Predicting the distribution of under-five deaths by cause in countries without adequate vital registration systems

BACKGROUND: The absence of complete vital registration and atypical nature of the locations where epidemiological studies of cause of death in children are conducted make it difficult to know the true distribution of child deaths by cause in developing countries. A credible method is needed for generating valid estimates of this distribution for countries without adequate vital registration systems. METHODS: A systematic review was undertaken of all studies published since 1980 reporting under-5 mortality by cause. Causes of death were standardized across studies, and information was collected on the characteristics of each study and its population. A meta-regression model was used to relate these characteristics to the various proportional mortality outcomes, and predict the distribution in national populations of known characteristics. In all, 46 studies met the inclusion criteria. RESULTS: Proportional mortality outcomes were significantly associated with region, mortality level, and exposure to malaria; coverage of measles vaccination, safe delivery care, and safe water; study year, age of children under surveillance, and method used to establish definitive cause of death. In sub-Saharan Africa and in South Asia, the predicted distribution of deaths by cause was: pneumonia (23% and 23%), malaria (24% and <1%), diarrhoea (22% and 23%), 'neonatal and other' (29% and 52%), measles (2% and 1%). CONCLUSIONS: For countries without adequate vital registration, it is possible to estimate the proportional distribution of child deaths by cause by exploiting systematic associations between this distribution and the characteristics of the populations in which it has been studied, controlling for design features of the studies themselves.     

Testing the feasibility of a culturally tailored breast cancer screening intervention with Native Hawaiian women in rural churches

The authors report on the feasibility of delivering a church-based breast cancer screening intervention tailored on the cultural strengths of rural-dwelling Hawaiians. Native Hawaiian women are burdened by disproportionately high mortality from breast cancer, which is attributed to low participation in routine mammography. Mammography is proven to be an effective means for detecting disease at its earliest stages, when treatments are most likely to be successful. Culturally tailored screening programs may increase participation. Hawaiian initiatives call for screening innovations that integrate Hawaiian cultural strengths, including those related to spirituality and the extended family system. Before full-scale testing of tailored interventions, it is important to conduct feasibility studies that gauge community receptiveness to the proposed intervention and research methods. Study results establish the attractiveness and potential effectiveness of the authors' screening intervention. Recruitment exceeded targets, and retention rates were comparable to those of other randomized behavioral trials, confirming the value of reaching rural Hawaiian women through churches. Women appreciated the integrative approach of Hawaiian and faith-based values, and positive outcomes are suggested.This article may be relevant to social workers interested in culturally responsive, community-based interventions and to researchers conducting pilot studies and controlled trials of interventions adapted from evidence-based programs.     

Socioeconomic status and quality of life in population‐based Australian men: data from the Geelong Osteoporosis Study

Objective : To investigate the relationship between socioeconomic status (SES) and reported perceptions of quality of life (QOL) in a cross‐sectional population‐based analysis of a representative sample of Australian men. Methods : In 917 randomly recruited men aged 24–92 years, we measured QoL in the domains of physical health, psychological health, environment and social relationships, using the Australian World Health Organization Quality of Life Instrument (WHOQOL‐BREF). Residential addresses were cross‐referenced with Australian Bureau of Statistics 2006 census data to ascertain SES. Participants were categorised into lower, mid, or upper SES based on the Index of Relative Socioeconomic Disadvantage and Advantage (IRSAD), the Index of Economic Resources (IER), and the Index of Education and Occupation (IEO). Lifestyle and health information was self‐reported. Results : Males of lower SES reported poorer satisfaction with physical health (OR=0.6, 95%CI 0.4–0.9, p=0.02), psychological health (OR=0.4, 95%CI 0.3–0.7, p<0.001) and environment (OR=0.5, 95%CI 0.3–0.7, p<0.001), although not social relationships (p=0.59). The poorest QOL for each domain was observed in the lower and upper SES groups, representing an inverse U‐shaped pattern of association; however, statistical significance was only observed for psychological health (OR=0.5, 95%CI 0.4–0.7, p<0.001). These relationships were similar for IEO and IER. Conclusions : Men from lower and upper SES groups have lower QOL compared to their counterparts in the mid SES group.     

Time of Arrival Analysis in NC DETECT to Find Clusters of Interest from Unclassified Patient Visit Records

Objective

To describe a collaboration with the Johns Hopkins Applied Physics Laboratory (JHU APL), the North Carolina Division of Public Health (NC DPH), and the UNC Department of Emergency Medicine Carolina Center for Health Informatics (CCHI) to implement time-of-arrival analysis (TOA) for hospital emergency department (ED) data in NC DETECT to identify clusters of ED visits for which there is no pre-defined syndrome or sub-syndrome.

Introduction

TOA identifies clusters of patients arriving to a hospital ED within a short temporal interval. Past implementations have been restricted to records of patients with a specific type of complaint. The Florida Department of Health uses TOA at the county level for multiple sub-syndromes (1). In 2011, NC DPH, CCHI and CDC collaborated to enhance and evaluate this capability for NC DETECT, using NC DETECT data in BioSense 1.0 (2). After this successful evaluation based on exposure complaints, discussions were held to determine the best approach to implement this new algorithm into the production environment for NC DETECT. NC DPH was particularly interested in determining if TOA could be used for identifying clusters of ED visits not filtered by any syndrome or sub-syndrome. In other words, can TOA detect a cluster of ED visits relating to a public health event, even if symptoms from that event are not characterized by a predefined syndrome grouping? Syndromes are continuously added to NC DETECT but a syndrome cannot be created for every potential event of public health concern. This TOA approach is the first attempt to address this issue in NC DETECT. The initial goal is to identify clusters of related ED visits whose keywords, signs and/or symptoms are NOT all expressed by a traditional syndrome, e.g. rash, gastrointestinal, and flu-like illnesses. The goal instead is to identify clusters resulting from specific events or exposures regardless of how patients present – event concepts that are too numerous to pre-classify.

Methods

In late 2011, NC DPH and JHU APL signed a Software License Agreement and soon thereafter CCHI received the TOA software package. In May 2012, the TOA controller was adapted and set up to run against ED visit data for all NC DETECT hospitals. The TOA looks for clusters in all ED visits by hospital based solely on arrival time in both 30-minute and 60-minute intervals. There is no pre-classification of the chief complaints or triage notes into syndromes. TOA alerts are viewable on the NC DETECT Web application and, as of August 2012, users are able to document any actions taken on these alerts.

Results

From April 15, 2012 to July 31, 2012, TOA generated 173 alerts across all 115 hospitals reporting to NC DETECT. The TOA identified a group of scabies-related ED visits that was not captured in another syndrome. The TOA also identified clusters identified by hospitals as disaster-related which included misspellings that had not been previously identified, e.g. “diaster” and “disater,” as well as events involving out-of-town groups that will not be identified spatially (

Prevalence and Risk Factors of Urinary Incontinence Among Jordanian Women: Impact on Their Life

We estimate the prevalence and type of urinary incontinence (UI), possible associated risk factors, and the impact of UI on women's social and psychological well-being. The sample consisted of women attending a family medicine clinic at Jordan University Hospital (JUH) who answered a self-administered questionnaire. More than one-third of the sample reported the presence of UI. Stress type was the most frequently reported risk factor, followed by mixed incontinence, then urge. Age, diabetes, chronic cough, parity, and hysterectomy were positively associated with the presence of UI. Incontinence caused low self-esteem in more than half of the women who experienced it.     

Increasing dietetic referrals: Perceptions of general practitioners,practice nurses and dietitians

Aim: To examine Australian private practice dietitians' relationships with general practitioners and practice nurses as a factor that influences dietetic referrals. Methods: Semistructured telephone interviews and an online survey were conducted with Australian private practice dietitians (n = 52 and n = 90, respectively) between April and May 2008. Semistructured questionnaires were conducted with general practitioners (n = 11) and practice nurses (n = 12) from the ‘GP Access’ Division of General Practice between March and July 2007. Results: General practitioners' relationships with dietitians were believed to be the primary influencing factor on referral, provided by 81% of survey dietitians and 25% of interview dietitians. The most common means of initially forming relationships with general practitioners were face‐to‐face introduction (48%) and introductory letters (37%). Patient feedback via letter, fax or email was the most popular method of maintaining relationships with general practitioners (77%). Meeting with general practitioners in person was believed to be the most effective activity in building relationships with general practitioners and increasing referral rates (42%). Referral was made easier for general practitioners by providing paper (37%) or electronic (19%) referral forms and contact details (19%). The majority of general practitioners and dietitians believed that the ‘Allied Health Services Under Medicare’ made it easier to refer to a dietitian. Conclusions: Dietetic referrals can be encouraged through good relationships between general practitioners, practice nurses and dietitians. Private practice dietitians would benefit from cultivating relationships with general practitioners and practice nurses through personal contact and providing good patient feedback.     

Introduction: Progress and issues in drug treatment courts

The first drug treatment court began in Miami, Florida in 1989, in direct response to the backlog of court cases for drug possession and trafficking. By mid-2001, there were 700 operational drug treatment courts and 400 more in the planning stages in the United States. In addition to providing an overview of the growth and development of drug treatment courts in the United States, this special issue examines their development in Australia, Canada, and the United Kingdom. The primary focus is the evaluation research conducted to date, which identifies some of the critical unresolved issues facing drug treatment courts.     

Solubility of E2050 at various pH: a case in which apparent solubility is affected by the amount of excess solid

The solubility of E2050, supplied as a dihydrochloride salt, in aqueous solutions at different pHs was studied. Two pK(a)s controlling the equilibrium between the various protonated species were determined. The solubility-pH profile of E2050 is expected to be high in acidic solutions because protonated species are formed and to be low in alkaline conditions due to the formation of hydrophobic free base. The solubility is also affected by chloride ion, a common ion for this drug substance. Two solubility products (K(sp)) were determined corresponding to the solubility of di-HCl salt and mono-HCl salt. Based on the pK(a)s (3.10 and 7.71), the solubility products with chloride (2.92 and 3.77 as corresponding pK(sp)), and the solubility of free base (2 x 10(-5) M), the solubility in solutions with different pH and different levels of chloride ion can be predicted. The prediction of the solubility change during the dilution of E2050 parenteral formulations by saline was also demonstrated. Furthermore, the present study presents an interesting example in which an apparent solubility can be different if varying (excess) amounts of salt are added to the solution. In this case, excess chloride ion suppresses the solubility in the pH region where mono-HCl salt controls the solubility.     

Wall-eyed bilateral internuclear ophthalmoplegia (Webino syndrome) and myelopathy in pyoderma gangrenosum

A 35-year-old female with pyoderma gangrenosum developed paraparesis with a sensory level at L1. Three months later she complained of diplopia and was found to have bilateral internuclear ophthalmoplegia with exotropia and no ocular convergence. The term Webino syndrome has been coined to design this set of neuro-ophthalmologic findings. Although it was initially attributed to lesions affecting the medial longitudinal fasciculus and the medial rectus subnuclei of the oculomotor complex in the midbrain the exact location of the lesion is still disputed. In the present case both myelopathy and Webino syndrome were probably due to vascular occlusive disease resulting from central nervous system vasculitis occurring in concomitance to pyoderma gangrenosum.     

Hierarchy of simulation models in predicting structure and energetics of the Src SH2 domain binding to tyrosyl phosphopeptides.

Structure and energetics of the Src Src Homology 2 (SH2) domain binding with the recognition phosphopeptide pYEEI and its mutants are studied by a hierarchical computational approach. The proposed structure prediction strategy includes equilibrium sampling of the peptide conformational space by simulated tempering dynamics with the simplified, knowledge-based energy function, followed by structural clustering of the resulting conformations and binding free energy evaluation of a single representative from each cluster, a cluster center. This protocol is robust in rapid screening of low-energy conformations and recovers the crystal structure of the pYEEI peptide. Thermodynamics of the peptide-SH2 domain binding is analyzed by computing the average energy contributions over conformations from the clusters, structurally similar to the predicted peptide bound structure. Using this approach, the binding thermodynamics for a panel of studied peptides is predicted in a better agreement with the experiment than previously suggested models. However, the overall correlation between computed and experimental binding affinity remains rather modest. The results of this study show that small differences in binding free energies between the Ala and Gly mutants of the pYEEI peptide are considerably more difficult to predict than the structure of the bound peptides, indicating that accurate computational prediction of binding affinities still remains a major methodological and technical challenge.