Performance of the non-laboratory based 2019 WHO cardiovascular disease risk prediction chart in Eastern Sub-Saharan Africa.

BACKGROUND AND AIMS: The World Health Organization (WHO) updated its cardiovascular disease (CVD) risk prediction charts in 2019 to cover 21 global regions. We aimed to assess the performance of an updated non-lab-based risk chart for people with normoglycaemia, impaired fasting glucose (IFG), and diabetes in Eastern Sub-Saharan Africa. METHODS AND RESULTS: We used data from six WHO STEPS surveys conducted in Eastern Sub-Saharan Africa between 2012 and 2017. We included 9857 participants aged 40-69 years with no CVD history. The agreement between lab- and non-lab-based charts was assessed using Bland-Altman plots and Cohen's kappa. The median age of the participants was 50 years (25-75th percentile: 44-57). The pooled median 10-year CVD risk was 3 % (25-75th percentile: 2-5) using either chart. According to the estimation, 7.5 % and 8.4 % of the participants showed an estimated CVD risk ≥10 % using the non-lab-based chart or the lab-based chart, respectively. The concordance between the two charts was 91.3 %. The non-lab-based chart underestimated the CVD risk in 57.6 % of people with diabetes. In the Bland-Altman plots, the limits of agreement between the two charts were widest among people with diabetes (-0.57-7.54) compared to IFG (-1.75-1.22) and normoglycaemia (-1.74-1.06). Kappa values of 0.79 (substantial agreement), 0.78 (substantial agreement), and 0.43 (moderate agreement) were obtained among people with normoglycaemia, IFG, and diabetes, respectively. CONCLUSIONS: Given limited healthcare resources, the updated non-lab-based chart is suitable for CVD risk estimation in the general population without diabetes. Lab-based risk estimation is suitable for individuals with diabetes to avoid risk underestimation.

A roadmap for the conservation of freshwater mussels in Europe.

Europe has a long history of human pressure on freshwater ecosystems. As pressure continues to grow and new threats emerge, there is an urgent need for conservation of freshwater biodiversity and its ecosystem services. However, whilst some taxonomic groups, mainly vertebrates, have received a disproportionate amount of attention and funds, other groups remain largely off the public and scientific radar. Freshwater mussels (Bivalvia, Unionida) are an alarming example of this conservation bias and here we point out six conceptual areas that need immediate and long-term attention: knowledge, threats, socioeconomics, conservation, governance and education. The proposed roadmap aims to advance research, policy and education by identifying the most pressing priorities for the short- and long-term conservation of freshwater mussels across Europe.

Patient trust and positive attitudes maximize non-communicable diseases management in rural Tanzania.

The objectives of this study were to identify difficulties and their related contexts non-communicable disease (NCD) patients in rural Tanzania experienced, examine how patients managed the situation by seeking better treatment of the diseases, and propose a realistic approach for optimizing disease management with long-term perspectives in resource-limited settings, based on views of patients (PTs), health-care providers (HPs), and health volunteers (HVs). Nine focus group discussions were performed with 56 participants of PTs, HPs, and HVs in three district hospitals in the Dodoma region. Their views and self-care practices were extracted, and the verbatim data were analyzed to derive codes and categories. The types of NCDs reported by the PTs were hypertension (HT), diabetes mellitus (DM), and HT/DM comorbidity. Reported barriers to disease management included discontinuation of treatment due to various factors and a lack of positive messages regarding disease management in NCD care. The following points were addressed in relation to the improved management of NCDs: (i) positive attitudes and coping skills, (ii) support from family members, (iii) good communication between PTs and HPs, and (iv) trustworthy relationships with HVs. The findings suggest that to gain the trust of PTs in optimizing disease control in overstretched health-care systems, patient support systems should be strengthened by empowering positive attitudes.

Non-communicable diseases (NCDs) are the leading cause of death globally. NCDs are common in low- and middle-income countries and their prevalence has been growing more prominent. In Tanzania, one-third of all deaths are NCD-related. This study aims to identify the factors that may lead to the improved management of NCDs in rural Tanzania based on actual situations in patients' daily lives. We conducted focus group discussions with three different groups (patients with hypertension and/or diabetes mellitus [PTs], health volunteers [HVs], and health-care providers [HPs]). The results revealed that PTs faced various barriers such as treatment discontinuation and a lack of positive messages regarding disease management in NCD care. However, the following points were indicated by the participants for the improved management of NCDs: (i) positive attitudes and coping skills, (ii) support from family members, (iii) good communication between PTs and HPs, and (iv) trustworthy relationships with HVs. Thus, to gain the trust of PTs in optimizing disease control and complications in overstretched health-care systems, patient support systems need to be strengthened by adopting a community empowerment approach, delivering supportive messages, and building reliable relationships.

Artificial Intelligence System to Determine Risk of T1 Colorectal Cancer Metastasis to Lymph Node.

BACKGROUND & AIMS: In accordance with guidelines, most patients with T1 colorectal cancers (CRC) undergo surgical resection with lymph node dissection, despite the low incidence (∼10%) of metastasis to lymph nodes. To reduce unnecessary surgical resections, we used artificial intelligence to build a model to identify T1 colorectal tumors at risk for metastasis to lymph node and validated the model in a separate set of patients. METHODS: We collected data from 3134 patients with T1 CRC treated at 6 hospitals in Japan from April 1997 through September 2017 (training cohort). We developed a machine-learning artificial neural network (ANN) using data on patients' age and sex, as well as tumor size, location, morphology, lymphatic and vascular invasion, and histologic grade. We then conducted the external validation on the ANN model using independent 939 patients at another hospital during the same period (validation cohort). We calculated areas under the receiver operator characteristics curves (AUCs) for the ability of the model and US guidelines to identify patients with lymph node metastases. RESULTS: Lymph node metastases were found in 319 (10.2%) of 3134 patients in the training cohort and 79 (8.4%) of /939 patients in the validation cohort. In the validation cohort, the ANN model identified patients with lymph node metastases with an AUC of 0.83, whereas the guidelines identified patients with lymph node metastases with an AUC of 0.73 (P < .001). When the analysis was limited to patients with initial endoscopic resection (n = 517), the ANN model identified patients with lymph node metastases with an AUC of 0.84 and the guidelines identified these patients with an AUC of 0.77 (P = .005). CONCLUSIONS: The ANN model outperformed guidelines in identifying patients with T1 CRCs who had lymph node metastases. This model might be used to determine which patients require additional surgery after endoscopic resection of T1 CRCs. UMIN Clinical Trials Registry no: UMIN000038609.

Performance of Computer-Aided Detection and Diagnosis of Colorectal Polyps Compares to That of Experienced Endoscopists.

BACKGROUND: Differential diagnosis of neoplasms and non-neoplasms is crucial in ensuring appropriate and proper medical management for patients undergoing colonoscopy. Diagnostic ability can vary, depending on the colonoscopist's experience. To overcome this issue, artificial intelligence (AI) may be effective. AIMS: To assess the performance of a computer-aided detection (CADe) and a computer-aided diagnosis (CADx) system for the detection and characterization of colorectal polyps by comparing their data with those of experienced endoscopists. METHODS: This retrospective, still image-based validation study was conducted at three Japanese medical centers. A total of 579 white-light images (WLIs) and 605 linked color images (LCIs) were used for testing the CADe and 308 WLIs and 296 blue laser/light images (BLIs) for testing the CADx. The performances of the CADe and CADx systems were assessed and compared with the correct answers provided by three experienced endoscopists. RESULTS: CADe in WLI demonstrated a sensitivity of 94.5% (95% confidence interval (CI), 92.0-96.9%) and a specificity of 87.2% (84.5-89.9%). CADe in LCI demonstrated a sensitivity of 96.0% (93.9-98.1%) and a specificity of 85.1% (82.3-87.9%). CADx in WLI demonstrated a sensitivity of 95.5% (92.9-98.1%) and a specificity of 84.4% (73.4-91.5%), resulting in an accuracy of 93.2% (90.4-96.0%). CADx in BLI showed a sensitivity of 96.3% (93.9-98.7%) and a specificity of 88.7% (77.1-95.1%), resulting in an accuracy of 94.9% (92.4-97.4%). CONCLUSIONS: CADe and CADx demonstrated sufficient diagnostic performance to support the use of an AI system.

In-service training programme for health and social care workers in the Philippines to strengthen interprofessional collaboration in caring for older adults: a mixed-methods study.

BACKGROUND: A growing number of older adults require complex care, but coordination among professionals to provide comprehensive and high-quality care is perceived to be inadequate. Opportunities to gain the knowledge and skills important for interprofessional collaboration in the context of geriatric care are limited, particularly for those already in the workforce. A short-term training programme in interprofessional collaboration for health and social care workers in the Philippines was designed and pilot tested. The programme was devised following a review of the literature about geriatric care education and group interviews about training needs. The objectives of this paper are to introduce the training programme and to evaluate its influence on attitudes and readiness to collaborate among participants using both quantitative and qualitative methodologies. METHODS: A total of 42 community health workers and 40 health institution workers participated in the training in July 2019. Quantitative indicators were used to evaluate attitudes towards and readiness for collaboration before and after the training. Content analysis was performed of responses to open-ended questions asking participants to evaluate the training. A convergent parallel mixed-methods design was applied to determine the patterns of similarities or differences between the quantitative and qualitative data. RESULTS: Significant improvements were seen in scores on the Attitudes Towards Health Care Teams Scale among community health (P < 0.001) and health institution (P < 0.001) staff after the training. Scenario-based case studies allowed participants to work in groups to practise collaboration across professional and institutional boundaries; the case studies fostered greater collaboration and continuity of care. Exposure to other professionals during the training led to a deeper understanding of current practices among health and social care workers. Use of the scenario-based case studies followed by task-based discussion in groups was successful in engaging care professionals to provide patient-centred care. CONCLUSIONS: This pilot test of in-service training in interprofessional collaboration in geriatric care improved community and health institution workers' attitudes towards such collaboration. A 3-day training attended by health and social care workers from diverse healthcare settings resulted in recommendations to enhance collaboration when caring for older adults in their current work settings.

Status of water, sanitation, and hygiene and standard precautions in healthcare facilities and its relevance to COVID-19 in Afghanistan.

BACKGROUND: To protect the health and safety of healthcare workers (HCWs), it is essential to ensure the provision of sustainable water, sanitation, and hygiene (WASH) services and standard precautions in healthcare facilities (HCF). The objectives of this short communication were 1) to assess the availability of WASH services and standard precautions in HCFs in seven provinces in Afghanistan before the COVID-19 pandemic, and 2) to elucidate the relevance of these patterns with the number of reported HCW infections from COVID-19 in the mentioned provinces. METHODS: We analyzed secondary data from the 2018-19 Afghanistan Service Provision Assessment survey, which included 142 public and private HCFs in seven major provinces in Afghanistan. Data on COVID-19 cases were obtained from the Afghanistan Ministry of Public Health Data Warehouse. Weighted prevalence of WASH services and standard precautions were calculated using frequencies and percentages. ArcGIS maps were used to visualize the distribution of COVID-19 cases, and scatter plots were created to visualize the relevance of WASH services and standard precautions to COVID-19 cases in provinces. RESULTS: Of the 142 facilities surveyed, about 97% had improved water sources, and over 94% had improved toilet for clients. Overall, HCFs had limited availability of hygiene services and standard precautions, which was lower in private than public facilities. More than half of the facilities had safe final disposal and appropriate storage of sharps and medical waste. Of the seven provinces, Herat province had the highest cumulative COVID-19 case rate among HCWs per 100,000 population and reported lower availability of WASH services and standard precautions in HCFs compared to other provinces. CONCLUSION: Our findings show disparities in the availability of WASH services and standard precautions in public and private facilities. Private facilities had a lower availability of hygiene services and standard precautions than public facilities. Provinces with higher availability of WASH services and standard precautions in HCFs had a lower cumulative COVID-19 case rate among HCWs per 100,000 population. Pre-pandemic preparation of adequate WASH services and standard precautions in HCFs could be potentially important in combating infectious disease emergence.

Nursing Difficulties and Issues in Endoscopic Sedation: Qualitative Research in Japan.

Gastrointestinal endoscopic treatments have increased in Japan. Respiratory depression is as an unexpected development during sedation. This study aimed to clarify the sedation-related difficulties encountered by nurses involved in endoscopic treatment. Participants were five nurses who had worked for more than a year in the endoscopy department of a gastrointestinal endoscopy specialist guidance facility in Sapporo. Semistructured interviews were conducted. The number of recording units obtained was 129, which were divided into 12 categories and subdivided into 42 subcategories. The nursing practice difficulties related to sedation in endoscopic treatment were classified into two major categories: "difficulties in nursing practice" and "system difficulties." All of the "difficulty in nursing practice" items were role-fulfilling difficulties involved in protecting patient safety and reducing anxiety and discomfort. Four of these items reflected difficulties related particularly to the role of the nurse in charge of the sedated patient in the endoscopy room. To reduce the difficulties encountered by nurses, a treatment environment system must be devised to ensure patient safety and improve the education support system for nurses with regard to sedation.

The role of anthropogenic habitats in freshwater mussel conservation.

Anthropogenic freshwater habitats may provide undervalued prospects for long-term conservation as part of species conservation planning. This fundamental, but overlooked, issue requires attention considering the pace that humans have been altering natural freshwater ecosystems and the accelerated levels of biodiversity decline in recent decades. We compiled 709 records of freshwater mussels (Bivalvia, Unionida) inhabiting a broad variety of anthropogenic habitat types (from small ponds to large reservoirs and canals) and reviewed their importance as refuges for this faunal group. Most records came from Europe and North America, with a clear dominance of canals and reservoirs. The dataset covered 228 species, including 34 threatened species on the IUCN Red List. We discuss the conservation importance and provide guidance on how these anthropogenic habitats could be managed to provide optimal conservation value to freshwater mussels. This review also shows that some of these habitats may function as ecological traps owing to conflicting management practices or because they act as a sink for some populations. Therefore, anthropogenic habitats should not be seen as a panacea to resolve conservation problems. More information is necessary to better understand the trade-offs between human use and the conservation of freshwater mussels (and other biota) within anthropogenic habitats, given the low number of quantitative studies and the strong biogeographic knowledge bias that persists.

Interprofessional collaboration and barriers among health and social workers caring for older adults: a Philippine case study.

BACKGROUND: There is limited information on how the barriers to interprofessional collaboration (IPC) across various professionals, organizations, and care facilities influence the health and welfare of older adults. This study aimed to describe the status of IPC practices among health and social workers providing care for older adults in the Philippines; investigate the perceived barriers to its implementation and perceived effects on geriatric care; and identify possible solutions to address the barriers limiting collaborative practice. METHODS: A case study approach was utilized employing 12 semi-structured in-depth interviews and 29 focus group discussions with care workers from selected primary health care units, public and private hospitals, and nursing homes that are directly involved in geriatric care delivery in two cities in the Philippines. Overall, 174 health and social workers consented to participate in this study. All interviews were audio-recorded and transcribed verbatim. An inductive thematic analysis using NVivo 12® was used to identify and categorize relevant thematic codes. RESULTS: Interprofessional geriatric care provided by health and social workers was observed to be currently limited to ad hoc communications typically addressing only administrative concerns. This limitation is imposed by a confluence of barriers such as personal values and beliefs, organizational resource constraints, and a silo system care culture which practitioners say negatively influences care delivery. This in turn results in inability of care providers to access adequate care information, as well as delays and renders inaccessible available care provided to vulnerable older adults. Uncoordinated care of older adults also led to reported inefficient duplication and overlap of interventions. CONCLUSION: Geriatric care workers fear such barriers may aggravate the increasing unmet needs of older adults. In order to address these potential negative outcomes, establishing a clear and committed system of governance that includes IPC is perceived as necessary to install a cohesive service delivery mechanism and provide holistic care for older adults. Future studies are needed to measure the effects of identified barriers on the potential of IPC to facilitate an integrated health and social service delivery system for the improvement of quality of life of older adults in the Philippines.

Male participation in antenatal care and its influence on their pregnant partners' reproductive health care utilization: insight from the 2015 Afghanistan Demographic and Health Survey.

Afghanistan has made remarkable progress in reducing maternal mortality over the past few decades, and male participation in their pregnant partner's reproductive health care is crucial for further improvement. This study aimed to examine whether male attendance at antenatal care (ANC) with their pregnant partners might be beneficially associated with the degree of utilization of reproductive health care by the pregnant partners. Data for 2660 couples (women aged 16-49 years) were taken from the 2015 Afghanistan Demographic and Health Survey (AfDHS). Bivariate and multivariate logistic regression models were employed to explore the association between male attendance at ANC with their pregnant partners and reproductive health care utilization outcomes, including adequate utilization (four or more visits) of ANC services, ANC visits during the first trimester (up to 12 weeks) of pregnancy, rate of blood and urine testing during pregnancy, rate of institutional delivery and utilization of postnatal check-up services. The results indicated that the rate of male attendance at ANC with their pregnant partners was 69.4%. After controlling for covariates, pregnant partners who were accompanied to ANC by their male partners were more likely to adequately utilize ANC services (AOR=1.42; 95% CI: 1.18-1.71), commence ANC visits even during the first trimester (AOR=1.21; 95% CI: 1.03-1.42), give birth at a health facility (AOR=1.23; 95% CI: 1.03-1.47) and present themselves for postnatal check-ups (AOR=1.24; 95% CI: 1.04-1.47) than those who were not accompanied by them. The study demonstrated that participation of male partners in ANC was positively associated with their pregnant partners' utilization of reproductive health care services in Afghanistan. The findings suggest that, to improve maternal and child health outcomes in the country, it would be worthwhile implementing interventions to encourage male partners to become more engaged in the ANC of their pregnant partners.

Cell Lysis Directed by SulA in Response to DNA Damage in Escherichia coli.

The SOS response is induced upon DNA damage and the inhibition of Z ring formation by the product of the sulA gene, which is one of the LexA-regulated genes, allows time for repair of damaged DNA. On the other hand, severely DNA-damaged cells are eliminated from cell populations. Overexpression of sulA leads to cell lysis, suggesting SulA eliminates cells with unrepaired damaged DNA. Transcriptome analysis revealed that overexpression of sulA leads to up-regulation of numerous genes, including soxS. Deletion of soxS markedly reduced the extent of cell lysis by sulA overexpression and soxS overexpression alone led to cell lysis. Further experiments on the SoxS regulon suggested that LpxC is a main player downstream from SoxS. These findings suggested the SulA-dependent cell lysis (SDCL) cascade as follows: SulA→SoxS→LpxC. Other tests showed that the SDCL cascade pathway does not overlap with the apoptosis-like and mazEF cell death pathways.

Different impacts of pMP19 on the virulence of Melissococcus plutonius strains with different genetic backgrounds.

Virulence factors responsible for bacterial pathogenicity are often encoded by plasmids. In Melissococcus plutonius, the causative agent of European foulbrood of honey bees, a putative virulence plasmid (pMP19) possessing mtxA, which encodes a putative insecticidal toxin, was found by comparative genome analyses. However, as the role of pMP19 in the pathogenesis of European foulbrood remains to be elucidated, we generated pMP19 cured-M. plutonius from representative strains of the three genetically distinct groups (CC3, CC12 and CC13) and compared their virulence against Apis mellifera larvae using our in vitro infection model. Under the conditions tested, the loss of pMP19 abrogated the pathogenicity in CC3 strains, and > 94% of pMP19-cured CC3 strain-infected larvae became adult bees, suggesting that pMP19 is a virulence determinant of CC3 strains. However, introduction of mtxA on its own did not increase the virulence of pMP19-cured strains. In contrast to CC3 strains, the representative CC12 strain remained virulent even in the absence of pMP19, whereas the representative CC13 strain was avirulent even in the presence of the plasmid. Thus, pMP19 plays a role in the virulence of M. plutonius; however, its impact on the virulence varies among strains with different genetic backgrounds.

Family history of colorectal cancer and prevalence of advanced colorectal neoplasia in asymptomatic screened populations in different age groups.

BACKGROUND AND AIMS: The clinical significance of a family history (FH) of colorectal cancer (CRC) in first-degree relatives (FDRs) in CRC screening stratified by different age groups of screened individuals is not fully understood. We investigated the relationship between FH and the presence of advanced colorectal neoplasia (ACN) in screened individuals in different age groups. METHODS: Data from screened individuals aged 40 to 54 years (n = 2263) and 55 to 69 years (n = 2621) who underwent their first-ever screening colonoscopy were analyzed. The relationship between FH and ACN was examined, and a multivariate logistic regression analysis incorporating other baseline characteristics was performed. RESULTS: Among individuals aged 40 to 54 years, the prevalence of ACN was significantly higher in 249 individuals with affected FDRs than in those without (5.6% vs 1.6%; P < .01), with an adjusted odds ratio of 3.7 (95% confidence interval, 1.9-7.0; P < .01); the prevalence was particularly high in those having FDRs with CRC mortality (7.3%). Among individuals aged 55 to 69 years, the prevalence of ACN was not significantly different between 291 individuals with affected FDRs and those without (5.8% vs 5.8%; P = .95); however, individuals with 2 FDRs with CRC and mortality showed a high prevalence of ACN (17.4% and 42.9%, respectively). CONCLUSIONS: An FH of CRC in FDRs was associated with a higher prevalence of ACN in younger individuals, with a particularly high impact of FH of CRC mortality. In contrast, the impact of FH was weaker in older individuals except those having 2 FDRs with CRC or mortality.

Glyburide inhibits the bone resorption induced by traumatic occlusion in rats.

OBJECTIVE: To examine whether glyburide inhibits bone destruction caused by traumatic occlusion in a rat occlusal trauma model. BACKGROUND: Excessive mechanical stress, such as traumatic occlusion, induces expression of IL-1ß and may be involved in bone resorption. NLRP3 inflammasomes have been linked to IL-1ß expression, but it is currently unclear whether glyburide, the inhibiter of NLRP3 inflammasome, suppresses occlusal trauma in rats. METHODS: Male SD rats aged 7 weeks were used. In the trauma group, the occlusal surface of the maxillary first right molar was raised by attaching a metal wire to apply occlusal trauma to the mandibular first right molar. In the trauma + glyburide group, the NLRP3 inhibitor glyburide was administered orally every 24 hours from 1 day before induction of occlusal trauma. Rats were euthanized after 5 or 10 days, and the maxillary first molars were harvested with the adjacent tissues for histopathological investigation. Immunohistochemical expression of IL-1ß, NLRP3, and RANKL was also assessed. RESULTS: On day 5, bone resorption was significantly greater in the trauma group compared with the control group or the trauma + glyburide group, and there were significantly higher numbers of osteoclasts and cells positive for IL-1ß, NLRP3, and RANKL in the trauma group. CONCLUSION: In this study, glyburide inhibits bone resorption by traumatic occlusion in rats. It suggests that the NLRP3/IL-1ß pathway might be associated with bone resorption induced by traumatic occlusion.

Prevalence of serrated lesions, risk factors, and their association with synchronous advanced colorectal neoplasia in asymptomatic screened individuals.

BACKGROUND AND AIM: Serrated lesions (SLs) have attracted attention as precursors of colorectal cancer (CRC). However, their prevalence, risk factors, and clinical significance have not been satisfactorily elucidated. This study used high-quality colonoscopy data to determine the prevalence of SLs and to identify their risk factors and relationship with synchronous advanced colorectal neoplasia (ACN) in asymptomatic screened individuals. METHODS: This study included data for 5218 individuals who underwent first-time screening colonoscopy by highly experienced endoscopists. The relationships between baseline characteristics and the presence of SLs and those between the presence of SLs and synchronous ACN were assessed using the chi-squared test and multivariate logistic regression. RESULTS: The proportions of individuals with SLs and right-sided SLs were 23.3% and 7.6%, respectively. Age, sex, family history of CRC, smoking, and body mass index were significantly related with the presence of SLs, and current smoking was most strongly associated with SLs (adjusted odds ratio [aOR] 2.6, 95% confidence interval [CI] 2.1-3.2). The aOR (95% CI) of the presence of SLs, SLs sized ≥ 10 mm, and right-sided SLs ≥ 5 mm for synchronous ACN was 1.4 (1.1-1.9), 3.5 (1.3-9.6), and 1.9 (1.0-3.8), respectively. The presence of left-sided SLs ≥ 10 mm (without right-sided SLs) was also significantly associated with ACN (aOR 8.1, 95% CI 2.0-33.7). CONCLUSIONS: The relatively high prevalence of SLs and risk factors in screened individuals were elucidated and the significant relationship between SLs, particularly SLs ≥ 10 mm and right-sided SLs ≥ 5 mm, and synchronous ACN was confirmed.

Feasibility of observational screening colonoscopy followed by deferred polypectomy.

BACKGROUND AND AIM: With the increasing necessity of colorectal cancer screening, observational screening colonoscopy during which only endoscopic observation and diagnosis is performed is worth consideration. However, whether detected lesions can be correctly identified at secondary colonoscopy performed for polypectomy is unclear. Further, whether new neoplastic lesions can be detected at secondary colonoscopy has not been fully examined. This study was performed to investigate the detectability of adenomatous polyps and advanced colorectal neoplasia (ACN) at secondary colonoscopy. METHODS: Data were analyzed from individuals who underwent initial observational screening colonoscopy followed by secondary colonoscopy for polypectomy. The proportion of correct detection at secondary colonoscopy of the lesions detected at initial colonoscopy was assessed. The number and characteristics of lesions that were newly detected at secondary colonoscopy were also evaluated. RESULTS: Data of 587 individuals were assessed. Among the 1 331 lesions detected at the initial colonoscopy, 1 151 (86.5%) were properly detected at the secondary colonoscopy. The proportions of correct detection at the secondary colonoscopy for ACN, non-advanced adenomas sized 5 to 9 mm, and non-advanced adenomas sized 1 to 4 mm were 100%, 95.4%, and 70.3%, respectively. In total, 175 adenomatous polyps and ACNs were newly detected at secondary colonoscopy in 112 individuals (19.1% of all individuals). Most of the lesions (165 lesions, 94.3%) were non-advanced adenomas, while advanced adenomas (5.7%) were also found. CONCLUSION: Screening by observational colonoscopy followed by deferred polypectomy is a feasible option in terms of lesion detectability, particularly when lesions sized ≥ 5 mm are the treatment target.

Fear of falling and cognitive impairment in elderly with different social support levels: findings from a community survey in Central Vietnam.

BACKGROUND: Fear of falling (FoF) in the elderly is one of the major public health concerns in this era of aging of the population. As there is limited evidence on how cognitive function may differ by social support level in relation to FoF among the elderly, this cross-sectional study aims to investigate the prevalence of FoF and the associations between cognitive impairment and FoF by the social support level, after adjustments for potential confounders. METHODS: Data from the "Health needs assessment of elderly in Thua Thien Hue Province, Vietnam in 2018" survey of 725 elderly aged 60 years or older were used for analysis. FoF was assessed using the Fall Efficacy Scale-International. High FoF was defined as a score above 28. The Multidimensional Scale of Perceived Social Support was used to measure the perception of support. Logistic regression analysis was performed to investigate the association between cognitive function and FoF by social support levels (p < 0.05). RESULTS: The prevalence of high FoF among the elderly was 40.8%. Female gender, advanced age, a marital status of single or formerly married, living alone, history of injury, history of falls, chronic diseases (arthritis and/or hypertension), limitations of the IADL and BADL, visual difficulty and walking difficulty, low social support, and cognitive impairment were all significantly associated with a high FoF. After adjustments for the age, gender, marital status, history of falls and health-related factors, cognitive impairment remained significantly associated with a high FoF among the elderly with a low to moderate social support level (OR = 2.97, 95% CI 1.49-5.89), but not in those with a high social support level. CONCLUSIONS: A high FoF was associated with impairment of cognitive function among the elderly who perceived themselves as having low or moderate support levels, even after adjustments for socio demographic and physical functional factors. However, this association was not observed among the elderly who perceived themselves as having high social support levels. Fall prevention programs for the elderly with various levels of social support should be carefully devised, keeping in mind the cognitive function levels of the target recipients.

Relationships among cyberbullying, parental attitudes, self-harm and suicidal behavior among adolescents: results from a school-based survey in Vietnam.

BACKGROUND: The rapid and widespread development of social networking sites has created a venue for an increase in cyberbullying among adolescents. Protective mechanisms and actions must be considered, such as how proximal family factors can prevent self-harm and suicidal behaviors among adolescents exposed to cyberbullying. The present study examined the associations among cyberbullying, parental attitudes, self-harm, and suicidal behaviors after adjusting for confounding factors. METHODS: Data were obtained from a school-based survey of randomly selected grade 6 students (11 years old) performed in Hue City, Vietnam, in 2018. A total of 648 students were interviewed face-to-face using a structured questionnaire based on the Global School-based Student Health Survey (GSHS). Univariate, multivariable logistic regression analyses were performed at 95% confidence level. RESULTS: After adjusting for gender, perceived academic pressure, unhealthy behaviors, use of Internet devices, school bullying, and family living situation, a significantly higher risk of self-harm was detected among those who had experienced cyberbullying (adjusted odd ratio [AOR] = 2.97; 95% CI, 1.32-6.71). Parental acceptance retained a significant association with self-harm and suicidal behavior (P < 0.05) while parental concentration did not exhibit a significant association in a multivariable logistic regression model. In addition, suicidal ideation and suicidal planning were associated with an interaction effect between cyberbullying and parental concentration (AOR = 0.37; 95% CI, 0.15-0.94 and AOR = 0.23; 95% CI, 0.06-0.87, respectively). CONCLUSION: Cyberbullying has become an important phenomenon associated with self-harm among young adolescents in developing countries, and parental acceptance in proxy of parental attitude was positively related with severe mental health issues among adolescents. Thus, sufficient attention in efforts to promote adolescent health should be focused on family factors in the digital era of developing countries.

Reduction in inequalities in health insurance coverage and healthcare utilization among older adults in the Philippines after mandatory national health insurance coverage: trend analysis for 2003-2017.

BACKGROUND: Health policies in the Philippines have evolved in response to increasing health demands of older adults. However, there is a lack of research on equity among the ageing population in low-middle income countries. The objective of this study was to identify the trends in National Health Insurance Program (NHIP) coverage and healthcare utilization among older adults in the Philippines for the period from 2003 to 2017, during which NHIP expansion policies were implemented, focusing on reductions in socio-economic inequalities. METHODS: A literature search of policies for older adults and an analysis of four Philippine National Demographic and Health Surveys (2003, 2008, 2013, and 2017) with data from 25,217 older adults who were 60 years or older were performed. The major outcome variables were NHIP coverage, self-reported illness, outpatient healthcare utilization, and inpatient healthcare utilization. Inequalities in NHIP coverage and healthcare utilization according to wealth were evaluated by calculating the concentration index for individual years, followed by a regression-based decomposition analysis. RESULTS: NHIP coverage among older adults increased from 9.4 (2003) to 87.6% (2017). Although inequalities according to wealth quintile were observed in all four surveys (all P < 0.001), the concentration index declined from 0.3000 (2003) to 0.0247 (2017), showing reduced inequalities in NHIP coverage over time as observed for self-reported illness and healthcare utilization. NHIP coverage expansion for older adults in 2014 enabled equal opportunity for access to healthcare. CONCLUSION: The passage of mandatory NHIP coverage for older Filipino adults in 2014 was followed by a reduction in inequality in NHIP coverage and healthcare utilization according to wealth.