Country-wide Studies Research Articles

PCR-RFLP analyses of Leishmania species causing cutaneous and mucocutaneous leishmaniasis revealed distribution of genetically complex strains with hybrid and mito-nuclear discordance in Ecuador.

PCR-Restriction Fragment Length Polymorphism (RFLP) analyses targeting multiple nuclear genes were established for the simple and practical identification of Leishmania species without using expensive equipment. This method was applied to 92 clinical samples collected at 33 sites in 14 provinces of Ecuador, which have been identified at the species level by the kinetoplast cytochrome b (cyt b) gene sequence analysis, and the results obtained by the two analyses were compared. Although most results corresponded between the two analyses, PCR-RFLP analyses revealed distribution of hybrid strains between Leishmania (Viannia) guyanensis and L. (V.) braziliensis and between L. (V.) guyanensis and L. (V.) panamensis, of which the latter was firstly identified in Ecuador. Moreover, unexpected parasite strains having the kinetoplast cyt b gene of L. (V.) braziliensis and nuclear genes of L. (V.) guyanensis, L. (V.) panamensis, or a hybrid between L. (V.) guyanensis and L. (V.) panamensis were identified. This is the first report of the distribution of a protozoan parasite having mismatches between kinetoplast and nuclear genes, known as mito-nuclear discordance. The result demonstrated that genetically complex Leishmania strains are present in Ecuador. Since genetic exchanges such as hybrid formation were suggested to cause higher pathogenicity in Leishmania and may be transmitted by more species of sand flies, further country-wide epidemiological studies on clinical symptoms, as well as transmissible vectors, will be necessary.

Susceptibility to common insecticides and detoxifying enzyme activities in Anopheles sundaicus (sensu lato) after cessation of indoor residual spraying of insecticides in the Jaffna Peninsula and its surroundings in northern Sri Lanka

BackgroundSri Lanka has been malaria-free since 2013 but re-introduction of malaria transmission by infected overseas travelers is possible due to a prevalence of potent malaria vectors. Knowledge of the insecticide resistance status among Anopheles vectors is important if vector control has to be reintroduced in the island. The present study investigated the insecticide susceptibility levels and resistance mechanisms of Anopheles sundaicus (sensu lato) (previously classified as Anopheles subpictus species B) an important malaria vector in the Jaffna Peninsula and it surroundings in northern Sri Lanka after indoor residual spraying of insecticides was terminated in 2013.ResultsSpecies-specific PCR assays identified An. sundaicus (s.l.) in four locations in the Jaffna and adjacent Kilinochchi districts. Bioassays confirmed that An. sundaicus (s.l.) collected in Kilinochchi were completely susceptible to 0.05% deltamethrin and 5% malathion and resistant to 4% dichlorodiphenyltrichloroethane (DDT), whereas those from Jaffna were relatively susceptible to all three insecticides. Kilinochchi populations of An. sundaicus (s.l.) showed significantly higher glutathione S-transferase activity than population from Jaffna. However, Jaffna An. sundaicus (s.l.) had significantly higher Propoxur-resistant acetylcholinesterase activity. Activities of non-specific esterases and monooxygenases were not significantly elevated in An. sundaicus (s.l.) collected in both districts.ConclusionsThe susceptibility to malathion and deltamethrin in An. sundaicus (s.l.) suggests that they can be still used for controlling this potential malaria vector in the Jaffna Peninsula and adjacent areas. Continuing country-wide studies on other malaria vectors and their insecticide susceptibilities are important in this regard.

Country-wide rapid screening for the Mycobacterium tuberculosis Beijing sublineage in Ecuador using a single-nucleotide polymorphism-polymerase chain reaction method.

Strains of the Beijing sublineage of Mycobacterium tuberculosis have caused large outbreaks of tuberculosis, often involving multidrug resistance strains and this genetically highly conserved family of strains predominates in some geographic areas. For most of the countries of Latin America, no country-wide studies about the prevalence of the Beijing lineage are available. In this study, we determine the prevalence of the Beijing sublineage in Ecuador, using a large nation-wide sample of 991 isolates from the years 2014-2016 and with the strains, in case-related-proportional representation, emerging from most of the provinces of the country. The isolates were genotyped with asinglenucleotidespecific polymorphism (SNP) polymerase chain reaction for the Beijing sublineage. SNPpositive strains were confirmed as belonging to this lineage with 24 mycobacterial interspersed repetitive unitvariable number of tandem repeat and DNA sequencing. We identified only four Beijing isolates in this collection of 991 strains and calculated a prevalence rate of 0.43%. Our study shows a limited dissemination of the Beijing strains in the Ecuadorian population. This in contrast with the neighbor countries of Peru and Colombia were locally a prevalence of up to 16% has been reported.

Entrepreneurial intention and regional internationalization in China

This study uses a novel approach to examine the link between regional internationalization and entrepreneurial intention in China. Robust findings suggest that higher degrees of internationalization in locations like Shenzhen and Hong Kong lead to lower levels of entrepreneurial intention, while lower degrees of internationalization in Mainland China lead to higher levels of entrepreneurial intention. This striking result underscores the significance of doing a regional-level analysis rather than countrywide studies for large diverse markets like China, where regional differences in internationalization policies, economic reforms, and institutions tend to vary significantly between locations compared to smaller or more developed economies. We conclude that the relatively higher levels of necessity-based entrepreneurship in China may help explain some of the regional differences observed in total entrepreneurial activity. Our findings also contribute to the literature by revealing significant complexity in the relationship between internationalization and entrepreneurship and support findings of previous studies regarding the importance of location for entrepreneurial intentions in emerging markets like China (as reported by Pan and Yang (Small Business Economics, 2018); Zhu, Lui, He, & Lu et al. (Small Business Economics, 2018b); and Liu et al. (Small Business Economics, 2018)).

In silico Identification of the Indispensable Quorum Sensing Proteins of Multidrug Resistant Proteus mirabilis.

Catheter-associated urinary tract infections (CAUTI) is an alarming hospital based disease with the increase of multidrug resistance (MDR) strains of Proteus mirabilis. Cases of long term hospitalized patients with multiple episodes of antibiotic treatments along with urinary tract obstruction and/or undergoing catheterization have been reported to be associated with CAUTI. The cases are complicated due to the opportunist approach of the pathogen having robust swimming and swarming capability. The latter giving rise to biofilms and probably inducible through autoinducers make the scenario quite complex. High prevalence of long-term hospital based CAUTI for patients along with moderate percentage of morbidity, cropping from ignorance about drug usage and failure to cure due to MDR, necessitates an immediate intervention strategy effective enough to combat the deadly disease. Several reports and reviews focus on revealing the important genes and proteins, essential to tackle CAUTI caused by P. mirabilis. Despite longitudinal countrywide studies and methodical strategies to circumvent the issues, effective means of unearthing the most indispensable proteins to target for therapeutic uses have been meager. Here, we report a strategic approach for identifying the most indispensable proteins from the genome of P. mirabilis strain HI4320, besides comparing the interactomes comprising the autoinducer-2 (AI-2) biosynthetic pathway along with other proteins involved in biofilm formation and responsible for virulence. Essentially, we have adopted a theoretical network model based approach to construct a set of small protein interaction networks (SPINs) along with the whole genome (GPIN) to computationally identify the crucial proteins involved in the phenomenon of quorum sensing (QS) and biofilm formation and thus, could be therapeutically targeted to fight out the MDR threats to antibiotics of P. mirabilis. Our approach utilizes the functional modularity coupled with k-core analysis and centrality scores of eigenvector as a measure to address the pressing issues.

Country-wide seroprevalence studies on Crimean-Congo hemorrhagic fever and hantavirus infections in general population of Bulgaria.

Crimean-Congo hemorrhagic fever (CCHF) and hantavirus infections are the two viral hemorrhagic fevers spread in Europe. To test actual circulation of CCHF virus (CCHFV) and hantaviruses in Bulgaria, we conducted country-wide seroepidemiological studies. Serum samples were collected prospectively from 1500 residents of all 28 districts in Bulgaria. CCHFV seroprevalence of 3.7% was revealed. Anamnesis for tick bites, contact with livestock, age over 40 years and residency in Haskovo district were found as risk factors. The highest CCHFV seroprevalence was observed in the known endemic districts in southeastern Bulgaria: Haskovo (28%) and Yambol (12%). Reactive samples were found in residents of 20 of the 28 districts in Bulgaria. In comparison with the previous studies, the data presented indicate that CCHFV increased substantially its circulation in the endemic regions and was introduced in many new areas. Hantavirus seroprevalence was based on results of the immunoblot and estimated as 3.1%. Surprisingly, contrary to all available data, Puumala virus seroprevalence rate was 2.3% versus 0.8% of Dobrava-Belgrade virus. Evidence for hantavirus IgG seropositivity was found in residents of 23 of the 28 districts in the country. The first hantavirus seroprevalence study in Bulgaria showed that Puumala virus is probably more wide-spread in the country than Dobrava-Belgrade virus.

Indirect industrial effects from space investments

Abstract Many impact assessments have been carried out to evaluate the economic and social effects of public investments in space. This paper focuses on ex post analyses of indirect industrial (intra-firm) effects, a sub-type of the impact assessments. A number of existing country-wide analyses report the ratio of the indirect industrial effects deriving from space-related contracts to the value of the space-related contracts placed with companies by governmental agencies (in Europe, mostly by the European Space Agency). This ratio is a widely accepted measure of the economic impact of the space contracts. The aim of this paper is to assess the usefulness of the ratio, a spin-off multiplier, for international benchmarking of the efficiency of space investments. The paper is the first attempt to provide an in-depth analysis of the methodological foundations of different country-wide studies on the spin-off multiplier performed in Europe. The country-wide studies have formulated different metrics and relied on different approaches to gathering quantitative data. The current paper discusses data quality issues that may result in a biased estimate of the spin-off multiplier. Data gathering techniques used in the studies tend to result in overestimated economic benefits. Even though the values of the spin-off multipliers are high in countries like Norway or Denmark, the confidence interval of the estimates is wide. The paper discusses time considerations to be taken into account for a standardized ratio as there is a time lag of several years until research and development becomes operative. Despite several methodological limitations, measuring the indirect industrial effects is a valuable tool for governments, especially for smaller ESA member states, as such studies can be implemented at low cost and provide information on spillovers from space programmes.

Systematic review of brucellosis in Kenya: disease frequency in humans and animals and risk factors for human infection.

BackgroundBrucellosis is a debilitating zoonotic disease affecting humans and animals. A comprehensive, evidence-based assessment of literature and officially available data on animal and human brucellosis for Kenya are missing. The aim of the current review is to provide frequency estimates of brucellosis in humans, animals and risk factors for human infection, and help to understand the current situation in Kenya.MethodsA total of accessible 36 national and international publications on brucellosis from 1916 to 2016 were reviewed to estimate the frequency of brucellosis in humans and animals, and strength of associations between potential risk factors and seropositivity in humans in Kenya.ResultsThe conducted studies revealed only few and fragmented evidence of the disease spatial and temporal distribution in an epidemiological context. Bacteriological evidence revealed the presence of Brucella (B.) abortus and B. melitensis in cattle and human patients, whilst B. suis was isolated from wild rodents only. Similar evidence for Brucella spp infection in small ruminants and other animal species is unavailable. The early and most recent serological studies revealed that animal brucellosis is widespread in all animal production systems. The animal infection pressure in these systems has remained strong due to mixing of large numbers of animals from different geographical regions, movement of livestock in search of pasture, communal sharing of grazing land, and the concentration of animals around water points. Human cases are more likely seen in groups occupationally or domestically exposed to livestock or practicing risky social-cultural activities such as consumption of raw blood and dairy products, and slaughtering of animals within the homesteads. Many brucellosis patients are misdiagnosed and probably mistreated due to lack of reliable laboratory diagnostic support resulting to adverse health outcomes of the patients and routine disease underreporting. We found no studies of disease incidence estimates or disease control efforts.ConclusionThe risk for re-emergence and transmission of brucellosis is evident as a result of the co-existence of animal husbandry activities and social-cultural activities that promote brucellosis transmission. Well-designed countrywide, evidence-based, and multidisciplinary studies of brucellosis at the human/livestock/wildlife interface are needed. These could help to generate reliable frequency and potential impact estimates, to identify Brucella reservoirs, and to propose control strategies of proven efficacy.

Spatial and Temporal Clustering of Anti-Glomerular Basement Membrane Disease.

An environmental trigger has been proposed as an inciting factor in the development of anti-GBM disease. This multicenter, observational study sought to define the national incidence of anti-GBM disease during an 11-year period (2003-2014) in Ireland, investigate clustering of cases in time and space, and assess the effect of spatial variability in incidence on outcome. We ascertained cases by screening immunology laboratories for instances of positivity for anti-GBM antibody and the national renal histopathology registry for biopsy-proven cases. The population at risk was defined from national census data. We used a variable-window scan statistic to detect temporal clustering. A Bayesian spatial model was used to calculate standardized incidence ratios (SIRs) for each of the 26 counties. Seventy-nine cases were included. National incidence was 1.64 (95% confidence interval [95% CI], 0.82 to 3.35) per million population per year. A temporal cluster (n=10) was identified during a 3-month period; six cases were resident in four rural counties in the southeast. Spatial analysis revealed wide regional variation in SIRs and a cluster (n=7) in the northwest (SIR, 1.71; 95% CI, 1.02 to 3.06). There were 29 deaths and 57 cases of ESRD during a mean follow-up of 2.9 years. Greater distance from diagnosis site to treating center, stratified by median distance traveled, did not significantly affect patient (hazard ratio, 1.80; 95% CI, 0.87 to 3.77) or renal (hazard ratio, 0.76; 95% CI, 0.40 to 1.13) survival. To our knowledge, this is the first study to report national incidence rates of anti-GBM disease and formally investigate patterns of incidence. Clustering of cases in time and space supports the hypothesis of an environmental trigger for disease onset. The substantial variability in regional incidence highlights the need for comprehensive country-wide studies to improve our understanding of the etiology of anti-GBM disease.

Latent Tuberculosis in Health Care Workers Exposed to Active Tuberculosis in a Tertiary Care Hospital in Oman.

Data on the prevalence of tuberculosis (TB) in healthcare workers (HCW) in Oman and the Arabian Gulf is scarce. The aim of this study was to estimate the prevalence of latent tuberculosis (LTB) among HCW exposed to active TB in one of the tertiary care hospitals in Muscat. Exposed HCW were screened for LTB from January to June 2012 using skin tuberculin and serum interferon tests. Candidates were followed-up for a total of nine months. Descriptive statistics were used to summarize the data. A total of 371 exposed HCW were involved in the study. The incidence of LTB in exposed HCW was 33.2% (n = 123). Almost 54% (66/123) of the HCW started treatment and only 42.4% (28/66) completed the full nine-month treatment course. The high prevalence of LTBI in exposed HCW merits further evaluation of the screening and treatment programs in the country. Future countrywide studies are warranted to provide more precise statistics on the prevalence and management of this public health issue.

The Welfare of Bears in Zoos: A Case Study of Poland

The welfare of captive bears became a big issue of concern in Poland when a case of a bear being ill-treated became a high-profile case in the media. This case created a challenge to verify, study, and understand the main problems associated with bear keeping so that zoos could significantly improve the conditions in which they keep bears or ensure they keep bears at the minimum required standards. The results presented here are from 1 of the few countrywide studies of captive bear conditions conducted in all the captive institutions in Poland that keep bears. Thirteen institutions kept bears at the time of the study (2007–2009), including 54 individuals of 5 species. Major welfare problems were identified, and the results have been used to challenge zoos to address the changes required and focus the government's attention on areas that require legislative improvement.

The role of individual adaptive practices for sustainable adaptation

Purpose – This paper aims to investigate the strategies used by Swedish citizens to adapt to changing climate variability and extremes. There is an increasing consensus that individual adaptive capacities are critical to successfully adapt to climate change and achieve sustainable development. However, little is known about individual adaptive practices, particularly in developed countries. Design/methodology/approach – The study covered a variety of geographical areas and included single-case studies of specific locations, cross-case studies and country-wide studies. Data were collected through literature review, interviews with at-risk people, observation and group discussions with municipal staff. Findings – The paper provides an overview of Swedish citizens’ adaptive practices and highlights how institutional development efforts affect individuals and their activities, including the equitable distribution of adaptation needs and resources. The paper concludes that individual adaptive capacities do not necessarily translate into adaptation. Practical implications – The results show that planned interventions are required. They emphasise the importance of more people-oriented adaptation planning that fosters the sustainable transformation of cities, together with the role that South-North knowledge transfer can play in this context. Originality/value – The paper offers critical insights into the positive and negative effects of citizens’ adaptation strategies (based on criteria such as effectiveness, sustainability and equity), and it discusses their relevance in the formulation of development policies and programmes.

Roadmap for elimination of gastric cancer in Korea.

Most gastric cancers are caused by infection with the common human bacterial pathogen, Helicobacter pylori. It is now accepted that gastric cancer can be prevented and virtually eliminated by H. pylori eradication and this knowledge was responsible for country-wide H. pylori eradication combined with secondary cancer prevention for those with residual risk that was introduced in Japan in 2013. Korea is a high H. pylori prevalence and high gastric cancer incidence country and a good candidate for a gastric cancer elimination program. The presence of an H. pylori infection is now considered as an indication for treatment of the infection. However, antimicrobial drug resistance is common among H. pylori in Korea making effective therapy problematic. Country-wide studies of the local and regional antimicrobial resistance patterns are needed to choose the most appropriate therapies. H. pylori and gastric cancer eradication can be both efficient and cost effective making it possible and practical to make Korea H. pylori and gastric cancer free. There is no reason to delay.

Federal Rivers – Managing Water in Multi-Layered Political Systems by Dustin Garrick, George R. M. Anderson, Daniel Connell and Jamie Pittock. 2014, hardback, 384 pages, Edwin Elgar Publishing, Cheltenham, UK. ISBN: 978-1-78195-504-8

As this book clearly illustrates, the regulation of rivers within federations presents a set of unique challenges. Federalism, with government power shared between the national government and provincial (sub-national) governments, potentially adds a layer of complexity to water resource management. Where rivers flow through more than one province, tensions can develop between the national and provincial governments, and also between two or more provincial governments, as to the way in which those waters are regulated. This edited collection is the product of a workshop hosted at the University of Oxford in 2012, bringing together experts on water policy and reform from the Americas, Asia, Africa, Europe and Australia. The chapters in this collection provide a series of case studies examining water resource management in ten countries, which provides breadth to this collection. Each chapter then provides great depth and detail of the water policy and political system of the country that it examines. The book is divided into 21 chapters. The 17 case studies, which include basin-specific studies and country-wide studies, are bookended by two introductory chapters and two concluding chapters. These opening and concluding chapters identify some of the themes that flow through the case studies. In doing so, these chapters demonstrate that some of the challenges faced in regulating rivers in countries with a federal system of government are common across a number of countries. However, each federation, with its own constitutional framework, will also have its own unique challenges. In Chapter 1 the editors (D. Garrick, G. Anderson, D. Connell and J. Pittock) provide an overview of water governance challenges in federal systems and identify two themes that permeate the case studies: first, ‘the increasing need for integrated water resource management and water security in federal rivers’; second, ‘the capacity of federal water management arrangements to respond …

Population-based analysis of tonsil surgery and postoperative hemorrhage.

Although tonsil surgery is one of the most frequent otorhinolaryngological procedures, not many population-based regional or country-wide studies are published on the incidence of postoperative bleeding and its risk factors. 2,216 patients underwent tonsil surgery in 2012 in Thuringia, a federal state in Germany. Most frequent indications were recurrent tonsillitis (44 % of all cases), tonsillar abscess (27 %), and tonsillar hyperplasia (20 %). 29 % of the patients were <10 years of age. Most frequent methods of surgery were tonsillectomy (73 %) and tonsillotomy (19 %). 215 patients (10 %) had 221 events of a postoperative hemorrhage. Re-surgery for hemostasis was necessary in 137 patients (6 %). The interval to re-surgery was 4.4 ± 4.6 days. The re-surgery rate was 8, 0.2, and 15 % after tonsillectomy, tonsillotomy, and radical tonsillectomy, respectively. In cases of recurrent tonsillitis, male gender (p < 0.001), age >24.78 years (median; (p = 0.018), and waiving of perioperative antibiotics (p = 0.029) were independent factors associated with hemorrhage. In cases of tonsillar hyperplasia tonsillectomy instead of tonsillotomy, the only significant risk factor was postoperative hemorrhage (p = 0.005). The overall incidence of tonsillar surgery was 87.6/100,000. The highest incidence was seen for patients 3-4 years of age with 862.7/100,000. In children <10 years, the incidence was always higher for boys than for girls. Throughout all age groups, a reverse gender relation was only seen, if surgery was indicated for recurrent tonsillitis. We recommend establishing national guidelines for indication of tonsil surgery, especially of tonsillectomy, including recommendations for perioperative care to decrease variations in tonsil surgery rates and minimize postoperative complications.

Evaluation of assaults on doctors in Canakkale within the last year

Evaluation of assaults on doctors in Canakkale within the last year Objective: Violence against doctors and health professionals in the healthcare environment is thought to have increased in recent years. Although physical and verbal assaults in the health care system have been evaluated in many different aspects, a limited amount of research has been done in this field in our country. For this reason, we aimed to investigate assaults towards doctors working at the Canakkale State Hospital and Canakkale Onsekiz Mart University in Turkey. Method: A questionnaire was prepared by researchers assessing assaults within the last year on doctors working in the state and university hospitals. Data from 130 doctors who agreed to participation in the study were analysed with SPSS version 16. Descriptive statistics, independent sample T-test for normally distributed variables and Mann-Whitney U test for non-normally distributed variables were used to compare the groups. Results: We found that 59.2% (n=77) of the doctors were verbally and/or physically assaulted at least once during the past year. The majority of attackers consisted of relatives of patients (40.8% verbal attack, n=31). The verbal assaults mostly occurred in outpatient clinics (61.5%), with half of the physical assaults occurring in the emergency department. The vast majority of doctors considered that poor health policies were the most important reason for assaults (83.3%, n=65), and nearly all of them thought that violence towards doctors has increased in recent years (97.4%). Conclusion: The fact that most of the doctors exposed to assaults, regardless of gender, institution, or work position, perceived health policies as being responsible for this violent atmosphere, is very striking. We believe that larger sample-size and comprehensive countrywide studies in this area would help to provide solutions for this problem.

Visiškai nuo alkoholio priklausančio ligotumo pokyčiai Lietuvoje 2006-2011 metais

Harmful use of alcohol is causing many negative effects, and it is essential to continuously analyze the burden of alcohol in countrywide and international studies. Alcohol is attributable to more than 50 health conditions, which may be partly or fully caused by alcohol. Methods. The aim of the study was to evaluate the change of prevalence of fully alcohol attributable conditions during the period of 2006-2011. The research was performed in collaboration with the State Mental Health Center, and the analysis was based on the summarized prevalence rate data originally received from the Lithuanian morbidity database SVEIDRA. The analysis covers the prevalence data based on 20 fully alcohol attributable conditions. Results. In 2007 the prevalence of fully alcohol attributable conditions reached its peak. In 2008 and 2009 it had declined, and in 2010 and 2011 it had started to rise again. The close links may be drawn between prevalence of alcohol attributable conditions and overall alcohol consumption in Lithuania. In 2007 the significant toughening of alcohol control policy has been introduced that came into effect in 2008 and 2009, and resulted into the decline of alcohol consumption. In 2006-2011 the prevalence of fully alcohol attributable conditions was in average 4 times higher among men than among women, and reached its peak in people between 45 and 54 years old. Article in Lithuanian

Social correlates of clotting disorders in adults and the very old: UK Understanding Society cohort, 2009–2010

Dear Editor, In spite of biological risk factors for coagulopathy [1], social correlates could also play a role. However, research in this area is rather scarce, and national population-based studies are limited. Therefore, it was aimed to understand social correlates of clotting disorders for adults and the very old in two compatible country-wide population-based studies in the UK (Scottish Health Survey and Health Survey for England in 2003). Study design and sampling method were described and published in detail elsewhere [2, 3]. Information on demographics, living and work conditions, and selfreported clotting disorders was obtained by household interview (Question: May I just check, do you have a clotting or clotting disorder or are currently on anticoagulant drugs such as Warfarin?). In the current analysis, only participants aged 16 and above were included. Analysis included logistic regression modeling. Adjustments were made to control for covariates mentioned above. Effects were estimated by using odds ratios (OR) and 95 % confidence intervals (CI) with P value <0.05 considered statistically significant. Statistical software STATA version 12.0 (STATA, College Station, TX, USA) was used to perform all the analyses. Since it is a secondary data analysis in the present study, no further ethics approval is required. In the year 2003, there were 316 (1.9 %) people who had ever clotting disorders. In Table 1a, unfortunately, social factor was not observed to be associated with clotting disorders among the very olds. In adults aged 16–79 (see Table 1b), however, it was shown that body mass index (BMI) ≥30 (OR 1.62, 95 % CI 1.09–2.39, P =0.02), being widowed (OR 2.28, 95 % CI 1.19–4.37, P =0.01), and not having regular exercise (OR 2.01, 95 % CI 1.41–2.88, P <0.001) were significantly associated with higher risk of clotting disorders. On the other hand, a protective effect from annual household income was noted. People whose annual household income was in the range of £18,200–52,000 (OR 0.52, 95 % CI 0.36–0.74, P < 0.001) or £52,000–99,999 (OR 0.42, 95 % CI 0.22–0.83, P = 0.01) had a lower risk of clotting disorders compared to those whose annual household income was in the range of £0–18, 200. In the present study, recent evidence on significant associated social factors for clotting disorders among adults and the very olds in Scotland and England was provided. Although it is not new to know that BMI and physical activity are related to risk of clotting disorders, additionally, it was observed that marital status also played a role in risk of clotting disorders in adults for the first time. To be specific, widowed people tended to be older and less physically active. Methodologically, this has revealed that in previous studies, marital status was not carefully examined and blinded by the advancing age and/or physical activity. After regrouping the study participants into adults aged 16–79 and the very old aged 80 and above, we have observed a significant effect of marital status on adults aged 16–79 in our study. From a public health perspective, intervention programs or supportive groups targeting helping relieve pains and grieves I. Shiue (*) School of the Built Environment, Heriot–Watt University, Riccarton, EH14 4AS Edinburgh, Scotland, UK e-mail: i.shiue@hw.ac.uk

The Effect of a Statewide Smoking Ordinance on Acute Myocardial Infarction Rates

Public smoking ordinances may reduce acute myocardial infarction events. Most studies assessed small communities with reported reductions as high as 40%. No reduction or smaller reductions were found in countrywide studies; less is known about the impact of statewide ordinances. We previously demonstrated identical 27% reductions in acute myocardial infarction hospitalizations in 2 Colorado communities after enactment of strict smoking ordinances. Subsequently, on July 1, 2006, a statewide ordinance went into effect. We sought to determine the impact of this legislation on acute myocardial infarction hospitalization rates. Hospital admissions for a primary acute myocardial infarction diagnosis were examined from 2000 to 2008. Poisson regression models were fit to the monthly events from January 1, 2000, to March 31, 2008. The final model included a quadratic trend over time, harmonic terms, and a post-ordinance effect. The model was adjusted temporally for population changes, using population estimates as an offset variable. A total of 58,399 unique acute myocardial infarctions were recorded during the study period. No significant reduction in acute myocardial infarction rates was observed post-ordinance (relative risk, 1.059; 95% confidence interval, 0.993-1.131). However, a steep decline in acute myocardial infarction rates was noted from 2000 to 2005 just before enactment. There were 11 strict, local smoking ordinances in effect within Colorado before enactment of the statewide ordinance. After excluding these communities, the findings were similar (relative risk, 1.038; 95% confidence interval, 0.971-1.11). Although local smoking ordinances in Colorado previously suggested a reduction in acute myocardial infarction hospitalizations, no significant impact of smoke-free legislation was demonstrated at the state level, even after accounting for preexisting ordinances.

THU0366 Does being a hepatitis B virus carrier decrease applying to hospital in patients with rheumatoid arthritis and ankylosing spondylitis?

BackgroundImmunosupressive therapy, especially tumor necrosis factor-α (TNF-α) inhibitors can induce viral reactivation and potentially fatal liver failure in patients with concurrent Hepatitis B virus (HBV) or Hepatitis C virus (HCV)...