Prevalence and Factors Associated With Liver Fibrosis Among Adult HIV-Infected Patients Attending Urban and Rural Care Clinics in Uganda.

BACKGROUND: Liver fibrosis is common among HIV-infected patients. Risk factors vary by location. Understanding this variation may inform prevention strategies. We compared the prevalence and correlates of liver fibrosis among HIV-infected patients attending care clinics in Uganda. METHODS: This was a cross-sectional study involving 2030 HIV-infected patients attending care clinics in urban and rural Uganda. Liver fibrosis was defined as liver stiffness measurement (LSM) >7.1 KPa. Proportions and correlates of liver fibrosis were assessed and compared using logistic regression stratified by gender and site. RESULTS: Prevalence of liver fibrosis was higher among participants in the rural clinic (15% vs 11%; P = .017). History of tobacco use (urban P = .022; rural P = .035) and serologic evidence of hepatitis C infection (HCV; urban P = .028; rural P = .03) was associated with liver fibrosis in all men. Elevated liver transaminases (urban P = .002; rural P = .028) and increasing age (urban P = .008; rural P = .052) were risk factors among all women. Tobacco use among women was only a risk factor in those attending the rural clinic (P = .003), and detectable HIV viral load (P = .002) for men in the urban clinic. CONCLUSIONS: Liver fibrosis is prevalent among HIV-infected persons in Uganda. HIV viral suppression and avoiding tobacco may be strategies to prevent liver fibrosis and cancer risk

Use of Internet Audience Measurement Data to Gauge Market Share for Online Health Information Services

BACKGROUND: The transition to a largely Internet and Web-based environment for dissemination of health information has changed the health information landscape and the framework for evaluation of such activities. A multidimensional evaluative approach is needed. OBJECTIVE: This paper discusses one important dimension of Web evaluation—usage data. In particular, we discuss the collection and analysis of external data on website usage in order to develop a better understanding of the health information (and related US government information) market space, and to estimate the market share or relative levels of usage for National Library of Medicine (NLM) and National Institutes of Health (NIH) websites compared to other health information providers. METHODS: The primary method presented is Internet audience measurement based on Web usage by external panels of users and assembled by private vendors—in this case, comScore. A secondary method discussed is Web usage based on Web log software data. The principle metrics for both methods are unique visitors and total pages downloaded per month. RESULTS: NLM websites (primarily MedlinePlus and PubMed) account for 55% to 80% of total NIH website usage depending on the metric used. In turn, NIH.gov top-level domain usage (inclusive of NLM) ranks second only behind WebMD in the US domestic home health information market and ranks first on a global basis. NIH.gov consistently ranks among the top three or four US government top-level domains based on global Web usage. On a site-specific basis, the top health information websites in terms of global usage appear to be WebMD, MSN Health, PubMed, Yahoo! Health, AOL Health, and MedlinePlus. Based on MedlinePlus Web log data and external Internet audience measurement data, the three most heavily used cancer-centric websites appear to be www.cancer.gov (National Cancer Institute), www.cancer.org (American Cancer Society), and www.breastcancer.org (non-profit organization). CONCLUSIONS: Internet audience measurement has proven useful to NLM, with significant advantages compared to sole reliance on usage data from Web log software. Internet audience data has helped NLM better understand the relative usage of NLM and NIH websites in the intersection of the health information and US government information market sectors, which is the primary market intersector for NLM and NIH. However important, Web usage is only one dimension of a complete Web evaluation framework, and other primary research methods, such as online user surveys, usability tests, and focus groups, are also important for comprehensive evaluation that includes qualitative elements, such as user satisfaction and user friendliness, as well as quantitative indicators of website usage

Trends and Costs Associated With Suboptimal Physical Activity Among US Women With Cardiovascular Disease

IMPORTANCE: Cardiovascular disease (CVD) is the leading cause of death and disability amongwomen. Achievement of recommended physical activity (PA) levels is an essential component ofCVD management.OBJECTIVE: To describe trends, sociodemographic factors, and health care expenditures associatedwith suboptimal PA among a nationally representative sample of US women with CVD.DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used serial data from theMedical Expenditure Panel Survey from 2006 through 2015. The analyses were conducted in August2018. Women who had self-reported and/or International Classification of Diseases, Ninth Revision,diagnosis of CVD were included.MAIN OUTCOMES AND MEASURES: Recommended PA was defined as 30 minutes or more ofmoderate- to vigorous-intensity exercise, 5 or more days per week. Weighted logistic regression wasused to examine the associations of various sociodemographic factors with suboptimal PA, adjustedfor comorbidities. A 2-part econometric model was used to assess health care expenditures.RESULTS: A total of 18 027 women were included in this study. The results were weighted to provideestimates for approximately 19.5 million adult women in the United States with CVD (mean [SD] age,60.4 [16.9] years). More than half of the women with CVD reported suboptimal PA, a trend thatincreased during the 10-year period, with 58.2% (95% CI, 55.9%-60.5%) of participants reportingsuboptimal PA in 2006-2007 vs 61.9% (95% CI, 59.7%-64.2%) in 2014-2015 (P = .004). Theproportion of women with suboptimal PA differed by sociodemographic factors. In adjusted models,compared with non-Hispanic white women, African American women (odds ratio, 1.22; 95% CI,1.08-1.38) and Hispanic women (odds ratio, 1.33; 95% CI, 1.13-1.58) were more likely to havesuboptimal PA. Women from low- or very low-income strata (compared with high-income strata),enrolled in public insurance (compared with private insurance), and with less than high schooleducation (compared with at least some college education) were more likely to have suboptimal PA.Health care costs among women with CVD with suboptimal PA were higher compared with thoseamong women who met the recommended PA, and this increased through time, from a mean totalhealth care expenditure of $12 724 (95$11 627-$13 821) in 2006-2007 to$14 820 (95% CI,$13 521-$16 119) in 2014-2015.CONCLUSIONS AND RELEVANCE: The proportion of women with CVD not meeting recommendedPA is high and increasing, particularly among certain racial/ethnic and socioeconomic groups, and isassociated with significant health care costs. More must be done to improve PA for secondaryprevention and reduction of expenditures among women with CVD

Age-specific differences in patient reported outcomes among adults with atherosclerotic cardiovascular disease: Medical expenditure panel survey 2006–2015

ObjectiveThe prevalence of atherosclerotic cardiovascular disease (ASCVD) in younger adults has increased over the past decade. However, it is less well established whether patient reported outcomes differ between younger and older adults with ASCVD. We sought to evaluate age-specific differences in patient reported outcomes among adults with ASCVD.MethodsThis was a retrospective cross-sectional survey study. We used data from the 2006–2015 Medical Expenditure Panel Survey (MEPS), a nationally representative sample of the United States population. Adults ≥18 years with a diagnosis of ASCVD, ascertained by ICD9 codes or self-reported data, were included. Logistic regression was used to compare self-reported patient-clinician communication, patient satisfaction, perception of health, emergency department (ED) visits, and use of preventive medications (aspirin and statins) by age category [Young: 18–44, Middle: 45–64, Older: ≥65 years]. We used two-part econometric modeling to evaluate age-specific annual healthcare expenditure.ResultsThere were 21,353 participants included. Over 9000 (42.6%-weighted) of the participants were young or middle aged, representing ~9.9 million adults aged <65 years with ASCVD nationwide. Compared with older adults, middle-aged and young adults with ASCVD were more likely to report poor patient-clinician communication [OR 1.73 (95% CI 1.28–2.33) and 2.49 (1.76–3.51), respectively], poor healthcare satisfaction, and poor perception of health status, have increased ED utilization and were also less likely to be using aspirin and statins. The mean annual healthcare expenditure was highest among middle-aged adults [$10,798 (95$10,012 to $11,583)].ConclusionCompared with older adults, younger adults with ASCVD were more likely to report poor patient experience and poor health status and less likely to be using preventive medications. More effort needs to be geared towards understanding the age-specific differences in healthcare quality and delivery to improve outcomes among high-risk young adults with ASCVD

Additional file 1: of Incidence of medically attended influenza among residents of Shai-Osudoku and Ningo-Prampram Districts, Ghana, May 2013 – April 2015

Figure SA. Enrolment process for severe acute respiratory illness (SARI) and influenza like illness (ILI) in Shai-Osudoku and Ningo-Prampram Districts, Ghana, 2013-2015. (DOCX 34 kb

\u3ci\u3eDrosophila\u3c/i\u3e Muller F Elements Maintain a Distinct Set of Genomic Properties Over 40 Million Years of Evolution

The Muller F element (4.2 Mb, ~80 protein-coding genes) is an unusual autosome of Drosophila melanogaster; it is mostly heterochromatic with a low recombination rate. To investigate how these properties impact the evolution of repeats and genes, we manually improved the sequence and annotated the genes on the D. erecta, D. mojavensis, and D. grimshawi F elements and euchromatic domains from the Muller D element. We find that F elements have greater transposon density (25–50%) than euchromatic reference regions (3–11%). Among the F elements, D. grimshawi has the lowest transposon density (particularly DINE-1: 2% vs. 11–27%). F element genes have larger coding spans, more coding exons, larger introns, and lower codon bias. Comparison of the Effective Number of Codons with the Codon Adaptation Index shows that, in contrast to the other species, codon bias in D. grimshawi F element genes can be attributed primarily to selection instead of mutational biases, suggesting that density and types of transposons affect the degree of local heterochromatin formation. F element genes have lower estimated DNA melting temperatures than D element genes, potentially facilitating transcription through heterochromatin. Most F element genes (~90%) have remained on that element, but the F element has smaller syntenic blocks than genome averages (3.4–3.6 vs. 8.4–8.8 genes per block), indicating greater rates of inversion despite lower rates of recombination. Overall, the F element has maintained characteristics that are distinct from other autosomes in the Drosophila lineage, illuminating the constraints imposed by a heterochromatic milieu