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Jul 2021 DOI 10.14302/issn.2769-2264.jw-21-3870
Danielly da Silva Lopes IrisCorresponding author
Universidade Federal Rural da Amazônia. Instituto Sócio Ambiental e Recursos Hídricos. Avenida Presidente Tancredo Neves, 2501-Terra Firme. Belém-PA. Brasil. CEP: 66077-530.
In this study, were multivariate analysis of the waters of the Arienga and Murucupí rivers located near an area of intense industrial activity in the Barcarena City, Pará State, Brazil. Were analyzed the variables temperature, pH, total dissolved solids, electrical conductivity, DO, BOD, ammoniacal-N, nitrite-N, nitrate-N, phosphate, sulfate and total hardness in four sampling campaigns in the year 2011. This amazon rivers presented physicochemical characteristics well heterogeneous, but similar behaviors for the variables pH, temperature and DO in the extensions evaluated, that is, increase in the source-mouth direction, with variations from 4.77 to 7.33 and 5.51 to 7.3, 25 to 31°C and 27 to 32°C and from 4.4 to 7.98 mg.L-1 and 1.17 to 6.55 mg.L-1 for the Arienga and Murucupi rivers respectively. In addition to these characteristics, the Arienga River also presented an increase for ammoniacal-N, nitrite-N, nitrate-N and hardness in the dry period, with variations from 0.014 to 6.336 mg.L-1, 0.005 to 0.334 mg.L-1, 0.009 to 4.818 mg.L-1 and 1.146 to 14.389 mg.L-1 respectively. In general, Murucupí River presented different physicochemical characteristics that are coherent with the local scenario, where the launch domestic effluents and the environmental impacts caused by industrial waste are visible and recurrent respectively.
Jul 2017 DOI 10.14302/issn.2476-1710.jdt-17-1564
Caroline Krefis AnneCorresponding author
Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany
The objective of this first part of our study was to investigate associations of road traffic noise, socioeconomic and -demographic risk factors, and health access on depression on borough level. We investigated in a large metropolis associations between prevalence rates of depression per borough (n = 67 boroughs) in all age groups (excluding the age group of 0–17 years) using health claims data (year 2011) and the variables “social deprivation” and “number of family members”, which were obtained from a previously conducted principal component analysis, and by using multivariate regression model. Additionally, the proportion of borough area affected by noise > 65 db(A) and physician density used as a surrogate parameter for health access were considered as potentially associated factors for depression. The results demonstrated that depression might be associated with increasing social borough deprivation. Additionally, the number of family members used as a proxy measure for positive family support showed decreasing prevalence rates the more family members were present. Furthermore, proportions of borough areas affected by noise > 65 db(A) was positively associated with depression. Our ecological study design has the advantage that a large number of large-scale, population-based aggregated data could easily be obtained and analysed and first potential associations could be found and discussed. To improve our findings, future studies will use data from a survey and data from the Hamburg City Health Study, a local follow-up health study, to better elucidate the individual risk factors together with environmental living and working conditions.
Jul 2024 DOI 10.14302/issn.2641-4538.jphi-24-5017
V K SashindranCorresponding author
Background Frailty is an ageing-associated state linked to poor prognostic outcomes. Chronic inflammation due to HIV-infection, AIDS-related infections. and the adverse effects of antiretroviral therapy (ART) all contribute to frailty in people living with HIV/AIDS (PLHA). Frailty has been comprehensively studied in populations comprising predominantly of Caucasian PLHA. However, there remains a dearth of such data in Indian populations, especially in younger PLHA. Methodology This cross-sectional study aimed to estimate the prevalence of frailty in PLHA (18 - 50 years) who had been on ART for 24-60 months and identify markers linked to frailty. Frailty was assessed in 152 subjects using the Fried frailty-index. Parameters measured included the mid-upper arm and calf circumferences, pain-severity (using the Brief Pain Inventory), highly-sensitivity C-reactive protein, d-dimer, and interleukin-6. Results The prevalence of frailty and pre-frailty were 6.58% and 23.02%, respectively. Reduced grip strength and self-reported exhaustion were associated with frailty (15.79% and 13.16%, respectively). Low calf-circumference and mid-upper arm circumference were not significantly associated with frailty/pre-frailty. The prevalence of pain was 21.7% and both pain severity and pain interference were significantly associated with frailty/pre-frailty. CD-4 counts at the time of assessment showed an inverse association with frailty. Elevated C-reactive protein (CRP of 0.04 associated with 0.49 probability of frailty (95% CI 0.40 – 0.59), CRP of 0.12 associated with 0.63 probability of frailty (95% CI 0.47 – 0.76)). D-dimer levels were not significantly associated with frailty /pre-frailty. Conclusion In this first-of-its-kind study on frailty in young PLHA (mean age 37 years) from the Indian sub-continent, the prevalence of frailty and pre-frailty was 6.58% and 23.02%, respectively. Multivariate analysis showed a strong association of frailty with pain severity, CD4 count at time of assessment, hs-CRP levels and duration of ART.
Feb 2024 DOI 10.14302/issn.2693-1176.ijgh-23-4879
Lin Shih-PingCorresponding author
Background Cancer and diabetes are risk factors for COVID-19 mortality rates. Remdesivir, dexamethasone, and vaccines are used to improve clinical outcomes. We aimed to evaluate the factors associated with COVID-19 mortality rates. Methods This retrospective study enrolled moderate to critical COVID-19 patients. The index day was the day of the COVID-19 diagnosis. Patients were followed up until either death or discharge. A two-way analysis of variance examined the interaction between independent mortality risk factors. Results A total of 205 patients were analyzed, and the mortality rate was 29.5% (n=60/205). The cumulative survival rate was significantly lower in patients with a CCI score ≥ 6, cancer, and diabetes. In multivariate analysis, critical illness, cancer, diabetes, chronic liver disease, a CCI score ≥ 6, unvaccinated, and early use of remdesivir/dexamethasone were independent risk factors for mortality. The onset of remdesivir/dexamethasone ≥ 2 days and < 3 doses of vaccinations were higher mortality rate, with its impact being more significant amongst patients with cancer/diabetes, compared to those without cancer/diabetes (p for interaction = 0.046/0.049, 0.060/0.042, and 0.038/0.048 respectively). Conclusions COVID-19 vaccination ≥ 3 doses and early administration of remdesivir and dexamethasone can significantly reduce mortality rates, particularly in patients with cancer or diabetes.
Oct 2022 DOI 10.14302/issn.2641-5518.jcci-22-4323
Y. Fernando GracieuxCorresponding author
Consultant, Section of Medical Oncology-Department of Internal Medicine, University of the Philippines-College of Medicine Philippine General Hospital, Manila
Introduction Primary sarcomas of the breast are <0.1% of all malignant tumours of the breast. To date, there are 13 major breast sarcoma series in English literature. This study adds to these series characterizing primary breast sarcoma among Philippine patients. Methods All breast biopsies from the pathology records of the University of the Philippines-Philippine General Hospital (UP-PGH) were searched for breast sarcoma cases from January 2000 to December 2010. Metaplastic carcinomas and phyllodes tumors were excluded. Results There were 52 patients (45 female, 7 male) ranging in age 25-83 years (median 46 years). Majority had lump, ten cases with pain. No history of previous cancer was given. No history of prior radiation was found. Histopathological diagnoses were spindle cell sarcoma (n=13), fibrosarcoma (n=6), liposarcoma (n=6), MPNST (n=5), stromal sarcoma (n=5), angiosarcoma (n=4), MFH (n=4), leiomyosarcoma (n=3), rhabdomyosarcoma (n=3), chondrosarcoma (n=2), and synovial sarcoma (n=1). Tumors were with grade 1 (n=18), grade 2 (n=8), and grade 3 (n=10). Necrosis was noted in 6 cases. Simple mastectomy was done in 19 cases (37%), MRM in 31 cases (59%), while 2 far advanced had no surgery (3%). None had adjuvant radiotherapy or chemotherapy. The duration of follow-up for 45 patients ranged from 1 – 117 months, excluding those who were lost to follow-up. All 15 deaths were due to progressive disease. Recurrences were observed in 9 patients. The disease-free survival (DFS) and overall survival (OS) was 73%and 75%, respectively. On multivariate analysis, DFS and OS were significantly correlated with size (HR=113.63; p=0.019 and HR=77.36; p=0.037), grade (HR=20.73 ; p=0.003andHR= 39.57; p= 0.004), and having a histology of angiosarcoma (HR=35.20 ; p=0.005and HR= 50.74; p=0.007), respectively. Conclusion Sarcoma remains an important clinical entity among primary breast cancers.
Oct 2022 DOI 10.14302/issn.2641-4538.jphi-22-4325
Rutayisire ErigeneCorresponding author
Department of public Health, Mount Kenya University Rwanda Kigali Rwanda
The aim of this study is determine the prevalence and factors associated with caesarean section among women delivered at Kirehe District Hospital. A retrospective study was conducted among women delivered at Kirehe District Hospital from January 2018 to December 2019. The medical files of all women delivered at the hospital who meet the inclusion criteria were reviewed. Data were checked for completeness, cleaned, coded and entered into excel sheet, and then exported to SPSS version 22.0 for further analysis. Descriptive statistics was used to estimate the prevalence and description of study participants. Multivariable logistic regression models were used to estimate risk for CS with 95% confidence intervals (CIs). The study was conducted in accordance with the research protocol Mount Kenya University Rwanda research ethical committee. The majority 806 (69.9%) of women who delivered at Kirehe district hospital from January 2018 to December 2019 were aged 22-35 years old. The prevalence of C-section at Kirehe District Hospital was 23.1%. Demographic and economic factors associated with Caesaren section in bivariate and multivariate analysis was respondent’s type of health insurance where women who used private health insurance were 3 times more likely to deliver by C-section. The findings from multivariate analysis revealed that women who experienced eclampisa had 45% risk of C-Setion compared to those without Eclampsia. Women in rural area of Rwanda seem to have increased access to and use of CS. However, the significant increase in the rate of CS is of concern due to the potential of unnecessary CS.
Oct 2021 DOI 10.14302/issn.2643-6655.jcap-21-3922
Ghazal ZandkarimiCorresponding author
Refah University, Tehran, Iran
This study aimed to evaluate acceptance and commitment therapy (ACT) effectiveness in reducing high-risk behaviors and elevating problem-solving strategies in adolescents with addiction susceptibility in cyberspace. This study is longitudinal with quantitative methods of data collection and analysis. The target community in this research was 60 female students randomly selected from a Persian high school in Iran. Participants were randomly divided and placed equally into the experimental and control groups. The participants’ entry criteria were gender, aged from 15 to 18 years, addiction susceptibility, and high-risk behaviors cut-off points. Eight training sessions of ACT were presented in cyberspace for the experimental group between the pre-test and post-test intervals. Data collection instruments were the Iranian youth risk-taking scale, problem-solving strategies, and Iranian adolescents’ addiction susceptibility questionnaires. Participants were followed up after two months. The results using multivariate analysis of among subjects ANOVA showed ACT significantly influenced high-risk behaviors and its’ sub-scales except for the violence (p < .001).Furthermore, ACT affected the problem-solving strategies and its’ sub-scales instead of control, creativity, and confidence (p < .001). According to the findings, ACT decreased high-risk behaviors such as drug abuse, smoking, and unprotected sexual behaviors. These changes might be due to decreased helplessness and avoidance as well as increased acceptance and tendency to solve problems. Instead, problem-solving strategies were improved through ACT cyber treatment.
May 2020 DOI 10.14302/issn.2641-4538.jphi-20-3324
Rutayisire ErigeneCorresponding author
Department of public Health, Mount Kenya University Rwanda Kigali Rwanda
Knowledge of tuberculosis has been shown to influence health seeking behaviour. The study aim was to assess knowledge of tuberculosis and identify the associated factors. This study was a cross sectional descriptive research design with quantitative approach. The target population was the TB patients visited health facilities in Gakenke District. A sample of 376 TB patients was randomly selected from three health centers. Interview-administrated structured questionnaire was used to collect data from 376 TB patients. Data was analyzed with SPSS-version 22. The study protocol was approved by Mount Kenya University Rwanda. The majority of respondents 71.0% were male, 51.6% were aged 45 years and above, 81.9% were married, and 65.2% had completed primary education. Few respondents identified a germ as the cause of TB (24.7%). This study revealed that 54.3% of TB patients had good knowledge about TB. The findings from multivariate analysis show that male were three times more likely to have good knowledge about TB compared to female (AOR=3.31, 95%CI: 1.98-5.53, p<0.001). Compared to TB patients aged 45 years and above, respondents aged 25-34 years old were more likely to have good knowledge about TB (AOR=38.71, 95%CI: 9.22-162.48, p<0.001). TB patients who live between 2-5 km from nearest health facility were more likely to have good knowledge about TB compared to those who live at more than 5 km (AOR=33.58, 95%CI: 14.95-74.40, p<0.001). The ministry of health and other stakeholders in health sector need to continue the interventions that aim to reduce TB infection.
May 2018 DOI 10.14302/issn.2381-862X.jwrh-18-2074
Olukemi Bello OluwasomidoyinCorresponding author
Department of Obstetrics and Gynaecology, University College Hospital.
Objective: To determine the prevalence and risk factors of non-fistulous urinary incontinence (UI) among non-parturient women at University College Hospital, Ibadan, Nigeria. Methods: A hospital based cross sectional study of 500 non-parturient women presenting with non- fistulous gynaecological symptoms at the University College Hospital, Ibadan. An interviewer administered questionnaire was used to obtain information. Data were analyzed using SPSS version 20. Data analysis involved descriptive statistics, bivariate and multivariate analysis to determine the risk factors of urinary incontinence. Results: Mean age was 36.61 (SD=10.1) years and almost all (83.2%) were married. Prevalence of urinary incontinence is 21.4%. Majority (40.6%) had symptoms of stress urinary incontinence and 8.0% had urge urinary incontinence. Only 19.6% of those who leaked urine in the last one month sought medical attention despite visiting the hospital for other ailment(s), while of those that had ever leaked urine, 13.1% of them ever sought medical attention. Risk factors for UI were age at first delivery (OR=21.21, 95%CI=2.179-206.478), marital status (OR=0.142, 95%CI=0.044-0.454), chronic illness (OR=3.987, 95%CI=2.147-7.405) and history of prolonged labour (OR=3.111, 95%CI=1.584-6.110). Conclusion: UI is not uncommon in Nigeria. The identified predisposing factors were low age at first delivery, history of prolonged labour and chronic illness. There is need to sensitize women of the symptoms and complications associated with urinary incontinence as well as its prevention and need to seek medical care if they have the symptoms.
Oct 2016 DOI 10.14302/issn.2574-450X.jom-16-1003
Daniel CottamCorresponding author
Introduction: The Roux-en-Y Gastric Bypass (RYGB) has been one of the most popular surgeries in the USA for years. While many models have been made to investigate the factors that affect weight loss, these factors are still highly debated. Objective: To create a model that predict performance of RYGB patients. Methods: 110 out of 344 patients who received a RYGB at a single institution between Jan 2010 and April 2014 were included in this study. Data was collected retrospectively. Patients were included if they had greater than 1 year follow up with at least three follow up points and could be modeled with r2>0.95. All patients were one year beyond surgery, while 40 were completely lost to follow up, 104 at 1 month, 138 at 3 months, 188 at 6 months, and 225 at one year. 9 patients were not included because they did not meet the criteria of the study. Patients were divided into quartiles based on percentage excess weight loss (%EWL) at one year. Multivariate analysis was performed to determine the significant factors that influence patients being in the first quartile of weight loss (17-60% %EWL). Results: Only males with a Body Mass Index (BMI) above 44 and females with a BMI above 64 were found to be predictive of patients being in the first quartile. Our model has Positive and Negative predictor values of 66% and 80% respectively with sensitivity and specificity of 29% and 95% respectively. Conclusions: An model to predict %EWL was created, only gender and pre-operative BMI were found to be significant factors. In general females have better outcomes with higher BMI’s than do males. This information should be discussed with patients when deciding a procedure. However, more studies are needed for validation of these results.
Jul 2016 DOI 10.14302/issn.2574-4526.jddd-16-1203
Mark R. BorgaonkarCorresponding author
Background: Iron deficiency is a common reason for referral to a gastroenterologist. Objective: To identify predictors of colorectal cancer in patients referred to a gastroenterologist for iron deficiency. Methods: This was a retrospective review of consecutive patients referred to one of two gastroenterologists for assessment of iron deficiency. The office files and electronic health records were reviewed for all patients. Clinical data, such as hemoglobin level, and clinical symptoms were recorded. The final diagnosis was that of the attending gastroenterologist. Variables associated with a diagnosis of colorectal cancer by univariate analysis were entered into a multivariate logistic regression model to identify variables independently associated with the diagnosis of colorectal cancer. Results: Two hundred and seventy eight patients were included in this study. One hundred and fifty-eight (56.8%) were female. Mean age was 60.7 years (± 16.7 years). The most common causes of iron deficiency were: menorrhagia 16.2%, colorectal cancer 14%, use of aspirin or non-steroidal agents 11.2% and regular blood donation 7.2%. In 11.5% of patients, no cause was found. In univariate analysis, lower hemoglobin, greater age, shorter duration of iron deficiency, weight loss, symptoms from anemia and NSAID use were associated with colorectal cancer. In multivariate analysis, only older age (OR=1.06; 95% CI 1.04-1.09) and symptoms from anemia (OR=2.19; 95% CI 1.20-4.0) were independently associated with colorectal cancer. Conclusions: Colorectal cancer was found in 14% of patients referred to a gastroenterologist because of iron deficiency. Older age, and symptomatic anemia may help predict a diagnosis of colorectal cancer.
Jul 2016 DOI 10.14302/issn.2471-7061.jcrc-14-575
V. Roig JoséCorresponding author
Consorcio Hospital General Universitario de Valencia, Department of General and Digestive Surgery.
Aim: To analyze the factors involved in and the results of stoma reversal after an emergency Hartmann's operation. Methods: A multicenter retrospective study from the Valencian Society of Surgery of patients who had undergone an emergent Hartmann’s operation from 2004 to 2008. An analysis of the reversal rate and related factors, delay, and morbidity of reconstruction was performed. Results: Three hundred sixty-two patients were studied. The most frequent initial diagnosis was colorectal cancer, followed by complicated acute diverticulitis; the primary surgical indication was acute peritonitis. After a median follow-up of 52 months, 151 patients (41.7%) underwent surgery to reverse the stoma at a median of 10 months after initial surgery. Diagnosis of diverticulitis or trauma, peritonitis as the surgical indication, and non-advanced tumors were associated with reversal. Multivariate analysis showed that only age and tumor stage were predictive of reversal. Postoperative complications occurred in 44% of the cases, and wound infection was the most common. There were 9 (6%) anastomotic leaks. Thirteen patients (8.6%) retained a permanent or temporary stoma after the attempted reconstruction. Conclusion: Hartmann’s reversal after emergency surgery is performed in less than half of all such patients and has significant morbidity.
May 2015 DOI 10.14302/issn.2372-6601.jhor-14-493
Prunier1 ECorresponding author
In autologous hematopoietic stem cell transplantation patients for whom granulocyte-colony stimulating factor fails to mobilize a sufficient number of peripheral blood stem cells, plerixafor proposes an option for successful rescue mobilization. This paper evaluates the efficacy of plerixafor to mobilize peripheral blood stem cells (PBSCs) in patients who failed previous mobilization with G-CSF alone, by retrospectively analysing the PBSC results from lymphoma and myeloma (MM) patients between 2006 and 2011. Patients were classified according to the CD34+ cells/kg yield collected by apheresis: < 2 x 106 CD34+ cells/kg was considered collection failure, whereas ≥ 5 x 106 CD34+ cells/kg was considered good mobilization. 797 patients underwent one or more apheresis. The first mobilization success rate was 82%; 140 patients proved to be poor mobilizers. Suboptimal first mobilization was significantly associated with age >50 years (p=0.005) and the absence of chemotherapy in prior PBSCs stimulation (p=0.04). 149 rescue protocols were used in the 140 poor mobilizers, and 71 patients received plerixafor. In univariate analysis the remobilization rate without plerixafor was 42% and increased to 65% when plerixafor was added. In multivariate analysis, plerixafor administration reduced the PBSC remobilization failure risk by a half (OR=0.47). The median value of CD34+ cells/kg in transplants increased from 1.43 (range, 014.03) without plerixafor to 3.85 (range, 0–18.25; p=1 x 10-4) with plerixafor. There were more good mobilizers after plerixafor use (35% with plerixafor versus 15% without plerixafor; p=0.005). Plerixafor efficacy was similar for lymphoma (60% remobilization) and MM (80%; p=0.12). These data show that plerixafor was effective in poor mobilizers and that it synergized with G-CSF to improve the quantity of collected PBSCs. Plerixafor also increased transplant feasibility by 23%. While the clinical results of this study are promising, economic data were not taken into account and there is a need for real work concerning the cost-effectiveness of this treatment. We propose a subsequent study in which the economic efficacy of plerixafor’s use is evaluated based on the financial aspects of the treatments received by the cohort evaluated in this paper.
Dec 2012 DOI 10.14302/issn.2324-7339.jcrhap-12-68
Tumwine ChristopherCorresponding author
Infectious Diseases Institute, Makerere University, P.O. Box 22418, Kampala-Uganda
New research suggests that people living with HIV have the potential to be strong advocates for HIV prevention by passing on HIV prevention messages within their social networks. However, there is a paucity of research into the nature and prevalence of HIV prevention behaviours engaged in by HIV clients, and the psychosocial correlates of such advocacy, which are the goals of this analysis. We examined engagement in HIV prevention advocacy among 602 new HIV clients at two clinics in Uganda. Eighty nine percent reported encouraging others to get tested for HIV, 79% told people they know to use condoms when they have sex, and 61% reported discussing HIV more generally with friends and family. A client was classified as fully engaged in HIV prevention advocacy if they reported engaging in all three of the measured HIV prevention advocacy behaviors. In the bivariate analysis, being from the rural study site (p<0.001), higher levels of HIV disclosure to friends (p<0.001), greater hopefulness (p<0.001), and lower levels of depression (p<0.001) and internalized HIV stigma (p<0.001) were associated with full engagement in HIV prevention advocacy. In the multivariate analysis, being from the rural study site (OR=5.461, 95% CI=3.11-9.61), lower levels of internalized HIV stigma (OR=0.524, 95% CI=0.39-0.70) and higher levels of HIV status disclosure to friends (OR=2.040, 95% CI=1.23-3.38) remained significantly associated with full engagement in prevention advocacy. These data suggest that psychosocial adjustment and functioning may play a key role in empowering HIV clients to be advocates for prevention.