An analysis on the risk of being injured and killed in road travel injuries in Namibia

Road traffic injuries (RTIs) are a major, global problem. Few studies on RTIs have been conducted in Namibia, despite having one of the highest RTI rates globally. We conducted multinomial logistic regression on national Namibian datasets on RTIs 2012–2014. Being a motorcyclist was associated with the greatest risk of being injured (adjusted Relative Risk Ratio (aRRR) 82.1 (95% CI 47.2–142.9)) or killed (aRRR 202.1 (112.7–362.7)). Risks were also elevated for cyclists (57.3 (23.6–139.5)), pedestrians (15.8 (13.2–18.9), passengers (6.1 (5.2–7.2)), relative to drivers. Among those admitted to hospital, the method of transportation to hospital had the largest association with the risk of dying. To our knowledge this study presents new information on vulnerability of different road users, which can be of use to policymakers to develop specific and targeted interventions to protect the most vulnerable road users

Sexual behaviour, sexually transmitted infections and attitudes to chlamydia testing among a unique national sample of young Australians: Baseline data from a randomised controlled trial

Background: Chlamydia infection is the most common notifiable sexually transmitted infection (STI) in Australia and mostly affects young people (15 - 25 years). This paper presents baseline data from a randomised controlled trial that aimed to increase chlamydia testing among sexually active young people. The objectives were to identify associations between sexual behaviour, substance use and STI history and explore attitudes to chlamydia testing. Methods: This study was conducted in cyberspace. Study recruitment, allocation, delivery of interventions and baseline and follow up data collection all took place online. Participants were 16 - 25 years old and resided in Australia. Substance use correlates of sexual activity; predictors of history of STIs; barriers to and facilitators of chlamydia testing were analysed. Results: Of 856 participants (79.1% female), 704 had experienced penetrative intercourse. Sexually active participants were more likely to smoke regularly or daily, to drink alcohol, or to have binge drunk or used marijuana or other illicit substances recently. Risk factors for having a history of any STI were 3 or more sexual partners ever, 6 or more partners in the past 12 months, condom non-use and being 20 years or older. Almost all sexually active participants said that they would have a chlamydia test if their doctor recommended it. Conclusions: Sexually active young people are at risk of STIs and may engage in substance use risk behaviours. Where one health risk behaviour is identified, it is important to seek information about others. Chlamydia testing can be facilitated by doctors and nurses recommending it. Primary care providers have a useful role in chlamydia control. © 2014 Kang et al.; licensee BioMed Central Ltd

The predictive validity of parent and teacher reports of ADHD symptoms

The objectives were to evaluate the ability of the Inattention and Hyperactivity-Impulsivity factors of the ADHD Rating Scale-IV to differentiate children with ADHD from a control group and to discriminate children with different subtypes of ADHD. Also, we sought to determine optimal cutoff scores on the teacher and parent versions of this scale for making diagnostic decisions about ADHD. In a sample of 92 boys and girls 6 to 14 years of age referred to a regional ADHD program, we assessed ADHD diagnostic status using categorical and dimensional approaches as well as parent- and teacher-report measures. Logistic regression analyses showed that the Inattention and Hyperactivity-Impulsivity factors of the ADHD Rating Scale-IV were effective in discriminating children with ADHD from a control group and differentiating children with ADHD, Combined Type from ADHD, Inattentive Type. Although both teacher and parent ratings were significantly predictive of diagnostic status, teacher ratings made a stronger contribution to the prediction of subtype membership. Using symptom utility estimates, optimal cutoff scores on the Inattention and Hyperactivity-Impulsivity scales for predicting subtypes of ADHD were determined

Diagnostic accuracy of the Xpert CT/NG and OSOM Trichomonas Rapid assays for point-of-care STI testing among young women in South Africa: a cross-sectional study.

CAPRISA, 2019.Abstract available in PDF

Beyond syndromic management: Opportunities for diagnosis-based treatment of sexually transmitted infections in low- and middle-income countries

Introduction In light of the limited impact the syndromic management approach has had on the global sexually transmitted infection (STI) epidemic, we assessed a care model comprising point-of-care (POC) STI testing, immediate treatment, and expedited partner therapy (EPT) among a cohort of young women at high HIV risk in South Africa. Methods and findings HIV negative women presenting for STI care underwent POC testing for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV), and swabs were sent for NG culture and susceptibility testing. Results were available within 2 hours and women with STIs were immediately treated and offered EPT packs, including medication, condoms, and information for sexual partners. An EPT questionnaire was administered after one week, and women retested for STIs after 6 and 12 weeks. 267 women, median age 23 (IQR 21–26), were recruited and 88.4% (236/267) reported genital symptoms. STI prevalence was CT 18.4% (95%CI 13.7–23.0), NG 5.2% (95%CI 2.6–7.9) and TV 3.0% (95%CI 1.0–5.0). After 12 weeks, all but one NG and two CT infections were cleared. No cephalosporin-resistant NG was detected. Of 63/267 women (23.6%) diagnosed with STIs, 98.4% (62/63) were offered and 87.1% (54/62) accepted EPT. At one week 88.9% (48/54) stated that their partner had taken the medication. No allergic reactions or social harms were reported. Of 51 women completing 6-week follow up, detection rates were lower amongst women receiving EPT (2.2%, 1/46) compared to those who did not (40.0%, 2/5), p = 0.023. During focus group discussions women supported the care model, because they received a rapid, specific diagnosis, and could facilitate their partners’ treatment. Conclusions POC STI testing and EPT were acceptable to young South African women and their partners, and could play an important role in reducing STI reinfection rates and HIV risk. Larger studies should evaluate the feasibility and cost-effectiveness of implementing this strategy at population level

Recognizable clinical subtypes of obstructive sleep apnea across international sleep centers: a cluster analysis

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked FilesSTUDY OBJECTIVES: A recent study of patients with moderate-severe obstructive sleep apnea (OSA) in Iceland identified three clinical clusters based on symptoms and comorbidities. We sought to verify this finding in a new cohort in Iceland and examine the generalizability of OSA clusters in an international ethnically diverse cohort. METHODS: Using data on 972 patients with moderate-severe OSA (apnea-hypopnea index [AHI] ≥ 15 events per hour) recruited from the Sleep Apnea Global Interdisciplinary Consortium (SAGIC), we performed a latent class analysis of 18 self-reported symptom variables, hypertension, cardiovascular disease, and diabetes. RESULTS: The original OSA clusters of disturbed sleep, minimally symptomatic, and excessively sleepy replicated among 215 SAGIC patients from Iceland. These clusters also generalized to 757 patients from five other countries. The three clusters had similar average AHI values in both Iceland and the international samples, suggesting clusters are not driven by OSA severity; differences in age, gender, and body mass index were also generally small. Within the international sample, the three original clusters were expanded to five optimal clusters: three were similar to those in Iceland (labeled disturbed sleep, minimal symptoms, and upper airway symptoms with sleepiness) and two were new, less symptomatic clusters (labeled upper airway symptoms dominant and sleepiness dominant). The five clusters showed differences in demographics and AHI, although all were middle-aged (44.6-54.5 years), obese (30.6-35.9 kg/m2), and had severe OSA (42.0-51.4 events per hour) on average. CONCLUSIONS: Results confirm and extend previously identified clinical clusters in OSA. These clusters provide an opportunity for a more personalized approach to the management of OSA.National Institutes of Health Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq) National Center For Advancing Translational Science

The estimated economic burden of genital herpes in the United States. An analysis using two costing approaches

BACKGROUND: Only limited data exist on the costs of genital herpes (GH) in the USA. We estimated the economic burden of GH in the USA using two different costing approaches. METHODS: The first approach was a cross-sectional survey of a sample of primary and secondary care physicians, analyzing health care resource utilization. The second approach was based on the analysis of a large administrative claims data set. Both approaches were used to generate the number of patients with symptomatic GH seeking medical treatment, the average medical expenditures and estimated national costs. Costs were valued from a societal and a third party payer's perspective in 1996 US dollars. RESULTS: In the cross-sectional study, based on an estimated 3.1 million symptomatic episodes per year in the USA, the annual direct medical costs were estimated at a maximum of $984 million. Of these costs, 49.7$214 million. The analysis of 1,565 GH cases from the claims database yielded a minimum national estimate of $283 million direct medical costs. CONCLUSIONS: GH appears to be an important public health problem from the health economic point of view. The observed difference in direct medical costs may be explained with the influence of compliance to treatment and possible undersampling of subpopulations in the claims data set. The present study demonstrates the validity of using different approaches in estimating the economic burden of a specific disease to the health care system

Global Patterns of Extinction Risk in Marine and Non-marine Systems

SummaryDespite increasing concern over the effects of human activities on marine ecosystems [1, 2], extinction in the sea remains scarce: 19–24 out of a total of >850 recorded extinctions [3, 4] implies a 9-fold lower marine extinction rate compared to non-marine systems. The extent of threats faced by marine systems, and their resilience to them, receive considerable attention [2, 4–6], but the detectability of marine extinctions is less well understood. Before its extinction or threat status is recorded, a species must be both taxonomically described and then formally assessed; lower rates of either process for marine species could thus impact patterns of extinction risk, especially as species missing from taxonomic inventories may often be more vulnerable than described species [7–11]. We combine data on taxonomic description with conservation assessments from the International Union for Conservation of Nature (IUCN) to test these possibilities across almost all marine and non-marine eukaryotes. We find that the 9-fold lower rate of recorded extinctions and 4-fold lower rate of ongoing extinction risk across marine species can be explained in part by differences in the proportion of species assessed by the IUCN (3% cf. 4% of non-marine species). Furthermore, once taxonomic knowledge and conservation assessments pass a threshold level, differences in extinction risk between marine and non-marine groups largely disappear. Indeed, across the best-studied taxonomic groups, there is no difference between marine and non-marine systems, with on average between 20% and 25% of species being threatened with extinction, regardless of realm

Application of activated barrier hopping theory to viscoplastic modeling of glassy polymers

YesAn established statistical mechanical theory of amorphous polymer deformation has been incorporated as a plastic mechanism into a constitutive model and applied to a range of polymer mechanical deformations. The temperature and rate dependence of the tensile yield of PVC, as reported in early studies, has been modeled to high levels of accuracy. Tensile experiments on PET reported here are analyzed similarly and good accuracy is also achieved. The frequently observed increase in the gradient of the plot of yield stress against logarithm of strain rate is an inherent feature of the constitutive model. The form of temperature dependence of the yield that is predicted by the model is found to give an accurate representation. The constitutive model is developed in two-dimensional form and implemented as a user-defined subroutine in the finite element package ABAQUS. This analysis is applied to the tensile experiments on PET, in some of which strain is localized in the form of shear bands and necks. These deformations are modeled with partial success, though adiabatic heating of the instability causes inaccuracies for this isothermal implementation of the model. The plastic mechanism has advantages over the Eyring process, is equally tractable,and presents no particular difficulties in implementation with finite elements.F. Boutenel acknowledges an Erasmus Programme Scholarshi