Hasil untuk "Medicine (General)"

Adama Ouedraogo, Patrice Ngangue, David Jean Simon et al.

Objective This study estimated the proportion of children aged 12–23 months who were fully vaccinated in sub-Saharan Africa (SSA), explored geographical disparities across subregions and countries, and identified country-level factors associated with full vaccination (FV).Design Cross-sectional study.Setting SSA.Participants Children aged 12–23 months.Primary outcome FV.Methods Data for this study were extracted from the most recent Demographic and Health Survey (DHS) conducted in 34 SSA countries between 2012 and 2023. The study included a total weighted sample of 69 218 children. Univariate analyses were performed to describe the socio-demographic profile of the participants and estimate the proportion of FV and the proportion for each of the eight vaccines (BCG, DTP1, DTP2, DPT3, Polio1, Polio2, Polio3, Measles1) at regional level. Bivariate and spatial analyses were produced to examine existing disparities at regional, subregional and countries’ income levels. A multivariate logistic regression analysis was fitted for identifying country-level factors associated with FV.Results 54.1% (95% CI 53.7% to 54.5%) children aged 12–23 months in SSA were fully vaccinated. In addition, substantial inequalities emerged in FV coverage across countries ranging from 23.9% in Guinea to a high of 95.5% in Rwanda. The same pattern was observed for the eight vaccines. Findings also showed that children of birth order 3 and above, who were delivered at home, had received less than four antenatal visits, from poor households and households with more than 5 members, whose mothers were under 25, had primary education level and below, and had no income-generating activities were less likely to be fully vaccinated.Conclusion To achieve WHO’s global vaccination coverage target of 90% by 2030 in SSA, vaccination programmes must take account of regional, subregional and national inequities. Our findings also underline the need for interventions tailored to each SSA country’s socio-cultural context.Ethical consideration Ethical approval was not required as this is a secondary analysis of publicly available data.

Evan S. Ross, Lance C. Visser, Lalida Tantisuwat et al.

ABSTRACT Background The effects of general anesthesia (GA) on less flow‐dependent (velocity ratio, velocity time integral [VTI] ratio and indexed pulmonary valve area [iPVA]) and flow‐dependent (mean [PVmeanPG] and maximum pressure gradient [PVmaxPG]) indices of severity of pulmonary stenosis (PS) are unclear. Objectives Determine the effects of GA on indices of severity of PS in dogs undergoing an interventional procedure (IP). Determine the reproducibility of indices of severity of PS. Animals Thirty‐nine dogs with PS. Methods Prospective cross‐sectional study. Five repeated echocardiograms were performed over 3 days. Day 1: two echocardiograms were performed by 2 different operators. Day 2: echocardiograms were performed before and after GA but before IP. Day 3: an echocardiogram was performed after the IP. Results After GA, median (IQR) cardiac index (2.1 [1.6–2.6] L/min/m2), PVmeanPG (45.0 [26.0–55.2] mmHg), PVmaxPG (76.6 [46.6–100.3] mmHg) were decreased (p ≤0.001) compared to before GA (2.8 [2.2–3.0] L/min/m2, 55.9 [47.6–73.1] mmHg, 96.1 [81.6–127.0] mmHg, respectively). There were no differences (p ≥0.35) in velocity ratio, VTI ratio, or iPVA after GA. Intra‐operator and inter‐operator coefficients of variation (95% CI) were highest for iPVA (13.8% [10.4–18.4] and 13.5% [11.0–18.4], respectively) and lowest for velocity ratio (9.2% [7.7–12.3] and 9.3% [7.7–12.4], respectively). Conclusions and Clinical Importance PVmeanPG and PVmaxPG might be misleading in states of reduced flow. An integrative assessment of severity of PS that includes less flow‐dependent indices is recommended. Reproducibility of indices of severity of PS should be considered when re‐evaluating dogs with PS.

Xindong Wei, Anfeng Si, Shuai Zhao et al.

Abstract Background Circular (circ)RNAs have emerged as crucial contributors to cancer progression. Nonetheless, the expression regulation, biological functions, and underlying mechanisms of circRNAs in mediating hepatocellular carcinoma (HCC) progression remain insufficiently elucidated. Methods We identified circUCK2(2,3) through circRNA sequencing, RT–PCR, and Sanger sequencing. CircUCK2(2,3) levels were measured in two independent HCC cohorts using quantitative real-time PCR (qRT–PCR). We explored the functions of circUCK2(2,3) using gain- and loss-of-function assays. Techniques such as RNA-sequencing, RNA immunoprecipitation (RIP), polysome fractionation, RNA pulldown, dual luciferase reporter assay, inhibitors of EGFR downstream signaling, CRISPR–Cas9, and medium transfer assays were employed to investigate the regulatory mechanisms and the protumoral activities of circUCK2(2,3). Additionally, in vitro cytotoxic assays and patient-derived xenograft (PDX) models assessed the effects of circUCK2(2,3) on the cytotoxic synergy of lenvatinib and EGFR inhibitors. Results CircUCK2(2,3) is upregulated in HCC tissues and serves as an independent risk factor for poor recurrence-free survival. The expression of circUCK2(2,3) is independent on its host gene, UCK2, but is regulated by its upstream promoter and flanking inverted complementary sequences. Functionally, circUCK2(2,3) enhances HCC proliferation, migration, and invasion, both in vitro and in vivo. Mechanistically, by sponging miR-149-5p, circUCK2(2,3) increases CNIH4 levels, which in turn amplifies TGFα secretion, resulting in the activation of EGFR and downstream pAKT and pERK signaling pathways. Moreover, circUCK2(2,3) overexpression sensitizes HCC cells to EGFR inhibitors, and increases the synergistic cytotoxicity of combined lenvatinib and EGFR inhibitor treatment. Conclusions CircUCK2(2,3) regulates a novel oncogenic pathway, miR-149-5p–CNIH4–TGFα–EGFR, in HCC, presenting a viable therapeutic target and biomarker for the precision treatment of HCC. Graphical Abstract

Moudy Annisa Seftyarni, Rini Gusya Liza, Ida Rahmah Burhan

Latar Belakang: Skizofrenia merupakan gangguan jiwa berat yang membutuhkan bantuan caregiver. Caregiver pasien skizofrenia di Indonesia rata-rata adalah keluarga pasien tersebut sehingga berisiko mengalami gangguan mental emosional akibat beban perawatan dan beban emosional yang harus dipikul. Gangguan mental emosional dapat menyebabkan terganggunya kualitas hidup seseorang. Objektif: Penelitian ini bertujuan untuk mengetahui hubungan gangguan mental emosional dengan kualitas hidup caregiver pasien skizofrenia. Metode: Penelitian dilakukan pada bulan Januari 2022 – November 2022. Jenis penelitian adalah penelitian analitik dengan pendekatan potong lintang. Populasi penelitian ini adalah seluruh caregiver pasien skizofrenia di RSJ Prof. Dr. HB Saanin Padang dengan total sampel sebanyak 160 responden yang dipilih dengan teknik consecutive sampling. Hasil: 50,6% caregiver mengalami gangguan mental emosional dan 45,9% caregiver berada pada tingkat kualitas hidup sedang. Terdapat hubungan yang bermakna antara gangguan mental emosional dengan kualitas hidup (p-value <0,001) pada nilai signifikansi 0,05. Kesimpulan: Terdapat hubungan yang bermakna antara gangguan mental emosional dengan kualitas hidup caregiver pasien skizofrenia. Kata kunci:  gangguan mental emosional, kualitas hidup, caregiver, skizofrenia

Allen Ting Chun Lee, Yishan Luo, Zhaohua Huo et al.

Summary: Background: Having more cognitive activities may prevent dementia, but its evidence of modulating the functional brain network is limited. This randomised controlled trial (RCT) investigated the effect of increased cognitive activity participation on the default mode network (DMN) in older adults who had already been having regular cognitive activity participation and experiencing subjective cognitive decline (SCD). Methods: Community-living Chinese individuals aged 55–75 years with regular practice of Chinese calligraphy and screened positive for SCD (but negative for mild cognitive impairment or dementia) were randomly allocated to either the intervention or control group. Over 6 months, the intervention group doubled their weekly calligraphy practice time, while the control group maintained their usual amount of practice. The primary outcome was functional connectivities (FCs) of DMN, with pre-specified regions of interest including medial prefrontal cortex (mPFC), inferior parietal lobe (IPL), hippocampal formation (HF), posterior cingulate cortex (PCC), and lateral temporal cortex (LTC). FC changes were compared using repeated measures multivariate analysis of variance (MANOVA). This study is registered at the Chinese Clinical Trial Registry, ChiCTR1900024433. Findings: Between 15 January 2020 and 31 December 2021, 112 individuals consented and completed the baseline assessment. The participants, who had a mean age of 66.3 (SD 4.3) years, with 83 (74%) being women, had been practising calligraphy for an average duration of 9.7 years before enrolment and, in the preceding six months, for an average of 3.1 hours per week. 96 (86%) completed the post-intervention fMRI scan. Significant between-group differences were observed in the FCs between mPFC and right LTC (group difference = 0.25 [95% CI = 0.06–0.44], p = 0.009), mPFC and right IPL (0.23 [0.06–0.39]; p = 0.007), left HF and right LTC (0.28 [0.002–0.57]; p = 0.04), and left HF and right IPL (0.34 [0.09–0.60]; p = 0.009). Interpretation: Our findings, which reveal positive neuromodulatory effects with increased calligraphy practice, highlight the importance of engaging more in cognitive activities in late life for better brain health. Funding: Research Grants Council, Hong Kong (grant number 24114519).

Pru Holder, Bethan Page, Julia Hackett et al.

ABSTRACT Background Guidance and principles for involving the public in research or service planning exist but are not specific to the needs of parents of children with life‐limiting conditions or bereaved parents. Aim Review the evidence on involving parents of children with life‐limiting conditions and bereaved parents in research, service planning and advocacy, and use this to develop best practice guidance. Methods Rapid review following the Cochrane Rapid Reviews Methods Group Guidance. MEDLINE and EMBASE were searched for primary studies of any design and literature/systematic reviews, and grey literature searching was conducted. Sources reporting on involving parents of children with life‐limiting conditions or bereaved parents in healthcare, research, or charity work in any setting, were included. Data were charted using the UK standards for public involvement in research (PPI). Two PPI consultation workshops were conducted with parents (n = 13) and healthcare professionals/charity representatives (n = 7). Results Six sources were included. Four reported benefits of parental involvement and two reported burdens. In relation to best practice, two reported on the importance of inclusive opportunities, three on working together, four on support and learning, three on communications, one on impact, and one on governance. PPI consultation workshops highlighted new factors which were not present in the literature around communication and understanding the impact of involvement. Conclusion Organisations working with this group should consider offering inclusive approaches to improve diversity, levelling power imbalances, ensuring flexibility of approach, and appropriate communication and impact. Patient or Public Contribution The study was conducted in collaboration with 13 parents of children with life‐limiting conditions and bereaved parents, and seven palliative care professionals. The group were involved at key stages of the review and contributed to the development of the findings and conduct of the review.

Prem Kumar A, PI Pragyan Pratik, Nithya Ravichandran

Objective: Adverse surgical events are a major cause of morbidity, mortality, and disability worldwide. The cause of many such events can be attributed to interruptions in the operating room (OR), multitasking by surgeons, etc. The objective of this study was to observe the types and frequency of intraoperative workflow interruptions in our ORs. Method: This cross-sectional study was conducted from March to April of 2023. An observational approach using an audio-video recording device was employed to record OR flow disruptions. One elective OR and one emergency OR under the Department of General Surgery were selected for the study. All open and laparoscopic surgeries conducted in the selected ORs were included. An Internet Protocol camera was installed in the selected ORs with a view of the entire room, including the anesthesia station. Audio-video recording was started after the first incision and stopped after closure of the surgical site. Result: Of the 51 cases that were studied, 45 (88.2%) were elective, and 18 (35.3%) were laparoscopic cases. They could be classified into 8 types of open procedures and 4 types of laparoscopic procedures. The mean maximum headcount inside the OR was 15.5 ± 3.6 and doors opened on average of 15.8 ± 6.0 times during a procedure. Other interruptions were surgeons attending phone calls (24, 47.1%), leaving the sterile area (21, 41.2%), technical disturbances (32, 62.7%), anesthetic interruptions (18, 35.3%), and faulty instruments (29, 56.9%). Elective procedures had a significantly higher average number of interruptions per operating hour than emergency procedures (17.5 ± 8.6 vs. 7.1 ± 2.9, p < 0.01). Conclusion: Preventable factors such as faulty instruments, anesthetic interruption, and attending phone calls by the surgeon are commonly observed in ORs. They need to be addressed by timely surgical audits or the adoption of continued surveillance methods that can help take measures to minimize their occurrence.

Madalin Bulzan, Simona Cavalu, Amir Mohamed Abdelhamid et al.

Background. In orthopedics, the patients’ quality of life relative to the preoperative and postoperative phase is referred with a low impact compared to other branches of medicine. In this context, our interest focused on assessing the quality of life in patients with traumatic and non-traumatic coxarthrosis by longitudinally following the evolution of the patients. Materials and Methods. The well-established instrument Short Form Survey SF-36 was applied in a retrospective study, conducted on a cohort of 203 participants who underwent THA (Total Hip Arthroplasty). Statistical analysis was generated using GraphPad Prism (version 9.5.1). Results. In the pre-operative phase, physical functioning was more affected in participants with traumatic coxarthrosis, while fatigue was specific to nontraumatic coxarthrosis. Emotional well-being and social functioning were high in patients with traumatic coxarthrosis. One month after surgery, we recorded an increased physical functioning and improvement in the perception of the ability to exercise roles in non-traumatic group. Energy/vitality and general health and wellbeing were at high level in traumatic group, 1st month post-surgery, although pain was still frequent. Age was the sole strong independent predictor of postoperative physical functioning in the traumatic group, while in the non-traumatic group, we identified gender, age, symptoms and type of prosthesis as strong predictors of postoperative physical functioning. The overall results related to daily living activities indicated that the traumatic group displayed more favorable post-surgery evolution and higher autonomy compared to the non-traumatic one. Conclusions. We conclude that SF-36 questionnaire is a specific, useful and inexpensive tool for evaluating the outcomes of orthopedic treatment and patients’ evolution after arthroplasty, especially in terms of functional outcome scores relative to coxarthrosis etiology.

Kevin Singh, Karim Ladak, Matthew Patel

Martina Focardi, Barbara Gualco, Vilma Pinchi et al.

Many studies have examined the genetic contribution to suicide. However, data on suicide in the Italian population are scarce. We therefore aimed to address this gap by investigating a cohort of 111 Italians for whom a verdict of suicide had been declared in court in Florence, Italy between 2007 and 2017. This cohort included 86 men and 25 women. DNA samples were obtained from tissues or blood, and 22 genes from multiple neurobiological pathways previously shown to be associated with the pathogenesis of suicide were analysed. Next-generation sequencing was used to compare these gene sequences with those from a large, normal population. In this study, we identified 19 gene variants that were present at significantly lower frequencies in our Italian cohort than in the general population. In addition, four missense mutations were identified in four different genes: Monoamine Oxidase A (MAOA), 5-Hydroxytryptamine Receptor 2 A (HTR2A), Sodium Voltage-Gated Channel Alpha Subunit 8 (SCN8A), and Nitric Oxide Synthase 3 (NOS3). Our study identified several potential genetic links with suicide in a cohort of Italians and supports a relationship between specific genetic variants and suicidal behaviour in this population. Key pointsThis study shows a genetic analysis of suicide.This study examines a cohort of 111 Italians for whom a verdict of suicide had been declared in court in Florence, Italy between 2007 and 2017. DNA samples were obtained from tissues or blood, and 22 genes from multiple neurobiological pathways were investigated.The study supports a relationship between specific genetic variants and suicidal behaviour.

Xinbo Wang, Jiaying Miao, Sizhen Wang et al.

Abstract Background Undifferentiated carcinoma with osteoclast-like giant cells (OGCs) of pancreas (UCOGCP) is a rare subtype of pancreatic ductal adenocarcinoma (PDAC), which had poorly described histopathological and clinical features. Methods In this study, single-cell RNA sequencing (scRNA-seq) was used to profile the distinct tumor microenvironment of UCOGCP using samples obtained from one UCOGCP patient and three PDAC patients. Bioinformatic analysis was carried out and immunohistochemical (IHC) staining was used to support the findings of bioinformatic analysis. After quality control of the raw data, a total of 18,376 cells were obtained from these four samples for subsequent analysis. These cells were divided into ten main cell types following the Seurat analysis pipeline. Among them, the UCOGCP sample displayed distinct distribution patterns from the rest samples in the epithelial cell, myeloid cell, fibroblast, and endothelial cell clusters. Further analysis supported that the OGCs were generated from stem-cell-like mesenchymal epithelial cells (SMECs). Results Functional analysis showed that the OGCs cluster was enriched in antigen presentation, immune response, and stem cell differentiation. Gene markers such as LOX, SPERINE1, CD44, and TGFBI were highly expressed in this SMECs cluster which signified poor prognosis. Interestingly, in myeloid cell, fibroblasts, and endothelial cell clusters, UCOGCP contained higher percentage of these cells and unique subclusters, compared with the rest of PDAC samples. Conclusions Analysis of cell communication depicted that CD74 plays important roles in the formation of the microenvironment of UCOGCP. Our findings illustrated the genesis and function of OGCs, and the tumor microenvironment (TME) of UCOGCP, providing insights for prognosis and treatment strategy for this rare type of pancreatic cancer.

Abi Sriharan, Calandra Li, Camilla Parpia et al.

Objective Healthcare provider (HCP) burnout is on the rise with electronic medical record (EMR) use being cited as a factor, particularly with the rise of the COVID-19 pandemic. Burnout in HCPs is associated with negative patient outcomes, and, therefore, it is crucial to understand and address each factor that affects HCP burnout. This study aims to (a) assess the relationship between EMR use and burnout and (b) explore interventions to reduce EMR-related burnout.Methods We searched MEDLINE (Ovid), CINAHL and SCOPUS on 29 July 2021. We selected all studies in English from any publication year and country that discussed burnout in HCPs (physicians, nurse practitioners and registered nurses) related to EMR use. Studies must have reported a quantitative relationship to be included. Studies that implemented an intervention to address this burnout were also included. All titles and abstracts were screened by two reviewers, and all full-text articles were reviewed by two reviewers. Any conflicts were addressed with a third reviewer and resolved through discussion. Quality of evidence of all included articles was assessed using the Quality Rating Scheme for Studies and Other Evidence.Findings The search identified 563 citations with 416 citations remaining after duplicate removal. A review of abstracts led to 59 studies available for full-text assessment, resulting in 25 studies included in the scoping review. Commonly identified associations between EMR-related burnout in HCPs included: message and alert load, time spent on EMRs, organisational support, EMR functionality and usability and general use of EMRs. Two articles employed team-based interventions to improve burnout symptoms without significant improvement in burnout scores.Conclusions and relevance Current literature supports an association between EMR use and provider burnout. Very limited evidence exists for burnout-reducing interventions that address factors such as time spent on EMRs, organisational support or EMR design.

Mohamed S. Muhamedhussein, Mohamed Manji, Kitugi S. Nungu et al.

Background: Polytrauma can lead to multi-organ dysfunction in addition to the local injuries. Acute kidney injury (AKI) is one of the most common causes and contributors to the high morbidity and mortality. Prevalence of acute kidney injury in trauma patients is as reported to be as high as 40.3%. Early detection and management leads to better outcomes. The prevalence of AKI among polytrauma patients remains unknown in our setting. Methodology: A cross-sectional study involving all adults with polytrauma who presented at the emergency department at Muhimbili Orthopedic Institute (MOI) was designed. A score of ≥18 on the New Injury Severity Score (NISS) screening tool was used to identify polytrauma patients. The Kidney Disease Improving Global Outcomes (KDIGO) criteria was used to identify patient with polytrauma who developed acute kidney injury. Descriptive statistics were then obtained followed by hypothesis testing between variables with the chi squared test. Logistic regression models were used to determine factors associated with acute kidney injury. Results: More than half (56.4%) of the patients were between 26 and 40 years and 92.3% of the polytrauma patients were males. Almost 2/5th (38.5%) of the polytrauma patients had acute kidney injury – half of these had stage 1 AKI, 33.3% had stage 2 AKI and the remaining 16.7% had stage 3 AKI. On multivariate logistic regression, it was found that patients who were older than 45 years (OR 8.53, CI 1.65–43.89, p = 0.01) and those patients with Systemic Inflammatory Response Syndrome (SIRS) (OR 21.83, CI 1.66–286.2, p = 0.019) had higher risk of acute kidney injury. Conclusion: There is high prevalence of AKI among polytrauma patients. Elderly patients and those with SIRS were seen to have higher likelihood of AKI.

Qian YF, Geng GL, Ren YQ et al.

Yu-Fei Qian,1 Gui-Ling Geng,1 Yu-Qin Ren,2 Xin-Tong Zhang,2 Wen-Jun Sun,2 Qing Li2 1Department of School of Nursing, Nantong University Medical School, Nantong, 226001, People’s Republic of China; 2Department of Emergency, Nantong First People’s Hospital, Nantong, 226006, People’s Republic of ChinaCorrespondence: Gui-Ling GengDepartment of School of Nursing, Nantong university Medical school, No. 19, Qixiu Road, Nantong City, Jiangsu Province, 226001, People’s Republic of ChinaTel +86 15152889466Fax +86-513-85051876Email geng_gl@126.comObjective: This study aimed to investigate community residents’ awareness of basic life support (BLS) and their willingness to attempt rescue.Methods: From October to December 2020, in the communities of Nantong City, a stratified three-stage random sampling method was adopted to select residents from 12 neighborhood committees over the age of 18 with whom to conduct a cross-sectional questionnaire survey. A self-designed questionnaire was adopted, the contents of which included the general situation of the respondent, knowledge, attitude, and behavior in relation to BLS; the Cronbach’s α coefficient of the questionnaire was 0.719.Results: A total of 3000 questionnaires were distributed, of which 2812 were valid, with a valid response rate of 93.73%. Of the 2812 respondents, 41.18% had seen an automatic external defibrillator (AED), 48.83% had experience of’ cardiopulmonary resuscitation (CPR), and 25.07% of the respondents had experience of’ AEDs. When an accident occurred, 50.50% of residents were willing to attempt rescue, 70.80% were willing to attempt rescue under professional guidance, and 71.23% were willing to attempt rescue after learning BLS techniques. Of the residents who were unwilling to attempt rescue, 32.75% were worried about their lack of ability, 27.91% were concerned about legal issues, 14.01% feared infectious diseases, and 10.35% were unwilling to perform mouth-to-mouth artificial respiration. Age, occupation, education level, and whether they had participated in first aid training were the influencing factors.Conclusion: Residents in Nantong have less knowledge of BLS, and their knowledge of CPR is better than that of AEDs. Residents have a strong willingness to learn BLS. Measures need to be taken to improve their understanding of BLS and their application skills. Residents have high levels of willingness to attempt rescue, but a certain percentage of residents have concerns. Interventions can be made to target the different reasons.Keywords: out-of-hospital cardiac arrest, basic life support, automatic external defibrillator, rescue willing

James Douketis

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N. I. Volkova, L. A. Ganenko, M. I. Porksheyan

The prevalence of obesity is growing all over the world. Obesity is an important risk factor for cardiovascular diseases, type 2 diabetes. However, not all obese patients have an unfavorable cardio-metabolic profile. Recently, much attention has been paid to the concept of «metabolically healthy obesity» (MHO). To date, there are no single criteria for identifying individuals with MHO, which makes it difficult to study this subgroup of patients and to conduct a comparative analysis of various studies. The article presents data of modern literature, including the definition, prevalence and mechanisms of MHO development, also discusses potentially protective factors involved in MHO development and the consequences of the therapeutic impact on MHO.

Dr Patrick T Wilson, MD, Frank Baiden, PhD, Joshua C Brooks, MPH et al.

Background: In low-income and middle-income countries, invasive mechanical ventilation is often not available for children at risk of death from respiratory failure. We aimed to determine if continuous positive airway pressure (CPAP), a form of non-invasive ventilation, decreases all-cause mortality in children with undifferentiated respiratory distress in Ghana. Methods: This open-label, cluster, crossover trial was done in two Ghanaian non-tertiary hospitals where invasive mechanical ventilation is not routinely available. Eligible participants were children aged from 1 month to 5 years with a respiratory rate of more than 50 breaths per min in children 1–12 months old, or more than 40 breaths per min in children older than 12 months, and use of accessory muscles or nasal flaring. CPAP machines were allocated to one hospital during each study block, while the other hospital served as the control site. The initial intervention site was randomly chosen using a coin toss. 5 cm of water pressure was delivered via CPAP nasal prongs. The primary outcome measure was all-cause mortality rate at 2 weeks after enrolment in patients for whom data were available after 2 weeks. We also did post-hoc regression analysis and subgroup analysis of children by malaria status, oxygen saturation, and age. This study is registered with ClinicalTrials.gov, number NCT01839474. Findings: Between Jan 20, 2014, and Dec 5, 2015, 2200 children were enrolled: 1025 at the intervention site and 1175 at the control site. Final analysis included 1021 patients in the CPAP group and 1160 patients in the control group. 2 weeks after enrolment, 26 (3%) of 1021 patients in the CPAP group, and 44 (4%) of 1160 patients in the control group, had died (relative risk [RR] of mortality 0·67, 95% CI 0·42–1·08; p=0·11). In children younger than 1 year, all-cause mortality was ten (3%) of 374 patients in the CPAP group, and 24 (7%) of 359 patients in the control group (RR 0·40, 0·19–0·82; p=0·01). After adjustment for study site, time, and clinically important variables, the odds ratio for 2-week mortality in the CPAP group versus the control group was 0·4 in children aged up to 6 months, 0·5 for children aged 12 months, 0·7 for children aged 24 months, and 1·0 for those aged 36 months. 28 patients (3%) in the CPAP group and 24 patients (2%) in the control group had CPAP-related adverse events, such as vomiting, aspiration, and nasal, skin, or eye trauma. No serious adverse events were observed. Interpretation: In the unadjusted analysis the use of CPAP did not decrease all-cause 2-week mortality in children 1 month to 5 years of age with undifferentiated respiratory distress. After adjustment for study site, time, and clinically important variables, 2-week mortality in the CPAP group versus the control group was significantly decreased in children 1 year of age and younger. CPAP is safe and improves respiratory rate in a non-tertiary setting in a lower-middle-income country. Funding: General Electric Foundation.

Siavash Etemadinezhad, Nafiseh Esmaili Naftchali, Ahmad Alizade Larimi et al.

Background and purpose: According to the World Health Organization, sick building syndrome (SBS) is a common complication among office workers and its symptoms include inflammation of the eyes, nose, throat, and skin, dry cough, dizziness, confusion, fatigue, and sensitivity to smells. Most of the symptoms disappear by leaving the building. Inappropriate design of buildings, workers activities, poor ventilation, chemical and biological pollutants are believed to be the risk factors for SBS. People involved in this situation usually have lower job satisfaction. The aim of this study was to determine the prevalence of SBS among bank employees and its relationship with job satisfaction and some environmental factors. Materials and methods: Data was obtained using the MM040EA questionnaire and JDI among all employees (n= 264) in one of the banks in Mazandaran province, Iran. To determine the parameters of air quality, temperature and concentrations of CO2, and humidity were measured using KIMO AQ-110 and TES1366, respectively. Data analysis was performed in SPSS16. Results: The mean age of workers was 33.25 years and the prevalence of SBS was 79.6%. Fatigue was the most common symptom. Gender, age, work experience, education, smoking, temperature, and humidity did not have a significant relationship with the prevalence of SBS. But CO2 concentration showed a weak relationship (P= 0.049). Job satisfaction was found to have a significant relationship with the prevalence of SBS (P= 0.001). Conclusion: A high prevalence of SBS was seen in our cases. Its negative impacts on their comfort and job performance calls for improving air quality and ventilation systems in workplace to reduce the symptoms of SBS.

Hang Xiong, Puqing Wang, Yueji Zhu

Empirical studies on social diffusions are often restricted by the access to data of diffusion and social relations on the same objects. We present a set of first-hand data that we collected in ten rural villages in central China through household surveys. The dataset contains detailed and comprehensive data of the diffusion of an innovation, the major social relationships and the household level demographic characteristics in these villages. The data have been used to study peer effects in social diffusion using simulation models, “Peer Effects and Social Network: The Case of Rural Diffusion in Central China” [1]. They can also be used to estimate spatial econometric models. Data are supplied with this article. Keywords: High-value crop, Diffusion, Social networks, Rural China, Household survey

Angélica Megda da Silva, Denis Moledo de Souza Abessa, Paulo Augusto Zantune Pamplin et al.

São Lourenço River (SLR) is part one of the Ribeira de Iguape River basin, and provides water to supply the cities of São Lourenço da Serra and Juquitiba. The SLR also receives large amounts of pollution from these municipalities. In this context, this study aimed to evaluate the impacts of the release of residues from water treatment (WTP) and wastewater treatment plants (WWTP) on the sediments of the SLR. Six sampling stations were established along the river (including upstream and downstream of both WTP and WWTP), and 6 sampling campaigns for sediments were conducted. In such 6 surveys sediments were collected for ecotoxicological tests, in 2 surveys, material was also collected for benthic community evaluation (March and September 2006), and in one survey samples for chemistry were taken (September 2006). Seven campaigns were conducted for water sampling aiming to ecotoxicological tests. The metal levels were low for all samples. Ecotoxicological tests with sediments showed acute toxicity in samples collected downstream to both WTP and WWTP in November 2005 and March 2006, and chronic effects for all samples in November 2005 and September 2006. All samples from SLS 008 were toxic. Results showed negative responses in the benthic community, with low richness and diversity. The water samples collected downstream to WTP presented acute ecotoxicity in 2004 and 2006. No chronic toxicity was observed for waters. The results indicate that SLR is influenced by other anthropic activities, beyond to WTP and WWTP discharges, and that sediments are more affected in this ecosystem.