Closing the Gap: How Improving Information Flow Can Help Community-Based Organizations Keep Uninsured Kids From Falling Through the Cracks

Evaluates how community-based organizations used a tool for systematic, ongoing data exchange with the state to monitor children's enrollment and redetermination status in public health insurance. Explores its potential to boost outreach and enrollment

Perception of proposed preliminary food-based dietary guidelines for Lake Victoria region of Kenya : findings from a qualitative study among adult community members

Background: Diets in the Lake Victoria region of Kenya have been described as monotonous, consisting chiefly of starchy staple foods, accompanied by green vegetables and oil. To promote healthy eating in the region, 11 food-based dietary guidelines (FBDGs) were proposed. Objective: This study was designed to assess perception of the proposed FBDGs amongst consumers in Lake Victoria region. Design and setting: A qualitative, descriptive cross-sectional design was used to collect data from 36 focus-group discussions (FGD) among adult males (18) and females (18) in Kisumu and Homa Bay Counties. Subjects: A total of 207 adult males (26–74 years) and 211 females (18–71 years) participated in this study. Data collection and analysis: Proposed FBDGs were printed on posters and presented to FGD participants. Proceedings were audio-taped, transcribed, translated and analysed based on themes. Results: The proposed FBDGs were perceived as promoting the consumption of a balanced diet. As a concept, a balanced diet was misrepresented as composed of only three nutrients: carbohydrates, proteins and vitamins. There was no mention of fats/oils and minerals as other significant nutrient constituents of a balanced diet. Other concepts, which included ‘three regular meals’, ‘snacks’, ‘food variety’, ‘healthy and physically active lifestyle’, were polysemous. Conclusion: The findings provide insight to guide the adaptation of the national FBDGs. The findings also provide a basis for nutrition advocacy programmes and a rationale for the revision of nutrition education materials, including the school curriculum, to align content with current evidence-based information

Refining fisheries advice with stock-specific ecosystem information

Although frequently suggested as a goal for ecosystem-based fisheries management, incorporating ecosystem information into fisheries stock assessments has proven challenging. The uncertainty of input data, coupled with the structural uncertainty of complex multi-species models, currently makes the use of absolute values from such models contentious for short-term single-species fisheries management advice. Here, we propose a different approach where the standard assessment methodologies can be enhanced using ecosystem model derived information. Using a case study of the Irish Sea, we illustrate how stock-specific ecosystem indicators can be used to set an ecosystem-based fishing mortality reference point (FECO) within the “Pretty Good Yield” ranges for fishing mortality which form the present precautionary approach adopted in Europe by the International Council for the Exploration of the Sea (ICES). We propose that this new target, FECO, can be used to scale fishing mortality down when the ecosystem conditions for the stock are poor and up when conditions are good. This approach provides a streamlined quantitative way of incorporating ecosystem information into catch advice and provides an opportunity to operationalize ecosystem models and empirical indicators, while retaining the integrity of current assessment models and the FMSY-based advice process.publishedVersio

Robotic-assisted, laparoscopic, and open radical cystectomy: surgical data of 1400 patients from The Italian Radical Cystectomy Registry on intraoperative outcomes

Introduction: The Italian Radical Cystectomy Registry (Registro Italiano Cistectomie - RIC) aimed to analyse outcomes of a multicenter series of patients treated with radical cystectomy (RC) for bladder cancer. Material and methods: An observational, prospective, multicenter, cohort study was performed to collect data from RC and urinary diversion via open (ORC), laparoscopic (LRC), or robotic-assisted (RARC) techniques performed in 28 Italian Urological Departments. The enrolment was planned from January 2017 to June 2020 (goal: 1000 patients), with a total of 1425 patients included. Chi-square and t-tests were used for categorical and continuous variables. All tests were 2-sided, with a significance level set at p <0.05. Results: Overall median operative-time was longer in RARCs (390 minutes, IQR 335-465) than ORCs (250, 217-309) and LRCs (292, 228-350) (p <0.001). Lymph node dissection (LND) was performed more frequently in RARCs (97.1%) and LRCs (93.5%) than ORCs (85.6%) (p <0.001), with extended-LND performed 2-fold more frequently in RARCs (61.6%) (p <0.001). The neobladder rate was significantly higher (more than one-half) in RARCs. The median estimated blood loss (EBL) rate was lower in RARCs (250 ml, 165-400) than LRCs (330, 200-600) and ORCs (400, 250-600) (p <0.001), with intraoperative blood transfusion rates of 11.4%, 21.7% and 35.6%, respectively (p <0.001). The conversion to open rate was slightly higher in RARCs (6.8%) than LRCs (4.3%). Intraoperative complications occurred in 1.3% of cases without statistically significant differences among the approaches. Conclusions: Data from the RIC confirmed the need to collect as much data as possible in a multicenter manner. RARCs proves to be feasible with perioperative complication rates that do not differ from the other approaches

A Fully Integrated Real-Time Detection, Diagnosis, and Control of Community Diarrheal Disease Clusters and Outbreaks (the INTEGRATE Project):Protocol for an Enhanced Surveillance System

BACKGROUND:Diarrheal disease, which affects 1 in 4 people in the United Kingdom annually, is the most common cause of outbreaks in community and health care settings. Traditional surveillance methods tend to detect point-source outbreaks of diarrhea and vomiting; they are less effective at identifying low-level and intermittent food supply contamination. Furthermore, it can take up to 9 weeks for infections to be confirmed, reducing slow-burn outbreak recognition, potentially impacting hundreds or thousands of people over wide geographical areas. There is a need to address fundamental problems in traditional diarrheal disease surveillance because of underreporting and subsequent unconfirmed infection by patients and general practitioners (GPs); varying submission practices and selective testing of samples in laboratories; limitations in traditional microbiological diagnostics, meaning that the timeliness of sample testing and etiology of most cases remains unknown; and poorly integrated human and animal surveillance systems, meaning that identification of zoonoses is delayed or missed. OBJECTIVE:This study aims to detect anomalous patterns in the incidence of gastrointestinal disease in the (human) community; to target sampling; to test traditional diagnostic methods against rapid, modern, and sensitive molecular and genomic microbiology methods that identify and characterize responsible pathogens rapidly and more completely; and to determine the cost-effectiveness of rapid, modern, sensitive molecular and genomic microbiology methods. METHODS:Syndromic surveillance will be used to aid identification of anomalous patterns in microbiological events based on temporal associations, demographic similarities among patients and animals, and changes in trends in acute gastroenteritis cases using a point process statistical model. Stool samples will be obtained from patients' consulting GPs, to improve the timeliness of cluster detection and characterize the pathogens responsible, allowing health protection professionals to investigate and control outbreaks quickly, limiting their size and impact. The cost-effectiveness of the proposed system will be examined using formal cost-utility analysis to inform decisions on national implementation. RESULTS:The project commenced on April 1, 2013. Favorable approval was obtained from the Research Ethics Committee on June 15, 2015, and the first patient was recruited on October 13, 2015, with 1407 patients recruited and samples processed using traditional laboratory techniques as of March 2017. CONCLUSIONS:The overall aim of this study is to create a new One Health paradigm for detecting and investigating diarrhea and vomiting in the community in near-real time, shifting from passive human surveillance and management of laboratory-confirmed infection toward an integrated, interdisciplinary enhanced surveillance system including management of people with symptoms. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):DERR1-10.2196/13941

Role of cellular senescence and NOX4-mediated oxidative stress in systemic sclerosis pathogenesis.

Systemic sclerosis (SSc) is a systemic autoimmune disease characterized by progressive fibrosis of skin and numerous internal organs and a severe fibroproliferative vasculopathy resulting frequently in severe disability and high mortality. Although the etiology of SSc is unknown and the detailed mechanisms responsible for the fibrotic process have not been fully elucidated, one important observation from a large US population study was the demonstration of a late onset of SSc with a peak incidence between 45 and 54 years of age in African-American females and between 65 and 74 years of age in white females. Although it is not appropriate to consider SSc as a disease of aging, the possibility that senescence changes in the cellular elements involved in its pathogenesis may play a role has not been thoroughly examined. The process of cellular senescence is extremely complex, and the mechanisms, molecular events, and signaling pathways involved have not been fully elucidated; however, there is strong evidence to support the concept that oxidative stress caused by the excessive generation of reactive oxygen species may be one important mechanism involved. On the other hand, numerous studies have implicated oxidative stress in SSc pathogenesis, thus, suggesting a plausible mechanism in which excessive oxidative stress induces cellular senescence and that the molecular events associated with this complex process play an important role in the fibrotic and fibroproliferative vasculopathy characteristic of SSc. Here, recent studies examining the role of cellular senescence and of oxidative stress in SSc pathogenesis will be reviewed

Type and extent of trans-disciplinary co-operation to improve food security, health and household environment in low and middle income countries: systematic review

Acknowledgements: We are grateful to Dr Steve Turner and Dr Adam Price for their insightful comments that improved the manuscript. We would like to thank Heather Clark and Bimbola Kalejaiye for their help in data extraction. We are also grateful to Melanie Bickerton and Dr Amudha Poobalan for their systematic review advice.Peer reviewedPublisher PD

Dietitians' perceptions of the Continuing Professional Development system in South Africa

Objective: To retrospectively evaluate the South African Continuing Professional Development (CPD) system (previous and current) for dietitians, by determining their perceptions of the system's implementation and participation in CPD activities. Design: An observational descriptive study in the quantitative and qualitative research domains. Methods: A national survey of 1 589 dietitians was conducted using a self-administered questionnaire, followed by 3 focus group discussions (FGD) with 19 Pretoria-based dietitians. In-depth interviews were also conducted with 6 CPD/Health Professions Council of South Africa (HPCSA) administrative personnel. Results: Twenty per cent of dietitians responded to the survey. The CPD administration fee was unreasonable to 54.5% (N = 156) of dietitians and most FGD participants. CPD activities were expensive to 55% (N=164) of respondents while 29% (N = 88) of respondents, in agreement with the FGD participants, acknowledged the availability of variably priced activities. Statistically significant cost differences were determined across practice areas, qualifications and provinces. Lectures and seminars were activities most commonly participated in, followed by conferences and articles with multiple choice questions (MCQs) from peer reviewed literature. However, conferences ranked highest as the most preferred activity. Barriers to CPD activities included costs, geographical access, obtaining leave from work, family obligations and internet access. More dietitians were satisfied with the service quality at the CPD office and the Association for Dietetics in South Africa (ADSA) than with that provided by the HPCSA, but requested simpler correspondence from all these offices. In the current system, dietitians need to keep their own CPD records, but 51.7% (N = 161) preferred not to do so. Conclusions: Addressing factors affecting CPD participation will contribute to the acceptability of the system by dietitians