The Determinant Factors of Acute Respiratory Infections (ARI) among Housewives in Allakuang Village, South Sulawesi, Indonesia

Acute respiratory infection (ARI) ranks first in the ten most frequent diseases occurring in Allakuang Village during the last five years. The physical conditions and the density of pollution inside houses are risk factors that cause ARI. Homemakers are particularly vulnerable to ARI because most of their time is spent inside their houses. The aim of this study is to determine the factors that affect the incidence of ARI among homemakers, including the physical condition of the house (temperature, humidity, lighting, ventilation, ceiling condition, floor, walls, and the location of the kitchen), the pollutants inside the house (PM10, cooking fuel, tobacco smoke, and smoke mosquito coils), and the number of occupants. The sample used in this cross-sectionalstudy comprised 103 homemakers. The analysis was conducted using chi-square and multiple logistic regression tests. The results showed that several factors had significant correlations with ARI, such as PM10 concentration, the type of cooking fuel, and the use of mosquito coils. Furthermore, the results of the multivariate analysis showed that the most influential factor that caused ARI was the type ofcooking fuel. Homemakers who used firewood and kerosene as their cooking fuel were47times more at risk of suffering ARI compared with those who used gas fuel. Hence, people are recommended to reduce the use of cooking fuel that produces smoke, to the kitchen from the family room, and to eliminate the use of mosquito coils. Keywords: PM10, acute respiratory infections, cooking fuels, homemaker

Particulate Matter 10 and the Incidence of Acute Respiratory Infectionsin Children in an Industrial Stone-carving Area in South Sulawesi, Indonesia

Stone carving, which is a common craft industry throughout Allakuang village, has the potential to produce particulate matter 10 (PM10) during the cutting and grinding of stone. This can result in air pollution in the workplace, as well as in the homes of local residents. PM10 is a risk factor for acute respiratory infections (ARIs) in children. This study aimed to determine the association between exposure to dust PM10 inside homes and the incidence of acute respiratory infections (ARI) in children. This was a cross-sectional study conducted in Allakuang village, Maritengngae subdistrict, Sidrap, South Sulawesi, Indonesia and consisted of 101 children. ARI cases were based on a doctor’s diagnosis. The concentration of PM10 in the workplace was assessed usinga Haz-Dust EPAM 5000 monitor. Chi-square analysis and multiple logistic regression tests were conducted. The concentration of PM10 was significantly associated with the incidence of ARIs (2.6; 1.1-6.1). The results of the multivariate analysis showed that children living in homes with PM10 concentrations that exceeded accepted limits had a 3.5 times higher risk of ARIs after adjusting for smoking behavior of family members. The significant association between the PM10 concentration and incidence of ARIs in children found in this study points to the need to control stone dust in the stone carving craft industry to prevent indoor air pollution of homes close to the industrial area. Keywords: PM10, acute respiratory infection, children, craft stone carvin

Risk Factors for Increased Urinary Cadmium Levels among a Rural Population Living Near a Dumpsite in the Deli Serdang District of Indonesia

Cadmium (Cd) is a toxic mineral, which occurs naturally in the environment and as a result of agricultural and industrial activities. It is also a carcinogenic heavy metal. After exposure, Cd accumulates in the kidney and is excreted in urine. The urinary Cd level is considered a biomarker of long-term exposure to the mineral. The aim of this study was to analyze the association between urinary Cd levels and sociodemographic characteristics of a rural population living close to Namo Bintang dumpsite. This study used a cross-sectional design and consisted of 99 participants, which were selected using the stratified random sampling method according to the distance from their homes to the dumpsite area. Urinary Cd levels were measured at baseline using agraphite furnace atomic absorption spectrophotometer and normalized by urinary creatinine. Demographic data and exposure to Cd-related risk factors were obtained through a direct interview using a questionnaire. The urinary Cd level of all the participants exceeded guidelines (>5 µg/g creatinine) according to the biologicalexposure indices of The American Conference of Governmental Industrial Hygienists (ACGIH). The presence of a smoking habit was significantly associated with increased urinary Cd levels (p = 0.041). It can be concluded that the community living close to the dumpsite has been exposed to Cd, which was related to urinary Cd levels. Keywords: cadmium; urinary Cd; heavy metal; dumpsit

Urinary Cadmium and Albumin Levels among Residents Living Close to Dumpsite in the Deli Serdang District of Indonesia

Albuminuria is a pathological condition wherein the protein albumin is present in urine. Albumin levels can be used as biomarker of kidney damage caused by cadmium (Cd). Many factors influence albuminuria, including environmental conditions, lifestylerelated factors, and sociodemographic characteristics. This study examined the association of sociodemographic characteristics with both urinary Cd levels and urinary albumin levels among rural residents living close to a dumpsite in Namo Bintang village. This study used a cross-sectional design, and the study population consisted of adult men and women (n = 99) who were selected using the stratified random sampling method based on the distance from their homes to the landfill. Thedata were analyzed using Spearman’s Rho and Mann–Whitney tests. Urinary albumin was determined using the urinary albumin (µg)/creatinine (mg) ratio, and urinary Cd levels were normalized to Cd (µg)/creatinine (g). Urinary albumin was measured by spectrophotometric and enzymatic analyses. Urinary Cd levels were determined using a graphite furnace atomic absorption spectrophotometer in spot urine sampled atbaseline. The characteristics of the participants, such as age, body mass index (BMI), sex, Cd exposure, occupation, and smoking status, were obtained through a direct interview using a questionnaire. The average urinary albumin level was 8.69 ± 14.55 µg/mg creatinine, and the average urinary Cd level was 35.1 ± 32.65 µg/g creatinine. Women had a higher risk than men of having albumin in their urine, pointing to an association between sex and urinary albumin levels (p = 0.041). Based on the findings of this study, local government officials should advise rural residents in dumpsite areas not to use well water for drinking and to check the water quality regularly to prevent urinary disease. Keywords: Albuminuria, Urinary Cadmium, Dumpsit

Effect of sex and underlying disease on the genetic association of QT interval and sudden cardiac death

Background Sudden cardiac death (SCD) accounts for ≈300 000 deaths annually in the United States. Men have a higher risk of SCD and are more likely to have underlying coronary artery disease, while women are more likely to have arrhythmic events in the setting of inherited or acquired QT prolongation. Moreover, there is evidence of sex differences in the genetics of QT interval duration. Using sex‐ and coronary artery disease–stratified analyses, we assess differences in genetic association between longer QT interval and SCD risk. Methods and Results We examined 2282 SCD subjects and 3561 Finnish controls. The SCD subjects were stratified by underlying disease (ischemic versus nonischemic) and by sex. We used logistic regression to test for association between the top QT interval–associated single‐nucleotide polymorphism, rs12143842 (in the NOS1AP locus), and SCD risk. We also performed Mendelian randomization to test for causal association of QT interval in the various subgroups. No statistically significant differences were observed between the sexes for associations with rs12143842, despite the odds ratio being higher in females across all subgroup analyses. Consistent with our hypothesis, female non‐ischemics had the highest odds ratio point estimate for association between rs12143842 and SCD risk and male ischemics the lowest odds ratio point estimate (P=0.036 for difference). Similar trends were observed for the Mendelian randomization analysis. Conclusions While individual subgroup comparisons did not achieve traditional criteria for statistical significance, this study is consistent with the hypothesis that the causal association of longer QT interval on SCD risk is stronger in women and nonischemic individuals

Syndromic Surveillance: Adapting Innovations to Developing Settings

The tools and strategies of syndromic surveillance, say the authors, hold promise for improving public health security in developing countries

Deep learning for clustering of multivariate clinical patient trajectories with missing values

BACKGROUND: Precision medicine requires a stratification of patients by disease presentation that is sufficiently informative to allow for selecting treatments on a per-patient basis. For many diseases, such as neurological disorders, this stratification problem translates into a complex problem of clustering multivariate and relatively short time series because (i) these diseases are multifactorial and not well described by single clinical outcome variables and (ii) disease progression needs to be monitored over time. Additionally, clinical data often additionally are hindered by the presence of many missing values, further complicating any clustering attempts. FINDINGS: The problem of clustering multivariate short time series with many missing values is generally not well addressed in the literature. In this work, we propose a deep learning-based method to address this issue, variational deep embedding with recurrence (VaDER). VaDER relies on a Gaussian mixture variational autoencoder framework, which is further extended to (i) model multivariate time series and (ii) directly deal with missing values. We validated VaDER by accurately recovering clusters from simulated and benchmark data with known ground truth clustering, while varying the degree of missingness. We then used VaDER to successfully stratify patients with Alzheimer disease and patients with Parkinson disease into subgroups characterized by clinically divergent disease progression profiles. Additional analyses demonstrated that these clinical differences reflected known underlying aspects of Alzheimer disease and Parkinson disease. CONCLUSIONS: We believe our results show that VaDER can be of great value for future efforts in patient stratification, and multivariate time-series clustering in general

Relationships of the Location and Content of Rounds to Specialty, Institution, Patient-Census, and Team Size

OBJECTIVE: Existing observational data describing rounds in teaching hospitals are 15 years old, predate duty-hour regulations, are limited to one institution, and do not include pediatrics. We sought to evaluate the effect of medical specialty, institution, patient-census, and team participants upon time at the bedside and education occurring on rounds. METHODS AND PARTICIPANTS: Between December of 2007 and October of 2008 we performed 51 observations at Lucile Packard Children's Hospital, Seattle Children's Hospital, Stanford University Hospital, and the University of Washington Medical Center of 35 attending physicians. We recorded minutes spent on rounds in three location and seven activity categories, members of the care team, and patient-census. RESULTS: Results presented are means. Pediatric rounds had more participants (8.2 vs. 4.1 physicians, p<.001; 11.9 vs. 2.4 non-physicians, p<.001) who spent more minutes in hallways (96.9 min vs. 35.2 min, p<.001), fewer minutes at the bedside (14.6 vs. 38.2 min, p = .01) than internal medicine rounds. Multivariate regression modeling revealed that minutes at the bedside per patient was negatively associated with pediatrics (-2.77 adjusted bedside minutes; 95% CI -4.61 to -0.93; p<.001) but positively associated with the number of non-physician participants (0.12 adjusted bedside minutes per non physician participant; 95% CI 0.07 to 0.17; p = <.001). Education minutes on rounds was positively associated with the presence of an attending physician (2.70 adjusted education minutes; 95% CI 1.27 to 4.12; p<.001) and with one institution (1.39 adjusted education minutes; 95% CI 0.26 to 2.53; p = .02). CONCLUSIONS: Pediatricians spent less time at the bedside on rounds than internal medicine physicians due to reasons other than patient-census or the number of participants in rounds. Compared to historical data, internal medicine rounds were spent more at the bedside engaged in patient care and communication, and less upon educational activities