18,258 research outputs found

    The Relationship between Waterpipe and Cigarette Smoking in Low and Middle Income Countries: Cross-Sectional Analysis of the Global Adult Tobacco Survey

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    Introduction Waterpipe tobacco smoking is receiving growing attention due to accumulating evidence suggesting increasing prevalence in some populations and deleterious health effects. Nevertheless, the relationship between waterpipe and cigarette smoking remain unknown, particularly in low and middle income countries. Materials and Methods We analysed waterpipe and cigarette smoking using data from Global Adult Tobacco Survey, a household survey of adults aged ≥15 years conducted between 2008–2010 in LMICs. Factors associated with waterpipe and cigarette use were assessed using multiple logistic regression. Factors associated with the quantity of waterpipe and cigarette smoking were assessed using log-linear regression models. Results After adjusting for age, gender, residence, education, occupation and smokeless tobacco use, waterpipe smoking was significantly higher among cigarette users than in non-cigarette users in India (5.6% vs. 0.6%, AOR 13.12, 95% CI 7.41–23.23) and Russia (6.7% vs. 0.2%, AOR 27.73, 95% CI 11.41–67.43), but inversely associated in Egypt (2.6% vs. 3.4%, AOR 0.21, 95% CI 0.15–0.30) and not associated in Vietnam (13.3% vs. 4.7%, AOR 0.96, 95% CI 0.74–1.23). Compared to non-cigarette smokers, waterpipe smokers who also used cigarettes had more waterpipe smoking sessions per week in Russia (1.3 vs. 2.9, beta coefficient 0.31, 95% CI 0.06, 0.57), but less in Egypt (18.2 vs. 10.7, beta coefficient −0.45, 95% CI −0.73, −0.17) and Vietnam (102.0 vs. 79.3, beta coefficient −0.31, 95% CI −0.56, −0.06) and similar amounts in India (29.4 vs. 32.6, beta coefficient −0.12, 95% CI −0.46, 0.22). Conclusions Waterpipe smoking is low in most LMICs but important country-level differences in use, including concurrent cigarette smoking, should be taken into account when designing and evaluating tobacco control interventions

    Impact of Pay for Performance on Prescribing of Long-Acting Reversible Contraception in Primary Care: An Interrupted Time Series Study

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    BACKGROUND: The aim of this study was to evaluate the impact of Quality and Outcomes Framework (QOF), a major pay-for-performance programme in the United Kingdom, on prescribing of long-acting reversible contraceptives (LARC) in primary care. METHODS: Negative binomial interrupted time series analysis using practice level prescribing data from April 2007 to March 2012. The main outcome measure was the prescribing rate of long-acting reversible contraceptives (LARC), including hormonal and non hormonal intrauterine devices and systems (IUDs and IUSs), injectable contraceptives and hormonal implants. RESULTS: Prescribing rates of Long-Acting Reversible Contraception (LARC) were stable before the introduction of contraceptive targets to the QOF and increased afterwards by 4% annually (rate ratios  = 1.04, 95% CI = 1.03, 1.06). The increase in LARC prescribing was mainly driven by increases in injectables (increased by 6% annually), which was the most commonly prescribed LARC method. Of other types of LARC, the QOF indicator was associated with a step increase of 20% in implant prescribing (RR =  1.20, 95% CI =  1.09, 1.32). This change is equivalent to an additional 110 thousand women being prescribed with LARC had QOF points not been introduced. CONCLUSIONS: Pay for performance incentives for contraceptive counselling in primary care with women seeking contraceptive advice has increased uptake of LARC methods

    Associations between active travel and weight, blood pressure and diabetes in six middle income countries: a cross-sectional study in older adults

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    BACKGROUND: There is little published data on the potential health benefits of active travel in low and middle-income countries. This is despite increasing levels of adiposity being linked to increases in physical inactivity and non-communicable diseases. This study will examine: (1) socio-demographic correlates of using active travel (walking or cycling for transport) among older adults in six populous middle-income countries (2) whether use of active travel is associated with adiposity, systolic blood pressure and self-reported diabetes in these countries. METHODS: Data are from the WHO Study on Global Ageing and Adult Health (SAGE) of China, India, Mexico, Ghana, Russia and South Africa with a total sample size of 40,477. Correlates of active travel (≥150 min/week) were examined using logistic regression. Logistic and linear regression analyses were used to examine health related outcomes according to three groups of active travel use per week. RESULTS: 46.4% of the sample undertook ≥150 min of active travel per week (range South Africa: 21.9% Ghana: 57.8%). In pooled analyses those in wealthier households were less likely to meet this level of active travel (Adjusted Risk Ratio (ARR) 0.77, 95% Confidence Intervals 0.67; 0.88 wealthiest fifth vs. poorest). Older people and women were also less likely to use active travel for ≥150 min per week (ARR 0.71, 0.62; 0.80 those aged 70+ years vs. 18-29 years old, ARR 0.82, 0.74; 0.91 women vs. men). In pooled fully adjusted analyses, high use of active travel was associated with lower risk of overweight (ARR 0.71, 0.59; 0.86), high waist-to-hip ratio (ARR 0.71, 0.61; 0.84) and lower BMI (-0.54 kg/m(2), -0.98;- 0.11). Moderate (31-209 min/week) and high use (≥210 min/week) of active travel was associated with lower waist circumference (-1.52 cm (-2.40; -0.65) and -2.16 cm (3.07; -1.26)), and lower systolic blood pressure (-1.63 mm/Hg (-3.19; -0.06) and -2.33 mm/Hg (-3.98; -0.69)). CONCLUSIONS: In middle-income countries use of active travel for ≥150 min per week is more common in lower socio-economic groups and appears to confer similar health benefits to those identified in high-income settings. Efforts to increase active travel levels should be integral to strategies to maintain healthy weight and reduce disease burden in these settings

    Construction productivity analysis for asphalt concrete pavement rehabilitation in urban corridors

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    The results of a constructibility and productivity analysis for the California Department of Transportation Long Life Asphalt Concrete Pavement Rehabilitation Strategies program are presented. With the assistance of California asphalt concrete (AC) paving contractors, the analysis explored the effects on construction productivity of rehabilitation materials, design strategy (crack seat and overlay, full-depth replacement), layer profiles, AC cooling time, resource constraints, and alternative lane closure tactics. Deterministic and stochastic analysis programs were developed. A sensitivity study that examined the construction production capability within a 55-h weekend closure was performed. Weekend closures were also compared with continuous closures. Demolition and AC delivery truck flows were the major constraints limiting the AC rehabilitation production capability. It was concluded from the study that efficient lane closure tactics designed to work with the pavement profile (an minimize the nonworking time to increase the construction product! on efficiency. The results of the study will help road agencies evaluate rehabilitation strategies and tactics with the goal of balancing the maximization of production capability and minimization of traffic delay during urban pavement rehabilitation.open114sciescopu

    On the relationship of quality factor and hollow winding structure of coreless printed spiral winding (CPSW) inductor

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    The principle of using hollow spiral winding is not novel, but the study on this topic is far from complete. In this paper, how hollow the central region of the coreless printed spiral winding (CPSW) inductor should be for a given footprint area in order to achieve the maximal quality factor Q max and to maintain high inductance value is explored. A hollow factor based on the ratio of the inner hollow radius and the outer winding radius τ = R in/R out, is proposed as for optimization and quantifying how hollow a spiral winding is. The relationship between τ and Q max, which depends on the operating frequency and the dimensional parameters of CPSW inductor, is established. For a specific operating frequency, it is discovered that if the conductor width is comparable with the skin depth, or the conductors are placed relatively far away from each others, the hollow design of the CPSW inductor has little improvement on Q but reduces the inductance. If the conductor width is much larger than the skin depth and the conductors are closely placed, the hollow spiral design is recommended. The optimal range of τ with which the Q max can be achieved is found to be around 0.45-0.55. © 2006 IEEE.published_or_final_versio

    Rural, urban and migrant differences in noncommunicable disease risk-factors in middle income countries: a cross-sectional study of WHO-SAGE Data

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    Understanding how urbanisation and rural-urban migration influence risk-factors for non-communicable disease (NCD) is crucial for developing effective preventative strategies globally. This study compares NCD risk-factor prevalence in urban, rural and migrant populations in China, Ghana, India, Mexico, Russia and South Africa.Study participants were 39,436 adults within the WHO Study on global AGEing and adult health (SAGE), surveyed 2007-2010. Risk ratios (RR) for each risk-factor were calculated using logistic regression in country-specific and all country pooled analyses, adjusted for age, sex and survey design. Fully adjusted models included income quintile, marital status and education.Regular alcohol consumption was lower in migrant and urban groups than in rural groups (pooled RR and 95%CI: 0.47 (0.31-0.68); 0.58, (0.46-0.72), respectively). Occupational physical activity was lower (0.86 (0.72-0.98); 0.76 (0.65-0.85)) while active travel and recreational physical activity were higher (pooled RRs for urban groups; 1.05 (1.00-1.09), 2.36 (1.95-2.83), respectively; for migrant groups: 1.07 (1.0 -1.12), 1.71 (1.11-2.53), respectively). Overweight, raised waist circumference and diagnosed diabetes were higher in urban groups (1.19 (1.04-1.35), 1.24 (1.07-1.42), 1.69 (1.15-2.47), respectively). Exceptions to these trends exist: obesity indicators were higher in rural Russia; active travel was lower in urban groups in Ghana and India; and in South Africa, urban groups had the highest alcohol consumption.Migrants and urban dwellers had similar NCD risk-factor profiles. These were not consistently worse than those seen in rural dwellers. The variable impact of urbanisation on NCD risk must be considered in the design and evaluation of strategies to reduce the growing burden of NCDs globally

    Genetic Code Mutations: The Breaking of a Three Billion Year Invariance

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    The genetic code has been unchanging for some three billion years in its canonical ensemble of encoded amino acids, as indicated by the universal adoption of this ensemble by all known organisms. Code mutations beginning with the encoding of 4-fluoro-Trp by Bacillus subtilis, initially replacing and eventually displacing Trp from the ensemble, first revealed the intrinsic mutability of the code. This has since been confirmed by a spectrum of other experimental code alterations in both prokaryotes and eukaryotes. To shed light on the experimental conversion of a rigidly invariant code to a mutating code, the present study examined code mutations determining the propagation of Bacillus subtilis on Trp and 4-, 5- and 6-fluoro-tryptophans. The results obtained with the mutants with respect to cross-inhibitions between the different indole amino acids, and the growth effects of individual nutrient withdrawals rendering essential their biosynthetic pathways, suggested that oligogenic barriers comprising sensitive proteins which malfunction with amino acid analogues provide effective mechanisms for preserving the invariance of the code through immemorial time, and mutations of these barriers open up the code to continuous change

    Return Visit Admissions May Not Indicate Quality of Emergency Department Care for Children

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    ObjectiveThe objective was to test the hypothesis that in‐hospital outcomes are worse among children admitted during a return ED visit than among those admitted during an index ED visit.MethodsThis was a retrospective analysis of ED visits by children age 0 to 17 to hospitals in Florida and New York in 2013. Children hospitalized during an ED return visit within 7 days were classified as “ED return admissions” (discharged at ED index visit and admitted at return visit) or “readmissions” (admission at both ED index and return visits). In‐hospital outcomes for ED return admissions and readmissions were compared to “index admissions without return admission” (admitted at ED index visit without 7‐day return visit admission).ResultsAmong 1,886,053 index ED visits to 321 hospitals, 75,437 were index admissions without return admission, 7,561 were ED return admissions, and 1,333 were readmissions. ED return admissions had lower intensive care unit admission rates (11.0% vs. 13.6%; adjusted odds ratio = 0.78; 95% confidence interval [CI] = 0.71 to 0.85), longer length of stay (3.51 days vs. 3.38 days; difference = 0.13 days; incidence rate ratio = 1.04; 95% CI = 1.02 to 1.07), but no difference in mean hospital costs ((7,138vs.7,138 vs. 7,331; difference = –193;95193; 95% CI = –479 to $93) compared to index admissions without return admission.ConclusionsCompared with children who experienced index admissions without return admission, children who are initially discharged from the ED who then have a return visit admission had lower severity and similar cost, suggesting that ED return visit admissions do not involve worse outcomes than do index admissions.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142896/1/acem13324_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142896/2/acem13324.pd
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