Preventable blindness is a global public health problem. In South Africa (SA) the prevalence of blindness is increasing, with a higher proportion of cataracts than the global norm, and a large rural ...population with limited access to specialised eye-care services.BACKGROUNDPreventable blindness is a global public health problem. In South Africa (SA) the prevalence of blindness is increasing, with a higher proportion of cataracts than the global norm, and a large rural population with limited access to specialised eye-care services.To determine the level of knowledge regarding preventable blindness and treatment options within a rural and urban population.OBJECTIVETo determine the level of knowledge regarding preventable blindness and treatment options within a rural and urban population.Rural and urban areas in the Eastern Cape, SA.SETTINGRural and urban areas in the Eastern Cape, SA.A descriptive cross-sectional study was conducted among 309 participants. Questionnaires were administered by fieldworkers at the different sites. Proportions were calculated and χ2 tests done to determine whether there was any significant relationship between the categorical variables. Data analysis was done using Stata version 15.METHODSA descriptive cross-sectional study was conducted among 309 participants. Questionnaires were administered by fieldworkers at the different sites. Proportions were calculated and χ2 tests done to determine whether there was any significant relationship between the categorical variables. Data analysis was done using Stata version 15.Participants were almost equally distributed among the urban (49.2%) and rural areas (50.8%). Both groups had a similar composition of males and females. Most participants had completed high school. The results showed a statistically significant difference between the urban and rural participants' knowledge about the causes of blindness: refractive error χ 2 (1, N=30) = 8.20, p<0.05, and cataract χ2 (1, N=28) = 8.64, p<0.05. The top two differences in the views between urban and rural participants regarding symptoms associated with eye problems (p<0.05) were: 'people who need spectacles have double vision', χ2 (1, N=122) = 28.19; and 'people who need spectacles squint their eyes', χ2 (1, N=124) = 17.37. The majority of urban participants reported opting to go to a private optometrist for eye health services, while the majority of rural participants would go to a pharmacy. Both groups were aware of the role of ageing in blindness.RESULTSParticipants were almost equally distributed among the urban (49.2%) and rural areas (50.8%). Both groups had a similar composition of males and females. Most participants had completed high school. The results showed a statistically significant difference between the urban and rural participants' knowledge about the causes of blindness: refractive error χ 2 (1, N=30) = 8.20, p<0.05, and cataract χ2 (1, N=28) = 8.64, p<0.05. The top two differences in the views between urban and rural participants regarding symptoms associated with eye problems (p<0.05) were: 'people who need spectacles have double vision', χ2 (1, N=122) = 28.19; and 'people who need spectacles squint their eyes', χ2 (1, N=124) = 17.37. The majority of urban participants reported opting to go to a private optometrist for eye health services, while the majority of rural participants would go to a pharmacy. Both groups were aware of the role of ageing in blindness.Urban participants in this study appeared to be more knowledgeable than rural participants about the causes and symptoms of blindness and its treatment options. These findings should provide some value to those who provide primary healthcare services in rural areas as there is a clear opportunity for patient education and health promotion regarding the causes and symptoms of these common preventable causes of blindness. Addressing this knowledge gap regarding the causes and symptoms of blindness and the treatment options is a critical first step for awareness programmes in rural areas. Without this, there will be little demand for any treatment or service. Future studies are needed to understand which health promotion interventions are effective in preventable blindness in rural populations.CONCLUSIONUrban participants in this study appeared to be more knowledgeable than rural participants about the causes and symptoms of blindness and its treatment options. These findings should provide some value to those who provide primary healthcare services in rural areas as there is a clear opportunity for patient education and health promotion regarding the causes and symptoms of these common preventable causes of blindness. Addressing this knowledge gap regarding the causes and symptoms of blindness and the treatment options is a critical first step for awareness programmes in rural areas. Without this, there will be little demand for any treatment or service. Future studies are needed to understand which health promotion interventions are effective in preventable blindness in rural populations.
Periglischrus calcariflexus new species, was found on the Greater Long-tongued bat Leptonycteris nivalis (Saussure) in Mexico. The female, male, deutonymphs, and protonymph are described and ...illustrated. Additionally, we evaluate the morphological variability of this species based on its geographical distribution. Considering this new species, the number of species in the vargasi species group within the genus Periglischrus increases to five; therefore, herein we include a key for the known species in the vargasi species group for the Neotropics. La nueva especie Periglischrus calcariflexus, fue hallada sobre la especie de murcielago mayor de lengua larga Leptonycteris nivalis (Saussure) en Mexico. La hembra, macho, deutoninfas y protoninfa se describen e ilustran. Adicionalmente, evaluamos la variabiliadad morfologica de esta especie con base en su distribucion geografica. Considerando esta nueva especie, el numero de especies en el grupo vargasi dentro del genero Periglischrus incrementa a cinco; por lo cual aqui incluimos una clave para las especies conocidas del grupo vargasi para el Neotropico. Key words: Spinturnicidae, Periglischrus calcariflexus n. sp., bat ectoparasite, Leptonycteris nivalis, Mexico
Cyberchondria is defined as the increase in health-related anxiety or anguish associated with excessive or repeated online searches for health-related information. Our objective was to ...cross-culturally adapt and validate the CSS-12 scale for Peruvian Spanish speakers, to determine whether the Bifactor model works as well in our population as in previous studies' and to explore whether the Bifactor-ESEM is a more suitable model. We performed a cultural adaptation using the Delphi method and a validation study on medical students between 2018 and 2019. Reliability was evaluated by using Cronbach's alpha (alpha) and McDonald's omega (OHM) for internal consistency, and Pearson's r and intraclass correlation coefficient (ICC), for test-retest reliability. We evaluated construct validity by contrasting four measurement models for the CSS-12 and the convergent validity against health anxiety. The Spanish CSS-12 showed excellent reliability (alpha = .93; OHM = .93; ICC = .93; r = .96). The Bifactor ESEM model showed the best fit, supporting a unidimensional measure of the general cyberchondria. This measure was positively associated with health anxiety (r = .51). The Spanish CSS-12 provides a valid and reliable unidimensional measure of cyberchondria, which is distinguishable from the more general health anxiety. This can be applied to similar populations and future research. The Bifactor-ESEM model appears to offer a more accurate and realistic representation of the multifaceted nature of cyberchondria. We provide a free-to-use form of the Spanish CSS-12 as supplemental material.
Background and Aims
A substantial share of fatal drug overdoses is missing information on specific drug involvement, leading to under‐reporting of opioid‐related death rates and a misrepresentation ...of the extent of the opioid epidemic. We aimed to compare methodological approaches to predicting opioid involvement in unclassified drug overdoses in US death records and to estimate the number of fatal opioid overdoses from 1999 to 2016 using the best‐performing method.
Design
This was a secondary data analysis of the universe of drug overdoses in 1999–2016 obtained from the National Center for Health Statistics Detailed Multiple Cause of Death records.
Setting
United States.
Cases
A total of 632 331 drug overdose decedents. Drug overdoses with known drug classification comprised 78.2% of the cases (n = 494 316) and unclassified drug overdoses (ICD‐10 T50.9) comprised 21.8% (n = 138 015).
Measurements
Known opioid involvement was defined using ICD‐10 codes T40.0–40.4 and T40.6, recorded in the set of contributing causes. Opioid involvement in unclassified drug overdoses was predicted using multiple methodological approaches: logistic regression and machine learning techniques, inclusion/exclusion of contributing causes of death and inclusion/exclusion of county‐level characteristics. Having selected the model with the highest predictive ability, we calculated corrected estimates of opioid‐related mortality.
Findings
Logistic regression and random forest models performed similarly. Including contributing causes substantially improved predictive accuracy, while including county characteristics did not. Using a superior prediction model, we found that 71.8% of unclassified drug overdoses in 1999–2016 involved opioids, translating into 99 160 additional opioid‐related deaths, or approximately 28% more than reported. Importantly, there was a striking geographic variation in undercounting of opioid overdoses.
Conclusions
In modeling opioid involvement in unclassified drug overdoses, highest predictive accuracy is achieved using a statistical model—either logistic regression or a random forest ensemble—with decedent characteristics and contributing causes of death as predictors.
Introducción: Las tasas de mortalidad “por” hipertensión arterial subestiman el impacto de esta causa en la mortalidad. Objetivo: Determinar el cambio de la contribución de la hipertensión arterial ...como causa de muerte, al involucrar todas sus menciones en el certificado de defunción en Cuba en el periodo 2013-2019. Material y Método: Se realizó un estudio observacional descriptivo de las defunciones ocurridas en Cuba entre enero de 2013 y diciembre de 2019. Se calcularon las Tasas de Mortalidad “por” (causa básica) y “con” hipertensión arterial (causas múltiples). Además, se determinaron las causas básicas más asociadas a la mención de esta afección. Resultados: Los riesgos de morir “por” y “con” hipertensión arterial evidencian un ascenso. El segundo es, como promedio, cuatro veces mayor que el primero; lo que significa que el análisis de mortalidad “por· HTA continúa infravalorando el papel de esta afección dentro de los procesos que causan muerte. Ambos riesgos son mayores para hombres y para los adultos de 85 años y más. Como promedio, en 15,7 % de las defunciones se mencionó a la HTA en alguna de las partes del certificado; sin embargo, solo en 3,8 % fue declarada como causa básica. Las enfermedades cerebrovasculares y las del corazón son las dos causas básicas en las que la HTA es más frecuentemente causa asociada. Conclusiones: La contribución de la hipertensión arterial a la mortalidad es mayor a lo que traduce el análisis tradicional. Disponer de estimaciones de causas múltiples fortalecería la planificación en salud y potenciaría los análisis de carga de enfermedad.
Complete diagnostic autopsies (CDA) remain the gold standard in the determination of cause of death (CoD). However, performing CDAs in developing countries is challenging due to limited facilities ...and human resources, and poor acceptability. We aimed to develop and test a simplified minimally invasive autopsy (MIA) procedure involving organ-directed sampling with microbiology and pathology analyses implementable by trained technicians in low- income settings.
A standardized scheme for the MIA has been developed and tested in a series of 30 autopsies performed at the Maputo Central Hospital, Mozambique. The procedure involves the collection of 20 mL of blood and cerebrospinal fluid (CSF) and puncture of liver, lungs, heart, spleen, kidneys, bone marrow and brain in all cases plus uterus in women of childbearing age, using biopsy needles.
The sampling success ranged from 67% for the kidney to 100% for blood, CSF, lung, liver and brain. The amount of tissue obtained in the procedure varied from less than 10 mm2 for the lung, spleen and kidney, to over 35 mm2 for the liver and brain. A CoD was identified in the histological and/or the microbiological analysis in 83% of the MIAs.
A simplified MIA technique allows obtaining adequate material from body fluids and major organs leading to accurate diagnoses. This procedure could improve the determination of CoD in developing countries.
A growing literature demonstrates increasing remunicipalization of local public services. Yet, while this literature is becoming extensive, many debates still exist about remunicipalization’s causes. ...This article reports the findings of a meta-analysis of the remunicipalization literature, focusing on the question: how do country, sector and method effects affect the findings of remunicipalization studies? I include articles on remunicipalization under different terms (‘remunicipalization’, ‘reverse privatization’, ‘insourcing’ and ‘contracting in’), using a large range of methods (case studies, surveys and document analysis) and covering a large period (1995–2019). I find 30 causes of remunicipalization that are considered and found in the literature. Political and pragmatic factors appear to be most frequently considered and found as causes of remunicipalization in the literature; environmental factors are less often considered but seem highly relevant. Moreover, I uncover large differences between the qualitative and quantitative literatures. I offer a research agenda to allow greater future synthesis in the remunicipalization literature.
Points for practitioners
The literature on remunicipalization is highly fragmented and remunicipalization can have many different causes. Remunicipalization appears to be both a political and a pragmatic trend, but the literature is still too fragmented to know for sure. Be aware of the potential biases and limitations in current research on (causes of) remunicipalization.
A recently developed pneumonia caused by SARS-CoV-2 bursting in Wuhan, China, has quickly spread across the world. We report the clinical characteristics of 82 cases of death from COVID-19 in a ...single center. Clinical data on 82 death cases laboratory-confirmed as SARS-CoV-2 infection were obtained from a Wuhan local hospital's electronic medical records according to previously designed standardized data collection forms. All patients were local residents of Wuhan, and a large proportion of them were diagnosed with severe illness when admitted. Due to the overwhelming of our system, a total of 14 patients (17.1%) were treated in the ICU, 83% of deaths never received Critical Care Support, only 40% had mechanical ventilation support despite 100% needing oxygen and the leading cause of death being pulmonary. Most of the patients who died were male (65.9%). More than half of the patients who died were older than 60 years (80.5%), and the median age was 72.5 years. The bulk of the patients who died had comorbidities (76.8%), including hypertension (56.1%), heart disease (20.7%), diabetes (18.3%), cerebrovascular disease (12.2%), and cancer (7.3%). Respiratory failure remained the leading cause of death (69.5%), followed by sepsis/MOF (28.0%), cardiac failure (14.6%), hemorrhage (6.1%), and renal failure (3.7%). Furthermore, respiratory, cardiac, hemorrhagic, hepatic, and renal damage were found in 100%, 89%, 80.5%, 78.0%, and 31.7% of patients, respectively. On admission, lymphopenia (89.2%), neutrophilia (74.3%), and thrombocytopenia (24.3%) were usually observed. Most patients had a high neutrophil-to-lymphocyte ratio of >5 (94.5%), high systemic immune-inflammation index of >500 (89.2%), and increased C-reactive protein (100%), lactate dehydrogenase (93.2%), and D-dimer (97.1%) levels. A high level of IL-6 (>10 pg/ml) was observed in all detected patients. The median time from initial symptoms to death was 15 days (IQR 11-20), and a significant association between aspartate aminotransferase (p = 0.002), alanine aminotransferase (p = 0.037) and time from initial symptoms to death was remarkably observed. Older males with comorbidities are more likely to develop severe disease and even die from SARS-CoV-2 infection. Respiratory failure is the main cause of COVID-19, but the virus itself and cytokine release syndrome-mediated damage to other organs, including cardiac, renal, hepatic, and hemorrhagic damage, should be taken seriously as well.
The presented case of dystocia with history of protrusion of ear of foetus outside the vulva of cow was diagnosed by physical examination and successful removal of dead foetus was done per vaginally ...by episiotomy operation. Foetal membranes were expelled two hours after removal of dead foetus and post operative management was done by antibiotic, analgesic, vitamin B complex, dextrose saline injection and intra uterine ecbolic administration for 05 days. Animal recovered eventually and suture was removed 14 days post conduction of episiotomy operation.
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