Assessment of related factors on delay in diagnosis of patients with smear-positive pulmonary tuberculosis

Background: Approximately, one third of the world population is infected with tuberculosis (TB) germs and is put at risk of tuberculosis. Pulmonary tuberculosis accounts for more than 80 percent of cases, mostly in adults with positive sputum smear. The mortality and morbidity of the disease are associated with delay in diagnosis. Delay in diagnosis can be related to the patients or the health care system. Methods: In this historical cohort study, all the patients with smear-positive pulmonary tuberculosis in Hamadan province from 21 March 2006 to 20 March 2012 were studied. Data on demographic characteristics, and clinical and treatment status of patients were extracted using patient registry software entitled TB Register. To determine the relationship between variables and the bacillus load, chi-square test was used. The logistic regression model was used to examine the co-effects of both variables on bacillus load of the patients at the time of the diagnosis. Data were analyzed using Stata11 software. Findings: From 440 patients with smear-positive pulmonary tuberculosis, 51 (221 patients) were men and 49 (219 patients) were women. 57 (251 people) were living in urban and others in rural areas. The grade of sputum smear at the time of diagnosis was associated with area of residence, age group, and gender, that all were statistically significant. Delay in diagnosis among women, was approximately 0.55 of men and those in urban areas were 67 higher than in rural areas, which were both statistically significant. Conclusion: Individual factors play important role in delayed diagnosis, regarding that men are diagnosed later than the women. Screening programs in the workplace are recommended. Sensitization of private physicians would be effective in early identification of patients in urban areas. © 2015 Isfahan University of Medical Sciences(IUMS). All rights reserved

Comparative study of dimensional accuracy in three dental implant impression techniques: Open tray, closed tray with impression coping, and snap cap

Aim: Several impression techniques have been proposed to result passive fitness between the prosthesis and osseointegrated implant. The aim of the study was to compare dimensional accuracy of three impression methods: Open tray, closed tray with impression coping, and closed tray with snap cap. Materials and methods: In this experimental study, a mandibular acrylic model was prepared with a milling machine to place three holes for dental implant analogs (Dio SM) with the dimension of 3.8 � 10 mm into the intended sites (one in midline and two others on the side at a distance of 10 mm) parallel with each other and perpendicular to the plane. Twenty-seven casts were prepared with impression material of polyvinyl siloxane (PVS) and dental stone type IV and divided into three groups. Implant situations were measured by coordinate measuring machine (CMM) and results were analyzed with Kruskal-Wallis and Mann-Whitney test to perform pairwise comparison among the groups. Results: The mean �R values for open tray, closed tray with impression coping, and closed tray with snap cap were respectively, 0.070 ± 0.088, 0.173 ± 0.205, and 0.142 ± 0.044.There were statistically significant differences between open tray and closed tray as well as open tray and snap cap methods (p < 0.05), but there was no statistically significant difference between closed tray and snap cap method (p = 0.1). Conclusion: Regarding the results, open tray impression technique had the highest dimensional accuracy compared with the other two methods. There were no statically significant differences between closed tray with snap cap and closed tray with impression coping technique. Clinical significance: Snap cap technique is less time consuming with similar dimensional accuracy in comparison with open tray impression technique. © 2018 Jaypee Brothers Medical Publishers (P) Ltd

Random survival forest in determination of important risk factors on overall survival and disease-free survival in gastric cancer patients

Objective: Although the incidence of stomach cancer is decreasing in the world, its incidence is still high in Iran. Despite different treatments for cancer, disease recurrence, and death may occur in some patients. Various factors affect survival and recurrence after treatment. This study aims to identify factors affecting overall survival (OS) and disease-free survival (DFS) in patients with gastric cancer (GC) using a random survival forest (RSF). Patients and Methods: In this retrospective study, 553 patients with GC, diagnosed between 2010 and 2018 in Kurdistan province in the west of Iran, were assessed. Important factors of OS and DFS were identified using the COX model and RSF. Analysis of data was implemented by R free software version 3.5.3. Results: The mean (Standard Deviation(SD)) age of patients was 66.99 (13.3) years. The median of OS and DFS was 18 and 37.5 months, respectively. Using RSF, the important affected factors on OS were tumor grade, stage, age, recurrence, surgery, and metastasis, respectively. Also according to the RSF model, stage, tumor grade, radiotherapy, tumor site, surgery, and age were the important risk factors for DFS. Based on the prediction error criterion, the random survival forest performed well in predicting disease-free survival. meanwhile, both RSF and Cox models had the same performance in predicting overall survival. Conclusions: Due to the relationship between tumor grade, disease stage and age, the random survival forest identified these variables as important variables in predicting both outcomes, although the Cox model was not able to detect these factors, which indicates better performance of RSF

Evaluation of the psychometric properties of the London Measure of Unplanned Pregnancy in Brazilian Portuguese

Background: Estimates of unplanned pregnancy worldwide are of concern, especially in low and middle-income countries, including Brazil. Although the contraceptive prevalence rate is high in Brazil, almost half of all pregnancies are reported as unintended. The only source of nationally representative data about pregnancy intention is the Demographic and Health Survey, as with many other countries. In more recent years, however, it has been realized that concept of unintended pregnancy is potentially more complex and requires more sophisticated measurement strategies, such as the London Measure of Unplanned Pregnancy (LMUP). The LMUP has been translated and validated in other languages, but not Portuguese yet. In this study, we evaluate the psychometric properties of the LMUP in the Portuguese language, Brazilian version. Methods: A Brazilian Portuguese version of the LMUP was produced via translation and back-translation. After piloting, the mode of administration was changed from self-completion to interviewer-administration. The measure was field tested with pregnant, postpartum, and postabortion women recruited at maternity and primary health care services in Sao Paulo city. Reliability (internal consistency) was assessed using Cronbach’s alpha and item-total correlations. Construct validity was assessed using principal components analysis and hypothesis testing. Scaling was assessed with Mokken analysis. Results: 759 women aged 15–44 completed the Brazilian Portuguese LMUP. There were no missing data. The measure was acceptable and well targeted. Reliability testing demonstrated good internal consistency (alpha = 0.81, all item-rest correlations >0.2). Validity testing confirmed that the measure was unidimensional and that all hypotheses were met: there were lower LMUP median scores among women in the extreme age groups (p<0.001), among non-married women (p<0.001) and those with lower educational attainment (p<0.001). The Loevinger H coefficient was 0.60, indicating a strong scale. Conclusion: The Brazilian Portuguese LMUP is a valid and reliable measure of pregnancy planning/intention that is now available for use in Brazil. It represents a useful addition to the public health research and surveillance toolkit in Brazil

Life Expectancy at Birth for People with Serious Mental Illness and Other Major Disorders from a Secondary Mental Health Care Case Register in London

Despite improving healthcare, the gap in mortality between people with serious mental illness (SMI) and general population persists, especially for younger age groups. The electronic database from a large and comprehensive secondary mental healthcare provider in London was utilized to assess the impact of SMI diagnoses on life expectancy at birth.People who were diagnosed with SMI (schizophrenia, schizoaffective disorder, bipolar disorder), substance use disorder, and depressive episode/disorder before the end of 2009 and under active review by the South London and Maudsley NHS Foundation Trust (SLAM) in southeast London during 2007-09 comprised the sample, retrieved by the SLAM Case Register Interactive Search (CRIS) system. We estimated life expectancy at birth for people with SMI and each diagnosis, from national mortality returns between 2007-09, using a life table method.A total of 31,719 eligible people, aged 15 years or older, with SMI were analyzed. Among them, 1,370 died during 2007-09. Compared to national figures, all disorders were associated with substantially lower life expectancy: 8.0 to 14.6 life years lost for men and 9.8 to 17.5 life years lost for women. Highest reductions were found for men with schizophrenia (14.6 years lost) and women with schizoaffective disorders (17.5 years lost).The impact of serious mental illness on life expectancy is marked and generally higher than similarly calculated impacts of well-recognised adverse exposures such as smoking, diabetes and obesity. Strategies to identify and prevent causes of premature death are urgently required

Physical inactivity in Parkinson’s disease

Patients with Parkinson’s disease (PD) are likely to become physically inactive, because of their motor, mental, and emotional symptoms. However, specific studies on physical activity in PD are scarce, and results are conflicting. Here, we quantified daily physical activities in a large cohort of PD patients and another large cohort of matched controls. Moreover, we investigated the influence of disease-related factors on daily physical activities in PD patients. Daily physical activity data of PD patients (n = 699) were collected in the ParkinsonNet trial and of controls (n = 1,959) in the Longitudinal Aging Study Amsterdam (LASA); data were determined using the LAPAQ, a validated physical activity questionnaire. In addition, variables that may affect daily physical activities in PD were recorded, including motor symptoms, depression, disability in daily life, and comorbidity. Patients were physically less active; a reduction of 29% compared to controls (95% CI, 10–44%). Multivariate regression analyses demonstrated that greater disease severity, gait impairment, and greater disability in daily living were associated with less daily physical activity in PD (R2 = 24%). In this large study, we show that PD patients are about one-third less active compared to controls. While disease severity, gait, and disability in daily living predicted part of the inactivity, a portion of the variance remained unexplained, suggesting that additional determinants may also affect daily physical activities in PD. Because physical inactivity has many adverse consequences, work is needed to develop safe and enjoyable exercise programs for patients with PD

Is Symptomatic Long QT Syndrome Associated with Depression in Women and Men?

We examined whether long QT syndrome (LQTS) mutation carrier status or symptomatic LQTS are associated with depression, and whether there are sex differences in these potential relationships. The sample comprised 782 participants (252 men). Of the 369 genetically defined LQTS mutation carriers, 169 were symptomatic and 200 were asymptomatic. The control group consisted of 413 unaffected relatives. Depression was assessed using the Beck Depression Inventory-II (BDI-II). No association was found for LQTS mutation carrier status with depression. The multinomial logistic regression showed that LQTS mutation carrier men with arrhythmic events scored higher on depression compared with the control group, even when adjusting for age, beta-blockers, antidepressants, and social support (OR = 1.09, 95 % CI [1.02, 1.15], p = .007). The binary logistic regression comparing symptomatic and asymptomatic LQTS mutation carriers showed that symptomatic LQTS was associated with depression in men (OR = 1.10, 95 % CI [1.03, 1.19], p = .009). The results were unchanged when additionally adjusted for education. These findings suggest that symptomatic LQTS is associated with depression in men but not in women. Overall, however, depression is more frequent in women than men. Thus, regular screening for depression in LQTS mutation carriers and their unaffected family members can be important.Peer reviewe

Improving physical health and reducing substance use in psychosis - randomised control trial (IMPACT RCT): study protocol for a cluster randomised controlled trial

The National Institute for Health Research funds the IMPACT programme at King’s College London and South London and Maudsley NHS Foundation Trust (ref: RP-PG-0606-1049)

Prevalence and determinants of unintended pregnancies amongst women attending antenatal clinics in Pakistan

Background: Unintended pregnancies are a global public health concern and contribute significantly to adverse maternal and neonatal health, social and economic outcomes and increase the risks of maternal deaths and neonatal mortality. In countries like Pakistan where data for the unintended pregnancies is scarce, studies are required to estimate its accurate prevalence and predictors using more specific tools such as the London Measure of Unplanned Pregnancies (LMUP). Methods: We conducted a hospital based cross sectional survey in two tertiary care hospitals in Pakistan. We used a pre tested structured questionnaire to collect the data on socio-demographic characteristics, reproductive history, awareness and past experience with contraceptives and unintended pregnancies using six item the LMUP. We used Univariate and multivariate analysis to explore the association between unintended pregnancies and predictor variables and presented the association as adjusted odds ratios. We also evaluated the psychometric properties of the Urdu version of the LMUP. Results: Amongst 3010 pregnant women, 1150 (38.2%) pregnancies were reported as unintended. In the multivariate analysis age \u3c 20 years (AOR 3.5 1.1-6.5), being illiterate (AOR 1.9 1.1-3.4), living in a rural setting (1.7 1.2-2.3), having a pregnancy interval of = \u3c 12 months (AOR 1.7 1.4-2.2), having a parity of \u3e2 (AOR 1.4 1.2-1.8), having no knowledge about contraceptive methods (AOR 3.0 1.7-5.4) and never use of contraceptive methods (AOR 2.3 1.4-5.1) remained significantly associated with unintended pregnancy. The Urdu version of the LMUP scale was found to be acceptable, valid and reliable with the Cronbach\u27s alpha of 0.85. Conclusions: This study explores a high prevalence of unintended pregnancies and important factors especially those related to family planning. Integrated national family program that provides contraceptive services especially the modern methods to women during pre-conception and post-partum would be beneficial in averting unintended pregnancies and their related adverse outcomes in Pakistan