Between “Voluntary Migrants” and War Refugees: The Health of the Shan Burmese Migrant Workers in Northern Thailand

The Shan are a large migrant group from Burma (Myanmar) found within Thailand. While some Shan migrate to escape the civil war within Burma, others migrate for economic opportunity. Despite the size of this population, little is known about their health. Our study highlights the need for expanded access to primary care among this Shan population. Despite the arduous and trying journeys of these Shan migrants, they do not display the level of health sometimes attributed to health selection among immigrant groups

Clinical outcomes of a treat and extend regimen with intravitreal aflibercept injections in patients with diabetic macular edema: Experience in clinical practice

Introduction: Treat-and-extend (T&E) and prore nata (PRN; ‘as needed’) regimens of intravitreal anti-vascular endothelial growth factor(VEGF) treatment have been found to reducethe injection burden on patients and improvethe cost effectiveness of the treatment of macular edema. The aim of this study was to assessthe effectiveness of a T&E regimen of aflibercept, in a clinical setting, in patients with diabetic macular edema (DME) who were either intravitreal anti-VEGF therapy naive or withminimal exposure to anti-VEGF (B 6 treatments) in the previous 12 months.Methods: This prospective, single arm, open labelstudy recruited patients with DME (macularthickness of C 300 lm) and best-corrected visualacuity (BCVA) between 28-78 ETDRS letters. Participants received five loading doses of intravitrealaflibercept at 4-weekly intervals. BCVA measurements and macular optical coherence tomographywere performed at each visit. If no disease activitywas detected, treatment intervals were increased by2 weeks to a maximum of 12 weeks. Outcomemeasures included: changes in BCVA and retinalanatomical measures (central foveal thickness[CFT] and central macular volume within 6 mm ofthe fovea [CSVol]) between baseline and 2 years,patient treatment intervals; and adverse events.Results: Of the 36 patients who providedinformed consent to participate in the studyand were screened, 26 patients (eyes) were eligible to participate in the study. After regressionanalysis, adjustment for repeated measures, andsignificant covariates, the mean BCVA increasedby 3.8 letters (95% confidence interval [CI] 1.1,6.4) and the CFT and CSVol decreased by127.2 lm (95% CI 91.7, 162.5) and 1.6 mm3 (95% CI 1.2, 2.0), respectively, over the courseof the study. In the second year, 16 of the 25patients still participating had their treatmentintervals extended to 12 weeks. There was noevidence of any new adverse events that wouldrequire changes to the aflibercept safety profile.Conclusion: For the majority of patients presenting with DME, a T&E regimen of afliberceptin the first 2 years of therapy is a practical alternative to PRN treatment with regular review

Simultaneous lesion and neuroanatomy segmentation in Multiple Sclerosis using deep neural networks

Segmentation of both white matter lesions and deep grey matter structures is an important task in the quantification of magnetic resonance imaging in multiple sclerosis. Typically these tasks are performed separately: in this paper we present a single segmentation solution based on convolutional neural networks (CNNs) for providing fast, reliable segmentations of multimodal magnetic resonance images into lesion classes and normal-appearing grey- and white-matter structures. We show substantial, statistically significant improvements in both Dice coefficient and in lesion-wise specificity and sensitivity, compared to previous approaches, and agreement with individual human raters in the range of human inter-rater variability. The method is trained on data gathered from a single centre: nonetheless, it performs well on data from centres, scanners and field-strengths not represented in the training dataset. A retrospective study found that the classifier successfully identified lesions missed by the human raters. Lesion labels were provided by human raters, while weak labels for other brain structures (including CSF, cortical grey matter, cortical white matter, cerebellum, amygdala, hippocampus, subcortical GM structures and choroid plexus) were provided by Freesurfer 5.3. The segmentations of these structures compared well, not only with Freesurfer 5.3, but also with FSL-First and Freesurfer 6.0

Electronic Event–based Surveillance for Monitoring Dengue, Latin America

Dengue, a potentially fatal disease, is spreading around the world. An estimated 2.5 billion people in tropical and subtropical regions are at risk. Early detection of outbreaks is crucial to prevention and control of dengue virus and other viruses. Case reporting may often take weeks or months. Therefore, researchers explored whether electronic sources of real-time information (such as Internet news outlets, health expert mailing lists, social media sites, and queries to online search engines) might be faster, and they were. Although information from unofficial sources should be interpreted with caution, when used in conjunction with traditional case reporting, real-time electronic surveillance can help public health authorities allocate resources in time to avert full-blown epidemics

Two-Year Clinical and Functional Outcomes of an Asian Cohort at Ultra-High Risk of Psychosis

Background: To determine the 2-year clinical and functional outcomes of an Asian cohort at ultra-high risk (UHR) of psychosis.Method: This was a longitudinal study with a follow-up period of 2 years on 255 help-seeking adolescents and young adults at UHR of psychosis managed by a multi-disciplinary mental health team in Singapore. Clients received case management, psychosocial, and pharmacological treatment as appropriate. Data comprising symptom and functional outcomes were collected over the observation period by trained clinicians and psychiatrists.Results: The 2-year psychosis transition rate was 16.9%, with a median time to transition of 168 days. After 2 years, 14.5% of the subjects had persistent at-risk symptoms while 7.5% developed other non-psychotic psychiatric disorders. 38.4% of the cohort had recovered and was discharged from mental health services. The entire cohort's functioning improved as reflected by an increase in the score of the Social and Occupational Functioning Assessment Scale during the follow-up period. Predictors to psychosis transition included low education level, baseline unemployment, a history of violence, and brief limited intermittent psychotic symptoms, while male gender predicted the persistence of UHR state, or the development of non-psychotic disorders.Conclusion: Use of the current UHR criteria allows us to identify individuals who are at imminent risk of developing not just psychosis, but also those who may develop other mental health disorders. Future research should include identifying the needs of those who do not transition to psychosis, while continuing to refine on ways to improve the UHR prediction algorithm for psychosis