Journal articles on the topic 'Foreign country screening'
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Sanchez, Sarimer, Eileen Searle, David Rubins, Sayon Dutta, Winston Ware, Paul Biddinger, and Erica Shenoy. "Implementation of an Electronic Travel Navigator to Enable "Identify-Isolate-Inform" for Emerging Infectious Diseases." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s273—s275. http://dx.doi.org/10.1017/ice.2020.843.
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Background: Travel screening can facilitate the identification of patients at risk for emerging infectious diseases, such as Middle East respiratory syndrome (MERS). A travel navigator with associated decision support through a best practice advisory (BPA) was implemented in an electronic health record to build upon the CDC identify-isolate-inform framework. Compliance with documentation of travel history, symptom screening when appropriate, and isolation of suspect MERS patients were assessed. Methods: Adult and pediatric emergency department encounters at the Massachusetts General Hospital, a 1,035-bed, tertiary-care, academic health center in Boston, Massachusetts, from August 2018 to October 2019, were included. We categorized an encounter as adherent to initial travel screening if providers answered foreign, domestic, or no travel to the screen. Encounters were defined as nonadherent if they were recorded as unknown or if an answer was not selected. Adherence to completion of data entry for the subgroup of patients with documented foreign travel was further assessed for region- and country-level specification, completion of symptom screen, and response to the MERS BPA (Fig. 1). Results: In total, 127,866 encounters were included, of which 105,593 (83%) were adherent to initial travel screening. Among 4,498 encounters with documented foreign travel, 2,970 (66%) specified the region of travel, and 710 (16%) selected a country of travel from the listing. Moreover, 214 encounters had documented travel to the Middle East. Selection of Middle East or 1 of the 13 countries identified by the CDC as at risk for MERS triggered symptom screening for fever and cough, which was performed in 139 encounters (65%). Of these, 95 encounters documented absence of fever and cough, 15 documented fever and cough, 12 documented a cough alone, and 17 documented a fever alone through reporting or obtaining vitals. The MERS BPA was triggered in 37 encounters; 10 patients were ordered for isolation using the BPA. Of these, 4 patients met CDC criteria for a MERS patient under investigation and were tested; all were negative. Conclusions: Initial screening to document foreign travel is completed at a high rate; however, use of the travel navigator to specify region and country, key components necessary to prompt clinicians for symptom screening, are documented in a minority of encounters. Future interventions are needed to improve region and country capture and appropriate symptom screening, with isolation when appropriate.Funding: NoneDisclosures: None
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Kiel, Frank Wilson. "Brief Report: Influence of Country of Origin on Prevalence of Hepatitis B Markers Among Employees in a Small Suburban Hospital." Infection Control 7, no. 11 (November 1986): 554–56. http://dx.doi.org/10.1017/s0195941700065310.
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AbstractHepatitis risk in a small suburban hospital was evaluated by laboratory screening of all hospital employees for hepatitis immunologic markers. Excluding four U.S.-born subjects who had received hepatitis vaccination, the laboratory screening revealed 21% of those tested had some hepatitis B antigen or antibody. Positive markers were found in 46% of foreign-born compared to 10% of native-born (P<0.001). Foreign-born participants accounted for 68% of the employee population. The country of origin appeared to have a statistically significant greater importance as a determinant of hepatitis B status than occupational area in this particular hospital setting.
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Burgess, Geoffrey P., Timothy McIver, Philippe Tenglemann, Rosanne Lariven, Andrea Pomana, Jan Schoberwalter, and Edoardo Troina. "Foreign direct investment rules in selected European countries – an overview." Journal of Investment Compliance 22, no. 1 (April 8, 2021): 1–19. http://dx.doi.org/10.1108/joic-07-2020-0009.
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Purpose To provide an overview of the national foreign direct investment (“FDI”) screening mechanisms in place across Europe including in France, Germany, Italy, the Netherlands, Spain and the UK. Design/methodology/approach This article summarizes the key elements of the national FDI screening regimes of some of the leading European economies. This includes setting out the relevant investment thresholds, protected sectors, lengths of review periods, standstill obligations and potential sanctions in each jurisdiction. Findings Many of Europe’s leading economies are following the wider global trend towards stricter reviews of foreign investment ahead of the EU Screening Regulation coming into force in October 2020. However, the approach taken to FDI screening can vary significantly at a country level in terms of both process and substance and the applicable laws are evolving rapidly, not least as a response to concerns related to the impact of COVID-19. Practical implications Investors looking to make acquisitions in Europe will need to consider whether national FDI screening will apply to their proposed investments. Depending on the jurisdiction, FDI screening can introduce lengthy review periods and require detailed information gathering as well as uncertainty as to the final outcome. Potential investors also need to consider the risk of sanctions, including criminal sanctions, for non-compliance with the screening regimes. Originality/value This article offers a summary and comparison of national FDI screening regimes across Europe.
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In, Haejin, Marisa Langdon-Embry, Lauren Gordon, Judith Wylie-Rosett, Clyde Schechter, Philip Castle, Margaret Kemeny, and Bruce D. Rapkin. "A pilot case control study: Could a gastric cancer risk screening tool help identify high risk patients for endoscopic screening in the United States?" Journal of Clinical Oncology 36, no. 4_suppl (February 1, 2018): 64. http://dx.doi.org/10.1200/jco.2018.36.4_suppl.64.
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64 Background: Gastric cancer incidence varies greatly among US racial/ethnic groups. Few studies have examined ethnicity, birth country, immigration and cultural diet as gastric cancer risk factors in the US. These factors, in combination with known risk factors may narrow a target population for gastric cancer screening. Methods: Two racially diverse hospital systems were used to recruit gastric cancer cases using the cancer registry, and primary care (PC) controls from waiting rooms or phone. Community controls were recruited at community gatherings. Participants were eligible if 40-85 years old, not under endoscopic surveillance and without genetic syndromes. The survey items (n = 227) included conventional risk factors, plus items about ethnicity, birth country, acculturation, and ethnic diet. Results: Of 150 participants, 39 cases, 41 PC-controls, and 44 community controls were eligible for analysis. PC-controls generally completed phone interviews (72% vs 28%), while community controls generally completed paper surveys (92% vs 8%). Gastric cancer cases were more likely to be foreign born (85% vs. 49%, p = < 0.01), from a country with gastric cancer incidence > 5 per 100,000: (62% vs. 30%, p = < 0.01) and report daily consumption of cultural food at ages 15 to 18 (69% vs. 35%, p = < 0.01) compared to controls. Cases were also older, male, Hispanic, and had stronger family history of gastric cancer. Cases and controls had similar frequency of alcohol consumption, smoking, acculturation, and barbequed food consumption. In multivariate analysis, increased age (per year, aOR 1.4, 95%CI 1.07-1.21), daily consumption of cultural foods at ages 15 to 18 (aOR 19.58, 95%CI 1.54-248.99), having less than high school education (aOR 7.24, 95%CI 1.49-35.10), and being foreign born (aOR 11.81, 95%CI 1.69-82.64) were associated with case status. Conclusions: A risk assessment tool that addresses awareness of gastric cancer risk factors, ethnicity, cultural habits and immigration patterns has potential to identify high-risk persons from multicultural areas within the US, who might benefit from endoscopic screening for gastric cancer. (Support: UG1CA189823)
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Kuznetsova, E. S., and N. Iu Kalinchenko. "Secondary testicular structures in the patients presenting with congenital adrenal cortical dysfunction." Problems of Endocrinology 58, no. 4 (August 15, 2012): 42–47. http://dx.doi.org/10.14341/probl201258442-47.
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According to publications in the foreign literature, the incidence of secondary testicular structures in the patients with congenital adrenal cortical dysfunction (CACD) amounts to 90%. In this country, the scheduled screening for TART tumours in the male patients presenting with CACD is not carried out. At the same time, the late consequences of this pathology (infertility, obstructive testicular diseases) require increasingly more attention starting from the early childhood.
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Wahedi, Katharina, Louise Biddle, and Kayvan Bozorgmehr. "Cost-effectiveness of targeted screening for active pulmonary tuberculosis among asylum-seekers: A modelling study with screening data from a German federal state (2002-2015)." PLOS ONE 15, no. 11 (November 5, 2020): e0241852. http://dx.doi.org/10.1371/journal.pone.0241852.
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Screening asylum-seekers for active pulmonary tuberculosis is common practice among many European countries with low incidence of tuberculosis. The reported yields vary substantially, partly due to the heterogeneous and dynamic nature of asylum-seeking populations. Rather than screening all new arrivals (indiscriminate screening), a few countries apply targeted screening based on incidence of tuberculosis in asylum-seekers’ country of origin. However, evaluations of its cost-effectiveness have been scarce. The aim of this modelling study was to assess whether the introduction of a screening threshold based on the tuberculosis incidence in the country of origin is sensible from an economic perspective. To this end, we compare the current, indiscriminate screening policy for pulmonary tuberculosis in Germany with a hypothetical targeted screening programme using several potential screening thresholds based on WHO-reported incidence of tuberculosis in countries of origin. Screening data is taken from a large German federal state over 14 years (2002–2015). Incremental cost-effectiveness is measured as cost per case found and cost per case prevented. Our analysis shows that incremental cost-effectiveness ratios (ICERs) of screening asylum-seekers from countries with an incidence of 50 to 250/100,000 range between 15,000€ and 17,000€ per additional case found when compared to lower thresholds. The ICER for screening asylum-seekers from countries with an incidence <50/100,000 is 112,000€ per additional case found. Costs per case prevented show a similar increase in costs. The high cost per case found and per case prevented at the <50/100,000 threshold scenario suggests this threshold to be a sensible cut-off for targeted screening. Acknowledging that no screening measure can find all cases of tuberculosis, and that reactivation of latent infections makes up a large proportion of foreign-born cases, targeting asylum-seekers from countries with an incidence above 50/100,000 is likely to be a more reasonable screening measure for the prevention and control of tuberculosis than indiscriminate screening measures.
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Vynnychenko, I. О., Yu V. Moskalenko, O. І. Vynnychenko, M. Yu Serdyuk, and O. А. Ternovenko. "PROSPECTS FOR THE APPLICATION OF THE MOST MODERN METHODS OF DIAGNOSIS OF LUNG CANCER." Likarska sprava, no. 4 (June 16, 2019): 3–7. http://dx.doi.org/10.31640/jvd.4.2019(1).
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Lung cancer is one of the major causes of death from malignancies. That is why the article devoted to the issue early diagnosis of lung cancer. The objective of the work is to consider the features and prospects of using the most modern methods of diagnosis of lung cancer. The introduction of the latest technologies is essential for quality screening of lung cancer patients. Gradually, there is a growing interest in developing strategies around the world to better assess the risk of human lung cancer, increase screening sensitivity, and reduce costs. The methods of early detection of lung cancer are described in the article: determination of the concentration of volatile organic compounds (LuCID method), endobronchial ultrasound (EBUS method), FISH-marker method, basic principles of the Nano-Nose device. Despite some advances in our country in the diagnosis of lung cancer using common advanced methods of computed tomography and biopsy, the introduction of foreign experience in lung cancer screening is necessary, because the current state-of-the-art methods of diagnosis allow to detect cancer.
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Brodkin, Elizabeth, Katy Short, and Dale Purych. "530. Sequential Screening of High-Risk Patients for Carbapenemase-Producing Enterobacteriaceae Colonization." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S255. http://dx.doi.org/10.1093/ofid/ofz360.599.
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Abstract Background Early identification of patients colonized with carbapenemase-producing Enterobacteriaceae (CPE) facilitates the implementation of appropriate infection control measures and reduces nosocomial transmission. Sequential screening for CPE colonization of close contacts of known cases to confirm initial negative results is recommended. Fraser Health (FH) expanded sequential screening to patients with recent exposure to other risk factors following the identification of CPE in patients who initially screened negative. Methods FH screens patients for CPE who report healthcare outside of Canada or travel to endemic countries within the previous 12 months. Patients remain on contact precautions and are re-screened 7 and 21 days after the last known exposure date. We reviewed CPE cases with foreign healthcare or travel to endemic countries who screened negative on admission but subsequently screened positive within 30 days. Patients without confirmation of colonization through a rectal screen or possible exposure to a current nosocomial source were excluded. Whole-genome sequencing results were examined to confirm foreign healthcare or travel as the likely source of acquisition. Medical records were reviewed to obtain patient history and clinical details. Results Between November 2015 and January 2019, 21 patients had a positive CPE screen within 30 days of a negative screen, with no known CPE exposures during that time. The median time between the last date of known exposure and positive CPE screen was 20 days (range: 7–77 days). Twelve (57%) cases were hospitalized outside of Canada, 8 (38%) reported other foreign healthcare encounters, and 1 (5%) had no reported healthcare outside of Canada but had traveled to an endemic country. Sixteen (71%) cases received antibiotics prior to the positive CPE screen. Conclusion Patients with unrecognized CPE colonization are a source for nosocomial transmission. Patients screening negative for CPE with recent exposure to risk factors other than contact with a known case may screen positive at a later date. This may be due to higher colonization levels or antibiotic selection pressures. Consideration should be given to sequential CPE screening of high-risk patients based on the last day of exposure. Disclosures All authors: No reported disclosures.
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Rennert-May, Elissa, Elisabeth Hansen, Toktam Zadeh, Valerie Krinke, Stan Houston, and Ryan Cooper. "A Step toward Tuberculosis Elimination in a Low-Incidence Country: Successful Diagnosis and Treatment of Latent Tuberculosis Infection in a Refugee Clinic." Canadian Respiratory Journal 2016 (2016): 1–6. http://dx.doi.org/10.1155/2016/7980869.
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Objectives.Approximately 65 percent of tuberculosis (TB) cases in Canada each year occur from reactivation in foreign-born individuals. Refugees are at high risk after immigration. Routine screening of this population for latent TB infection (LTBI) is generally considered infeasible. We evaluated the outcome of LTBI screening and treatment amongst refugees.Methods.Government-sponsored refugees in Edmonton are seen at the New Canadians’ Clinic and screened for TB and LTBI. We reviewed records of patients between 2009 and 2011. Completeness of initial assessment, diagnosis of latent infection, and completion of LTBI treatment were evaluated. Treatment for LTBI was offered when patients had a positive Tuberculin Skin Test (TST) and risk factors for progression to TB. An Interferon-Gamma Release Assay (IGRA) was performed on all other TST positives; treatment is only offered if it was positive.Results.949 refugees were evaluated. 746 TSTs were read, with 265 positive individuals. IGRA testing was performed in 203 TST positive individuals without other TB risk factors; 110 were positive. LTBI treatment was offered to 147 of 151 eligible patients, 141 accepted, and 103 completed a treatment course.Conclusion.We observed high proportions of patient retention, completion of investigations, and treatment. This care model promises to be a component of effective TB prevention in this high-risk population.
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Coelho, Anabela, Cláudia Leone, Vanessa Ribeiro, Pedro Sá Moreira, and Gilles Dussault. "Integrated Disease Management: A Critical Review of Foreign and Portuguese Experience." Acta Médica Portuguesa 27, no. 1 (February 12, 2014): 116. http://dx.doi.org/10.20344/amp.4758.
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<span style="font-family: Times New Roman; font-size: small;"><strong> Introduction:</strong> The present article reviews findings from empirical evaluations of integrated disease management programmes. The objective is to provide insights on integration levels, priority interventions and their effect on patient outcomes.<br /><strong>Material and Methods: </strong>The literature review identified 1 251 articles, published from 2006 to 2011. Upon a detailed screening 61 articles were selected for bibliometric analysis and critical discussion.<br /><strong>Results:</strong> Among several findings, it can be noted that United States of America is the country with the highest amount of published evidence on the subject under study. The most frequently referred disease is diabetes mellitus and the main reported issue of integrated disease management is self-management support. The majority of the studies were developed and exclusively managed by managed care organizations, organized family doctors or hospitals. From a total of 360 interventions reported in studies, patient interventions are the most frequently used across all disease groups, followed by professional interventions. To monitor the effectiveness of the disease programmes, the most frequently used outcomes are patient physiological measures, service use and patient health status.<br /><strong>Discussion:</strong> Every country has its own way to implement the integrated disease management strategy. The focus of practice lies on patient empowerment, particularly through self-management. Physiological measures and service use are the outcomes with the highest rate of assessment, which are also the indicators that show higher impact among all integrated disease management programmes.<br /><strong>Conclusion:</strong> The Portuguese health care system still faces challenges in the coordination and integration of care for patients with chronic disease thus improvements at integrated disease management programmes should be incorporate.</span>
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Petrelli, Alessio, Paolo Giorgi Rossi, Lisa Francovich, Barbara Giordani, Anteo Di Napoli, Marco Zappa, Concetta Mirisola, and Lidia Gargiulo. "Geographical and socioeconomic differences in uptake of Pap test and mammography in Italy: results from the National Health Interview Survey." BMJ Open 8, no. 9 (September 2018): e021653. http://dx.doi.org/10.1136/bmjopen-2018-021653.
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ObjectiveThe Italian National Health Service instituted cervical and breast cancer screening programmes in 1999; the local health authorities have a mandate to implement these screening programmes by inviting all women aged 25–64 years for a Pap test every 3 years (or for an Human Papilloma Virus (HPV) test every 5 years) and women aged 50–69 years for a mammography every 2 years. However, the implementation of screening programmes throughout the country is still incomplete. This study aims to: (1) describe cervical and breast cancer screening uptake and (2) evaluate geographical and individual socioeconomic difference in screening uptake.MethodsData both from the Italian National Health Interview Survey (NHIS) conducted by the National Institute of Statistics in 2012–2013 and from the Italian National Centre for Screening Monitoring (INCSM) were used. The NHIS interviewed a national representative random sample of 32 831 women aged 25–64 years and of 16 459 women aged 50–69 years. Logistic multilevel models were used to estimate the effect of socioeconomic variables and behavioural factors (level 1) on screening uptake. Data on screening invitation coverage at the regional level, taken from INCSM, were used as ecological (level 2) covariates.ResultsTotal 3-year Pap test and 2-year mammography uptake were 62.1% and 56.4%, respectively; screening programmes accounted for 1/3 and 1/2 of total test uptake, respectively. Strong geographical differences were observed. Uptake was associated with high educational levels, healthy behaviours, being a former smoker and being Italian versus foreign national. Differences in uptake between Italian regions were mostly explained by the invitation coverage to screening programmes.ConclusionsThe uptake of both screening programmes in Italy is still under acceptable levels. Screening programme implementation has the potential to reduce the health inequalities gap between regions but only if uptake increases.
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Elhafid, Melanie, Shaun Morris, Haifa Kourdi, Valerie Waters, Ray Lam, and Ian Kitai. "15 PAEDIATRIC TUBERCULOSIS MANAGED AT A CANADIAN CHILDRENS HOSPITAL: RELATIONSHIP TO BIRTHPLACE AND TRAVEL HISTORY." Paediatrics & Child Health 25, Supplement_2 (August 2020): e6-e6. http://dx.doi.org/10.1093/pch/pxaa068.014.
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Abstract Background There are limited data about the relationship of child’s birthplace, parents’ birthplace, and travel history to paediatric tuberculosis (TB) acquisition and disease phenotype in Canada. Travel history is not routinely collected by public health authorities for cases of TB in Canada. Objectives The objective of this study is to investigate the association of paediatric TB acquisition and disease phenotype at a metropolitan Canadian children’s hospital with child’s birthplace, parents’ birth place, and travel history. Design/Methods We reviewed prospectively collected TB clinic data (which include travel histories) and records of patients aged 0-17 years managed for active TB disease at a children’s hospital ambulatory TB clinic between January 1, 2002 and December 31, 2018. Results Two hundred and twenty six cases were identified, of which 116 (51%) were Canadian-born and 110 (49%) were foreign born children. Of the Canadian-born cases, only one case had parents who were both Canadian-born. In comparison to foreign-born patients, Canadian-born patients were more likely to have a history of travel to a TB-endemic country (63/104) [61%] versus (25/103) [24%], odds ratio [OR] 4.8; 95% confidence interval [CI] 2.6-8.7 p<0.001. Canadian-born patients were also more likely to have a known index case (80/116) [69%] versus foreign-born patients (23/110) [21%], OR 8.4; 95% CI 4.5-15.4, p<0.001. For Canadian-born patients, those without a known index case were more likely to have a history of travel to a TB-endemic country than those with a known index case (28/34) [82%] versus (35/70) [50%], [OR] 4.7 95% CI 1.7-12.7, p=0.02. Compared to Canadian-born patients, foreign-born patients had more extrapulmonary disease (48/109) [44%] versus (19/114) [17%], OR 3.9; 95% CI 2.1-7.3, p <0.001. Conclusion Canadian-born children often acquired TB through contact with an infectious source in Canada. However, travel was likely important in a significant minority of cases, especially in Canadian-born children without a known index case. Post-immigration travel may also have been the source of TB in some foreign-born individuals. This would reduce the effectiveness of screening children for TB infection upon immigration. Strategies to prevent and detect travel-related TB are needed to reduce paediatric TB in areas with high immigration rates.
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Kwarah, Abdullahi Murtala, Irrshad Kaseeram, and Aliyu Sanusi Rafindadi. "The Capital Flow Volatility Spillover in Some Selected African Economies." Finance & Economics Review 3, no. 1 (April 24, 2021): 1–22. http://dx.doi.org/10.38157/finance-economics-review.v3i1.272.
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Purpose: The study conducted an empirical examination of the link between capital flows and exchange rate by examining the relative influence of FDI and FPI on the exchange rates.
Method: The study proceeded with the EGARCH model and the data sample covering the period from 1990-2016. The data were subjected to cross-country screening. The screening criteria are such that all the data that constitute capital in all sampled countries must have equal sample sizes. The measurement of capital flow in each of the sampled countries was restricted to two categories capital, namely, foreign portfolio investment (FPI) and foreign direct investment (FDI).
Results: The research establishes that the behavior of capital flow volatility spillover of the sample countries' currencies exchange rate differs, with only South Africa's and Morocco's currencies revealing some slight similarity and existence of asymmetric volatility spillover from capital flows to exchange rate. Additionally, the study discloses that capital flows spillover has a considerable effect on exchange rate volatility than harmful spillover. The study also observed that positive shocks associated with capital flow volatility affect exchange rate value in Botswana more than capital outflow. Further positive capital flow spillover impending from capital inflow has a considerable effect on exchange rate volatility than the harmful spillover impending from the capital outflow. Further, the positive capital flow spill over impending from capital inflow significantly affects exchange rate volatility more than the negative spillovers that emanate from the capital outflow.
Implications: This suggests that the monetary policy should consider options that can accelerate capital flow into the Moroccan economy. However, in South Africa for any given quantum of capital flow into the economy, the South African Reserve Bank must use instruments to affect stability; otherwise, the currency exchange rate could remain unstable. Thus, capital withdrawals out of the Egyptian economy will create domestic currency instability.
Keywords: Spill-over, Foreign Direct Investments (FDI), Portfolio Investments (PI), asymmetric, capital flow volatility, Exchange rate volatility.
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Espinoza, Eloy E. Ordaya, Megan Shaughnessy, Patricia F. Walker, Rachel Husmann, Gabriel Hale, Jacob Stauffer, and William Stauffer. "1108. Transplantation and Immigration: Comparing Infectious Complications Between Foreign-born vs. U.S.-born Kidney Transplant Recipients in Minnesota." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S584. http://dx.doi.org/10.1093/ofid/ofaa439.1294.
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Abstract Background Immigrant patients face barriers to kidney transplantation due to language, cultural, and economic issues. Unprepared health systems and providers further contribute to health disparities in transplantation. Foreign-born patients are also at risk for reactivation of latent infections which differ from U.S.-born population. Stratifying transplant recipients according to country of birth could guide clinicians in the prevention, anticipation, diagnostics, and treatment of post-transplant infections. Methods A retrospective, observational, multicenter study of patients that underwent kidney transplantation from 1/2014-12/2018 at the University of Minnesota Medical Center and Hennepin Healthcare is being conducted. Sociodemographic, clinical, and laboratory data are collected, including infectious episodes during the first year post-transplant. Results One-hundred patients are included in this preliminary analysis (recruitment goal is 800 patients). Sixty-five patients were males (65%), with median age 56 years (range 20 – 77). The majority were Caucasians (64%), followed by Asians (12%) and Africans (9%). Living donation was 59%. Seventy-eight patients developed infectious complications during the first year after transplantation, for a total of 175 infectious episodes: viral etiology (51%), followed by bacterial (42%) and fungal (7%). No tropical diseases were found. Comparing foreign-born (30%) vs. U.S.-born (70%), foreign-born recipients had a higher frequency of latent tuberculosis infection (LTBI) (37% vs 1%, p< 0.001), hepatitis B core antibody positive (20% vs 0, p< 0.001), and deceased donor transplant (67% vs 30%, p= 0.001). CMV mismatch (3% vs 36%, p= 0.002) was more frequent in U.S.-born recipients; CMV reactivation was similar in both groups. While not statistically significant, more foreign-born recipients had an infection in the first year post-transplant (90% vs 73%, p= 0.1), and higher median infectious episodes (2 vs 1, p= 0.6). Comparison of foreign-born vs U.S.-born kidney transplant recipients (n=100, preliminary data) Conclusion Per this preliminary data, foreign-born transplant recipients had a higher frequency of LTBI, hepatitis B core antibody and infectious complications, but lower frequency of CMV mismatch. No cases of tuberculosis, hepatitis B reactivation or tropical diseases were observed. Disclosures Patricia F. Walker, MD, DTM&H, FASTMH, UpToDate (Other Financial or Material Support, Royalties from UpToDate for chapter on refugee screening)
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Razumnova, Lyudmila L., and Tatyana E. Migaleva. "The Rise of China's Political and Economic Influence in the Modern World: Pluralism of Opinions." International Trade and Trade Policy, no. 4 (January 3, 2020): 42–64. http://dx.doi.org/10.21686/2410-7395-2019-4-42-64.
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The increasing political and economic influence of China on the international economic relations, whilst remaining the relative closeness of its economy and reluctance to provide reciprocal access to the national market, is becoming an important topic for discussion among Western and Russian researchers. The purpose of the study is to analyze the modern scientific view on growing influence of the PRC worldwide as a new political player, as well as to identify contradictions arising in the world economy. The methodological basis consists of general scientific methods of analysis and synthesis, generalization and comparison methods, historical and logical approaches to the examined phenomena, which allow to identify contradictions and problems that Russia could face due to China's global economic expansion. The authors substantiate the need for Russian to use the experience of other country in protecting its national interests throw creating mechanisms for foreign investments screening, as those investment can have negative impact on the recipient economy and its integration partners. The article provides recommendations for Russia on how to develop the mutually beneficial and effective investment cooperation with China.
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Ezeji-Okoye, Stephen, Brittney L. Bilodeau, Divya K. Madhusudhan, Eileen Pruett, Sujith Thokala, and Dena M. Bravata. "Inadequate Measles, Mumps, Rubella, and Varicella Immunity Among Employees." Journal of Primary Care & Community Health 12 (January 2021): 215013272110059. http://dx.doi.org/10.1177/21501327211005902.
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Objectives: The purpose of this cohort study was to evaluate measles, mumps, rubella (MMR), and varicella immunity among a population of adult employees receiving primary care in an employer-sponsored health center. Methods: Participants were eligible for MMR and varicella immunity screening if they were an employee receiving primary care in an employer-sponsored health center between January 1, 2019 and November 1, 2020 who could not provide proof of immunization and 1) had it recommended by their provider, 2) specifically requested immunity testing (often because they had heard of measles outbreaks in their country of origin), or 3) were seen for an immigration physical for their Green Card application. Results: Overall, 3494 patients were screened for their MMR immunity. Of these, 3057 were also screened for varicella immunity. Among these patients, 13.9% lacked measles immunity, 0.83% lacked immunity to all 3 components of MMR, and 13.2% lacked varicella immunity. Among the 262 patients who presented specifically for immunity screening, the rates of lacking immunity were higher for all conditions: 22.7% lacked measles immunity and 9.2% lacked varicella immunity. Conclusion: Given declines in immunizations during the COVID-19 pandemic, there is reason to be concerned that measles and varicella-associated morbidity and mortality may rise. Employers, especially those with large foreign-born populations or who require international travel may want to educate their populations about common contagious illnesses and offer immunity validation or vaccinations at no or low cost.
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Carlberg, Magdalena, Maigun Edhborg, and Lene Lindberg. "Paternal Perinatal Depression Assessed by the Edinburgh Postnatal Depression Scale and the Gotland Male Depression Scale: Prevalence and Possible Risk Factors." American Journal of Men's Health 12, no. 4 (January 19, 2018): 720–29. http://dx.doi.org/10.1177/1557988317749071.
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Several studies have used the Edinburgh Postnatal Depression Scale (EPDS), developed to screen new mothers, also for new fathers. This study aimed to further contribute to this knowledge by comparing assessment of possible depression in fathers and associated demographic factors by the EPDS and the Gotland Male Depression Scale (GMDS), developed for “male” depression screening. The study compared EPDS score ≥10 and ≥12, corresponding to minor and major depression, respectively, in relation to GMDS score ≥13. At 3–6 months after child birth, a questionnaire was sent to 8,011 fathers of whom 3,656 (46%) responded. The detection of possibly depressed fathers by EPDS was 8.1% at score ≥12, comparable to the 8.6% detected by the GMDS. At score ≥10, the proportion detected by EPDS increased to 13.3%. Associations with possible risk factors were analyzed for fathers detected by one or both scales. A low income was associated with depression in all groups. Fathers detected by EPDS alone were at higher risk if they had three or more children, or lower education. Fathers detected by EPDS alone at score ≥10, or by both scales at EPDS score ≥12, more often were born in a foreign country. Seemingly, the EPDS and the GMDS are associated with different demographic risk factors. The EPDS score appears critical since 5% of possibly depressed fathers are excluded at EPDS cutoff 12. These results suggest that neither scale alone is sufficient for depression screening in new fathers, and that the decision of EPDS cutoff is crucial.
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Potapov, D. "The European Union and China Foreign Direct Investment Cooperation in the Context of the Belt and Road Initiative." Analysis and Forecasting. IMEMO Journal, no. 4 (2020): 76–93. http://dx.doi.org/10.20542/afij-2020-4-76-93.
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The article analyses the foreign direct investment cooperation between the European Union and the People’s Republic of China under the Belt and Road Initiative. The initiative is proposed by China and is aimed at developing cross-regional transport and logistics infrastructure connecting China with South-East, South and Central Asia, the Middle East, East Africa and Europe. The author examines the history of the initiative and its assessments by international organizations (e.g. the World Bank and the ESCAP UN) and investigates the structure and statistics of the EU-China investment relations, basing on the examples of the most important China’s investment partners (including France, Italy, Germany and the Vishegrad Group countries). The discrepancy between the conditions for the EU and the Chinese investors is highlighted. The author defines and characterizes the major models of the Belt and Road projects’ development, which are used by China in cooperation with the EU Member States. The EU investors in China face restrictions imposed by the national regulation of foreign investments. In particular, the external investors do not have access to the sectors crucially important for national interest and security (e.g. high-tech sectors and mass media). At the same time, Chinese investors’ access to the EU financial markets is not limited, allowing them to become important shareholders in the EU companies and to transfer technologies. It raises concerns within national governments and the European Union itself. The national governments are establishing and adopting screening mechanisms for foreign direct investments and additional regulations to control important sectors and enterprises. At the same time, the EU Member States are developing a common view on the prospects and mechanisms of cooperation with China under the Belt and Road initiative. The EU countries have not yet reached a consensus upon the Belt and Road initiative and the prospects of the EU participation in it, so the author focuses on the strategies of the examined countries. Germany is calling for a common position for all the EU member states and advocates for using the EU-based mechanisms and platforms for cooperation with China. Such demands are also connected with the promotion of a common EU investment screening mechanism in order to protect the Member States’ interests and security. Italy is deepening its cooperation with China through bilateral mechanisms, mainly based on a memorandum of understanding with China on the Belt and Road initiative. France, on the one hand, shares the common interest with Germany regarding the need for the common EU policy towards the Chinese initiative, but on the other hand, the country is deploying new projects with China. The Visegrad Group states are forging their ties with China through bilateral and multilateral cooperation mechanisms and they are interested in the growth of Chinese investment inflows. This undermines the unanimity of policy towards China and the Belt and Road.
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Tran, Bach Xuan, Giang Thu Vu, Kiet Tuan Huy Pham, Quan-Hoang Vuong, Manh-Tung Ho, Thu-Trang Vuong, Hong-Kong T. Nguyen, et al. "Depressive Symptoms among Industrial Workers in Vietnam and Correlated Factors: A Multi-Site Survey." International Journal of Environmental Research and Public Health 16, no. 9 (May 11, 2019): 1642. http://dx.doi.org/10.3390/ijerph16091642.
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Depressive disorders have been found to be a significant health issue among industrial workers, resulting from work-related factors and causing serious burdens for the workers as well as their employers. Literature on mental health problems of Vietnamese industrial workers has been limited, despite the rapid foreign investment-fueled industrialization process of the country. This study aimed to fill the gap in literature by examining the prevalence of depressive disorders and their potential associated factors among a cohort of Vietnamese industrial workers. A cross-sectional study was conducted in 3 industrial areas in Hanoi and Bac Ninh. A total of 289 workers agreed to participate in the study. Generalized linear mixed models were applied to identify associated factors with depression status of respondents. 38.6% of participants reported suffering depression. Factors found to be positively associated with the possibility of having depression and higher PHQ9 score were long working hours, suffering more health problems, and health hazards exposure at work. Meanwhile, being females, having more children, living with parents, engaging in smoking, and being local workers were found to correlate with lower likelihood of being depressed. The findings suggested the importance of regular health screening, work safety assurance, and social support outside of workplace on the mental health of the workers.
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Ohlsson, Rehnholm, Shubham, and Döbeln. "Incidence of Glucose-6-Phosphate Dehydrogenase Deficiency among Swedish Newborn Infants." International Journal of Neonatal Screening 5, no. 4 (October 29, 2019): 38. http://dx.doi.org/10.3390/ijns5040038.
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Sweden has 10.2 million inhabitants and more than 2.4 million have a foreign background. A substantial number of immigrants come from countries where glucose-6-phosphate dehydrogenase deficiency (G6PDD) is frequent. The total birth rate annually in Sweden is approximately 117,000 and newborn screening is centralized to one laboratory. We determined glucose-6-phosphate dehydrogenase (G6PD) activity in 10,098 dried blood spot samples (DBS) from the whole country with a fluorometric assay (LabSystems Diagnostics Oy, Finland). The first 5451 samples were anonymised and run as singletons, whilst the following 4647 samples were coded. Enzyme activity ≤40% of the mean of the day was found in 58 samples (1/170) and among these, 29 had activities ≤10% (1/350). Twenty-nine samples with residual activities between 2–39% in the coded cohort were subjected to Sanger sequencing. Disease-causing variants were identified in 26 out of 29 infants, of which six were girls. In three patients, we did not find any disease-causing variants, although two patients were hemizygous for the known polymorphisms c.1311T>C and c.1365-13C>T. The most common disease-causing variant found in 15 of the 29 samples (12 hemizygotes, two heterozygotes, one homozygote) was the Mediterranean mutation, c.563C>T (p.(Ser188Phe)) in exon 6. G6PDD is thus a surprisingly prevalent disorder in Sweden.
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Conly, John M., Marianna Ofner-Agostini, Shirley Paton, Lynn Johnston, Michael Mulvey, Amar Kureishi, Lindsay Nicolle, Anne Matlow, and the Canadian Hospital Epidemiology Committee. "The Emerging Epidemiology of VRE in Canada: Results of the CNISP Passive Reporting Network, 1994 to 1998." Canadian Journal of Infectious Diseases 12, no. 6 (2001): 364–70. http://dx.doi.org/10.1155/2001/424608.
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OBJECTIVE:To provide a rapid and efficient means of collecting descriptive epidemiological data on occurrences of vancomycin-resistant enterococcus (VRE) in Canada.DESIGN AND METHODS:Passive reporting of data on individual or cluster occurrences of VRE using a one-page surveillance form.SETTING:The surveillance form was periodically distributed to all Canadian Hospital Epidemiology Committee members, Community and Hospital Infection Control Association members, L'Association des professionnels pour la prevention des infections members and provincial laboratories, representing 650 health care facilities across Canada.PATIENTS:Patients colonized or infected with VRE within Canadian health care facilities.RESULTS:Until the end of 1998, 263 reports of VRE were received from 113 health care facilities in 10 provinces, comprising a total of 1315 cases of VRE, with 1246 cases colonized (94.7%), 61 infected (4.6%)and eight of unknown status. (0.6%). VRE occurrences were reported in 56% of acute care teaching facilities and 38% of acute care community facilities. All facilities of more than 800 beds reported VRE occurences compared with only 10% of facilities with less than 200 beds (r2=0.86). Medical and surgical wards accounted for 51.4% of the reported VRE occurences. Sixty-five (24.7%) reports indicated an index case was from a foreign country, with 85.2% from the United States and 14.8% from other countries. Some type of screening was conducted in 50% of the sites.CONCLUSIONS:A VRE passive reporting network provided a rapid and efficient means of providing data on the evolving epidemiology of VRE in Canada.
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Knopf, Kevin B., Samantha Siegel, and Charles L. Bennett. "Avoidance of fulminant liver failure from hepatitis B reactivation with chemotherapy and immunotherapy: A value-based approach." Journal of Clinical Oncology 32, no. 30_suppl (October 20, 2014): 134. http://dx.doi.org/10.1200/jco.2014.32.30_suppl.134.
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134 Background: Fulminant liver failure (FLF) is a potentially fatal complication of hepatitis B reactivation in patients who receive rituximab and cytotoxic chemotherapy. Often patients receiving these regimens are treated with curative intent (e.g. diffuse large cell Non Hodgkin’s lymphoma, adjuvant chemotherapy for breast cancer) and thus avoidance of this complication is desirable. The only known treatment for fulminant liver failure is orthotropic liver transplant. We have developed a cost-effective approach to avoiding FLF. Methods: NCCN recommends screening for hepatitis B serologies in any patient who is to receive Rituximab therapy. Review of the literature regarding fulminant liver failure and cytotoxic chemotherapy revealed that the regimens most strongly associated with reactivation of HepB and fulminant liver failure included doxorubicin and high dose of cyclophosphamide—we have targeted Hepatitis B screening to patients receiving these two chemotherapy drugs. We target patients either felt to have a high probability of occult hepatitis B are screened—these include patients who have had a blood transfusion in a foreign country, those with a transfusion more than 20 years ago, and those patients where Hepatitis B can be passed vertically—including first and second generation Asian American immigrants. Patients deemed at high risk are checked for Hepatitis B surface Antigen and Hepatitis B Core antibodies. No routine imaging is performed. Patients who are HepBSag or HepBCoreAb positive who are to receive high risk chemo/immunotherapy are then started on entecavir 0.5 mg/d two weeks before starting therapy and this is continued for 6 months after completion of therapy. Patients who are HepBAg- and HepBCab+ are monitored with HBV DNA levels monthly during therapy with initiation of entecavir if HBV DNA becomes detectable. Results: Patients receiving chemo/immunotherapy associated with Hep B reactivation can be safely identified and given prophylactgic entecavir treatment. Conclusions: We have created a value-driven cost effective approach to minimizing FLF in patients receiving chemo/immunotherapy. Cost estimates based on US pricing will be presented.
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Hernández-Garduño, Eduardo, and R. Kevin Elwood. "The Prevalence and Predictors of Tuberculin Positivity in Subjects Screened for Reasons other than Contact Investigation." Canadian Respiratory Journal 15, no. 4 (2008): 181–87. http://dx.doi.org/10.1155/2008/575190.
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BACKGROUND: No previous studies have estimated the rates of tuberculin positivity (TP) in noncontact populations within the same community, which is important for prioritizing and implementing preventive measures.OBJECTIVES: To estimate the prevalence and predictors of TP in noncontact populations.METHODS: A retrospective analysis of tuberculin results of non-contact populations screened in British Columbia from 1990 to 2002 was conducted.RESULTS: The period prevalence of TP in 59,791 screened subjects was 12.7% (95% CI 12.4% to 13.0%), 30.4% (95% CI 28.2% to 32.7%) and 60.9% (95% CI 60.3% to 61.6%) for Canadian-born non-Aboriginals (CBNAs), Canadian-born Aboriginals (CBAs) and foreign born (FB), respectively. After controlling for age and sex, independent predictors of TP included Bacille Calmette-Guérin (BCG) vaccination (OR 19.6, 95% CI 17.9 to 21.5), country of birth (CBA: OR 2.87, 95% CI 2.44 to 3.37; FB: OR 3.67, 95% CI 3.34 to 4.03) and the following populations: correctional centre residents (OR 4.14, 95% CI 1.87 to 9.15), residents of long-term care and community care facilities (OR 1.79, 95% CI 1.44 to 2.23), immigrants (OR 1.75, 95 % CI 1.50 to 2.04), health centre employees (OR 1.71, 95 % CI 1.56 to 1.88), volunteers (OR 1.38, 95% CI 1.14 to 1.68), self-referred healthy subjects (OR 1.30, 95% CI 1.15 to 1.48) and students (OR 1.27, 95% CI 1.19 to 1.35). CBAs, FB and male subjects were less likely to react to tuberculin than CBNAs and female subjects among those vaccinated with Bacille Calmette-Guérin (P<0.05).CONCLUSIONS: Rates of TP correlate with disease rates by sex and origin. The continuation of tuberculin screening programs is warranted in noncontact populations with high TP rates, where unknown exposure to active cases is more likely to occur. Further research is needed to determine the reasons why a higher response to tuberculin occurs in BCG-vaccinated women and CBNAs.
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Tsukanov, V. V., A. V. Vasyutin, and Yu L. Tonkikh. "Prevalence, risk factors, and ethnic characteristics of uninvestigated dyspepsia." Russian Medical Inquiry 4, no. 5 (2020): 263–67. http://dx.doi.org/10.32364/2587-6821-2020-4-5-263-267.
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Background: in our country, studies on the prevalence of dyspepsia performed using the Rome IV criteria are rare, which makes it difficult to objectively compare Russian and international data, including ethnic characteristics. Aim: to study the prevalence and risk factors of uninvestigated dyspepsia in indigenous and foreign residents in rural areas of the Republic of Khakassia. Patients and Methods: continuous epidemiological screening (coverage 93.4%) of dyspepsia was performed in the villages Matur, Anchul, Verchnii Kurlugash, Nizhnie Siry, Bolshoy Bor, Bolshaya Seya, Verkhnyaya Seya, Inchul, Verkhnii Tashtyp of the Tashtyp district. A total of 2,080 newly-arrived residents (Caucasians, 911 males, average age 43.6 years) and 2,117 indigenous residents (Khakas, 978 males, average age 42.9 years) were surveyed. Dyspepsia was studied in accordance with the recommendations of the Rome IV criteria. Epigastric pain syndrome and postprandial distress syndrome were distinguished. Due to the fact that endoscopic examination of patients was not used, dyspepsia was considered as uninvestigated dyspepsia. The presence of Helicobacter pylori was determined serologically in 566 Caucasians and 533 Khakas. The results of clinical examination and interview (social status, complaints, medical history) were recorded in the standard questionnaires. Results: uninvestigated dyspepsia was diagnosed in 24.6% of Caucasians and 19.2% of Khakas (p<0.001). Gender did not affect the prevalence of dyspepsia in Khakas. Among Caucasians, there was a tendency to more common detection of dyspepsia in women. The pain variant of dyspepsia prevailed in men in both populations. The incidence of postprandial distress syndrome among Caucasians was significantly higher in women. Other risk factors for dyspepsia in both populations were the following: age older than 50, Helicobacter pylori infection, smoking 20 or more cigarettes per day for more than 10 years, history of gallbladder pathology, acute viral hepatitis and helminthiasis. Conclusion: the data obtained allow to consider the influence of ethnicity on the prevalence of uninvestigated dyspepsia, including depending on gender identity. KEYWORDS: uninvestigated dyspepsia, ethnic characteristics, Helicobacter pylori, prevalence, risk factors. FOR CITATION: Tsukanov V.V., Vasyutin A.V., Tonkikh Yu.L. Prevalence, risk factors, and ethnic characteristics of uninvestigated dyspepsia. Russian Medical Inquiry. 2020;4(5):264–267. DOI: 10.32364/2587–6821–2020–4-5-263-267.
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Liu, Sophia Yijia, Lin Lu, Karmugi Balaratnam, Dan Pringle, Mary Mahler, Chongya Niu, Hiten Naik, et al. "Impact of immigration status on health behaviors and perceptions in cancer survivors." Journal of Clinical Oncology 36, no. 7_suppl (March 1, 2018): 27. http://dx.doi.org/10.1200/jco.2018.36.7_suppl.27.
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27 Background: Health behaviors including smoking cessation, physical activity (PA) and alcohol moderation are key aspects of cancer survivorship. Disparities in health literacy and cancer screening behaviors have been reported between immigrant and native-born cancer patients. However, disparities in health behaviors in cancer survivorship has not been explored. We compared health behaviors and perceptions about these behaviors between immigrant and native-born cancer survivors. Methods: Adult cancer patients from Princess Margaret Cancer Centre (Toronto, Canada) were surveyed on their smoking, PA, and alcohol habits and perceptions of the effects of these behaviors on quality of life (QoL), 5-year survival, and fatigue. Multivariable models evaluated the effect of immigration status on behaviors and perceptions. The effect of originating from a Western vs. non-Western country was also evaluated. Results: Of 1275 patients, 27% self-identified as foreign-born. At 1 year before diagnosis (baseline), 17% smoked, 69% were physically inactive, and 58% consumed alcohol. Although immigration status was not associated with smoking at baseline (P > 0.05), immigrants were less likely to perceive that smoking was harmful on QoL (adjusted odds ratio [aOR] 0.58, P = 0.008), survival (aOR 0.56, P = 0.002), and less so for fatigue (aOR 0.75, P = 0.11). Immigrants were less likely to meet PA guidelines at baseline (aOR = 0.70, P = 0.08), and perceive that PA improved fatigue (aOR 0.62, P = 0.04) and survival (aOR 0.64, P = 0.08). Immigrants were also less likely to drink alcohol at baseline (aOR = 0.47, P = 0.001), but alcohol perceptions did not differ between immigrants and native-born. Those from non-Western countries were less likely to smoke (aOR 0.63, P = 0.03), drink alcohol (aOR 0.48, P = 0.006), or meet PA guidelines at baseline (aOR 0.44, P = 0.006). Conclusions: Immigrants were less likely to perceive continued smoking as harmful and less likely to be aware of the benefits of PA. Patients from non-Western countries were less likely to meet PA guidelines, but were also less likely to smoke or drink at baseline. Culturally tailored counselling should be considered for immigrants who smoke or are physically inactive at baseline.
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Pavloshchuk, Olga O., Viktoriia E. Melnychuk, and Nadiia V. Roshchyna. "Transformation of the Process of Hiring Employees Under the Influence of Information Technologies." Mechanism of an Economic Regulation, no. 3 (2019): 49–57. http://dx.doi.org/10.21272/mer.2019.85.05.
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The socio-economic and political transformations in the country cannot be perceived without the implementation of information technology. Nowadays, Internet resources are actively used in all spheres of life, so personnel management departments, following the example of foreign recruitment companies, adapt the system of selection of personnel to the modern technological realities. Human capital is still one of the most important factors in the country's development. It was approved that the proper selection of a qualified specialist is the key to the success of any company, organization, enterprise because the staff influences their efficiency and competitiveness in the occupied market segment. On this basis, it should be noted that the output of the Human Resource department is crucial. Staffing is not possible without the use of information technology and the Internet. Analyzing the existing changes in the field of hiring employees, we verified that new technologies are implemented solidly. Head-hunters and recruiters use dedicated social networking sites and job search sites to recruit highly qualified personnel. Recent advances in marketing, such as targeted advertising, are also actively and purposefully used to attract the attention of potential employees. Moreover, specialized software is being developed to simplify the selection and screening system for those candidates who do not meet the requirements of the enterprise. It should be noted that the development of information technology has fundamentally affected the change in the relationships and interactions of people in society, involving all spheres of life. Looking at people around the world who spend a lot of time in the virtual space and want to find a particular job, it should be confirmed that there is no longer a need to print it in the newspaper, broadcast it on the radio or to show on television. The results of our research show that the advertisement for the job position can be entirely spread on the Internet in the nearest future. Information technology has made adjustments to the specifics of hiring qualified personnel in the world, and in particular in Ukraine. The widespread availability of information resources in the world has fundamentally changed the policies of Human Resource Management departments and the tactics of their specialists. It has been done a lot in the development of the Human Resource department in Ukraine, but several unresolved issues should be overcome. It`s the quandary of the future. Key words: information technology, human capital, human resources management, social networks.
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Higginbottom, Gina MA, Catrin Evans, Myfanwy Morgan, Kuldip K. Bharj, Jeanette Eldridge, Basharat Hussain, and Karen Salt. "Access to and interventions to improve maternity care services for immigrant women: a narrative synthesis systematic review." Health Services and Delivery Research 8, no. 14 (March 2020): 1–122. http://dx.doi.org/10.3310/hsdr08140.
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Background In 2016, over one-quarter of births in the UK (28.2%) were to foreign-born women. Maternal and perinatal mortality are disproportionately higher among some immigrants depending on country of origin, indicating the presence of deficits in their care pathways and birth outcomes. Objectives Our objective was to undertake a systematic review and narrative synthesis of empirical research that focused on access and interventions to improve maternity care for immigrant women, including qualitative, quantitative and mixed-methods studies. Review methods An information scientist designed the literature database search strategies (limited to retrieve literature published from 1990 to 2018). All retrieved citations (45,954) were independently screened by two or more team members using a screening tool. We searched grey literature reported in related databases and websites. We contacted stakeholders with subject expertise. In this review we define an immigrant as a person who relocates to the destination country for a minimum of 1 year, with the goal of permanent residence. Results We identified 40 studies for inclusion. Immigrant women tended to book and access antenatal care later than the recommended first 10 weeks of pregnancy. Primary factors included limited English-language skills, lack of awareness of availability of the services, lack of understanding of the purpose of antenatal appointments, immigration status and income barriers. Immigrant women had mixed perceptions regarding how health-care professionals (HCPs) had delivered maternity care services. Those with positive perceptions felt that HCPs were caring, confidential and openly communicative. Those with negative views perceived HCPs as rude, discriminatory or insensitive to their cultural and social needs; these women therefore avoided accessing maternity care. We found very few interventions that had focused on improving maternity care for these women and the effectiveness of these interventions has not been rigorously evaluated. Limitations Our review findings are limited by the available research evidence related to our review questions. There may be many aspects of immigrant women’s experiences that we have not addressed. For example, few studies exist for perinatal mental health in immigrant women from Eastern European countries (in the review period). Many studies included both immigrant and non-immigrant women. Conclusions Available evidence suggests that the experiences of immigrant women in accessing and using maternity care services in the UK are mixed; however, women largely had poor experiences. Contributing factors included a lack of language support, cultural insensitivity, discrimination and poor relationships between immigrant women and HCPs. Furthermore, a lack of knowledge of legal entitlements and guidelines on the provision of welfare support and maternity care to immigrants compounds this. Future work Studies are required on the development of interventions and rigorous scientific evaluation of these interventions. Development and evaluation of online antenatal education resources in multiple languages. Development and appraisal of education packages for HCPs focused on the provision of culturally safe practice for the UK’s diverse population. The NHS in the UK has a hugely diverse workforce with a vast untapped linguistic resource; strategies could be developed to harness this resource. Study registration This study is registered as PROSPERO CRD42015023605. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 14. See the NIHR Journals Library website for further project information.
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Bedard, Brenden, Melissa Pennise, Anita C. Weimer, and Byron S. Kennedy. "Magnitude of Giardia cases among refugees, adoptees and immigrants in Monroe County, New York, 2003-2013." International Journal of Migration, Health and Social Care 12, no. 3 (September 12, 2016): 211–15. http://dx.doi.org/10.1108/ijmhsc-05-2015-0019.
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Purpose The purpose of this paper is to determine the morbidity of Giardia in Monroe County, New York attributed to refugees, foreign adoptees and immigrants, and to examine factors related to asymptomatic Giardia infection. Design/methodology/approach A retrospective epidemiological analysis was conducted of Giardia case investigations submitted to the New York State Department of Health on the Communicable Disease Electronic Surveillance System, between January 1, 2003 and December 31, 2013 from Monroe County Department of Public Health. Univariate and multivariate logistic regression models were used to assess odds for asymptomatic Giardia. Findings Of the 1,221 Giardia cases reported in Monroe County during that time, 38 percent (n=467) were refugees, 6 percent (n=77) were foreign adoptees and 1.4 percent (n=17) were immigrants. In total, 95 percent of the refugees and 89 percent of the adoptees/immigrants were asymptomatic, compared to 15 percent of the non-refugee/adoptee/immigrant cases. Unadjusted odds for asymptomatic infection were 113.4 (95 percent CI: 70.6-183.7) for refugees, and 45.6 (95 percent CI: 22.9-91) for adoptees/immigrants. Originality/value This study demonstrates the importance of routine screening for Giardia during refugees’ initial health assessment.
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Ruisi, Mary M., Evangelista Jessica, Daniel Green, Brenda Oiyemhonlan, Shivani Shah, Benjamin T. Kile, Rachel Burt, Alexis Thompson, and James B. Bussel. "Radioulnar Synostosis and Its Hematology and Genetic Associations." Blood 116, no. 21 (November 19, 2010): 2521. http://dx.doi.org/10.1182/blood.v116.21.2521.2521.
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Abstract Abstract 2521 Defects in the radial ray are associated with hematological problems such as thrombocytopenia and bone marrow failure, i.e. Thrombocytopenia Absent Radius Syndrome and Fanconi Anemia. Congenital radioulnar synostosis (RUS), a rare developmental anomaly involving fusion of the bones of the forearms, has been recognized in the orthopedic literature since the mid-1800s. The bony union of the radius and ulna prevents normal supination of the affected forearm, yet the condition is painless and compatible with a normal functional existence without the need for surgery. RUS occurs more frequently in males, and is bilateral in about fifty percent of cases. In utero, growth patterning of the limbs along the various axes requires products of the Homeobox (Hox) genes, which are members of a highly conserved set of transcription gene factors that are expressed very early in embryonic development. In addition to limb patterning, studies regarding homeobox genes have suggested that they are involved in hematopoiesis, including self-renewal, proliferation, differentiation, and leukemogensis. In the year 2000, Thompson and Nguyen published a report in Nature Genetics that identified an unusual association of amegakaryocytic thrombocytopenia and radioulnar synostosis in two unrelated, non-consanguineous families; sequencing of these families found a point mutation of exon 2 of HoxA11. Several other studies have confirmed the association of bone marrow failure or thrombocytopenia and RUS, although a number of patients have not tested positive for the HoxA11 mutation. The aims of our IRB approved project are to create a registry of patients and their family members with congenital RUS with or without hematological problems; compile their medical histories, clinical phenotypes, and results of complete blood counts; archive blood samples; and perform genomic testing for HoxA11 and other DNA screening. We began recruiting subjects at New York Presbyterian Hospital Department of Hematology/Oncology in August of 2009. Through radiology screening, chart review, and referrals from our collaborating pediatric orthopedists, we have identified eight source patients with RUS. All except one patient have hematological manifestations; three have subtle symptoms of easy bruising and recurrent epistaxis, one had thrombocytopenia with reduced megakaryoctyes, one has intermittent thrombocytopenia and leucopenia of undetermined etiology, one had pancytopenia/bone marrow failure in infancy and is status post bone marrow transplant (s/p BMT), and one had acute lymphoblastic leukemia/lymphoma in young adulthood and is also s/p BMT. The eighth patient was recently adopted from an orphanage in a foreign country, and his past and family histories are unknown. Other related anomalies or syndromes found in the primary subjects or family members are clinodactyly of the 5th finger, Angelman Syndrome, Autism Spectrum Disorders, Pulmonary Hypertension (PHTN), Polycystic Kidney Disease (PCKD), and possible Poland Syndrome. We have also compiled family pedigrees and collected blood from immediate family members, some of whom also have RUS and hematological manifestatations [Figure 1]. Five of the eight families are of Mediterranean (mostly Italian) ancestry, suggesting a possible founder effect to the mutation versus geographic bias of the New York metropolitan area. One family of Italian descent had consanguinity of the subject's maternal grandparents. We are in the process of sequencing HoxA11 for the subjects and their families. Subject #1 previously tested normal for the HoxA11 gene. If samples are determined to be normal for HoxA11, genome wide SNP analysis for further homozygosity and/or linkage mapping will be pursued. We hope to increase awareness of the linked clinical entities of RUS, thrombocytopenia, bone marrow failure, and possible malignant transformation at the level of the general pediatrician, orthopedists, and hematologists. Additionally, besides HoxA11, we hope to discover other candidate genes or molecular mechanisms within related Hox genes that may influence the development of forearm morphogenesis, thrombopoiesis, and leukemogenesis. Disclosures: No relevant conflicts of interest to declare.
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Muhammad Imran Majeed, Syed, and Aisha Mohyuddin. "Human Genetic Research in Pakistan: Challenges and Way forward." Life and Science 2, no. 1 (February 10, 2021): 2. http://dx.doi.org/10.37185/lns.1.1.182.
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The 90s ushered in the era of molecular genetics in Pakistan. Our centuries’ old tradition of consanguineous marriages, resulting in the availability of large, inbred families with inherited disorders, proved to be a goldmine for geneticists, working to discover new genes and their functions. A multitude of novel genes with previously unknown functions were discovered through genetic linkage analysis, a technique that compares the segregations of DNA markers in normal and affected family members to pinpoint the region that contains the suspect gene. The first few landmark publications on linkage analysis in genetic diseases, from Pakistan, identified only the regions harboring the suspected disease genes.1,2 As the field advanced, disease causing mutations segregating in affected family members were identified through Sanger DNA sequencing of candidate genes in the linked region. In the last decade, the advent of high throughput techniques such as whole exome analysis and animal disease modeling, functional genomics studies became an integral of part of such genetic studies. In addition, bioinformatics tools were developed for predictive modeling of the effect of mutations on protein structure.
The analysis of a single large multigenerational family with a genetic disorder could provide the same information that would be obtained from many small nuclear families, as usually found in developed countries. This allowed Pakistani researchers to attract collaborators from Universities around the world. DNA samples of numerous Pakistani families were sent to labs across the world for analysis, many times accompanied by a PhD student who would typically spend around six months working on those families. Universities developed efficient pipelines, whereby students would find families with genetic diseases, extract DNA and carry out linkage analysis and, in some cases, identify the gene mutations using Sanger sequencing. This led to a significant increase in the number of publications on genetics, from Pakistan. However, despite all the good work carried in the country, no credible effort had been made to build national capacity to carry the work beyond initial mutation screening.
We lack the ability to conduct good quality high through put –omics analysis and animal model studies within the country. There are several reasons for this. Firstly, the cost of such research is prohibitive. While some institutes have invested in next generation sequencing platforms, these machines are largely underutilized due to high cost of consumables. Lack of adequate funding for reagents, required for genomic, transcriptomic and proteomic studies, is a major roadblock. Secondly, the ease in attracting foreign collaborators to carry out the functional studies in their labs, has made many Pakistani researchers complacent, often, they are happy to be co-authors in research papers without having to go through the pains to set up the required laboratory facilities. Lastly, the bureaucratic processes and red tape, especially in public sector Universities, make procurement of chemicals and consumables, tedious and time consuming, resulting in demotivation of researchers and faculty. There is a need to address these issues, if we wish to move towards self-sufficiency in conducting high level functional genomics and stem the flow of biological samples from Pakistan.
While genetic studies in Pakistan have resulted in the discovery of many novel genes, the benefit of these studies is yet to trickle down to the patients. The willingness of the affected families to participate in these studies is crucial. Many affected families belong to far flung rural areas and have no understanding of their disease, how it is inherited or the implications of participating in such research. It is unlikely that families participating in these studies have any immediate benefits and they should be informed at the time of recruitment using common language which they are able to understand. The role of Institutional Ethics and Review Boards, for the protection of study participants and their rights, needs to be strengthened. It is important not to abandon these families after sample collection but to relay the results of the study and counsel them regarding their future options.
Despite the rapid advances in genetic medical knowledge, our population has yet to reap its benefits. A small step in right direction is the Compulsory Blood Test of the Relatives of Thalassemia Patient Bill-2017, which makes it compulsory for couples to get tested before marrying. However, the scarcity of gene testing facilities and healthcare professionals trained in clinical genetics is an impediment to the implementation of this bill in the true spirit. It is becoming imperative to educate our healthcare professionals regarding the application of genetics to medical practice. Clinical genetics and its related competencies need to be recognized as medical specialties in the country, before they can be introduced into mainstream clinical practice to improve health outcomes of our affected families.
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Jasuja, Supriya, Anna Lee, Raymond Macdonald, and Susan G. Marantz. "LATENT TUBERCULOSIS INFECTION SCREENING OF FOREIGN BORN PATIENTS USING QUANTIFERON-GOLD (QFT-G) IN SUBURBAN COOK COUNTY TB CLINICS IN ILLINOIS." Chest 132, no. 4 (October 2007): 433A. http://dx.doi.org/10.1378/chest.132.4_meetingabstracts.433.
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Fraiwan, Arwa, Muhammad Noman Hasan, Ran An, Amy J. Rezac, Nicholas J. Kocmich, Tolulope Oginni, Grace Mfon Olanipekun, et al. "Advancing Healthcare Outcomes for Sickle Cell Disease in Nigeria Using Mobile Health Tools." Blood 134, Supplement_1 (November 13, 2019): 2173. http://dx.doi.org/10.1182/blood-2019-131344.
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Nigeria leads the world in the number of cases of sickle cell disease (SCD). An estimated 150,000 babies are born annually in Nigeria with SCD, a heredity disorder, and 70-90% die before age 5. Only a small portion of affected infants and children in sub Saharan Africa (SSA) reach adolescence. Over 650 children die per day in sub-Saharan Africa from SCD. These dismal statistics are in sharp contrast to outcomes in high-income countries (HICs) where more than 90% of SCD patients reach adulthood. The World Health Organization (WHO) estimates that 70% of deaths could be prevented with a low cost diagnostic and treatment plan. Meaningful preventive care and treatment cannot be implemented without a structured plan for early diagnosis and patient tracking.Early diagnosis requires improved access to parents and guardians of children with SCD, and gaining this access remains a challenge in most of SSA. In 2015, Nigeria's Kano state government, with support from foreign partners, established a community-based program for newborn registration. This platform provides unique access to newborn babies in one of Nigeria's most populous cities, but still lacks a functioning patient testing, tracking, and monitoring system, which we plan to address in our ongoing study. This study will introduce mobile health in a low-income country with low literacy rate and hopefully accustom that segment of the population to more varied mobile health applications that will ultimately improve their health in the long run. Our current operational platform in Kano, Nigeria provides access to a large population with a high prevalence of SCD. We have previously completed pilot testing of 315 subjects for SCD using our microchip electrophoresis test. We are planning to test up to 4,500 additional subjects less than 5 years of age at Murtala Muhammed Specialist Hospital. The hospital staff includes 97 physicians and 415 nurses and outpatient clinics serve about 30,000 patients monthly. The maternity department has a 200-bed capacity and the antenatal clinic performs about 1,000 deliveries and serves an average of 3,000 mothers monthly. Enrollment is planned to start on September 15, 2019 and medical staff are currently being trained to run the tests. Our study is registered in the United States National Library of Medicine's ClinicalTrials.gov (Identifier: NCT03948516). Our technology is uniquely paired with an automatic reader and an Electronic Medical Record (EMR) and patient management solution to record POC test results, register new cases, and track patients for follow-up (Fig. 1). The reader enables automated interpretation of test results, local and remote test data storage, and includes geolocation (Global Positioning System) (Fig. 2). The system will generate reports for all cases of SCD, track hospital visits, appointments, lab tests, and will have mobile and dashboard applications for tracking patients and samples. The application will be installed on mobile devices provided to users. The proposed system will be compliant with the existing privacy standards to handle medical data (e.g., HIPAA in the US and GDPR in the EU). All communications between the parties will be secured via end-to-end encryption as a safeguard. We anticipate that our project will increase the rates of screening, diagnosis and timely treatment of SCD in Kano State of Nigeria. The project's broader impact will likely be the ability to track and monitor screening, disease detection, diagnosis and treatment, which can be scaled up to the whole nation of Nigeria, then to sub-Saharan Africa. The data obtained and analyzed will be the first of their kind and will be used to inform the design of programs to improve access to, and availability of, effective care for this underserved populations. The importance of increased access to diagnosis and treatment should not be underestimated - it is crucial for realizing effective management of people with SCD. The impact can be enhanced by complementing diagnosis and patient tracking with education for the families so they can provide or seek the necessary preventative treatment. Identification of the location of the patients in need would help identify the areas where family, parent, caregiver education should be provided. Disclosures Fraiwan: Hemex Health, Inc.: Equity Ownership, Patents & Royalties. Hasan:Hemex Health, Inc.: Equity Ownership, Patents & Royalties. An:Hemex Health, Inc.: Patents & Royalties. Thota:Hemex Health, Inc.: Employment. Gurkan:Hemex Health, Inc.: Consultancy, Employment, Equity Ownership, Patents & Royalties, Research Funding.
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Gulati, Nupur, Sri Ram Pentakota, Kristina N. Feja, Bishakha Ghoshal, Rajita Bhavaraju, Arpita Jindani, Gaur Sunanda, and Sabah Kalyoussef. "1376. Physician Practice Patterns for Screening and Treatment of Latent Tuberculosis Infection in the South Asian Population in Central New Jersey." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S499—S500. http://dx.doi.org/10.1093/ofid/ofz360.1240.
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Abstract Background New Jersey (NJ) has a significant burden of tuberculosis (TB) cases (ranked 8th in the United States) and 22% of the cases are among foreign-born (FB) individuals. We have approximately 33% FB residents in our targeted counties in Central NJ of whom 43% are originally from high TB burden areas of South Asia. Central NJ is home to the county with the second highest TB case rate in NJ. Latent tuberculosis infection (LTBI) treatment remains a key component of the World Health Organization TB elimination strategy. We sought to survey community physicians about their LTBI screening and treatment practices in South Asian (SA) patients. Methods An IRB-approved anonymous survey was distributed online to practicing staff physicians at local hospitals over a 2-month period. The primary outcome measure was whether physicians appropriately screen for LTBI. A secondary outcome measure was whether follow-up after medication initiation was provided. Predictors measured included: age, gender, self -identification of physician as SA, years in practice, and if they were a foreign medical graduate (FMG). Descriptive statistics were provided using counts and proportions. Chi-square tests were used for bivariate analyses to look for factors associated with LTBI screening and treatment. Results A total of 218 physicians responded to the survey; of whom, 137 identified themselves as primary care physicians (i.e., pediatrics (62%), internal medicine (30%), or family medicine (8%)). About half of them were FMG and 40% identify themselves as SA. Three out of four of these physicians (n = 101) indicated they routinely screen their patients for LTBI. Bivariate analyses using chi-square did not find any statistically significant associations with LTBI screening. A quarter of the physicians screened with an IGRA and 60% reported always offering treatment for LTBI. Isoniazid was the most common medication prescribed. A majority of respondents did not report prescribing Rifampin or Rifapentine. Follow-up after initiation of treatment was provided at least every other month by 52.7% of physicians. Conclusion There is wide variability in LTBI screening, treatment, and follow-up among our physician sample. Physicians have not yet adopted newer treatment regimens suggesting the need for an educational intervention. Disclosures All authors: No reported disclosures.
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Ma, Yingyi. "Academic Elites or Economic Elites." Journal of International Students 10, no. 3 (August 15, 2020): xxiii—xxiv. http://dx.doi.org/10.32674/jis.v10i4.2003.
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At an academic conference, I chatted with the Dean of Admissions from a prestigious public university in the mid-West and was struck by a story he told me: A Chinese doctoral student walked into his office one day and blasted him for admitting so many undergraduates from China, saying that this devalued his own credentials, as the qualities of those Chinese undergraduates, in his opinion, were no comparison to his.
The dean narrated this story half-jokingly, apparently feeling it was funny. However, he might not fully understand the roots of this student’s complaint. In a test-oriented Chinese education system, students are ranked by test scores, and by test scores only. In this student’s eyes, he had been able to score high on the competitive Gaokao, and then was selected by an equally, if not more, competitive screening to study at this famous U.S. university (Liu 2016). In his view, he had abilities superior to those who were not able to score high on the Gaokao but, instead, paid to study at the same university he had tried so hard to get into. This student’s statements may sound crude and cruel, but they are based on the perspective from his small world.
However, the larger world is changing and getting flatter (Friedman 2005). In part, that means an increasing number of Chinese students have access to world-class universities. Despite the massive growth of higher education sector in China, only two Chinese universities are ranked among the top 100 best universities in the world, while 41 out of these top 100 are located in the United States (Times higher education 2018). With the increasing proportion of upper middle-class families in today’s China, more and more Chinese students do not have to rely on American scholarships to study at American institutions. The recent history of Chinese students’ dependency on full American scholarships to study abroad was merely a reflection of the economic deprivation and limited education opportunities of the country at that time. This gave rise to the mindset of academic elitism exhibited by this doctoral student, which sees prestigious universities as belonging to the few students who can outscore the masses. Perhaps, instead, he should feel happy for the younger generation of Chinese students who have the freedom to choose.
This change, of Chinese international students’ academic and social backgrounds and their ensuing experiences abroad, has motivated my research over the past 7 years. My book (Ma 2020) Ambitious and Anxious has shown a diverse set of Chinese students in terms of both family backgrounds and education trajectories. Their capacity to pay for the overseas education has often obscured their socioeconomic diversity, the parental sacrifices and their own academic and social challenges and struggles.
In other words, this freedom to choose and access a wider set of education options overseas is backed by economic resources that are vastly unequally distributed among Chinese students and their families. Perhaps this doctoral student is frustrated partly because American universities often admit Chinese undergraduates who have the resources to study here.
This touches upon a thorny identity issue that American universities, particularly selective ones, have to grapple with. How can they avoid being considered bastions of privilege and wealth? Over the past few decades, American universities have made efforts to recruit students from humble backgrounds. However, these efforts have been almost exclusively limited to domestic students. For many institutions, the tuition dollars of international students are a key revenue source for funding financial aid for domestic students. This logic may help balance the books, but it runs the risk of challenging institutions’ meritocratic ideals. The increasing concentration of economic elites from foreign countries may not enter into the diversity metrics of campus administrators, but surely it tacitly reinforces the culture of privilege and wealth that our universities strive to break out of.
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Porsa, Esmaeil, Lee Cheng, and Edward A. Graviss. "Comparison of an ESAT-6/CFP-10 Peptide-Based Enzyme-Linked Immunospot Assay to a Tuberculin Skin Test for Screening of a Population at Moderate Risk of Contracting Tuberculosis." Clinical and Vaccine Immunology 14, no. 6 (April 18, 2007): 714–19. http://dx.doi.org/10.1128/cvi.00073-07.
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ABSTRACT Screening for latent tuberculosis infection (LTBI) with the Mantoux tuberculin skin test (TST) has many limitations including false-positive results due to Mycobacterium bovis bacillus Calmette-Guérin (BCG) vaccination. Three hundred ninety adult inmates with normal screening chest radiographs in a county jail were evaluated for LTBI using TST and an ESAT-6/CFP-10 peptide-based enzyme-linked immunospot assay (T-SPOT.TB). LTBI prevalence rates were 19.0% and 8.5% by T-SPOT.TB and TST, respectively. Overall agreement between test results was 82.8% (κ = 0.29). Positive T-SPOT.TB results were significantly associated with increased age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01 to 1.06) and intravenous drug use history (OR, 2.92; 95% CI, 1.36 to 6.27). Positive TST results were significantly associated with increased age (OR, 1.06; 95% CI, 1.02 to 1.09) and foreign birth (OR, 6.61; 95% CI, 1.98 to 22.01). Discordant covariates between the assay results included increased age (OR, 0.96; 95% CI, 0.94 to 0.99) and intravenous drug use history (OR, 0.41; 95% CI, 0.19 to 0.88). T-SPOT.TB reactivity is unaffected by prior BCG vaccination. T-SPOT.TB may be more sensitive than TST in diagnosing LTBI among a moderate risk population of inmates, particularly those with intravenous drug use history. Longitudinal studies are needed to assess the positive predictive value of T-SPOT.TB in identifying those most likely to convert to active disease in general populations as well as in high-risk subpopulations.
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Dang, Catherine M., Sylvia Estrada, Catherine Bresee, and Edward H. Phillips. "Exploring Potential Use of Internet, E-mail, and Instant Text Messaging to Promote Breast Health and Mammogram Use among Immigrant Hispanic Women in Los Angeles County." American Surgeon 79, no. 10 (October 2013): 997–1000. http://dx.doi.org/10.1177/000313481307901008.
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Breast cancer is now the leading cause of death in Hispanic women (HW). Internet, e-mail, and instant text messaging may be cost-effective in educating HW about breast health and in reducing breast cancer mortality. We surveyed 905 HW women attending a free health fair about their technology use, acculturation, insurance status, mammography use, and breast cancer knowledge. Data were analyzed by t test or χ2 tests. Mean age was 51.9 ± 14.2 years (range, 18 to 88 years). Ninety-two per cent were foreign-born. Most had completed some high school (39%) or elementary (38%) education. Most (62%) were uninsured. The majority spoke (67%) and read (66%) only Spanish. Only 60 per cent of HW older than 40 years had a recent mammogram. HW older than 40 years who had not had a recent mammogram were younger (mean 54.9 ± 10.8 vs 58 ± 10.4 years) and less likely to have health insurance (25 vs 44%; P < 0.001). Most HW never use the Internet (58%) or e-mail (64%). However, 70 per cent have mobile phones (66% older than 40 years), and 65 per cent use text messaging daily (58% older than 40 years, P = 0.001). In fact, 45 per cent wish to receive a mammogram reminder by text. Text messaging may be an inexpensive way to promote breast health and screening mammography use among uninsured HW.
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Sagiraju, Hari Krishna Raju, Ismail Jatoi, Melissa Valerio, Lung-Chang Chien, and David Gimeno. "Effects of county-level attributes on geographic variation in female breast cancer mortality rates across counties in United States." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): e13093-e13093. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e13093.
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e13093 Background: Though studies have examined geographic disparities in breast cancer mortality among United States (U.S.) counties, county-level risk factors were not accounted for. The aim of this study is to efficiently map the spatial association between female breast cancer mortality rates & socioeconomic attributes across U.S. counties for identifying high risk geographical clusters in terms of socioeconomic attributes. Methods: County-specific age standardized breast cancer mortality rates for women ≥20 years in the U.S. were obtained for 3,109 counties in 48 contiguous states from Surveillance Epidemiology and End Results program from 1990-2012. County-level attributes such as percentages of Hispanic white, Non-Hispanic white, Non-Hispanic black, < high school education, below 200% poverty, urban, foreign born, language isolation, women aged ≥ 40 years with mammography within last 2 years, and median household income were gathered from U.S. decennial census. Factor analysis condensed county attributes into three factor covariates namely Hispanic immigrants, health care access among urban high socioeconomic population, and non-Hispanic black unemployment. Spatiotemporal analysis was carried out by structured additive regression model to incorporate spatial functions & Markov chain Monte Carlo simulation techniques. Results: Moran’s index suggested existence of spatial dependence for breast cancer mortality among U.S. counties. As mammography screening, %urban population, % with high socioeconomic status and non-Hispanic black unemployment increased in counties of the Southwest region, Rocky mountain region and those in the western border of Midwest region of U.S, risk of breast cancer mortality increased significantly above the national average. As the Hispanic immigrant culture increased, counties of Midwest region of U.S had significantly higher mortality rates compared to national average. Conclusions: These initial results describe socio-economic, cultural, and healthcare access factors for observed geographic variations in female breast cancer mortality, and in turn, could support a stronger theoretical basis for public health policy.
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Porsa, Emaeil, Lee Cheng, Michael M. Seale, George L. Delclos, Xin Ma, Robert Reich, James M. Musser, and Edward A. Graviss. "Comparison of a New ESAT-6/CFP-10 Peptide-Based Gamma Interferon Assay and a Tuberculin Skin Test for Tuberculosis Screening in a Moderate-Risk Population." Clinical and Vaccine Immunology 13, no. 1 (January 2006): 53–58. http://dx.doi.org/10.1128/cvi.13.1.53-58.2006.
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ABSTRACT Screening for latent tuberculosis infection (LTBI) with Mantoux tuberculin skin test (TST) has many limitations, including false-positive results due to exposure to Mycobacterium other than tuberculosis (TB) and BCG vaccination. A total of 474 adult inmates in a county jail were screened for LTBI using TST and a new ESAT-6/CFP-10 peptide-based whole-blood gamma interferon (IFN-γ) assay. LTBI prevalence was 9.0 and 5.4% as determined by TST and IFN-γ assay, respectively. Overall, agreement between test results was 90% (κ = 0.25). Positive TST results were significantly associated with increased age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01 to 1.08), African-American ethnicity (OR, 4.97; 95% CI, 1.58 to 15.68), foreign birth (OR, 20.20; 95% CI, 4.21 to 97.02) and prior incarceration (OR, 6.19; 95% CI, 1.48 to 25.95). Positive IFN-γ assay results were significantly associated with African-American ethnicity (OR, 5.58; 95% CI, 1.16 to 26.74). Factors associated with statistically significant discordance between TST and IFN-γ assay results were African-American ethnicity (OR, 0.29; 95% CI, 0.11 to 0.77), foreign birth (OR, 0.23; 95% CI, 0.07-0.80), and prior incarceration (OR, 0.06; 95% CI, 0.01-0.50). Among subjects born in the United States, African-American ethnicity was the only variable significantly associated with positive test results for both TST (OR, 4.26; 95% CI, 1.38 to 13.16) and IFN-γ assay (OR, 5.74; 95% CI, 1.19 to 27.75) and remained associated with statistically significant discordance between TST and IFN-γ assay results. The reactivity of the new IFN-γ assay is unaffected by prior BCG vaccination or serial TSTs but may be diminished in African-Americans. Future longitudinal studies are needed to assess the sensitivity and specificity of this new assay in detecting LTBI.
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Kushner, Lauren E., Vidya Mony, and David M. Vu. "1377. Use of Interferon-Gamma Release Assays (IGRAs) Reduced Latent Tuberculosis Infection (LTBI) Diagnosis in Refugee and Immigrant Children." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S500. http://dx.doi.org/10.1093/ofid/ofz360.1241.
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Abstract Background For foreign-born children from countries with high tuberculosis (TB) burden, positive tuberculin skin test (TST) results, associated with Bacillus Calmette Guerin (BCG) vaccination, paradoxically increase the risk for overdiagnosis and overtreatment of latent TB infection (LTBI) during immigration. The higher specificity of interferon-gamma release assays, such as QuantiFERON-TB (QFT), may help distinguish LTBI from positive TSTs due to BCG or non-TB Mycobacteria. However, data on QFT usage in pediatric populations, particularly refugee and immigrant children, are sparse. Our objective was to assess the impact of QFT on LTBI diagnosis and treatment in the vulnerable child refugee and immigrant population. Methods We initiated a retrospective study of children (≤15 years) seen in Santa Clara County Refugee/Immigrant Clinic for post-immigration TB re-evaluation in 2017. We collected information from the Electronic Disease Notification system and post-immigration clinic records, including laboratory studies, imaging, and clinical impression. The primary outcome was post-immigration LTBI diagnosis in patients with positive pre-immigration TB screening. Patients with prior active TB or LTBI treatment were excluded. Results 102/135 clinic encounters examined to date were post-immigration encounters. Median age was 9 years (range 14mo to 15y). Most (82.5%) were from Asia, primarily the Philippines (n = 48), Afghanistan (n = 10), Iran (n = 9), and Vietnam (n = 8). Sixty-six (64.7%) had documented BCG vaccination. Among 102 encounters, 71 (69.6%) were of children diagnosed pre-immigration with LTBI based on positive TST and normal chest radiograph. After post-immigration evaluation with retesting by QFT, 13/71 (18%) were diagnosed with LTBI (Table 1). There were no active TB cases among 102 patients, though long-term follow-up varied (mean 5.5 ± 6.5 months). Conclusion QFT use for post-immigration LTBI re-evaluation reduced LTBI diagnosis by 82% in children as young as 2 years old. Preliminary data suggest the preferential use of QFT over TST in non-United States-born children, in accordance with new California Department of Public Health TB screening recommendations for children ≥2 years, could reduce unnecessary diagnosis and treatment of LTBI in refugee and immigrant children. Disclosures All authors: No reported disclosures.
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Sodavarapu, Soujanya, Kate Hatter, Megha Goyal, Prakash Ramdass, Majed Sayedi, Nashwan Obad, Amandeep Singh Gill, and Dinesh Vyas. "Health disparity in Central Valley of California: Higher incidence of breast cancer in Asian population." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e19029-e19029. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e19029.
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e19029 Background: California has the most immigrants of any state in the U.S., with approximately a quarter of the residents being foreign-born. The impact of migration on breast cancer incidences over time has not yet been characterized in the Northern Central Valley. This provides a unique opportunity to study the influence of migration, socioeconomic gradient, and racial identity on the incidence of breast cancer in San Joaquin County. Methods: This study was a retrospective, single-institution study that compared the socio-demographic variables and clinical characteristics of the patients who had a history of breast cancer in a teaching central valley hospital. We reviewed all charts with a breast cancer diagnosis from 2014-2019. We compared age, demographics, socioeconomic status comorbidities, pathology, treatment, and outcomes. Appropriate statistics have been used to analyze the data. Results: A retrospective chart review of all patients with a diagnosis of breast cancer from 2014-2019 at a central valley teaching hospital. 33.5% were white, 17.2% African American, 26.6% Hispanic, and 22.6% were Asian. Migrated Asian women are having three times increased incidence in central California compared to their peers in Asian. Additionally, those of lower socioeconomic status were more often affected (61.9% vs. 30.4% of middle-class status) in our population. Demographics and comorbidities were studied. Smoking was seen in 23.2% of patients, alcohol in 16.3%, hypertension in 43.6%, Diabetes in 18.9%, lung disease in 11.7%, and Kidney disease in 6.9%. 23.8% of the patients had a family history of cancer. Screening was only done in 41% of patients, and the distribution of race was as follows: white 10.6%, African American 7.7%, Hispanic 8.9%, Asian 8.9%. It was found that infiltrating ductal carcinoma was seen in 54.8% of patients, of which 16.1% were white, 10% African American, 15.5% Hispanic, and 13.2% were Asian. Triple-negative breast cancer was seen in 14.9% in our patient population. We further reviewed treatment methods, including chemotherapy, radiation, and surgery, as well as recurrence rates. Conclusions: We suggest that screening has to be more concentrated in all communities. The fact that the Asian population in the Central Valley shows higher rates of breast cancer could be due to epigenetic, western lifestyle, and environmental factors. Higher awareness and willingness as a subgroup may be contributing as well or there may be an actual increase; this requires further investigation, and we will present further subgroup analysis at presentation.
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Loganathan, Tharani, Deng Rui, and Nicola Suyin Pocock. "Healthcare for migrant workers in destination countries: a comparative qualitative study of China and Malaysia." BMJ Open 10, no. 12 (December 2020): e039800. http://dx.doi.org/10.1136/bmjopen-2020-039800.
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ObjectivesThis paper explores policies addressing migrant worker’s health and barriers to healthcare access in two middle-income, destination countries in Asia with cross-border migration to Yunnan province, China and international migration to Malaysia.DesignQualitative interviews were conducted in Rui Li City and Tenchong County in Yunnan Province, China (n=23) and Kuala Lumpur, Malaysia (n=44), along with review of policy documents. Data were thematically analysed.ParticipantsParticipants were migrant workers and key stakeholders with expertise in migrant issues including representatives from international organisations, local civil society organisations, government agencies, medical professionals, academia and trade unions.ResultsMigrant health policies at destination countries were predominantly protectionist, concerned with preventing transmission of communicable disease and the excessive burden on health systems. In China, foreign wives were entitled to state-provided maternal health services while female migrant workers had to pay out-of-pocket and often returned to Myanmar for deliveries. In Malaysia, immigration policies prohibit migrant workers from pregnancy, however, women do deliver at healthcare facilities. Mandatory HIV testing was imposed on migrants in both countries, where it was unclear whether and how informed consent was obtained from migrants. Migrants who did not pass mandatory health screenings in Malaysia would runaway rather than be deported and become undocumented in the process. Excessive attention on migrant workers with communicable disease control campaigns in China resulted in inadvertent stigmatisation. Language and financial barriers frustrated access to care in both countries. Reported conditions of overcrowding and inadequate healthcare access at immigration detention centres raise public health concern.ConclusionsThis study’s findings inform suggestions to mainstream the protection of migrant workers’ health within national health policies in two middle-income destination countries, to ensure that health systems are responsive to migrants’ needs as well as to strengthen bilateral and regional cooperation towards ensuring better migration management.
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Ma, Y., P. Zhou, D. Liu, G. Xia, and S. Bou. "304 HUMAN AUGMENTER OF LIVER REGENERATION TRANSGENIC OVINE EMBRYO DERIVED FROM SOMATIC CELL NUCLEAR TRANSFER." Reproduction, Fertility and Development 20, no. 1 (2008): 232. http://dx.doi.org/10.1071/rdv20n1ab304.
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The aim of this research was to develop an efficient screening technique to detect transgenic ovine embryos using neomycin resistance (NeoR) and enhanced green fluorescence protein (EGFP) genes as genetic markers. A 0.8-kb fragment of the ovine β-lactoglobulin promoter sequence (BLG) and 1.8 kb of the human augmenter of liver regeneration (ALR) genomic sequence were derived by PCR amplification. These 2 fragments were inserted into the MCS of pGEM-7zf(+) plasmid; this vector was named p7Z-BA. The coding sequence of NeoR was derived by PCR amplification from the plasmid pIRES2-EGFP and was assembled into the MCS of the pIRES2-EGFP plasmid. The resultant vector (pNIE) contained a NeoR gene coding sequence and an EGFP coding sequence linked by an internal ribosome entry site (IRES) sequence downstream of the CMV promoter. The vector pNIE was excised as an NsiI-SspI fragment and inserted into the vector p7Z-BA. In the end, we had a vector named pNEA, which contained the NeoR gene and the EGFP gene regulated by a CMV promoter for expression in a non-tissue specific mode, and the human ALR gene regulated by the BLG promoter for expression specifically in mammary gland. Sheep fetal fibroblast (SFFB) cells were isolated by attachment of tissue pieces from the ear skin of a 1- to 2-month ovine fetus. Karyotypes of the cells at the third passage and after 15 passages were analyzed. The cells proliferated well and more than 72% of the cells maintained a diploid karyotype after 15 passages. Therefore, the SFFB cells are amenable for transgenic cloning manipulations. For transfection, third-passage SFFB cells at 70% confluency were transfected in a 100-mm dish with pNEA (0.5, 1.0, 2.0, 3.0, 5.0, and 7.0 µg) using Lipofectamine 2000 (2, 4, 6, 8, 10, and 12 µL; Invitrogen, Carlsbad, CA). Cells were checked 24 to 48 h after transfection under fluorescence microscopy for GFP expression, and G418 selection (800 µg mL–1) was applied at that time. After 2 weeks, selected colonies were counted and propagated in culture medium containing 300 µg mL–1 G418 for 2 to 3 passages and cryopreserved. A small portion of the cells was analyzed by PCR for gene integration. Bright green fluorescence could be detected 24 to 48 h after transfection. More colonies were selected when transfection parameters were 2 µg of DNA and 10 µL of Lipofectamine. The results of PCR detection showed that the foreign gene was integrated into the genome. A total of 612 oocytes were aspirated from 2- to 5-mm follicles of ovine ovaries collected from an abattoir; 78% of them were matured after 18 h in culture. Four hundred forty-three oocytes were enucleated, and 332 enucleated oocytes were treated for electrofusion with green fluorescence cells. Of these, 180 (54.2%) couplets were fused. A total of 172 reconstructed embryos were stimulated and cultured in vitro, 31 (18%) of which developed to the blastocyst stage, and 19 blastocysts expressed GFP. In conclusion, we established an effective method to select transgenic embryos formed by nuclear transfer using transfected donor cells.
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Greenaway, Christina, Manish Pareek, Claire-Nour Abou Chakra, Moneeza Walji, Iuliia Makarenko, Balqis Alabdulkarim, Catherine Hogan, et al. "The effectiveness and cost-effectiveness of screening for active tuberculosis among migrants in the EU/EEA: a systematic review." Eurosurveillance 23, no. 14 (April 5, 2018). http://dx.doi.org/10.2807/1560-7917.es.2018.23.14.17-00542.
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Background : The foreign-born population make up an increasing and large proportion of tuberculosis (TB) cases in European Union/European Economic Area (EU/EEA) low-incidence countries and challenge TB elimination efforts. Methods : We conducted a systematic review to determine effectiveness (yield and performance of chest radiography (CXR) to detect active TB, treatment outcomes and acceptance of screening) and a second systematic review on cost-effectiveness of screening for active TB among migrants living in the EU/EEA. Results : We identified six systematic reviews, one report and three individual studies that addressed our aims. CXR was highly sensitive (98%) but only moderately specific (75%). The yield of detecting active TB with CXR screening among migrants was 350 per 100,000 population overall but ranged widely by host country (110–2,340), migrant type (170–1,192), TB incidence in source country (19–336) and screening setting (220–1,720). The CXR yield was lower (19.6 vs 336/100,000) and the numbers needed to screen were higher (5,076 vs 298) among migrants from source countries with lower TB incidence (≤ 50 compared with ≥ 350/100,000). Cost-effectiveness was highest among migrants originating from high (> 120/100,000) TB incidence countries. The foreign-born had similar or better TB treatment outcomes than those born in the EU/EEA. Acceptance of CXR screening was high (85%) among migrants. Discussion: Screening programmes for active TB are most efficient when targeting migrants from higher TB incidence countries. The limited number of studies identified and the heterogeneous evidence highlight the need for further data to inform screening programmes for migrants in the EU/EEA.
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Gerbaud, L., B. Chabanas, A. Perrève, and Bureau de l’ADSSU. "Tuberculosis screening for foreign students change: good saving and bad idea?" European Journal of Public Health 29, Supplement_4 (November 1, 2019). http://dx.doi.org/10.1093/eurpub/ckz187.070.
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Abstract Issue There was a mandatory screening of tuberculosis (TB) for the 60.000 foreign students (out of European Union) annually newcomer in France. It was organized by screening centers of the Office of Immigration and Integration, a State agency. There was a link with university students’ health services (USHS) by systematic exchange of data, and sometimes the USHS was in charge of this screening and financed for that. In March 2016, a law, applied since January 2017, stopped this obligation, and transferred the responsibility of a “preventive survey” to USHS, without any means and financing. Problem As the decision was made without any data, thanks to the national network of UHSH, we made a brief national survey showing a 2,7 to 7,9/1.000 incidence, from year to year, 40% being active. About 50% of the cases came from North Africa and China. These data did not changed the decision, and we present its consequences in one French University, which was a previous TBI screening center. We computed all the cases of TB known in our USHS, since 2010, completed by the data form health authorities. Results Since screening is not anymore mandatory we faced a global refusal from Chinese and Moroccan students arguing that there was no TB in their country. Number of foreign students and their origin were approximately stable from 2010 to 2016, and mean TB incidence was 1,97/1.000. Students from China and North Africa represented half of the cases and 40% were latent TB. Since January 2017, TB incidence lowers to 1,51/1.000. Latent TB represent less than ¼, and there was no more cases screened from North Africa and China, while there was no change in foreign students origins, showing a significant degradation of screening effectiveness. Lessons The main reason for screening cessation was to save public money. Due to important lack of knowledge among French state authorities, we couldn’t change a decision which threatens the TB epidemic control. Key messages Cost saving policy reduced the effectiveness of tuberculosis screening. Health policy decisions may not take into account epidemiologic objectives.
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Wahedi, K., L. Biddle, and K. Bozorgmehr. "Cost-effectiveness of targeted screening for active pulmonary tuberculosis among asylum-seekers." European Journal of Public Health 30, Supplement_5 (September 1, 2020). http://dx.doi.org/10.1093/eurpub/ckaa165.799.
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Abstract Background Screening asylum-seekers for active pulmonary tuberculosis is common practice among many European countries with low incidence of tuberculosis. The reported yields vary substantially, partly due to the heterogeneous and dynamic nature of asylum-seeking populations. Some countries apply targeted screening measures based on the incidence of tuberculosis in the country of origin. Evaluations of such approaches with respect to (cost)-effectiveness is scarce. Methods Using screening data from a large German state over 14 years (2002-2015), we evaluate the cost-effectiveness of targeted screening based on WHO-reported incidence of tuberculosis in country of origins (from thresholds of 50 to 250/100,000 inhabitants). Incremental cost-effectiveness is measured as cost per case found and cost per case prevented. Results Incremental cost-effectiveness ratios (ICERs) of screening asylum-seekers from countries with an incidence of 50 to 250/100,000 range between 15,000€ and 17,000€ per additional case found when compared to lower thresholds. The ICER for additional screening of asylum-seekers from countries with an incidence <50/100,000 is 112,000€ per additional case found. Costs per case prevented show a similar increase in costs. Conclusions The high cost per case found or case prevented in the <50/100,000 threshold scenario suggests this threshold to be a sensible cut-off for targeted screening. Acknowledging that no screening measure can find all cases of tuberculosis, and that reactivation of latent infections makes up a large proportion of foreign-born cases, targeting asylum-seekers from countries with an incidence above 50/100,000 is likely to be a more reasonable screening measure for the prevention and control of tuberculosis than indiscriminate screening measures. Key messages We challenge the widespread belief that indiscriminate tuberculosis screening programmes are placed at an acceptable balance between costs and benefits. Targeting asylum-seekers from countries with an incidence above 50/100,000 is likely to be a reasonable screening measure for the prevention and control of tuberculosis.
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Mueller-Hermelink, Maya, Robin Kobbe, Benedikt Methling, Cornelius Rau, Ulf Schulze-Sturm, Isa Auer, Frank Ahrens, and Folke Brinkmann. "Universal screening for latent and active tuberculosis (TB) in asylum seeking children, Bochum and Hamburg, Germany, September 2015 to November 2016." Eurosurveillance 23, no. 12 (March 22, 2018). http://dx.doi.org/10.2807/1560-7917.es.2018.23.12.17-00536.
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Background In Germany, the incidence of tuberculosis (TB) in children has been on the rise since 2009. High numbers of foreign-born asylum seekers have contributed considerably to the disease burden. Therefore, effective screening strategies for latent TB infection (LTBI) and active TB in asylum seeking children are needed. Aim: Our aim was to investigate the prevalence of LTBI and active TB in asylum seeking children up to 15 years of age in two geographic regions in Germany. Methods: Screening for TB was performed in children in asylum seeker reception centres by tuberculin skin test (TST) or interferon gamma release assay (IGRA). Children with positive results were evaluated for active TB. Additionally, country of origin, sex, travel time, TB symptoms, TB contact and Bacille Calmette-Guérin (BCG) vaccination status were registered. Results: Of 968 screened children 66 (6.8%) had TB infection (58 LTBI, 8 active TB). LTBI prevalence was similar in children from high (Afghanistan) and low (Syria) incidence countries (8.7% vs 6.4%). There were no differences regarding sex, age or travel time between infected and non-infected children. Children under the age of 6 years were at higher risk of progression to active TB (19% vs 2% respectively, p=0,07). Most children (7/8) with active TB were asymptomatic at the time of diagnosis. None of the children had been knowingly exposed to TB. Conclusions: Asylum seeking children from high and low incidence countries are both at risk of developing LTBI or active TB. Universal TB screening for all asylum seeking children should be considered.
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"Sino-Bulgarian Economic Relations in the Post Pandemic World." Economic Alternatives 27, no. 2 (June 28, 2021): 177–96. http://dx.doi.org/10.37075/ea.2021.2.01.
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Since 2013, China has launched the “Belt and Road” Initiative adhering to “The Five-Connectivity Program”, which aims at achieving win-win results with the countries along the road. Meantime, “17+1” mechanism is an important regional platform that promotes cooperation between China and Central and Eastern European countries. In this context, the Sino-Bulgarian economic relationships are constantly expanding and increasingly diversified in terms of foreign direct investment, trade, and cooperation of companies. There are increasing research interests and results of these two policies but there are still a lot of gaps to fill. The most pressing one is that more researches are needed about the impact of the Belt and Road Initiative and “17+1” mechanism on Central and Eastern Europe Countries, especially an individual country such as Bulgaria. Bulgaria was the second country that recognized and established diplomatic relations with China in 1949. Since then, Bulgaria and China have established a very good and strong relationship in different ways. However, the outbreak of COVID-19 in 2020 has brought many challenges for both Bulgaria and China, which has a deep impact on the bilateral economic relations. herefore, by searching the past ten years of SSCI literature in the database, this paper systematically sorts out the existing research on Sino-Bulgarian economic relations and makes a comprehensive review, reflecting the latest and changing landscape of the Sino-Bulgarian economic relations. Then by collecting, screening and analyzing the latest statistical data in multiple sources, this paper identifies the characteristics of FDI, the bilateral trade respectively. The purpose is to provide a guidance of the prospect of Sino- Bulgarian economic relations in the future. The paper establishes that the economic relations between the two countries have made great progress under this initiative and new mechanism but still remain unstable and far below their potential. Finally, the paper concludes that there is a very promising future for the bilateral economic relations even facing many challenges and risks in the post pandemic world.
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"The Myth and Reality of the Restructuring of Public Service in Nigeria." International Journal of Recent Technology and Engineering 8, no. 2S9 (November 2, 2019): 390–93. http://dx.doi.org/10.35940/ijrte.b1089.0982s919.
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The Nigerian public service is revising the course of governance and presenting more robust and more viable systems of providing amenities to the public and working actively on its foreign affairs to reinstate investors’ confidence. It is a machinery of executing policies and programs. Apart from this crucial function, it also provides services through the Ministries, Department, and Agencies. Many decades ago, the said services were inadequate in terms of how they are delivering. However, to further toughen its determination in implementing the federal government national development plan in the country. Office of the head of service of the federation has taken a critical look at its performance towards building and developing the capacity for civil servants and effort to create employment through various entrepreneurial and skill acquisition programmes. The primary objective of this paper is to scrutinise the myth and reality of the restructuring of public service in Nigeria. The study used a systematic literature review (SLR) as a methodology, the author searched document from the journal database, i.e. google scholar and library catalogue using different terms and synonyms, relevant articles found and critically review. The screening has conducted which exclude predatory papers because of the low quality of the journal. The related studies were selected and included in this study base on these criteria: Journal articles must be peer review, indexed by SCOPUS or web of science. It must not be too older in years of publication, qualitative and quantitative study design can be accepted; the geographical location is mostly developing countries. It comes out with the methodological result on the restructuring of public service in Nigeria. Finally, this study recommends the need to improve and provide the conducive working environment for workers in the public sector in Nigeria.
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Gauthier, Lauraine, Laurent Dortet, Garance Cotellon, Elodie Creton, Gaëlle Cuzon, Valérie Ponties, Rémy A. Bonnin, and Thierry Naas. "Diversity of Carbapenemase-Producing Escherichia coli Isolates in France in 2012-2013." Antimicrobial Agents and Chemotherapy 62, no. 8 (June 4, 2018). http://dx.doi.org/10.1128/aac.00266-18.
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ABSTRACT With the dissemination of carbapenemase-producing Enterobacteriaceae (CPE) strains worldwide, carbapenem-hydrolyzing enzymes are increasingly reported among isolates of Escherichia coli, the first hospital and community-acquired opportunistic pathogen. Here, we have performed an epidemiological survey of carbapenemase-producing E. coli (CP-Ec) isolates received at the French National Reference Centre (F-NRC) in 2012 and 2013. Antimicrobial susceptibilities for last-resort antibiotics and antimicrobial compounds commonly used to treat urinary tract infections were determined by broth microdilution. Clonal relationship was assessed using repetitive sequence-based PCR (rep-PCR) and multilocus sequence typing (MLST). From this collection of 140 carbapenemase-producing E. coli isolates, 74% produced an OXA-48-like carbapenemase and 21% produced an NDM carbapenemase. A link with a foreign country was suspected for 37% of infected/colonized patients. Most of the isolates were from screening (56%) and from urine samples (26%). Colistin, fosfomycin, and nitrofurantoin possessed the most consistent activity, with 100%, 95%, and 96% isolates susceptible, respectively. A wide diversity of carbapenemase-producing E. coli isolates has been found (50 different sequence types [STs]). The most prevalent clones were (i) E. coli sequence type 38 (ST38) producing OXA-48 (n = 21), a clone linked to Turkey and North African countries, (ii) E. coli ST-90 producing OXA-204 (n = 9), which was responsible for an outbreak related to a contaminated duodenoscope, and (iii) E. coli ST-410 producing OXA-181 (n = 5), which was recovered from patients of different geographical origins. These specific clones might be considered high-risk clones for the dissemination of carbapenemases in E. coli. The wide diversity of STs, combined with the increasing number of CP-Ec isolates received by the F-NRC, suggests a likely dissemination of CP-Ec isolates in the community.
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Sane Schepisi, M., A. S. Miglietta, C. Cerocchi, P. Grillo, S. Renzi, R. Cirilli, R. Pavone, S. Vaccarello, F. Magrelli, and G. De Angelis. "Tuberculosis contact investigations in congregate settings in Rome, Italy: contribution of migration." European Journal of Public Health 29, Supplement_4 (November 1, 2019). http://dx.doi.org/10.1093/eurpub/ckz185.613.
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Abstract Background In middle to low incidence countries tuberculosis (TB) is known to concentrate in big cities as national incidence falls: in the last decade TB incidence in Rome metropolitan area and in Lazio region has been higher than the national estimates; TB incidence among foreign born fell by more than half despite remaining higher than among Italian born. We aimed to describe the current dynamics of TB transmission among residents of our local health unit in Rome metropolitan area in order to drive specific TB control interventions at local level. Methods We retrospectively evaluated characteristics of TB cases and results of contact investigations among the residents of ASL Roma 2 in congregate settings over year 2018. Results Overall 217 TB cases were notified, of which 70.5% with pulmonary involvement. Male/female ratio was 2.4/1 and age group most affected was 25-44 among foreign born and >65 among natives. During the study period foreign born cases accounted for 65% of the total number of TB cases. 19/141 (13.5%) foreign born patients were hosted in a reception center. 479 exposed close contacts were screened, with no evidence of secondary TB disease transmission. No identifiable links were found among cases occurred in the same immigrant reception center. Conclusions Italian guidelines recommend symptom screening for TB and LTBI testing both of new entrants and of long term residents -including second–generation migrants- from high TB burden countries. These findings suggest that local public health efforts should prioritize the identification of reactivations of remotely acquired latent TB rather than of new postarrival infections acquired in the host county through local transmission. Key messages City-specific data on TB incidence trends among native and foreign-born residents help understanding the wider interaction between migration and TB. To prevent TB incidents in congregate settings remotely acquired latent TB should be targeted.