Vision impairment and cognitive function among urban-dwelling malaysians aged 55 years and over from the Malaysian Elders Longitudinal Research (MELoR) study

IntroductionPublished literature on vision impairment and cognitive function amongst older Malaysians remains scarce. This study investigates the association between vision impairment and cognitive function in an older Malaysian population.MethodsSubjects aged 55 years and above from the Malaysian Elders Longitudinal Research (MELoR) study with available information on vision and Montreal Cognitive Assessment (MoCA) scores were included. Data were obtained through a home-based interview and hospital-based health check by trained researchers. Visual acuity (VA) was assessed with logMAR score with vision impairment defined as VA 6/18 or worse in the better-seeing eye. Cognition was evaluated using the MoCA-Blind scoring procedure. Those with a MoCA-Blind score of <19/22 were considered to have cognitive impairment.ResultsData was available for 1144 participants, mean (SD) age = 68.57 (±7.23) years. Vision impairment was present in 143 (12.5 %) and 758 (66.3 %) had MoCA-Blind score of <19. Subjects with vision impairment were less likely to have a MoCA-Blind score of ≥19 (16.8 % vs 36.2 %, p < 0.001). Vision impairment was associated with poorer MoCA-Blind scores after adjustments for age, gender, and ethnicity (β = 2.064; 95 % CI, −1.282 to 3.320; P = 0.003). In those who had > 6 years of education attainment, vision impairment was associated with a significant reduction of cognitive function and remained so after adjustment for age and gender (β = 1.863; 95 % CI, 1.081–3.209; P = 0.025).ConclusionOur results suggest that vision impairment correlates with cognitive decline. Therefore, maintaining good vision is an important interventional strategy for preventing cognitive decline in older adults.     

Molecular inference of sources and spreading patterns of Plasmodium falciparum malaria parasites in internally displaced persons settlements in Myanmar–China border area

In Myanmar, civil unrest and establishment of internally displaced persons (IDP) settlement along the Myanmar–China border have impacted malaria transmission. The growing IDP populations raise deep concerns about health impact on local communities. Microsatellite markers were used to examine the source and spreading patterns of Plasmodium falciparum between IDP settlement and surrounding villages in Myanmar along the China border. Genotypic structure of P. falciparum was compared over the past three years from the same area and the demographic history was inferred to determine the source of recent infections. In addition, we examined if border migration is a factor of P. falciparum infections in China by determining gene flow patterns across borders. Compared to local community, the IDP samples showed a reduced and consistently lower genetic diversity over the past three years. A strong signature of genetic bottleneck was detected in the IDP samples. P. falciparum infections from the border regions in China were genetically similar to Myanmar and parasite gene flow was not constrained by geographical distance. Reduced genetic diversity of P. falciparum suggested intense malaria control within the IDP settlement. Human movement was a key factor to the spread of malaria both locally in Myanmar and across the international border.     

Influenza vaccine uptake in the elderly population: Individual and general practitioner’s determinants in Central Italy,Lazio region, 2016–2017 season

BackgroundElderly people are a priority target group for influenza vaccination and their decision to be vaccinated might partly depend on advice received from general practitioners (GP). This study aims to investigate the association between influenza vaccine uptake in the elderly residents in the Lazio region of Italy and the demographic and professional characteristics of their GPs, taking simultaneously into account the elderly’s individual characteristics.MethodsWe used data retrieved from different administrative sources to retrospectively analyse the cohort of 1,255,657 elderly residents aged ≥65 years who were alive and registered in the regional healthcare service at the beginning of the 2016–2017 influenza vaccination campaign (1 Oct. 2016–31 Jan. 2017). We assessed influenza vaccine uptake at the end of the vaccination campaign and evaluated its association with both individual and GP-related characteristics through a multilevel Poisson regression models accounting for clustering at physician level.ResultsOverall, vaccination coverage at the end of vaccination campaign was 50.6%. Elderly residents who were male, older, vaccinated in the previous seasons, living in smaller provinces, and spending more money for specialist medical care showed a significantly increased probability to be vaccinated. Vaccine uptake was also significantly higher in the elderly residents assisted by GPs who got master’s degree more recently, assisted a relatively high proportion of elderly patients, received influenza vaccination, had a computer assistant, and were associated with other physicians.ConclusionsOur results indicate that influenza vaccination coverage in the elderly residents of the Lazio region is still unsatisfactorily low. We identified several determinants of influenza vaccine uptake, related to both individual and GP characteristics. Understanding how GP characteristics affected influenza vaccine uptake in the elderly population might provide insight on GPs’ attitudes and concerns regarding influenza vaccination, allowing the implementation of targeted evidence-based interventions to sensitise GPs and increase vaccination coverage.     

Mass media effect on vaccines uptake during silent polio outbreak

BackgroundDuring 2013, isolation of a wild type 1 poliovirus from routine sewage sample in Israel, led to a national OPV campaign. During this period, there was a constant cover of the outbreak by the mass media.AimsTo investigate the association of media exposure and OPV and non-OPV vaccines uptake during the 2013 silent polio outbreak in Israel.MethodsWe received data on daily immunization rates during the outbreak period from the Ministry of Health (MoH). We conducted a multivariable time trend analysis to assess the association between daily media exposure and vaccines uptake. Analysis was stratified by ethnicity and socio-economic status (SES).ResultsDuring the MoH supplemental immunization activity, 138,799 OPV vaccines were given. There was a significant association between media exposure and OPV uptake, most prominent in a lag of 3–5 days from the exposure among Jews (R.R 1.79C.I 95% 1.32–2.41) and high SES subgroups (R.R 1.71C.I 95% 1.27–2.30). These subgroups also showed increased non-OPV uptake in a lag of 3–5 days from the media exposure, in all vaccines except for MMR. Lower SES and non-Jewish subgroups did not demonstrate the same association.ConclusionOur findings expand the understanding of public behaviour during outbreaks. The public response shows high variability within specific subgroups. These findings highlight the importance of tailored communication strategies for each subgroup.     

Application of UPLC-MS/MS Method for Analyzing B-vitamins in Human Milk

Objective To determine ten B-vitamins in human milk by ultra-high performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS).
Methods The pretreated human milk samples were adequately separated and quantified within 11 min by UPLC-MS/MS with an Acquity UPLC HSS T3 column (2.1×100 mm, 1.8 μm). The mobile phase was a gradient of 2.5 mmol/L ammonium formate aqueous solution and acetonitrile at a flow rate of 0.35 mL/min. Stable isotope internal standards were used in the analysis, to correct for the method variability, including matrix and ionization effects. The homogenized human milk samples were deproteinzed using methanol, unknown contaminants were extracted with diethyl ether and hydrophobic phase was discarded. The analytes were monitored via ESI+ionization and detected in multiple reaction monitoring (MRM) with three acquisition functions.
Results Calibration curves ranged from 0.5-160 ng/mL (thiamin, riboflavin, biotin, nicotinic acid, pyridoxine, pyridoxamine, pyridoxal), and 2.5-800 ng/mL (pantothenic acid, FAD and nicotinamide) (R2=0.990-0.999). The relative recovery ranged from 80.1% to 120.2%; accuracy was determined to be 98.3% to 108.0%. Intra-day and inter-day variation were 3.4%-19.9% and 5.9%-18.1%, respectively. The limit of quantification (LOQ) for all vitamins was between 0.25 and 3 μg/L.
Conclusion This method was successfully applied for simultaneous analysis of ten B-vitamins in human milk.     

Waning of measles maternal antibody in infants in measles elimination settings – A systematic literature review

IntroductionMost infants are born with immunity to measles through maternal antibodies transferred in pregnancy, which decay over time. However, in measles elimination settings, where measles does not circulate endemically and most immunity is from immunization rather than infection, maternal antibody levels are lower. This results in infant immunity that wanes earlier, and a wider susceptibility gap between maternal antibody decay and infant immunization than in non-eliminated settings. We aimed to systematically quantify the extent and duration of protection from measles in infants in settings that have sustained measles elimination.MethodsWe conducted a systematic review of studies of measles maternal antibody waning in infants in measles elimination settings. We searched MEDLINE, Embase, CINAHL, Scopus, BIOSIS Previews, and Global Health databases for relevant studies. Studies were included if they were set in countries that had eliminated measles for ≥3 years, and if the study cohort included healthy, full-term, unvaccinated infants ≤12 months, born to healthy mothers, and reported a relevant measure of measles maternal antibody in infants. We assessed study quality using the MetaQAT tool.ResultsWe identified 4692 unique citations, eight of which met inclusion criteria. One study reported anti-measles antibody in cord blood, six reported antibody in infant sera, and one reported both. Two studies reported that 80 and 100% of infants were protected from measles at birth. One study reported no protection amongst 3–7 month old infants, and another reported limited protection in infants >4 months. The remaining studies reported the proportion of infants with detected antibody, but not the proportion immune.ConclusionAlthough limited, these data suggest that in settings that have sustained measles elimination, some infants are susceptible to measles well before the age of routine measles immunization. Setting-specific seroprevalence and vaccine effectiveness studies are required to evaluate this in different jurisdictions.     

Consequence of enhanced LC3-trafficking for a live,attenuated M. tuberculosis vaccine

Development of a new vaccine against tuberculosis is urgently needed. Recent work has demonstrated that two related LC3-associated trafficking pathways, autophagy and LC3-associated phagocytosis (LAP), enhance antigen presentation and might play a role in vaccine efficacy. Mycobacterium tuberculosis inhibits both LC3-trafficking pathways. Moreover, the vaccine strain, BCG, induces even less LC3-trafficking than M. tuberculosis, which may help explain its limited efficacy. To determine whether enhanced LC3-trafficking can improve efficacy of a live, attenuated M. tuberculosis vaccine, we took advantage of our recent finding that the bacterial virulence factor CpsA inhibits LAP. When we deleted cpsA in the mc²6206 vaccine strain, it dramatically increased LC3-trafficking. We compared the protective efficacy of the strain lacking cpsA to the parent strain and to BCG in mice challenged with M. tuberculosis. We found that the strain lacking cpsA generated modestly enhanced protection in the spleen, but overall did not outperform BCG.     

Delay of adjuvant radiotherapy due to postoperative complications after oncoplastic breast conserving surgery

BackgroundIn the past a mastectomy was the first approach of treating breast cancer. Oncoplastic techniques combined with breast conserving surgery (BCS) and radiotherapy has become an alternative to mastectomy in patients with non-metastasized breast cancer. The aim of this study was to analyse the amount and types of complications occurring after oncoplastic BCS before and after adjuvant radiotherapy and the delay of adjuvant therapy due to the complications.MethodA retrospective study based on all patients who received immediate oncoplastic BCS by a plastic surgeon at two medical hospitals in The Netherlands between 2013 and 2015. (n = 150). The performed oncoplastic BCS techniques were the primary outcome measures. In particular major complications with the need for antibiotics or surgical intervention. A one-year follow-up was achieved for all patients.Results52% of the 150 included patients received an oncoplastic BCS through the reduction pattern, 35% with a LICAP and 10% with an AICAP. Complications occurred in 37.5% of the patients, 10% of the patients needed treatment with antibiotics and in 6.6% of the patients a revision operation was indicated. 79.6% of all postoperative complications occurred before the start of adjuvant radiotherapy. In 8.2% of the patients the adjuvant radiotherapy had to be delayed due to a complication.ConclusionThis study provides a detailed overview of the used techniques of oncoplastic BCS and their postoperative complications. Most complications occurred before the start of the adjuvant radiotherapy. Just a small amount caused a delay for the radiotherapy to start.