Inform Disease Management Research Articles

Epidemiology and Characterization of Atopic Dermatitis in East Asian Populations: A Systematic Review.

IntroductionAs atopic dermatitis (AD) grows increasingly prevalent in Asian populations worldwide, understanding how environmental, genetic, and cultural factors uniquely influence AD in Asians is essential for informing disease management. Our objectives were to characterize the epidemiology of AD in East Asian populations with sensitivity to the changing demographics of AD in these populations and the effects of urbanization and immigration.MethodsA systematic review was performed on epidemiologic studies of AD in East Asian populations over the past 10 years.ResultsThere is a rising prevalence of both pediatric and adult AD in Asian populations worldwide, particularly in Asians living in urban areas. Studies suggest that the children of Asian immigrants may be at higher risk for developing AD, potentially resulting from epigenetic phenomena unique to immigrant populations. A number of genetic polymorphisms implicated in AD are shared by Asian populations around the world and appear to be rare among other ethnic populations.ConclusionsAs the prevalence of AD continues to increase in Asian populations, it is important to understand its distinct genetic and pathophysiologic profile in these populations, as well as characterize the cultural beliefs and practices surrounding its treatment. Future research should aim to capitalize on our growing understanding of pathophysiologic differences to inform the most promising treatments for AD in Asians. Additionally, the impact of immigration on AD suggests that further investigation of these trends may lead to a greater understanding of the epigenetics of AD.

To identify the problems of pomegranate growers in information management and to obtain their suggestions

The present study was conducted with the specific objective of “To identify the problems of pomegranate growers in information management and to obtain their suggestions”. For the study, Aurangabad district was purposively selected for the present study as it is one of the maximum pomegranate growing district of Marathwada region. There are nine talukas in Aurangabad district out of which two talukas purposively selected for the study. Four villages from each talukas selected randomly and fifteen farmers from each village selected on the lottery basis. Thus total sample size 120. Ex-post facto research design was adopted in this study. From the study it was found that, pomegranate growers faced the problems like Lack of sufficient training programmes conducted by KVK, SAUs followed by they cant visit easily because good distance from KVK, SAUs, lack of information about disease and pest management, network problems in using internet and kisan call centre, non availability of farm publications like farm magazine, lack of proper market information and its source, lack of skills of using internet and lack of time and mobility to meet agricultural scientists and extensionists. Pomegranate growers given the suggestions on problems like Regular training programmes should be conducted by KVK and SAUs followed by Government should take steps to improve mobile networks in villages, agricultural department should disseminate disease and pest management information in proper time, KVK, SAUs should sent representative to villages, more field visits should be undertaken by the researchers and extensionists, farm publications like farm magazine should be multiplied and distribute in villages, training should be provided to the farmers to use internet and mobile SMS service and steps should be taken to disseminate proper information about market in time.

Spontaneous and Fungicide-Induced Genomic Variation in Sclerotinia sclerotiorum.

Stress from exposure to sublethal fungicide doses may cause genomic instability in fungal plant pathogens, which may accelerate the emergence of fungicide resistance or other adaptive traits. In a previous study, five strains of Sclerotinia sclerotiorum were exposed to sublethal doses of four fungicides with different modes of action, and genotyping showed that such exposure induced mutations. The goal of the present study was to characterize genome-wide mutations in response to sublethal fungicide stress in S. sclerotiorum and study the effect of genomic background on the mutational repertoire. The objectives were to determine the effect of sublethal dose exposure and genomic background on mutation frequency/type, distribution of mutations, and fitness costs. Fifty-five S. sclerotiorum genomes were sequenced and aligned to the reference genome. Variants were called and quality filtered to obtain high confidence calls for single nucleotide polymorphisms (SNPs), insertions/deletions (INDELs), copy number variants, and transposable element (TE) insertions. Results suggest that sublethal fungicide exposure significantly increased the frequency of INDELs in two strains from one genomic background (P value ≤ 0.05), while TE insertions were generally repressed for all genomic backgrounds and under all fungicide exposures. The frequency and/or distribution of SNPs, INDELs, and TE insertions varied with genomic background. A propensity for large duplications on chromosome 7 and aneuploidy of this chromosome were observed in the S. sclerotiorum genome. Mutation accumulation did not significantly affect the overall in planta strain aggressiveness (P value > 0.05). Understanding factors that affect pathogen mutation rates can inform disease management strategies that delay resistance evolution.

COVID-19 epidemic and its characteristics in Heilongjiang province

Objective: To describe the COVID-19 epidemic and its characteristics in Heilongjiang province, and provide evidence for the further prevention and control of COVID-19 in the province. Methods: The information of COVID-19 cases and clusters were collected from national notifiable disease report system and management information system for reporting public health emergencies of China CDC. The Software's of Excel 2010 and SPSS 23.0 were applied for data cleaning and statistical analysis on the population, time and area distributions of COVID-19 cases. Results: On January 22, 2020, the first confirmed case of COVID-19 was reported in Heilongjiang. By March 11, 2020, a total of 482 cases domestic case of COVID-19, The incidence rate was 1.28/100 000, the mortality rate was 2.70% (13/482) in 13 municipalities in Heilongjiang. There were 81 clusters of COVID-19, The number of confirmed cases accounted for 79.25% (382/482) of the total confirmed cases and 12 cases of deaths. The family clusters accounted for 86.42% (70/81). Compared with the sporadic cases, the mortality rate, proportion of elderly cases aged 60 or above and severe or critical cases of clinical classification were all higher in the clusters especially the family clusters, but the differences were not significant (P>0.05). There were 34 clusters involving more than 5 confirmed cases accounted for 41.98% (34/81) of the total clusters, the involved cases accounted for 68.31% (261/382) of the total cases of clusters. There were significant differences in age distribution of the cases among the case clusters with different case numbers. In the clusters involving 6-9 cases, the proportion of cases aged 65 years or above was more (26.53%, 39/147). Conclusions: The incidence rate of COVID-19 was relatively high and the early epidemic was serious in Heilongjiang, The number of cases was large in clusters especially family clusters.

Preferred Strategies for Delivering Health Information to Patients With Musculoskeletal Disorders: A Qualitative Study.

Patients' information needs may differ from what their care providers may perceive to be the patients' needs. This discordance needs to be recognized and addressed. We conducted a qualitative study to explore the perceptions of patients with selected musculoskeletal disorders and those of rheumatologists, on their preferred strategies for delivery of disease management information. Fifty-two patients diagnosed with either rheumatoid arthritis, knee osteoarthritis, or osteoporosis took part in 6 focus groups and 18 individual semistructured interviews. In addition, 11 rheumatologists participated in 2 focus groups and 4 semistructured individual interviews. Data were explored by thematic content analysis. Perceived preferences were identified and compared between patients and rheumatologists regarding (a) media, (b) setting, (c) messengers, and (d) key message content. Patients' preferred media for disease management information were electronic (television and videos delivered as digital optical discs or the Internet), group instruction, and printed material. Patients preferred the information to be delivered in the setting of their homes, doctor's offices, or clinic waiting areas by the rheumatologists and patients with disease experience, addressing healthy lifestyle changes, medication adherence, and consequences of noncompliance. For rheumatologists, the perceived preference for information delivery was through printed material (brochures, booklets, and pamphlets) delivered in waiting areas by nurses and physicians, addressing nature of the disease, complications, and treatment adverse effects. Provider perspectives on strategies for education may differ from those of patients. Our findings highlight the need for considering different stakeholder perspectives in designing educational tools and decision support materials for patients with chronic diseases. Rheumatologists' preferences on strategies for education (mode of delivery, delivery setting, messengers, and topics) differ from those of patients. For example, patients want to learn about lifestyle changes and consequences of compliance versus noncompliance, whereas rheumatologists considered more important for patients to understand their disease, treatment adverse effects, and consequences of noncompliance.

Accuracy of Smoking Status Reporting: Proxy Information in a Rapidly Fatal Cancer Setting.

ObjectiveTo assess whether patients and relatives can serve as reliable proxy reporters of other family members’ cigarette-smoking history.Patients and MethodsTwo samples (325 patients, 707 relatives) were identified from the Mayo Clinic Biospecimen Resource for Pancreas Research, enrolled from November, 6, 2000, to March 15, 2018. Smoking-history data, including categorical (ever/never) and quantitative (packs per day and years smoked) smoking measures, were obtained from self-completed questionnaires by patients and relatives. Relative reports were compared with patient reports on self; patient reports were compared with relative reports on self.ResultsOverall, spouses and first-degree relatives (FDRs) were accurate (94.5%) when reporting patient ever smoking; spouse reports were 98.6% sensitive and 97.7% accurate. Accuracy of patient reports was 97.8% for spouse smoking and 85.5% for FDR smoking; accuracy varied by relationship of FDR. When not concordant, patients generally over-reported daily packs smoked by relatives and under-reported years smoked. Within a 25% agreement range, spouse reports about patients’ daily packs smoked was 46.7%, and years smoked was 69.6%, whereas FDRs were 50% and 64.6%, respectively. When not concordant, relatives generally over-reported daily packs smoked by patients, but no consistent pattern was observed of over- or under-reporting years smoked by patients.ConclusionsPatients and relatives can be reliable proxies for smoking history (ever/never) in their family members, especially spouses. An accurate reporting of smoking status will help physicians to better gauge performance status and family smoking exposures to inform disease management.

Spatial analysis of chronic wasting disease in free‐ranging white‐tailed deer ( Odocoileus virginianus ) in Illinois, 2008–2019

Understanding the geographic distribution and clustering of chronic wasting disease (CWD) among free-ranging white-tailed deer (Odocoileus virginianus) populations can inform disease management practices. We used a retrospective analysis of surveillance data to evaluate CWD's spatial and temporal dynamics within 16 CWD-infected northern Illinois counties. Of 42,541 deer samples collected and tested for CWD from recreational hunter harvest between 2008 and 2019, we recorded 359 (0.84%) CWD-positive samples. We observed variability in CWD cases over time and space. By county, the median CWD-positive proportion was 0.84%, varying from a minimum of 0.14% in McHenry County to a maximum of 6.28% in Boone County. Across years, there were differences among CWD-positive proportions with a median of 0.90%, ranging from a minimum of 0.27% in 2012 to a maximum of 1.60% in 2019. We used a retrospective discrete Poisson scan statistic model to evaluate the space-time clustering of CWD-positive deer. We identified a statistically significant (p<.001) primary cluster C1 (area=23.59km2 ; RR=10.48), occurring from 2010 to 2015 in the north-central part of the study area, and a secondary cluster C2, occurring from 2014 to 2019 (area=9.27km2 ; RR=3.88) in the north-west of the study area. Detected CWD-positive space-time clusters suggest that the risk of CWD is not random. Space-time clusters of CWD can be used to evaluate the effectiveness of the Illinois CWD management programme. The area surrounding the older C1 cluster has undergone longer and more intense CWD management compared with C2. Currently, the older C1 cluster is no longer as high risk compared with the newer cluster C2, suggesting that management efforts in C2 should be increased. However, all CWD clusters should be targeted with surveillance, prevention and management programmes, including reducing deer densities to limit further spread of CWD.

Identifying frailty in trials: an analysis of individual participant data from trials of novel pharmacological interventions

BackgroundFrailty is common in clinical practice, but trials rarely report on participant frailty. Consequently, clinicians and guideline-developers assume frailty is largely absent from trials and have questioned the relevance of trial findings to frail people. Therefore, we examined frailty in phase 3/4 industry-sponsored clinical trials of pharmacological interventions for three exemplar conditions: type 2 diabetes mellitus (T2DM), rheumatoid arthritis (RA), and chronic obstructive pulmonary disease (COPD).MethodsWe constructed a 40-item frailty index (FI) in 19 clinical trials (7 T2DM, 8 RA, 4 COPD, mean age 42–65 years) using individual-level participant data. Participants with a FI > 0.24 were considered ‘frail’. Baseline disease severity was assessed using HbA1c for T2DM, Disease Activity Score-28 (DAS28) for RA, and % predicted FEV1 for COPD. Using generalised gamma regression, we modelled FI on age, sex, and disease severity. In negative binomial regression, we modelled serious adverse event rates on FI and combined results for each index condition in a random-effects meta-analysis.ResultsAll trials included frail participants: prevalence 7–21% in T2DM trials, 33–73% in RA trials, and 15–22% in COPD trials. The 99th centile of the FI ranged between 0.35 and 0.45. Female sex was associated with higher FI in all trials. Increased disease severity was associated with higher FI in RA and COPD, but not T2DM. Frailty was associated with age in T2DM and RA trials, but not in COPD. Across all trials, and after adjusting for age, sex, and disease severity, higher FI predicted increased risk of serious adverse events; the pooled incidence rate ratios (per 0.1-point increase in FI scale) were 1.46 (95% CI 1.21–1.75), 1.45 (1.13–1.87), and 1.99 (1.43–2.76) for T2DM, RA, and COPD, respectively.ConclusionThe upper limit of frailty in trials is lower than has been described in the general population. However, mild to moderate frailty was common, suggesting trial data may be harnessed to inform disease management in people living with frailty. Participants with higher FI experienced more serious adverse events, suggesting screening for frailty in trial participants would enable identification of those that merit closer monitoring. Frailty is identifiable and prevalent among middle-aged and older participants in phase 3/4 drug trials and has clinically important safety implications.

'Your wealth is your health': the fundamental causes of inequalities in diabetes management outcomes: a qualitative analysis.

Fundamental Cause Theory (FCT) is among the most influential explanations for health inequalities. The theory posits that the social gradient in health persists because higher-socioeconomic status (SES) groups are systematically more able to take advantage of new medical innovations and health-enhancing knowledge due to their greater access to resources. Taking the life histories of people with diabetes (PwD) (N=17) in the Republic of Ireland as a case study, this paper aims to elucidate the behaviours and agencies underlying 'fundamental causality' through examining how PwD of contrasting SES respond to disease management information. Findings highlight how the most common barriers to effective diabetes control were chronic psychological distress, combined with the cultural significance of alcohol consumption, which was central to both the social and economic subsistence of male participants in particular. However, higher-SES groups were more likely to experience a 'turnabout' in their life, whereby they could remove themselves from the conditions giving rise to their distress and move into a social space where more health-enhancing behaviours were possible. It concludes with a discussion of potential mechanisms that may explain why such turnabouts were more likely to occur in the case of higher-SES groups and the implications for FCT.

Relative Reliability Of A CT-Based Measurement System To Assess Body Composition In Colon Cancer Patients

Body composition is associated with important clinical and functional outcomes in colon cancer patients. Colon cancer patients often undergo computed tomography (CT) in routine clinical care. These images may then be used to assess body composition to potentially identify individuals who may benefit most from physical activity (PA) intervention. Developing reliable and accurate ways to measure body composition is a prerequisite to using CT-generated body composition to inform disease management. PURPOSE: To determine inter- and intra-rater relative reliability of CT to measure body composition in colon cancer patients in a randomized controlled trial (PA vs. usual care). METHODS: 25 CT scans were randomly selected from 10 men and 8 women (59.1±9.7yrs), all post-primary treatment for stage II-III colon cancer. Manual image analysis was conducted for each single CT image slice using SliceOmatic software (Tomovision, Montreal, Canada) to mark the third lumbar vertebra and segment/quantify muscle (MUS), intramuscular adipose tissue (IMAT), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and the muscle attenuation coefficient (MA). Inter-rater reliability was assessed by estimating the agreement between measures from a) 2 trained manual analysts and b) a manual analyst and automated software (Voronoi Health Analytic ABACS L3 Module), respectively. Intra-rater reliability was evaluated by estimating the agreement between measures by the same manual analyst one month apart. Inter- and intra-class correlation coefficients (ICCs) were calculated with ICC ≥ 0.9 deemed excellent reliability. RESULTS: ICCs were excellent for both measures of inter-rater reliability (analyst 1 vs. 2: MUS=0.999, IMAT=0.928, VAT=1.000, SAT=0.999, MA=0.999; manual vs. automated: MUS=0.981, IMAT=0.710, VAT=0.997, SAT=0.992, MA=0.992), and intra-rater reliability (MUS=1.000, IMAT=0.971, VAT=1.000, SAT=0.999, MA=1.000) (all p<0.01). CONCLUSION: Body composition analyses using clinical CT scans, SliceOmatic software, and a trained analyst is feasible for a single analyst across time, between two separate analysts, and between a manual analyst/automated software. Relatively reliable CT analyses of body composition is possible in stage II-III, post-primary treatment colon cancer patients.

Prognostic implications of gene amplifications identified by circulating tumor DNA (ctDNA) analysis in metastatic prostate cancer (mPC).

e17594 Background: mPC is a dynamic disease that confers a poor prognosis- particularly in the metastatic castration-resistant prostate cancer (mCRPC) setting. Analysis of ctDNA provides an opportunity to identify and monitor somatic alterations (SAs) in a patient’s treatment course. However, how certain SAs can inform disease management is not fully characterized. We evaluated whether the presence of specific gene amplifications (GAs) and changes in plasma copy number (PCN) are associated with disease features and prognosis. Methods: This is a retrospective study of mPC patients seen at the Hollings Cancer Center between 2015-2019 who underwent ctDNA profiling using Guardant360 (Guardant Health Inc). Guardant360 identifies SAs and GAs of select genes by NGS. Descriptive statistics were used to summarize baseline patient characteristics. The chi-square test and odds ratio (OR) were used to evaluate associations between clinical factors and GAs. The Kaplan-Meier method was used to estimate OS from either the date of GA detection or the initiation of systemic therapy. Results: 130 men with mPC were identified as having ≥1 GA. The presence of liver and/or lung metastases were associated with GAs of BRAF (OR 2.5; 95%CI 1.1-5.8, p &lt; 0.05) , CDK6 (OR 2.3; 95%CI 1.4-8.0, p &lt; 0.01) , PI3KCA (OR 4.4; 95%CI 1.8-10.7, p &lt; 0.01) , and FGFR1 (OR 3.1; 95%CI 1.1-9.0, p = 0.038). These GAs were also associated with having ≥2 concurrent GAs (p &lt; 0.01 for each gene). From this cohort, survival analyses were completed on 59 patients with mCRPC. Men with only 1 GA, compared to men with ≥2 GAs, had improved median survival (mo.) from date of initial GA(s) detection (16.5 vs 9.4, p &lt; 0.01) or therapy initiation (16.0 vs 9.0, p &lt; 0.01). Among men with mCRPC, AR and/or MYC GA, median survival improved in men who had reduction in AR or MYC PCN during therapy compared to men without a PCN decrease (25.1 vs 15.9 p &lt; 0.01). Conclusions: Patients with mPC who had liver and/or lung metastases were associated with having specific GAs in BRAF, CDK6, PI3KCA, and FGFR1. Notably, the presence of liver or lung metastases was not associated with AR GA. In mCRPC, patients with ≥2 GAs had decreased OS compared to men with one GA. Having an increased number of GAs is likely reflective of greater chromosomal instability and be associated with more aggressive disease. Our study reveals serial monitoring of AR and MYC PCN during therapy demonstrated reduced OS in patients without PCN reduction. This supports the use of serial ctDNA monitoring of PCN to inform therapeutic response and prognosis.

Real world study of influenza vaccination intervention among key population of chronic disease management in Shanghai community

Objective: To analyze the effect of influenza vaccination intervention among key populations of chronic disease management in communities of Shanghai. Methods: A total of 50 787 patients aged ≥60 with diabetes, hypertension and chronic obstructive pulmonary disease (COPD) in Huangpu, Yangpu, Baoshan and Qingpu districts of Shanghai from January 2013 to August 2017 were selected as the intervention group, and 52 268 people from key populations with chronic disease management in Xuhui, Hongkou, Jiading and Fengxian districts were selected as the control group according to the geographical location and economic level. The intervention group accepted follow-up and health education of influenza vaccination via chronic disease outpatient based on information system. The implementation time of the intervention was from September 2017 to January 2018. The basic information and diagnosis information of two groups, and intervention completion of the intervention group were obtained from Shanghai chronic disease management information system and hospital record system. Results: The age of the intervention group and the control group were (76.76±8.33) and (77.97±8.51) years old, respectively (P<0.001); and there were statistical differences in gender, occupational and influenza vaccination rate between the two groups (P<0.001). A total of 28 644 (56.40%) subjects of the intervention group received intervention. There was no significant difference in age composition between finished and unfinished intervention groups (P=0.095), and there was significant difference in gender composition (P=0.044). Before the intervention, the vaccination rate of the intervention group was 0.75% (382 subjects) which was lower than that of the control group with 1.02% (533 subjects) (χ(2)=20.96, P<0.001). After the intervention, the vaccination rate of the intervention group was 1.73% (496 subjects) which was higher than that of the control group with 1.42% (744 subjects) (χ(2)=11.65, P=0.001). Subjects that were male, younger, uptake of influenza vaccine before the intervention, received intervention and professional and technical personnel were more likely to take influenza vaccine, with OR (95%CI) 1.29 (1.13-1.47), 0.97 (0.96-0.98), 260.30 (215.21-314.83), 1.85 (1.61-2.11) and 1.48 (1.10-1.99), respectively. Conclusion: Influenza vaccination intervetion raised the vaccination rate of key population of chronic disease management. Male, younger, those who had been vaccinated before the intervention, who received the intervention, and professional and technical personnel were more likely to be vaccinated.

Current status of the management of hereditary angioedema in China: a patient-based, cross-sectional survey.

Hereditary angioedema (HAE) is a rare, inherited disorder characterized by unpredictable and recurrent cutaneous and mucosal oedema. This study aimed to identify the current status of HAE management in China. An internet-based survey was sent to 129 patients with type 1 and 2 HAE diagnosed between 1983 and 2017; a total of 107 patients provided complete disease management information. The survey response rate was 82.9% (107 responders). Ten patients reported 18 fresh frozen plasma (FFP) transfusions for the main purpose of treating lethal laryngeal oedema. Two patients reported adverse events. Eighty-nine (83.2%) patients had taken danazol for long-term prophylaxis, and 74 (69.2%) were on long-term danazol prophylaxis. Among patients on long-term prophylaxis, 56 (75.7%) patients reported a decrease in their annual attack frequency after taking danazol. Twenty-five (33.8%) patients had an attack frequency of no more than once per year. The most common side effects were menstrual disorders, weight gain, osteoarticular pain, acne, and sebaceous hypersecretion. Patients with higher education levels, positive family histories, and laryngeal oedema attacks before medication tended to show better adherence. Patients maintaining high or medium adherence showed better control of laryngeal and gastrointestinal involvement than patients with low adherence. Four (3.7%) patients reported current or past use of tranexamic acid. Attenuated androgen and FFP transfusions remain the mainstay in China, where specifically targeted drugs are currently lacking. Maintaining good medication adherence should be recommended to achieve improved disease control.

Developing a national minimum data set for hospital information systems in the Islamic Republic of Iran.

Standardized data collection supports disease information management and leads to better quality of care. The Islamic Republic of Iran lacks a standard data set for data collection in hospitals. The aim of this study was to design a minimum data set for hospital information systems in the Islamic Republic of Iran. This study was conducted in 2015. Data sets of other countries, hospital records, hospital information systems and electronic health record systems in the Islamic Republic of Iran were reviewed for data elements for the minimum data set. Data elements were collected using a data extraction form and were categorized into similar classes, which were divided into administrative and clinical sections. The list of data elements was reviewed by experts in technical offices of the Iranian Ministry of Health and Medical Education, and a minimum data set was drawn up. There were nine and 18 data classes in the administrative and clinical sections with a total of 166 and 684 data elements respectively. After review by the expert panel, 159 administrative and 621 clinical data elements were retained as the minimum data set for the Iranian hospital information system. Our dataset can be used by the Iranian health ministry, hospital information system companies and health surveillance centres for more efficient management of health data.

Vaccination coverage with the pneumococcal and influenza vaccine among persons with chronic diseases in Shanghai, China, 2017

BackgroundAdults with chronic conditions such as heart disease, diabetes, or lung disease are more likely to develop complications from a number of vaccine-preventable diseases, including influenza and pneumonia. In this study, we use the data from a chronic disease management information system in Shanghai to estimate vaccination coverage and characterize predictors of seasonal influenza and 23-valent pneumococcal polysaccharide vaccine (PPSV23) vaccination among people with chronic disease in Shanghai.MethodsThe Shanghai Centers for Disease Control and Prevention have information systems related to chronic disease management, hospital records, and immunizations. Data from individuals with hypertension, diabetes and chronic obstructive pulmonary disease (COPD) were abstracted during July 2017. The main outcome was coverage of pneumococcal and influenza vaccination. Vaccination coverage was calculated across demographic groups. Significance in bivariate associations was assessed through Pearson’s chi-square tests, and in multivariable models through logistic regression models with a forward stepwise method to select variables.ResultsIn the sample of 2,531,227 individuals ≥15 years, 22.8% were vaccinated for pneumonia from January 2013 to July 2017, and the vaccination coverage of influenza in the 2016/17 influenza season was 0.4%. Vaccination coverage was highest in those 70–79 and lowest in those younger than 60. Compared to urban areas, uptake in rural areas was higher for pneumonia vaccination (OR: 2.43, 95% CI: 2.41, 2.45), but lower for influenza vaccination (OR: 0.55, 95% CI: 0.51, 0.59). Having a greater number of chronic diseases was associated with higher likelihood of pneumonia vaccination (3 vs 1: OR: 1.68, 95% CI: 1.64, 1.71), but this relationship was not statistically significant for influenza vaccination.ConclusionsWe found low levels with of pneumococcal vaccination, and extremely low uptake of influenza vaccination among individuals with high risk conditions in Shanghai who should be priority groups targeted for vaccination. Interventions could be designed to target groups with low uptake – like younger adults, and individuals who have not yet retired.

Effect of cropping system, shade cover and altitudinal gradient on coffee yield components at Mt. Elgon, Uganda

Coffee is a key export commodity of East Africa, but average smallholders’ yields are low. To guide sustainable yield improvements of smallholders’ coffee systems, we investigated coffee yield components in three different types of coffee cropping systems along an altitude gradient (1100−2100 m.a.s.l.) during two production years (2015 and 2016). We selected 810 coffee trees distributed over 27 farms and monitored number of stems per tree, fruit load per branch, productive nodes per branch (on four branches of one stem per tree) and number of productive branches per stem (on one stem per selected tree) in both years. Additionally, we monitored productive stems per ha, coffee tree density and cherry weight in combination with pest and disease occurrence and management information from interviews. Coffee farms were classified as Coffee-Open (CO) (< 20 % shade cover), Coffee-Banana (CB) (coffee dominantly intercropped with bananas) or Coffee-shade Tree (CT) (coffee dominantly intercropped with shade trees). Coffee-Banana had larger yield per ha (green bean kg ha−1) (1086 ± 736 kg ha−1) and yield per stem (green bean kg stem−1) (0.24 ± 0.16 kg stem−1) than CO (670 ± 457 kg ha−1 and 0.21 ± 0.26 kg stem−1) and CT (428 ± 259 kg ha-1 and 0.10 ± 0.12 kg stem−1). Fruit loads, productive nodes, productive branches and cherry weight declined with shade cover, especially for shade cover > 30 %. Additionally, the same yield components correlated negatively with number of stems per tree. Fertilizer and fungicide use were related to more productive branches and cherry weight respectively, and stem borer was identified as the most important pest in this area. Our results suggest that yield in the region could be increased, i) by maintaining shade at an intermediate level, particularly at low and mid altitude and by reducing the number of stems per coffee tree (<4), and ii) by improving soil fertility and protection against pest and disease.

Trade-offs with telemetry-derived contact networks for infectious disease studies in wildlife.

Network analysis of infectious disease in wildlife can reveal traits or individuals critical to pathogen transmission and help inform disease management strategies. However, estimates of contact between animals are notoriously difficult to acquire. Researchers commonly use telemetry technologies to identify animal associations; but such data may have different sampling intervals and often captures a small subset of the population. The objectives of this study were to outline best practices for telemetry sampling in network studies of infectious disease by determining (1) the consequences of telemetry sampling on our ability to estimate network structure, (2) whether contact networks can be approximated using purely spatial contact definitions, and (3) how wildlife spatial configurations may influence telemetry sampling requirements.We simulated individual movement trajectories for wildlife populations using a home range-like movement model, creating full location datasets and corresponding "complete" networks. To mimic telemetry data, we created "sample" networks by subsampling the population (10-100% of individuals) with a range of sampling intervals (every minute to every three days). We varied the definition of contact for sample networks, using either spatiotemporal or spatial overlap, and varied the spatial configuration of populations (random, lattice, or clustered). To compare complete and sample networks, we calculated seven network metrics important for disease transmission and assessed mean ranked correlation coefficients and percent error between complete and sample network metrics.Telemetry sampling severely reduced our ability to calculate global node-level network metrics, but had less impact on local and network-level metrics. Even so, in populations with infrequent associations, high intensity telemetry sampling may still be necessary. Defining contact in terms of spatial overlap generally resulted in overly connected networks, but in some instances, could compensate for otherwise coarse telemetry data.By synthesizing movement and disease ecology with computational approaches, we characterized trade-offs important for using wildlife telemetry data beyond ecological studies of individual movement, and found that careful use of telemetry data has the potential to inform network models. Thus, with informed application of telemetry data, we can make significant advances in leveraging its use for a better understanding and management of wildlife infectious disease.

Treatment patterns and long-term clinical outcomes in Chinese patients with nonmetastatic gastric cancer: Results from the non-interventional EVIDENCE registry study.

307 Background: Although gastric cancer (GC) is a leading cause of cancer-related death in China, important questions about optimal management remain unanswered. The EVIDENCE registry study evaluated data from patients with GC in China to assess the pattern of treatments and long-term clinical outcomes. Methods: Five cohorts of patients with different HER2 and metastatic (m) status were evaluated from April 2013 to June 2018 in this prospective, multicenter, non-interventional, real-world study. Data from patients with operable non-mGC are reported: Cohort III (HER2+) and Cohort V (HER2−). Outcome measures included overall survival (OS), event-free survival (EFS), and disease-free survival (DFS). Results: Cohorts III/V included 758 patients (Cohort III, 271; Cohort V, 487); 75.5% were male and the mean age was 58.8 years. The majority of Cohort III/V patients (538/758; 71.0%) received only adjuvant treatment, with 215/758 (28.4%) receiving S1+oxaliplatin. Neoadjuvant or adjuvant trastuzumab was administered to 43/758 patients (Cohort III, 42; Cohort V, 1). Radiation during neoadjuvant or adjuvant treatment was administered to 23/758 (3.0%) patients. The median duration of follow-up was 515 days, during which 72 (9.5%) patients died due to progressive disease. OS rates (95% CI) for Cohorts III and V were 94% (89–96) and 95% (92–97) at 1 year, and 76% (67–83) and 70% (64–75) at 3 years, respectively. Respective EFS rates were 82% (76–87) and 86% (83–89) at 1 year, and 62% (53–70) and 57% (51–63) at 3 years; and respective DFS rates were 88% (82–93) and 86% (81–89) at 1 year and 69% (58–78) and 62% (55–68) at 3 years. Multivariate analysis indicated that the primary tumor site (p = 0.004) and overall cancer stage (p &lt; 0.001) were associated with DFS. Regarding the primary tumor site, there was a trend towards better DFS for antrum tumors (hazard ratio 0.59; 95% CI 0.32–1.07) when evaluated against gastroesophageal junction tumors. Conclusions: This longitudinal analysis of clinicopathologic characteristics and outcomes of Chinese patients with non-mGC will provide critical information that will help to inform disease management. Clinical trial information: NCT01839500.

Qualitative Assessment of Adult Patients' Perception of Atopic Dermatitis Using Natural Language Processing Analysis in a Cross-Sectional Study.

IntroductionAtopic dermatitis (AD) is an incurable, inflammatory skin disease characterized by skin barrier disruption and immune dysregulation. Although AD is considered a childhood disease, adult onset is possible, presenting with daily sleep disturbance and functional impairment associated with itch, neuropsychiatric issues (anxiety and depression), and reduced health-related quality of life. Although such aspects of adult AD disease burden have been measured through standardized assessments and based on population-level data, the understanding of the disease experienced at the patient level remains poor. This text-mining study assessed the impact of AD on the lives of adult patients as described from an experiential perspective.MethodsNatural language processing (NLP) was applied to qualitative patient response data from two large-scale international cross-sectional surveys conducted in the USA and countries outside of the USA (non-USA; Canada, France, Germany, Italy, Spain, and the UK). Descriptive analysis was conducted on patient responses to an open-ended question on how they felt about their AD and how the disease affected their life. Character length, word count, and stop word (common words) count were evaluated; centrality analysis identified concepts that were most strongly interlinked.ResultsPatients with AD in all countries were most frequently impacted by itch, pain, and embarrassment across all levels of disease severity. Patients with moderate-to-severe AD were more likely than patients with mild AD to describe sleep disturbances, fatigue, and feelings of depression, anxiety, and a lack of hope that were directly associated with AD. Centrality analysis revealed sleep disturbance was strongly linked with itch. Collectively, these concepts revealed that patients with AD are impacted by both physical and emotional burdens that are intricately connected.ConclusionsQualitative data from NLP, being more patient-centric than data from clinical standardized measures, provide a more comprehensive view of the burden of AD to inform disease management.

Retinal vessel diameter changes after 6 months of treatment in the Idiopathic Intracranial Hypertension Treatment Trial

Background/AimsPrior studies support an association between increased retinal venule diameter and elevated intracranial pressure (ICP). The purpose of this study was to test the hypothesis that retinal venule diameters decrease...