How specific is the immune response to malaria in adults living in endemic areas?

It is documented that people living in malaria endemic areas acquire immunity against malaria afterrepeated infections. Studies involving passive transfer of IgG from immune adults to the nonimmunesubjects have shown that circulating antibodies play an important role, and that immuneadults possess protective antibodies, which susceptible malaria patients do not. Through a differentialimmunoscreen, we have identified several novel cDNA clones, which react exclusively andyet extensively with immune sera samples. Specific antisera raised against the immunoclones inhibitthe growth of parasites in culture. The clones studied so far turn out to be novel conserved Plasmodiumgenes. In order to study the response of sera of adults from malaria endemic areas of Indiaand Africa to these immunogens, we carried out ELISA assays using these immunopeptides, otherP. falciparum specific antigens, peptides, antigens from other infections such as mycobacterial infectionsand other proteins such as BSA. Children from the same areas and normal healthy urbanpeople showed very little activity to each of these categories. A large percentage of adults from endemicareas responded positively to all the malarial immunogens tested. However, the same personsalso showed high response to other antigens and proteins as well. The implications of theseresults are reported in this paper

Immediate and Early Postnatal Care for Mothers and Newborns in Rural Bangladesh

The study evaluated the impact of essential newborn-care interventions at the household level in the Saving Newborn Lives project areas. Two household surveys were conducted following the 30-cluster sampling method using a structured questionnaire in 2002 (baseline) and 2004 (endline) respectively. In total, 3,325 mothers with children aged less than one year in baseline and 3,110 mothers in endline from 10 sub-districts were interviewed during each survey. The proportion of newborns dried and wrapped immediately after birth increased from 14% in 2002 to 55% in 2004; 76.2% of the newborns were put to the mother's breast within one hour of birth compared to 38.6% in baseline. Newborn check-up within 24 hours of delivery increased from 14.4% in 2002 to 27.3% in 2004. Postnatal check-up of mothers by trained providers within three days of delivery rose from 2.4% in 2002 to 27.3% in 2004. Knowledge of the mothers on at least two postnatal danger signs increased by 17.2%, i.e. from 47.1% in 2002 to 64.3% in 2004. Knowledge of mothers on at least three postnatal danger signs also showed an increase of 16%. Essential newborn-care practices, such as drying and wrapping the baby immediately after birth, initiation of breastmilk within one hour of birth, and early postnatal newborn check-up, improved in the intervention areas. Increased community awareness helped improve maternal and newborn-care practices at the household level. Lessons learnt from implementation revealed that door-to-door visits by community health workers, using community registers as job-aids, were effective in identifying pregnant women and following them through pregnancy to the postnatal periods

Outcomes from COVID-19 across the range of frailty: excess mortality in fitter older people

Purpose: Our aim was to quantify the mortality from COVID-19 and identify any interactions with frailty and other demographic factors. / Methods: Hospitalised patients aged ≥ 70 were included, comparing COVID-19 cases with non-COVID-19 controls admitted over the same period. Frailty was prospectively measured and mortality ascertained through linkage with national and local statutory reports. / Results: In 217 COVID-19 cases and 160 controls, older age and South Asian ethnicity, though not socioeconomic position, were associated with higher mortality. For frailty, differences in effect size were evident between cases (HR 1.02, 95% CI 0.93–1.12) and controls (HR 1.99, 95% CI 1.46–2.72), with an interaction term (HR 0.51, 95% CI 0.37–0.71) in multivariable models. / Conclusions: Our findings suggest that (1) frailty is not a good discriminator of prognosis in COVID-19 and (2) pathways to mortality may differ in fitter compared with frailer older patients

Risk Assessment at the Cosmetic Product Manufacturer by Expert Judgment Method

A case study was performed in a cosmetic product manufacturer. We have identified the main risk factors of occupational accidents and their causes. Risk of accidents is assessed by the expert judgment method. Event tree for the most probable accident is built and recommendations on improvement of occupational health and safety protection system at the cosmetic product manufacturer are developed. The results of this paper can be used to develop actions to improve the occupational safety and health system in the chemical industry

Immediate and Early Postnatal Care for Mothers and Newborns in Rural Bangladesh

The study evaluated the impact of essential newborn-care interventions at the household level in the Saving Newborn Lives project areas. Two household surveys were conducted following the 30-cluster sampling method using a structured questionnaire in 2002 (baseline) and 2004 (endline) respectively. In total, 3,325 mothers with children aged less than one year in baseline and 3,110 mothers in endline from 10 sub-districts were interviewed during each survey. The proportion of newborns dried and wrapped immediately after birth increased from 14% in 2002 to 55% in 2004; 76.2% of the newborns were put to the mother\u2019s breast within one hour of birth compared to 38.6% in baseline. Newborn check-up within 24 hours of delivery increased from 14.4% in 2002 to 27.3% in 2004. Postnatal check-up of mothers by trained providers within three days of delivery rose from 2.4% in 2002 to 27.3% in 2004. Knowledge of the mothers on at least two postnatal danger signs increased by 17.2%, i.e. from 47.1% in 2002 to 64.3% in 2004. Knowledge of mothers on at least three postnatal danger signs also showed an increase of 16%. Essential newborn-care practices, such as drying and wrapping the baby immediately after birth, initiation of breastmilk within one hour of birth, and early postnatal newborn check-up, improved in the intervention areas. Increased community awareness helped improve mater\uadnal and newborn-care practices at the household level. Lessons learnt from implementation revealed that door-to-door visits by community health workers, using community registers as job-aids, were effective in identifying pregnant women and following them through pregnancy to the postnatal periods

Changing Behavior of Cyclone in Bangladesh and its Risk Assessment for Adaptation

Tropical cyclone (TC) is one of the most crucial topics not only for the natural loss but also for physical and economical loss of any country. The Bay of Bengal (BoB) generates number of tropical cyclones in each year. Bangladesh also experiences a number of cyclones. The surface temperature of the sea and air temperature is observed from NOAA high resolution satellite image. The Sea Surface Temperature (SST) of about 27°C and its higher is one of the prerequisite conditions for formation of a TC. But SST has increased by 1.2°C since last 40 years. It can be settled that both the Air Temperature and SST are increasing over the years. This rise in temperature of the BoB contributes to the occurrence of TC. Among the whole coastal zone of Bangladesh, the Chittagong- Cox’s Bazar coast and Barisal-Patuakhali coast are more vulnerable than the other parts. About 35 million people of Bangladesh are living in the TC exposed area. Most of the TC are associated with storm surges and heavy rainfall, which add up to the damages and complications in the risky area in addition to high winds. It also includes flash flood, salt water intrusion, and loss of lands. In case of vulnerability and risk, it is noticed that Bangladesh is hit by Severe TC (Category-5) at least one in every 10 years, where the wind speed crosses 220 Km/hr. The huge amount of rainfall and storm surge result in floods, which in- crease the severity of this hazard. By this time Government takes steps to reduce the damages of the coastal area. Also, the analysis of behavior of the track and damage of Severe TC indicates that the whole coastal zone stays at risk at different times of the year. With proper analysis and measures, the damages caused by TC can be reduced. The management system of TC risk is not sufficient. The study shows that the TC has significant impact of high winds, rainfall and storm surge. Accordingly, it has the impact on all relevant objects on the society in addition to human loss and damage. Though it has the main influence on the coastal areas but rainfall associated with TC has significant impact on all over Bangladesh. The impacts are dependent on the behavior, landfall time and landfall area. The impact has been divided into three classes- low, medium and high. The classified impacts are varying from TC to TC, but high impact is observed more times over southwestern part of Bangladesh. It also influences the vegetation of the coastal part. Proper measurements should be taken to reduce risk of vulnerable areas of TC in Banglades

Complementing chronic frailty assessment at hospital admission with an electronic frailty index (FI-Laboratory) comprising routine blood test results

BACKGROUND: Acutely ill and frail older adults have complex social and health care needs. It is important to understand how this complexity affects acute outcomes for admission to hospital. We validated a frailty index using routine admission laboratory tests with outcomes after patients were admitted to hospital. METHODS: In a prospective cohort of older adults admitted to a large tertiary hospital in the United Kingdom, we created a frailty index from routine admission laboratory investigations (FI-Laboratory) linked to data comprising hospital outcomes. We evaluated the association between the FI-Laboratory and total days spent in hospital, discharge to a higher level of care, readmission and mortality. RESULTS: Of 2552 admissions among 1750 older adults, we were able to generate FI-Laboratory values for 2254 admissions (88.3% of the cohort). More than half of admitted patients were women (55.3%) and the mean age was 84.6 (SD 14.0) years. We found that the FI-Laboratory correlated weakly with the Clinical Frailty Scale (CFS; r2 = 0.09). An increase in the CFS and the equivalent of 3 additional abnormal laboratory test results in the FI-Laboratory, respectively, were associated with an increased proportion of inpatient days (rate ratios [RRs] 1.43, 95% confidence interval [CI] 1.35-1.52; and 1.47, 95% CI 1.41-1.54), discharge to a higher level of care (odd ratios [ORs] 1.39, 95% CI 1.27-1.52; and 1.30, 95% CI 1.16-1.47) and increased readmission rate (hazard ratios [HRs] 1.26, 95% CI 1.17-1.37; and 1.18, 95% CI 1.11-1.26). Increases in the CFS and FI-Laboratory were associated with increased mortality HRs of 1.39 (95% CI 1.28-1.51) and 1.45 (95% CI 1.37-1.54), respectively. INTERPRETATION: We determined that FI-Laboratory, distinct from baseline frailty, could be used to predict risk of many adverse outcomes. The score is therefore a useful way to quantify the degree of acute illness in frail older adults