Height and timing of growth spurt during puberty in young people living with vertically acquired HIV in Europe and Thailand.

OBJECTIVE: The aim of this study was to describe growth during puberty in young people with vertically acquired HIV. DESIGN: Pooled data from 12 paediatric HIV cohorts in Europe and Thailand. METHODS: One thousand and ninety-four children initiating a nonnucleoside reverse transcriptase inhibitor or boosted protease inhibitor based regimen aged 1-10 years were included. Super Imposition by Translation And Rotation (SITAR) models described growth from age 8 years using three parameters (average height, timing and shape of the growth spurt), dependent on age and height-for-age z-score (HAZ) (WHO references) at antiretroviral therapy (ART) initiation. Multivariate regression explored characteristics associated with these three parameters. RESULTS: At ART initiation, median age and HAZ was 6.4 [interquartile range (IQR): 2.8, 9.0] years and -1.2 (IQR: -2.3 to -0.2), respectively. Median follow-up was 9.1 (IQR: 6.9, 11.4) years. In girls, older age and lower HAZ at ART initiation were independently associated with a growth spurt which occurred 0.41 (95% confidence interval 0.20-0.62) years later in children starting ART age 6 to 10 years compared with 1 to 2 years and 1.50 (1.21-1.78) years later in those starting with HAZ less than -3 compared with HAZ at least -1. Later growth spurts in girls resulted in continued height growth into later adolescence. In boys starting ART with HAZ less than -1, growth spurts were later in children starting ART in the oldest age group, but for HAZ at least -1, there was no association with age. Girls and boys who initiated ART with HAZ at least -1 maintained a similar height to the WHO reference mean. CONCLUSION: Stunting at ART initiation was associated with later growth spurts in girls. Children with HAZ at least -1 at ART initiation grew in height at the level expected in HIV negative children of a comparable age

Time to Switch to Second-line Antiretroviral Therapy in Children With Human Immunodeficiency Virus in Europe and Thailand.

Background: Data on durability of first-line antiretroviral therapy (ART) in children with human immunodeficiency virus (HIV) are limited. We assessed time to switch to second-line therapy in 16 European countries and Thailand. Methods: Children aged <18 years initiating combination ART (≥2 nucleoside reverse transcriptase inhibitors [NRTIs] plus nonnucleoside reverse transcriptase inhibitor [NNRTI] or boosted protease inhibitor [PI]) were included. Switch to second-line was defined as (i) change across drug class (PI to NNRTI or vice versa) or within PI class plus change of ≥1 NRTI; (ii) change from single to dual PI; or (iii) addition of a new drug class. Cumulative incidence of switch was calculated with death and loss to follow-up as competing risks. Results: Of 3668 children included, median age at ART initiation was 6.1 (interquartile range (IQR), 1.7-10.5) years. Initial regimens were 32% PI based, 34% nevirapine (NVP) based, and 33% efavirenz based. Median duration of follow-up was 5.4 (IQR, 2.9-8.3) years. Cumulative incidence of switch at 5 years was 21% (95% confidence interval, 20%-23%), with significant regional variations. Median time to switch was 30 (IQR, 16-58) months; two-thirds of switches were related to treatment failure. In multivariable analysis, older age, severe immunosuppression and higher viral load (VL) at ART start, and NVP-based initial regimens were associated with increased risk of switch. Conclusions: One in 5 children switched to a second-line regimen by 5 years of ART, with two-thirds failure related. Advanced HIV, older age, and NVP-based regimens were associated with increased risk of switch

The great transformation of Japanese capitalism

In the 1980s the performance of Japan's economy was an international success story, and led many economists to suggest that the 1990s would be a Japanese decade. Today, however, the dominant view is that Japan is inescapably on a downward slope. Rather than focusing on the evolution of the performance of Japanese capitalism, this book reflects on the changes that it has experienced over the past 30 years, and presents a comprehensive analysis of the great transformation of Japanese capitalism from the heights of the 1980s, through the lost decades of the 1990s, and well into the 21st century. This book posits an alternative analysis of the Japanese economic trajectory since the early 1980s, and argues that whereas policies inspired by neo-liberalism have been presented as a solution to the Japanese crisis, these policies have in fact been one of the causes of the problems that Japan has faced over the past 30 years. Crucially, this book seeks to understand the institutional and organisational changes that have characterised Japanese capitalism since the 1980s, and to highlight in comparative perspective, with reference to the ‘neo-liberal moment’, the nature of the transformation of Japanese capitalism. Indeed, the arguments presented in this book go well beyond Japan itself, and examine the diversity of capitalism, notably in continental Europe, which has experienced problems that in many ways are also comparable to those of Japan. The Great Transformation of Japanese Capitalism will appeal to students and scholars of both Japanese politics and economics, as well as those interested in comparative political economy

Prediction of Dengue Fever Cases in Malang City Using A Neural Network Model

Dengue fever has been declared endemic in many cities of Indonesia, one of them being the Malang City. In 2015, the incidence of dengue fever in the region was recorded at 1,629 with 13 deaths. There are many factors that contribute to the disease. The factors associated with dengue-fever transmission include population density, population mobility, quality of housing and attitude of life. However, the factors that can trigger dengue fever are environmental in nature, and include changes in temperature, humidity and rainfall, which cause mosquitoes to lay eggs more often and facilitates a rapid reproduction of the dengue virus. Parasites and disease carriers (mosquitoes) are very sensitive to climatic factors, especially temperature, rainfall, humidity, water levels and wind. Therefore, this study aimed to develop a suitable model for forecasting dengue fever in Malang City based on the Transfer Function and Artificial Neural Network (ANN). Data used were dengue fever data from 2004 to 2019. The results showed that the smallest RMSE, MAPE and SMAPE values of the two models were ANN models. Keywords: Artificial Neural Network (ANN), transfer function, dengue feve

Peningkatan Pengetahuan Masyarakat dalam Penggunaan Resume Medis pada Fasilitas Pelayanan Kesehatan

Mutu pelayanan kesehatan ditentukan dari peningkatan mutu klinis dan pelayanan yang berorientasi kepada kepuasan pelanggan. Hal tersebut dapat diketahui dari kelengkapan pengisian rekam medis. Pada berkas rekam medis terdapat nilai hukum rahasia medis pasien. Nilai hukum kerahasiaan medis sering kali terabaikan terutama bagi masyarakat dengan pendidikan yang rendah dan secara letak geografis sangat sulit untuk mendapatkan akses Fasilitas kesehatan yang memadai. Kegiatan pengabdian kepada masyarakat ini bertujuan untuk meningkatkan kualitas pelayanan kesehatan melalui pemahaman penggunaan resume medis. Kegiatan ini dilaksanakan di Dusun Sukosari Desa Pandansari Kecamatan Poncokusumo Kabupaten Malang, sebanyak 3 kali pertemuan dengan memberikan penyuluhan dan pendampingan yang dikemas dalam bentuk materi presentasi dan pembagian brosur kepada 25 peserta. Dari hasil evaluasi, terdapat peningkatan pemahaman warga dengan kategori baik dari nilai pre test sebesar 8% dan post test sebesar 52%. Selanjutnya, secara berkesinambungan agar kader kesehatan yang ada di lingkungan warga dapat memberikan contoh dalam menggunakan resume medis untuk keperluan pasien secara baik dan benar agar ikut meningkatkan mutu pelayanan kesehatan yang berkelanjutan

Comparisons of Gait Variability and Symmetry in Healthy Runners, Runners with a History of Lower Limb Injuries, and Runners with a Current Lower Limb Injury

Background: Running is a cyclic movement and requires a bilateral symmetry between the lower limbs to reduce injury risk, and the assessment of side-to-side differences is often performed to detect functional deficits. Objectives: The purpose was to study side-to-side differences using clinical and running performance assessments in healthy runners (HR), runners with a history of lower limb injuries (RHI), and runners with a current lower limb injury. Methods: Forty-three runners were recruited with 14 participants being allocated to the HR group, 13 to the RHI group, and 16 to the RLI group. Peak vertical ground reaction force (GRF), midfoot pressure, foot rotation, and gait variability were recorded using a Zebris FDM-T treadmill analysis system, and participants were also assessed using the navicular drop test. Dependent t-tests were used to determine if any differences existed between the lower limbs within each group. One-way ANOVAs were then used to investigate the side-to-side differences between the three groups. Results: Significant differences were seen in navicular drop height between lower limbs within both the HR (p=0.02) and RHI (p=0.009) groups, and side-to-side differences in foot rotation were greatest in the RLI group (~34%) compared to both the RHI (~30.5%) and HR (~24%) groups. The lateral variability of the centre of pressure was greatest in the RLI group (37.1mm) compared to the RHI (28.9mm) and HR (22.2mm) groups. Conclusion: Centre of pressure variability may help identify runners at a greater risk of lower limb injury. Side-to-side differences should be expected to progressively decrease from the injured stage, through the recovery and return to sport phases. Target goals of less than 34% side-to-side difference for foot rotation and 37.1mm for lateral centre of pressure variability may be used to help the decision making process when considering a return to running practice