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Purpose: The target population for fertility preservation recently has been expanded from adolescents with cancer undergoing gonadotoxic chemotherapy to include transgender youth before initiating ...

Background Even after 35 years of the National Leprosy Eradication Program (NLEP) and 15 years post-elimination, leprosy continues to be a public health challenge in India. This paper discusses the current awareness of leprosy among people living in urban slums of western Maharashtra. Methods The study was conducted in an urban slum of western Maharashtra with 400 participants. A closed-ended questionnaire regarding the knowledge, attitude, practices, and stigma existing among the people was administered, followed by a small awareness talk and screening for leprosy. Results Of the total 400 participants, 205 (51.25) were females and 195 (48.75) were males. Only 154/400 (38.5%) people were aware of leprosy. 130/400 (32.5%) people thought that it is treatable; however, 71/130 (54.6) of them thought that it would recur even after completing the treatment. Only 103/400 (25.75) said that they would marry a person with leprosy, denoting prevalent stigma in the society, and 79/400 (19.75) were aware of government services for leprosy and NLEP. Screening of all the participants surveyed did not reveal any new or doubtful cases of leprosy. Conclusion The present study shows a lack of awareness and knowledge of leprosy among the target population. With only 20% of them being aware of government services and the NLEP, combined with an extremely low knowledge about the disease; it shows the need to further augment the government programs. There is also an increasing need to educate people to accomplish a positive attitude of the community towards leprosy patients.

Background Tolvaptan (TLV) is effective for acute heart failure (HF) with congestion, but its long-term administration in patients with chronic HF (CHF) remains controversial. Moreover, the cost-effectiveness of TLV for CHF treatment has not yet been investigated. Thus, we sought to validate the cost-effectiveness of TLV for CHF treatment in Japan. Methods A Markov model was developed to compare total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) between long-term TLV strategy and the standard strategy using furosemide for CHF. The target population included 75-year-old patients with CHF. The effectiveness of the TLV strategy for CHF treatment was determined based on a systematic review and meta-analysis. We used a 10-year horizon, with sensitivity analyses for significant variables and a scenario analysis for patients with CHF receiving high-dose furosemide (≥60 mg per day). Results In the base case analysis, the total cost of the long-term TLV strategy was higher than that of the standard strategy (\3,243,779 vs. \1,179,964). The total QALYs of the long-term TLV strategy were lower than those of the standard strategy (4.52 vs 4.59). Thus, a standard TLV prescription for CHF treatment has no clinical or economic benefit. In the scenario analysis (i.e. in patients with CHF receiving high-dose furosemide), the long-term TLV strategy was more effective (total QALYs, 5.10 vs. 4.41) but more expensive (total costs, \3,540,558 vs. \1,272,208) than the standard strategy. The ICER of the TLV strategy against the standard strategy (¥3,289,579/QALY) was below the willingness-to-pay of \5,000,000, which suggests that the long-term TLV strategy is cost-effective relative to the standard strategy in patients with CHF receiving high-dose furosemide. Conclusions Long-term TLV administration did not provide a clear benefit for all patients with CHF. However, this treatment strategy may be a cost-effective therapeutic option for patients who require high-dose furosemide.

Objectives The world is fighting with a COVID-19 pandemic, some of the uncertainties have been revealed. To figure out an estimation of asymptomatic patients and seropositive SARS-COV-2 blood donors in Iran, a national survey was conducted to find the prevalence of asymptomatic blood donors with positive SARS-COV-2 IgM/IgG test results at the end of May 2020. Material and methods From all 31 provinces, 1339 blood donors were included. At first, data was collected with an interview containing demographic data, risk factors and possible signs and symptoms held for each donor by a trained medical expert. Then, SARS-COV-2 serologic rapid tests were conducted. Subsequently, the test results were observed and recorded; all of their photos were checked by one single expert. We corrected the prevalence rates for sensitivity and weighted them by the last year rate of blood donation of each province. Results The corrected prevalence rates of positive serological test results for sensitivity in provinces were between zero and 38.24%. The national prevalence was calculated 14.45% after weighting. Out of 161 positive donors, only 43 cases reported related signs or symptoms during the defined period of time, while 118 (73.29%) seropositive cases had not reported any related signs or symptoms. Some signs or symptoms were reported more frequent in the SARS-COV-2 serologic rapid test positives. The highest OR (10.19) was linked to ageusia. Conclusions This study has shown the prevalence of seropositive results to be around 14% in target population in which around ¾ had not reported any signs or symptoms.

Background Various atopic dermatitis (AD) phenotypes showed an enormously heterogenic risk for subsequent asthma development. Objective We aimed to investigate the association between AD phenotypes and the risk for progression to asthma. Methods We searched PubMed, Embase, and Web of Science databases for relevant publications. Pooled relative risks (RR) with 95% CI were calculated using the CMA-3.0 software. This study has been registered with PROSPERO (CRD42019129273). Results We analyzed 39 publications with 458,810 participants. The RR for asthma in AD was 2.16 (95% CI, 1.88-2.48). The risk in persistent AD (RR, 3.36; 95% CI, 2.83-3.99) was higher than in transient AD (RR, 1.52; 95% CI, 1.34-1.73), and the risk in severe AD (RR, 2.40; 95% CI, 1.96-2.94) was higher than in mild AD (RR, 1.82; 95% CI, 1.03-3.23) or moderate AD (RR, 1.51; 95% CI, 1.30-1.75). The risk for asthma in early-onset AD was slightly higher than in late-onset AD and higher in boys than in girls. Limitations The AD and asthma definitions differed across the included studies. Conclusion Patients with persistent or severe AD were at a higher risk for developing asthma. These findings further elucidate the atopic march and identify target populations for asthma prevention.

Abstract. Background: Communication campaigns offer a portable intervention to effectively reach and engage target populations at risk for suicide including US veterans. Few studies have evaluated such efforts, and still fewer have examined factors that contribute to failed suicide prevention messaging. Aims: We aimed to examine characteristics of suicide prevention messages and persuasive processes that may underlie failed communicative intervention with US veterans. Method: Telephone interviews were completed with veterans ( N = 33) from June to September 2016 using a semi-structured interview guide. Interview transcripts were coded by the authors with NVivo using a constant comparison analytic strategy. Results: Several reasons emerged for why suicide prevention messaging may fail to produce intended responses among veterans. Participants identified message features (e.g., language, images, messenger) and communication strategies that may diminish campaign effects. Limitations: Findings are not generalizable, are limited to participants who used VA healthcare and were not suicidal, and are subject to several biases. Conclusion: This work provides initial insights into barriers to effective message use with veterans.

Aims: To determine the relationship between distant learning and neck pain during COVID-19 pandemic especially among medical students, thus we aim to assess prevalence of neck pain for specific Group and time. Study Design: An observational cross-sectional study. Place and Duration of Study: Conducted in Saudi Arabia, between July 2020and October 2021. Methodology: This is a cross-sectional observational descriptive study that started in July 2020. Our target population include all medical students either male or female suffering from neck pain in Kingdom of Saudi Arabia during the period of distant learning due to the Covid-19 pandemic. Sample size: Total Number of medical students in KSA (26126), Confidence level 95% and margin of error 5%. The sample size 379 was estimated using the Qualtrics calculator. Results: A total of 2071 participants were a part of study. Most of them are female n=1509(72.9%) and least of them are male n=562(27.1%). The minimum age of participant was 18 years old n=61(2.9%), And the maximum age was 30 years old n=10(0.5%). Most of medical students noticed increase of neck pain during the period of pandemic. Most of them had noticed exacerbation of neck pain during COVID-19 pandemic n=1002(72.3%), where n=384(27.7%) had same pain before and during pandemic. Majority of them were completely relying on electronic devices for their education. Conclusion:A high Pervasiveness of neck pain in the medical students during COVID-19 pandemic has been observed. Most of medical students noticed increase of neck pain during the period of pandemic. Majority of them were completely relying on electronic devices for their education.

This study aims to determine the influence of corporate governance on performance of Public Universities in Kenya. The study was anchored on social network theory. To achieve the objective, the study was based on a pragmatic philosophy and mixed research design with a target population of 234 University top managers. Primary data was collected using a 5 point Likert type questionnaire and an interview guide. Data was analyzed using descriptive and inferential statistics. Findings revealed that corporate governance had significantly statistical influence on performance of public universities in Kenya. This study concluded that adherence to good corporate governance practices are essential strategies Public Universities can use in their endeavour to improve on their performance. It is further recommended that University top managers should adhere to good corporate governance practices, specifically to management guidelines, allow for public participation and be transparent in their actions. Further, the results present important implications to University top managers, other corporate entities, policy makers, and stakeholders in the University education sector in Kenya and across the world.

Objectives This study aims to estimate the prevalence of coronavirus disease 2019 (COVID-19) in the general population of Iran. Methods The target population was all Iranian people aged 6 years and older in the country. A stratified random sampling design was used to select 28 314 people from among the individuals registered in the electronic health record systems used in primary health care in Iran. Venous blood was taken from each participant and tested for the IgG antibody against COVID-19. The prevalence of COVID-19 was estimated at provincial and national levels after adjusting for the measurement error of the laboratory test, non-response bias and sampling design. Results Of the 28 314 Iranians selected, 11 256 (39.75%) participated in the study. Of these, 5406 (48.0%) were male and 6851 (60.9%) lived in urban areas. The mean (standard deviation) participant age was 35.89 (18.61) years. The adjusted prevalence of COVID-19 until 20 August 2020 was estimated as 14.2% (95% uncertainty interval 13.3%–15.2%), which was equal to 11 958 346 (95% CI 11 211 011–12 746 776) individuals. The adjusted prevalences of infection were 14.6%, 13.8%, 16.6%, 11.7% and 19.4% among men, women, urban population, rural population and individuals aged 60 years or more, respectively. Ardabil, Golestan and Khuzestan provinces had the highest prevalence and Alborz, Hormozgan and Kerman provinces had the lowest. Conclusions Based on the study results, a large proportion of the Iranian population had not yet been infected by COVID-19. The observance of hygienic principles and social restrictions should therefore continue until the majority of the population has been vaccinated.

Objective: complex assessment of clinical and economic effectiveness as well as saving of the state budget assets within the therapy of patients with sepsis/septic shock based on different technologies of blood purification.Methods. Evaluation of direct and indirect costs of the eight blood purifcation methods. The target population includes adult patients 18+ with septic acute kidney injury. The study was conducted in compliance with acting Standards on Clinical Economic Studies used in the Russian Federation.The study methods included evaluation of existing randomized clinical studies and trials with data from network meta-analyses and systematic reviews of the target technologies. The direct medical and indirect non-medical costs were calculated and analyzed in respect of cost-effectiveness and budget impact analyses.Results. Direct and indirect costs were calculated for the sorption devices oXiris (Baxter International Inc.), Toraymyxin (Toray Medical Co.), Alteco LPS Adsorber (Alteco Medical AB), Toxipak (POKARD NPF), Desepta.LPS (BIOTECH M NPP), CytoSorb (CytoSorbents Inc.), HA330 (Jafron Biomedical Co.), Desepta (BIOTECH M NPP) for two time-horizons: 1-year period and 5-years period with discounting. For both periods, the use of oXiris hemoflter results in the least economic burden for the state budget.Conclusion. The use of blood purifcation in septic patients therapy is associated with considerable direct and indirect fnancial expenses, the amount of which and consequential budget saving depend on the technology of blood purifcation applied. The actual tariff compensation policy evidently demands revising.

The ICOPE program proposed by the WHO to reduce the number of dependent subjects is composed of 5 steps that can be carried out in primary care: screening, integrated assessment, personalized care plan, monitoring of the plan care, community involvement and support for caregivers. The target population is independent seniors aged 60 years and over. Digital tools have been developed to facilitate the assessment and follow-up of the subjects included in this care project.

Background Assessing depression symptoms in Hispanic/Latin American (H/Ls) older adults, a group at high risk for depression, is nuanced due to the influence of cultural characteristics in symptom expression and manifestation. Little is known about the psychometric properties of available measures when used with this population. Methods We conducted a two-stage systematic review of available depression assessment tools. We first identified self-report measures designed for use with adults. We then identified studies where at least one of such measures was used with older H/Ls that reported psychometric properties for the measure(s) used. Results Only 3 measures were identified for use with older H/Ls: the BDI, GDS, and CES-D. However, few data were found to support the validity of the BDI, and the CES-D was not consistently valid across cultural groups. The GDS was found appropriate, though its performance varied based on race/ethnicity, nationality, and cutoff scores. The CES-D and GDS also demonstrated varying psychometric properties based on study setting (research versus clinical) and target population (inpatient psychiatric patients versus community-dwelling individuals). Limitations The number of articles that met criteria for inclusion in our review was small, and there was variation among samples of the few studies included. Conclusions Currently available self-report depression screening measures have acceptable applicability among older H/Ls, but their utility may vary based on their intended use. Modified cutoff scores may be beneficial in maximizing the utility of these measures when given to diverse older adults.

Background Our objective was to develop a nutrient-based index for evaluating and improving menus in public catering. The nutriRECIPE-Index comprises 24 nutrients and nutrient groups. In developing the index, the following steps were included: setting the goals of the index, nutrient selection, target metrics and scaling, weighting, proof of concept and validation of the index. Furthermore, a unique database was created to integrate bioactive plant compounds in the assessment. An assessment of standard recipes and supposedly healthy recipes should show a significant difference in the results of the nutriRECIPE-Index. Finally, the nutriRECIPE-Index should generate similar or more specific results than existing indices such as the Nutri-Score and the Healthy Meal Index. Methods A whole meal cycle (comprising 6 weeks, 106 recipes and including different menu lines, partially with different side dishes) at a university canteen was analysed with the Federal Food Code (BLS) and the nutriRECIPE-Index. The Healthy Meal Index (comprising 3 nutritionally relevant items) and the Nutri-Score algorithm (comprising 7 items) were used to validate the nutrient composition and the results of the nutriRECIPE-Index. Results The resulting scores of the recipes and menu lines showed substantial differences, wherein the meals of a health-promoting menu line usually received higher scores than the standard recipes. A correlation between the nutriRECIPE-Index and the Healthy Meal Index (0.604) and the Nutri-Score (0.591) was observed. The nutriRECIPE-Index was better at identifying the worst menus and could better separate mediocre menus from good menus. Conclusion The nutriRECIPE-Index is a useful and comprehensive tool for evaluating the nutritional value of recipes and is the first to consider bioactive plant compounds. Further adjustments to different target populations, settings, and cultural backgrounds are possible.

Introduction: Information Communication Technology (ICT) is the use of computers, mobile phones and internet to access, process, receive, send, and use various kinds of data and information. With the expansion of mobile phone users and availability of internet services, teenagers are now using ICT to create awareness and use contraceptives, an area considered to be the preserved of married couple. Purpose: The paper examines how the application of ICT by teenagers broken traditional and religious barriers to accessing and utilizing contraceptive information in the Sunyani East Municipality. Methodology: The research design was a mixed method combining qualitative and quantitative approaches. The target population was teenagers between the ages of 11 and 19 years in Senior High and Junior High Schools. Out of 87 schools, 16 schools were randomly selected using simple random sampling technique. The total sample size was 212 teenagers. Data was collected from the respondents, using interviews, questionnaires and focus group discussions. The paper found that ICT is a major means of accessing, sharing and using information about contraceptives by the teenagers, information is hard to access because of societal perceptions, sociocultural and psycho-religious barriers. Findings: The paper found that ICT has impact on their perceptions, utilization or otherwise, because they now the effects of various kinds of contraceptives. Recommendation: The paper recommends that teenagers should be given proper ICT education to enable them use credible websites on the internet to get contraceptive information. Education should be intensified through the mass media, free lectures, radio and television discussions to augment the use of ICT to expand the number of teenagers using contraceptive.

Purpose: The current study sought to establish the entrepreneurial determinants affecting the growth of small and medium enterprises in the motor vehicle industry in Nairobi county, Kenya. The study specifically aimed at assessing how entrepreneurial innovativeness, Service Quality, Entrepreneurial Competency and business operational policies determines the growth of SMEs in motor vehicle industry in Nairobi County, Kenya. Methodology: The study was anchored on Schumpeter’s Innovation Theory, Commitment Trust Theory, Competency Theory and Policy Theory. A descriptive research design was adopted and the target population comprised of SMEs operating within Central Business District in Nairobi County. A total of 245SMEs were targeted and the unit of observation comprised of owners, managers and supervisors of the enterprises. A census approach was adopted where all the targeted enterprises were involved in the study. Questionnaires were used for collecting data both qualitative and quantitative data. The study conducted a pilot on 12 small enterprises in Kiambu County before collecting data for the main study to assess the reliability and validity of the questionnaires. Data was analyzed using both Microsoft excel and SPSS tools. Both descriptive and inferential statistics were used. The study findings were presented in form of tables and figures for easier interpretation. Findings: The study concludes that the entrepreneurial innovativeness level has a positive and significant influence on the growth of SMEs in motor vehicle industry in Nairobi County, Kenya. In addition, the study concludes that the service quality has a positive and significant influence on the growth of SMEs in motor vehicle industry in Nairobi County, Kenya. Further, the study concludes that the entrepreneurial competency has a positive and significant influence on the growth of SMEs in motor vehicle industry in Nairobi County, Kenya. The study also concludes that the business operational policies have a positive and significant influence on the growth of SMEs in motor vehicle industry in Nairobi County, Kenya. Unique Contribution to Theory, Practice and Policy: From the results, the study recommends that the management of SMEs in the motor vehicle industry should enhance their ability to introduce new product, new services and ability to capture market niche of products and services. In addition, that the management of SMEs in the motor vehicle industry should be more focused on ensuring quality services are provided to their customers.

Content validity is the most important property of PROMs. The COSMIN initiative has published guidelines for evaluating the content validity of PROMs, but they have only sparsely been applied to relevant PROMs for musculoskeletal conditions. The aim of this study was to use the COSMIN Risk of Bias checklist to evaluate the content validity of five PROMs, that are highly relevant in musculoskeletal research and used by the arthroscopic surgery community: the modified Harris’ Hip Score (mHHS), the Copenhagen Hip and Groin Outcome Score (HAGOS), the International Knee Documentation Committee Subjective Knee evaluation Form (IKDC-SKF), the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Knee Numeric-Entity Evaluation Score ACL (KNEES-ACL). The development articles for the five PROMs were identified through searches in PubMed and SCOPUS. A literature search was performed to identify additional studies assessing content validity of the PROMs. Additional information, necessary for the assessments, was obtained from the PROM developers after direct request. To evaluate the quality of the development studies and rate the content validity, the COSMIN Risk of Bias checklist was applied to all studies. All five development studies were identified. Three subsequent content validity studies were identified, all evaluating KOOS and one also IKDC. One content validity study was of inadequate quality and excluded from further analysis. The development of mHHS, IKDC-SKF, and KOOS was rated inadequate and possess insufficient content validity for their target populations. Due to the irrelevance of multiple items, KOOS was in particular inappropriate to evaluate patients with an ACL injury. The development of HAGOS was also rated inadequate, although the insufficiency aspects can be regarded as minor. KNEES-ACL possessed sufficient content validity. Out of five PROMs, only KNEES-ACL possessed sufficient content validity. Particularly, KOOS should not be used as an outcome for patients with an ACL injury. There is an urgent need for condition-specific PROMs for musculoskeletal conditions, developed with adequate methods. III.

Alopecia areata is an autoimmune disease that results in partial or total balding of the scalp and/or body. Treatments available are minimally effective, have severe side effects, and are often painful. Given these burdens, patients may not feel undergoing treatment is worthwhile. The purpose of this study is to characterize the willingness of patients with alopecia areata to undergo treatment. We found that few patients are willing to undergo treatment at the risk of severe health side effects. The most acceptable form of treatment administration was topical and the least acceptable was injection at the site of hair loss. A majority of patients would only undergo treatment for hair growth that is cosmetically acceptable and the most important site of hair regrowth was the scalp. The willingness to undergo treatment differed significantly by gender, age, time since disease onset, and disease severity. This study offers insight into the preferences of patients with alopecia areata and characteristics that would make treatment widely acceptable. Institutions conducting research on treatment for alopecia areata can use the results of this study to better understand the needs of their target population.

Background: Drooling is a clinically relevant non-motor symptom of people with Parkinson’s disease (PwP). Several drooling rating scales are available. Nevertheless, the compelling scientific evidence supporting their validity is limited. This study aims to evaluate clinical rating scales for drooling, assessing their characteristics, clinimetric properties, and clinical utility classification. Methods: A systematic review was undertaken. Two reviewers performed independent literature searches using the CENTRAL®, CINAHL®, Embase®, MEDLINE®, SciElo®, and SPEECH BITE® databases. We used consensusbased standards for the selection of health measurement instruments (COSMIN) and the International Parkinson’s disease and the Movement Disorders (MDS) criteria to evaluate the included rating scales. Results: The following six rating scales were identified: Drooling Impact Scale (DIS), Sialorrhea Scoring Scale (SSS), Drooling Severity and Frequency Scale (DSFS), Drooling Rating Scale (DRS), Sialorrhea Clinical Scale for Parkinson Disease (SCS-PD), and the Radboud Oral Motor inventory for Parkinson’s disease – Saliva (ROMPsaliva). The scales had heterogeneous characteristics: (i) not all were created/adapted for PwP; (ii) different dimensions associated with drooling are assessed; (iii) cross-cultural adaptations are limited to some languages. The clinimetric properties showed: (i) target population size limitations; (ii) incomplete reliability analysis; (iii) lack of robust validity; (iv) sensitivity to change not fully explored. Following the MDS criteria, only one tool was classified as “recommended”, the ROMP-saliva. Conclusions: This review provides information for an adequate selection of a drooling rating scale for clinical and/or research purposes. To date, ROMP-saliva is the only scale with substantial evidence of its clinimetric properties adequacy and data in PwP. info:eu-repo/semantics/publishedVersion

Background:Hypertension has been among the most studied topics of the previous century and has been one of the most significant comorbidities. Aim: This study aimed at the estimating the frequency of depressive symptoms among hypertensive patients; in addition to, identifying the associated risk factors for depressive symptoms among the target population. Patients and Methods: The present study was designed as descriptive cross-sectional study that included 274 adult hypertensive patients attending family medicine outpatient clinic at Suez Canal University Hospitals. Results: The mean age of the patients was 49.89 ± 9.53 years and about half of the sample was females. About 60% of the patients discovered having hypertension after frequent headache complaint and about one quarter discovered the diagnosis preoperatively. About one quarter of the patients had developed complications (24.1%). There is an increase by 4 times in the odds of having depression among married and divorced patients compared to single patients (OR= 4.6, p=0.008) and (OR= 3.9, p=0.026), respectively. Higher educational level was associated with less likelihood to develop depression. Patients on B-blocker based regimen had an increase by 6.9 times in the odds of having depression compared to those on CCB+ ARBs combination (OR= 6.909, p=0.017). Conclusion: From the previous results, it can be concluded that depressive symptoms were common among adults with hypertension with prevalence 39.8%. The top three risk factors of depression found among hypertensive patients were financial hardship, death of a dear person and history of divorce/ separation in family.

Noot AlOtaibi,1 Sarah Alsaleebi,2 Fahad Alanezi,3 Hala Alhodaib,4 Bashair AlThani,5 Duaa Aljabri,1 Demah Alsalman,1 Asma Al-Fayez,1 Amjad Saadah,1 Sumaiah Alrawiai,1 Norah Alyousif,6 Turki Alanzi1 1Department of Health Information Management and Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2Blood Bank, King Fahad Specialist Hospital, Dammam, Saudi Arabia; 3Community College, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 4Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyad, Saudi Arabia; 5College of Business Administration, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 6Information Technology Department, Saudi Aramco, Dhahran, Saudi ArabiaCorrespondence: Turki AlanziDepartment of Health Information Management and Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, King Faisal Road, Dammam, 31441, Saudi ArabiaTel +966 133331211Email talanzi@iau.edu.saPurpose: The main objective of this research was to investigate the opinion of the population of Saudi Arabia on the use and acceptability of the Wateen application.Methods: This research was a quantitative cross-sectional study in which an online questionnaire was distributed among the target population who were healthy people over 18 years of age that had used or known about the Wateen application. A total of 352 participants responded to the questionnaire. The data collection was carried out between November and December 2020. A basic descriptive statistical analysis was used to analyze the data.Results: The participants had used the Wateen app to follow the donation record, as a reminder of donation dates, to find lists and blood bank locations, to request blood donation, and to find donation requests on social media. After receiving the blood donation request from the Wateen app, majority of the respondents felt encouraged, motivated, and educated to donate blood, and about blood donation, respectively. Participants also indicated that the application helped them to find donors. Besides, majority of the respondents stated that the Wateen app had reduced the gap between blood donors and the need for blood. However, few participants expressed that they had not received or observed a post about the Wateen application on social media networks.Conclusion: The results of this research indicated that there is a general acceptance of the use of the Wateen app among the participants of this study. However, the importance of the Wateen app needs to be further advertised so that it can be used in the blood donation process in all regions of Saudi Arabia. In this way, the people of Saudi Arabia will be more aware of the importance of the Wateen app in the blood donation process, and the goal of the Ministry of Health of bridging the gap between donation centers and blood donors could be achieved.Keywords: Wateen application, blood donation, m-health, Saudi Arabia, user acceptability

Background Coronavirus disease (COVID‐19) is related to several extrapulmonary disorders; however, little is known about the clinical, laboratory, and histopathological characteristics of pernio‐like skin lesions associated with COVID‐19 infection. Objective To evaluate and summarize the clinical, laboratory, and histopathological characteristics of pernio‐like lesions reported in the literature. Methods We conducted a search of the PubMed, SciELO, and ScienceDirect databases for articles published between January 1, 2020 and November 30, 2020, following the PRISMA recommendations (PROSPERO registration ID: CRD42020225055). The target population was individuals with suspected or laboratory‐confirmed COVID‐19 with pernio‐like lesions. Observational studies, research letters, and case/series reports were all eligible for inclusion. Observational studies were evaluated using a random‐effects model to calculate the weighted mean prevalence, overall mean, and 95% confidence interval. We evaluated case studies using the chi‐square test for dichotomous variables and the Mann‐Whitney test for continuous variables. Results A total of 187 patients from case reports and 715 patients from 18 observational studies were included. The mean age of patients was 16.6 years (range 14.5‐18.8). Feet were affected in 91.4% (87.0‐94.4%) of patients in observational studies. The proportion of patients with a positive RT‐PCR test was less than 15%. Lesion topography and morphology were associated with age. Conclusion Lesions mostly occurred in pediatric patients, and the morphological characteristics tended to differ between pediatric and non‐pediatric populations. There is a possible multifactorial component in lesion pathophysiology. The non‐positivity of laboratory tests does not exclude an association with COVID‐19. Pernio‐like lesions may be a late manifestation of COVID‐19.

Context Defining high quality palliative care in seriously ill surgical patients is essential to provide patient-centered surgical care. Quality indicators specifically for seriously ill surgical patients are necessary in order to integrate palliative care into existing surgical quality improvement programs. Objectives To identify existing quality indicators that measure palliative care delivery in seriously ill surgical patients, characterize their development, and assess their methodological quality. Methods A PRISMA-guided systematic review included studies that reported on the development process and characteristics of palliative care quality indicators and guidelines in adult surgical patients. Relevant measures were categorized into the previously defined National Consensus Project domains of palliative care and the Donabedian quality framework, and assessed for methodological quality. Results There were 263 unique measures identified from 26 studies, of which 70% were process measures. Indicators addressing Care of the Patient Near the End of Life (31.5%) and Physical Aspects of Care (20.8%) were the most common. Indicators addressing Spiritual (2.6%) and Cultural Aspects of Care (1.2%) were the least common. Methodological quality varied widely across studies. Although most studies defined a purpose for the indicators and used scientific evidence, many studies lacked input from target populations and few had discussed the practical application of indicators. Conclusion This review was a key step that informed efforts to develop quality indicators for seriously ill surgical patients. Few indicators addressed non-physical aspects of suffering and no indicators were identified addressing palliative surgery. Future attention is needed toward the development and practical application of palliative care quality indicators in surgical patients.

Introduction Earlier national surveys on the management of acute pancreatitis (AP) had reported non-compliance to practice guidelines. In the past decade, several guidelines were revised based on new evidence. In this multicenter international survey, we aimed to evaluate the practice patterns of early management of AP and compliance to the revised treatment guidelines across different disciplines and practice environments. Methods A structured questionnaire was sent via email to a target population of 654 that constituted of medical and surgical gastroenterologists, physicians and general surgeons, paediatricians from academic and non-academic centres across 30 countries. Other than demographic variables, the questionnaire contained items pertaining to early management of AP, such as, assessment at admissions and within first 72 h s, details regarding analgesics, IV hydration, oral/enteral feeding and antibiotic use. Results The response rate was 46.2% and after exclusions, a total of 297 participant's responses were analysed. Majority of the participants were from Asia, followed by Europe and the Americas. 181 (60.9%) claimed to follow practice guidelines, out of which 59 (32.6%) followed more than one. On further probing, only 41.9% were actually compliant to feeding and 59.7% to antibiotic guidelines. Even though participants opted for aggressive hydration, early feeding and avoidance of prophylactic antibiotics, there were non-compliance and discrepancies in titration of fluid therapy, indications of feeding and antibiotic use. Discussion Discrepancies and non-compliance still appear to exist in the early management of AP due to lack of strong evidence. We discuss ways that could improve compliance to the existing guidelines until stronger evidence comes to the fore.

Supplemental Digital Content is Available in the Text., Background: We constructed self-reported pre-exposure prophylaxis (PrEP) cascades and explored factors associated with and barriers to PrEP use to inform efforts to support PrEP use among young women who sell sex. Methods: Using self-reported data from HIV-negative young women who sell sex enrolled into a cohort study using respondent-driven sampling in Zimbabwe, we constructed PrEP cascades assessing knowledge of, ever offered, ever used, and current PrEP use in 2017 and 2019. We used logistic regression to examine factors associated with PrEP use by 2019. Through qualitative interviews with 43 women enrolled in the cohort, we investigated barriers to PrEP use. Results: At enrollment, 50% of women had heard of PrEP, 12% had ever been offered PrEP, and 7% ever used PrEP. Over time, all cascade domains: 96% of women had heard of and 55% reported an active offer of PrEP. Among women retained in the study in 2019 (56%; n = 538), 34% ever took PrEP by 2019. PrEP use was associated with, at enrollment, reporting more clients in the past month (10+: 45% vs 1–3: 27% adjOR = 1.71 95% CI: 1.06 to 2.76), duration of selling sex (24%

Purpose: The purpose of this study was to establish the effect of integrated information technology on sustainable mobility of Matatu Saccos in Nairobi County, Kenya. Materials and Methods: The study was guided by Positivism philosophy while descriptive research design was adopted. The target population was 177 Sacco Managers and two representatives, one from MOT and other from MVOA respectively. The whole population of 179 respondents was used in the study hence; the study employed the census approach. The questionnaire was pilot tested on 18 respondents who were selected randomly. The study applied Cronbach's alpha and the results displayed a high level of internal consistency hence infers that the research tool used in the study was reliable. The data collection instrument was a semi-structured questionnaire, which were dropped and picked later. A semi-structured interview guide was also used. Data was analysed using descriptive and SPSS Version 24. Results: The research findings indicatd that most Saccos have embraced speed-recording devices, vehicle-tracking devices, and that Sacco’s were using smartphones. Correlation analysis showed that information technology had a strong positive significant relationship on sustainable mobility of Matatu Saccos in Nairobi County, Kenya (rho = 0.821, p value

Most daunting threat for humankind is the corona virus disease 2019 (COVID-19) pandemic caused by SARS-CoV-2. Various vaccine production platforms are available, each with distinct advantages and obstacles. Pharmaceutical formulation science plays a critical role in the race for a safe, effective coronav virus disease vaccine (COVID)-19. The target population of vaccinees includes high-risk individuals over the age of 60, those with chronic co-morbid conditions, frontline healthcare workers, and those involved in critical industries. Once a safe and reliable vaccine policy becomes available, pre-pandemic normalcy will never return. As COVID-19 continues to wreak havoc on people's health and livelihoods around the world, the prospect of an effective vaccine may appear to be a silver bullet. Despite this, a number of challenges remain, each of which necessitates careful and ongoing debate to ensure that vaccination strategies are safe, appropriate, and realistic. So the best way forward is simply to register oneself on Aarogya Setu and get vaccinated as soon as possible, regardless of Covishield or Covaxin. Keywords: Vaccine, Pandemic, COVID, Corona virus 19

Introduction: This descriptive study aimed to study an association between the level of readiness of administrative factors and the timely cardiac catheterization rate of patients with acute ischemic heart disease in hospitals in Thailand. Materials and methods: The target population was 1,180 hospitals that serving heart disease in Thailand. Data were collected by using a questionnaire. A total of 1,022 response data were obtained. The statistics used to analyze the data were frequency, percentage, mean, standard deviation, and correlation was analyzed by multiple regression analysis. Results: The organizational factors, which consisted of personnel, finance, supporting, and management factors, had overall average readiness at a high level (x̄ = 3.34, S.D. = 0.27). While budget sufficiency was at a low level (x̄ = 2.43, S.D. = 0.43). All factors were significantly related to the timely cardiac catheterization rate, as follows: management factor (Adjust R2 = 0.442), personnel factor (Adjust R2 = 0.244), supporting factor (Adjust R2 = 0.212) and financial factor (Adjust R2 = 0.091). Conclusion: Therefore, the Thai Ministry of Public Health should provide adequate support for organizational factors, especially in terms of budget sufficiency.

Methods based on propensity score (PS) have become increasingly popular as a tool for causal inference. A better understanding of the relative advantages and disadvantages of the alternative analytic approaches can contribute to the optimal choice and use of a specific PS method over other methods. In this article, we provide an accessible overview of causal inference from observational data and two major PS-based methods (matching and inverse probability weighting), focusing on the underlying assumptions and decision-making processes. We then discuss common pitfalls and tips for applying the PS methods to empirical research and compare the conventional multivariable outcome regression and the two alternative PS-based methods (ie, matching and inverse probability weighting) and discuss their similarities and differences. Although we note subtle differences in causal identification assumptions, we highlight that the methods are distinct primarily in terms of the statistical modeling assumptions involved and the target population for which exposure effects are being estimated.

Online surveys, despite their cost and effort advantages, are particularly prone to selection bias due to the differences between target population and potentially covered population (online population). This leads to the unreliability of estimates coming from online samples unless further adjustments are applied. Some techniques have arisen in the last years regarding this issue, among which superpopulation modeling can be useful in Big Data context where censuses are accessible. This technique uses the sample to train a model capturing the behavior of a target variable which is to be estimated, and applies it to the nonsampled individuals to obtain population-level estimates. The modeling step has been usually done with linear regression or LASSO models, but machine learning (ML) algorithms have been pointed out as promising alternatives. In this study we examine the use of these algorithms in the online survey context, in order to evaluate and compare their performance and adequacy to the problem. A simulation study shows that ML algorithms can effectively volunteering bias to a greater extent than traditional methods in several scenarios., Ministerio de Economía y Competitividad, Spain, Ministerio de Ciencia, Innovación y Universidades, Spain

Objective: To compare the effectiveness of intraarticular injections of hyaluronic acid and corticosteroids in the treatment of patients with knee osteoarthritis symptoms.Study Design: Prospective comparative study.Place and Duration of Study: Rheumatology/General Medicine department, Pak Emirates Military Hospital Rawalpindi, from May 2019 to Jun 2020.Methodology: Patient of knee osteoarthritis with active symptoms of pain and stiffness who fulfilled American college of rheumatology criteria of 1997 were included in the study. They were randomly divided into two groups with group A receiving intraarticular hyaluronic acid. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was administered before and three months after the management to assess the efficacy of treatment in both the groups. Student ttest was applied to ascertain that the difference in the WOMAC scores before and after the management has been statistically significantly different in both groups. Results: A total of 150 patients of osteoarthritis of knee joint were included in the study. Mean age of the study participants was 58.439 ± 7.35. 85 (56.7%) patients were female while 65 (43.3%) were male. 81 (54%) received the intraarticular hyaluronic Acid while 69 (46%) received the intraarticular steroids. Mean difference before and after the management in WOMAC score in corticosteroids group was 9.295 ± 1.24 while in hyaluronic Acid group was 5.41 ± 4.556 (p-value

Policymakers and scholars acknowledge the significance of small and medium enterprises in stirring the economic growth and development in developing and developed economies. In spite of the generally fast pace by which access to financial services for small and medium enterprises is being established, significant segments of the small and medium enterprises sector do not yet benefit from the expansion. This study, therefore, investigated the effect of relationship lending on access to financial services by small and medium enterprises in Kenya. The study was based on credit rationing theory and information asymmetry theory. The target population comprised 4,253 small and medium enterprises in Kenya. A sample size of 366 SMEs was used by the study. The study adopted a multistage sampling technique to obtain the SME respondents. Primary data was utilized and was acquired through semi-structured questionnaires. Data were analyzed using descriptive and inferential statistics utilizing Heckman two-stage regression model. The study findings showed that relationship lending had a positive and significant effect on access to financial services among SMEs in Kenya. The study concluded that relationship lending plays a critical role in access to financial services by SMEs in Kenya. The study recommends that SMEs owners should strive to meet the terms and conditions provided by lending institutions in their various financing practices while management of the lending institutions should adopt financing practices favorable to SMEs to increase their access to financial services.

Background. Gastric perforation is one of the serious complications caused by a peptic ulcer, with the appearance of symptoms in the form of an acute abdomen that requires immediate treatment. Approximately 2 to 3% of all ulcers perforate which usually occurs in the anterior wall of the duodenum or stomach. Objective. To determine the profile of patients with gastric perforation due to peptic ulcer at RSUD Kolonel Abundjani Bangko. Method. This is descriptive study with a retrospective total sampling method. The target population is patients with a diagnosis of gastric perforation due to peptic ulcers in the period January-December 2020. Result. Total patients with gastric perforation in RSUD Kolonel Abundjani Bangko for the January-December 2020 period totaled 14 people. Male patients were more than female (64.3% vs. 35.7%), the age range of 50-59 years was slightly higher than patients aged over 60 years (50% vs. 42.9%). There was no difference in the number of patients who had and did not have a history of taking NSAIDs. The location of the pre-pyloric perforation (50%) was more common than in the major curvature (14.29), minor (21.43%), and corpus (14.29%). The diameter of the perforation was most commonly found 0.5-1 cm (85.71%) Total deaths were 3 out of 14 people (21.43%). Conclusion. There are more male patients with gastric perforation than female, and the age range of 50-59 years is more common. The location of the perforation was found mostly in the pre-pylorus, and the majority had a perforation diameter of 0.5-1 cm. The mortality rate was reported as 21.43%

Background: The School of Pharmacy of the University of the Western Cape implemented a service learning programme where second year students participated in tuberculosis (TB) screening. Objectives: To determine the views of students and nurses about student-led TB screening at primary healthcare (PHC) facilities. Methods: The study was descriptive and quantitative. The target populations were pharmacy students and nurses, who completed self-administered semi-structured questionnaires. Results: Study participants included 99 students from 19 facilities and 38 nurses who represented 15 facilities. Students had screened 1323 patients and referred 210 for further testing. Students and nurses felt students were adequately trained to conduct TB screening and seemed to screen patients with ease. Students and nurses believed that students gained more TB knowledge and clinical experience. Students also believed the TB screenings were beneficial to the patients and nurses. Conclusion: Students and nurses perceived the outcomes of student-led TB screening to be mostly positive.

Objective: To determine the frequency of non-compliance among the patients of epilepsy and factors related to the presence of non-compliance at a tertiary care hospital of Pakistan. Study Design: Cross-sectional analytical study. Place and Duration of Study: Neurology department, Pak Emirates Military Hospital Rawalpindi, form Dec 2018 to Jun 2019. Methodology: A total of 133 cases were included in the study, which were diagnosed as epilepsy for more than 6 months by a consultant neurologist. Medication and drug adherence was assessed by validated Urdu version of our-item Morisky Medication Adherence Scale. Relationship of age, gender, socio-economic class, duration of epilepsy, education, marital status and poly-pharmacy was assessed with the presence of non-compliance among the patients suffering from epilepsy. Results: There were 53 (39.9%) patients were females while 80 (60.1%) were males. Out of 118 patients of epilepsy, 59 (44.4%) showed the presence of non-compliance while 74 (55.6%) had good compliance. After applying the logistic regression we found that duration of illness and poly-pharmacy had significant association with the presence of non-compliance among the patients of epilepsy. Conclusion: Non-compliance emerged as a highly prevalent behavior or clinical condition among the patients of epilepsy in our target population. Before combining the pharmacological agents it is advisable to check the compliance of already prescribed drugs used to control the seizures. Patients with long standing illness or those who are put on multiple medications should be regularly screened for non-adherence.

Objetivo: buscar na literatura cientí­fica o que as evidências apontam sobre a assistência da enfermagem ao paciente em cuidados paliativos direcionada ao controle de sintomas. Método: Revisão integrativa da literatura realizada nas bases de dados Lilacs, Scielo, Medline e periódicos da Capes, cujo corpus da análise foi de 8 artigos. Foram incluí­dos artigos disponí­veis nos idiomas inglês, português e espanhol, publicados nos últimos 5 anos, disponí­veis na í­ntegra e gratuitamente. Resultados: Os artigos selecionados apresentaram caracterí­sticas diversas, possuindo populações alvo, amostras, finalidades e métodos variados. Após análise dos dados foram encontradas informações que se complementaram acerca do tema, possibilitando apresentação dos resultados em duas categorias: Manifestações clí­nicas em pacientes em cuidados paliativos e Assistência de enfermagem no manejo de paciente em cuidados paliativos. Conclusão: A enfermagem tem papel de auxiliar na monitoração dos casos de câncer e intervir nos sintomas fí­sicos e psicológicos através de tratamentos farmacológicos e não farmacológicos

Introduction Olfactory testing must be culturally adapted to be relevant to the target population. This study aimed to validate the Sniffin’ Sticks test for the UK setting. Methods A cohort study was conducted at a tertiary olfactory dysfunction clinic. Phase 1—healthy volunteers underwent the original German identification test followed by a UK adapted version. Phase 2—patients with olfactory dysfunction underwent the extended smell test (TDI) including the new descriptors. Outcome measures included differences in identification test (phase 1), retest reliability and differences in scores before and after treatment. Results A total of 31 healthy volunteers and 87 patients were recruited (6 and 31 males, respectively). Phase 1—mean identification scores showed a small improvement after descriptor adaptations (13.77 and 14.57, p = 0.0029). Phase 2—41 untreated participants had a mean identification score of 7.31 at both intervals (95% CI: − 1.15 to 1.15, p > 0.999). The mean change in treated participants was 1.88 (0.70 to 3.06, p = 0.0224). TDI score difference between treated and untreated groups was 6.63 (2.48 to 10.79, p = 0.0023). The intraclass correlation coefficient for untreated patients was high for both TDI score (ICC = 0.82, 95% CI 0.57 to 0.93) and identification score (ICC = 0.80, 0.52 to 0.93); CIs suggest the reliability is moderate to excellent. Conclusions This study confirms the validity of the descriptor adaptations of the identification component of the Sniffin’ Sticks test to distinguish between health and disease. Implications The Sniffin’ Sticks test can now reliably be used for clinical assessment of British patients, modifying only the descriptors.

Aim: The present paper aims to discuss on the construction and validation of a survey tool for measuring knowledge of people of West Bengal regarding junk foods. Method: Questionnaire was selected as the data collection tool. The questionnaire was prepared on the basis of certain dimensions and initially it had 41 items. At first, the questionnaire was administered to a target population of 30 respondents. After the pre-test among 30 respondents the readability, discrimination indices, and difficulty indices were determined for ‘Knowledge’ questionnaire. Rejection criteria were set for each parameter and the final questionnaire was constructed with the items retained after validation. The reliability of the tool was confirmed by Test-Retest method. Result: Finally, the knowledge questionnaire retained 31 items. Reliability co-efficient was found to be 0.76090 which was significant. Conclusion: Validity and reliability of the knowledge questionnaire were well established. There were 31 items in the final questionnaire depending on the rejection criterion. The high reliability of the questionnaire was found. This questionnaire will help to find out the level of knowledge of people regarding junk food and its effects on health. Key words: Junk food, Food consumption, Knowledge.

Lung cancer (LC) has been the most common cancer worldwide for several decades. This study comprehensively examines recent geographic patterns and temporal trends in LC incidence from 1978 to 2012 in 43 countries and evaluates the effects of birth cohort and period on temporal trends.Data were retrieved from the Cancer Incidence in Five Continents database. Joinpoint regression and age-period-cohort models were applied.The age-standardized rate was highest in Turkey (69.3 per 100,000 person-years) for men and in Denmark (36.7) for women in the period 2008 to 2012. Sex disparities were noted in most countries. From 1978 to 2012, a total of 19 countries had significantly declining trends among men, whereas 26 countries had significantly increasing trends among women (all p0.05). Quasi-reversed V-shaped and U-shaped incidence rate ratio trends indicating birth cohort effects were detected in 26 countries for men, with the highest risks mainly occurring in the 1930 to 1950 birth cohorts. However, the risks among recent generations have moderately increased in the People's Republic of China and Japan for men and sharply increased in Lithuania, Belarus, and Republic of Korea for women. Incidence rate ratio increases were steep among earlier birth cohorts and gradual among the post-1930s cohorts in 15 countries for women. Period effects were more evident than birth cohort effects in five countries for both sexes.Disparities in LC incidence and carcinogenic risk persist worldwide. Our findings identified high-risk target populations for primary prevention to reduce the LC incidence and highlighted the urgent need for etiologic studies to identify the reasons for pronounced cohort-specific risk increases in certain countries.

The surgical decision-making process for cavernous malformation (CM) must weigh the risks of surgery against the burden of patient symptoms/hemorrhage and anticipated natural history. Here, we sought to internally validate an International Classification of Disease (ICD)-10 search algorithm for CM surgery to use to analyze a nationwide administrative database.Institutional records were accessed to test the validity of a novel ICD-10 search algorithm for CM surgery. The algorithm identified patients with positive predictive value (92%), specificity (100%), and sensitivity of 55%. The algorithm was applied to extract our target population from the Nationwide Readmissions Database. Univariate and multivariable analyses were used to identify factors influencing patient outcomes.We identified 1235 operations for supratentorial (87%) or infratentorial (13%) CM surgery from the Nationwide Readmissions Database (2016-2017). The overall rate of adverse disposition and 30-day readmission were 19.7% and 7.5%, respectively. The rate of adverse disposition was significantly higher for infratentorial (vs. supratentorial cases) (34.3% vs. 17.6%, P = 0.001) and brainstem (vs. cerebellar) cases (55% vs. 28%, P = 0.03). Hospital case-volume percentile was associated with decreasing rates of adverse disposition (1-74th: 22%, 75th: 16%, 90th: 13%, 95th: 7%). Treatment at HVCs was also associated with shorter average length of stay (4.6 vs. 7.3 days, P0.001) without significant changes to average cost of hospitalization (P = 0.60).Our ICD-10 coding algorithm reliably identifies CM surgery with minimal false positives. Outcomes were influenced by patient age, clinical presentation, location of CM, and experience of institution. Centralization of care may improve outcomes and warrants further investigation.

Background As the duration of diabetes progresses, various disease related complications might occur in patients. The main goal of this paper is to compare acoustic and aerodynamic measures of patients with type 2 diabetes mellitus (T2DM) with a control group of healthy subjects. Methods A total of 91 subjects, 51 individuals with type 2 diabetes mellitus (DM group) and 40 healthy volunteers (HV group) were participated in the study. Maximum phonation time (MPT) was captured for assessing phonatory mechanics. Acoustic voice parameters, including mean fundamental frequency (mean fo), jitter local (Jlocal), jitter absolute (Jabs), shimmer local (Slocal), shimmer decibel (SdB), and harmonics to noise ratio (HNR) were detected using the Praat software program. Results Only for Jabs, statically significant difference was found between the groups. There were no statically significant differences between any voice parameters of HV versus those with the duration of diabetes >= 10 years and the HbA1c level >= 7%. However, statically significant differences for MPT and Slocal were found between patients with neuropathy versus HV. In addition, a comparison between patients with voice complaint versus HV showed significant differences for Slocal and SdB. Conclusions The findings of the present study do not provide strong evidence about the possible effect of DM on the human voice. However, diabetic neuropathy is considered to be a factor affecting the voice parameters in the target population. The physicians should pay attention to the acoustic and aerodynamic voice parameters in patients with diabetes, particularly in those with neuropathy or voice complaints.

Summary Background and objectives Due to the development of new anti‐psoriatic drugs in combination with improved structures for implementation throughout Germany, the medical care of psoriasis patients has markedly improved. In this study we investigated the real‐life utilization of the health care system and identified reasons for dissatisfaction in affected individuals. Patients and methods This non‐interventional cross‐sectional study was conducted as an anonymous online survey from 12/2018 to 01/2019 in Germany. Participants with a self‐reported physician‐confirmed diagnosis of psoriasis and symptoms answered questions about their disease, its influence on daily life and their medical care. Results 649 participants with a mean age of 42.5 ± 13.7 years and equal gender distribution (male: 50.2 %) were evaluated. 54.1 % received medical treatment at the time of the study, 45.9 % did not. Among the participants with medical care, 59.3 % were only moderately or less satisfied with their treatment. Reasons for dissatisfaction with the medication included lack of efficacy and side effects. Participants without medical treatment specified a physician’s lack of time as a main reason for not seeking medical help. Conclusions Despite the availability of efficient therapeutic options in Germany, many individuals with psoriasis are not satisfied. This under‐treated group was identified as a new target population.

Inhaled therapy remains the cornerstone of chronic obstructive pulmonary disease pharmacologic care, but some systemic treatments can be of help when the burden of the disease remains high. Azithromycin, phosphodiesterase-4 inhibitors, and mucoactive agents can be used in such situations. The major difficulty remains in the identification of the optimal target populations. Another difficulty is to determine how these treatments should be positioned in the global treatment algorithm. For instance, should they be prescribed in addition to other antiinflammatory agents or should they replace them in some cases? Research is ongoing to identify new therapeutic targets.

Background Rates of suicide attempts and deaths are highest on Mondays and these occur more frequently in the morning or early afternoon, suggesting weekly temporal and diurnal variation in suicidal behaviour. It is unknown whether there are similar time trends on social media, of posts relevant to suicide. We aimed to determine temporal and diurnal variation in posting patterns on the Reddit forum SuicideWatch, an online community for individuals who might be at risk of, or who know someone at risk of suicide. Methods We used time series analysis to compare date and time stamps of 90,518 SuicideWatch posts from 1st December 2008 to 31st August 2015 to (i) 6,616,431 posts on the most commonly subscribed general subreddit, AskReddit and (ii) 66,934 of these AskReddit posts, which were posted by the SuicideWatch authors. Results Mondays showed the highest proportion of posts on SuicideWatch. Clear diurnal variation was observed, with a peak in the early morning (2:00–5:00 h), and a subsequent decrease to a trough in late morning/early afternoon (11:00–14:00 h). Conversely, the highest volume of posts in the control data was between 20:00–23:00 h. Conclusions Posts on SuicideWatch occurred most frequently on Mondays: the day most associated with suicide risk. The early morning peak in SuicideWatch posts precedes the time of day during which suicide attempts and deaths most commonly occur. Further research of these weekly and diurnal rhythms should help target populations with support and suicide prevention interventions when needed most.

Maternal underweight (BMI18.5) is an uncommon situation with potentially serious obstetric consequences, though data in the literature are scarce.To compare the obstetrical prognosis of patients with normal BMI and BMI18.5.We performed a retrospective study in France (Normandy).We included 14,246 patients between January 2011 and November 2017, among whom 12,648 (88.8 %) had normal BMI, 1269 were considered mild underweight (17 ≤ BMI18.5 kg/m²) and 329 (2.3 %) were considered severe to moderate underweight (BMI17 kg/m²). The risk of preterm birth was all the greater as the thinness was severe (ORa: 1.34 [1.12-1.60] and ORa 1.77 [1.31-2.34]) and the risk of intrauterine growth retardation also increased with severe thinness (ORa: 1.63 [1.35-1.96] and ORa 2.28 [1.69-3.07]). The risk of a caesarean section or scheduled labour was no different. Neonatal parameters were comparable between the groups.Our study confirms an increased risk of preterm delivery and intrauterine growth retardation with increased thinness after adjusting for confounding factors. This link had only been shown previously in 2 studies Neither the type of prematurity (induced or spontaneous) nor the severity of prematurity is influenced by the severity of thinness; however, the low prevalence of thinness limits the power of these data. It would be interesting to study the medico-economic relevance of a policy of close maternal-foetal surveillance in this target population.

Lung cancer is the leading cause of cancer-related death worldwide, and its early detection is critical to achieving a curative treatment and to reducing mortality. Low-dose computed tomography (LDCT) is a highly sensitive technique for detecting noninvasive small lung tumors in high-risk populations. We here analyze the current status of lung cancer screening (LCS) from a European point of view. With economic burden of health care in most European countries resting on the state, it is important to reduce costs of screening and improve its effectiveness. Current cost-effectiveness analyses on LCS have indicated a favorable economic profile. The most recently published analysis reported an incremental cost-effectiveness ratio (ICER) of €3,297 per 1 life-year gained adjusted for the quality of life (QALY) and €2,944 per life-year gained, demonstrating a 90% probability of ICER being below €15,000 and a 98.1% probability of being below €25,000. Different risk models have been used to identify the target population; among these, the PLCOM2012 in particular allows for the selection of the population to be screened with high sensitivity. Risk models should also be employed to define screening intervals, which can reduce the general number of LDCT scans after the baseline round. Future perspectives of screening in a European scenario are related to the will of the policy makers to implement policy on a large scale and to improve the effectiveness of a broad screening of smoking-related disease, including cardiovascular prevention, by measuring coronary calcium score on LDCT. The employment of artificial intelligence (AI) in imaging interpretation, the use of liquid biopsies for the characterization of CT-detected undetermined nodules, and less invasive, personalized surgical treatments, will improve the effectiveness of LCS.

Objective: To assess the frequency, variants, clinical profile and outcome of patients admitted with the diagnosis of GuillianBarre Syndrome at neurology unit of a tertiary care teaching hospital of Pakistan. Study Design: Cross-sectional study. Place and Duration of Study: Neurology department, Pak Emirates Military Hospital Rawalpindi, from Jan to Dec 2018. Methodology: This study was conducted on 42 patients of Guillian-Barre Syndrome admitted in hospital. Demographic profile included age, gender, and the symptoms with which the patient presented. Medical and neurological complications were also documented among the target population. Outcomes included recovery, shifting to intensive care unit and death. Results: Out of 42 patients included in the final analysis 25 were male and 17 were female. Most of the patients presented with lower limb weakness followed by numbness. Acute inflammatory demyelinating polyneuropathy was the commonest while cranial nerve variant was least reported. Motor deficit were the commonest complication faced by the patients followed by respiratory involvement. Out of 42 patients, 34 (80.9%) recovered, 4 (9.5%) were shifted to the intensive care unit and 4 (9.5%) died. Conclusion: This study gives an insight into the pattern of a fairly common neurological illness which if diagnosed and managed in time has a good outcome in our set up. Management of critically ill Guillian-Barre Syndrome patients involves a multidisciplinary team with a need of intensive care unit during the course of management. Variety of types and presentations should be part of training of neurology doctors as well as internal medicine doctors.

Introduction: Risk Management Plans (RMPs) aim to optimize a medicinal product’s benefit/risk balance for the individual patient and the target population. Despite differences in regulatory RMP req...

Despite efforts taken by the Government of India, still mothers and new-borns are excluded from the postnatal care services, especially during the critical first 24 h after delivery. Hence, we have done this study to find the determinants of postnatal care for mothers and new-borns in India. We have analysed the NFHS-4 data gathered from Demographic Health Survey programme. Stratification and clustering in the sample design was accounted using svyset command. Point estimates were reported as proportions with 95% Confidence Interval (CI). In total, 190,797 women who had at least one live birth were included. About 25.2% and 27.1% of the new-born received post-natal care within 24 and 48 h of delivery. The proportion of women who received post-natal care within 24 and 48 h after delivery was 63.4% and 65.2% respectively. Higher socioeconomic status, women living in Southern region, utilization of proper antenatal and intranatal care, and Caesarian mode of delivery had significantly higher postnatal care coverage among mothers and new-borns. This finding informs the policy makers regarding the status of postnatal care coverage, that can be incorporated to identify target populations for further strengthening of service delivery.

Human Papillomavirus (HPV) vaccines are safe and are highly effective in reducing the prevalence of HPV infections and subsequent HPV associated diseases in the target population. A systematic review and meta-analysis was carried out searching electronic databases for articles published between January 2007 and September 2020 reporting the prevalence estimates of vaccine HPV (vHPV) types in women who had received one or more doses of quadrivalent or bivalent vaccines. This systematic review was based on standard systematic review guidelines and the meta-analysis was performed by pooling the HPV vaccine type prevalence data with 95% confidence interval (CI) among 16,929 young women who had received the prophylactic HPV vaccines before the age of 27 years. The overall pooled prevalence of vHPV types was.0.04 (95% CI: 0.02, 0.05). The meta-analysis concludes that prophylactic HPV vaccination before the age of 27 years results in a decline of vHPV types in young women.