回归模型实证分析.结果 通过实例分析发现,收入水平、保险类别对自我医疗有不同程度的显著影响.结论 自我医疗与社会经济状况及缺少专业健康照顾有关.通过增加健康保险覆盖比例,减轻老百姓医疗保健负担,可减少自我医疗行为.     

“Predicting” parental longevity from offspring endophenotypes: Data from the Long Life Family Study (LLFS)

While there is evidence that longevity runs in families, the study of long-lived families is complicated by the fact that longevity-related information is available only for the oldest old, many of whom may be deceased and unavailable for testing, and information on other living family members, primarily descendents, is censored. This situation requires a creative approach for analyzing determinants of longevity in families. There are likely biomarkers that predict an individual's longevity, suggesting the possibility that those biomarkers which are heritable may constitute valuable endophenotypes for exceptional survival. These endophenotypes could be studied in families to identify human longevity genes and elucidate possible mechanisms of their influence on longevity. In this paper, we analyze data collected in the Long Life Family Study (LLFS) investigating whether indicators of physiological state, cognitive functioning and health/well-being among offspring predict longevity in parents. Good predictors can be used as endophenotypes for exceptional survival. Our analyses revealed significant associations between cumulative indices describing physiological state, as well as a number of offspring phenotypes, and parental lifespan, supporting both their familial basis and relevance to longevity. We conclude that the study of endophenotypes within families is a valid approach to the genetics of human longevity.     

Long-term stability of fibrinolytic factors stored at -80 °C

Introduction

Blood samples in epidemiological studies are often stored for several years and analysed at different occasions. The reagent kits are continually modified for better precision and accuracy. Our hypothesis was that epidemiological studies are affected by long-term storage and/or modifications of reagent kits.

Materials and Methods

Plasma samples stored at -80 ^°C from two populations were used: A case-referent study with samples collected from 1985 to 2000 and analysed 2005 (n = 1598) were used to study influence of long-term storage. A cross-sectional study analysed 1990 (n = 1558) and re-analysed 2001 (n = 78) and 2005 (n = 828) was used to study influence of reagent kit modifications. Fibrinolytic analyses included immunoassays of tPA, PAI-1 and tPA-PAI-1 complex and chromogenic substrate assays of the activities of tPA and PAI-1.

Results

Long-term storage for a median time of 11.6 years (range 5 to 20) showed an effect of time on tPA antigen R² = 0.01, PAI-1 antigen R² = 0.01 and tPA-PAI-1 complex R² = 0.02. Modifications in reagent kits affected the levels of fibrinolytic factors; for tPA antigen the slope coefficients were between 0.72 and 0.95 (R² 0.47 - 0.75), whereas tPA activity showed an agreement with slope coefficients 1.06 to 1.09 (R² 0.67 - 0.93).

Conclusions

This study showed that long-term storage affects fibrinolytic variables to a negligible extent, but modifications in reagent kits introduced an element of bias. We conclude that analysis of samples on a single occasion is preferable to multiple occasions, as storage has negligible effect.     

Prevalence of plasmid-mediated quinolone resistance determinants in Enterobacteriaceae strains isolated in North-East Italy

Abstract

We investigated the prevalence of plasmid-mediated quinolone resistance genes in 756 clinical isolates of Enterobacteriaceae originating from Microbiology Diagnostic Laboratories of North-East Italy. Five point zero two percent of isolates carried a qnr determinant while the aac(6')-Ib-cr determinant was detected in 9·25% of isolates. We also investigated the association between the plasmid-mediated quinolone resistance and the beta-lactamase genes, and characterized the plasmids carrying these determinants of resistance.     

Determinants of Incomplete Childhood Vaccination among Children Aged 12–23 Months in Gambela Region,Southwest Ethiopia: A Case Control Study

BackgroundChildhood vaccination is considered as one of the most cost-effective public health interventions. With an increasing dropout rate from vaccination, the factors for incomplete vaccination are not well explored. The objective of this study was to identify determinants of incomplete childhood vaccination.MethodCommunity based case-control study was conducted from March 1–30, 2018. Cases were children who missed at least one dose of routine vaccine while controls were children who completed all recommended doses. Face-to-face interviews were used to collect data. Multivariable logistic regression was performed in order to identify determinants with 95% CI and a p-value of <0.05.ResultA total of 93 cases and 185 controls were participated in the study. Not attending postnatal care [AOR=2.16, 95% CI: 1.08–4.28], household not visited by health workers [AOR=3.99, 95% CI: 2.13–7.48], postponing vaccination schedules [AOR = 6.15, 95% CI: 3.08–12.27], caretakers who had misconception of vaccination [AOR = 2.90, 95% CI: 1.53–5.52], unsatisfied care takers [AOR=1.970, 95% CI:1.04–3.74] and poor knowledge about vaccines [AOR = 2.33, 95% CI: 1.19–4.59] were determinants of incomplete childhood vaccination.ConclusionFailure to attend postnatal care, postponing vaccination schedules, having misconception for vaccine contraindication, households not visited by health workers, caretakers who had poor knowledge about vaccines and unsatisfied caretakers were determinants of incomplete childhood vaccination. Based on the finding, it is recommended that health education should be improved to decrease caretakers'' misconception, poor knowledge and postponement of the vaccine schedule. It is also recommended to increase health workers household visit.     

唐山煤矿工人幽门螺杆菌感染的影响因素调查

目的 了解煤矿工人幽门螺杆菌(Hp)感染情况及其影响因素。方法 采用多阶段分层随机整群抽样方法选取425名煤矿工人,进行问卷调查。同时行胃镜检查,采取胃黏膜标本用于菌培养和病理诊断;Hp感染的检测方法采用细菌培养法和ELISA法;全部调查资料采用X~2分析和分层分析。结果 煤矿工人Hp总的感染率为69.9％,井下工人的Hp感染率比井上工人的高,差异有显著性(P=0.004);大兴矿、鲍店矿、唐山矿工人Hp的感染率差别无显著性(P>0.05)。影响煤矿工人Hp感染的主要因素有年龄、未成年时月人均经济收入、未成年时住房形式、现家庭人口数等社会经济因素,个人嗜好中的饮酒状况。影响井下工人Hp感染还有家庭进餐形式。结论 井下工人Hp感染率比井上工人的高;影响因素有社会经济因素、个人嗜好、家庭进餐形式。     

BMI, pain and hyper-mobility are determinants of long-term outcome for women with low back pain and pelvic pain during pregnancy

Low back pain and pelvic pain (LBPP) is common during pregnancy and up to 40% of women still have symptoms half a year after delivery. The aim of the study was to investigate determinants and the prevalence of persistent LBPP after pregnancy in a Swedish cohort. In a previous study 891 women had responded to a questionnaire on risk factors and prevalence of LBPP during pregnancy. Altogether 72% (n=639) of the women had reported LBPP during pregnancy. These respondents were sent a second questionnaire at approximately 6 months after delivery. The response rate was 72.6% (n=464). Independent t-test and Pearson’s chi-squared test were used to test the difference between the two groups. In response to the questionnaire, 43.1% of the women reported persistent LBPP 6 months after delivery. Women with persistent LBPP after pregnancy had had significantly earlier onset of pain during pregnancy, higher maternal age, higher body mass index (BMI), and assessed a higher level of pain due to LBPP during pregnancy and after pregnancy, and included a higher proportion of women with joint hyper-mobility. In summary, recurrent or continuous LBPP is prevalent after pregnancy. BMI as well as hyper-mobility are prominent determinants of persistent LBPP after pregnancy. Level and onset of pain during pregnancy were strong predictors of persistent LBPP.