Exploring water, sanitation, and hygiene coverage targets for reaching and sustaining trachoma elimination: G-computation analysis

BACKGROUND: Trachoma is the leading infectious cause of blindness. To reduce transmission, water, sanitation, and hygiene (WaSH) improvements are promoted through a comprehensive public health strategy. Evidence supporting the role of WaSH in trachoma elimination is mixed and it remains unknown what WaSH coverages are needed to effectively reduce transmission. METHODS/FINDINGS: We used g-computation to estimate the impact on the prevalence of trachomatous inflammation-follicular among children aged 1-9 years (TF1-9) when hypothetical WaSH interventions raised the minimum coverages from 5% to 100% for "nearby" face-washing water (<30 minutes roundtrip collection time) and adult latrine use in an evaluation unit (EU). For each scenario, we estimated the generalized prevalence difference as the TF1-9 prevalence under the intervention scenarios minus the observed prevalence. Data from 574 cross-sectional surveys conducted in 16 African and Eastern Mediterranean countries were included. Surveys were conducted from 2015-2019 with support from the Global Trachoma Mapping Project and Tropical Data. When modeling interventions among EUs that had not yet met the TF1-9 elimination target, increasing nearby face-washing water and latrine use coverages above 30% was generally associated with consistent decreases in TF1-9. For nearby face-washing water, we estimated a ≥25% decrease in TF1-9 at 65% coverage, with a plateau upon reaching 85% coverage. For latrine use, the estimated decrease in TF1-9 accelerated from 80% coverage upward, with a ≥25% decrease in TF1-9 by 85% coverage. Among EUs that had previously met the elimination target, results were inconclusive. CONCLUSIONS: Our results support Sustainable Development Goal 6 and provide insight into potential WaSH-related coverage targets for trachoma elimination. Targets can be tested in future trials to improve evidence-based WaSH guidance for trachoma

Flaxseed flour addition on fatty acid profile and sensory properties of brazilian cheese roll Adição de farinha de linhaça no perfil de ácidos graxos e nas propriedades sensoriais do pão de queijo brasileiro

In recent decades, studies on human nutrition have emphasized the importance of omega-3 and 6 intake. Since flaxseed is a good source for such fatty acids, the aim of this study was to develop a Brazilian cheese roll enriched with flaxseed flour. Three formulations were produced to determine the intensity of some sensory attributes and to set the best composition for conducting a consumer acceptance test. In the selected formulation, it was determined the Brazilian cheese roll's expansion rate, its physico-chemical characteristics, fatty acid composition and acceptance rate. Regarding its flavor and general characteristics, the results showed a good acceptance of the cheese roll enriched with flaxseed flour. The product also presented an omega-6/omega-3 ratio of 7.32:1.0, which is within the recommended one. Therefore, the cheese roll enriched with flaxseed presents as a good alternative for the traditional one, specially concerning the omega-3 and omega-6 content, which aggregates nutritional and functional benefits to the product.<br>Nas últimas décadas, estudos sobre nutrição humana têm enfatizado a importância da ingestão de ômega 3 e 6. Considerando que a linhaça é uma boa fonte desses ácidos graxos, neste estudo, objetivou-se desenvolver um pão de queijo enriquecido com farinha de linhaça. Foram produzidas três formulações para determinar a intensidade de alguns atributos sensoriais e para definir a melhor composição para a realização do teste de aceitação com consumidores. Na formulação selecionada, foram determinadas a taxa de expansão do pão de queijo, suas características físico-químicas, perfil de ácidos graxos e o índices de aceitação. Em relação ao sabor e às características gerais, os resultados mostraram que o pão de queijo enriquecido com farinha de linhaça foi bem aceito pelos consumidores. O produto apresentou também uma razão de ômega 6/ômega 3 de 7,32:1,0, que está dentro do recomendado. Portanto, o pão de queijo enriquecido com linhaça parece ser uma boa alternativa ao pão de queijo tradicional, especialmente no que concerne ao seu conteúdo de ômega-3 e ômega-6, que agrega benefícios nutricionais e funcionais para o produto

Video-assisted thoracic surgery―the past, present status and the future

Video-assisted thoracic surgery (VATS) has developed very rapidly in these two decades, and has replaced conventional open thoracotomy as a standard procedure for some simple thoracic operations as well as an option or a complementary procedure for some other more complex operations. In this paper we will review its development history, the present status and the future perspectives

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used