Caregiver-reported delay in presentation to pediatric emergency departments for fear of contracting COVID-19: a multi-national cross-sectional study

Objective: To determine if caregivers of children presenting to pediatric emergency departments (EDs) during the COVID-19 pandemic are delaying presenting to care for fear of contracting COVID-19. Methods: This was a pre-planned secondary analysis of a cross-sectional survey study of caregivers accompanying their children aged 0-19 years to 16 pediatric EDs in 5 countries from May to June 2020. An anonymous online survey, completed by caregivers via RedCAP, included caregiver and child demographics, presenting complaints, if they delayed presentation and whether symptoms worsened during this interval, as well as caregiver concern about the child or caregiver having COVID-19 at the time of ED visit. Results: Of 1543 caregivers completing the survey, 287 (18.6%) reported a delay in seeking ED care due to concerns of contracting COVID-19 in the hospital. Of those, 124 (43.2%) stated their child's symptoms worsened during the waiting interval. Caregiver relationship to child [mother] (OR 1.85, 95% CI 1.27-2.76), presence of chronic illness in child (OR 1.78. 95% CI 1.14-2.79), younger age of caregiver (OR 0.965, 95% CI 0.943-0.986), and caregiver concerns about lost work during the pandemic (OR 1.08, 95% CI 1.04-1.12) were independently associated with a COVID-19-related delayed presentation in multivariable regression analysis. Conclusions: Almost one in five caregivers reported delaying ED presentation for their ill or injured child specifically due to fear of contracting COVID-19 while in hospital, with mothers, younger caregivers, caregivers of children with chronic illness, and those concerned about lost work more likely to report delaying ED presentation. Keywords: COVID-19; Caregivers; Children; Emergency department; Presentation dela

Discovery of Novel Hypermethylated Genes in Prostate Cancer Using Genomic CpG Island Microarrays

BACKGROUND: Promoter and 5' end methylation regulation of tumour suppressor genes is a common feature of many cancers. Such occurrences often lead to the silencing of these key genes and thus they may contribute to the development of cancer, including prostate cancer. METHODOLOGY/PRINCIPAL FINDINGS: In order to identify methylation changes in prostate cancer, we performed a genome-wide analysis of DNA methylation using Agilent human CpG island arrays. Using computational and gene-specific validation approaches we have identified a large number of potential epigenetic biomarkers of prostate cancer. Further validation of candidate genes on a separate cohort of low and high grade prostate cancers by quantitative MethyLight analysis has allowed us to confirm DNA hypermethylation of HOXD3 and BMP7, two genes that may play a role in the development of high grade tumours. We also show that promoter hypermethylation is responsible for downregulated expression of these genes in the DU-145 PCa cell line. CONCLUSIONS/SIGNIFICANCE: This study identifies novel epigenetic biomarkers of prostate cancer and prostate cancer progression, and provides a global assessment of DNA methylation in prostate cancer

The reason that I did not go - determinants of the use of antenatal care services in South Africa, two decades after the end of apartheid

According to South Africa's new constitution, access to health care is a fundamental right. Equitable provision of maternal health care is important in redressing past legacies and achieving the Millennium Development Goals. We analyse the utilisation of antenatal care (ANC) services under South Africa's public health system to inform policy concerned with equity of access.We conceptualise access to care as covering three distinct but interacting dimensions: availability, affordability and acceptability. We explain variations in the number of ANC visits among women giving birth in four selected communities, two urban and two rural.Results indicate that more-marginalised women were significantly less likely to have the minimum recommended number of ANC visits whereas being older, in a stable or married relationship and more highly educated and having no previous deliveries were positive influences. Further analysis revealed variations between facilities in the determinants of sufficient ANC visits. These results are discussed using insights based on qualitative patient interviews. Our findings show inequalities in utilisation which may indicate remaining inequities in access

Representative homeobox genes showing methylation for cancer/reference and progression dataset (genes in bold overlap with Table 1).

<p>Representative homeobox genes showing methylation for cancer/reference and progression dataset (genes in bold overlap with <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0004830#pone-0004830-t001" target="_blank">Table 1</a>).</p

Partek Genomics Suite Visualization.

<p>(A) <i>BMP7</i> and (B) <i>HOXD3</i>. Line graphs in the upper panel of each show log₂ ratio values for each probe, with red representing PP4 cases A–J and blue representing PP3 cases 1–10. The lower panel of each is a heat map for each probe in individual PP4 and PP3 cases. Red arrows correspond to regions selected for EpiTYPER analysis while black arrows correspond to regions chosen for MethyLight analysis.</p

EpiTYPER analysis of <i>HOXD3</i>.

<p>(A) PP3 cases 4 and 8 and (B) PP4 cases F and I. Reference lymphocyte is shown for each. Coloured bars represent the average methylation over three replicates with standard error bars displayed.</p

RT-PCR analysis of DU-145 cells.

<p>NTC – no template control. −DAC – untreated. +DAC – treated with 5-aza-2-deoxycytidine.</p

PMR values of positive cases for <i>BMP7</i> and <i>HOXD3</i> methylation.

<p>PMR values of positive cases for <i>BMP7</i> and <i>HOXD3</i> methylation.</p

EpiTYPER analysis of <i>BMP7</i>.

<p>(A) PP3 cases 3 and 4 and (B) PP4 cases B and I. Reference lymphocyte is shown for each. Coloured bars represent the average methylation over three replicates with standard error bars displayed.</p

Representative genes and average PGS fold change (across multiple probes) from the top 100 for cancer/reference and progression dataset.

<p>Representative genes and average PGS fold change (across multiple probes) from the top 100 for cancer/reference and progression dataset.</p