Combination antifungal therapy (amphotericin B deoxycholate and flucytosine) is the recommended treatment for cryptococcal meningitis but has not been shown to reduce mortality, as compared with ...amphotericin B alone. We performed a randomized, controlled trial to determine whether combining flucytosine or high-dose fluconazole with high-dose amphotericin B improved survival at 14 and 70 days.
We conducted a randomized, three-group, open-label trial of induction therapy for cryptococcal meningitis in patients with human immunodeficiency virus infection. All patients received amphotericin B at a dose of 1 mg per kilogram of body weight per day; patients in group 1 were treated for 4 weeks, and those in groups 2 and 3 for 2 weeks. Patients in group 2 concurrently received flucytosine at a dose of 100 mg per kilogram per day for 2 weeks, and those in group 3 concurrently received fluconazole at a dose of 400 mg twice daily for 2 weeks.
A total of 299 patients were enrolled. Fewer deaths occurred by days 14 and 70 among patients receiving amphotericin B and flucytosine than among those receiving amphotericin B alone (15 vs. 25 deaths by day 14; hazard ratio, 0.57; 95% confidence interval CI, 0.30 to 1.08; unadjusted P=0.08; and 30 vs. 44 deaths by day 70; hazard ratio, 0.61; 95% CI, 0.39 to 0.97; unadjusted P=0.04). Combination therapy with fluconazole had no significant effect on survival, as compared with monotherapy (hazard ratio for death by 14 days, 0.78; 95% CI, 0.44 to 1.41; P=0.42; hazard ratio for death by 70 days, 0.71; 95% CI, 0.45 to 1.11; P=0.13). Amphotericin B plus flucytosine was associated with significantly increased rates of yeast clearance from cerebrospinal fluid (-0.42 log10 colony-forming units CFU per milliliter per day vs. -0.31 and -0.32 log10 CFU per milliliter per day in groups 1 and 3, respectively; P<0.001 for both comparisons). Rates of adverse events were similar in all groups, although neutropenia was more frequent in patients receiving a combination therapy.
Amphotericin B plus flucytosine, as compared with amphotericin B alone, is associated with improved survival among patients with cryptococcal meningitis. A survival benefit of amphotericin B plus fluconazole was not found. (Funded by the Wellcome Trust and the British Infection Society; Controlled-Trials.com number, ISRCTN95123928.).
Traffic-related air pollution (TRAP) negatively impacts children's health. Self-protective measures are available, but population uptake is variable. It is essential to understand human beliefs and ...behaviours related to air pollution in order to understand the lack of self-protection in communities.
As a prelude to undertaking a comprehensive assessment of children's attitudes and beliefs on the health effects of TRAP exposure, we sought to develop and validate an appropriate instrument.
This study used exploratory sequential mixed methods.
This instrument, based on the constructs of the health belief model (HBM), aimed to determine factors predicting wearing a mask to protect against TRAP exposure. An initial literature-based questionnaire was modified using in-depth interviews, focus group discussions, and a quantitative survey pilot. This study included 121 school students and nine professional experts in Vietnam. The questionnaire was tested for content validity, agreement, test-retest reliability, and internal consistency.
The concordance of questionnaire items between two repeated assessments ranged from 47.2% to 78.3%, intraclass correlation coefficients ranged from 0.16 to 0.87 and Cronbach's internal reliability coefficient for the instrument was 0.60.
The self-administered instrument, based on the HBM, is suitable to understand health attitudes and beliefs related to self-protective behaviours to reduce TRAP exposure.
Combined effects of global warming and rapid urbanization replace green spaces with urban facilities. Children in urban areas are at a higher risk of heat-related adverse health effects. Our study ...aimed to examine the protective effect of urban green space on heat-related respiratory hospitalization among children under 5 years of age in Hanoi, the capital city of Vietnam. We estimated district-specific meteorological conditions from 2010 to 2014 by using a dynamic downscaling approach with a fine-resolution numerical climate model. The green space in each district was calculated using satellite data. The attributable fraction of heat-related respiratory hospitalization was estimated using a two-stage model, including a distributed lag non-linear model (DLNM) coupled with multivariate meta-analysis. The association between heat-related respiratory hospitalization and green spaces at the district level was explored using a linear regression model. The central districts were more crowded and hotter, with less green spaces than the outer districts. At temperatures > 34 °C (extreme heat threshold), the hospitalizations in the central districts increased significantly; however, in the outer districts, the hospitalization rate was insignificant. On average, extreme heat attributed 0.33% to citywide hospitalization, 0.35% in the center, and 0.32% in the outer region. Every 1% increase in the green space fraction will reduce heat-related respiratory hospitalization risk by 3.8%. Heat significantly increased the risk of respiratory hospitalization among children under 5 years in Hanoi, Vietnam. These findings are valuable for authorities to consider strategies to protect children’s health against the effects of heat, including increasing green space.
This study quantified the secondhand smoke (SHS) concentration in a sample of public places in Vietnam to determine changes in SHS levels 5 years after a public smoking ban was implemented.
Two ...monitoring campaigns, one in 2013 (before the tobacco control law was implemented) and another in 2018 (5 years after the implementation of the law) were conducted in around 30 restaurants, cafeterias and coffee shops in major cities of Vietnam. Concentrations of PM
, as an indicator of SHS, were measured by portable particulate matter monitors (TSI SidePak AM510 and Air Visual Pro).
The geometric mean PM
concentration of all monitored venues was 87.7 µg/m
(83.7-91.9) in the first campaign and 55.2 µg/m
(53.7-56.7) in the second campaign. Pairwise comparison showed the PM
concentrations in the smoking observed area was triple and double those in the non-smoking area and the outdoor environment. After adjusting for sampling locations and times, the SHS concentration 5 years after the implementation of the tobacco control law reduced roughly 45%.
The study results indicate an improvement in air quality in public places in Vietnam via both the reduction in PM
levels and the number of people observed smoking. However, greater enforcement of the free-smoke legislation is needed to eliminate SHS in public places in Vietnam.
The rate of H. pylori infection in Vietnam is reportedly high, but the spectrum of H. pylori-associated gastroduodenal diseases has not been systematically investigated. Moreover, despite the ...similarities of ethnicity and diet, the age-standardized incidence rate of gastric cancer in the northern city of Hanoi is higher than that in the southern city of Ho Chi Minh, but the reason for this phenomenon is unknown. The virulence of Vietnamese H. pylori has also not been investigated in detail.
Individuals undergoing esophagogastroduodenoscopy were randomly recruited. H. pylori infection status was determined based on the combined results of culture, histology, immunohistochemistry, rapid urine test and serum ELISA. Peptic ulcer (PU) and gastroesophageal reflux disease was diagnosed by endoscopy, and chronic gastritis was determined histologically. H. pylori virulence factors were investigated by PCR and sequencing.
Among the examined patients, 65.6% were infected with H. pylori. The prevalence of infection was significantly higher in those over 40 years of age than in those aged ≤40. Chronic gastritis was present in all H. pylori-infected individuals, 83.1% of whom had active gastritis, and 85.3% and 14.7% had atrophy and intestinal metaplasia, respectively. PU was present in 21% of infected patients, whereas its incidence was very low in non-infected individuals. The prevalence of PU was significantly higher in Hanoi than in Ho Chi Minh. The prevalence of vacA m1, which has been identified as an independent risk factor for PU in Vietnam, was significantly higher among H. pylori isolates from Hanoi than among those from Ho Chi Minh.
H. pylori infection is common in Vietnam and is strongly associated with PU, active gastritis, atrophy and intestinal metaplasia. vacA m1 is associated with an increased risk for PU and might contribute to the difference in the prevalence of PU and gastric cancer between Hanoi and Ho Chi Minh.
Traffic-related air pollution (TRAP) problems are unlikely to be solved in the short term, making it imperative to educate children on protective measures to mitigate the negative impact on their ...health. Children and their caregivers may hold differing views on wearing a face mask as a safeguard against air pollution. While many studies have focused on predicting children's health-protective behaviours against air pollution, few have explored the differences in perceptions between children and their caregivers.
To examine this, we conducted a study that compared the health beliefs of two generations and evaluated the factors that influence the use of masks by children to reduce air pollution exposure.
The study was conducted in 24 secondary schools and involved 8420 children aged 13-14 and their caregivers. We used a Health Belief Model (HBM)-based instrument containing 17-item self-administered health beliefs questionnaires to gather data. The results were analysed using hierarchical logistic regression to determine the probability of children frequently wearing masks to protect against TRAP.
Our study showed both children and caregivers recognised that several factors could influence mask-wearing among children: discomfort or difficulty breathing while wearing a mask and forgetting to bring a mask when going outside; perceived threats of the poor quality of air and children's respiratory health problems; and cues to mask use (i.e., seeing most of their friends wearing facemasks and ease of finding masks in local stores). However, only children were significantly concerned with public perception of their appearance while wearing a mask. Females were more likely to wear masks, and caregivers with higher levels of education were more likely to encourage their children to wear masks. Children who commuted to schools by walking, biking, or motorbiking were also more accepting of mask-wearing than those who travelled by car or bus.
Children and their caregivers hold different perceptions of wearing masks to protect against air pollution. Children are more susceptible to social judgements regarding their appearance when wearing a mask.
Summary
Worldwide, obesity almost tripled between 1975 and 2016 and is now prevalent in both rich and poor countries. Using annual food availability data produced by the Food and Agriculture ...Organisation of the United Nations (FAO) covering half a century in 118 countries, this article explores the diets that are central to the problem of obesity, identifying groups of countries with similar consumption patterns. Applying algorithms from the fuzzy clustering literature, five distinct consumption patterns are revealed whose dietary composition broadly corresponds to diets that we label ‘Western’, ‘Traditional’, ‘Mediterranean’, ‘Tropical’ and ‘Vegetarian’. Despite differences in dietary characteristics, all five share two common themes: rising total calories and declining healthiness, both of which are linked to the substitution of plant‐based foods with food derived from animals. That the evidence points to a convergence on the ‘Western’ diet, the most obesogenic and least healthy of all the diets we consider, is a cause for concern. The key message is that in a future where people are predicted to live longer – but not necessarily healthier – lives, recent efforts to address the challenge are prescient, and as the results in the article imply, need to be heeded globally.
L'obésité a presque triplé dans le monde entre 1975 et 2016 et elle est désormais répandue dans les pays riches comme dans les pays pauvres. À l'aide de données annuelles sur la disponibilité alimentaire couvrant un demi‐siècle dans 118 pays, produites par l'Organisation des Nations Unies pour l'alimentation et l'agriculture (FAO), cet article explore les régimes alimentaires qui sont au cœur du problème de l'obésité, en identifiant des groupes de pays ayant des modes de consommation similaires. En appliquant des algorithmes tirés de la littérature sur les grappes floues, apparaissent cinq modes de consommation distincts dont la composition alimentaire correspond largement aux régimes que nous appelons ‘occid'entaux’, ‘traditionnels’, ‘méditerranéens’, ‘tropicaux’ et ‘végétariens’. Malgré des différences dans les caractéristiques alimentaires, les cinq partagent deux thèmes communs: l'augmentation des calories totales et la baisse du caractère bénéfique à la santé, tous deux liés à la substitution des aliments d'origine végétale par des aliments d'origine animale. Le fait que les résultats indiquent une convergence sur le régime ‘occidental’, le plus générateur d'obésité et le moins sain de tous les régimes que nous considérons, est préoccupant. Le message clé est que dans un avenir où les gens devraient vivre plus longtemps ‐ mais pas nécessairement en meilleure santé ‐, les efforts récents pour relever le défi sont visionnaires et, comme les résultats de l'article le sous‐entendent, doivent être pris en compte à l’échelle mondiale.
Zwischen 1975 und 2016 hat sich die Anzahl an Übergewichtigen weltweit verdreifacht. Übergewicht ist heute in reichen wie auch in armen Ländern weit verbreitet. In diesem Artikel werden Ernährungsweisen betrachtet, die für das Problem des Übergewichts von zentraler Bedeutung sind und Gruppen von Ländern identifiziert, die ähnliche Ernährungsgewohnheiten aufweisen. Hierfür wurden jährliche Daten zur Lebensmittelverfügbarkeit verwendet, welche die Ernährungs‐ und Landwirtschaftsorganisation der Vereinten Nationen (FAO) über ein halbes Jahrhundert lang in 118 Ländern gesammelt hat. Unter Anwendung von Algorithmen aus der Fuzzy‐Clustering‐Literatur wurden fünf verschiedene Ernährungsmuster herausgearbeitet, deren Nahrungszusammensetzung allgemein der von uns als ‘westlich’, ‘traditionell’, ‘mediterran’, ‘tropisch’ und ‘vegetarisch’ bezeichneten Ernährungsformen entspricht. Trotz Unterschieden in ihren Merkmalen haben alle fünf Ernährungsformen zwei Themen gemeinsam: steigende Gesamtkalorienmenge und abnehmende Gesundheit, die beide in Verbindung mit dem Ersatz pflanzlicher Lebensmittel durch Lebensmittel auf Basis von Tierprodukten stehen. Dass die Erkenntnisse auf eine Annäherung an die „westliche” Ernährung hindeuten, welche die am stärksten Übergewicht verursachende und ungesündeste Ernährungsform unter allen betrachteten ist, gibt Anlass zur Sorge. Die Schlüsselbotschaft ist, dass in einer Zukunft, in der die Menschen voraussichtlich länger ‐ aber nicht unbedingt gesünder ‐ leben werden, die jüngsten Bemühungen zur Bewältigung dieser Herausforderung vielversprechend sind und, wie die Ergebnisse des Artikels andeuten, weltweit Beachtung finden müssen.
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