ABSTRACT
BACKGROUND: The associations of vegetarian diets with risks for site-specific cancers have not been estimated reliably due to the low number of vegetarians in previous studies. Therefore, the Cancer Risk in Vegetarians Consortium was established. The aim is to describe and compare the baseline characteristics between non-vegetarian and vegetarian diet groups and between the collaborating studies. METHODS: We harmonised individual-level data from 11 prospective cohort studies from Western Europe, North America, South Asia and East Asia. Comparisons of food intakes, sociodemographic and lifestyle factors were made between diet groups and between cohorts using descriptive statistics. RESULTS: 2.3 million participants were included; 66% women and 34% men, with mean ages at recruitment of 57 (SD: 7.8) and 57 (8.6) years, respectively. There were 2.1 million meat eaters, 60,903 poultry eaters, 44,780 pescatarians, 81,165 vegetarians, and 14,167 vegans. Food intake differences between the diet groups varied across the cohorts; for example, fruit and vegetable intakes were generally higher in vegetarians than in meat eaters in all the cohorts except in China. BMI was generally lower in vegetarians, particularly vegans, except for the cohorts in India and China. In general, but with some exceptions, vegetarians were also more likely to be highly educated and physically active and less likely to smoke. In the available resurveys, stability of diet groups was high in all the cohorts except in China. CONCLUSIONS: Food intakes and lifestyle factors of both non-vegetarians and vegetarians varied markedly across the individual cohorts, which may be due to differences in both culture and socioeconomic status, as well as differences in questionnaire design. Therefore, care is needed in the interpretation of the impacts of vegetarian diets on cancer risk.
Subject(s)
Diet, Vegetarian , Neoplasms , Humans , Male , Female , Neoplasms/epidemiology , Middle Aged , Prospective Studies , Cross-Sectional Studies , Diet, Vegetarian/statistics & numerical data , Aged , Vegetarians/statistics & numerical data , Life Style , Adult , Risk Factors , Europe/epidemiologyABSTRACT
BACKGROUND: Height loss in aging has been recognized to reflect a decline in musculoskeletal health but not investigated in relation to dietary factors, such as sugar-sweetened beverages (SSBs), the consumption of which may deteriorate musculoskeletal health. OBJECTIVES: This study aimed to evaluate the longitudinal association of habitual consumption of total SSBs and its subtypes with height loss and examine effect-modification by age, sex, and anthropometry. METHODS: We evaluated 16,230 adults aged 40-79 y in the European Prospective Investigation into Cancer and Nutrition-Norfolk cohort. At baseline (1993-1997), SSB consumption (soft drinks, squashes, sweetened milk beverages, sweetened coffee/tea, and sweetened alcoholic beverages) was assessed using 7-d food diaries. Height was objectively measured at the baseline, second (1997-2000), and third (2004-2011) health checks. Multivariable linear regression was used to examine baseline SSB consumption and the rate of height change over the follow-up. RESULTS: The median (IQR) height change was -1.07 (-2.09 to -0.28) cm/10 y. Adjusted for potential confounders including behavioral factors, medications, and baseline body mass index (BMI), total SSB consumption was associated with height loss (ß: -0.024; 95% CI: -0.046, -0.001 cm/10 y per 250 g/d of SSB), and similar results were seen for the individual beverages, except for sweetened milk beverages (ß: +0.07; 95% CI: -0.16, 0.30), with wide CIs. No effect-modification by prespecified factors was evident, except for baseline BMI (P-interaction = 0.037). Total SSB consumption was associated with height loss (-0.038; 95% CI: -0.073, -0.004) in participants with BMI ≤ 25 kg/m2 but not apparently in those with BMI > 25 kg/m2. CONCLUSIONS: SSB consumption was modestly associated with height loss, particularly in adults with normal weight status.
Subject(s)
Body Height , Sugar-Sweetened Beverages , Humans , Middle Aged , Male , Female , Sugar-Sweetened Beverages/adverse effects , Adult , Longitudinal Studies , Aged , Prospective Studies , Body Mass Index , Diet Records , DietABSTRACT
Influenza in dogs holds considerable public health significance due to their close companionship with humans, yet several facets of this phenomenon remain largely unexplored. This study undertook a systematic review and meta-analysis of observational studies to gauge the global seroprevalence of influenza in dogs. We also assessed whether pet dogs exhibited a higher seroprevalence of influenza compared to non-pet dogs, explored seasonal variations in seroprevalence, scrutinised the design and reporting standards of existing studies, and elucidated the geographical distribution of canine influenza virus (cIV). A comprehensive analysis of 97 studies spanning 27 countries revealed that seroprevalence of various influenza strains in dogs consistently registered below 10% and exhibited relative stability over the past decade. Significantly, we noted that seroprevalence of human influenza virus was notably higher in pet dogs compared to their non-pet counterparts, whereas seroprevalence of other influenza strains remained relatively uniform among both categories of dogs. Seasonal variations in seroprevalence of cIV were not observed. In summary, our findings indicated the global circulation of cIV strains H3N2 and H3N8, with other strains primarily confined to China. Given the lack of reported cases of the transmission of cIV from dogs to humans, our findings suggest a higher risk of reverse zoonosis than zoonosis. Finally, we strongly advocate for standardised reporting guidelines to underpin future canine influenza research endeavours.
Subject(s)
Dog Diseases , Orthomyxoviridae Infections , Animals , Dogs , Humans , Dog Diseases/epidemiology , Dog Diseases/virology , Global Health , Influenza A virus/immunology , Influenza A virus/isolation & purification , Influenza A Virus, H3N2 Subtype/immunology , Influenza A Virus, H3N2 Subtype/isolation & purification , Orthomyxoviridae Infections/epidemiology , Orthomyxoviridae Infections/veterinary , Orthomyxoviridae Infections/virology , Orthomyxoviridae Infections/immunology , Prevalence , Seasons , Seroepidemiologic StudiesABSTRACT
Healthcare costs arising from venous leg ulcers (VLU) are expected to increase due to an aging population and increased prevalence of comorbidities. We aim to estimate the healthcare resources incurred by VLU patients, and to quantify the extent to which predictors explain variation in cost-related outcomes. Retrospective patient-level cohort data for VLU patients were analysed using generalised linear regression models. Data were extracted from a tertiary hospital registry in Singapore, between 2013 and 2017. The outcome variables were length of stay per admission; inpatient and outpatient bill per admission; whether a patient underwent a surgical treatment of the venous system; and, whether they visited the emergency department. Cost outcomes were reported in Singapore dollars (S$). A total of 162 VLU patients were included with a mean age of 67.5 (±14.4). For the inpatient setting the mean length of stay was 8.1 days and the mean inpatient bill was S$7886. For outpatients, the mean number of dressings was 29.4, and mean outpatient bill was S$6962. Heart disease patients incurred longer hospital stays and larger inpatient bills per admission and females had greater odds of undergoing a surgical procedure on the venous system. Certain VLU patient groups were found to be associated with larger cost outcomes.
Subject(s)
Leg Ulcer , Varicose Ulcer , Female , Humans , Aged , Retrospective Studies , Singapore/epidemiology , Wound Healing , Varicose Ulcer/therapy , Health Services , Leg Ulcer/therapyABSTRACT
Solder/Cu joints are important components responsible for interconnection in microelectronics. Construction of the solder/Cu joints through liquid/solid (L/S) reactions accompanies the formation of the Cu-Sn intermetallic compounds (IMCs) at the joint interface. The Cu6Sn5 IMC exhibits remarkable distinctions in thickness and morphology upon increasing the L/S reaction time. Effects of the initial characteristics of thickness and morphology on the growth kinetics of Cu6Sn5 during subsequent isothermal aging were investigated. SAC305 solder was reflowed on a Cu electroplated layer at 265 °C for 1 to 60 min to produce the Cu6Sn5 IMC with different thickness and morphology at the SAC305/Cu interface. The as-fabricated SAC305/Cu joint samples were aged at 200 °C for 72 to 360 h to investigate the growth kinetics of Cu6Sn5. The results show that the initial characteristics of thickness and morphology significantly influenced the growth kinetics of Cu6Sn5 during the subsequent solid/solid (S/S) reaction. A prolonged L/S reaction time of 60 min (L/S-60) produced a scallop-type Cu6Sn5 IMC with a larger grain size and a thicker thickness, which reduced the quantity of fast diffusion path (grain boundary) and the magnitude of concentration gradient, thus slowing down the growth rate of Cu6Sn5. According to the growth kinetics analysis, the growth rate constant of Cu6Sn5 could be remarkably reduced to 0.151 µm/h0.5 for the L/S-60 sample, representing a significant reduction of 70 % compared to that of the L/S-1 sample (0.508 µm/h0.5 for L/S reaction time of 1 min).
ABSTRACT
A majority of lower extremities neuro-ischaemic wounds (NIU) are related to: (a) only diabetes (DM); (b) only peripheral artery disease (PAD); (c) co-existing diabetes and peripheral artery disease (DM-PAD). This study aims to characterise the major clinical outcomes of forementioned three groups of lower extremity wound patients in Singapore. Patients hospitalised for lower extremity NIU between January 2014 and October 2017 in a tertiary hospital in Singapore were analysed. Patients' major limb amputation and mortality were assessed using Cox regression models. Cumulative survival and amputation-free survival among the three classified groups were calculated using Kaplan-Meier analysis. Compared with patients with only DM, those in the PAD group and the DM-PAD group had higher risk of major limb amputation (adjusted hazard ratio: 2.47, 95% CI: 1.65-3.70; adjusted hazard ratio: 2.01, 95% CI: 1.53-2.65 respectively) and mortality (adjusted hazard ratio: 2.36, 95% CI: 1.57-3.55; adjusted hazard ratio: 2.46, 95% CI: 1.86-3.26 respectively). The 3-year survival and amputation-free survival were lowest in the DM-PAD group (52.1% and 41.5% respectively), followed by the PAD group (53.3% and 44.6% respectively) and the DM group (74.2% and 68.5% respectively). Lower extremity NIU patients with PAD or DM-PAD were found to have poorer clinical prognosis than those with DM only.
Subject(s)
Diabetes Mellitus , Peripheral Arterial Disease , Humans , Ischemia , Lower Extremity/blood supply , Lower Extremity/surgery , Peripheral Arterial Disease/complications , Peripheral Arterial Disease/surgery , Retrospective Studies , Risk Factors , Tertiary Care Centers , Time Factors , Treatment OutcomeABSTRACT
PURPOSE: Ultrasound (US)-guided percutaneous kidney biopsy is a challenge for interventionists as US artefacts prevent accurate viewing of the biopsy needle tip. Automatic needle tracking and trajectory prediction can increase operator confidence in performing biopsies, reduce procedure time, minimize the risk of inadvertent biopsy bleedings, and enable future image-guided robotic procedures. METHODS: In this paper, we propose a tracking-by-segmentation model with spatial and channel "Squeeze and Excitation" (scSE) for US needle detection and trajectory prediction. We adopt a light deep learning architecture (e.g. LinkNet) as our segmentation baseline network and integrate the scSE module to learn spatial information for better prediction. The proposed model is trained with the US images of anonymized kidney biopsy clips from 8 patients. The contour is obtained using the border-following algorithm and area calculated using Green formula. Trajectory prediction is made by extrapolating from the smallest bounding box that can capture the contour. RESULTS: We train and test our model on a total of 996 images extracted from 102 short videos at a rate of 3 frames per second from each video. A set of 794 images is used for training and 202 images for testing. Our model has achieved IOU of 41.01%, dice accuracy of 56.65%, F1-score of 36.61%, and root-mean-square angle error of 13.3[Formula: see text]. We are thus able to predict and extrapolate the trajectory of the biopsy needle with decent accuracy for interventionists to better perform biopsies. CONCLUSION: Our novel model combining LinkNet and scSE shows a promising result for kidney biopsy application, which implies potential to other similar ultrasound-guided biopsies that require needle tracking and trajectory prediction.
Subject(s)
Image-Guided Biopsy/methods , Kidney/pathology , Ultrasonography, Interventional/methods , Algorithms , Biopsy, Needle/methods , Humans , Kidney/diagnostic imaging , Models, Anatomic , RoboticsABSTRACT
BACKGROUND: Poor adherence to medications is a global public health concern with substantial health and cost implications, especially for chronic conditions. In the USA, poor adherence is estimated to cause 125,000 deaths and cost $US100 billion annually. The most successful adherence-promoting strategies that have been identified so far have moderate effect, are relatively costly, and raise availability, feasibility, and/or scalability issues. OBJECTIVE: The main objective of SIGMA (Study on Incentives for Glaucoma Medication Adherence) was to measure the effectiveness on medication adherence of a novel incentive strategy based on behavioral economics that we refer to as adherence-contingent rebates. These rebates offered patients a near-term benefit while leveraging loss aversion and regret and increasing the salience of adherence. METHODS: SIGMA is a 6-month randomized, controlled, open-label, single-center superiority trial with two parallel arms. A total of 100 non-adherent glaucoma patients from the Singapore National Eye Centre were randomized into intervention (adherence-contingent rebates) and usual care (no rebates) arms in a 1:1 ratio. The primary outcome was the mean change from baseline in percentage of adherent days at Month 6. The trial registration number is NCT02271269 and a detailed study protocol has been published elsewhere. FINDINGS: We found that participants who were offered adherence-contingent rebates were adherent to all their medications on 73.1% of the days after 6 months, which is 12.2 percentage points (p = 0.027) higher than in those not receiving the rebates after controlling for baseline differences. This better behavioral outcome was achieved by rebates averaging 8.07 Singapore dollars ($US5.94 as of 2 November 2017) per month during the intervention period. CONCLUSION: This study shows that simultaneously leveraging several insights from behavioral economics can significantly improve medication adherence rates. The relatively low cost of the rebates and significant health and cost implications of medication non-adherence suggest that this strategy has the potential to cost-effectively improve health outcomes for many conditions.
Subject(s)
Chronic Disease/drug therapy , Drug Therapy/economics , Glaucoma/drug therapy , Medication Adherence , Reimbursement, Incentive , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young AdultSubject(s)
Contracture/diagnosis , Hearing Loss, Sensorineural/diagnosis , Histiocytosis/diagnosis , Nucleoside Transport Proteins/genetics , Contracture/genetics , Contracture/pathology , DNA Mutational Analysis , Hearing Loss, Sensorineural/genetics , Hearing Loss, Sensorineural/pathology , Histiocytosis/genetics , Histiocytosis/pathology , Humans , Malaysia , Male , Pedigree , Skin/pathology , Young AdultABSTRACT
BACKGROUND: Many glaucoma patients do not adhere to their medication regimens because they fail to internalize the (health) costs of non-adherence, which may not occur until years or decades later. Behavioural economic theory suggests that adherence rates can be improved by offering patients a near-term benefit. Our proposed strategy is to offer adherence-contingent rebates on medication and check-up costs. This form of value pricing (VP) ensures that rebates are granted only to those most likely to benefit. Moreover, by leveraging loss aversion, rebates are expected to generate a stronger behavioural response than equivalent financial rewards. METHODS/DESIGN: The main objective of the Study on Incentives for Glaucoma Medication Adherence (SIGMA) is to test the VP approach relative to usual care (UC) in improving medication adherence. SIGMA is a randomized, controlled, open-label, single-centre superiority trial with two parallel arms. A total of 100 non-adherent (Morisky Medication Adherence Scale ≤6) glaucoma patients from the Singapore National Eye Centre are block-randomized (blocking factor: single versus multiple medications users) into the VP and UC arms in a 1:1 ratio. The treatment received by VP patients will be strictly identical to that received by UC patients, with the only exception being that VP patients can earn either a 50 % or 25 % rebate on their glaucoma-related healthcare costs conditional on being adherent on at least 90 % or 75 % of days as measured by a medication event monitoring system. Masking the arm allocation will be precluded by the behavioural nature of the intervention but blocking size will not be disclosed to protect concealment. The primary outcome is the mean change from baseline in percentage of adherent days at month 6. A day will be counted as adherent when the patients take all their medication(s) within the appropriate dosing windows. DISCUSSION: This trial will provide evidence on whether adherence-contingent rebates can improve medication adherence among non-adherent glaucoma patients, and more generally whether this approach represents a promising strategy to cost-effectively improve chronic disease management. TRIAL REGISTRATION: NCT02271269 . Registered on 19 October 2014.
Subject(s)
Drug Costs , Glaucoma/drug therapy , Glaucoma/economics , Insurance, Health, Reimbursement , Medication Adherence , Motivation , Office Visits/economics , Value-Based Health Insurance/economics , Adult , Aged , Aged, 80 and over , Female , Glaucoma/diagnosis , Glaucoma/psychology , Health Knowledge, Attitudes, Practice , Humans , Male , Middle Aged , Research Design , Risk Assessment , Risk Factors , Singapore , Time Factors , Treatment Outcome , Young AdultABSTRACT
An antimicrobial peptide, LL-37, is found in an innate defense system of humans. Patients who suffer urinary tract infection (UTI) will generate LL-37 and which is released into urine. LL-37 can be used as an indicator for the diagnosis of UTI. We have designed a biosensor with an interdigitated electrode on a printed-circuit board (PCB). The surface of the electrode was modified with 3-mercaptopropionic acid and immobilized with anti-LL37 antibody to improve the specificity of the biosensor. By de-embedding jig impedance, the impedance associated with the change of LL-37 concentration was calculated. The sensitivity of this biosensor for LL-37 in a urine sample can reach 50 µg/mL.