High-risk Population Groups Research Articles

Results of a Single Center's Stenting Procedure for the Treatment of Carotid Stenosis

Stenting may be a safer alternative to endarterectomy for treating carotid artery stenosis (CAS), but its long-term efficacy is uncertain. There is a lack of long-term and noncontrolled clinical trial data that reflects "real-world" CAS. This study aimed to analyze the long-term efficacy and safety of our center's CAS procedure. We retrospectively analyzed our database of patients who underwent CAS. Patient demographic data, previous risk factors, diagnostic and procedural information, and clinical and image follow-up data were collected from up to 1 year after treatment. Overall, 187 patients were analyzed. Our patient population largely comprised higher-risk patients compared with the patient populations of randomized controlled trials. We had more symptomatic (n= 145, 77.5%) than asymptomatic patients (n= 42, 22.5%), and 49% of patients had >90% stenosis. By the 30-day follow-up, there were 10 major adverse events (5.3%) observed in 8 patients (4.2%), including 7 strokes (3 ischemic and 4 hemorrhagic) and 3 deaths. By the 1-year follow-up, 6 strokes and 5 deaths occurred in 9 patients (4.8%), and color Doppler control showed that 87.6% of patients had stenosis-free stents. Despite our high-risk population group, there were high rates of successful stent placement, low complication rates, good clinical outcomes, and low rates of stenting restenosis.

Prevalence and Determinants of Soil Transmitted Helminthes Infections among Primary School Children in Kerewo Town, Gena Bossa Woreda, Ethiopia: Cross Sectional Study

Soil-Transmitted Helminthes (STH) infection is a major public health problem among school-aged children in developing countries. In Ethiopia, school aged children have been identified as high risk group of population to be infected with Soil Transmitted Helminthes. Effective prevention and control of STH infection requires identification of risk factors among high risk groups.

Meningococcal vaccines in Australia: a 2019 update.

SUMMARYInvasive meningococcal disease is a rare but serious infection caused by Neisseria meningitidisSerogroup B was the predominant serogroup causing invasive meningococcal disease in Australia until 2015. Serogroup W disease has increased substantially since 2014, and in 2017, serogroups B and W caused similar numbers of invasive disease casesVaccines against serogroups A, C, W, Y and B are available for anyone who wishes to reduce the risk of meningococcal diseaseVaccination is strongly recommended for people in high-risk age or population groups. These are children under 2 years, 15–19 year olds, Aboriginal and Torres Strait Islander children, and people with medical, occupational, behavioural or travel-related risk factors for invasive meningococcal diseaseMeningococcal ACWY vaccine is funded under the National Immunisation Program for babies aged 12 months. Since April 2019, it has been funded for year 10 students through a school program. There are additional state and territory-based programs for both meningococcal ACWY and meningococcal B vaccines

Prevalence of Metabolic Syndrome in Professional Drivers

Background: Metabolic syndrome (MetS) is known as an important predictor of cardiovascular mortality, which has recently increasing among professional drivers. Objectives: The present study was carried out to determine the prevalence of MetS and some related components among taxi and bus drivers in Zahedan, because they have the working conditions and unusual lifestyles that can increases the risk of Mets. Methods: In a cross-sectional study, 500 male taxi and bus drivers were randomly selected. Waist circumference (WC), blood pressure, lipid profile and fasting blood sugar (FBS) levels were measured. The MetS was defined using criteria of Iranian National Committee of Obesity (INCO). Results: The prevalence of MetS among taxi and bus drivers was 20% and 29.5%, respectively. The most frequent components contributing to MetS in taxi drivers were high triglyceride (81.4%), low HDL-C (high-density lipoprotein-cholesterol) (81.4%) and central obesity (64.4%); while in the bus drivers were central obesity (75%), high fasting blood glucose (73.3%) and high triglyceride (76.7%). By increasing age, driving duration and decreasing physical activity, odds ratio of MetS was increased. Conclusions: The findings show that drivers are in high risk population groups for MetS and its complications. Thus, the substantial changes in lifestyle and educational programs implementation for promotion of their public health may be able to reduce the MetS risk and disease consequences.

A 5-year study of human parechoviruses in children living in bad sanitation conditions and non-polio acute flaccid paralysis children from Greece.

In Greece, data for human parechoviruses (HPeVs) are scarce and our aim was to conduct a large scale study to determine for the first time their occurrence. Under the spectrum of surveillance, we retrospectively screened stool specimens obtained from 71 children with acute flaccid paralysis (AFP) symptoms and from 311 individuals in high-risk population groups such as children living in bad sanitation conditions for HPeVs presence by rRT-PCR targeting the 5' UTR. All positive samples were then genotyped by targeting the HPeVs VP1 region. Totally, 15/311 (5%) stool samples from children living in bad sanitation conditions and 4/71 (6%) from the non polio AFP children were positive for HPeVs. Sequencing analysis revealed that genotypes HPeV1 (n = 4/15), HPeV5 (n = 2/15), and HPeV6 (n = 2/15) were circulating among Roma children population whereas HPeV1 (n = 1/4) and HPeV5 (n = 1/4) were circulating in children with AFP-like symptoms. We did not obtain a seasonality motive among HPeV1 or HPeV5 genotypes whereas HPeV6 was detected only in July. Phylogenetic analysis showed that Greek HPeVs strains are clustered together with HPeV strains circulating in other European countries during the same period. We describe the presence of HPeVs in Greece, and we enforce that their diagnosis should be considered in children with neurological outcome such as non-polio AFP.

Health Equity in National Cancer Control Plans: An Analysis of the Ontario Cancer Plan.

Background: National cancer control plans (NCCPs) are important documents that guide strategic priorities in cancer care and plan for the appropriate allocation of resources based on the social, geographic and economic needs of a population. Despite the emphasis on health equity by the World Health Organization (WHO), few NCCPs have a focus on health equity. The Ontario Cancer Plan (OCP) IV, (2015 to 2019) is an example of an NCCP with clearly defined health equity goals and objectives. Methods: This paper presents a directed-content analysis of the OCP IV health equity goals and objectives, in light of the synergies of oppression analytical framework. Results: The OCP IV confines equity to an issue of access-to-care. As a result, it calls for training, funding, and social support services to increase accessibility for high-risk population groups. However, equity has a broader definition. And as such, it also implies that systematic differences in health outcomes between social groups should be minimal. This is particularly significant given that socially disadvantaged cancer patients in Ontario have distinctly poorer cancer-related health outcomes. Conclusion: Health systems are seeking ways to reduce the health equity gap. However, to reduce health inequities which are socially-based will require a recognition of the living and working conditions of patients which influence risk, mortality and survival. NCCPs represent a way to politically advocate for the determinants of health which profoundly influence cancer risk, outcomes and mortality.

What is the effect of interrupting prolonged sitting with frequent bouts of physical activity or standing on first or recurrent stroke risk factors? A scoping review.

The objective of this review was to ascertain the scope of the available literature on the effects of interrupting prolonged sitting time with frequent bouts of physical activity or standing on stroke and recurrent stroke risk factors. Databases Medline, Embase, AMED, CINAHL and Cochrane library were comprehensively searched from inception until 21st February 2018. Experimental trials which interrupted sitting time with frequent bouts of physical activity or standing in adults (≥ 18 years) were included. Comparison to a bout of prolonged sitting and a measure of at least one first or recurrent stroke risk factor was required to be included. Overall, 30 trials (35 articles) were identified to meet the inclusion criteria. Fifteen trials were completed in participants at an increased risk of having a first stroke and one trial in participants at risk of a recurrent stroke. Outcomes of hypertension and dysglycemia were found to be more favourable following predominately light- to moderate-intensity bouts of physical activity or standing compared to sitting in the majority of trials in participants at risk of having a first stroke. In the one trial of stroke survivors, only outcomes of hypertension were significantly improved. These findings are of significant importance taking into consideration hypertension is the leading risk factor for first and recurrent stroke. However, trials primarily focused on measuring outcomes of dysglycemia and without assessing a dose-response effect. Additional research is required on the dose-response effect of interrupting sitting with frequent bouts of physical activity or standing on first and recurrent stroke risk factors, in those high risk population groups.

Meningococcal serogroups and surveillance: a systematic review and survey.

BackgroundMeningococcal disease continues to be a global public health concern due to its epidemic potential, severity, and sequelae. The global epidemiological data on circulating meningococcal serogroups have never been reviewed concurrently with the laboratory capacity for meningococcal surveillance at the national level. We, therefore, aimed to conduct a country-level review of meningococcal surveillance, serogroup distribution, and vaccine use.MethodsWe conducted a systematic literature review across six databases to identify studies (published January 1, 2010 to October 16, 2017) and grey literature reporting meningococcal serogroup data for the years 2010-2016. We performed independent random effects meta-analyses for serogroups A, B, C, W, X, Y, and other. We developed and circulated a questionnaire-based survey to surveillance focal points in countries (N = 95) with known regional bacterial meningitis surveillance programs to assess their surveillance capacity and summarized using descriptive methods.ResultsWe included 173 studies from 59 countries in the final analysis. The distribution of meningococcal serogroups differed markedly between countries and regions. Meningococcal serogroups C and W accounted for substantial proportions of meningococcal disease in most of Africa and Latin America. Serogroup B was the predominant cause of meningococcal disease in many locations in Europe, the Americas, and the Western Pacific. Serogroup Y also caused many cases of meningococcal disease in these regions, particularly in Nordic countries. Survey responses were received from 51 countries. All countries reported the ability to confirm the pathogen in-country, while approximately 30% either relied on reference laboratories for serogrouping (N = 10) or did not serogroup specimens (N = 5). Approximately half of countries did not utilize active laboratory-based surveillance system (N = 22). Nationwide use of a meningococcal vaccine varied, but most countries (N = 36) utilized a meningococcal vaccine at least for certain high-risk population groups, in private care, or during outbreaks.ConclusionsDue to the large geographical variations in circulating meningococcal serogroups, each country should continue to be monitored for changes in major disease-causing serogroups in order to inform vaccine and control policies. Similarly, laboratory capacity should be appropriately scaled up to more accurately understand local epidemiology and disease burden, as well as the impact of vaccination programs.

Sero-Mapping of HBV, HCV, HSV2 and Syphilis Across Regions in Kenya

This study was funded by Internal Research Grants of the Kenya Medical Research Institute. We acknowledge support from director KEMRI and institutions that participated in this study. Abstract Hepatitis B and C,herpes Simplex Virus 2 and syphilis are important infections that share common modes of transmission. The global burden of these infections and their occurrence as co-infection of HIV in high risk population groups calls for more attention in control and management. While HIV has been a program priority disease in many low resource settings, hepatis B and C have not had as much attention. Yet there is substantial indication that transmission of hepatitis, herpes virus 2 and syphilis is on the increase. This study aimed at determining the prevalence of hepatitis B, hepatitis C, Herpes simples virus 2 and syphilis and their distribution across different regions in Kenya. Samples were collected from HIV positive study participants in 11 counties (out of total 47) distributed in 7 out of the 8 regions (provinces).A total of 1829 samples were tested for the 4 infections and their distribution analysised. Mapping of the infection was presented by study sites and regions . Overall prevalence of HSV2 was the highest (at 50%) followed by that of HBV (29%) and HCV and Syphilis (14% repectively). Majority of study participants (71%) had co-infections while the rest of the study participants (29%) had none of the four infections. Western and Nyanza regions of the country had higher prevalence of HBV (above 31%). Sero-prevalence of HCV across the regions ranged between 8 to 19 percent. Syphilis sero-prevalence was highest in western and Nyanza region (Range 18% to 26%) compared to other regions (4% to15%), the lowest prevalence was in Central region. Distribution of HSV2 indicated Nairobi was leading at 62%, Central at 48.5% and Rift Valley at 47.5%. Lowest prevalence of HSV2 was at eastern region with an average of 29%. There was significant relation between infections and study sites. Since routine testing for HBV, HCV and HSV is not readily available, there is need to develop a strategy for prevention and control of these infections. Integration of services would be an important consideration in this regard. Keywords: HBV, HCV, HSV, Syphilis, prevalence, co-infection, distribution DOI : 10.7176/JBAH/9-12-06 Publication date :June 30 th 2019

The impact of dental status on perceived ability to eat certain foods and nutrient intakes in older adults: cross-sectional analysis of the UK National Diet and Nutrition Survey 2008\u20132014

BackgroundMany factors determine dietary intake in older adults, including physical health, psychological well-being and socio-economic status. Dental status may also be important. The aim was to examine how dental status impacts perceived ability to eat to certain foods, nutrient intake and nutritional status in UK older adults.MethodsData collected by the National Diet and Nutrition Survey Rolling Programme was analysed. A 4-day food diary assessed dietary intake, while a Computer Assisted Personal Interview collected socio-demographic, health behaviour and oral health information. Participants aged 65 years and over (n = 1053) were categorised into three groups according to their dental status: edentate with dentures (E-DEN, n = 292), dentate with dentures (D-DEN, n = 305) or dentate with no dentures (DEN, n = 456). A total of 515 participants provided a blood sample that was used to assess nutrient concentrations including vitamin B12, vitamin C, ferritin, vitamin B6 (pyridoxal-5-phosphate, PLP), retinol, β-carotene and 25-hydroxyvitamin D (25-OH-D). Multiple regression methods were performed to examine cross-sectional associations between dental status, food selection, nutrient intake and nutritional status.ResultsBoth E-DEN and D-DEN groups, compared with the DEN group, were more likely to report difficulty eating apples, raw carrots, lettuce, nuts, well-cooked steak and crusty bread (P < 0.01). No group differences were observed in perceived ability to eat sliced bread, sliced cooked meats and cheese. The E-DEN group compared with the DEN group had lower mean daily intakes of omega 3 fatty acids (P = 0.006), non-starch polysaccharides (P = 0.001), β-carotene (P = 0.001), folate (P = 0.001), vitamin C (P = 0.008), magnesium (P < 0.001) and potassium (P < 0.001), and had lower plasma vitamin B6 PLP (P = 0.001), vitamin C (P = 0.009) and β-carotene (P = 0.015) concentrations, after adjusting for socio-demographic and health behavioural factors. Compared with the DEN group, the D-DEN group did not have lower nutrient intakes or lower blood nutrient concentrations.ConclusionsWithin this sample of older adults, impaired dental status appears to influence food selection, and intake of important nutrients. Future research should focus on developing dental interventions coupled with dietary counselling to encourage the adoption of healthy eating habits in this high-risk population group.

Respiratory Virus Infections in People Over 14 Years of Age in Poland in the Epidemic Season of 2017/18.

People most at risk of influenza complications are the elderly with impaired immunity. Clinical picture of influenza virus infection includes symptoms such as chills, increased body temperature, dry cough, chest pain, or dizziness as well as headaches and muscle aches. In the diagnosis of influenza, quick and effective tests are necessary. Sensitive diagnostic methods of molecular biology require more time, but the result firmly confirm or exclude the presence of the genetic material of influenza or other respiratory viruses. Influenza vaccination plays an important role in combating influenza infection. Unfortunately, the awareness of vaccination benefits is insufficient in Poland. In this study we demonstrate the results of examination of 4,507 people aged over 14 years toward the influenza infection in the epidemic season of 2017/18. Most of the confirmed infections were reported in older people aged over 65, a high-risk population group. A low percentage of the vaccinated population may affect an increased number of confirmed influenza viruses in the elderly. The findings demonstrate a need to increase awareness of vaccination benefits, which is particularly essential to avoid influenza infection in the elderly.

Aflatoxins in rice: Worldwide occurrence and public health perspectives.

Aflatoxins are fungal secondary metabolites that contaminate dietary staples worldwide, including maize, rice and groundnuts. Dietary exposure to aflatoxins is a public health concern due to their carcinogenic, acute and chronic effects. Rice is an important staple food consumed widely and consists of a major part of the diets for half of the world population. Human exposure to these mycotoxins is a serious problem especially in developing countries where hot and humid climates favor the fungal growth and where food storage conditions are poor and lack of regulatory limits enforcement. The recent developments of biomarkers have provided opportunities in assessing aflatoxins exposure and related health effects in the high-risk population groups. This review describes the worldwide occurrence of aflatoxins in rice during the period from 1990 to 2015 and biomarkers-based evidence for human exposure to aflatoxins and their adverse health effects. Aflatoxin is a potent hepatocarcinogen and humans may expose to it at any stage of life. Epidemiological studies reported an association between aflatoxin intake and the incidence of hepatocellular carcinoma in some sub-Saharan and Asian countries. Even daily high intake of rice with a low level of contamination is of health concern. Thus, it is necessary to implement effective strategies to prevent contamination and fungal growth in rice. A good agricultural and manufacturing practice should be applied during handling, storage and distribution of rice to ensure that aflatoxins contamination level is lower in the final product. Moreover, a regular survey for aflatoxins occurrence in rice and biomarkers-based studies is recommended to prevent and reduce the adverse health effects in the world population.

The Economic Burden of HIV and AIDS on Fish Production in Turkana County, Kenya

Estimating and determining the economic burden of Human Immunodeficiency Virus (HIV) and Acquired Immuno Deficiency Syndrome (AIDS) on productivity is critical especially on the primary livelihood of any fishing community. If these communities are adversely affected by HIV and AIDS, the aggregate supply of fish may be adversely affected in real absolute numbers. It is in this reference that this study sought not only to identify factors affecting fish productivity but also to investigate the economic burden of HIV and AIDS in Lake Turkana County. To achieve this objective, the study collected primary data through structured questionnaires in the sampled areas of Namukuse and Kalokol sub-locations in Turkana County. Since HIV and AIDS is endogenous in the production model, the study applied Two Stage Least Square (2SLS) regression modeling technique to estimate the economic burden of HIV and AIDS on fish production. The findings showed that both HIV and AIDS, and the number of fishing nets significantly influence fish productivity in Lake Turkana while other diseases and age were also found to be significant determinants of fish production. Based on the study results, the study recommends that the national government and county government accelerate HIV/AIDS education among the finishing community and also fast track implementation of appropriate prevention measures such as use early diagnosis and treatment and use of PrEP given that the finishing community can be classified among the high-risk population groups.

Living arrangement dynamics of older adults in Mexico: Latent class analysis in an accelerated longitudinal design.

BACKGROUNDBecause living arrangements have many implications for the well-being of older adults, knowledge regarding typical age-related developmental changes in living arrangements is of a major concern for public health policymakers, particularly in low- and middle-income countries dealing with growing aging populations. However, the much-needed empirical analysis of living arrangement dynamics is hindered by a lack of proper data.OBJECTIVETo exploit often-available short-term longitudinal data in the study of long-term phenomena, in this paper we accelerate the Mexican Health and Aging Study (MHAS) panel as a means to explore, over a broad age span, the household dynamics of Mexican older adults.METHODSInstead of working with a priori definitions of different household structures when analyzing transitions between them, we introduce a novel approach that estimates latent classes of developmental trends in the household composition of older people as they age.RESULTSWe show how accelerated longitudinal designs, coupled with latent class analysis, can offer new insights into living arrangement dynamics. Our findings suggest that in Mexico the typical living arrangements at 50 years old serve as an important predictor of future living arrangements, and that typical living-arrangement trajectories are strongly gendered in Mexico. This new approach may prove to be indispensible when determining the social support needed by high-risk population groups and as a means to better anticipate the necessary financial resources to do so.

Prevalence of Soil Transmitted Helminthes Infections and its Determinants among Primary School Children in Gena Bossa Tiworeda, Ethiopia: Cross-Sectional Study

Background: Soil-Transmitted Helminths (STH) infection is a major public health problem among school-aged children in developing countries. In Ethiopia, school-aged children have been identified as a high-risk group of population to be infected with Soil Transmitted Helminthes. Effective prevention and control of STH infection require the identification of risk factors among high-risk groups. Therefore, the aim of this study was to assess the prevalence of Soil Transmitted Helminthes infections and its determinants among primary school children in Gena Bossa Woreda, Ethiopia. Methods: Cross-sectional study was conducted in Gena Bossa Woreda, Ethiopia. The data were collected using pre-tested and structured questionnaires. Simple random sampling technique was used. Data analysis was done by SPSS for Windows Version 20.0. Bivariate and Multivariate logistic regressions analyses were conducted. p-value <0.05 was used to declare statistically significant variables. Result: About 303 (97.7%) of the study subjects participated in the study. Above one-third (38.3%) of the study, participants were tested positive for at least one of the STH species. lumbricoides (42.1%) was the predominant parasite followed by Hookworms (37.4%) and T. trichiura (11.2%). Lack of private latrines (AOR=4.12, 95% CI: 1.64 and 3.37), not wearing shoes always (AOR=1.80, 95% CI: 1.01, 3.23), age of children (5 to 10 years) (AOR=2.43, 95%, CI: 1.42 and 4.16) and not knowing causative agents of STH infection (AOR=2.60, 95% CI: 1.37 and 4.93) were found to be determinants of Soil Transmitted Helminthes Infections. Conclusion: Lack of private latrines, not wearing shoes always, age of children (5 to 10 years) and not knowing causative agents of STH infections were found to be major determinants of STH Infections. Therefore; public health policymakers and stakeholders working in the area should focus their intervention against STH infections on integrated control programs including regular health education on children ’ s shoes wearing habits, raising awareness of school children and their families on STH infections and promoting private latrines in every household.

The Dark Side of Female HIV Patient Care: Sexual and Reproductive Health Risks in Pre- and Post-Clinical Treatments

This study examines the pre- and post-clinical issues in human immunodeficiency virus (HIV) care and treatment for women and girls of high-risk population groups—namely sex workers, injecting drug users, women living with HIV, primary sexual partners of people living with HIV, adolescent girls who are children of these groups, and migrant young girls and women—in five provinces and cities in Vietnam. Through a sample of 241 surveyed participants and 48 respondents for in-depth interviews and 32 respondents in the focus group discussions, the study identifies multiple barriers that keep these groups from receiving the proper health care that is well within their human rights. Most respondents rated HIV testing as easily accessible, yet only 18.9% of the surveyed women living with HIV disclosed their infection status, while 37.8% gave no information at the most recent prenatal care visit. The level of knowledge and proper practices of sexual and reproductive health (SRH) care also remains limited. Meanwhile, modern birth control methods have yet to be widely adopted among these populations: only 30.7% of respondents reported using condoms when having sex with their husband. This increases the risks of unwanted pregnancy and abortion, as well as vulnerability to sexually transmitted infections (STIs) and HIV transmission. On the other hand, HIV-related stigma and discrimination at health care settings are still pervasive, which create significant barriers for patients to access proper care services. Based on these results, six recommendations to improve SRH status of women and girls of populations at high risk are put forward.

Study of Hepatitis C Virus Detection Assays.

BackgroundHepatitis C virus is a small, enveloped, positive-sense single-stranded RNA virus that causes and liver cancer like hepatocellular carcinoma and lymphomas.Aim of the study: to assess different methods in diagnosis HCV infection.Patients and methodsA retrospective study of 426 patients was admitted to Al-Kindy Teaching Hospital, Baghdad-Iraq for surgical operations or renal dialysis from January-2015 to December-2016. Their serum tested for HCV Abs by rapid immunochromatography, Enzyme Linked ImunoSorbent Assay (ELISA), and RIBA test.ResultsThe study sample was 426 patients, their age was ranged from 15 to 65 years. Males were represented 58% and the rest were females. The serum of all samples has tested by rapid Immunochromatography test. Fifty percent of them showed positive results by this test and the rest were negative. Those fifty serum samples who were positive by Immunochromatography test were reexamined by ELISA test and showed 39out of 50 (78%) were true positive by ELISA test and the rest were negative (P = 0.0001).The positive samples by ELISA have tested by RIBA test that showed 200(80%)were true positive in males and 130(74%)were true positive in females and the rest were false positive (P = 0.0001).ConclusionsEarly screening of the high risk group of population by highly sensitive test is important to treat infected patients and prevent dissemination among population.

Co-existence of endometriosis with 13 non-gynecological co-morbidities: Mutation analysis by whole exome sequencing.

Endometriosis is an enigmatic condition with an unknown etiology and poorly understood pathogenesis and women with endometriosis represent a high-risk population group for a large category of chronic conditions. The study focused on a 67-year-old woman who presented with a 40-year history of familial endometriosis associated with various non-gynecological co-morbidities, thus representing a unique case from a cohort of 1,000 patients with endometriosis. Her family history included infertile members suffering from endometriosis. Thirteen non-gynecological co-morbidities were documented throughout the years, including five autoimmune diseases (i.e., systemic lupus erythematosus, ankylosing spondylitis, multiple sclerosis, bronchial asthma and Crohn's disease), urinary bladder diverticulum, osteoporosis, multinodular goiter, cardiovascular diseases, gastroesophageal reflux disease, malignant tumor of urinary bladder, Barrett's esophagus and bilateral cataract. In order to understand the potential role of gene mutations in the development of all those co-morbidities, whole exome sequencing was performed and the presence of various disease-associated, potentially causal missense variants, were observed. These findings are in accordance with the previously suggested common underlying etiologic pathway for some, but not all, autoimmune disorders. This unusual case provides novel insights demonstrating that endometriosis can coexist with various chronic autoimmune diseases and other conditions, including non-gynecological malignancies, which possibly share a common genetic cause, a fact that should be taken into consideration seriously by clinicians.

Quantifying the impact of social groups and vaccination on inequalities in infectious diseases using a mathematical model

BackgroundSocial and cultural disparities in infectious disease burden are caused by systematic differences between communities. Some differences have a direct and proportional impact on disease burden, such as health-seeking behaviour and severity of infection. Other differences—such as contact rates and susceptibility—affect the risk of transmission, where the impact on disease burden is indirect and remains unclear. Furthermore, the concomitant impact of vaccination on such inequalities is not well understood.MethodsTo quantify the role of differences in transmission on inequalities and the subsequent impact of vaccination, we developed a novel mathematical framework that integrates a mechanistic model of disease transmission with a demographic model of social structure, calibrated to epidemiologic and empirical social contact data.ResultsOur model suggests realistic differences in two key factors contributing to the rates of transmission—contact rate and susceptibility—between two social groups can lead to twice the risk of infection in the high-risk population group relative to the low-risk population group. The more isolated the high-risk group, the greater this disease inequality. Vaccination amplified this inequality further: equal vaccine uptake across the two population groups led to up to seven times the risk of infection in the high-risk group. To mitigate these inequalities, the high-risk population group would require disproportionately high vaccination uptake.ConclusionOur results suggest that differences in contact rate and susceptibility can play an important role in explaining observed inequalities in infectious diseases. Importantly, we demonstrate that, contrary to social policy intentions, promoting an equal vaccine uptake across population groups may magnify inequalities in infectious disease risk.

Incident stroke among Ghanaians with hypertension and diabetes: A multicenter, prospective cohort study

BackgroundThe burden of stroke among hypertensive and diabetic population in sub-Saharan Africa remains high. We sought to identify the risk factors associated with stroke occurrence in these high-risk population groups. MethodsA prospective cohort study involving adults with hypertension and or type II diabetes mellitus at 5 public hospitals in Ghana who were stroke-free at enrollment. Patients were followed every 2 months at clinic for 18 months and assessed clinically for first ever stroke by physicians. We calculated crude incidence rates for stroke and assessed the factors associated with stroke occurrence using a multivariate Cox Proportional Hazards regression models. ResultsOf 3220 eligible participants with 3805 person-years of follow-up, there were 54 clinically confirmed new strokes. Incidence rate of stroke was 14.19 events per 1000 person-years [95% CI: 10.77–18.38], with rates among diabetics with hypertension being 16.64 [10.58–25.00], hypertension of 13.77 [9.33–19.64] and diabetes was 9.81 [3.59–21.74]. Two factors independently associated with stroke occurrence were previous cigarette smoking with adjusted HR (95% CI) of 2.59 (1.18–5.67) and physical inactivity, 1.81 (1.06–3.10). In secondary analysis, stage II hypertension compared with optimal BP was associated with aHR of 3.04 (1.00–9.27), p = .05 for stroke occurrence. ConclusionIncident stroke among Ghanaians with hypertension and diabetes is quite high. Stricter control of blood pressure and engaging in regular physical activities are strongly recommended to reduce the risk of strokes.