Tracking Demographic Movements and Immunization Status to Improve Children’s Access to Immunization: Field-Based Randomized Controlled Trial

BackgroundCountries’ Expanded Program on Immunization (EPI) contribute to the reduction of mortality and morbidity, but access to these vaccines remains limited in most low-income countries.ObjectiveWe aim to assess whether involving community volunteers (CVs) to track children’s vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions can improve children’s vaccination timeliness, completeness, and coverage.MethodsThis was a field-based randomized controlled trial and communities of the Foumban health district in West Cameroon were allocated to intervention or control groups. In the intervention group, a CV per community was trained to visit households monthly for a year to assess and record in a register, details of EPI-targeted children, their demographic movements and immunization status. The scanned recorded pages were sent to the health center immunization team through WhatsApp and used to organize monthly community catch-up immunization sessions. In the control group, EPI vaccination sessions were routinely conducted. Surveys were conducted at 6 and 12 months from the beginning of the intervention in both study groups to assess and compare immunization timeliness, coverage, and completeness.ResultsOverall, 30 buildings per cluster were surveyed at midline and endline. Of the 633 and 729 visited households in the intervention group at midline and endline, 630 (99.5%) and 718 (98.4%), respectively, consented to participate. In the control group, 507 and 651 households were visited and 505 (99.6%) and 636 (97.7%), respectively, consented to participate. At 12 months intervention, the month one timeliness of bacille Calmette–Guerin (BCG) vaccine did not increase in the intervention group compared with the control group for the age groups 0-11 months (adjusted odds ratio [aOR] 1.1, 95% CI 0.7-1.8) and 0-59 months (aOR 1.1, 95% CI 0.9-1.4), and significantly increased for the first-year BCG vaccine administration for the age group 0-23 months (aOR 1.5, 95% CI 1.1-2.2). The coverage of diphtheria-pertussis-tetanus and hepatitis B+Hemophilus influenzae type B (DPT-Hi +Hb) dose 3 (aOR 2.0, 95% CI 1.5-2.7) and of DPT-Hi+Hb dose 1 (aOR 1.8, 95% CI 1.4-2.4) vaccines increased significantly in the intervention group compared with the control group in the age groups 12-59 months and 12-23 months, respectively. Specific (DPT-Hi+Hb dose 1 to DPT-Hi+Hb dose 3: aOR 1.9, 95% CI 1.4-2.6) and general (BCG to measles: aOR 1.5, 95% CI 1.1-2.1) vaccine completeness increased significantly in the intervention group compared with the control group.ConclusionsFindings support that involving CVs to track children’s vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions improve children’s vaccination timeliness, completeness, and coverage. This strategy should be adopted to improve access to vaccination for EPI target populations and the consistency verified in other contexts.Trial RegistrationPan African Clinical Trials Registry PACTR201808527428720; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3548     

The Association between Diet Quality and Health Status in Mobile Food Pantry Users in Northeastern Connecticut

Low-income Americans tend to have poor diet quality and disease prevalence overall. Mobile food pantries aim to improve these outcomes, and have rarely been studied. This cross-sectional study aimed to evaluate the association between diet quality and health status in mobile food pantry users. Data were collected from two mobile food pantry sites in Northeastern Connecticut (n = 83). Sociodemographic food security and diet quality data were collected. Overall, diet quality was low among all participants with intakes of fruits, vegetables, and whole grains of concern. Participant adherence to the 2020–2025 US Dietary Guidelines were low, with no participants meeting recommendations for whole grains. Obesity, diabetes, and hypertension prevalence in this population exceeded national averages. After adjusting for covariates, hypertension was associated with higher dairy and added sugar intake, as well as a greater intake of added sugar from sugar-sweetened beverages (p < 0.05). Although results were not statistically significant, participants with obesity, diabetes, and hypertension showed a trend of having lower adherence to the guidelines than those without these chronic diseases. Questions assessing participant interest in changing their diets were also posed, indicating overall high interest in learning about current diet quality and weight improvement.     

Electromagnetic fields and the blood-brain barrier

The mammalian blood-brain barrier (BBB) consists of endothelial cells, linked by tight junctions, and the adjoining pericytes and extracellular matrix. It helps maintain a highly stable extracellular environment necessary for accurate synaptic transmission and protects nervous tissue from injury. An increase in its normally low permeability for hydrophilic and charged molecules could potentially be detrimental. Methods to assess the permeability of the BBB include histological staining for marker molecules in brain sections and measurement of the concentration of marker molecules in blood and brain tissue. Their advantages and disadvantages are discussed. Exposure to levels of radiofrequency electromagnetic fields (EMF) that increase brain temperature by more than 1 °C can reversibly increase the permeability of the BBB for macromolecules. The balance of experimental evidence does not support an effect of ‘non-thermal’ radiofrequency fields with microwave and mobile phone frequencies on BBB permeability. Evidence for an effect of the EMF generated by magnetic resonance imaging on permeability is conflicting and conclusions are hampered by potential confounders and simultaneous exposure to different types and frequencies of EMF. The literature on effects of low frequency EMF, which do not cause tissue heating, is sparse and does not yet permit any conclusions on permeability changes. Studies on the potential effect of EMF exposure on permeability of the BBB in humans are virtually absent. Future permeability studies should focus on low frequency effects and effects in humans. Care should be taken to avoid the methodological limitations of earlier studies and to determine the pathophysiological relevance of any changes found.     

Consumer views on the potential use of mobile phones for the delivery of weight‐loss interventions

Background: The surge in the incidence of obesity and being overweight demands new options to extend the reach of weight‐loss interventions. Mobile phones provide a medium for reaching large numbers of people in a cost‐effective manner. The present study aimed to explore the potential for weight‐loss interventions to be delivered via mobile phone. Methods: A mixed methods approach was employed. A telephone survey was conducted with 306 randomly selected participants, and 10 focus groups were undertaken with 54 purposively selected participants. The telephone survey comprised questions exploring the nature and acceptability of any potential weight‐loss programme that might be delivered via mobile phones. The focus groups were conducted to explore issues of acceptability in more depth than was possible in the survey. Results: Two‐thirds of participants reported support for a mobile phone weight‐loss intervention, with greater levels of support amongst younger age groups and rural Māori (the indigenous population in New Zealand). Participants liked the idea of ready access to weight‐loss information, and associated feedback and encouragement. The results suggest that interventions would need to include aspects of social support, use tailored and personalised content, and be practical and relevant so that they appeal to consumers. Appropriate methods of providing social support using a mobile phone require further exploration. Conclusions: Mobile phones may provide a novel but acceptable way to deliver a weight‐loss intervention. They have the potential to be automatically personalised and tailored to the needs of the individual, at the same time as being delivered at a population level.     

Evaluation of the Food And Nutrient Database for Dietary Studies for use with a mobile telephone food record

The development of a mobile telephone food record (mpFR) in which image analysis and volume estimation data can be indexed with the Food and Nutrient Database for Dietary Studies (FNDDS) has the potential to improve the accuracy of dietary assessment. To validate the mpFR for use with adolescents, a convenience sample of adolescents, aged 11–18 years, was recruited to eat all meals and snacks in a controlled feeding environment over a 24-h period. Each food item matched a food code in the FNDDS 3.0. The objective of this analysis was to compare the measured energy and protein content of foods to the published values in the FNDDS. Duplicate plates of all meals and snacks were prepared, and samples of 20 foods were individually weighed, homogenized, freeze dried, and analyzed for energy with a bomb calorimeter and for protein with a Dumas nitrogen analyzer. Eleven of the twenty food items had energy values in the FNDDS within ±10% of the measured energy value. The measured energy and protein values from all foods correlated significantly with the energy (r = 0.981, P < 0.01) and protein (r = 0.911, P < 0.01) values in the FNDDS. These results support the use of the FNDDS with the mpFR.     

薄层色谱法快速筛查降血糖中成药及保健食品中添加磺酰脲类化学降糖药

目的:建立快速筛查中成药及保健食品中添加磺酰脲类化学降糖药的薄层色谱方法。方法:采用硅胶 GF_(254)薄层板,三氯甲烷-环己烷-乙醇-冰醋酸(8∶12∶1∶1)为展开剂,碘化铋钾试液为显色剂测定。结果:5种磺酰脲类化学降糖药格列喹酮、格列齐特、格列美脲、格列本脲和格列吡嗪呈橙红色斑点,在中成药中的最低检出限分别为每1g 中成药中含0.2,0.3,0.2,0.1,0.2 mg。对16种18个批次的市售降糖中成药及保健食品进行筛查,检出有3种4个批次的降糖中成药及保健食品中分别添加有格列本脲和格列吡嗪。结论:本方法经济、快速简便、灵敏、准确有效。可用于药品检测车上有关中药、保健食品添加化学降糖药的快速筛查。     

野战医疗所批量伤员救治信息保障研究

根据高技术条件下战争野战医疗所大批量伤员救治的需求和特点，应用无线网络、移动计算和智能识别等相关现代信息技术，构建无线移动信息保障系统，以实时、移动、高效率的信息共享处理方式再造伤员救治信息流转流程，彻底改变了传统手工记录、反复转抄、人工传递信息的工作模式，也弥补了电子伤票和有线信息管理系统的不足，真正实现了伤员救治信息流转的数字化、自动化和现代化，实现了指挥员对伤员流、物资流的实时可知，对伤员救治全程的实时可控，极大的提高了救治效率，最大限度降低由于救治延误造成的伤死率和伤残率，为野战医疗所批量伤员快速通过提供了高效、便捷、稳定的信息保障。     

信息系统和技术在临床中的应用

文章根据医疗过程中所产生的信息特点,结合信息技术和信息系统的发展,阐述了病房移动工作站、条码系统、心电系统、手术麻醉系统在临床中的应用。     

3G移动通信在社区医疗的应用和发展

本文基于对未来社区医疗服务需求分析，并结合第三代移动通信（3G）技术，本着以人为本的服务理念，尝试把3G技术引入社区医疗信息系统，并对移动化社区医疗信息系统构建作了初步的探讨。     

建设全面过硬的机动卫勤分队

本文阐述了应急机动卫勤分队的基本情况，回顾总结了应急机动卫勤分队近年来建设的主要做法，提出了搞好应急机动卫勤分队建设必须提高认识、强化领导、舍得投入、刻苦训练和严格管理。