Origin Level Research Articles

Factors associated with potential over- and undertreatment of hyperglycaemia and annual measurement of HbA1c in type 2 diabetes in norwegian general practice.

AimsTo identify individual and general practitioner (GP) characteristics associated with potential over‐ and undertreatment of hyperglycaemia in type 2 diabetes and with HbA1c not being measured.MethodsA cross‐sectional study that included 10233 individuals with type 2 diabetes attending 282 GPs. Individuals with an HbA1c measurement during the last 15 months were categorized as potentially overtreated if they were prescribed a sulphonylurea and/or insulin when the HbA1c was less than 53 mmol/mol (7%) when aged over 75 years or less than 48 mmol/mol (6.5%) when aged between 65 and 75 years. Potential undertreatment was defined as age less than 60 years and HbA1c > 64 mmol/mol (8.0%) or HbA1c > 69 mmol/mol (8.5%) and treated with lifestyle modification and/or monotherapy. We used multilevel binary and multinominal logistic regression models to examine associations.ResultsOverall, 4.1% were potentially overtreated, 7.8% were potentially undertreated and 11% did not have HbA1c measured. Characteristics associated with potential overtreatment were as follows: long diabetes duration, prescribed antihypertensive medication, cardiovascular disease and renal failure. Potential undertreatment was associated with male gender, non‐western origin and low educational level. Characteristics associated with not having an HbA1c measurement performed were male gender, age < 50 years and cardiovascular diseases. GP specialist status and GPs’ use of a Noklus diabetes application reduced the risk of not having an HbA1c measurement performed.ConclusionPotential overtreatment in elderly individuals with type 2 diabetes was relatively low. Nevertheless, appropriate de‐intensification or intensification of treatment and regular HbA1c measurement in identified subgroups is warranted.

ZnO nanorods alloyed with Mo/Er. The effect of post-deposition treatment on defect states and luminescence

Free-standing ZnO nanorods alloyed with Er/Mo were synthesized by the hydrothermal growth method. To characterize them, the number of experimental techniques was applied including X-ray diffraction (XRD), scanning emission microscopy (SEM), electron paramagnetic resonance (EPR), photo- and radioluminescence (PL, RL). EPR confirmed the existence of F+ centres common for ZnO-based structures in the ZnO:Er(30%) nanorods whereas in the ZnO:Mo(30%) this kind of defect was absent. Air annealing at elevated temperatures results in the reduction of F+ centres in all the materials studied. Moreover, Er3+ EPR signal also undergoes changes including broadening in the ZnO:Er. This allowed suggesting oxidation of Er ions on the ZnO nanorods surface. Red luminescence (~680 nm) appears in all studied samples regardless the dopant origin and doping level after the annealing in air. The exciton-related band at 380 nm never observed in the samples before the annealing appears upon the annealing at 350 °C in ZnO:Mo(10%) and ZnO:Er(30%). No such band was observed in the ZnO:Mo(30%) sample under the same conditions. According to SEM there are nanorods no more but microrods upon the content of Mo/Er as compared to the as-grown untreated ZnO as reported in a recent work.

DAPI Banding Pattern of Chromosomes in Several Brassicaceae Species

BRASSICACEAE family includes a number of the most important Brassica cultivars such as canola, mustard and cabbage, and Arabidopsis thaliana as plant biology model species. Chromosome banding is the most probable protocol for karyotyping and to distinguish numerical chromosome abnormalities, duplications, inversions or deletions of chromosome parts, or exchanging a part from one to another chromosome as well. The aim of this study is to illustrate the DAPI banding patterns in 16 Brassicaceae species with small chromosome size, and they have different origin, ploidy level (chromosome number varies from 2n= 14 to 2n= 32). These species belong to five tribes (Brassiceae, Sisymbrieae, Lepidieae, Arabideae and Alyssea. The aim of this study is to illustrate the DAPI banding patterns in 16 Brassicaceae species with small chromosome size, and they have different origin and ploidy level (chromosome number varies from 2n= 14 to 2n= 32). In the current study we investigated different genera belong to five tribes of the family in regard to the position of regions as by using DAPI staining. It was excluded that most of plants with small chromosomes have mostly a centromeric bands and the more the chromosome size the more tendency to have interstitial bands.

The Impact of Kerogen Tortuosity on Shale Permeability

SummaryShale-matrix-associated transport phenomena exhibit multiple mechanisms including advective-, diffusive-, and adsorptive-driven transport modes, depending on the pore type. Diffusive processes are governed by the shale organic constituents known as kerogens. Kerogens, composed of fine-scale organic microstructures, vary with respect to their petrophysical properties, depending on their origin and maturity level. The extent to which kerogens contribute to the overall transport is governed by their ability to diffuse hydrocarbons contained within. The diffusion coefficient is a crucial parameter used to quantify diffusivity based on the interactions between the host material and the diffusing molecules. Kerogen as a hosting medium allows for diffusion of natural gas at various rates based on several factors. One of these factors, kerogen porosity, is conjectured to significantly influence diffusive transport phenomena. In this paper, taking advantage of the predictive power of molecular dynamics (MD) simulation, we investigate the impact of kerogen porosity on the diffusivity coefficient of natural gas. Starting from a single type II kerogen macromolecule, several kerogen structures for a realistic range of porosity values were created and, subsequently, used for diffusivity calculations of methane molecules. Simulation results suggest a direct link between diffusion and kerogen porosity, allowing for delineation of the diffusion tortuosity factor. Furthermore, the microscale tortuosity–diffusivity relationship in kerogens was investigated at the reservoir scale by means of a shale permeability model. The results substantiate the critical impact of the diffusion process on the shale permeability.

Function of family of origin and current quality of life: exploring the mediator role of resilience in Chinese patients with type 2 diabetes

Early physical and mental experiences from family of origin and parents might influence individuals’ later adulthood quality of life (QOL). The present study was undertaken to examine the inter-relationships among function of family of origin, resilience, and current quality of life in a T2DM sample from China. Three hundred T2DM participants were included in this investigation. A Chinese version of Connor-Davidson Resilience Scale 25, an APGAR family functioning scale, and a Diabetes Specificity Quality of Life Scale were used to assess the levels of mental resilience, function of family of origin, and QOL of these patients, respectively. Multiple stepwise regression analysis was performed to identify the predictors of QOL. A 3-step composite analysis was used to examine the predicted mediating effect. QOL total score was negatively related to resilience (r = − .299, p < 0.01) and family function (r = − .246, p < 0.01). In contrast, a significantly positive correlation between resilience and family function (r = .302, p < 0.01) was found. Two subscales of resilience (strength and optimism) and function of family of origin explained an additional 4.5% of the variance in QOL changes after controlling for demographic variables. Resilience had a 26.3% mediating effect between function of family of origin and current QOL. In conclusion, the present work suggested a synthetic and stable association between function of family of origin and QOL level in the later life in a sample of Chinese T2DM population, with resilience acting as a mediating factor. Adult individuals who have grown up in an unfavorable family setting may be low in mental resilience, and would have worse QOL in their mid- and later life, especially when they are confronted with certain adversity or stress, such as having diabetes.

Evaluation of facial artery course variations and depth by Doppler ultrasonography.

As deep nasolabial folds (NLF) are associated with facial aging, there is an increasing demand for esthetic correction with filler injections. Understanding the anatomy of the angular artery (AA) and facial artery (FA) around the NLF region is essential for ensuring the safety of dermal filler injections into the NLF. The purpose of this study was to provide detailed vascular anatomical information on the course and depth of AA and FA around NLF using Doppler ultrasound on live cases. FA was observed from the origin level adjacent to the mandible corpus to the end of its terminal branch AA in 168 hemifaces of 84 cases with Doppler ultrasonography. We made a classification of the FA course based on the NLF. The minimum and maximum depths of the FA along its course were measured in 84 cases. The results showed that its course may be highly superficial (2.5mm at the mandibular origin, 3.7mm at the cheilion, 3.7mm at the nasal ala) or it may follow a very deep course near the periosteum (15.0mm at the mandibular origin, 18.7mm at the cheilion, 23.5mm at the nasal ala). FA depth was varied between 5.98mm and 6.62mm at the mandibular origin, between 8.36mm and 9.20mm at the cheilion, between 9.52mm and 10.51mm at the nasal ala at a 95% confidence interval. This study suggests that there is no absolutely safe depth or region for nasolabial fold filler injections.

Adverse perinatal outcomes among children in Switzerland: the impact of national origin and socio-economic group

ObjectivesWe examined the effect of the mother’s origin and socio-economic characteristics on adverse perinatal outcomes in Switzerland.MethodsBirths occurring from 2011 to 2017 were identified in the Swiss population register and merged with the Swiss civil register and the Register of the first pillar to obtain information on the migration origin and socio-economic level. Four indicators of adverse perinatal outcomes were defined.ResultsLogistic regressions show that both the migration origin and the socio-economic level are measured by the parents’ income, influence risk. Compared to the children of mothers born in Switzerland, those of mothers from EU/EFTA countries have a lower risk of infant mortality, low birth weight and extreme prematurity. The highest risk is observed for children born to mothers from the rest of the world. High levels of risk consistently characterize children with low-income parents (first decile).ConclusionsOur results justify further investigations at the level of health services to better identify the factors causing differences in the prevalence of adverse outcomes and to take them into account in adapted health policies.

Local Perceptions of Ecosystem Services Across Multiple Ecosystem Types in Spain

Combining socio-cultural valuations of ecosystem services with ecological and monetary assessments is critical to informing decision making with an integrative and multi-pronged approach. This study examined differences in the perceptions of ecosystem service supply and diversity across eight major ecosystem types in Spain and scrutinized the social and ecological factors shaping these perceptions. First, we implemented 1932 face-to-face questionnaires among local inhabitants to assess perceptions of ecosystem service supply. Second, we created an ecosystem service diversity index to measure the perceived diversity of services considering agroecosystems, Mediterranean mountains, arid systems, two aquatic continental systems, coastal ecosystems and two urban ecosystems. Finally, we examined the influence of biophysical, socio-demographic and institutional factors in shaping ecosystem service perceptions. Overall, cultural services were the most widely perceived, followed by provisioning and regulating services. Provisioning services were most strongly associated with agroecosystems, mountains and coastal systems, whereas cultural services were associated with urban ecosystems and regulating services were specifically linked with agroecosystems, mountains and urban recreational areas. The highest service diversity index values corresponded to agroecosystems, mountains and wetlands. Our results also showed that socio-demographic factors, such as place of origin (urban vs. rural) and educational level, as well as institutional factors, such as management and access regimes, shaped the perception of ecosystem services.

Celebrity endorsements in destination marketing: A three country investigation

The present study extends research on the role of celebrity endorsements in destination marketing by exploring various facets of the effect of celebrity endorsements in destination marketing on the consumer. More specifically, theories of source credibility, congruence, social identity and consumer cosmopolitanism, are used to build research questions that investigate the relative effectiveness of a celebrity endorsed tourism advertisement vis a vis a generic advertisement and the boundary conditions governing the same such as destination type (local/global), celebrity country of origin and consumer level factors. The research questions are addressed using four experimental studies in sequence. The same four experiments are run in three countries with different socio-cultural backgrounds to enhance generalization, with a combined sample size of 1073 respondents. Major findings suggest that a celebrity endorser is effective for a destination advertisement. Significant cross-country differences were observed in consumer affect depending on the choice of celebrity (local or global) and the destination type (i.e., domestic or international). The effects are also moderated by consumer cosmopolitanism. The study has multiple theoretical and managerial implications.

Integrated origin-based demand modeling for air transportation

This paper proposes an origin-based air travel demand model that assumes saturation at the origin level and explicitly accounts for substitutability between destinations. We simultaneously integrate demand generation and allocation by means of a multilevel aggregate nested logit formulation that covers the choices of whether or not to travel by air, where to travel (destination), and how to travel (itinerary). Two specifications are proposed to reflect systematic differences between lengths of haul and the bootstrap is applied to jointly address endogeneity issues and data missingness. The validity of the proposed approach is tested over the entire network of outbound air trips from Italy in 2018.

Analysis of Clinical Features and Endoscopic Ultrasonography in the Diagnosis of Gastric Submucosal Tumors

To explore the clinical features and endosonographic (EUS) features of gastric submucosal tumors, the connection of submucosal tumor features and pathological features are analyzed to increase the awareness of submucosal tumors. This study is based on 237 cases of gastric mucosal lesions from March 2015 to March 2019. Endoscopic ultrasonography was performed to record the size and origin of the lesions and to make the preliminary qualitative diagnosis of the lesions, where endoscopic resections have 186 cases. According to the actual lesion resection in endoscopic ultrasonography, the origin level of SMTs and the coincidence rate of endoscopic ultrasonography diagnoses are judged. Therefore, endoscopic ultrasonography has high localization, characterization, and differential diagnosis value for gastric mucosal lesions. Diagnosis of gastric mucosal lesions under endoscopic ultrasonography is helpful for the choice of endoscopic resection surgical method.

Relationship between Bone Stability and Egg Production in Genetically Divergent Chicken Layer Lines.

Simple SummaryBrittle or fractured bones due to continuous demineralisation cause major welfare and economic problems in laying hens. Bone weakness in laying hens is frequently attributed to long-term selection for increased egg production, but this is controversially discussed in the scientific literature. We aimed at characterizing factors influencing the bone breaking strength of laying hens, focusing mainly on the effect of eggshell production. By examining four different chicken layer lines separately, a genetically diverse spectrum of laying hen origins was included in our study. It was shown that bone strength is primarily influenced by bone mineral density. A strong association between bone strength and eggshell production was not observed within each of the lines studied. This applied to all layer lines. Our results suggest that a high egg number does not generally impair bone stability within layer lines. Findings from this study contribute to the discussion on the improvement of bone stability in poultry breeding programs and thus lead to increased animal welfare in egg production.Impaired animal welfare due to skeletal disorders is likely one of the greatest issues currently facing the egg production industry. Reduced bone stability in laying hens is frequently attributed to long-term selection for increased egg production. The present study sought to analyse the relationship between bone stability traits and egg production. The study comprised four purebred layer lines, differing in their phylogenetic origin and performance level, providing extended insight into the phenotypic variability in bone characteristics in laying hens. Data collection included basic production parameters, bone morphometry, bone mineral density (BMD) and bone breaking strength (BBS) of the tibiotarsus and humerus. Using a multifactorial model and regression analyses, BMD proved to be of outstanding importance for bone stability. Only for the tibiotarsus were morphometric parameters and the bone weight associated with BBS. Within the chicken lines, no effect of total eggshell production on BBS or BMD could be detected, suggesting that a high egg yield itself is not necessarily a risk for poor bone health. Considering the complexity of osteoporosis, the estimated genetic parameters confirmed the importance of genetics in addressing the challenge of improving bone strength in layers.

Circulating miRNAs are associated with sleep duration in children/adolescents: Results of the I.Family Study.

What is the central question of this study? Are differential patterns of circulating miRNAs associated with sleep duration in normal-weight European children and adolescents? What is the main finding and its importance? Differences in the expression level of circulating miR-26b-3p and miR-485-5p are positively associated with total sleep duration in healthy normal-weight children and adolescents. It is commonly recognized that sleep is essential for children's health, and that insufficient sleep duration is associated with negative health outcomes. In humans, sleep duration and quality are influenced by genetic, environmental and social factors. Epigenetic mechanisms, likewise, regulate circadian rhythms and sleep patterns. In the present study, we aimed to identify circulating microRNAs associated with sleep duration in a subsample of normal-weight European children/adolescents (n=111) participating in the I.Family Study. Subjects were divided into two groups based upon self-reported sleep duration, according to the recommended amount of sleep for paediatric populations. Sleep needs for children<13 years were at least 9h per day, and for children>13 were at least 8h per day. There were group differences (short sleepers versus normal sleepers) in circulating levels of miR-26b-3p (mean (95% CI)=2.0 (1.3-2.7) versus 2.3 (1.9-2.7), P=0.05) and miR-485-5p (mean (95% CI)=0.6 (0.3-0.9) versus 0.9 (0.7 - 1.0), P<0.001), adjusting for country of origin, age, sex, pubertal status, screen time and highest educational level of parents. Our findings show for the first time that sleep duration reflects the profile of specific circulating microRNAs in school-aged children and adolescents. It is conceivable that epigenetic modifications, mainly related to circadian rhythm control, may be modulated or interfere with sleep duration.

The Uruguayan semen donor population: A twenty‐eight‐year retrospective study

Several studies have reported a global decline in seminal quality over the years. The objective of this study was to describe the semen donor population of Uruguay through comparing data of successive samples banked by the same donors and the analysis of their semen and physical characteristics, ancestry origin and educational level. A total of 3,449 ejaculated samples collected from 71 donors, cryobanked between 1989 and March 2017 at Fertilab, were analysed. Results revealed a mean age of 23.90±3.98years, an average weight of 74.95±1.09kg and a mean height of 1.78±0.06m. The majority of the donors trace their origin to Europe (74.65%, 53/71) and 66.19% (47/71) have a level of education higher than secondary school. We observed longitudinal differences in two parameters, that is sperm concentration and semen volume. Sperm concentration declined, while semen volume increased significantly over the 28-year period. The results of the present study are in accordance with that of previous articles that also reported a decline in sperm concentration over time. However, no differences were observed in total sperm number per ejaculate due to the increase in semen volume values, thus reflecting no real changes in sperm production over time.

Identification of the Artery of Adamkiewicz Using Multidetector Computed Tomography Angiography (MCTA).

Objective The aim of the present study is to evaluate the artery of Adamkiewicz by multidetector computed tomography angiography (MCTA) in a Brazilian population. Methods Two independent observers evaluated 86 coronary MCTA examinations. The variables studied included the identification of the artery of Adamkiewicz at its origin level, and its entry side in the spine. Results The artery of Adamkiewicz was detected in 71 (82.5%) examinations. The origin level was identified between the 9th and 11th thoracic vertebrae (T9 and T11) in 56 (79.2%) patients. In 65 (91.5%) patients, the artery was on the left side. The identification of the artery of Adamkiewicz using MCTA showed high reproducibility. Conclusions Our results were consistent with the literature regarding the identification of the artery of Adamkiewicz using MCTA, suggesting that this technique should be considered as an option to recognize this structure. In addition, we found that the distribution of the artery of Adamkiewicz in the Brazilian population is similar to that of other populations, that is, its most common origin is at the left side, between the 8th and 12th thoracic vertebrae (T8–T12).

Academic Dishonesty in Indonesian College Students: an Investigation from a Moral Psychology Perspective

The present study aimed to investigate academic dishonesty among college students in Indonesia, as well as exploring various aspects of morality (i.e., moral integrity, moral disengagement, and moral foundations) that may affect academic dishonesty. This study drew upon data obtained from an online survey of 574 students from diploma, undergraduate, and postgraduate levels of study in Indonesia (Male = 175, Female = 399). The data revealed a high prevalence of academic dishonesty in Indonesian college students and indicated that the level of academic dishonesty is affected by gender, college origin, and study level. Regressions confirmed that higher academic dishonesty is associated with lower moral integrity and higher level of moral disengagement, as expected, but not with moral foundations. We also present detailed examinations on the three forms of academic dishonesty (i.e., cheating, unauthorized collaboration, and plagiarism) and discuss the theoretical and practical implications of these findings.

English

The health of a pregnant mother and her nutritional status can influence the health and survival of the growing foetus because of the biological link between her and her child. This study was conducted to assess the knowledge and practice of healthy nutrition among pregnant women attending selected private hospital, Benin City. Descriptive cross-sectional research design was used for the study. Two hundred and twenty two (222) women were selected using convenient sampling technique. Self structured questionnaire served as instrument of the study. Reliability was ensured using test retest and alpha value of 0.87. Data were analyzed using descriptive statistics; hypothess were tested using logistic regression and t-test at 5% level of significance. Result show that 159 (76.8%) of the respondents have good knowledge of healthy nutrition, 28 (13.5%) of the respondents have a fair knowledge of healthy nutrition, while only 20 (9.7%) have poor knowledge of healthy nutrition. Also 82 (39.6%), have a good practice of healthy nutrition, 69 (33.3%) fairly practice healthy nutrition, while 69 (27.1%) poorly practice healthy nutrition. Factors influencing poor practices include ignorance 45(36.6%), forgetfulness 44(35.8%), and husband’s attitude 29(23.6%). Majority 79(38.2%) of the respondents avoided certain foods because they don’t just like them. logistic regression shows a statistically significant relationship (p=0.000 OR -0.567, 0.002 OR -0.241 and 0.000 OR 0.417) with the tribe, state of origin and educational level of the husband and the practice of healthy nutrition. Health talk should be encouraged on each antenatal day and nurses should put more emphasis on healthy nutrition. Government should provide public awareness for girl child education as illiteracy is a major factor that affects dietary practice during pregnancy and acceptance to practice which will help reduce the rate of intrauterine fetal death, low birth weight (LBW) and maternal mortality Key words: Knowledge, practice, healthy nutrition, pregnant women.

Fecundity among women with polycystic ovary syndrome (PCOS)-a population-based study.

Does the long-term fecundity of women with polycystic ovary syndrome (PCOS) differ from those without PCOS? Cumulative probability of childbirth is similar between women with and without PCOS. PCOS is the main cause of anovulatory infertility in women after menarche. Previous studies indirectly suggest that fecundity in women with PCOS over the longer term may not be lower than in women without PCOS. This is a population-based study using four linked Swedish national registries. A total of 45 395 women with PCOS and 217 049 non-PCOS women were included. Follow-up began at the age of 18years and continued for a maximum of 26years, from 1989 to the end of 2015. Childbirth was the main outcome, as identified from the Medical Birth Register. All women born between 1971 and 1997 who were identified with a PCOS diagnosis in the Swedish Patient Registry between 1 January 2001 and 31 December 2016 were included in the study population. Five controls per women with PCOS were randomly drawn from the Total Population Registry. The control women were born in the same year and living in the same municipality as the patient. The fecundity ratio (FR) was calculated by clustered Cox regression using a robust variance, adjusted for maternal birth period, country of birth and level of education. The cumulative probability of childbirth was 80.2% (95% CI, 79.5-80.9%) in women with PCOS and 78.2% (95% CI, 77.9-78.5%) in those without PCOS. Adjusted FR was 0.81 (95% CI, 0.80-0.82) for first childbirth and 0.58 (95% CI, 0.57-0.60) for first childbirth following a spontaneous pregnancy. The FR for second childbirth was 0.79 (95% CI, 0.77-0.80). Women with PCOS had more than one child less frequently than the comparison group. Within the PCOS group, early age at diagnosis, later birth year, Nordic country of origin and low educational level positively influenced the FR. Results are not adjusted for BMI, and time from intention to conceive to first childbirth could not be captured. Data on pregnancies, miscarriages or abortions and fertility treatment are unknown for women who did not give birth during the study period. Women with PCOS who did not seek medical assistance might have been incorrectly classified as not having the disease. Such misclassification would lead to an underestimation of the true association between PCOS and outcomes. While cumulative probability of childbirth is similar between groups, women with PCOS need longer time to achieve their first childbirth. Women with PCOS have a lower FR and give birth to fewer children per woman than women without PCOS. Early diagnosis of and information about PCOS may improve affected women's reproductive potential. This study was funded by the Swedish Society of Medicine. Inger Sundström Poromaa has, over the past 3 years, received compensation as a consultant and lecturer for Bayer Schering Pharma, MSD, Gedeon Richter, Peptonics and Lundbeck A/S. The other authors declare no competing interests.

Consequences of consumer origin and omnivory on stability in experimental food web modules

Abstract Food web stability, a fundamental characteristic of ecosystems, is influenced by the nature and strength of species interactions. Theory posits that food webs are stabilised by omnivory and disrupted by novel consumers. To test the effects of secondary consumer origin and trophic level on basal resource stability, we constructed crayfish–snail–algae modules using four congeneric species of crayfish (Faxonius spp.), two from native populations (Faxonius propinquus and Faxonius virilis) and two from non‐native populations (Faxonius limosus and Faxonius rusticus). We performed surgical manipulations of crayfish feeding structures to create omnivore food web and predator food chain modules. We compared the temporal stability of these modules using measures of the coefficient of variation of the basal resource (benthic algae). Consistent with theoretical and empirical predictions, food web modules with omnivory had the lowest coefficient of variation. However, contrary to prediction, we did not find consistently higher coefficients of variation in modules with non‐native species. Rather, across species, we found the lowest coefficient of variation in modules with one of the non‐native species (F. rusticus) and one native species (F. virilis), owing to stronger interactions between these crayfish species and their snail and algal food resources. The results suggest that omnivory is indeed stabilising and that very weak interactions or very low attack rates of the consumer on the basal resource can be unstable. Thus, we demonstrate that omnivores may have different impacts than predators when introduced into a novel ecosystem, differences that can supersede the effect of species identity.

Implementation of latent tuberculosis infection screening and treatment among newly arriving immigrants in the Netherlands: A mixed methods pilot evaluation.

IntroductionTo reach pre-elimination levels of tuberculosis (TB) incidence in the Netherlands, prevention of TB among immigrants through diagnosis and treatment of latent TB infection (LTBI) is needed. We studied the feasibility of a LTBI screening and treatment program among newly arriving immigrants for national implementation.MethodsWe used mixed methods to evaluate the implementation of LTBI screening and treatment in five Public Health Services (PHS) among immigrants from countries with a TB incidence >50/100,000 population. We used Poisson regression models with robust variance estimators to assess factors associated with LTBI diagnosis and LTBI treatment initiation and reported reasons for not initiating or completing LTBI treatment. We interviewed five PHS teams using a semi-structured method to identify enhancing and impeding factors for LTBI screening and treatment.ResultsWe screened 566 immigrants; 94 (17%) were diagnosed with LTBI, of whom 49 (52%) initiated and 34 (69%) completed LTBI treatment. LTBI diagnosis was associated with male gender, higher age group, higher TB incidence in the country of origin and lower level of education. Treatment initiation was associated with PHS (ranging from 29% to 86%), lower age group, longer intended duration of stay in the Netherlands, and lower level of education. According to TB physicians, clients and their consulted physicians in the home country lacked awareness about benefits of LTBI treatment. Furthermore, TB physicians questioned the individual and public health benefit of clients who return to their country of origin within the foreseeable future.ConclusionsDoubt of physicians in both host country and country of origin about individual and public health benefits of LTBI screening and treatment of immigrants hampered treatment initiation: the high initiation proportion in one PHS shows that if TB physicians are committed, the LTBI treatment uptake can be higher.