Perceived effectiveness of HPV test as a primary screening modality among US providers

BackgroundThe human papillomavirus (HPV) test, administered alone without the Papanicolaou (Pap) test, was recently recognized as a cervical cancer screening option in the United States by the Society of Gynecologic Oncology and the American Society for Colposcopy and Cervical Pathology, and the Food and Drug Administration has approved an HPV test for primary screening.MethodsSurveys of US internists, family practitioners, nurse practitioners, and obstetrician–gynecologists were conducted in 2009 and 2012 to investigate providers' perceptions of the effectiveness of the HPV test administered alone as a population-based screening modality (2009: N = 1040, 141–494 per provider group; 2012: N = 1039, 155–435 per provider group).ResultsThe majority in each provider group agreed that the HPV test administered alone is an effective screening modality in 2009 (75.3%–86.1%) and 2012 (79.5%–91.8%), and agreement rose significantly during this time period among family practitioners (χ² = 15.26, df = 1, p < 0.001) and nurse practitioners (χ² = 4.53, df = 1, p = 0.033).ConclusionsAgreement that the HPV test administered alone is an effective cervical cancer screening modality was widespread among providers in both 2009 and 2012, however implementation of guidelines for screening with the HPV test may be influenced by many other factors including reimbursement and patient preferences.     

Single nucleotide polymorphisms in Plasmodium falciparum V type H+ pyrophosphatase gene (pfvp2) and their associations with pfcrt and pfmdr1 polymorphisms

BackgroundChloroquine resistance in Plasmodium falciparum malaria has been associated with pfcrt 76T (chloroquine resistance transporter gene) and pfmdr1 86Y (multidrug resistance gene 1) alleles. Pfcrt 76T enables transport of protonated chloroquine out of the parasites digestive vacuole resulting in a loss of hydrogen ions (H⁺). V type H⁺ pyrophosphatase (PfVP2) is thought to pump H⁺ into the digestive vacuole. This study aimed to describe the geographic distribution of single nucleotide polymorphisms in pfvp2 and their possible associations with pfcrt and pfmdr1 polymorphisms.MethodsBlood samples from 384 patients collected (1981–2009) in Honduras (n = 35), Colombia (n = 50), Liberia (n = 50), Guinea Bissau (n = 50), Tanzania (n = 50), Iran (n = 50), Thailand (n = 49) and Vanuatu (n = 50) were analysed. The pfcrt 72–76 haplotype, pfmdr1 copy numbers, pfmdr1 N86Y and pfvp2 V405I, K582R and P711S alleles were identified using PCR based methods.ResultsPfvp2 was amplified in 344 samples. The pfvp2 allele proportions were V405 (97%), 405I (3%), K582 (99%), 582R (1%), P711 (97%) and 711S (3%). The number of patients with any of pfvp2 405I, 582R and/or 711S were as follows: Honduras (2/30), Colombia (0/46), Liberia (7/48), Guinea-Bissau (4/50), Tanzania (3/48), Iran (3/50), Thailand (1/49) and Vanuatu (0/31). The alleles were most common in Liberia (P = 0.01) and Liberia + Guinea-Bissau (P = 0.01). The VKP haplotype was found in 189/194 (97%) and 131/145 (90%) samples harbouring pfcrt 76T and pfcrt K76 respectively (P = 0.007).ConclusionsThe VKP haplotype was dominant. Most pfvp2 405I, 582R and 711S SNPs were seen where CQ resistance was not highly prevalent at the time of blood sampling possibly due to greater genetic variation prior to the bottle neck event of spreading CQ resistance. The association between the pfvp2 VKP haplotype and pfcrt 76T, which may indicate that pfvp2 is involved in CQ resistance, should therefore be interpreted with caution.     

Annual influenza vaccination reduces total hospitalization in patients with chronic hepatitis B virus infection: A population-based analysis

BackgroundThis study evaluated hospitalization and mortality in patients with chronic hepatitis B virus infection (HBV (+)) and matched comparison patients after stratifying the patients according to annual influenza vaccination (Vaccine (+)).MethodsData from Taiwan's National Health Insurance program from 2000 to 2009 were used to identify HBV(+)/vaccine(+) (n = 4434), HBV(+)/Vaccine(−) (n = 3646), HBV(−)/Vaccine(+) (n = 8868), and HBV(−)/Vaccine(−) (n = 8868) cohorts. The risk of pneumonia/influenza, respiratory failure, intensive care, hospitalization, and mortality in the four cohorts was evaluated.ResultsThe total hospitalization rate was significantly lower in patients with chronic HBV infection who received an annual influenza vaccination than in chronic HBV-infected patients who did not receive an influenza vaccination (16.29 vs. 24.02 per 100 person-years), contributing to an adjusted hazard ratio (HR) of 0.56 (95% confidence interval (CI) = 0.50–0.62). The HBV(+)/Vaccine(+) cohort also had lower risks than the HBV(+)/Vaccine(−) cohort for pneumonia and influenza (adjusted HR = 0.79, 95% CI = 0.67–0.92), intensive care unit admission (adjusted HR = 0.33, 95% CI = 0.25–0.43), and mortality (adjusted HR = 0.19, 95% CI = 0.15–0.24).ConclusionsOur results suggest that annual influenza vaccination can reduce the risk of hospitalization and mortality in patients with chronic HBV infection.     

Implementing care programmes for frail older people: A project management perspective

ObjectiveTo examine the issues that influenced the implementation of programmes designed to identify and support frail older people in the community in the Netherlands.MethodsQualitative research methods were used to investigate the perspectives of project leaders, project members and members of the steering committee responsible for the implementation of the programmes. Interviews were conducted in 2009 (n = 10) and in 2012 (n = 13) and a focus group was organised in 2012 (n = 5).Main FindingsThe interviews revealed that the implementation was influenced by the extent and quality of collaboration between organisations, adaptation to existing structures, future funding for the programmes and project leadership. A good relationship between participating organisations and professionals is required for successful implementation. A lack of clear project leadership and structural funding hampers the implementation of complex programmes in primary care settings.Implications for practiceThe findings of this study are useful for organisations and professionals who are planning to implement complex programmes. Identifying barriers concerning institutional collaboration, adaptation to existing structures, leadership and continuation of financial support at an early stage of the implementation process can support practitioners in overcoming them.     

Genetic basis of antimicrobial resistance and clonal dynamics of carbapenem-resistant Acinetobacter baumannii sequence type 191 in a Korean hospital

This study investigated the genetic basis of antimicrobial resistance and the epidemiological characteristics of 125 carbapenem-resistant Acinetobacter baumannii (CRAB) isolates collected from 2011 to 2012 in a Korean hospital. All CRAB isolates showed an extensively drug-resistant phenotype, but were susceptible to tigecycline. The bla_OXA − 23 and armA genes were mainly responsible for resistance to carbapenems and aminoglycosides, respectively. Four colistin-resistant CRAB isolates with different pulsotypes were identified. All four colistin-resistant isolates had a deletion at nucleotide 776 in lpxA, while one also had an insertion at nucleotide 732 in lpxA. All CRAB isolates belonged to three sequence types (STs): ST191 (n = 118), ST208 (n = 6), and ST436 (n = 1), but were classified into 33 arbitrary pulsotypes. Of the CRAB ST191 isolates, two main arbitrary pulsotypes 5 (n = 20) and 18 (n = 17) emerged sequentially, but were not clonally related to CRAB isolates collected from 2009 to 2010 in the same hospital. Furthermore, of the two main pulsotypes identified among CRAB ST191 isolates from 2009 to 2010, one was clonally related to sporadic CRAB ST191 isolates from 2011 to 2012, but the other was not related to any CRAB isolate from 2011 to 2012. In conclusion, this study shows the clonal dynamics of CRAB ST191 isolates in a Korean hospital during the last four years.     

Changes in pathogens and pneumococcal serotypes causing community-acquired pneumonia in The Netherlands

BackgroundIn 2006 a 7-valent pneumococcal conjugate vaccine (PCV7) was introduced in the immunisation programme for infants in The Netherlands and replaced by PCV10 in 2011. Limited data exist about the impact of PCV on the aetiology of CAP as a whole. The aim of the present study is to describe the overall changes in microbial aetiology, pneumococcal burden (including non-bacteraemic pneumococcal pneumonia) and its serotypes in adult community-acquired pneumonia (CAP) after the introduction of these PCVs.MethodsHospitalised adult CAP patients who participated in three consecutive trials were studied (2004–2006 (n = 201), 2007–2009 (n = 304) and 2012–2016 (n = 300) and considered as pre-PCV7, PCV7 and PCV10 period). Extensive conventional microbiological testing was applied for all patients. In addition, patients with a serotype-specific pneumococcal antibody response were diagnosed with pneumococcal CAP. Changes in proportions of causative pathogens and distributions of pneumococcal serotypes were calculated.ResultsThe proportion of pneumococcal CAP decreased from 37% (n = 74/201) to 26% (n = 77/300) comparing the pre-PCV7 period with the PCV10 period (p = 0.01). For other pathogens, including Legionella spp., Mycoplasma pneumoniae, S. aureus, H. influenzae, and respiratory viruses, no sustained shifts were observed in their relative contribution to the aetiology of CAP. Within the pneumococcal CAP patients, we observed a decrease in PCV7 and an increase in non-PCV10 serotype disease. PCV10-extra type disease did not decrease significantly comparing the PCV10 period with the pre-PCV7 and PCV7 period, respectively. Notably, PCV7 type disease decreased both in bacteraemic and non-bacteraemic patients.ConclusionsOur findings confirm that PCV introduction in infants impact the microbial aetiology of adult CAP and suggest herd effects in adults with CAP after introduction of PCVs in children.     

Borréliose de Lyme : recensement des cas adultes hospitalisés en Indre-et-Loire, à partir du PMSI (1999–2006)

BackgroundTo describe the clinical forms and epidemiology of Lyme borreliosis, in French adult patients hospitalized in Indre-et-Loire (Centre region).MethodsPatients were recruited from standardized discharge summaries collected in the hospital database. All adult patients, hospitalized in public hospitals of the Indre-et-Loire administrative district, over a period of 8 years (1999–2006), who satisfied the European diagnostic criteria of Lyme borreliosis, were included.ResultsEncoding of Lyme borreliosis had a poor positive predictive value (65%). Forty-seven adult patients presented with the 50 following clinical forms: erythema migrans (n = 5), neuroborreliosis (n = 32), knee single-joint arthritis (n = 4), acrodermatitis chronica atrophicans (n = 3), carditis (n = 2), ocular borreliosis (n = 2), miscellaneous (n = 2). Three patients had a combination of two different clinical forms. Meningoradiculitis was the most frequent neurologic manifestation. When a cranial nerve was involved, it was constantly the facial nerve, and mainly bilaterally. Few patients in our study had erythema migrans: these patients are usually treated in a general medicine setting. Although the incidence in the Centre region was lower than in some other regions of France and Europe, the clinical spectrum of the disseminated forms was similar.ConclusionThis cohort illustrates the diversity of clinical manifestations of Lyme borreliosis in hospitalized patients, particularly at disseminated and late stages as well as the complexity of its diagnosis and its epidemiological surveillance.     

Empowering adolescents to be physically active: Three-year results of the Sigue la Huella intervention

ObjectiveTo examine the effects of a school-based intervention called Sigue la Huella (Follow the Footstep) on adolescents' daily moderate-to-vigorous physical activity (MVPA).MethodThis quasi-experimental, cohort study took place in four secondary schools in Huesca (Spain) during the 2009–2010, 2010–2011, and 2011–2012 academic years (students aged 12–15 years). Two schools were assigned to the experimental condition (n = 368) and two schools to the control condition (n = 314). Sigue la Huella was based on the social ecological model and self-determination theory. MVPA was measured for 7 days on 4 occasions using accelerometers. Data were analyzed with individual growth curve models.ResultsThere was a significant difference in linear growth rate of daily MVPA between the experimental and the control group, independent of study wave, type of school (public vs. private), grade level and gender (p < 0.001). Specifically, MVPA increased in the experimental group (β = 7.02, 95% confidence interval (CI) = 1.27 to 12.78, p = 0.017) and tended to decrease in the control group (β = − 5.26, 95% CI = − 11.17 to 0.65, p < 0.081). The observed increase was larger in boys than in girls (p = 0.003).ConclusionsSigue la Huella had a positive effect on adolescents' daily MVPA over three school years. Both genders benefited from the intervention, although boys to a greater extent.     

Acute kidney injury in infective endocarditis: A retrospective analysis

BackgroundAcute kidney injury (AKI) is associated with high case fatality in infective endocarditis (IE), but epidemiological data on the frequency of AKI during IE is scarce. We aimed to describe the frequency and risk factors for AKI during the course of IE using Kidney Disease: Improving Global Outcomes consensual criteria.MethodsUsing the French hospital discharge database (French acronym PMSI), we retrospectively reviewed the charts of 112 patients presenting with a first episode of probable or definite IE between January 2010 and May 2015.ResultsSeventy-seven patients (68.8%) developed AKI. In univariate analysis, risk factors for AKI were cardiac surgery for IE (n = 29, 37.7% vs. n = 4, 1.4%, P < 0.0005), cardiac failure (n = 29, 36.7% vs. n = 1, 2.9%, P < 0.0005), diabetes mellitus (n = 14, 18.2% vs. n = 1, 0.9%, P = 0.034), and prosthetic valve IEs (n = 24, 31.2% vs. n = 4, 11.4%). No differences were observed for gentamicin exposure (n = 57, 64% vs. n = 32, 86.5%, P = 0.286). Prosthetic valve IE, cardiac failure, and vancomycin exposure were independently associated with AKI with respective odds ratio of 5.49 (95% CI 1.92–17.9), 4.37 (95% CI 4.37–465.7), and 1.084 (1.084–16.2). Mean length of hospital stay was significantly longer in patients presenting with AKI than in controls (respectively 52.4 ± 22.1 days vs. 39.6 ± 12.6, P < 0.005).ConclusionAKI is very frequent during IE, particularly in patients with prosthetic valve IE, cardiac failure, and those receiving vancomycin.     

Vaccine-associated reduction in symptom severity among patients with influenza A/H3N2 disease

BackgroundThe moderate level of protection conferred by influenza vaccines is well-known, but the vaccine's ability to attenuate symptom severity among vaccinated individuals (i.e., vaccine failures) has not been established.MethodsWe enrolled otherwise healthy adults who presented with influenza-like illness (ILI) at five US military hospitals between 2009 and 2014. Influenza was diagnosed and subtyped by PCR. Individual and composite severity scores were compared between those who had vs. had not received the seasonal influenza vaccine >14 days prior to enrollment.ResultsA total of 155 cases of influenza (A/H1N1, n = 69; A/H3N2, n = 66; A/untyped, n = 3; B, n = 17) were identified, of whom 111 (72%; A/H1N1, n = 44; A/H3N2, n = 52; A/untyped, n = 3; B, n = 12) had been vaccinated. Women were significantly less likely to be vaccinated than men (49% vs. 89%; p < 0.01). In multivariate analysis, vaccinated individuals were significantly less likely to report a fever >101 °F (OR 0.24; 95% CI [0.10, 0.62]) and more likely to report myalgias (OR 3.31; 95% CI [1.22, 8.97]) than vaccinated individuals. Among patients with A/H3N2 infection, upper respiratory and total symptom severity scores were significantly lower for vaccinated patients during the first 2 days of illness, and differences in total symptom severity persisted over 7 days (p < 0.05 for all comparisons). Differences across additional symptom categories (lower respiratory and systemic) were also observed throughout 7 days of illness in bivariate analyses. Differences in symptom severity were not observed between vaccinated and unvaccinated participants with A/H1N1 infection.ConclusionsAmong patients with A/H3N2 infection, receipt of seasonal influenza vaccine was associated with reduced symptom severity. Patient-centered discussion about the benefits of influenza vaccination should be expanded to include the possibility that the vaccine could attenuate symptoms.     

Determinants of use of smoking cessation aids in 27 European countries

ObjectiveTo identify determinants of use of smoking cessation aids among current and former smokers in the European Union (EU).MethodsData from n = 9921 current and ex-smokers from 27 European countries (Eurobarometer 77.1, February–March 2012) were analysed. Multivariate binary logistic regression was used to assess for correlates of use of any recommended aid with proven efficacy, defined as use of pharmacotherapy or psychosocial counselling (p < 0.05). The regression analyses assessed for socio-demographic characteristics, EU region, as well as scope of national smoking cessation policies.ResultsAmong current smokers who had made a quit attempt and ex-smokers, 19.9% had used any recommended aid with proven efficacy. Respondents from Northern (adjusted odds ratio [aOR] = 1.90), Western (aOR = 3.21) and Eastern Europe (aOR = 1.69) were more likely to have used an efficacious smoking cessation aid compared to respondents from Southern Europe (all p < 0.05). Respondents in countries with comprehensive tobacco cessation programmes that offered cost-covered national quit lines, medication, and other cessation services had increased likelihood of using efficacious cessation aids (OR = 1.29; 95% Confidence Interval: 1.07–1.55).ConclusionsThese findings underscore the need for enhanced and sustained efforts to ensure increased access to cessation services and aids as part of a comprehensive tobacco control programme.     

Immune response to pneumococcal conjugate vaccine in patients with systemic vasculitis receiving standard of care therapy

AimTo study the effect of standard of care therapy on antibody response and functionality following immunization with 13-valent pneumococcal conjugate vaccine (PCV13) in patients with primary systemic vasculitis compared to healthy controls.Methods49 patients with vasculitis and 49 controls received a single dose (0.5 ml) PCV13 intramuscularly. Ongoing treatments: azathioprine (AZA; n = 11), cyclophosphamide (CYC; n = 6), methotrexate (MTX; n = 9), rituximab (n = 3); anti-TNF (n = 2), mycophenolate mofetil (n = 2), prednisolone alone (n = 15) and no active treatment (n = 2). Specific antibody concentrations for serotypes 6B and 23F were determined using ELISA and opsonophagocytic activity (OPA) assay (23F) was performed, on serum samples taken immediately before and 4–6 weeks after vaccination. Proportion of individuals with putative protective antibody concentration (≥1.0 µg/mL) and positive antibody response (≥2-fold increase from prevaccination concentration) for both serotypes were calculated and groups were compared.ResultsAt baseline, 6 patients (12%) and 12 controls (24%) had protective antibody levels for both serotypes. After vaccination, antibodies increased for both serotypes in patients and controls (p < 0.001), 32 patients (65%) and 35 controls (71%) reached protective level for 6B, and 32 patients (65%) and 37 controls (76%) for 23 F. Compared to controls, patients had lower prevaccination geometric mean concentration (23F, p = 0.01) and a numerical trend towards lower prevaccination level (6B) and postvaccination levels (both serotypes). Patients with prednisolone alone had lower prevaccination OPA (p < 0.01) compared to controls. OPA increased after vaccination in both patients and controls (p < 0.001), but improvement was better in controls (p = 0.001). AZA, CYC or MTX, but not prednisolone alone, tended towards a lower proportion of patients reaching protective antibody levels (p = 0.06), compared to controls.ConclusionsPneumococcal conjugate vaccine was safe and immunogenic in patients with established vasculitis. Treatment with DMARDs, mostly AZA, CYC and MTX but not systemic prednisolone may impair antibody response.Trial registration. ClinicalTrials.gov Identifier: NCT02240888. Registered 4 September, 2014     

Experience with outcomes research into the real-world effectiveness of novel therapies in Dutch daily practice from the context of conditional reimbursement

Policymakers more often request outcomes research for expensive therapies to help resolve uncertainty of their health benefits and budget impact at reimbursement. Given the limitations of observational data, we assessed its usefulness in evaluating clinical outcomes for bortezomib in advanced multiple myeloma patients. Data were retrospectively collected from patients included in the pivotal Assessment of Proteasome Inhibition for Extending Remissions trial (APEX; n = 333) and two groups of daily practice patients treated with bortezomib following progression from upfront therapy (n = 201): real-world patients treated as of May 2009 (RW-1; n = 72) and June 2012 (RW-2; n = 129). Prognosis, treatment, and effectiveness were compared. Outcomes research was useful for policymakers for addressing to whom and how bortezomib was administered in daily practice. It was limited however in generating robust evidence on real-world safety and effectiveness. The quality of real-world evidence on effectiveness was low due to missing data in patient charts, existing treatment variation and the dynamics in care during the novel drug's initial market uptake period. Policymakers requesting real-world evidence on clinical outcomes for reimbursement decisions should be aware of these limitations and advised to carefully consider beforehand the type of evidence that best addresses their needs for the re-assessment phase.     

Preliminary state of development of prediction models for primary care physical therapy: a systematic review

ObjectiveTo summarize the methodological quality and developmental stage of prediction models for musculoskeletal complaints that are relevant for physical therapists in primary care.Study Design and SettingA systematic literature search was carried out in the databases of Medline, Embase, and Cinahl. Studies on prediction models for musculoskeletal complaints that can be used by primary care physical therapists were included. Methodological quality of the studies was assessed and relevant study characteristics were extracted.ResultsThe search retrieved 4,702 references of which 29 studies were included in this review. The study quality of the included studies showed substantial variation. The studied populations consisted mostly of back (n = 10) and neck pain (n = 6) patients, and patients with knee complaints (n = 4). Most studies (n = 22) used “perceived recovery” as primary outcome. Most prediction models (n = 18) were at the derivation level of development.ConclusionsMany prediction models are available for a wide range of patient populations. The developmental stage of most models is preliminary and the study quality is often moderate. We do not recommend physiotherapist to use these models yet. All models reviewed here are in the developmental stage and need validation and impact evaluation before using them in daily practice.     

Mode-specific physical activity and leukocyte telomere length among U.S. adults: Implications of running on cellular aging

BackgroundPrevious research demonstrates that physical activity participation is associated with longer leukocyte telomere length, with shorter leukocyte telomere length being a hallmark characteristic of cellular aging. What remains under-investigated, however, is whether there is a mode-specific association of physical activity on leukocyte telomere length, which was this study's purpose.MethodsData from the 1999–2002 National Health and Nutrition Examination Survey were used (N = 6474 adults analyzed). Leukocyte telomere length was assessed using quantitative polymerase chain reaction. Physical activity was assessed via self-report, with participants classified as meeting physical activity guidelines (≥ 2000 metabolic equivalent of task-min-month) for 9 separate physical activities, including aerobics (unweighted percent meeting guidelines: 2.98%; n = 193), basketball (2.0%; n = 129), bicycling (3.71%; n = 240), dance (2.30%; n = 149), running (3.09%; n = 200), stair climbing (1.33%, n = 86), swimming (1.85%, n = 120), walking (13.53%; n = 876), and weight lifting (2.61%; n = 169).ResultsIn a single multivariable linear regression model including the independent variables of age, gender, race-ethnicity, weight status, total cholesterol, C-reactive protein, total metabolic equivalent of task-min-month of physical activity and the 9 binary meeting physical activity guideline variables, the only mode of physical activity that was significantly associated with leukocyte telomere length was meeting physical activity guidelines from running (β = 0.06; 95% CI: 0.01–0.11; P = 0.03).ConclusionRunning-specific physical activity was the only evaluated physical activity associated with leukocyte telomere length, which may provide one potential mechanism (i.e., leukocyte telomere length) through which running-based physical activity may help to prevent cardiovascular disease and premature mortality.     

The predominance of Ethiopian specific Mycobacterium tuberculosis families and minimal contribution of Mycobacterium bovis in tuberculous lymphadenitis patients in Southwest Ethiopia

BackgroundEthiopia has an extremely high rate of extrapulmonary tuberculosis, dominated by tuberculous lymphadenitis (TBLN). However, little is known about Mycobacterium tuberculosis complex (MTBc) lineages responsible for TBLN in Southwest Ethiopia.MethodsA total of 304 MTBc isolates from TBLN patients in Southwest Ethiopia were genotyped primarily by spoligotyping. Isolates of selected spoligotypes were further analyzed by 15-loci mycobacterial interspersed repetitive unit–variable number tandem repeat (MIRU-VNTR) (n = 167) and qPCR-based single nucleotide polymorphism (n = 38). Isolates were classified into main phylogenetic lineages and families by using the reference strain collections and identification tools available at MIRU-VNTRplus data base. Resistance to rifampicin was determined by Xpert MTB/RIF.ResultsThe majority of isolates (248; 81.6%) belonged to the Euro-American lineage (Lineage 4), with the ill-defined T and Haarlem as largest families comprising 116 (38.2%) and 43 (14.1%) isolates respectively. Of the T family, 108 isolates were classified as being part of the newly described Ethiopian families, namely Ethiopia_2 (n = 44), Ethiopia_3 (n = 34) and Ethiopia_H₃₇Rv-like (n = 30). Other sub-lineages included URAL (n = 18), S (n = 17), Uganda I (n = 16), LAM (n = 13), X (n = 5), TUR (n = 5), Uganda II (n = 4) and unknown (n = 19). Lineage 3 (Delhi/CAS) was the second most common lineage comprising 44 (14.5%) isolates. Interestingly, six isolates (2%) were belonged to Lineage 7, unique to Ethiopia. Lineage 1 (East-African Indian) and Lineage 2 (Beijing) were represented by 3 and 1 isolates respectively. M. bovis was identified in only two (0.7%) TBLN cases. The cluster rate was highest for Ethiopia_3 isolates showing clonal similarity with isolates from North Ethiopia. Lineage 3 was significantly associated with rifampicin resistance.ConclusionsIn TBLN in Southwest Ethiopia, the recently described Ethiopia specific Lineage 4 families were predominant, followed by Lineage 3 and Lineage 4-Haarlem. The contribution of M. bovis in TBLN infection is minimal.     

Physically active vs. sedentary academic lessons: A dose response study for elementary student time on task

BackgroundPhysically active academic lessons are an effective intervention to reduce sedentary time and increase student physical activity. They have also been shown to enhance task engagement, as indicated by observations of attention and behavior control, time on task (TOT). However, it is not clear if the improved TOT stems from the physical activity or if it is the result of an enjoyable break from traditional instruction. If it is due to physical activity, what dose of intensity is required for the effect? This study was designed to test these questions.MethodsParticipants were 320 children (7–9 years) recruited from school districts in Central Texas in 2012. They were assigned by classroom (n = 20) to one of four conditions: 1) sedentary, standard lesson (n = 72); 2) sedentary academic game (n = 87); 3) low to moderate intensity PA (LMPA), academic game (n = 81); and 4) moderate to vigorous intensity PA (MVPA), academic game (n = 76). Measures included PA via accelerometer and TOT.ResultsMixed-method RMANOVA indicated TOT decreased following the standard lesson (p < 0.001), showed no change following the sedentary academic game (p = 0.68), and increased following the LMPA (p < 0.01) and MVPA (p < 0.001) academic games.ConclusionsWhile the sedentary, academic game prevented the reduction in TOT observed in the standard lesson, PA resulted in increased TOT. Future research should be designed to examine the potential academic benefits of the change in TOT.     

A meta-analysis of psycho-behavioral obesity interventions among US multiethnic and minority adults

ObjectiveThe present review examines efficacious psycho-behavioral interventions in preventing weight gains or reducing weight among US multiethnic and minority adults as few studies were conducted to review such interventions to date.MethodsData were examined from 24 controlled intervention studies, representing 23 programs and involving 13,326 adults. Studies were identified through manual and online search of databases that include MEDLINE, Academic Search Premier, ERIC, PsycARTICLES, SPORTDiscus, and CINAHL Plus.ResultsWhereas one-component (n = 5, d = 0.08, 90% CI = − 0.04, 0.35) and two-component interventions (n = 13, d = 0.22, 90% CI = 0.05, 0.40) showed a low mean effect size, three-component interventions (n = 6, d = 0.52, 90% CI = 0.39, 0.65) showed a moderate effect size. Interventions conducted in individual sessions (n = 15, d = 0.40, 90% CI = 0.24, 0.56) showed a higher mean effect size than group interventions (n = 9, d = 0.08, 90% CI = − 0.04, 0.30) although the confidence intervals overlapped.ConclusionsThe study results indicate that future obesity prevention interventions targeting multiethnic and minority adults might benefit from incorporating individual sessions, family involvement, and problem solving strategies into multi-component programs that focus on lifestyle changes.     

Association between unmet dental needs and school absenteeism because of illness or injury among U.S. school children and adolescents aged 6–17 years, 2011–2012

BackgroundWe assessed the prevalence of dental disease among U.S. children and adolescents aged 6–17 years, as well as the impact of unmet dental needs on school absenteeism because of illness/injury within the past 12 months.MethodsData were from the 2011/2012 National Survey of Children's Health (n = 65,680). Unmet dental need was defined as lack of access to appropriate and timely preventive or therapeutic dental healthcare when needed within the past 12 months. The impact of unmet dental needs on school absenteeism was measured using a multivariate generalized linear model with Poisson probability distribution (p < 0.05).ResultsWithin the past 12 months, 21.8% (10.8 million) of all U.S. children and adolescents aged 6–17 years had “a toothache, decayed teeth, or unfilled cavities.” Of all U.S. children and adolescents aged 6–17 years, 15.8% (7.8 million) reported any unmet dental need (i.e., preventive and/or therapeutic dental need) within the past 12 months. The mean number of days of school absence because of illness/injury was higher among students with an unmet therapeutic dental need in the presence of a dental condition compared to those reporting no unmet dental need (β = 0.25; p < 0.001).ConclusionsEnhanced and sustained efforts are needed to increase access to dental services among underserved U.S. children and adolescents.     

Tocilizumab therapy reduced intensive care unit admissions and/or mortality in COVID-19 patients

IntroductionNo therapy has yet proven effective in COVID-19. Tocilizumab (TCZ) in patients with severe COVID-19 could be an effective treatment.MethodWe conducted a retrospective case-control study in the Nord Franche-Comté Hospital, France. We compared the outcome of patients treated with TCZ and patients without TCZ considering a combined primary endpoint: death and/or ICU admissions.ResultsPatients with TCZ (n = 20) had a higher Charlson comorbidity index (5.3 [±2.4] vs 3.4 [±2.6], P = 0.014), presented with more severe forms (higher level of oxygen therapy at 13 L/min vs 6 L/min, P < 0.001), and had poorer biological findings (severe lymphopenia: 676/mm³ vs 914/mm³, P = 0.037 and higher CRP level: 158 mg/L vs 105 mg/L, P = 0.017) than patients without TCZ (n = 25). However, death and/or ICU admissions were higher in patients without TCZ than in the TCZ group (72% vs 25%, P = 0.002).ConclusionDespite the small sample size and retrospective nature of the work, this result strongly suggests that TCZ may reduce the number of ICU admissions and/or mortality in patients with severe SARS-CoV-2 pneumonia.