Infections produced by non-symptomatic (pre-symptomatic and asymptomatic) individuals have been identified as major drivers of COVID-19 transmission. Non-symptomatic individuals, unaware of the ...infection risk they pose to others, may perceive themselves-and be perceived by others-as not presenting a risk of infection. Yet, many epidemiological models currently in use do not include a behavioral component, and do not address the potential consequences of risk misperception. To study the impact of behavioral adaptations to the perceived infection risk, we use a mathematical model that incorporates the behavioral decisions of individuals, based on a projection of the system's future state over a finite planning horizon. We found that individuals' risk misperception in the presence of non-symptomatic individuals may increase or reduce the final epidemic size. Moreover, under behavioral response the impact of non-symptomatic infections is modulated by symptomatic individuals' behavior. Finally, we found that there is an optimal planning horizon that minimizes the final epidemic size.
Lockdowns imposed throughout the US to control the COVID-19 pandemic led to a decline in all routine immunizations rates, including the MMR (measles, mumps, rubella) vaccine. It is feared that ...post-lockdown, these reduced MMR rates will lead to a resurgence of measles.
To measure the potential impact of reduced MMR vaccination rates on measles outbreak, this research examines several counterfactual scenarios in pre-COVID-19 and post-COVID-19 era. An agent-based modeling framework is used to simulate the spread of measles on a synthetic yet realistic social network of Virginia. The change in vulnerability of various communities to measles due to reduced MMR rate is analyzed.
Results show that a decrease in vaccination rate Formula: see text has a highly non-linear effect on the number of measles cases and this effect grows exponentially beyond a threshold Formula: see text. At low vaccination rates, faster isolation of cases and higher compliance to home-isolation are not enough to control the outbreak. The overall impact on urban and rural counties is proportional to their population size but the younger children, African Americans and American Indians are disproportionately infected and hence are more vulnerable to the reduction in the vaccination rate.
At low vaccination rates, broader interventions are needed to control the outbreak. Identifying the cause of the decline in vaccination rates (e.g., low income) can help design targeted interventions which can dampen the disproportional impact on more vulnerable populations and reduce disparities in health. Per capita burden of the potential measles resurgence is equivalent in the rural and the urban communities and hence proportionally equitable public health resources should be allocated to rural regions.
Depression in long-term care Thakur, Mugdha; Blazer, Dan G
Journal of the American Medical Directors Association,
02/2008, Volume:
9, Issue:
2
Journal Article
Peer reviewed
To review the diagnosis and treatment of depressive disorders in long-term care settings.
A review of the literature on the diagnosis and treatment of depression in long-term care.
Up to 35% of ...residents in long-term care facilities may experience either major depression or clinically significant depressive symptoms. These symptoms are often not recognized for at least 2 reasons: depression is not the focus of physicians and nursing personnel and depression is frequently comorbid with other problems that are common in long-term care, such as cognitive impairment, medical illness, and functional impairment. Nevertheless, depression, once diagnosed, can be treated effectively in the nursing home setting. The foundation of treatment is pharmacotherapy, yet other therapeutic approaches, such as exercise and psychological therapies may be of value.
Depression, although often unrecognized in long-term care, is a treatable condition and deserves the attention of the entire medical and nursing staff.
While the precise role of sleep in maintaining optimal health and function remains unknown, it is clear that disturbances of sleep have a profound impact on the lives of affected individuals. In ...psychiatric disorders, not only is there a relationship between sleep disturbances and impaired function, problems with sleep also appear to affect the course of the disorder.
We carried out a literature review of sleep studies in mood disorders, alcoholism and schizophrenia to determine how associated alterations in sleep architecture and disturbances of sleep are related to patient function and quality of life, and the course of these disorders.
The literature speaks to the need to address sleep problems in the overall management of mood disorders, alcoholism and schizophrenia. The support for this viewpoint is best established for mood disorders. There is also relatively strong support for treatment in alcoholism. Schizophrenia, however, has received scant attention and the literature suggests a need for more studies in this area.
Further research is needed into the treatment of co-morbid insomnia and psychiatric disorders. Successful therapy is more likely to be achieved if the sleep difficulty and co-morbid disorder are simultaneously targeted for treatment.
•The prevalence of Herpes continues to increase in spite of existing programs and hence, improved public health efforts are urgently needed.•Both, mild (constitutional) or severely ...(nonconstitutional) infected contribute to the transmission and so, both needs consideration.•Current treatment strategies only target individuals at the nonconstitutional stage, and miss mild cases, which are hard to detect and treat.•The proposed strategy of this study consists of treating patients in both stages and resulted in reduction of the incidence of Herpes by 38%.•The proposed strategy cost less and decreases R0 by 40% and hence, it has much higher potential for eliminating disease.
Infection of Herpes Simplex Virus type 2 (HSV–2) is a lifelong sexually transmitted disease. According to the Center for Disease Control and Prevention (CDC), 11.9% of the United States (U.S.) population was infected with HSV–2 in 2015–2016. The HSV–2 pathogen establishes latent infections in neural cells and can reactivate causing lesions later in life, a strategy that increases pathogenicity and allows the virus to evade the immune system. HSV–2 infections are currently treated by Acyclovir only in the non-constitutional stage, marked by genital skin lesions and ulcers. However, patients in the constitutional stage expressing mild and common (with other diseases) symptoms, such as fever, itching and painful urination, remain difficult to detect and are untreated. In this study, we develop and analyze a mathematical model to study the transmission and control of HSV–2 among the U.S. population between the ages of 15–49 when there are options to treat individuals in different stages of their pathogenicity. In particular, the goals of this work are to study the effect on HSV–2 transmission dynamics and to evaluate and compare the cost-effectiveness of treating HSV–2 infections in both constitutional and non-constitutional stages (new strategy) against the current conventional treatment protocol for treating patients in the non-constitutional stage (current strategy). Our results distinguish model parameter regimes where each of the two treatment strategies can optimize the available resources and consequently gives the long-term reduced cost associated with each treatment and incidence. Moreover, we estimated that the public health cost of HSV–2 with the proposed most cost-effective treatment strategy would increase by approximately 1.63% in 4 years of implementation. However, in the same duration, early treatment via the new strategy will reduce HSV–2 incidence by 42.76% yearly and the reproduction number will decrease to 0.84 from its current estimate of 2.5. Thus, the proposed new strategy will be significantly cost-effective in controlling the transmission of HSV–2 if the strategy is properly implemented.
Automated vehicle (AV) platooning has the potential to improve the safety, operational, and energy efficiency of surface transportation systems by limiting or eliminating human involvement in the ...driving tasks. The theoretical validity of the AV platooning strategies has been established and practical applications are being tested under real-world conditions. The emergence of sensors, communication, and control strategies has resulted in rapid and constant evolution of AV platooning strategies. In this paper, we review the state-of-the-art knowledge in AV platooning using a five-component platooning framework, which includes vehicle model, information-receiving process, information flow topology, spacing policy, and controller and discuss the advantages and limitations of the components. Based on the discussion about existing strategies and associated limitations, potential future research directions are presented.
Neglected tropical diseases (NTDs) comprise of diverse communicable diseases that affect mostly the developing economies of the world, the “neglected” populations. The NTDs Visceral Leishmaniasis ...(VL) and Soil-transmitted Helminthiasis (STH) are among the top contributors of global mortality and/or morbidity. They affect resource-limited regions (poor health-care literacy, infrastructure, etc.) and patients’ treatment behavior is irregular due to the social constraints. Through two case studies, VL in India and STH in Ghana, this work aims to: (i) identify the additional and potential hidden high-risk population and its behaviors critical for improving interventions and surveillance; (ii) develop models with those behaviors to study the role of improved control programs on diseases’ dynamics; (iii) optimize resources for treatment-related interventions.Treatment non-adherence is a less focused (so far) but crucial factor for the hindrance in WHO’s past VL elimination goals. Moreover, treatment non-adherers, hidden from surveillance, lead to high case-underreporting. Dynamical models are developed capturing the role of treatment-related human behaviors (patients’ infectivity, treatment access and non-adherence) on VL dynamics. The results suggest that the average duration of treatment adherence must be increased from currently 10 days to 17 days for a 28-day Miltefosine treatment to eliminate VL. For STH, children are considered as a high-risk group due to their hygiene behaviors leading to higher exposure to contamination. Hence, Ghana, a resource-limited country, currently implements a school-based Mass Drug Administration (sMDA) program only among children. School staff (adults), equally exposed to this high environmental contamination of STH, are largely ignored under the current MDA program. Cost-effective MDA policies were modeled and compared using alternative definitions of “high-risk population”. This work optimized and evaluated how MDA along with the treatment for high-risk adults makes a significant improvement in STH control under the same budget. The criticality of risk-structured modeling depends on the infectivity coefficient being substantially different for the two adult risk groups. This dissertation pioneers in highlighting the cruciality of treatment-related risk groups for NTD-control. It provides novel approaches to quantify relevant metrics and impact of population factors. Compliance with the principles and strategies from this study would require a change in political thinking in the neglected regions in order to achieve persistent NTD-control.
Purpose: To study the health profiles and behavioral differences between primary open angle glaucoma (POAG) and normal tension glaucoma (NTG) patients.
Methods: Confidential mail survey of ICD-9 ...defined POAG (n = 277) and NTG (n = 116) patients was carried out to collect information regarding age, gender, height, weight, waist circumference, blood pressure (BP), medications prescription (Rx) and over the counter (OTC), education, and the Short Health Anxiety Inventory (SHAI).
Results: NTG patients (59/116) were significantly more likely to respond to the survey than POAG patients (43/277), p = 0.0001, and to have obtained college level education (70% vs. 42%), p = 0.003. Body weight, waist circumference, body mass index, systolic BP, pulse pressure, and ratio of prescription medications to OTC medications were significantly lower in the NTG group (p < 0.0001). The SHAI score, mean age, and diastolic BP were not different between the two groups. A subgroup analysis of college-educated patients in both groups revealed persisting significant differences in waist circumference, systolic BP, and ratio of Rx to OTC medications.
Conclusions: NTG patients do not have significantly greater health anxiety than POAG patients. NTG patients are more likely to have lower BMI, systolic BP, and ratio of Rx to OTC medications than POAG patients. The pilot nature of this study limits generalizability of these findings. Larger studies confirming these findings and elucidating the role of refractive error and medical history on such differences are needed.
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