Meet World Health Organization Research Articles

Use of telehealth in home nutrition support: Challenges and advantages.

Coronavirus disease 2019 (COVID-19), after initially being detected in Wuhan, China in late 2019, quickly spread to most regions of the world, meeting World Health Organization criteria for a pandemic. Social distancing along with other measures implemented to control spread had a drastic impact on the provision of healthcare including deferred elective procedures and surgeries as well as delayed care and evaluation for emergent diagnoses such as heart attacks and strokes. In the home nutrition practice, patients began to delay routine laboratory tests and were canceling or deferring annual visits. Our group soon began to rapidly deploy telehealth to meet the needs of the home nutrition patients. Telehealth is not a new concept with descriptions of healthcare being provided at a distance with the use of telephone in the 1870s. However, widespread adoption has been limited because of regulation (licensure, prescriptions, credentialing, and privileges), lack of reimbursement, as well as adoption and availability of technology needed to carry out telehealth visits. As regulations and limits on reimbursements were waived during COVID-19 pandemic, our home nutrition practice began to evaluate core components of the care we provide for our patients and assess which could be successfully transitioned to telehealth. In addition to the history and regulation of telehealth, the current manuscript provides details regarding successful implementation of telehealth visits such as change management, selection of telehealth platform, scheduling and logistics, as well as carrying out the virtual visit including history and physical exam.

Sudden Cardiac Death and Myocardial Fibrosis, Determined by Autopsy, in Persons with HIV

BackgroundThe incidence of sudden cardiac death and sudden death caused by arrhythmia, as determined by autopsy, in persons with human immunodeficiency virus (HIV) infection has not been clearly established.MethodsBetween February 1, 2011, and September 16, 2016, we prospectively identified all new deaths due to out-of-hospital cardiac arrest among persons 18 to 90 years of age, with or without known HIV infection, for comprehensive autopsy and toxicologic and histologic testing. We compared the rates of sudden cardiac death and sudden death caused by arrhythmia between groups.ResultsOf 109 deaths from out-of-hospital cardiac arrest among 610 unexpected deaths in HIV-positive persons, 48 met World Health Organization criteria for presumed sudden cardiac death; of those, fewer than half (22) had an arrhythmic cause. A total of 505 presumed sudden cardiac deaths occurred between February 1, 2011, and March 1, 2014, in persons without known HIV infection. Observed incidence rates of presumed sudden cardiac death were 53.3 deaths per 100,000 person-years among persons with known HIV infection and 23.7 deaths per 100,000 person-years among persons without known HIV infection (incidence rate ratio, 2.25; 95% confidence interval [CI], 1.37 to 3.70). Observed incidence rates of sudden death caused by arrhythmia were 25.0 and 13.3 deaths per 100,000 person-years, respectively (incidence rate ratio, 1.87; 95% CI, 0.93 to 3.78). Among all presumed sudden cardiac deaths, death due to occult drug overdose was more common in persons with known HIV infection than in persons without known HIV infection (34% vs. 13%). Persons who were HIV-positive had higher histologic levels of interstitial myocardial fibrosis than persons without known HIV infection.ConclusionsIn this postmortem study, the rates of presumed sudden cardiac death and myocardial fibrosis were higher among HIV-positive persons than among those without known HIV infection. One third of apparent sudden cardiac deaths in HIV-positive persons were due to occult drug overdose. (Supported by the National Heart, Lung, and Blood Institute.)

Detection of Bacteriological Contaminants in Hand-Pump Fitted Borehole Water from a Residential Suburb in Ringim Local Government, Jigawa State

Water from borehole source can be contaminated due to indiscriminate waste disposal. This pilot study was conducted to assess the bacteriological quality of water from five (5) hand-pump-fitted borehole sources present in Sabon Gari quarters in Ringim Local Government Area of Jigawa State. Presumptive, confirmed and completed tests were employed to determine total and faecal coliforms from the water samples using most probable number (MPN) technique. Bacterial isolates were identified by standard microbiologicalmethods. Results obtained indicate that all the water samples across all the dilution strengths tested recorded substantial growth of total coliforms at 37.3°C while faecal coliforms were observed at 44°C after incubation for 48 h. Using the MPN table, the five water samples assayed recorded 50 MPN/100mL, 14 MPN/100mL, 3 MPN/100mL, 5 MPN/100mL and 1 MPN/100mL. Results were also positive for gas and acid production in all samples collected characteristic of presence of E. coli. The results obtained in this study show bacterial contamination of the water from the boreholes which may constitute a public health risk. It is therefore recommended that the water pumped from these boreholes should be subjected to adequate treatment to meet World Health Organization (WHO) required standard for potable water meant for drinking.
 Keywords: Boreholes, hand pump, most probable number, total coliforms and faecal coliforms.

Progress in Immunization Safety Monitoring - Worldwide, 2010-2019.

High levels of coverage with safe and effective immunizations are critical to the successful control and prevention of vaccine-preventable diseases worldwide. In addition to stringent standards to regulate the safety of vaccines, robust postlicensure monitoring systems help ensure that the benefits of vaccines continue to outweigh the risks for the populations who receive them. National Expanded Programmes on Immunization (EPI) are typically responsible for identifying and investigating adverse events following immunization (AEFI), including assessment of causality. National regulatory authorities (NRAs) are mandated to perform postlicensure surveillance of adverse drug reactions, including those associated with receipt of vaccines. This report describes global progress toward meeting World Health Organization (WHO) indicators on minimal country capacity for vaccine safety surveillance and coordination of AEFI reporting between countries' EPI and NRAs. In 2019, among 194 countries, 129 (66.5%) reported having an operational national AEFI causality review committee, compared with 94 (48.5%) in 2010. During 2010-2019, the proportion of countries reporting ≥10 AEFI per 100,000 surviving infants per year (an indicator of country capacity to monitor immunization safety) increased, from 41.2% to 56.2%. In 2019, however, only 46 (23.7%) countries reported AEFI data from both EPI and NRAs. Although global progress has been made toward strengthening systems for vaccine safety monitoring over the past decade, new indicators for monitoring global immunization safety performance are needed to better reflect program functionality. Continued global efforts will be vital to address barriers to routine reporting of AEFI, build national capacity for AEFI investigation and data management, and improve sharing of AEFI data at national, regional, and global levels.

Sodium and Potassium Intakes assessed by 24-h Urine among Moroccan University students in Casablanca, Morocco: Cross-Sectional Study

In Morocco, the high consumption of dietary sodium increases the risk of non-communicable diseases (NCDs) and predisposes to cardiovascular diseases (CVDs) and hypertension. This study aims to assess the dietary sodium and potassium intake in a random sample of Moroccan adult students as a benchmark informing a national strategy for reducing salt intake. This cross-sectional study was conducted with 103 adults aged 18 to 25 years recruited in Casablanca. The 24-hour urinary excretion was used to measure the sodium and potassium. Creatinine excretion was used to validate the completeness of the urine collections. The average urinary sodium excretion was 3125.77 ± 121.99 mg/day, 13.5% consumed less than 5g/day, while 69% consumed more than 5 g/day of which 17.5% consumed more than twice the recommendations. For the average urinary potassium excretion was 1826.1 ± 61.2 mg/day, and more than 98% of the students consumed less than the adequate intake. The results of this pilot study show that the population studied has a high sodium intake and low potassium intake which does not meet World Health Organization (WHO) recommendations, which requires implementing an action plan to reduce salt.

Upscaling HIV and hepatitis C testing in primary healthcare settings: stigma-sensitive practice.

Increasing testing for viral hepatitis and HIV is central to meeting World Health Organization and Australian targets to eliminate blood-borne viruses as public health priorities by 2030. In this paper we draw on findings and recommendations from a Victorian consultation with 40 health and community practitioners engaged with blood-borne virus testing. The consultation focused on identifying what constitutes best practice in pre- and post-testing discussion in the current era of highly effective treatments for HIV and hepatitis C. Overall, the consultation found that the pre- and post-test discussion remains an important feature of testing, but, given that stigma continues to impact the lives of people affected by these viruses, sensitivity to this issue needs to inform how these discussions take place. We describe how primary healthcare settings can support the goal of upscaling HIV and hepatitis C testing in a way that delivers safe and stigma-free testing encounters. We offer the notion of 'stigma-sensitive practice' as a term to describe this approach to pre- and post-test discussions.

Characteristics and Outcomes of 241 Births to Women With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection at Five New York City Medical Centers.

To describe the characteristics and birth outcomes of women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection as community spread in New York City was detected in March 2020. We performed a prospective cohort study of pregnant women with laboratory-confirmed SARS-CoV-2 infection who gave birth from March 13 to April 12, 2020, identified at five New York City medical centers. Demographic and clinical data from delivery hospitalization records were collected, and follow-up was completed on April 20, 2020. Among this cohort (241 women), using evolving criteria for testing, 61.4% of women were asymptomatic for coronavirus disease 2019 (COVID-19) at the time of admission. Throughout the delivery hospitalization, 26.5% of women met World Health Organization criteria for mild COVID-19, 26.1% for severe, and 5% for critical. Cesarean birth was the mode of delivery for 52.4% of women with severe and 91.7% with critical COVID-19. The singleton preterm birth rate was 14.6%. Admission to the intensive care unit was reported for 17 women (7.1%), and nine (3.7%) were intubated during their delivery hospitalization. There were no maternal deaths. Body mass index (BMI) 30 or higher was associated with COVID-19 severity (P=.001). Nearly all newborns tested negative for SARS-CoV-2 infection immediately after birth (97.5%). During the first month of the SARS-CoV-2 outbreak in New York City and with evolving testing criteria, most women with laboratory-confirmed infection admitted for delivery did not have symptoms of COVID-19. Almost one third of women who were asymptomatic on admission became symptomatic during their delivery hospitalization. Obesity was associated with COVID-19 severity. Disease severity was associated with higher rates of cesarean and preterm birth.

Are yuppies and muppies more physically active than the others aged 20-39?

Background: Values of young urban professionals (yuppies) are still valid and it is possible to find references to the lifestyle of young people. This also applies to the younger generation, in other words, middle-aged urban professionals (muppies). Objective: The aim is evaluating whether yuppies and muppies can be a role model for society in the field of taking care of leisure-time physical activity (PA). Methods: Surveys were conducted by an Omnibus survey on the representative sample of Poles in two studies (N = 1053, N = 1067). Persons aged 20-39 (N = 762 were selected) and based on the criteria: education, residence in cities, study skills character of work, income, there was created a yuppie/muppie group (n = 67) and non-yuppies (n = 695). International Physical Activity Questionnaire - Long Form was used. Results: Recommendations of WHO were met by 43.3% of yuppies/muppies and 33.4% of non-yuppies. No significant differences between groups were observed (p = .103) in this regard. There were no significant differences also between groups in practiced days per week leisure-time PA (walking p = .069, moderate PA p = .095, vigorous PA p = .256). The average value of MET-min/week for vigorous PA during leisure time was significantly higher declared (p = .03) by the yuppie/muppie group (628.7 ± 1415.5 vs. 345.8 ± 1073.4 MET-min/week). Conclusions: Yuppies and muppies cannot be regarded as a role model for Polish society in terms of taking up active leisure-time activities and meeting World Health Organization recommendations. Thus, it seems valuable to carry out further research in order to find role-model groups within the population aged 20-39.

SELF-REPORTED PHYSICAL ACTIVITY, ENJOYMENT AND WELL-BEING OF GREEK YOUTH BASKETBALL PLAYERS

Children and adolescents’ regular participation in sports can help them to increase their physical activity (PA) levels and fitness and to adopt healthy behaviors in adulthood. The purpose of this study was to examine the relationship of self-reported PA and enjoyment of youth basketball players with their well-being variables (self-rated health, self-esteem and subjective vitality). Participants were 208 male athletes (Mage: 13.88 ± 1.38 years), members of seven Greek basketball clubs, who voluntarily participated in this research. Data were collected prior to training with several valid and reliable questionnaires measuring PA, self-rated health, subjective vitality and self-esteem (Cronbach’s α = .66 to .82). The findings suggested that 71.5% of youth basketball players spend 6 to 7 days per week in moderate to vigorous PA (MVPA) and 73.1% of them reported spend 5 to 6 hours per week in MVPA. There was no significant effect of age on players’ MVPA. Correlation analysis revealed that MVPA and enjoyment were positively related to players’ self-reported health, subjective vitality and self-esteem. Findings also revealed a direct effect of sport-related enjoyment on players’ self-rated health, self-esteem and subjective vitality, but not on their PA levels. Based on the above, it can be assumed that regular participation of children and adolescents in basketball training may contribute to increase or maintain their PA levels, to meet World Health Organization (WHO) recommendations for PA and to improve their quality of life. Article visualizations:

Impact of salt levels on the sensory profile and consumer acceptance of Italian dry-cured ham.

Reduction of the salt (NaCl) content in typical Italian dry-cured ham is intended to reduce sodium dietary intake to meet World Health Organization (WHO) recommendations for the prevention of serious diseases. This reduction is a complex issue because of the multiple roles that salt plays in the product. Hams that were processed to obtain a final product with target salt levels (hams with reduced salt concentration and controls) were analyzed using chemical parameters (salt, moisture, fat, and proteolysis indexes). Their sensory properties were described by a trained panel and 87 consumers evaluated the impact of salt reduction on their liking for the products. The dry-cured hams under investigation are representative of Italian dry-cured hams, which are considered to be low and medium to high in terms of salt content. Consistent with the role of salt in proteolytic enzymes inhibition, there was an increase in the proteolysis index in fully matured dry-cured hams with reduced salt content. Salt level affected saltiness perception but also texture, color, and, to a lesser extent, flavor intensity in matured dry-cured hams. On average, reduced-salt dry-cured hams resulted in increased consumer liking. However, the resulting three consumer segments (37%, 27%, and 36% of the consumer cohort, respectively), differed in the acceptability ranking given to reduced-salt hams and controls. The tested reduction in salt content, besides improving the nutritional profile of dry-cured ham, was effective in increasing consumers' acceptance. These results were useful for exploring the effect of reducing salt concentration on consumer liking for dry-cured hams. © 2020 Society of Chemical Industry.

Associations of self-reported physical activity and anxiety symptoms and status among 7,874 Irish adults across harmonised datasets: a DEDIPAC-study

BackgroundAnxiety is an adaptive response to an objective or perceived threat; however, when symptoms become severe and chronic it that can become a maladaptive anxiety disorder. Limited evidence suggests that physical activity may be associated with prevention against anxiety. This study uses data from The Irish Longitudinal Study on Ageing (TILDA) and The Mitchelstown Cohort Study to investigate cross-sectional associations between physical activity and anxiety symptoms and status among Irish adults.MethodsBoth datasets were harmonized (n = 7874). The short form International Physical Activity Questionnaire measured physical activity. Participants were classified as meeting World Health Organization physical activity guidelines (≥150 min weekly of moderate intensity physical activity, ≥75 min weekly of vigorous intensity physical activity, or ≥ 600 MET-minutes) or not. They were also divided into three groups based on weekly MET-minutes of moderate-to-vigorous physical activity (Low: 0–599; Moderate: 600–1199; High: ≥1200), and three groups based on weekly minutes of walking (Low: 0–209; Moderate: 210–419; High: 420+). Anxiety symptoms were measured by the Hospital Anxiety and Depression Scale with a score of ≥8 indicating anxiety. Binomial logistic regression, adjusted for relevant confounders examined physical activity–anxiety associations.ResultsFemales had higher rates of anxiety than males (28.0% vs 20.0%; p < 0.001). Following adjustment for relevant covariates, meeting physical activity guidelines was associated with 13.5% (95% CI: 2.0–23.7; p = 0.023) lower odds of anxiety. Moderate and High physical activity were associated with 13.5% (− 11.0–32.6; p = 0.254) and 13.6% (1.4–4.2; p = 0.030) lower odds of anxiety compared to Low physical activity, respectively. Moderate and High walking were associated with 2.1% (− 14.5–16.3; p = 0.789) and 5.1% (− 9.3–17.6; p = 0.467) lower odds of anxiety compared to Low walking, respectively.ConclusionMeeting physical activity guidelines is associated with lower odds of anxiety, but the strength of associations did not increase considerably with increased physical activity levels.

Comparison of Antibacterial Efficacy of Locally Produced Alcohol Based Hand Sanitizer and Commonly Available Commercial Hand Sanitizer Used in Healthcare Facilities in Uganda

Use of hand sanitizers has become a cornerstone in clinical practice for the prevention of disease transmission between practitioners and patients. There are a number of hand sanitizers sold on the Ugandan market with labels on their packages that claim that the hand sanitizer can kill 99.999% of germs and also there are hospitals that embarked on the local production of alcohol based hand sanitizer whose efficacy data are not locally available. Objective: To evaluate antibacterial efficacy of locally produced alcohol based hand sanitizer and commonly available commercial hand sanitizer used in healthcare facilities in Uganda. Method: This was an in vitro experimental, laboratory-based study of two different brands of hand sanitizers commonly used in healthcare facilities in Uganda and these were compared to a reference standard 60% Isopropyl alcohol. Efficacy was evaluated using standard organisms of Klebsiella pneumoniae American Type Culture Collection (ATCC 13883), Escherichia coli (ATCC 25922), and S. aureus (ATCC 25923) as per prEN12054, a European standard method. The logarithmic and percentage reduction factors (RF) were assessed at baseline and after treatment. Results: Both hand sanitizers studied were able to reduce bacteria by more than 105-fold within 15 seconds. Efficacy was independent of the alcohol concentration in each brand (Saraya 70% and locally made 80% alcohol). Conclusion: All of the hand sanitizers assessed had efficacy that meets World Health Organization (WHO) and PrEN12054 standards. From this study we are in agreement with the use of the locally made hand sanitizer and Saraya. The two hand sanitizers had broad antibacterial spectrum. However, there is a need to evaluate efficacy and organoleptic properties using in vivo studies.

Physical activity behaviour and barriers to activity in adults at high risk of obstructive sleep apnoea.

INTRODUCTION Physical inactivity is a risk factor for disease severity among people with obstructive sleep apnoea. AIM To determine physical activity levels in patients at risk of obstructive sleep apnoea and explore their perceptions about barriers to participation in physical activity. METHODS This was a cross-sectional observational study. Eligible participants were adults with symptoms of obstructive sleep apnoea hypopnea syndrome and Epworth Sleepiness Scale score ≥11, awaiting prioritisation for a diagnostic overnight sleep study at the local sleep clinic. Sixty participants (mean age±standard deviation: 51±12 years) each attended an individual appointment. Anthropometric measurements were taken and standardised questionnaires regarding quality of life, physical activity behaviour and perceptions of physical activity were completed. RESULTS Over one-third of the cohort did not meet World Health Organization guidelines for weekly physical activity. Hypertension, type 2 diabetes and obesity were also more prevalent in this subgroup. Low motivation and pain were commonly reported barriers to activity in participants not meeting the physical activity guidelines. Overall, 53 (88%) participants stated they would like to be more active. DISCUSSION Physical inactivity represents an additional risk factor for adults at high risk of obstructive sleep apnoea. Lack of motivation and pain were the most commonly perceived barriers to participation in activity. Physical activity interventions tailored to the individual, and including a motivational component, need to be included as integral components of management to reduce cardiovascular and metabolic risk factors more effectively in this group.

Characterizations of Drinking Water Quality for Populations of Hann Bel-Air (Dakar, Senegal)

Populations of Hann Bel-Air municipality are supplied with drinking water from taps water of “Sénégalaise Des Eaux” (SDE) and Jambar pumps which capturie directly the groundwater. This municipality is characterized by a strong environmental pollution which can affect the quality of drinking water. To determine actual quality of that water, 10 samples were taken and analyzed. Physico-chemical results have shown that tap water is more suitable for domestic consumption than Jambar pump water. The results show that physical parameters such as electrical conductivity (maximum value of 2671 μS/cm) exceed World Health Organization standard. The pH of the water from Jambar pumps is between 6.04 and 6.09, which demonstrates the aggressive character of that water. For tap water, pH values of 7.03 to 7.09 demonstrate their alkalinity. For chemical analyses, bicarbonates and sulphates concentrations respectively meet World Health Organization standards. Tap water meets World Health Organization standard for nitrates. With respect to chloride, the threshold of 250 mg/L is exceeded at all levels, but we note that high chloride concentrations are part of the exemptions granted to SDE. Tap water and water from water table have concentrations of calcium, potassium, iron and magnesium irreproachable. For sodium, EP3, EP4 and P5 samples from the web exceed World Health Organization standard with a peak of 310.27 mg/L. Tap water is more drinkable than groundwater but its quality needs to be improved and especially controlled for the well-being and sustainable health of consumers.

Children with Congenital Heart Disease Are Active but Need to Keep Moving: A Cross-Sectional Study Using Wrist-Worn Physical Activity Trackers

To compare daily physical activity of children with congenital heart disease (CHD) with healthy peers measured using wearables bracelets in a large cohort. Additionally, subjectively estimated and objectively measured physical activity was compared. From September 2017 to May 2019, 162 children (11.8±3.2years; 60 girls) with various CHD participated in a self-estimated and wearable-based physical activity assessment. Step-count and moderate-to-vigorous physical activity were recorded with the Garminvivofit jr. for 7 consecutive days and compared with a reference cohort (RC) of 96 healthy children (10.9±3.8years; 49 girls). Children with CHD were active and 123 (75.9%) achieved 60minutes physical activity on a weekly average according to the World Health Organization criteria as 81 (84.3%) of the healthy peers did (P=.217). After correction for age, sex, and seasonal effects, only slightly lower step count (CHD: 10 206±3178 steps vs RC: 11 142±3136 steps; P=.040) but no lower moderate-to-vigorous physical activity (CHD: 80.5±25.6minutes/day vs RC: 81.5±25.3minutes/day; P=.767) occurred comparing CHD with RC. In children with CHD higher age (P=.004), overweight or obesity (P=.016), complex severity (P=.046), and total cavopulmonary connection (P=.027) were associated with not meeting World Health Organization criteria. Subjective estimation of daily moderate-to-vigorous physical activity was fairly correct in half of all children with CHD. Even though the majority is sufficiently active, physical activity needs to be promoted in overweight or obese patients, patients with complex CHD severity, and in particular in those with total cavopulmonary connection.

Systematic review of cardiac rehabilitation guidelines: Quality and scope.

Cardiac rehabilitation is a comprehensive model of secondary prevention proven to reduce mortality and morbidity. The World Health Organization is developing a Package of Rehabilitation Interventions for implementation by ministries of health as part of universal healthcare across the continuum. Through a systematic review, we sought to identify the best-quality cardiac rehabilitation guidelines, and extract their recommendations for implementation by member states. A systematic search was undertaken of academic databases and guideline repositories, among other sources, through to April 2019, for English-language cardiac rehabilitation guidelines from the last 10 years, free from conflicts, and with strength of recommendations. Two authors independently considered all citations. Potentially eligible guidelines were rated for quality using the Appraisal of Guidelines for Research and Evaluation tool, and for other characteristics such as being multi-professional, comprehensive and international in perspective; the latter criteria were used to inform selection of 3-5 guidelines meeting inclusion criteria. Equity considerations were also extracted. Altogether, 2076 unique citations were identified. Thirteen passed title and abstract screening, with six guidelines potentially eligible for inclusion in the Package of Rehabilitation Interventions and rated for quality; for two guidelines the Appraisal of Guidelines for Research and Evaluation tool ratings did not meet World Health Organization minimums. Of the four eligible guidelines, three were selected: the International Council of Cardiovascular Prevention and Rehabilitation (2016), National Institute for Health and Care Excellence (#172; 2013) and Scottish Intercollegiate Guideline Network (#150; 2017). Extracted recommendations were comprehensive, but psychosocial recommendations were contradictory and diet recommendations were inconsistent. A development group of the World Health Organization will review and refine the recommendations which will then undergo peer review, before open source dissemination for implementation.

Compliance to dietary guidelines on fruit and vegetable intake and prevalence of hypertension among Vietnamese adults, 2015.

The aim of this study was to investigate whether the Western dietary guidelines on fruit and vegetable intake are associated with blood pressure parameters and hypertension among Vietnamese adults. Participants included 1384 women and 1049 men aged 18-69 years from the 2015 Vietnam national survey on risk factors of non-communicable diseases. Associations between dietary intake score based on the Dietary Approaches to Stop Hypertension (DASH) guidelines and World Health Organization recommendations on fruit and vegetable consumption and blood pressure parameters and hypertension were evaluated by multivariate regression analyses. Approximately 17.0% and 40.1% of participants met the respective definitions of hypertension according to Joint National Committee 7 (JNC7) and 2017 American College of Cardiology/American Heart Association (ACC/AHA) Hypertension Guideline. Highest tertiles of DASH scores for fruit intake were significantly associated with increased blood pressure parameters, particularly in women. Hypertension was associated with DASH score for fruit intake with odds ratios and 95% confidence intervals for tertiles 2-3 versus tertile 1: 1.31 (0.98, 1.76) and 1.43 (1.05, 1.93) for JNC7; 1.26 (1.01, 1.58) and 1.31 (1.04, 1.66) for 2017 ACC/AHA guideline (all p-trend <0.05). No association with blood pressure parameters and hypertension was observed for DASH score for vegetable intake and meeting World Health Organization recommendations for fruit and vegetable intake. We found an unexpected positive association between DASH score for fruit intake and blood pressure parameters and hypertension among Vietnamese adults. More research is needed in this population to understand the relationship between vegetable and fruit intake with hypertension before a firm conclusion and recommendation are made.

Performance investigation of a solar still having polythene film cover and black painted stainless steel basin integrated with a photovoltaic module–direct current heater

This work investigated the performance of two solar stills with similar polythene film cover and black painted stainless steel basin. One was a passive solar still and the other named active solar still was augmented with an external heat source of a photovoltaic module with output power of 45.9 W and a direct current heater. The maximum daily water production of active solar still and passive solar still was 4.36 and 3.21 L/m2, respectively. The estimated cost per L/m2 for active solar still and passive solar still was USD 0.045 and 0.015, respectively. The quality of water produced from both solar stills met World Health Organization drinking water standards.

A pragmatic patient-reported outcome strategy for rare disease clinical trials: application of the EORTC item library to myelodysplastic syndromes, chronic myelomonocytic leukemia, and acute myeloid leukemia

BackgroundNovel, pragmatic, patient-centered strategies are needed to ensure fit-for-purpose patient-reported outcomes (PRO) instruments in clinical trial research for rare diseases such as myelodysplastic syndromes (MDS), acute myeloid leukemia (AML), and chronic myelomonocytic leukemia (CMML). The objective of the current study was to select supplemental items to add to the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life-Core 30 (QLQ-C30) to ensure content coverage of all important clinical concepts in patients with higher-risk (HR) MDS, low-blast count (LB) AML, and CMML, thus, improving the instrument’s ability to detect clinically meaningful treatment benefit for this context of use.MethodsOur mixed methods approach comprised literature review, clinician consultation (n = 3), and qualitative and quantitative analysis of two stages of patient interview data (n = 14, n = 18) to select library bank items to supplement a generic cancer PRO, the EORTC QLQ-C30.ResultsUnique symptom (n = 54) and impact (n = 72) concepts were organized into conceptual frameworks of treatment benefit, compared with EORTC QLQ-C30 items and conceptual gaps identified. Supplemental items (n = 13) addressing those gaps were selected from the EORTC Item Library and tested with patients. Supplemental item endorsement frequencies met World Health Organization Quality of Life criteria, suggesting good targeting and relevance for this sample. However, three supplemental items were confirmed as problematic based upon cognitive debriefing results, and expert clinical consultations. Ultimately, 10 supplemental items (n = 7 symptom; n = 3 impact) were selected for the MDS/AML/CMML context.ConclusionSupplemental items were selected to enhance the conceptual coverage of the EORTC QLQ-C30 in the areas of fatigue, shortness of breath, and functioning.

Do country-level environmental factors explain cross-national variation in adolescent physical activity? A multilevel study in 29 European countries

BackgroundWorldwide, roughly 80% of adolescents fail to meet World Health Organization (WHO) recommendations regarding physical activity, though there is substantial variation in adolescent physical activity prevalence across countries. This study explored whether country-level environmental differences explained cross-national variation in adolescent moderate- to vigorous-intensity physical activity (MVPA) and vigorous-intensity activity (VPA).MethodUsing the data of 138,014 11- to 15-year-olds from 29 European countries in the 2013/2014 Health Behaviour in School-aged Children (HBSC) study, multilevel regression models examined the influence of four types of country-level environmental factors (physical, socio-cultural, economic, and political) on self-reported individual-level physical activity (MVPA and VPA).ResultsThe environmental variables explained 38% of country-level variance in MVPA and 81% of country-level variance in VPA. Lower annual average national temperature, higher community safety, lower average national household income and a weaker physical education policy were significantly associated with more MVPA. Greater urbanisation, lower annual average national temperature, higher adult physical activity and higher average national household income were significantly associated with more VPA.ConclusionsThe findings showed that national differences in the physical, socio-cultural and economic environment were related to adolescent physical activity. They point to potential avenues for future research looking at interactions between individual and environmental factors.