Recruitment Of Study Subjects Research Articles

Effect of Insulin Injection Techniques on Glycemic Control Among Patients with Diabetes.

Previous studies have shown that healthcare professionals rarely instruct patients about proper insulin injection techniques. This study aimed to assess the practices of insulin injection techniques among patients with diabetes treated and assess the effect of these practices on glycemic control. This cross-sectional study was conducted between November 2020 and February 2021. A random systematic sampling technique was used to recruit study subjects at specialist outpatient clinics. Subjects with type 1 or 2 diabetes mellitus who had been using insulin injections for at least a year were included in this study. A total of 298 subjects with type 1 diabetes and 553 with type 2 diabetes participated in this study. The mean age of patients with type 1 diabetes was 20.1 ± 10.4 years. The mean age of patients with type 2 diabetes was 58.6 ± 9.5 years. The median type 1 diabetes duration was 6.0 years, and median type 2 diabetes duration was 15.0 years. About 66.8% of patients with type 1 diabetes and 69.4% of patients with type 2 diabetes were rotating insulin injection sites. Almost 36.6% of patients with type 1 diabetes and 50.5% of patients with type 2 diabetes reported using the same insulin needle more than three times. The prevalence of lipohypertrophy was 57.0% among patients with type 1 diabetes and 55.5% among patients with type 2 diabetes. The absence of lipohypertrophy, rotation of insulin injection site, and total daily insulin dose ≤50 units were all independently significantly associated with better glycemic control. Insulin injection techniques were suboptimal among significant proportion of patients with diabetes in Jordan. Improper insulin injection technique, especially the rotation of injection sites and lipohypertrophy formation, was associated with uncontrolled blood glucose levels. Educational interventions that focus on insulin injection techniques among Jordanian patients with diabetes are strongly recommended.

Factors associated with stroke associated pneumonia among adult stroke patients admitted to university of Gondar hospital, Northwest Ethiopia

Stroke is the major cause of disability and death in sub-Saharan African countries. The presence and severity of complications play a major role in the outcome of stroke. Stroke associated pneumonia is often noticed post stroke infection that has been linked to an increased risk of hospital mortality, a longer hospital stay and higher healthcare expenses. Report on details of stroke-associated pneumonia has never been documented in countries of sub-Saharan Africa. This study aimed to determine the incidence and risk factors of stroke-associated pneumonia among adult stroke patients in hospital settings, Northwest Ethiopia. The study was undertaken at a stroke care unit, University of Gondar hospital between January 1, 2020 and December 31, 2020. A convenience sampling method was used to recruit study subjects. Relevant clinical history was taken, focused physical examination was done, and brain imaging (CT scan or MRI) was performed to settle the diagnosis of stroke. A modified Centre for Disease Control and Prevention (CDC) criteria was used to diagnose stroke-associated pneumonia. All patients with stroke-associated pneumonia were treated according to the 2016 Infectious Diseases Society of America/American Thoracic Society Clinical Practice Guidelines. The Data were cleaned in Epi Info version 4.6.0.2, and analyzed using SPSS version 26. Variables associated with stroke-associated pneumonia were computed using logistic regression analysis. P value < 0.05 was considered to declare statistical significance. The study comprised a total of 325 adult stroke patients. The mean age of study subjects was 65.2 years (SD ± 15.7). The most prevalent type of stroke was ischemic stroke, which accounted for 68% of all cases. Hemiparesis (94%), facial palsy (87%), and swallowing disturbance (51%) were the frequently noticed neurological findings. Stroke-associated pneumonia complicated 116/325 (36%) of stroke patients. Multi-variate regression analysis revealed that patients who were elderly (age > 75 years) (AOR = 3.910, CI 1.181–12.936, P = 0.026), had swallowing disturbance (AOR = 4.656, CI 2.356–9.202, P-value < 0.001), epileptic seizures (AOR = 2.678, 95% CI 1.253–5.721, P-value < 0.001) and moderate to severe stroke (NIHSS score = 16–21) (AOR = 5.994, 95% CI 2.043–17.585, P-value < 0.001) were at risk of developing stroke-associated pneumonia. SAP was a substantial medical complication among stroke patients. Early identification and prompt intervention measures for the identified risk factors might address the burden of SAP.

Effect of maternal employment on exclusive breastfeeding practice among mothers of infants 6–12 months old in Wolkite town, Ethiopia: a comparative cross-sectional study

IntroductionExclusive breastfeeding (EBF) means providing only breast milk for infants for up to six months without the addition of solid or liquid matter. Even though EBF had great benefits for infants and mothers, the rate of EBF is so limited below the global target. In Ethiopia, the overall EBF practice is 59%. This low EBF practice had a great unexplained variation among employed and unemployed mothers. Therefore, this study aimed to compare EBF practice and associated factors among employed and unemployed mothers of infants aged 6–12 months in Wolkite town, Southern Ethiopia, 2020.MethodsA community-based comparative cross-sectional study was conducted in March 2020. A total sample of 485 (241 employed and 244 unemployed) study subjects was involved in the study. A simple random sampling technique was used to recruit study subjects. A pre-tested structured interviewer-administered questionnaire was used. Multivariable logistic regression was used to identify associated factors of EBF practice for the whole study participants and then for employed and unemployed mothers independently.ResultsThe pooled prevalence of exclusive breastfeeding practice was 63.9% [95% CI (59.8–68.2%)]. Exclusive breastfeeding practice was 54.8% [95% CI (48.5–61.4%)] and 73% [95% CI (66.8–78.7%)] among employed and unemployed mothers respectively. Three or more years of a birth interval [AOR = 4.03; 95% CI (1.80–8.99)], three or more ANC visits [AOR = 5.39; 95% CI (1.49–19.45)], and having PNC service [AOR = 4.56; 95% CI (2.0–9.4)] significantly associated to exclusive breastfeeding practice among employed mothers. No history of breastfeeding counseling during ANC visits [AOR = 0.15; 95% CI (0.06–0.41)], had history of breast disease [AOR = 0.28; 95% CI (0.08–0.99)], three or more ANC visits [AOR = 5.11; 95% CI (1.66–15.8)], and having social support [AOR = 3.05; 95% CI (1.23–7.6)] significantly associated to EBF practice among unemployed mothers.ConclusionEmployment among mothers was found to discourage EBF practice. The predictors of exclusive breastfeeding practice are different for employed and unemployed. Therefore Policymakers and program planners are called to come together and create a conducive environment for lactating employees, and appropriate intervention at respective predictor variables is needed to enhance EBF practice.

Morbidity profile and dynamics of determinants of health-seeking behaviour in geriatric population of Chandigarh, India

Introduction: Aging is a natural process that usually results in physiological, biological, emotional, and financial decline. As a result, a robust health system is required to meet their escalating health needs. Through this study, we got an opportunity to study the morbidity profile of the elderly and to assess their health-seeking behavior and its determinants in urban areas of Chandigarh.Material and Methods: The sample consisted of 360 participants. Multistage and proportionate sampling techniques were used to recruit study subjects. A structured interview was carried out to get information on the different parameters of health-seeking behavior of the elderly population.Results: The most pervasive determinant of health-seeking behavior was perceiving health issues related to age, no family support, and health-care expenditure.Conclusion: The elderly had a positive behavior toward seeking help with regard to health care. Multiple morbidities were evident among the elderly, and modern medication was the greatest choice. Improved perspective toward health, easy accessibility, and awareness regarding the disease may contribute to the willingness of seeking help for the health-care needs.

Seizure control and its associated factors among epileptic patients at Neurology Clinic, University of Gondar hospital, Northwest Ethiopia.

Background:Epilepsy is characterized by two or more unprovoked recurrent seizures, which often respond to available antiseizure medications. However, seizure control among epileptic patients in the developing world is low. Factors determining seizure control among epileptic patients were not evidently explored in the study setting.Objectives:This study aimed to determine the magnitude of uncontrolled seizures and associated factors among epileptic patients at the University of Gondar hospital.Methods:This cross-sectional study was conducted at the University of Gondar hospital, Northwest Ethiopia. A convenience sampling method was used to recruit study subjects. Controlled seizure was defined as seizure freedom for the past 1 year. Logistic regression analysis was used to identify factors associated with seizure control. A p-value < 0.05 was used to declare a significant association.Results:A total of 320 study subjects were included in the study. The mean (±SD) age of patients was 27.5 ± 7.6 years. More than half (182/320, 57%) of epileptic patients had uncontrolled seizures. Five or more pretreatment seizure episodes (adjusted odds ratio = 3.98, 95% confidence interval: 1.81–8.75, p = 0.001), less than 2 years on anti-seizure medications (adjusted odds ratio = 8.64, 95% confidence interval: 3.27–22.85, p < 0.001), taking 2 or more ASMs (adjusted odds ratio = 2.48, 95% confidence interval: 1.23–5.02, p = 0.011), poor adherence to ASMs (adjusted odds ratio = 9.37, 95% confidence interval: 4.04–21.75, p < 0.001), and living at a single trip distance from hospital equaled 1 h or more (adjusted odds ratio = 4.20, 95% confidence interval: 2.11–8.41, p < 0.001) were significantly associated with uncontrolled seizures.Conclusion:The dose of a preferred anti-seizure medication should be optimized before combinations of anti-seizure medications are used. Adherence to anti-seizure medications should be reinforced for better seizure control. Epilepsy care should be integrated into primary health care services in the catchment region.

Evaluation of Anticoagulation Control among Patients Taking Warfarin in University of Gondar Hospital, Northwest Ethiopia.

Introduction Warfarin is a widely used oral anticoagulant in clinical practice. It has variable intraindividual and interindividual dose response and a narrow therapeutic index. Therefore, it requires frequent and regular international normalized ratio (INR) determination to maintain the INR within the therapeutic range. The study evaluated parameters of anticoagulation control among patients on warfarin. Methods A cross-sectional study was conducted at University of Gondar hospital. A consecutive sampling method was used to recruit study subjects. The anticoagulation control was evaluated by determining the proportion of desired INRs and the proportion of time spent in the therapeutic range (TTR). Logistic regression analysis was used to identify associated factors with adequate TTR. A P value <0.05 was used to declare significant association. Result A total of 338 study subjects were included in the study. The mean age of patients was 48.8 (SD = 16.4) years. Atrial fibrillation was the commonest indication for warfarin therapy. One-third (33%) of study subjects achieved the desired INRs of 2.0–3.0, while about one-tenth (13%) of patients attained good INR control (TTR ≥ 65%). Multivariate logistic regression analysis revealed no significant association of sociodemographic and clinical characteristics with good TTR outcome. Conclusion The level of anticoagulation control with warfarin among study subjects was very low. The authors recommend to implement a validated warfarin-dose titration protocol and to establish anticoagulation clinics to mitigate the low anticoagulation level.

Determinants of acute respiratory infection among under-five children in rural Ethiopia

IntroductionIn low- and middle-income nations, acute respiratory infection (ARI) is the primary cause of morbidity and mortality. According to some studies, Ethiopia has a higher prevalence of childhood acute respiratory infection, ranging from 16 to 33.5%. The goal of this study was to determine the risk factors for acute respiratory infection in children under the age of five in rural Ethiopia.MethodsA cross-sectional study involving 7911 children under the age of five from rural Ethiopia was carried out from January 18 to June 27, 2016. A two stage cluster sampling technique was used recruit study subjects and SPSS version 20 was used to extract and analyze data. A binary logistic regression model was used to identify factors associated with a childhood acute respiratory infection. The multivariable logistic regression analysis includes variables with a p-value less than 0.2 during the bivariate logistic regression analysis. Adjusted odds ratios were used as measures of effect with a 95% confidence interval (CI) and variables with a p-value less than 0.05 were considered as significantly associated with an acute respiratory infection.ResultsThe total ARI prevalence rate among 7911 under-five children from rural Ethiopia was 7.8%, according to the findings of the study. The highest prevalence of ARI was found in Oromia (12.8%), followed by Tigray (12.7%), with the lowest frequency found in Benishangul Gumuz (2.4%). A multivariable logistic regression model revealed that child from Poor household (AOR = 2.170, 95% CI: 1.631–2.887), mother’s no education (AOR = 2.050,95% CI: 1.017–4.133), mother’s Primary education (AOR = 2.387, 95% CI:1.176–4.845), child had not received vitamin A (AOR = 1.926, 95% CI:1.578–2.351), child had no diarrhea (AOR = 0.257, 95% CI: 0.210–0.314), mothers not working (AOR = 0.773, 95% CI:0.630–0.948), not stunted (AOR = 0.663, 95% CI: 0.552–0.796), and not improved water source (AOR = 1.715, 95% CI: 1.395–2.109). Similarly, among under-five children, the age of the child, the month of data collection, anemia status, and the province were all substantially linked to ARI.ConclusionsChildhood ARI morbidity is a serious health challenge in rural Ethiopia, according to this study, with demographic, socioeconomic, nutritional, health, and environmental factors all having a role. As a result, regional governments, healthcare staff, and concerned groups should place a priority on reducing ARI, and attempts to solve the issue should take these variables into account.

Knowledge, Perceptions, Satisfaction, and Readiness of Health-Care Providers Regarding COVID-19 in Northern Ethiopia.

BackgroundTo protect health-care providers (HCPs) from COVID-19, the WHO recommends applying basic principles of infection prevention and control measures at all health-care facilities. This study aimed to assess the knowledge, perceptions, satisfaction, and readiness of HCPs regarding COVID-19 in Tigrai, Ethiopia in 2020.MethodsThis cross-sectional study was conducted from June 1 to July, 2020. Data were collected using a self-administered structured questionnaire. Multistage sampling followed by purposive sampling were used to recruit study subjects. SPSS 21 was used to compute proportions and χ2 to identify risk factors.ResultsOf 765 participants, 88% had adequate knowledge, close to a third showed positive perceptions and were satisfied with their job and nearly a quarter demonstrated readiness to prevent and control COVID-19. Education, knowledge, readiness, perceptions, and job satisfaction with associated with type and readiness of health facilities.ConclusionDespite adequate knowledge of the HCPs about COVID-19, their perceptions and job satisfaction are a concern for the health-care system. Only one in five HCPs was found to be ready to prevent and control COVID-19. Efforts should be exerted to improve perceptions, job satisfaction, and readiness of HCPs to fight COVID-19.

Analysis of the Spatial Distribution Characteristics of Abnormal Bone Density in Male Long-Distance Runners from Different Regions in China

Objective: To investigate the occurrence pattern of abnormal bone density in male long-distance runners from several different regions of China, and provide a basis for elucidating the influences of geo-environmental differences on bone density. Methods: We employed a set of well-designed exclusion-inclusion criteria to recruit study subjects, in which compounding factors were managed and regional environmental traits were fully incorporated. WHO (World Health Organization) criteria for the diagnosis of osteoporosis were then used to examine the subjects to determine occurrence of abnormal bone density. The resulting data were analyzed using methods of spatial statistics, which included several approaches, such as spatial autocorrelation, hot spot analysis, and Geodetector Software analysis, to depict and analyze the spatial distribution of abnormal bone density in male athletes from different regions in China, thereby investigating the influences of geo-environmental factors (e.g., temperature, humidity, and altitude) on bone density. Results: A total of 685 subjects were effectively examined in this study, including 486 with normal bone density, 185 with osteopenia, and 14 with osteoporosis. Spatial distribution analysis revealed that the distribution of subjects with abnormal bone density overall exhibited a pattern indicating that the level of abnormal bone density in the eastern regions was higher than that in the western regions and that the levels of abnormal bone density in the southern and northern regions were higher than that in the middle regions. Spatial autocorrelation analysis revealed a Moran’s I = 0.136, Z-score = 1.114, and P value = 0.265 and indicated that the athletes with abnormal bone density were randomly distributed in each region. Hot spot analysis revealed that Tibet and Qinghai displayed distributions of cold spots. Geodetector Software analysis yielded a Q value for annual average temperature of 1.000 and a corresponding P value of 0.000, and the results revealed that temperature significantly affected bone density and that altitude, relative humidity, sunlight hours, and temperature variations displayed synergistic effects on bone density and could diminish the influences of temperature on bone density. Conclusion: Our data revealed that different regions displayed different distribution patterns of abnormal bone density such that the level in the eastern regions was higher than that in the western ones and that the levels in the southern and northern regions were higher than that in the middle regions; specifically, the provinces of Yunnan, Heilongjiang, Hainan, and Inner Mongolia had high rates of abnormal bone density, whereas Tibet and Qinghai had relatively good conditions of bone density. Our data suggested that suitable temperature changes and appropriate levels of temperature variations can decrease the occurrence rates of osteopenia and osteoporosis.

Risk factors of acute respiratory infections among under five children attending public hospitals in southern Tigray, Ethiopia, 2016/2017

BackgroundAcute Respiratory infection accounts for 94,037000 disability adjusted life years and 1.9 million deaths worldwide. Acute respiratory infections is the most common causes of under-five illness and mortality. The under five children gets three to six episodes of acute respiratory infections annually regardless of where they live. Disease burden due to acute respiratory infection is 10–50 times higher in developing countries when compared to developed countries. The aim of this study was to assess risk factors of acute respiratory infection among under-five children attending Public hospitals in Southern Tigray, Ethiopia 2016/2017.MethodsInstitution based case control study was conducted from Nov 2016 to June 2017. Interviewer administered structured questionnaire was used to collect data from a sample of 288 (96 cases and 192 controls) children under 5 years of age. Systematic random sampling was used to recruit study subjects and SPSS version 20 was used to analyze the data. Bivariate and multivariate analysis were employed to examine statistical association between the outcome variable and selected independent variables at 95% confidence level. Level of statistical Significance was declared at p < 0.05. Tables, figures and texts were used to present data.ResultOne hundred sixty (55.6%) and 128 (44.4%) of the participants were males and females respectively. Malnutrition (AOR = 2.89; 95%CI: 1.584–8.951; p = 0.039), cow dung use (AOR =2.21; 95%CI: 1.121–9.373; p = 0.014), presence of smoker in the family (AOR = 0.638; 95% CI: 0.046–0.980; p = 0.042) and maternal literacy (AOR = 3.098; 95%CI: 1.387–18.729; p = 0.021) were found to be significant predictors of acute respiratory infection among under five children.ConclusionAccording to this study maternal literacy, smoking, cow dung use and nutritional status were strongly associated with increased risk of childhood acute respiratory infection. Health care providers should work jointly with the general public, so that scientific knowledge and guidelines for adopting particular preventive measures for acute respiratory infection are disseminated.

Characteristics of obstetric fistula women repaired at Kisii Gynocare Fistula Centre

Aims: To determine the characteristics of obstetric fistula women repaired at the Kisii Gynocare fistula centre. Specifically the study sought to determine the ages of women and age at which they developed obstetric fistula, level of education, whether in gainful employment or not, marital status of fistula women and whether they had good social family support and number of children born to a fistula survivor. The study also focused on each women’s labor experiences taking into account whether delivery occurred in a hospital or not, duration of labor, mode of delivery and whether skilled health workers attended to the fistula survivor or not.&#x0D; Methods: The study employed both qualitative and quantitative study methods. A survey sample (n=157) was used and in which interviewer administered questionnaire; both open ended and closed ended were used. Qualitative data was obtained by participant observation (face to face in-depth interviews) and key informant interviews.&#x0D; Both purposive and snowball sampling methods were employed to recruit study subjects. The setting was Kisii Gynocare Fistula Centre in Kisii County, about 420 km south west from the Kenyan capital Nairobi.&#x0D; Results: The majority of the women (n=98,62.4%) were in the reproductive age 15-40 years. 68 (43.3%) had attained secondary level education 34(21.6%) dropped at primary and 27(17.2%) had attained tertiary education level. 17(10.8%) were in some formal employment and the rest were peasant farmers and others engaged in small scale business enterprises. 72(45.8%) were in marriage, 40(25.5%) divorced or widowed and 45(28.7%) were single. Among those presented with RVFs majority had many children (more than 2) while of those who had VVFs (n=66) had no child (the child died at birth) or had 1-2 children. Many of those with VVFs (n=49) reported experiencing leakage of urine within a week of difficult delivery and in their early first or second pregnancy at 15-24 years while those with RVFs were evenly spread throughout the reproductive years (15-40 years). Among the VVF group (n=66), 47(71.2%) reported they labored at home. 19(28.8%) went to hospital/health centre at advanced labor. All of them reported being in labor for between 1-3 days. Among the RVF group, most (n=78) reported presenting to the hospital in time and that they were attended by ‘students’ during delivery while others reported by the time a midwife came the babies were already out. On mode of delivery, 14(21.2%) of VVF women reported leaking urine after undergoing a c-section. This was after many hours of unrelieved long labors. All women in the RVF group reported they developed tears and RVF after a difficult vaginal delivery. Majority of women (n=119) reported that they did not attend ANC clinics at all throughout their pregnancy and 13.4% (n=21) reported attending ANC once or twice. The remainder 10.l8% (n=17) attended all the WHO recommended focused ANC attendance.&#x0D; Conclusions: 8 in 10 women with OF developed fistula at their first pregnancy at a very young age. Majority of these women did not have adequate formal education, many being school drop-outs; 9 in 10 women labored at home and only transferred to hospitals late. A large number, 7 in 10, were not in gainful employment.&#x0D; A major social impact of OF include ostracization and stigmatization by the community and divorce from the spouse. Women suffering from OF also lose jobs, don’t participate in income generating activities and are resigned to perennial poverty. They lose self esteem and many of them become depressed.

IMPACT OF PHARMACIST-LED DIABETES PROGRAM ON GLYCATED HEMOGLOBIN AND DIABETES-RELATED HOSPITALIZATIONS IN A DISTRICT-LEVEL HOSPITAL: A PILOT RETROSPECTIVE COHORT STUDY

Purpose: The purpose of this study is to evaluate the effectiveness of pharmacist-led diabetes program in improving glycated hemoglobin and diabetes-related hospitalizations of patients with type 2 diabetes mellitus in a district level hospital without structured diabetes care model. Thus far, the impact of pharmacist-led diabetes program in hospital settings without endocrinologist, dietitian, nutritionist, diabetes educator and diabetes link nurse is unknown. This study hypothesized that there would be a difference in the aforementioned outcomes among patients with type 2 diabetes mellitus managed primarily by pharmacist. Methods: A pilot retrospective cohort study was conducted among patients with type 2 diabetes mellitus attending regular follow-up in the medical outpatient department and diabetes medication therapy adherence clinic. Convenience sampling method was used to recruit study subjects who were diagnosed with type 2 diabetes mellitus, aged ≥18 years old and A1C ≥8%. Results: Twenty-nine study subjects were eligible for both groups respectively. Pharmacist group had study subjects with higher baseline A1C values, more dyslipidemia cases and all prescribed with insulin therapy. A significant mean A1C reductions from the baseline to twelve months after enrollment could be observed in the pharmacist program but not in the usual medical care group. However, there was no significant difference between these two groups in terms of diabetes-related hospitalizations. Conclusion: Pharmacist-led diabetes program has a significant impact on glycated hemoglobin reductions among patients with type 2 diabetes mellitus but not diabetes-related hospitalizations.

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A web-based registry for patients with sarcoidosis.

The objective is to present the development of a novel web-based patient registry for sarcoidosis. We describe recruitment efforts and assess efficacy of internet-based advertising on recruitment. "Worldwide Sarcoidosis Research Study (WISE)" started in 2011 under the domain www.sarcoidstudy.org. The registry includes thirteen patient-reported surveys about patient characteristics, diagnosis, and treatment. Effects of two internet-based advertising methods (geographically-broad versus geographically-targeted to high sarcoidosis search areas) on recruitment were analyzed with time series regression. Since 2011, over 1500 participants have registered (82% whites, 9% African Americans, 5% mixed, 4% other), with 23% of participants providing saliva samples for DNA. Median age is 43 years (range 21-80). African Americans were more frequently recruited via support groups, while whites had a higher frequency of finding the registry via internet. Generalized internet-based advertising significantly improved recruitment in all demographic groups (p<0.001). However, a higher response rate to internet-based advertising was seen in whites compared to African Americans(p<0.001), females versus males(p=0.043), higher income categories(p=0.048), and increased education level(p<0.001). Targeting advertising campaigns to geographical areas with high internet-search patterns for sarcoidosis, with different demographics, was not effective in raising registry recruitment above baseline or increasing diversity. A web-based registry is an effective method for establishing a cohort of patients with sarcoidosis invested in clinical research with DNA specimens. Despite limitations, opportunities for research in patient-oriented outcomes and broad internet-based research methodology are possible. Our results demonstrate that web-based approaches to recruit study subjects need to be focused to match different target populations.

The skin microbiome is different in pediatric versus adult atopic dermatitis

The skin microbiome is different in pediatric versus adult atopic dermatitis

Long-term development of parental knowledge about skin cancer risks in Germany: Has it changed for the better?

Substantial public health efforts have been undertaken throughout the last 25years to increase awareness about skin cancer risks in the German population. An evaluation of long-term effects of these awareness campaigns and preventive activities on the population level and in specific subgroups is yet lacking. We address the temporal development of knowledge about skin cancer risk factors and agreement to the necessity of sun protection in different outdoor situations among parents of young children. We compiled data from four population-based surveys comprising data from 8184 parents of 3- to 6-year-old children in two regions of Germany performed over a nineteen-year period between 1993 and 2012. These individual cross-sectional studies used an identical methodology to recruit study subjects and to assess the principal outcome measures. Overall, parental knowledge about skin cancer risk factors and agreement to the necessity of sun protection improved significantly over the nineteen-year period. For instance, the recognition of fair skin/hair, sunburns during childhood and a high number of naevi, respectively, being risk factors for skin cancer increased by 20.0%, 19.9% and 19.2% from the first to the most recent survey. Two remaining knowledge gaps became evident: (i) the underrating of intermittent intensive sun exposure as a skin cancer risk factor and (ii) the erroneous belief that clouds provide sufficient sun protection at midday during summertime. The messages of future public health campaigns in Germany addressing skin cancer risks and informing about preventive measures for sun protection should thus be refined regarding these aspects.

Assessment of health system challenges and opportunities for possible integration of diabetes mellitus and tuberculosis services in South-Eastern Amhara Region, Ethiopia: a qualitative study.

BackgroundThe double burden of tuberculosis (TB) and diabetes mellitus (DM) is a significant public health problem in low and middle income countries. However, despite the known synergy between the two disease conditions, services for TB and DM have separately been provided. The objective of this study was to explore health system challenges and opportunities for possible integration of DM and TB services.MethodsThis was a descriptive qualitative study which was conducted in South-Eastern Amhara Region, Ethiopia. Study participants included health workers (HWs), program managers and other stakeholders involved in TB and DM prevention and control activities. Purposive sampling was applied to select respondents. In order to capture diversity of opinions among participants, maximum variation sampling strategy was applied in the recruitment of study subjects. Data were collected by conducting four focus group discussions and 12 in-depth interviews. Collected data were transcribed verbatim and were thematically analyzed using NVivo 10 software program.ResultA total of 44 (12 in-depth interviews and 32 focus group discussion) participants were included in the study. The study participants identified a number of health system challenges and opportunities affecting the integration of TB-DM services. The main themes identified were: 1. Unavailability of system for continuity of DM care. 2. Inadequate knowledge and skills of health workers. 3. Frequent stockouts of DM supplies. 4. Patient’s inability to pay for DM services. 5. Poor DM data management. 6. Less attention given to DM care. 7. Presence of a well-established TB control program up to the community level. 8. High level of interest and readiness among HWs, program managers and leaders at different levels of the health care delivery system.ConclusionThe study provided insights into potential health systems challenges and opportunities that need to be considered in the integration of TB-DM services. Piloting TB and DM integrated services in selected HFs of the study area is needed to assess feasibility for possible full scale integration of services for the two comorbid conditions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1378-6) contains supplementary material, which is available to authorized users.

Household food insecurity and mental distress among pregnant women in Southwestern Ethiopia: a cross sectional study design.

BackgroundThere are compelling theoretical and empirical reasons that link household food insecurity to mental distress in the setting where both problems are common. However, little is known about their association during pregnancy in Ethiopia.MethodsA cross-sectional study was conducted to examine the association of household food insecurity with mental distress during pregnancy. Six hundred and forty-two pregnant women were recruited from 11 health centers and one hospital. Probability proportional to size (PPS) and consecutive sampling techniques were employed to recruit study subjects until the desired sample size was obtained. The Self Reporting Questionnaire (SRQ-20) was used to measure mental distress and a 9-item Household Food Insecurity Access Scale was used to measure food security status. Descriptive and inferential statistics were computed accordingly. Multivariate logistic regression was used to estimate the effect of food insecurity on mental distress.ResultsFifty eight of the respondents (9 %) were moderately food insecure and 144 of the respondents (22.4 %) had mental distress. Food insecurity was also associated with mental distress. Pregnant women living in food insecure households were 4 times more likely to have mental distress than their counterparts (COR = 3.77, 95 % CI: 2.17, 6.55). After controlling for confounders, a multivariate logistic regression model supported a link between food insecurity and mental distress (AOR = 4.15, 95 % CI: 1.67, 10.32).ConclusionThe study found a significant association between food insecurity and mental distress. However, the mechanism by which food insecurity is associated with mental distress is not clear. Further investigation is therefore needed to understand either how food insecurity during pregnancy leads to mental distress or weather mental distress is a contributing factor in the development of food insecurity.

Evaluation of two treatment strategies for the prevention of preterm birth in women identified as at risk by ultrasound (PESAPRO Trial): study protocol for a randomized controlled trial

BackgroundPremature birth is considered one of the main problems in modern Obstetrics. It causes more than 50 % of neonatal mortality; it is responsible for a large proportion of infant morbidity and incurs very high economic costs. Cervical length, which can be accurately measured by ultrasound, has an inverse relationship with the risk of preterm birth. As a result, having an effective intervention for asymptomatic patients with short cervix could reduce the prematurity. Although recently published data demonstrates the effectiveness of vaginal progesterone and cervical pessary, these treatments have never been compared to one another.Methods/DesignThe PESAPRO study is a noncommercial, multicenter, open-label, randomized clinical trial (RCT) in pregnant women with a short cervix as identified by transvaginal ultrasonography at 19 to 22 weeks of gestation. Patients are randomized (1:1) to either daily vaginal progesterone or cervical pessary until the 37th week of gestation or delivery; whichever comes first. During the trial, women visit every 4 weeks for routine questions and tests. The primary outcome is the proportion of spontaneous preterm deliveries before 34 weeks of gestation. A sample size of 254 pregnant women will be included at 29 participating hospitals in order to demonstrate noninferiority of placing a pessary versus vaginal progesterone. The first patient was randomized in August 2012, and recruitment of study subjects will continue until the end of December 2015.DiscussionThis trial assesses the comparative efficacy and safety between two accepted treatments, cervical pessary versus vaginal progesterone, and it will provide evidence in order to establish clinical recommendations.Trial registrationEU Clinical Trials Register EudraCT2012-000241-13 (Date of registration: 16 January 2012); ClinicalTrials.gov Identifier NCT01643980 (Date of registration: 12 June 2012).

Consent for audio-video recording of informed consent process in rural South India.

Introduction and Objectives:In recent times, audio-video (A-V) recording of consent process for all the study subjects entering a clinical trial has been made mandatory. A-V recording of informed consent process is a big challenge due to confidentiality and the sociocultural environment in India. It is important to find out the acceptability for A-V recording of the consent process and reasons for refusal, if any to address this new challenge.Materials and Methods:A descriptive survey was done among 150 residents of a rural community of South India. Acceptability for A-V recording of consent process was assessed among those who had given the informed written consent for participation in the study. An attempt to find the factors determining the refusal was also made.Results:More than one-third (34%) of the study subjects refused to give consent for A-V recording of consent process. Not interested in recording or don’t like to be recorded (39%) were the most common reasons to refuse for A-V recording of consent process. The refusal was higher among female and younger age-group adult subjects. Socioeconomic status was not found to be significantly associated with refusal to consent for A-V recording.Conclusion:Refusal for A-V recording of consent process is high in the South Indian rural population. Before any major clinical trial, particularly a field trial, an assessment of consent for A-V recording would be helpful in recruitment of study subjects.