Background The overlap of malaria and Hepatitis B Virus (HBV) infections present a major threat to public health throughout endemic countries of tropical and sub-Saharan Africa. There is a paucity of data on the prevalence and associated factors of malaria and HBV infections among pregnant women in Ejule, a semiurban area of Nigeria. Therefore, the current study was designed to assess the seroprevalence of malaria and HBV among pregnant women attending antenatal clinics in Ejule Metropolis. Materials and Methods In a hospital-based cross-sectional study, blood samples collected from 200 apparently healthy pregnant women at the Ilemona Clinic were screened for Plasmodium falciparum (P. falciparum) and HBsAg using histidine-rich protein 2 (HRP2) and hepatitis B surface antigen (HBsAg) rapid diagnostic tests (RDTs), respectively. Relevant sociodemographic and putative risk factor information was obtained with structured questionnaires. Results The prevalence of the infections was 44 (22%), 5 (2.5%), and 1 (0.5%) for P. falciparum monoinfection and HBV monoinfection and coinfection, respectively. Single and concurrent infections peaked at ages 31–40 years but decreased with older ages. High P. falciparum, 31 (59.62%), and HBV 2 (3.85%) infection were observed among those without formal education. Contrary to ages, occupation, and knowledge of infection, malaria parasitemia differed significantly with lower educational qualification (p ≤ 0.001), being single (p=0.001), and inconsistent use of insecticide-treated bed nets (ITNs) (p=0.04, OR = 5, CI: 0.10–0.47). History of blood donation (OR = 5, p=0.04, CI: 1.10–32.80) and multiple sex partners (OR = 11.9, p=0.01, CI: 0.01–0.93) were found to be significantly associated with hepatitis B surface antigenemia rate during pregnancy. No evidence of HBV infection was observed in women with a history of HBV vaccination. Conclusions Malaria is still highly prevalent among pregnant women due to high illiteracy and noncompliance to using ITNs. Therefore, routine screening and educating pregnant mothers are crucial in eliminating malaria in endemic settings. The low rate of hepatitis B and coinfection with malaria shows that further improvement in HBV vaccination could considerably reduce the disease burden among pregnant women.
Background: Public health emergencies (PHE) caused by natural hazards spread from one particular locality to adjacent geographic areas and then encompass the entire planet in today’s fast global connectivity mode. Each country, including India, has its own set of potential disasters based on the hazards present as well as the unique vulnerabilities of the community and community’s preparedness to respond to particular disasters. Currently, human history is observing a very critical time fighting an invisible enemy—COVID-19. Therefore, in this study, we seek to understand the standardised measures of public hospital preparedness and resilience at times of health emergencies, including a pandemic, the most current one being COVID-19. Methods: We conducted a descriptive, cross-sectional study among health officials of district hospitals (DHs) and community health centres (CHCs) of Rajasthan using a semi-structured online questionnaire, with COVID-19 in mind, and sending it to those who had attended a training programme on disaster preparedness in hospitals. Results: In all, questionnaires were sent to 80 health officials of DHs and CHCs, of which 58 responded, with a response rate of 72.5 per cent. We collected responses on public health emergency preparedness, training-related issues, the capacity to deal with emergencies and prior experience in managing an emergency. Conclusion: The resilience and preparedness of DHs and CHCs in Rajasthan appear to be limited. From the studies it has been revealed that proper training and education on disasters like the current COVID-19, which is of significant importance for healthcare workers, is limited to only 37.9 per cent of healthcare workers. It also emerges that the staff members whenever required could mark and perform in the triage area, but the Isolation room haven’t got the request facilities and equipped to stabilise a critical patient despite availability of emergency stock of medicine. The stated functional status of DHs and CHCs reveals that the level of emergency preparedness is between low and medium and also varies from hospital to hospital and from CHC to CHC. Hence, it is time to reassess and upgrade emergency preparedness plans, which include mitigation, preparedness, response and recovery. Federal-, state- and local-level emergency management agencies’ functioning has to be effective and well-coordinated with the local level of operation.
Background Polypharmacy is common in heart failure (HF), whereas its effect on adverse outcomes in patients with HF with preserved ejection fraction (HFpEF) is unclear. Aim To evaluate the prevalence, prognostic impacts, and predictors of polypharmacy in HFpEF patients. Design and setting A retrospective analysis performed on patients in the Americas region (including the US, Canada, Argentina, and Brazil) with symptomatic HF and a left ventricular ejection fraction ≥45% in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial, an international, randomised, double-blind, placebo-controlled study conducted during 2006–2013 in six countries. Method Patients were categorised into four groups: controls (<5 medications), polypharmacy (5–9 medications), hyperpolypharmacy, (10–14 medications), and super hyperpolypharmacy (≥15 medications). The outcomes and predictors in all groups were assessed. Results Of 1761 participants, the median age was 72 years; 37.5% were polypharmacy, 35.9% were hyperpolypharmacy, and 19.6% were super hyperpolypharmacy, leaving 7.0% having a low medication burden. In multivariable regression models, three experimental groups with a high medication burden were all associated with a reduction in all-cause death, but increased risks of HF hospitalisation and all-cause hospitalisation. Furthermore, several comorbidities (dyslipidemia, thyroid diseases, diabetes mellitus, and chronic obstructive pulmonary disease), a history of angina pectoris, diastolic blood pressure <80 mmHg, and worse heart function (the New York Heart Association functional classification level III and IV) at baseline were independently associated with a high medication burden among patients with HFpEF. Conclusion A high prevalence of high medication burden at baseline was reported in patients with HFpEF. The high medication burden might increase the risk of hospital readmission, but not the mortality.
BACKGROUND WNV causes 1.4% of all central nervous system infections and is the most common cause of epidemic neuro-invasive disease in humans. OBJECTIVES Our main objective was to investigate retrospectively West Nile virus neuroinvasive disease (WNND) cases hospitalized during 2010-2017 and identified factors that can influence prognosis. STUDY DESIGN We documented the demographic, epidemiologic, clinical and laboratory data of WNND and identified factors that can influence prognosis. The data were recruited through Infectious Diseases International Research Initiative (ID-IRI), which serves as a network for clinical researches. RESULTS We investigated 165 patients with WNND in 10 countries from three continents. 27 patients died and the mortality rate was 16.4%. In an univariate analysis age, congestive heart failure, neoplasm and ischemic heart disease (p < 0.001), neuropsychiatric disorders (p = 0.011), chronic hepatitis (p = 0.024) and hypertension (p = 0.043) were risk factors for death. Fatal evolution was also correlated with ICU addmission, disorientation, speech disorders, change in consciousnes, coma, a low Glasgow coma score, obtundation, confusion (p < 0.001), history of syncope (p = 0.002) and history of unconsciousness (p = 0.037). In a binomial logistic regresssion analysis only age and coma remained independent prediction factors for death. We created an equation that was calculated according to age, co-morbidities and clinical manifestations that may be used to establish the prognosis of WNND patients. CONCLUSIONS WNND remain an important factor for morbidity and mortality worldwide, evolution to death or survival with sequelae are not rare. Our study creates an equation that may be used in the future to establish the prognosis of WNND patients.
INTRODUCTION Between February and November 2016, 17 tuberculosis (TB) cases were identified among high school students in Novi Pazar, Serbia. The objectives of our study were to describe the outbreak, to identify potential risk factors and to evaluate the applied control measures. METHODOLOGY The outbreak was described by time, person and place. A retrospective cohort study was conducted. Attack rates, unadjusted relative risks (RR) and 95% confidence intervals (CI) were calculated. Multiple log-binomial regression analysis was performed to calculate adjusted RR. RESULTS Sixteen of the total 17 cases occurred among grade 3 students, AR 5.5%. Previous TB family history, (RR = 5.29; 95% CI = 1.63-17.12), spending time with a known TB case at school (RR = 5.38; 95% CI = 1.48-19.55) and exposure to secondhand smoke (RR = 3.37; 95% CI = 1.11-10.29) were all significantly and independently associated with the occurrence of TB. CONCLUSIONS Delayed diagnosis and reporting resulted in delayed initiation of the contact investigation and non-identification of latent TB cases probably favored the occurrence of this outbreak in a low incidence country. Public health authorities should consider revising the existing guidelines, promoting inter-sectorial collaboration and increasing awareness of public health professionals.
Adriana Guimarães Negromonte Bezerra, Vanessa Sá Leal, P. Lira
et al.
OBJECTIVE To identify the prevalence of iron-deficiency anemia and associated factors in women at reproductive age in the city of Vitoria de Santo Antão, Pernambuco. METHODS Cross-sectional study with a representative sample of 322 women aged between 15 and 49 years. Anemia was diagnosed by measuring hemoglobin below 12 g/dL. The independent variables were: demographic and socioeconomic conditions (age, race/color, education, literacy, presence of children aged < 5 years in the household, regime of residence occupation, ownership of assets, and per capita income), housing conditions (number of people in the household, number of bedrooms, and basic sanitation), food and nutrition security and women's health conditions (menarche, number of pregnancies, history of miscarriages, body mass index, and ferritin). Poisson regression was used to analyze the factors associated with anemia. RESULTS The mean age of women surveyed was 31.1 ± 6.61 years old (standard deviation - SD) and the prevalence of anemia was 18.6% (95%CI 14.7 - 23.3). After multivariate analysis, anemia was significantly associated with age ≤ 19 years and low ferritin. CONCLUSION The prevalence of anemia is characterized as a mild public health problem and follows the world trend in developing countries.
This essay considers one of the more striking qualities of the historiography of the Netherlands: its attitude vis-à-vis outsiders. On the one hand, there is a comparative bent in the scholarship and an interest in seeing the Dutch in the world; in this sense, it is an admirably outward-looking historiography. On the other hand, there is a tendency to underscore the exceptional Dutchness of Dutch history, which encourages analyses to turn inward. Comparativism thus vies with a provincialism, which can devolve into parochialism. Recent Dutch historiography, moreover, has shown a marked ambivalence toward the work of outsiders, namely non-Dutch historians. This reflects a basic tension in the literature between a scholarly posture of cosmopolitanism and a deep-rooted tendency toward exceptionalism; it suggests the paradox of Dutch distinctiveness. This essay raises questions about the permeability of Dutch historiography. Do the dikes and dunes of Dutch historical practice hold in or hold out the currents of scholarship? And, further, do they function to keep outsiders at bay? This article is part of the forum 'Outside In? Reflections on BMGN – Low Countries Historical Review: Introduction'In dit essay komt een van de opvallende eigenschappen van de historiografie van Nederland aan de orde: de houding van Nederlandse historici op het gebied van Nederlandse geschiedenis ten opzichte van buitenstaanders. Aan de ene kant is er binnen de historiografie van Nederland sprake van een toename van vergelijkendestudies en belangstelling voor de positie van Nederlanders in de wereld; wat dit betreft is de blik van de historiografie van Nederland op bewonderenswaardigewijze naar buiten gericht. Aan de andere kant kun je stellen dat deze historici ertoeneigen Nederlandse geschiedenis als uitzonderlijk te beschouwen, waarmee ze hun blik juist weer naar binnen richten. Op deze wijze moet een comparatieve houding wedijveren met provincialisme, wat tot bekrompenheid kan leiden. Bovendien wordt de meest recente Nederlandse historiografie gekenmerkt door een opmerkelijke ambivalente houding ten opzichte van het werk van buitenstaanders, dat wil zeggen, van niet-Nederlandse historici. Deze houding weerspiegelt een fundamentele spanning in de literatuur tussen eenwe tenschappelijke, kosmopolitische houding en een diepgewortelde neiging tot exeptionalisme; dit kan betekenen dat er sprake is van een paradox van een typisch Nederlandse houding. Dit essay stelt de toegankelijkheid van de Nederlandse historiografie ter discussie. Zorgen de dijken en duinen van de Nederlandse geschiedschrijving ervoor dat de nieuwe ontwikkelingen op het gebied van de wetenschap worden omarmd, of sluiten ze die juist buiten? Of is hun functie buitenstaanders op een afstand te houden? Dit artikel maakt deel uit van het forum 'Outside In? Reflections on BMGN – Low Countries Historical Review: Introduction'
This essay explores the first appearance of actresses on the public stage in England and the Dutch Republic. It considers the cultural climate, the theaters, and the plays selected for these early performances, particularly from the perspective of public femininity. In both countries antitheatricalists denounced female acting as a form of prostitution and evidence of inner corruption. In England, theaters were commercial institutions with intimate spaces that capitalized on the staging of privacy as theatrical. By contrast, the Schouwburg, the only public playhouse in Amsterdam, was an institution with a more civic character, in which the actress could be treated as unequivocally a public figure. I explain these differences in the light of changing conceptions of public and private and suggest that the treatment of the actress shows a stronger public-private division in the Dutch Republic than in England.
Liesbeth Hoeven, Een boek om in te wonen. De verhaalcultuur na Auschwitz (Dissertatie Tilburg 2015; Hilversum: Verloren, 2015, 310 pp., isbn 978 90 8704 491 6).