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Because of the increasing adoption and use of technology in primary health care (PHC), public health informatics competencies (PHIC) are becoming essential for public health workers. Unfortunately, no studies have measured PHIC in resource-limited setting. This paper describes the process of developing and validating Public Health Informatics Competencies for Primary Health Care (PHIC4PHC), an instrument for measuring PHC workers’ competencies in public health informatics. Method: This study developed a questionnaire that had three stages: the Delphi technique, a pretest, and field test. Eleven academicians from a university and 13 PHC workers joined 2 rounds of group discussion in the first stage. The second stage comprised two pilot studies with 75 PHC workers in Semarang Municipality. The third stage involved validating the questionnaire with 462 PHC workers in Kendal District. This study used Pearson’s product-moment correlation for the validity check and Cronbach’s alpha coefficient for determining the internal consistency. This study used the K-means algorithm for clustering the results of the PHIC4PHC questionnaire. Results and Conclusion: PHIC4PHC is the first comprehensive PHIC questionnaire administered in a resource-limited setting, consisting of 11 indicators and 42 measurement items concerning knowledge of health information systems, skills required for health data management, ethical aspects of data sharing and health information literacy. The final results of PHIC4PHC were clustered into three classes based on the K-means algorithm. Overall, 45.7% PHC workers achieved medium competency, whereas 25.6% and 27.7% achieved low and high competency, respectively. Men had higher competency than women. The higher the worker’s level of education, the higher the PHIC level; the longer the worker’s work experience, the lower the PHIC score; and the greater the worker’s age, the lower the PHIC score. Measuring and monitoring PHIC is vital to support successful health IT adoption in PHC.
Considerable and continuing interest has been shown in the thin film transducer fabrication for surface acoustic waves (SAW) in the past few years. Due to the high degree of miniaturization, compatibility with silicon integrated circuit technology, simplicity and ease of design, this new technology has played an important role in the design of new devices for communications and signal processing. Among the commonly used piezoelectric thin films, ZnO generally yields superior electromechanical properties and is expected to play a leading role in the development of SAW devices.
Introduction: Many cardiac arrest survivors die later due to hemorrhage or thromboembolism, thought to be caused by acquired coagulopathy in post-cardiac arrest syndrome (PCAS) from shock and reperfusion injury. Understanding PCAS is a priority identified by the AHA for the prevention of complications in cardiac arrest survivors. Shock dysregulates both coagulation and fibrinolysis. The key effector enzyme thrombin (Th), is responsible for both up- and down-regulating coagulation and fibrinolysis. Measuring early Th activity may allow for predicting PCAS coagulopathy, and early medical intervention in the ED. Therefore, we aimed to characterize the time-course profile of early coagulation using an established pig model of cardiac arrest. Methods: Yorkshire pigs were anaesthetised and intubated, had VF-arrest induced by pacing, and were resuscitated per ACLS. Rotational thromboelastometry (ROTEM) was performed on whole blood at four times: baseline, intra-arrest, post-arrest, and death, using the fibrin-based test with tissue factor to initiate clotting in the presence of a platelet inhibitor cytochalasin D (FIBTEM). Clot time (CT), clot formation time (CFT), alpha-angle during clot formation (Alpha), clot amplitude at 10 min (A10), maximum clot firmness (MCF), and maximum lysis as total percentage (ML%) were quantified. The primary outcome is the overall coagulation initiation measured by CFT, while secondary outcomes include ROTEM parameters reflecting Th activity. Parameters are compared over time in SPSS using repeated measures ANOVA and Bonferroni correction. Results: Pilot data from one experiment show that cardiac arrest causes immediate early changes to coagulation that subsequently normalized with ROSC (Figure 1). CFT was impaired immediately upon cardiac arrest (2.3-fold increase), normalized with ROSC, and impaired again at death when compared with baseline. Consistent with clotting impairment, A10, Alpha, and MCF were all reduced with cardiac arrest, normalized with ROSC, and impaired again at death. Conclusion: Higher initial indices of coagulopathy in patients with cardiac arrest appear to correlate with death and thromboembolism. In this pilot, CFT is acutely modified by cardiac arrest. Since CFT is affected by overall Th activity, early Th dysregulation may be a critical driver of coagulopathy. Th may therefore be a lead target that is modifiable in the emergency post-arrest setting to decrease morbidity and mortality from PCAS in cardiac arrest survivors.
Background: Massive hemorrhage protocols (MHPs) streamline the complex logistics required for prompt care of the bleeding patient, but their uptake has been variable and few regions have a system to measure outcomes from these events. Aim Statement: We aim to implement a standardized MHP with uniform quality improvement (QI) metrics to increase uptake of evidence-based MHPs across 150-hospitals in Ontario between 2017 and 2021. Measures & Design: We performed ongoing PDSA cycles; 1) stakeholder analysis by surveying the Ontario Regional Blood Coordinating Network (ORBCoN), 2) problem characterization and Ishikawa analysis for key QI metrics based on areas of MHP variability in 150 Ontario hospitals using a web-based survey, 3) creation of a consensus MHP via a modified Delphi process, 4) problem characterization at ORBCoN for the design of a freely available toolkit for provincial implementation by expert working groups, 5) design of 8 key QI metrics by a modified Delphi process, and 6) identification of process measures for QI data collection by implementation metrics. Evaluation/Results: PDSA1-2; 150-hospitals were surveyed. 33% of hospitals lacked MHPs, mostly in smaller sites. Major areas for QI were related to activation criteria, hemostatic agents, protocolized hypothermia management, variable MHP naming, QI metrics and serial blood work requirements. PDSA3; 3 Delphi rounds were held to reach 100% expert consensus for 42 statements and 8 CQI metrics. Major areas for modification were protocol name, laboratory resuscitation targets, cooler configurations, and role of factor VIIa. PDSA4; adaptable toolkit is under development by the steering committee and expert working groups. Implementation is scheduled for Spring 2020. PDSA5; the 8 CQI metrics are: TXA administration < 1 h, RBC transfusion < 15 min, call to transfer for definitive care < 60 min, temp >35°C at end of protocol, Hgb kept between 60-110g/L, transition to group-specific RBC by 90 min, appropriate activation defined by ≥6 units RBC in the first 24 hours, and any blood component wastage. Discussion/Impact: MHP uptake, content, and tracking is variable. A standardized MHP that is adaptable to diverse settings decreases complexity, improves use of evidence-based practices, and provides a platform for continuous QI. PDSA6 will occur after implementation; we will complete an implementation survey, and design a pilot and feasibility study for prospective tracking of patient outcomes using existing prospectively collected inter-hospital and provincial databases.
The primary purposes of this study were 1) to examine relationships among stress, coping and comorbidity and 2) to test the interaction effect of comorbidity.
Hemodialysis imposes a variety of physical and psychosocial stressors that challenge patients. Comorbidity is a risk factor for many health outcomes. Research on how comorbidity influences the relationship between coping and stress is limited.
In this cross-sectional study using face to face interviews, we interviewed 2642 hemodialysis patients fifteen years or older on dialysis for at least 3 months from October 2002 to January 2003. The Hemodialysis Stressor Scale measured stressors and the Jalowiec Coping Scale were used to measure coping strategies. A hierarchical regression was used to analyze the data.
Hemodialysis patients with comorbidities were found to have higher levels of stress. Comorbidity had a moderating effect between choice of problem-oriented responses and isolated thoughts as coping strategies. These findings show that hemodialysis patients with comorbidities often choose positive coping strategies.
HD patients with comorbidity have a higher stress scores than those without comorbidities. Comorbidity not only has a direct impact on stress but also has a moderating effect on the relationship between coping and stress. Therefore, taking into account the comorbidity factor became very crucial when assessing the HD patients’ level of stress.
The present study examined the relationship between the Lie scale scores and striatal D2/D3 receptor availability with respect to the cerebellum in 42 healthy community volunteers in Taiwan using single photon emission computed tomography (SPECT) with [123I]iodo-benzoaminde (IBZM). Even after controlling of age and educational level, subjects' Lie scale scores of the Maudsley personality inventory correlate negatively with D2/D3 receptor availability. Individual with higher Lie scale scores may have higher impulsivity due to lower dopaminergic availability.
Patients with chronic kidney disease (CKD) have more cognitive impairments. However, the etiologies are not fully clear. Plasma homocysteine levels and vascular burden rise in CKD; meanwhile, high homocysteine levels and vascular factors are known risk factors of dementia in non-CKD patients. Thus, we aimed to investigate the association between homocysteine, vascular burden and cognitive impairment in CKD and to see if the effect of elevated homocysteine on cognitive impairment mediated by vascular factor.
146 patients with CKD and 69 normal comparisons were recruited. Cognitive function was evaluated by comprehensive neuropsychological tests assessing processing speed, executive function, language, visuospatial function, memory, and attention domains. Vascular burden was assessed by Framinghan cardiovascular risk scale (FCRS) which indicates risk of atherosclerotic diseases including stroke.
In controlled analysis, patients with CKD had lower scores in all cognitive domains, and had higher homocysteine levels (18.5±6.4 vs. 9.8±2.9, p< 0.0001) and FCRS(17.0±4.7 vs. 14.0±4.7, p< 0.0001). Among patients with CKD, higher homocysteine levels (p=0.026) were associated with lower score on digit symbol task which is related to processing speed and executive function with controlling for age, sex, education and stage of CKD. The association persisted (p=0.047) after controlling for vascular risks.
Patients with CKD had extensive cognitive impairments. Elevated homocysteine levels may be an risk factor, which is independent of vascular burden, of cognitive impairment on processing speed and executive function. Further studies to investigate if normalization of homocysteine can improve cognitive function will be suggested.
Cardiovascular disease (CVD) and depressive disorders are the most two harmful problems for human health in the 21st century. The relationships between the two diseases are complicated, yet the mechanisms are not clear so far. This study addressed this issue by clarifying shared and unique factors between metabolic syndrome (MS) and mild psychiatric disorder (MPD) using the 8-year follow-up Landseed cohort.
A total of 5712 community residents were followed-up and analyzed. The point prevalence rates of MS and MPD and their comorbidity rate were estimated by each wave. Three multiple logistic regression models, with each treating MS, MPD, and comorbid condition as dependent variable, were compared to identify the shared and unique factors. Variables specifically correlate with MS or MPD are defined as unique factors; whilst those correlated with both MS and MPD or with comorbid condition as shared factors.
The point prevalence rates of MS ranged 13.83-14.26%, MPD ranged 17.17-19.60%, and comorbidity rates 2.75-3.07% in three waves. Educational level and weekly exercise frequency are shared factors of MS and MPD. Moderate personal income is a unique protective factor for MS; and male and abstaining from alcohol use are unique protective factors for MPD.
A balanced life style is beneficial for both physical and psychological health. Specifically, there are no dose-response effects between weekly exercise frequency and MS or MPD. It is important for clinicians and health educators to educate community people to engage in exercise in a proper way to improve public health.
This study was performed to investigate the association between the mid-brain serotonin transporter (SERT) availability and intelligence quotient (IQ).
One hundred and thirteen healthy participants, including 52 male and 61 female subjects, were recruited. We used SPECT with [123I]ADAM images to determine the SERT availability in the mid-brain, and measured the subjects’ IQ using the WAIS-R.
We found a significant positive correlation between the mid-brain SERT availability and the IQ of the participants. Even when controlling for age and sex, the significant association still existed.
This result implied that the higher the SERT binding in the mid-brain, the better the IQ in healthy participants.
Serotonin transporter (SERT) and dopamine transporter (DAT) levels differ in patients with major depressive disorder (MDD) who are in a depressed state in comparison with healthy controls. In addition, a family history of depression is a potent risk factor for developing depression, and inherited vulnerability to serotonergic and dopaminergic dysfunction is suspected in this. The aim of this study was to examine the availabilities of midbrain SERT and striatal DAT in healthy subjects with and without a first-degree family history of MDD.
Eight healthy subjects with first-degree relatives with MDD and 16 sex- and age-matched healthy controls were recruited. The availabilities of SERT and DAT were approximated using SPECT, employing [123I] 2-((2-((dimethylamino)methyl)phenyl)thio)-5-iodophenylamine (ADAM) and [99mTc] TRODAT-1 as the ligands, respectively. There are missing data for one participant with a first-degree family history of MDD from the ADAM study, due to a lack of the radio-ligand at the time of experiment.
SERT availability in the midbrain was significantly lower in subjects with a first-degree family history of MDD than in healthy subjects. However, DAT availability was no different between two groups.
The results with regard to the midbrain SERT level suggest the heritability of MDD.
It is known that Sexual Dysfunction (SD) is higher in patient with depression than in the general population. Though antidepressant seems to worsen the situation, there are also indications that the gender may play a role on it.
Evaluate the gender effect of sexual function among unmedicated MDD, MDD receiving antidepressant, and healthy controls.
The sample was formed by male and female Taiwanese outpatients in three age and sex matched groups, with sixty nine participants per group: unmedicated MDD, MDD receiving antidepressant, and healthy controls. the diagnoses of depressions were performed according DSM-IV and Taiwanese Depression Questionnaire. SD was evaluated with the Chinese version of the Changes in Sexual Functioning Questionnaire. Finally, the data was analyzed using SPSS software v17. Mixed designed ANOVA was used.
There are significant differences between males and females CSFQ results (sex main effect F = 82.44, p < 0.001) and between groups (group main effect F = 3.48, p = 0.034). Additionally, the 2-way interaction between sex and group was also significant (F = 3.40, p = 0.036). Simple main effect analysis shows differences among male participants, between healthy and medicated males (F = 11.41, p = 0.002), but not in female (F = 1.58, p = 0.21). However the statistics weren’t different between females groups, the medicated expresses better results (similar to healthy group) than the unmedicated one.
SD is different between genders in each of the groups. Antidepressant seems to increase SD in man, while improves sexual satisfaction/function among depressive woman. We speculate that psychological improvement after treatment may have different impact between genders on sexual satisfaction.
Attrition can pose significant barriers to treatment success of depression; its contributing factors and impacts on treatment outcome need further clarification. Current study aimed to describe patterns of treatment attrition, to examine associated demographic and clinical determinants and to test whether and how attrition affects outcome of depression in a national cohort of adults treated for depression.
Material and methods
All adult patients prescribed with antidepressants for depression (n=216,557) in 2003 were identified from the National Health Insurance Research Database in Taiwan. Based on individuals’ clinical visit and antidepressant prescription, three attrition types, i.e., non-attrition, returning attrition and non-returning attrition, and their demographic/disease characteristics were identified. The relationships between attrition type and remission outcome over an 18-month follow-up period were further explored.
Factors pertaining to disease characteristics (severity of depression, comorbidities, painful physical symptoms and past treatment history) and clinical practice (physician specialty and choice of antidepressants) were associated with attrition and remission outcome at 18-month follow-up. Patients remaining in treatment within the first three months were associated with higher odds of having sustained remission (OR=1.21; 99% CI: 1.16, 1.27) and lower odds of having relapses/recurrences (OR=0.20; 99% CI: 0.19, 0.21) over the 18-month period, compared to those returning attriters.
Early attrition has significant negative impacts on antidepressant treatment outcome; it hence needs to be minimized through shared decision-making, exchange of treatment preferences and proper patient-physician communication. Based on current understanding, further efforts to reduce early attrition are highly warranted.
The Canadian Multiple Sclerosis Working Group has updated its treatment optimization recommendations (TORs) on the optimal use of disease-modifying therapies for patients with all forms of multiple sclerosis (MS). Recommendations provide guidance on initiating effective treatment early in the course of disease, monitoring response to therapy, and modifying or switching therapies to optimize disease control. The current TORs also address the treatment of pediatric MS, progressive MS and the identification and treatment of aggressive forms of the disease. Newer therapies offer improved efficacy, but also have potential safety concerns that must be adequately balanced, notably when treatment sequencing is considered. There are added discussions regarding the management of pregnancy, the future potential of biomarkers and consideration as to when it may be prudent to stop therapy. These TORs are meant to be used and interpreted by all neurologists with a special interest in the management of MS.
Excessive alcohol use has been associated with health, social and legal problems. Studies of alcohol-drinking problems have mainly focused on patients with alcohol-drinking problems and few studies have focused on their family members. The purpose of this study was to explore the perceptions of family members of problem-drinker patients about their own hazardous or harmful alcohol-drinking behaviours.
In this qualitative descriptive study, participants were recruited from three hospitals randomly selected from northern and central Taiwan (2:1). Hazardous-drinker patients and their family members were screened using the Chinese version AUDIT. AUDIT scores > 8 indicated harmful or hazardous drinkers. Data were collected in individual, audiotaped, in-depth interviews using an interview guide. Verbatim interview transcripts were analysed using ATLAS.ti, version WIN 7.0.
The sample of 35 family members with hazardous or harmful drinking behaviours perceived that their own alcohol-drinking behaviours were related to six major patterns: family habits, leisure activities with friends, work pressures, personal taste, a way to forget one's problems and to express happiness.
We recommend that programs to prevent harmful or hazardous drinking should emphasize understanding standard amounts of alcohol in alcoholic beverages, recommended amounts of alcohol consumption for males and females, knowledge about the long-term effects of excessive alcohol consumption; offer strategies to resist social pressure to drink; and build positive strategies for coping with stress.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Resolvent analysis is performed to identify the origin of two-dimensional transonic buffet over an airfoil. The base flow for the resolvent analysis is the time-averaged flow over a NACA 0012 airfoil at a chord-based Reynolds number of 2000 and a free-stream Mach number of 0.85. We reveal that the mechanism of buffet is buried underneath the global low-Reynolds-number flow physics. At this low Reynolds number, the dominant flow feature is the von Kármán shedding. However, we show that with the appropriate forcing input, buffet can appear even at a Reynolds number that is much lower than what is traditionally associated with transonic buffet. The source of buffet is identified to be at the shock foot from the windowed resolvent analysis, which is validated by companion simulations using sustained forcing inputs based on resolvent modes. We also comment on the role of perturbations in the vicinity of the trailing edge. The present study not only provides insights on the origin of buffet but also serves a building block for low-Reynolds-number compressible aerodynamics in light of the growing interests in Martian flights.
Precise bone cut is fundamental in total knee arthroplasty. However, notching of anterior femoral is not uncommon in clinical practice. Reviewing the article, notching and its complication may reach up to 30% and 2.5%, and there is scanty study of notching on the femoral strength. We therefore conduct the finite element analysis to elucidate the effect of notching on femoral mechanical strength. The computerized tomography images were used as the basis to develop the knee model, which was assumed mainly to consist of cortical and cancellous bones. For the implant joint, Zimmer data was considered partly as the basis to develop the model. This study investigated the femoral improper cut effect on the surgery with a static standing condition. The results show that the anterior femoral cut should be undercut 2 mm to overcut 1 mm during the surgery, in order to prevent bone materials from yielding. The exposure of the cancellous bone may cause bone materials to yield when the femur overcut was 2 mm; the cancellous bone may load too much and result in a fracture when the undercut was 3 mm. The effect of undercut, which was rarely discussed, was particularly addressed in our study. Precise femoral cut is crucial for the longevity of total knee arthroplasty.
Consumption of a high-fat diet increases fat accumulation and may further lead to inflammation and hepatic injuries. The aim of the study was to investigate the effects of Camellia oleifera seed extract (CSE) on non-alcoholic fatty liver disease (NAFLD). After a 16-week NAFLD-inducing period, rats were assigned to experimental groups fed an NAFLD diet with or without CSE. At the end of the study, we found that consuming CSE decreased the abdominal fat weight and hepatic fat accumulation and modulated circulating adipokine levels. We also found that CSE groups had lower hepatic cytochrome P450 2E1 and transforming growth factor (TGF)-β protein expressions. In addition, we found that CSE consumption may have affected the gut microbiota and reduced toll-like receptor (TLR)-4, myeloid differentiation primary response gene 88, toll/IL-1 receptor domain-containing adaptor-inducing interferon-β (TRIF) expression and proinflammatory cytokine concentrations in the liver. Our results suggest that CSE may alleviate the progression of NAFLD in rats with diet-induced steatosis through reducing fat accumulation and improving lipid metabolism and hepatic inflammation.
Evolution of a solitary wave travelling along a submerged sill is studied. The disturbance from the sill creates a phase lag along the wave crest between the ambient water depth and the shallower depth over the sill. This phase lag causes wave diffraction between the different parts of the wave, which induces radiating waves off the edge of the sill. The radiating waves act as an outlet for wave energy, resulting in significant and continual amplitude reduction of the solitary wave. Findings from laboratory experiments are confirmed numerically by simulating a much longer propagation distance with different sill breadths. When the sill breadth is narrow, the solitary wave slowly attenuates by wave radiation, maintaining a quasi-steady wave pattern. This is not the case for a broader sill. The resulting phase lag on the sill continually changes the wave pattern and the attenuation rate is substantially greater than the rate for the case of the narrow sill. The significant energy radiation together with the continual change in the wave formation eventually leads to the complete annihilation of the solitary wave in a wave tank. We also report a wave-breaking process along the sill observed in laboratory experiments. This breaking is induced when the wave amplitude on the sill is smaller than the maximum amplitude of a solitary wave in a uniform depth. Also found is the wake-like formation of gravity–capillary waves behind the breaking crest forming on the sill. Other features associated with the breaking are presented.