A self-management app to improve asthma control in adults with limited health literacy: a mixed-method feasibility study.

BACKGROUND: Digital technology tailored for those with limited health literacy has the potential to reduce health inequalities. Although mobile apps can support self-management in chronic diseases, there is little evidence that this approach applies to people with limited health literacy. We aimed to determine the acceptability of a self-management app in adults living with asthma and have limited health literacy and the feasibility of delivering the intervention and assessing outcomes. METHODS: We recruited eligible adults from the Klang Asthma Cohort registry in primary care for a 3-month mixed-method study plus a 2-month extended observation. We collected baseline data on socio-demography, health literacy and asthma control level. The outcomes of the intervention were assessed at 1- and 3-month: i) adoption (app download and usage), ii) adherence (app usage), iii) retention (app usage in the observation period), iv) health outcomes (e.g., severe asthma attacks) and v) process outcomes (e.g., ownership and use of action plans). At 1-month, participants were purposively sampled for in-depth interviews, which were audio-recorded, transcribed verbatim, and analysed deductively. RESULTS: We recruited 48 participants; 35 participants (23 Female; median age = 43 years; median HLS score = 28) completed the 3 months study. Of these, 14 participants (10 Female; median age = 48 years; median HLS score = 28) provided interviews. Thirty-seven (77%) participants adopted the app (downloaded and used it in the first month of the study). The main factor reported as influencing adoption was the ease of using the app. A total of 950 app usage were captured during the 3-month feasibility study. App usage increased gradually, peaking at month 2 (355 total log-ins) accounting for 78% of users. In month 5, 51.4% of the participants used the app at least once. The main factors influencing continued use included adherence features (e.g., prompts and reminders), familiarity with app function and support from family members. CONCLUSIONS: An asthma self-management app intervention was acceptable for adults with limited health literacy and it was feasible to collect the desired outcomes at different time points during the study. A future trial is warranted to estimate the clinical and cost-effectiveness of the intervention and to explore implementation strategies.

Insights into how Malaysian adults with limited health literacy self-manage and live with asthma: A Photovoice qualitative study.

BACKGROUND: Adjusting to life with a chronic condition is challenging, especially for people with limited health literacy, which is associated with low compliance with self-management activities and poor clinical outcomes. OBJECTIVE: We explored how people with limited health literacy understand asthma and undertake self-management practices. DESIGN: We adapted the arts-based qualitative methodology Photovoice. SETTING AND PARTICIPANTS: We sampled ethnically diverse adults with asthma and limited health literacy from four primary healthcare clinics in Malaysia. After a semistructured in-depth interview, a subset of participants took part in the Photovoice component in which participants undertook a 2-week photo-taking activity and subsequent photo-interview. Interviews, conducted in participants' preferred language, were audio-recorded, transcribed verbatim, translated and analysed thematically. We used the Sorensen's framework (Domains: access, understand, appraise, apply) to describe participants' experience of living with asthma, what they understood about asthma and how they decided on self-management practices. RESULTS: Twenty-six participants provided interviews; eight completed the Photovoice activities. Participants with limited health literacy used various sources to access information about asthma and self-management. Doctor-patient communication had a pivotal role in helping patients understand asthma. The lack of appraisal skills was significant and experiential knowledge influenced how they applied information. Self-management decisions were influenced by sociocultural norms/practices, stigmatizing experiences, and available social support. CONCLUSION: Locally tailored multilevel interventions (interpersonal, health system, community and policy) will be needed to support people with limited health literacy to live optimally with their asthma in an ethnically diverse population. PATIENT/PUBLIC CONTRIBUTION: Patients were involved in the study design, recruitment, analysis and dissemination.

Diagnostic Accuracy of Centor Score for Diagnosis of Group A Streptococcal Pharyngitis among Adults in Primary Care Clinics in Malaysia.

Background: Pharyngitis is a common presentation seen in general practice, but it is difficult to differentiate whether its etiology is viral or bacterial. The Centor score gives an approximation of the etiology of the pharyngitis, which informs physicians of the need to prescribe antibiotics. This study aimed to assess the validity of the Centor score in diagnosing Group A streptococcal (GAS) pharyngitis amongst adults in Malaysia. Methods: This cross-sectional study was conducted to compare the clinical criteria of the Centor score to the gold standard throat swab culture results amongst 215 adults presenting with sore throat in primary care clinics. The participants were adult patients who complained of sore throat and visited the three public primary care clinics in Sepang, Malaysia. The convenience sampling method was used. The throat swabs were analysed for ß-haemolytic streptococci. Demographic and clinical data, including the Centor score, were analysed in relation to the pathogen. Results: Pharyngitis was diagnosed in 130 (60.5%) of the participants. Six isolates (2.4%) were identified as GAS pharyngitis. Both Centor scores 3 and 4 had a sensitivity of 50%, and specificities of 97.6% and 100%, respectively. Conclusion: A Centor score < 3 is favourable for excluding a diagnosis of GAS pharyngitis. Centor scores 3 and 4 require further examination to confirm a diagnosis of GAS pharyngitis.

Antibiotic Prescribing Patterns for Patients with Pharyngitis in Malaysian Public Primary Care Clinics.

Background: Over-prescription of antibiotics for upper respiratory tract infection (URTI) is a continuing problem in Malaysia, leading to increased antimicrobial resistance and unnecessary cost incurred for treatment. In a patient presenting with a sore throat, it is recommended to only prescribe antibiotics to group A streptococcus (GAS) pharyngitis confirmed by a throat culture, rapid antigen test or in patients with a Centor score of 4. Methods: This cross-sectional study assessed the proportion of antibiotics prescribed and antimicrobial susceptibility patterns of GAS pharyngitis in the Malaysian primary care setting. Two-hundred and fifteen adult patients presenting with sore throat were recruited in three primary care clinics. Demographic data and clinical information were collected and analysed. Centor scores were calculated according to the clinical information and throat swabs were collected from all participants for GAS identification. Results: Only six throat swabs isolated GAS and indicated for antimicrobial treatment (2.8%). However, 48 participants (22.3%) were prescribed antibiotics out of which only four (8.3%) patients with isolated GAS, including three (6.2%) patients who clinically had a Centor score of 4 and one patient with a score of 3. Amoxicillin and erythromycin were the most commonly prescribed antibiotics (58.3% and 25% of all antibiotics, respectively). Conclusion: There is a high proportion of antibiotic prescriptions which were not indicated in patients with sore throat in this study. This may reflect a common practice of antibiotic overuse for sore throat in primary care settings in Malaysia. Concerted interventions to reduce the inappropriate prescribing of antibiotics are urgently needed.

Developing an Asthma Self-management Intervention Through a Web-Based Design Workshop for People With Limited Health Literacy: User-Centered Design Approach.

BACKGROUND: Technology, including mobile apps, has the potential to support self-management of long-term conditions and can be tailored to enhance adoption. We developed an app to support asthma self-management among people with limited health literacy in a web-based workshop (to ensure physical distancing during the COVID-19 pandemic). OBJECTIVE: The aim of this study is to develop and test a prototype asthma self-management mobile app tailored to the needs of people with limited health literacy through a web-based workshop. METHODS: We recruited participants from a primary care center in Malaysia. We adapted a design sprint methodology to a web-based workshop in five stages over 1 week. Patients with asthma and limited health literacy provided insights into real-life self-management issues in stage 1, which informed mobile app development in stages 2-4. We recruited additional patients to test the prototype in stage 5 using a qualitative research design. Participants gave feedback through a concurrent thinking-aloud process moderated by a researcher. Each interview lasted approximately 1 hour. Screen recordings of app browsing activities were performed. Interviews were audio-recorded and analyzed using a thematic approach to identify utility and usability issues. RESULTS: The stakeholder discussion identified four themes: individual, family, friends, and society and system levels. Five patients tested the prototype. Participants described 4 ways in which the app influenced or supported self-management (utility): offering information, providing access to an asthma action plan, motivating control of asthma through support for medication adherence, and supporting behavior change through a reward system. Specific usability issues addressed navigation, comprehension, and layout. CONCLUSIONS: This study proved that it was possible to adapt the design sprint workshop to a web-based format with the added advantage that it allowed the development and the testing process to be done efficiently through various programs. The resultant app incorporated advice from stakeholders, including sources for information about asthma, medication and appointment reminders, accessible asthma action plans, and sources for social support. The app is now ready to move to feasibility testing.

Perceptions toward a pilot project on blended learning in Malaysian family medicine postgraduate training: a qualitative study.

BACKGROUND: Blended learning (BL) is a learning innovation that applies the concept of face-to-face learning and online learning. However, examples of these innovations are still limited in the teaching of postgraduate education within the field of family medicine. Malaysian postgraduate clinical training, is an in-service training experience and face-to-face teaching with the faculty members can be challenging. Given this, we took the opportunity to apply BL in their training. This study provides an exploration of the perceptions of the educators and students toward the implementation of BL. METHODS: A qualitative approach was employed using focus group discussions (FGD) and in-depth interviews (IDI) at an academic centre that trains family physicians. Twelve trainees, all of whom were in their hospital specialty's rotations and five faculty members were purposively selected. Three FGDs among the trainees, one FGD and two IDIs among the faculty members were conducted using a semi-structured topic guide. Data were collected through audio-recorded interviews, transcribed verbatim and checked for accuracy. A thematic approach was used to analyse the data. RESULTS: There were four main themes that emerged from the analysis. Both educators and trainees bill the perspective that BL encouraged continuity in learning. They agreed that BL bridges the gap in student-teacher interactions. Although educators perceived that BL is in concordance with trainees learning style, trainees felt differently about this. Some educators and trainees perceived BL to be an extra burden in teaching and learning. CONCLUSION: This study highlights a mix positive and negative perceptions of BL by educators and trainees. BL were perceived positively for continuity in learning and student-teacher interaction. However, educator and learner have mismatched perception of learning style. BL was also perceived to cause extra burden to both educators and learners. Integrating BL to a traditional learning curriculum is still a challenge. By knowing the strengths of BL in this setting, family medicine trainees in Malaysia can use it to enhance their current learning experience. Future study can investigate different pedagogical designs that suit family medicine trainees and educators in promoting independent learning in postgraduate training.

Clinical Screening Tools to Diagnose Group A Streptococcal Pharyngotonsillitis in Primary Care Clinics to Improve Prescribing Habits.

This review highlights the clinical scoring tools used for the management of acute pharyngotonsillitis in primary care clinics. It will include the prevalence of group A pharyngotonsillitis among children and adults worldwide and the selective tests employed for diagnosing group A streptococcal pharyngotonsillitis. Pharyngotonsillitis is one of the common reasons for visits to primary care clinics worldwide, and physicians tend to prescribe antibiotics according to the clinical symptoms, which leads to overprescribing antibiotics. This in turn may lead to serious health impacts and severe reactions and may promote antibiotic resistance. These significantly add on to the health care costs. The available information from health organisations and previous studies has indicated the need to manage the diagnosis of pharyngotonsillitis to improve prescribing habits in primary care clinics.

Calibration of Thermal Viscoelastic Material Models for the Dynamic Responses of PVB and SG Interlayer Materials.

Laminated glass interlayer materials polyvinyl butyral (PVB) and SentryGlas® (SG, kuraray, Houstan, TX, USA) exhibit thermal viscoelastic behavior under dynamic tensile loading. Significant temperature and strain rate effects on the behavior of these interlayer materials pose a challenge for accurately modeling the dynamic response of laminated glass. Many researchers have simplified their approaches by modeling the response of the interlayer material using a bilinear approximation or established hyperelastic models. However, temperature and strain rate effects can be captured using the three-network viscoplastic (TNV) model. Therefore, the objective of this study is to calibrate material models for the thermal viscoelastic dynamic responses of PVB and SG interlayer materials. Uniaxial tensile tests were performed at strain rates of 2, 20, and 45 s-1 and temperatures of 0, 23, and 60 °C, and material models were calibrated using the experimental data. Finite element analysis using the calibrated material models successfully predicted the dynamic responses of PVB and SG under the experimental test conditions within a 10% error margin. This suggests that the calibrated models using the TNV model represent significant improvements over existing approaches to modeling the dynamic response of laminated glass. Similar procedures can be applied to other thermoplastics, laying the groundwork for establishing a standard calibration guide.

The Influence of Strain Rate Behavior on Laminated Glass Interlayer Types for Cured and Uncured Polymers.

Recent explosions and impact events have highlighted the exposure of civil structures, prompting the need for resilient new constructions and retrofitting of existing ones. Laminated glass panels, particularly in glazed facades, are increasingly used to enhance blast resistance. However, the understanding of glass fragments and their interaction with the interlayer is still incomplete. This paper investigates experimentally the quasi-static and dynamic responses of cured and uncured polymers for seven different materials-two different products of polyvinyl butyral (PVB), two ethylene vinyl acetate products (EVA), one product of thermoplastic polyurethane (TPU), and two SentryGlas products (SG)-that were tested between 21 and 32 °C (69.8 and 89.6 °F), which is the recommended room temperature. In these experiments, the responses of PVB, EVA, TPU, and SG were evaluated under a quasi-static strain rate of 0.033 s-1 and compared to the results under a relatively higher strain rate of 2 s-1. Moreover, the high strain rate loading of the materials was accomplished using a drop-weight testing appliance to evaluate the engineering stress-strain response under strain rates between 20 and 50 s-1. The results demonstrated that with strain rates of 20 s-1, PVB behaved like a material with viscoelastic characteristics, but at 45 s-1 strain rates, PVB became a non-elastic material. SG, on the other hand, offered both a high stiffness and a high level of transparency, making it a very good alternative to PVB in structural applications. In contrast, after the maximum stress point, the response to the failure of the seven materials differed significantly. The tests provided ample information for evaluating alternative approaches to modeling these different materials in blast events.

Environmental Bond Degradation of Different Laminated Glass Panels.

Since buildings are designed to endure over time, it is crucial to comprehend how laminated glass (LG) windows, and consequently, the polymer interlayer materials, respond to weathering. This paper explores the impact of accelerated humidity on the mechanical properties of several polymer interlayer materials and LG sections. The study specifically focuses on three polymer interlayer materials of industrial interest: polyvinyl butyral (PVB), ethylene-vinyl acetate (EVA), and ionomer (SG). To examine the environmental effects, testing setups were devised to subject the polymeric materials and LG panels to specific conditions. Uniaxial tension coupons and LG disks were submerged in a water bath to simulate the environmental effect. A dedicated testing fixture was designed and manufactured for the LG disks. The results showed that the properties of EVA, including strength, maximum strain, and toughness, were not significantly affected by the environmental conditions. However, the properties of SG5000 were notably impacted, with a significant reduction in its bond strength due to water immersion.

Physical Activity with Sports Scientist (PASS) programme to promote physical activity among patients with non-communicable diseases: a pragmatic randomised controlled trial protocol.

Physical activity (PA) effectively prevents and treats non-communicable diseases in clinical settings. PA promotion needs to be more consistent, especially in busy primary care. Sports scientists have the potential to support PA promotion in primary care. The Physical Activity with Sports Scientist (PASS) programme is created to personalise PA promotion led by a sports scientist in a primary care clinic. A pragmatic randomised controlled trial with two parallel groups will be conducted at a family medicine clinic. Physically inactive participants aged 35-70 years who have type 2 diabetes mellitus, hypertension or dyslipidaemia will be invited. The control group (n=60) will receive usual care. The intervention group (n=60) will receive the PASS programme and usual care. The PASS programme will consist of a tailored PA prescription after the physician's consultation at the first visit and monthly phone follow-ups. The primary outcome is the proportion of participants who have achieved the PA goal defined as aerobic activity (≥150 min/week of moderate to vigorous-intensity PA), muscle-strengthening activity (≥2 days/week of moderate or greater intensity) and multicomponent PA (≥2 days/week of moderate or greater intensity). Secondary outcomes are body composition and physical fitness. The primary and secondary outcomes will be measured and compared between the control and intervention groups at visit 1 (month 0: baseline measurements), visit 2 (months 3-4: follow-up measurements), visit 3 (months 6-8: end-point measurements) and visit 4 (months 9-12: continuing measurements). The study protocol was registered with the Thai Clinical Trials Registry. Trial registration number: TCTR20240314001.

Use of ChatGPT in medical research and scientific writing.

ChatGPT, an artificial intelligence (AI) language model based on the GPT-3.5 architecture, is revolutionising scientific writing and medical research. Researchers employ ChatGPT for diverse tasks, including automated literature reviews, structured-outline generation and drafting/editing assistance. The tool adapts language for varied audiences, aids in citation management, supports collaborative writing and peer review and facilitates table/figure creation. While it enhances efficiency, concerns arise regarding ethics, bias, accuracy and originality. Transparent data sourcing and validation are crucial, as ChatGPT complements human efforts but does not replace critical thinking. Accordingly, researchers must uphold integrity, ensuring that AI-assisted content aligns with research principles. Acknowledgement of AI use in manuscripts, as recommended by the International Committee of Medical Journal Editors, ensures accountability. ChatGPT's transformative potential lies in harmonising its capabilities with researchers' expertise, fostering a symbiotic relationship that advances scientific progress and ethical standards.

Polymeric Interlayer Strengthening with Boron Neutron Capture Radiation Treatment for Laminated Glass.

Polymer interlayer materials are utilized in laminated glass systems to provide increased resilience from blast incidents. The polymer chains within the interlayer material can benefit from material modifications that increase the crosslinking between adjacent chains. One theorized method of targeted crosslinking is made possible through a boron neutron capture process. This process utilizes neutron radiation that bombards boron material, thus producing emissions of highly energetic particles into the polymer. The method has been experimentally utilized for bulk material processing as well as surface treatment. The surface treatment process has been extensively investigated in this study to manipulate polymers commonly used as interlayer material. Comparison evaluation tests have been completed to show the material behavior change through static tensile loading, dynamic tensile loading, indentation testing, and scratch resistance testing. Results present the specific material behavior changes, effects on different interlayer material, and optimizations for the treatment processes. Data resulting from these tests will expand the understanding of the material behavior changes from treatment techniques and show evidence of the expected crosslinking. This understanding will lead to a quantifiable application of system capacities to improve the future designs of the window and building systems and lead to a safer, more secure, and resilient infrastructure. Polymer treatment by boron neutron capture radiation has produced polymer interlayers with the potential of increased resilience to blast. The research to date has evaluated treated polymers and shown that the hardening and increased elasticity of the material can be initiated through treatment, thus indicating crosslinking behavior. These results show distinct changes in the material behavior, particularly with the EVA interlayer material. The harder surface of the interlayer may resist the cutting of the interlayer surface by glass shards. Scratch resistance was 30% higher and the measured hardness was 100% on treated surfaces. Treated EVA exhibited a 40% higher stress capacity, a 35% higher toughness, and a 40% increase in the elasticity of the material. The overall toughness increase of the treated polymer material allows for a higher energy absorption, and an overall improvement of window performance in blast conditions. The treatment technique can be applied to a variety of window interlayer products for optimal material performance in blast conditions.

Prevalence of mental health problems among children with long COVID: A systematic review and meta-analysis.

INTRODUCTION: The number of children with mental health problems has more than doubled since the COVID-19 pandemic. However, the effect of long Covid on children's mental health is still debatable. Recognising long Covid as a risk factor for mental health problems in children will increase awareness and screening for mental health problems following COVID-19 infection, resulting in earlier intervention and lower morbidity. Therefore, this study aimed to determine the proportion of mental health problems post-COVID-19 infection in children and adolescents, and to compare them with the population with no previous COVID-19 infection. METHODOLOGY: A systematic search was done in seven databases using pre-defined search terms. Cross-sectional, cohort and interventional studies reporting the proportion of mental health problems among children with long COVID in the English language from 2019 to May 2022 were included. Selection of papers, extraction of data and quality assessment were done independently by two reviewers. Studies with satisfactory quality were included in meta-analysis using R and Revman software programmes. RESULTS: The initial search retrieved 1848 studies. After screening, 13 studies were included in the quality assessments. Meta-analysis showed children who had previous COVID-19 infection had more than two times higher odds of having anxiety or depression, and 14% higher odds of having appetite problems, compared to children with no previous infection. The pooled prevalence of mental health problems among the population were as follows; anxiety: 9%(95% CI:1, 23), depression: 15%(95% CI:0.4, 47), concentration problems: 6%(95% CI: 3, 11), sleep problems: 9%(95% CI:5, 13), mood swings: 13% (95%CI:5, 23) and appetite loss: 5%(95% CI:1, 13). However, studies were heterogenous and lack data from low- and middle-income countries. CONCLUSION: Anxiety, depression and appetite problems were significantly increased among post-COVID-19 infected children, compared to those without a previous infection, which may be attributed to long COVID. The findings underscore the importance of screening and early intervention of children post-COVID-19 infection at one month and between three to four months.

Mechanical Behavior of Laminated Glass Polymer Interlayer Subjected to Environmental Effects.

It is known that weathering action has a significant impact on polymer interlayer materials, and previous studies have evaluated certain aspects of weathering such as temperature, humidity, and UV radiation. In this paper, the environmental effect on the mechanical properties of the virgin and cured/processed polymer interlayer materials will be studied. Three polymer interlayer materials were focused, i.e., Polyvinyl butyral (PVB), Ethylene-vinyl acetate (EVA), and Ionomer (SG), due to their industrial interest. Testing setups were designed to apply the environmental effects and perform mechanical testing on the polymeric materials. Four environmental effects were studied, including water submersion (E1), constant high temperature (E2), cyclic temperature with low relative humidity (E3), cyclic temperature, and relative humidity (E4). After the exposure of these materials to these environmental effects, the samples were prepared and mechanically tested. Uniaxial tests were performed under static and high strain rates (around 45-1). It was found that under dynamic load, the properties of EVA such as the strength, maximum strain, and the toughness were not significantly affected by the environmental effects. SG5000 properties were significantly affected.

Correction: Prevalence of limited health literacy among patients with type 2 diabetes mellitus: A systematic review.

[This corrects the article DOI: 10.1371/journal.pone.0216402.].

Enhanced Mechanical and Durability Properties of Cement Mortar by Using Alumina Nanocoating on Carbon Nanofibers.

This study evaluated the effect of carbon nanofibers (CNFs) coated by aluminum oxide Al2O3 as a reinforcement on compressive strength, frost resistance, and drying shrinkage of cement mortars. Three weight ratios of 0.125%, 0.25%, and 0.5% of Al2O3/CNFs and bare CNF cement mortars were compared with reference cement mortar samples. The reactive porous and high surface area layer of alumina induced the hydration reaction and promoted the production of well-distributed hydration gel. Derivative thermal analysis-differential thermogravimetric (TGA-DTG) and X-ray powder diffraction (XRD) characterization showed that Al2O3/CNFs reinforcement led to greater hydration gel production than bare CNFs. Transmission electron microscopy (TEM) and scanning electron microscopy (SEM) were performed to study the coating and microstructure of the cement mortars evaluated in this paper. The results show that the optimum enhancement of the cement mortar properties was obtained at ratios of 0.125% for Al2O3/CNFs and 0.25% for CNFs. This enhancement was greater with Al2O3/CNFs-reinforced specimens in terms of high compressive strength, less compressive strength degradation after 150 cycles, and less drying shrinkage. The low use of the CNFs in Al2O3/CNFs samples indicates the coating is an economical and promising approach for improving the performance of cement mortars.

Global, regional, and national prevalence of asthma in 2019: a systematic analysis and modelling study.

Background: Asthma has a significant impact on people of all ages, particularly children. A lack of universally accepted case definition and confirmatory tests and a poor understanding of major risks interfere with a global response. We aimed to provide global estimates of asthma prevalence and cases in 2019 across four main epidemiological case definitions - current wheezing, ever wheezing, current asthma, and ever asthma. We further investigated major associated factors to determine regional and national distributions of prevalence and cases for current wheezing and ever asthma. Methods: We identified relevant population-based studies published between January 1, 1990, and December 31, 2019. Using a multilevel multivariable mixed-effects meta-regression model, we assessed the age- and sex-adjusted associations of asthma with study-level variables, including year, setting, region and socio-demographic index (SDI). Using a random-effects meta-analysis, we then identified risk factors for current wheezing and asthma. From a "risk factor-based model", which included current smoking, and biomass exposure for current wheezing, and rural setting, current smoking, biomass exposure, and SDI for ever asthma, we estimated case numbers and prevalence across regions and 201 countries and territories in 2019. Results: 220 population-based studies conducted in 88 countries were retained. In 2019, the global prevalence estimates of asthma in people aged 5-69 years by various definitions, namely current wheezing, ever wheezing, current asthma, and ever asthma were 11.5% (95% confidence interval (CI) = 9.1-14.3), 17.9% (95% CI = 14.2-22.3), 5.4% (95% CI = 3.2-9.0) and 9.8% (95% CI = 7.8-12.2), respectively. These translated to 754.6 million (95% CI = 599. 7-943.4), 1181.3 million (95% CI = 938.0-1,471.0), 357.4 million (95% CI = 213.0-590.8), 645.2 million (95% CI = 513.1-806.2) cases, respectively. The overall prevalence of current wheezing among people aged 5-69 years was the highest in the African Region at 13.2% (95% CI = 10.5-16.5), and the lowest in the Americas Region at 10.0% (95% CI = 8.0-12.5). For ever asthma, the estimated prevalence in those aged 5-69 years was also the highest in the African Region at 11.3% (95% CI = 9.0-14.1), but the lowest in South-East Asia Region (8.8, 95% CI = 7.0-11.0). Conclusions: Although varying approaches to case identification in different settings make epidemiological estimates of asthma very difficult, this analysis reaffirms asthma as a common global respiratory condition before the COVID-19 pandemic in 2019, with higher prevalence than previously reported in many world settings.

Structural Behavior of RC Beams Containing Unreinforced Drilled Openings with and without CFRP Strengthening.

Construction deficiencies can cause serious problems that significantly decrease the design strength of concrete structures, such as the unreinforced drilled openings. With the absence of sufficient reinforcement, the stress concentrations generated around the opening corners produce cracks in the beams. The size and location of the opening significantly affect the behavior of the beam under static and dynamic load. In this work, an experimental and numerical program was performed to investigate the behavior of drilled reinforced concrete beams with and without strengthening using CFRP sheets. Energy absorption and SDOF analyses were performed to preliminary assess the behavior of the beams under the dynamic load, such as blast. One control beam without any openings, six beams with tension-zone openings, and six beams with shear-zone openings were tested. It was found that the samples with tension-zone openings were slightly affected by the opening, where the reduction in the ultimate strength was approximately 7 to 14%. The beams were able to recover up to 46% of the lost strength by CFRP strengthening. On the other hand, the shear-zone opening significantly decreased the strength and energy absorption and increased the blast response. It can be concluded that it is not recommended to drill any opening at the shear zone as strength loss can reach 57% even with the strengthening, especially for blast resisting structure; in addition, the strength recovered from approximately 11.95 to 32.46% only. The finite element model was able to predict the strength of the beams. The results were closer in the case of tension-zone opening than those in the case of the shear-zone opening. Shear cracks were observed at the corners of the openings even if the opening exists at the tension zone. A reduction in the density of cracks can be observed after the strengthening, where the FRP sheet decreases the stress in the concrete.

Feasibility of supported self-management with a pictorial action plan to improve asthma control.

Supported self-management reduces asthma-related morbidity and mortality. This paper is on a feasibility study, and observing the change in clinical and cost outcomes of pictorial action plan use is part of assessing feasibility as it will help us decide on outcome measures for a fully powered RCT. We conducted a pre-post feasibility study among adults with physician-diagnosed asthma on inhaled corticosteroids at a public primary-care clinic in Malaysia. We adapted an existing pictorial asthma action plan. The primary outcome was asthma control, assessed at 1, 3 and 6 months. Secondary outcomes included reliever use, controller medication adherence, asthma exacerbations, emergency visits, hospitalisations, days lost from work/daily activities and action plan use. We estimated potential cost savings on asthma-related care following plan use. About 84% (n = 59/70) completed the 6-months follow-up. The proportion achieving good asthma control increased from 18 (30.4%) at baseline to 38 (64.4%) at 6-month follow-up. The proportion of at least one acute exacerbation (3 months: % difference -19.7; 95% CI -34.7 to -3.1; 6 months: % difference -20.3; 95% CI -5.8 to -3.2), one or more emergency visit (1 month: % difference -28.6; 95% CI -41.2 to -15.5; 3 months: % difference -18.0; 95% CI -32.2 to -3.0; 6 months: % difference -20.3; 95% CI -34.9 to -4.6), and one or more asthma admission (1 month: % difference -14.3; 95% CI -25.2 to -5.3; 6 months: % difference -11.9; 95% CI -23.2 to -1.8) improved over time. Estimated savings for the 59 patients at 6-months follow-up and for each patient over the 6 months were RM 15,866.22 (USD3755.36) and RM268.92 (USD63.65), respectively. Supported self-management with a pictorial asthma action plan was associated with an improvement in asthma control and potential cost savings in Malaysian primary-care patients.Trial registration number: ISRCTN87128530; prospectively registered: September 5, 2019, http://www.isrctn.com/ISRCTN87128530 .