Epidemiology of COVID-19 outbreak in Ghana, 2020

Coronaviruses are RNA viruses that cause respiratory, hepatic and neurological diseases in domestic and wild animals, and humans. Among humans, six species of coronavirus have been identified to cause disease. Among these, Severe Acute Respiratory Syndrome (SARS-CoV) and Middle East Respiratory Syndrome (MERS-CoV) are of zoonotic origin and have been known to cause severe acute respiratory syndrome outbreaks among humans

Community acceptance of COVID-19 and demystifying stigma in a severely affected population in Ghana

Objective: We assessed the level of community acceptance of COVID-19, identified and implemented strategies to demystifying stigma in a severely affected population in Tema.Design and Setting: We conducted a cross-sectional study to assess stigma among the Tema community, then identified and implemented interventions to demystify COVID-19 stigma. We interviewed positive cases, their contacts, contact tracers, case management team members, and community members who shared their first hand experiences and knowledge on the current pandemic.Intervention: Based on the information received, we came up with ways of reducing stigma and implemented them in their community.Main Outcome: Stigma demystifiedResults: Cases and contacts reported being avoided, discriminated against, insulted or had derogatory words used on them by family, friends, work colleagues or the community. Cases and their contacts stated that stigmatisation was fueled by the presence of COVID -19 branded vehicles and security officials at their homes or workplaces. Stakeholder engagement, education and extensive sensitisation of community members were implemented to reduce stigma.Conclusion: We observed deeply entrenched stigma to COVID - 19 positive patients and their contacts in the community. Health care response mechanisms such as the presence of security personnel with contact tracers and case managers and the use of COVID -19 branded vehicles fueled stigma. A multifaceted approach through the engagement of key stakeholders, training of health workers and extensive education and community sensitisation was essential in reducing stigma

Forensic Investigation of Cyberstalking Cases using Behavioural Evidence Analysis

Behavioural Evidence Analysis (BEA) is, in theory, useful in developing an understanding of the offender, the victim, the crime scene, and the dynamics of the crime. It can add meaning to the evidence obtained through digital forensic techniques and assist investigators with reconstruction of a crime. There is, however, little empirical research examining the application of BEA to actual criminal cases, particularly cyberstalking cases. This study addresses this gap by examining the utility of BEA for such cases in terms of understanding the behavioural and motivational dimensions of offending, and the way in which digital evidence can be interpreted. It reports on the forensic analysis of 20 cyberstalking cases investigated by Dubai Police in the last five years. Results showed that BEA helps to focus an investigation, enables better understanding and interpretation of victim and offender behaviour, and assists in inferring traits of the offender from available digital evidence. These benefits can help investigators to build a stronger case, reduce time wasted to mistakes, and to exclude suspects wrongly accused in cyberstalking cases

Can there be water scarcity with abundance of water? : Analyzing water stress during a severe drought in Finland

Severe droughts can affect water security even in countries with ample water resources. In addition, droughts are estimated to become more frequent in several regions due to changing climate. Drought affects many socio-economic sectors (e.g., agriculture, water supply, and industry), as it did in 2018 in Finland. Understanding the basin-wide picture is crucial in drought management planning. To identify vulnerable and water stressed areas in Finland, a water use-to-availability analysis was executed with a reference drought. Water stress was analyzed with the Water Depletion Index WDI. The analysis was executed using national water permits and databases. To represent a severe but realistic drought event, we modelled discharges and runoffs from the worst drought of the last century in Finland (1939–1942). The potential for performing similar analyses in data scarce contexts was also tested using estimates from global models as a screening tool. The results show that the South and Southwest of Finland would have problems with water availability during a severe drought. The most vulnerable areas would benefit from drought mitigation measures and management plans. These measures could be incorporated into the EU River Basin Management Plans

Serum FGF19 predicts outcomes of Kasai portoenterostomy in biliary atresia

BACKGROUND AND AIMS: Outcomes after Kasai portoenterostomy (KPE) for biliary atresia remain highly variable for unclear reasons. As reliable early biomarkers predicting KPE outcomes are lacking, we studied the prognostic value of FGF19. APPROACH AND RESULTS: Serum and liver specimens, obtained from biliary atresia patients (N=87) at KPE or age-matched cholestatic controls (N=26) were included. Serum concentration of FGF19 and bile acids, liver mRNA expression of FGF19, and key regulators of bile acid synthesis were related to KPE outcomes and liver histopathology. Immunohistochemistry and in situ hybridization were used for the localization of liver FGF19 expression. Serum levels (223 vs. 61 pg/mL, p<0.001) and liver mRNA expression of FGF19 were significantly increased in biliary atresia. Patients with unsuccessful KPE (419 vs. 145 pg/mL, p=0.047), and those subsequently underwent liver transplantation (410 vs. 99 pg/mL, p=0.007) had significantly increased serum, but not liver, FGF19, which localized mainly in hepatocytes. In Cox hazard modeling serum FGF19 <109 pg/mL predicted native liver survival (HR: 4.31, p<0.001) also among patients operated <60 days of age (HR: 8.77, p=0.004) or after successful KPE (HR: 6.76, p=0.01). Serum FGF19 correlated positively with increased serum primary bile acids (R=0.41, p=0.004) and ductular reaction (R=0.39, p=0.004). CONCLUSIONS: Increased serum FGF19 at KPE predicted inferior long-term native liver survival in biliary atresia and was associated with unsuccessful KPE, elevated serum primary bile acids, and ductular reaction

Prognostic and Pathophysiologic Significance of IL-8 (CXCL8) in Biliary Atresia

Interleukin (IL)-8 (CXCL8), a chemokine involved in neutrophil recruitment, has been implicated in ductular reaction and liver fibrogenesis. We studied liver and serum IL-8 expression in a large biliary atresia (BA) cohort and explored its prognostic and pathophysiological potential. IL-8 expression was assessed in liver utilizing quantitative polymerase chain reaction (qPCR), immunohistochemistry and in situ hybridization and in serum using an enzyme-linked immunosorbent assay, among 115 BA patients, 10 disease controls and 68 normal controls. Results were correlated to portoenterostomy (PE) outcomes, biochemical and histological liver injury, transcriptional markers of fibrosis and cholangiocytes, and expression of other related cytokines. IL-8 was markedly overexpressed in liver and serum of BA patients at PE (n = 88) and in serum samples obtained during postoperative follow-up (n = 40). IL-8 expression in the liver was predominantly in cholangiocytes within areas of ductular reaction. Liver IL-8 mRNA expression correlated positively with its serum concentration, bile ductular proliferation, Metavir fibrosis stage, and transcriptional markers of activated myofibroblasts (ACTA2) and cholangiocytes (KRT19). Taken together, IL-8 may mediate liver injury in BA by promoting ductular reaction and associated liver fibrogenesis. Prognostic value of serum IL-8 to predict native liver survival was limited and confined to the postoperative period after PE

Immune-microbiota interaction in Finnish and Russian Karelia young people with high and low allergy prevalence

Background After the Second World War, the population living in the Karelian region was strictly divided by the "iron curtain" between Finland and Russia. This resulted in different lifestyle, standard of living, and exposure to the environment. Allergic manifestations and sensitization to common allergens have been much more common on the Finnish compared to the Russian side. Objective The remarkable allergy disparity in the Finnish and Russian Karelia calls for immunological explanations. Methods Young people, aged 15-20 years, in the Finnish (n = 69) and Russian (n = 75) Karelia were studied. The impact of genetic variation on the phenotype was studied by a genome-wide association analysis. Differences in gene expression (transcriptome) were explored from the blood mononuclear cells (PBMC) and related to skin and nasal epithelium microbiota and sensitization. Results The genotype differences between the Finnish and Russian populations did not explain the allergy gap. The network of gene expression and skin and nasal microbiota was richer and more diverse in the Russian subjects. When the function of 261 differentially expressed genes was explored, innate immunity pathways were suppressed among Russians compared to Finns. Differences in the gene expression paralleled the microbiota disparity. High Acinetobacter abundance in Russians correlated with suppression of innate immune response. High-total IgE was associated with enhanced anti-viral response in the Finnish but not in the Russian subjects. Conclusions and clinical relevance Young populations living in the Finnish and Russian Karelia show marked differences in genome-wide gene expression and host contrasting skin and nasal epithelium microbiota. The rich gene-microbe network in Russians seems to result in a better-balanced innate immunity and associates with low allergy prevalence.Peer reviewe

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Ajanvarauskirjeen mukana lähetettävä elämäntapaopas Naistenklinikan lapsettomuuspotilaille

Opinnäytetyön tarkoituksena oli tuottaa lapsettomuuspotilaille suunnattu elämäntapaopas Naistenklinikan hormonipoliklinikan käyttöön. Oppaan tarkoituksena oli toimia työelämäkumppanille potilaan ohjausta helpottavana apuvälineenä. Opinnäytetyön tavoitteena oli kehittää lapsettomuutta koskevaa potilasohjausta hoitotyössä. Opinnäytetyön yhteistyökumppanina toimi Helsingin yliopistolliseen keskussairaalaan (HYKS) kuuluva Naistenklinikan hormonipoliklinikka, jonka toimenkuvaan kuuluu pääkaupunkiseudulla asuvien pariskuntien lapsettomuuden tutkiminen ja hoito. Opinnäytetyö tehtiin toiminnallisena opinnäytetyönä ja sen tuotos koostuu opinnäytetyöraportista sekä kirjallisesta potilasoppaasta, joka toteutettiin sekä suomen- että englanninkielisenä. Käytännöllisen oppaan teoreettisena viitekehyksenä toimi laadullisen lähestymistavan mukaan toteutettu kirjallisuuskatsaus. Oppaan arviointia varten kehitettiin kirjallinen kyselylomake, jonka avulla selvitettiin oppaan soveltuvuutta sen käyttötarkoitusta ja kohderyhmää varten. Oppaan arvioinnissa hyödynnettiin kokemusperäisen tiedon käyttöä ja opas arvioitettiin hormonipoliklinikan henkilökunnalla. Arviointiin osallistui yhteensä 12 hoitohenkilökuntaan kuuluvaa työntekijää. Arvioinnin pohjalta elämäntapaoppaan sisältöä muokattiin kertaalleen ja näin oppaasta saatiin kohderyhmää ja tarkoitustaan entistä paremmin palveleva. Opas on kompakti teos, joka käsittelee lyhyesti hedelmällisyyteen yhteydessä olevia elämäntapoja ja niiden vaikutuksia ihmisen lisääntymisterveyteen. Opas on kohdistettu hormonipoliklinikalle ensikäynnille tuleville pariskunnille ja se toimitetaan potilaille ennen suunnitellulle käynnille saapumista ajanvarauskirjeen yhteydessä. Oppaan on tarkoitus lisätä potilaiden tietoa elämäntapojen vaikutuksesta hedelmällisyyteen ja valmistaa heitä ensikäyntiä varten. Jatkotutkimusaiheena voitaisiin selvittää, ovatko hormonipoliklinikan potilaat kokeneet hyötyneensä oppaasta ja onko tiedonsaannin lisääntymisellä ollut positiivisia vaikutuksia potilaiden hedelmällisyyteen ja lapsettomuushoitojen tuloksiin. Kirjallisuuskatsauksen perusteella ilmeni lapsettomuudesta kärsivien potilaiden psyykkisen tuen tarve. Lapsettomien potilaiden ohjausta voitaisiin kehittää lisäämällä ohjausta lapsettomuuden aiheuttamista psykososiaalisista vaikutuksista, jotka ovat yleisiä lapsettomien parien kohdalla ja edesauttavat hedelmättömyyttä. Asiasanat: lapsettomuus, elämäntavat, potilasohjaus, opasThe purpose of the thesis was to produce a lifestyle guide designed to infertility patients for the use of Women’s Hospital’s Hormone Outpatient Clinic. The purpose of the guide was to work as a tool for the working life partner in order to facilitate patient guidance. The aim of the thesis was to develop patient education on infertility in nursing practice. The thesis was carried out in co-operation with the Hormone Outpatient Clinic of Women’s Hospital which is a part of the Helsinki University Central Hospital (HUCH) and provides fertility investigation and treatment for infertile couples living in the metropolitan area. The thesis was conducted as a functional thesis and the outcome is a thesis report and a patient guide written both in Finnish and in English. A literature review, which was carried out using a qualitative approach, provided the theoretical framework for the practical guide. A written questionnaire was created for the evaluation of the guide booklet to examine the suitability of the guide for its intended purpose and target population. Experiential knowledge was utilized in the assessment process and the evaluation was carried out by the staff of the Hormone Outpatient Clinic. In total 12 members of the nursing staff participated in the evaluation. Some of the contents of the guide were edited based on the feedback, thereby the guide was designed to serve its purpose and target population better. The guide is a compact work which introduces shortly lifestyle factors associated with fertility and the impacts of these factors on human reproductive health. The guide is aimed at couples who attend the Clinic on a previously made appointment and it will be delivered for them beforehand as an enclosure of an appointment letter. The guide is intended to increase the patients’ knowledge about the effects of lifestyle factors on fertility and prepare them for their appointment. Further studies could be conducted to determine whether the guide was beneficial for the patients and whether it brought positive impacts on patients’ fertility and fertility treatment results. The literature review revealed infertility patients’ need of psychological support. Infertility patients’ guidance could be improved by including the guidance of psychosocial effects of infertility, which are common in infertile couples and contribute to infertility. Keywords: infertility, lifestyle factors, patient education, a guid

Patch Size Evolution During Pulsating Aurora

We report both decreasing and increasing trends in the patch sizes during pulsating aurora events. About 150 pulsating auroral events over the Fennoscandian Lapland have been successfully analyzed for their average patch size, total patch area, and number of patches as a function of event time, typically 1–2 hr. An automatic routine has been developed to detect patches in the all‐sky camera images. In addition to events with decreasing and increasing average patch size evolution over the course of the pulsating aurora, events with no size trends and events with intermittently increasing and decreasing patch size trends were also found. In this study, we have analyzed a subset of events for which the average and total patch size systematically increase or decrease. The events with increasing patch size trend do not experience a decrease in the peak emission height, which was previously associated with the behavior of pulsating aurora precipitation. Furthermore, the events with increasing patch sizes have shorter lifetimes and twice as many substorm‐injected energetic electrons at geosynchronous orbit as the events with decreasing patch sizes. Half of the events with increasing patch sizes occur during substorm expansion phases, while a majority (64%) of the ones with decreasing patch sizes take place during the recovery phase. These findings suggest that the visual appearance of pulsating aurora may be used as an indication of the pulsating aurora energy deposition to the atmosphere