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The Indian Journal of Tuberculosis Dec 2020Surveillance of tuberculosis is one of the oldest disease surveillance systems in the world. This article briefly reviews its history, describes its methods and main... (Review)
Review
Surveillance of tuberculosis is one of the oldest disease surveillance systems in the world. This article briefly reviews its history, describes its methods and main results, with a specific focus on low- and middle-income countries, and underlines its main challenges and future prospects. Surveillance of tuberculosis started more than two centuries ago with the recording of tuberculosis mortality in England and Wales. After Koch's discovery of the tubercle bacillus, repeated tuberculin surveys were implemented to monitor infection, and case notification of active disease was progressively established during the 20th century. Because treatment of tuberculosis disease is the key intervention to stop transmission, monitoring of treatment outcome and more recently of drug resistance became integral parts of tuberculosis surveillance. At global level, the World Health Organization (WHO) is publishing a global TB report annually since 1997. Reports present data notified by each country as well as global estimates. Estimates of tuberculosis incidence are based on case notification adjusted by various correction factors, or on derivation from results of tuberculosis prevalence surveys, e.g. in India. In 2018, 10.1 million cases of tuberculosis are estimated to have occurred, among which about 0.5 million were resistant to rifampicin, and an estimated 1.5 million patients died. While global estimates are useful to raise public awareness and attract public and private funding, their uncertainty make them less useful to guide national policies. The backbone of tuberculosis surveillance at national and subnational level is the case notification. Newly diagnosed cases of active disease, whether new or recurrent, are reported with their key characteristics (age, sex, case category, HIV co-infection, drug resistance), and treatment outcomes are reported after scheduled treatment termination. All countries follow internationally standardized definitions. Incidence rates are compared by time to observe trends, by place to compare geographical areas, and by patient's characteristics to identify high-risk groups. The laboratory plays an essential role, since the surveillance of bacteriologically confirmed cases allows the most reliable comparisons, and because of the importance of the identification of drug resistance. The number of patients examined for tuberculosis diagnosis is also a key indicator to monitor case-finding activities. Tuberculosis surveillance is today among the most performant surveillance systems for infectious diseases. The two major changes currently observed are the move from paper-based registers to individual computerized surveillance databases and the multiplication of indicators for documenting progress towards tuberculosis elimination. There is a risk that implementation of these changes be followed by a loss in data quality. All efforts should be made to accompany these changes with adequate quality control. This will only be possible if health care workers are actively involved in the process of data production and analysis.
Topics: Global Health; Humans; Population Surveillance; Tuberculosis, Pulmonary
PubMed: 33308670
DOI: 10.1016/j.ijtb.2020.11.006 -
Circulation Nov 2022Morbidity from undiagnosed atrial fibrillation (AF) may be preventable with early detection. Many consumer wearables contain optical photoplethysmography (PPG) sensors...
BACKGROUND
Morbidity from undiagnosed atrial fibrillation (AF) may be preventable with early detection. Many consumer wearables contain optical photoplethysmography (PPG) sensors to measure pulse rate. PPG-based software algorithms that detect irregular heart rhythms may identify undiagnosed AF in large populations using wearables, but minimizing false-positive detections is essential.
METHODS
We performed a prospective remote clinical trial to examine a novel PPG-based algorithm for detecting undiagnosed AF from a range of wrist-worn devices. Adults aged ≥22 years in the United States without AF, using compatible wearable Fitbit devices and Android or iOS smartphones, were included. PPG data were analyzed using a novel algorithm that examines overlapping 5-minute pulse windows (tachograms). Eligible participants with an irregular heart rhythm detection (IHRD), defined as 11 consecutive irregular tachograms, were invited to schedule a telehealth visit and were mailed a 1-week ambulatory ECG patch monitor. The primary outcome was the positive predictive value of the first IHRD during ECG patch monitoring for concurrent AF.
RESULTS
A total of 455 699 participants enrolled (median age 47 years, 71% female, 73% White) between May 6 and October 1, 2020. IHRDs occurred for 4728 (1%) participants, and 2070 (4%) participants aged ≥65 years during a median of 122 (interquartile range, 110-134) days at risk for an IHRD. Among 1057 participants with an IHRD notification and subsequent analyzable ECG patch monitor, AF was present in 340 (32.2%). Of the 225 participants with another IHRD during ECG patch monitoring, 221 had concurrent AF on the ECG and 4 did not, resulting in an IHRD positive predictive value of 98.2% (95% CI, 95.5%-99.5%). For participants aged ≥65 years, the IHRD positive predictive value was 97.0% (95% CI, 91.4%-99.4%).
CONCLUSIONS
A novel PPG software algorithm for wearable Fitbit devices exhibited a high positive predictive value for concurrent AF and identified participants likely to have AF on subsequent ECG patch monitoring. Wearable devices may facilitate identifying individuals with undiagnosed AF.
REGISTRATION
URL: https://www.
CLINICALTRIALS
gov; Unique identifier: NCT04380415.
Topics: Adult; Female; Humans; Middle Aged; Male; Atrial Fibrillation; Prospective Studies; Photoplethysmography; Electrocardiography, Ambulatory; Electrocardiography; Wearable Electronic Devices
PubMed: 36148649
DOI: 10.1161/CIRCULATIONAHA.122.060291 -
Obstetrics and Gynecology Feb 2020To systematically review the effectiveness of telehealth interventions for improving obstetric and gynecologic health outcomes.
OBJECTIVE
To systematically review the effectiveness of telehealth interventions for improving obstetric and gynecologic health outcomes.
DATA SOURCES
We conducted a comprehensive search for primary literature in ClinicalTrials.gov, Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE.
METHODS OF STUDY SELECTION
Qualifying primary studies had a comparison group, were conducted in countries ranked very high on the United Nations Human Development Index, published in English, and evaluated obstetric and gynecologic health outcomes. Cochrane Collaboration's tool and ROBINS-I tool were used for assessing risk of bias. Summary of evidence tables were created using the United States Preventive Services Task Force Summary of Evidence Table for Evidence Reviews.
TABULATION, INTEGRATION, RESULTS
Of the 3,926 published abstracts identified, 47 met criteria for inclusion and included 31,967 participants. Telehealth interventions overall improved obstetric outcomes related to smoking cessation and breastfeeding. Telehealth interventions decreased the need for high-risk obstetric monitoring office visits while maintaining maternal and fetal outcomes. One study found reductions in diagnosed preeclampsia among women with gestational hypertension. Telehealth interventions were effective for continuation of oral and injectable contraception; one text-based study found increased oral contraception rates at 6 months. Telehealth provision of medication abortion services had similar clinical outcomes compared with in-person care and improved access to early abortion. Few studies suggested utility for telehealth to improve notification of sexually transmitted infection test results and app-based intervention to improve urinary incontinence symptoms.
CONCLUSION
Telehealth interventions were associated with improvements in obstetric outcomes, perinatal smoking cessation, breastfeeding, early access to medical abortion services, and schedule optimization for high-risk obstetrics. Further well-designed studies are needed to examine these interventions and others to generate evidence that can inform decisions about implementation of newer telehealth technologies into obstetrics and gynecology practice.
Topics: Female; Gynecology; Humans; Obstetrics; Pregnancy; Prenatal Care; Quality of Health Care; Randomized Controlled Trials as Topic; Telemedicine
PubMed: 31977782
DOI: 10.1097/AOG.0000000000003646 -
Progress in Cardiovascular Diseases 2023Artificial Intelligence (AI) is a broad discipline of computer science and engineering. Modern application of AI encompasses intelligent models and algorithms for... (Review)
Review
Artificial Intelligence (AI) is a broad discipline of computer science and engineering. Modern application of AI encompasses intelligent models and algorithms for automated data analysis and processing, data generation, and prediction with applications in visual perception, speech understanding, and language translation. AI in healthcare uses machine learning (ML) and other predictive analytical techniques to help sort through vast amounts of data and generate outputs that aid in diagnosis, clinical decision support, workflow automation, and prognostication. Coronary computed tomography angiography (CCTA) is an ideal union for these applications due to vast amounts of data generation and analysis during cardiac segmentation, coronary calcium scoring, plaque quantification, adipose tissue quantification, peri-operative planning, fractional flow reserve quantification, and cardiac event prediction. In the past 5 years, there has been an exponential increase in the number of studies exploring the use of AI for cardiac computed tomography (CT) image acquisition, de-noising, analysis, and prognosis. Beyond image processing, AI has also been applied to improve the imaging workflow in areas such as patient scheduling, urgent result notification, report generation, and report communication. In this review, we discuss algorithms applicable to AI and radiomic analysis; we then present a summary of current and emerging clinical applications of AI in cardiac CT. We conclude with AI's advantages and limitations in this new field.
Topics: Humans; Artificial Intelligence; Fractional Flow Reserve, Myocardial; Heart; Algorithms; Tomography, X-Ray Computed; Computed Tomography Angiography
PubMed: 37689230
DOI: 10.1016/j.pcad.2023.09.001 -
Nature Sep 2021Enhancing vaccine uptake is a critical public health challenge. Overcoming vaccine hesitancy and failure to follow through on vaccination intentions requires effective... (Randomized Controlled Trial)
Randomized Controlled Trial
Enhancing vaccine uptake is a critical public health challenge. Overcoming vaccine hesitancy and failure to follow through on vaccination intentions requires effective communication strategies. Here we present two sequential randomized controlled trials to test the effect of behavioural interventions on the uptake of COVID-19 vaccines. We designed text-based reminders that make vaccination salient and easy, and delivered them to participants drawn from a healthcare system one day (first randomized controlled trial) (n = 93,354 participants; clinicaltrials number NCT04800965) and eight days (second randomized controlled trial) (n = 67,092 individuals; clinicaltrials number NCT04801524) after they received a notification of vaccine eligibility. The first reminder boosted appointment and vaccination rates within the healthcare system by 6.07 (84%) and 3.57 (26%) percentage points, respectively; the second reminder increased those outcomes by 1.65 and 1.06 percentage points, respectively. The first reminder had a greater effect when it was designed to make participants feel ownership of the vaccine dose. However, we found no evidence that combining the first reminder with a video-based information intervention designed to address vaccine hesitancy heightened its effect. We performed online studies (n = 3,181 participants) to examine vaccination intentions, which revealed patterns that diverged from those of the first randomized controlled trial; this underscores the importance of pilot-testing interventions in the field. Our findings inform the design of behavioural nudges for promoting health decisions, and highlight the value of making vaccination easy and inducing feelings of ownership over vaccines.
Topics: Adult; Aged; Appointments and Schedules; COVID-19 Vaccines; California; Female; Health Behavior; Humans; Immunization Programs; Intention; Kaplan-Meier Estimate; Male; Ownership; Public Health; Reminder Systems; Vaccination
PubMed: 34340242
DOI: 10.1038/s41586-021-03843-2 -
Zeitschrift Fur Gerontologie Und... Nov 2022The clinical presentation of infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV‑2) is very heterogeneous and the risk of a severe course clearly... (Review)
Review
The clinical presentation of infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV‑2) is very heterogeneous and the risk of a severe course clearly increases with age. Therefore, older adults are an important target group for vaccinations. Several vaccines are currently licensed in Europe for older adults, namely two mRNA vaccines, two adenoviral vector vaccines and a protein-based vaccine. The immunogenicity and clinical efficacy of these vaccines in the first approval trials were equal or only slightly reduced for older adults compared to younger age groups; however, the concentration of neutralizing antibodies and protection against infection greatly declined over time and the latter is substantially reduced for virus variants, particularly for the Omicron variant. Nevertheless, protection against severe disease and hospitalization is maintained at a high level for longer time periods, and after three vaccine doses (2 + 1 schedule) also for the Omicron variant. Additional booster vaccinations are currently recommended for patients with risk factors, especially older adults. With respect to the currently valid recommendations for different age and risk groups, the publications and notifications of the national vaccine advisory bodies should be referred to.All currently available vaccines target the original virus strain. New vaccines, which are adapted to virus variants are currently being developed and tested, and it is highly likely that they will be used in the near future; however, viral evolution is ongoing and a continuous development of adapted vaccines will probably be necessary.
Topics: Humans; Aged; COVID-19; SARS-CoV-2; Vaccination; Antibodies, Neutralizing
PubMed: 36112215
DOI: 10.1007/s00391-022-02102-x -
Scientific Reports Apr 2024Beauty surrounds us in many ways every day. In three experience sampling (ESM) studies we investigated frequency, category of eliciting stimuli (natural vs human-made)...
Beauty surrounds us in many ways every day. In three experience sampling (ESM) studies we investigated frequency, category of eliciting stimuli (natural vs human-made) and, the potential moderating role of several individual difference measures on such everyday experiences of beauty in an ecologically valid manner. Further, we explored the impact of such experiences on valence & arousal. Study 1 re-analysed data from a previous study, in line with the current aims. In Studies 2 and 3, we asked participants to report daily experiences of beauty using a mixed random and event-contingent sampling schedule. Mobile notifications (random sampling) prompted participants to take a photo and rate the beauty of their surroundings. Further, current valence and arousal were assessed. Notification frequency and total days of participation differed between these two studies. Participants were able to report additional experiences outside of the notification windows (event-contingent sampling). Our results indicate that we frequently encounter beauty in everyday life and that we find it in nature, in particular. Our results further suggest a mood-boosting effect of encounters with beauty. Lastly, our results indicate influences of individual differences however, these were inconclusive and require further attention.
Topics: Humans; Beauty; Female; Adult; Male; Young Adult; Arousal; Affect; Adolescent; Middle Aged
PubMed: 38658638
DOI: 10.1038/s41598-024-60091-w -
Communicable Diseases Intelligence... Mar 2015Since the introduction of measles vaccine to the vaccination schedule, the burden of measles has substantially fallen in Australia. Despite this, a number of recent... (Review)
Review
BACKGROUND
Since the introduction of measles vaccine to the vaccination schedule, the burden of measles has substantially fallen in Australia. Despite this, a number of recent measles outbreaks have occurred. The aim of this study was to examine the burden of measles in Australia using notification, hospitalisation and mortality data with the objectives of setting a baseline for comparison prior to the introduction of the combined measles-mumps-rubella-varicella vaccine.
METHODS
Data were obtained from the Australian National Notifiable Diseases Surveillance System, the National Hospital Morbidity Database and the National Mortality Database to obtain notification, hospitalisation and death data, respectively from 2000 to 2011. Rates were calculated and compared over time by age group and jurisdiction.
RESULTS
Since 1993, measles notifications have fallen considerably in Australia. However, between 2000 and 2011, measles notification rates and hospitalisation rates fluctuated. Between 2000 and 2011, there were 990 measles notifications in Australia. The average annual notification rate was 0.4 per 100,000 population. Children aged 0-4 years were the most susceptible group, particularly infants less than 1 year of age (average annual rate, 1.6 per 100,000 population). High incidence was also observed in adolescents (average annual rate, 0.7 per 100,000 population) and young adults (average annual rate, 0.8 per 100,000 population). Jurisdictional variation occurred with differing patterns of notifications and hospitalisations.
CONCLUSIONS
Although a marked reduction in measles notifications and hospitalisations has occurred in the past decade, susceptible individuals should be vaccinated to prevent outbreaks and to maintain a low incidence of measles and Australia's elimination status.
Topics: Adolescent; Adult; Australia; Chickenpox Vaccine; Child; Child, Preschool; Disease Notification; Disease Outbreaks; Epidemiological Monitoring; Female; Hospitalization; Humans; Immunization Schedule; Incidence; Infant; Male; Measles; Measles-Mumps-Rubella Vaccine; Morbillivirus; Survival Analysis; Vaccination; Vaccines, Combined
PubMed: 26063085
DOI: No ID Found -
Clinical Epidemiology 2016The Danish Multiple Sclerosis Treatment Register (DMSTR) serves as a clinical quality register, enabling the health authorities to monitor the quality of the... (Review)
Review
AIM OF THE DATABASE
The Danish Multiple Sclerosis Treatment Register (DMSTR) serves as a clinical quality register, enabling the health authorities to monitor the quality of the disease-modifying treatment, and it is an important data source for epidemiological research.
STUDY POPULATION
The DMSTR includes all patients with multiple sclerosis who had been treated with disease-modifying drugs since 1996. At present, more than 8,400 patients have been registered in this database. Data are continuously entered online into a central database from all sites in Denmark at start and at regular visits.
MAIN VARIABLES
Include age, sex, onset year and year of the diagnosis, basic clinical information, and information about treatment, side effects, and relapses.
DESCRIPTIVE DATA
Notification is done at treatment start, and thereafter at every scheduled clinical visit 3 months after treatment start, and thereafter every 6 months. The longitudinally collected information about the disease activity and side effects made it possible to investigate the clinical efficacy and adverse events of different disease-modifying therapies.
CONCLUSION
The database contributed to a certain harmonization of treatment procedures in Denmark and will continue to be a major factor in terms of quality in clinical praxis, research and monitoring of adverse events, and plays an important role in research.
PubMed: 27822098
DOI: 10.2147/CLEP.S99500 -
Journal of Drugs in Dermatology : JDD Jan 2021The coronavirus pandemic (COVID-19) has served as a call-to-arms in preparing practices for the next disaster whether it is another infectious disease or a flood,... (Review)
Review
The coronavirus pandemic (COVID-19) has served as a call-to-arms in preparing practices for the next disaster whether it is another infectious disease or a flood, hurricane, earthquake, a sustained power outage, or something else. A group of predominantly core aesthetic physicians discussed the various aspects of their office procedures that warrant consideration in a proactive approach to the next pandemic/disaster-related event. This guide does not set a standard of practice but contains recommendations that may avoid some of the "lessons learned" with the COVID-19 pandemic. In this paper, the board-certified core aesthetic physicians classified these recommendations into four generalized areas: Practice Management; Supplies and Inventory; Office Staffing Considerations and Protocols; and Patient Management Strategies. Proactive strategies are provided in each of these categories that, if implemented, may alleviate the processes involved with an efficient office closure and reopening process including, in the case of COVID-19, methods to reduce the risk of transmission to doctors, staff, and patients. These strategies also include being prepared for emergency-related notifications of employees and patients; the acquisition of necessary equipment and supplies such as personal protective equipment; and the maintenance and accessibility of essential data and contact information for patients, vendors, financial advisors, and other pertinent entities.J Drugs Dermatol. 2021;20(1):10-16. doi:10.36849/JDD.5803.
Topics: COVID-19; Civil Defense; Disaster Planning; Disasters; Disease Management; Humans; Personnel Staffing and Scheduling; Physician's Role
PubMed: 33400419
DOI: 10.36849/JDD.5803