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Quantitative microbial risk assessment for O157: H7 via drinking water in the Gaza Strip, Palestine.SAGE Open Medicine 2024Microbial contamination of drinking water, particularly by pathogens such as O157: H7, is a significant public health concern worldwide, especially in regions with...
INTRODUCTION
Microbial contamination of drinking water, particularly by pathogens such as O157: H7, is a significant public health concern worldwide, especially in regions with limited access to clean water like the Gaza Strip. However, few studies have quantified the disease burden associated with O157: H7 contamination in such challenging water management contexts.
OBJECTIVE
This study aimed to conduct a comprehensive Quantitative Microbial Risk Assessment to estimate the annual infection risk and disease burden attributed to O157: H7 in Gaza's drinking water.
METHODS
Applying the typical four steps of the Quantitative Microbial Risk Assessment technique-hazard identification, exposure assessment, dose-response analysis, and risk characterization-the study assessed the microbial risk associated with O157: H7 contamination in Gaza's drinking water supply. A total of 1317 water samples from various sources across Gaza were collected and analyzed for the presence of O157: H7. Using Microsoft ExcelTM and @RISKTM software, a Quantitative Microbial Risk Assessment model was constructed to quantify the risk of infection associated with O157: H7 contamination. Monte Carlo simulation techniques were employed to assess uncertainty surrounding input variables and generate probabilistic estimates of infection risk and disease burden.
RESULTS
Analysis of the water samples revealed the presence of O157: H7 in 6.9% of samples, with mean, standard deviation, and maximum values of 1.97, 9.74, and 112 MPN/100 ml, respectively. The risk model estimated a median infection risk of 3.21 × 10-01 per person per year and a median disease burden of 3.21 × 10-01 Disability-Adjusted Life Years per person per year, significantly exceeding acceptable thresholds set by the WHO.
CONCLUSION
These findings emphasize the urgent need for proactive strategies to mitigate public health risks associated with waterborne pathogens in Gaza.
PubMed: 38846513
DOI: 10.1177/20503121241258071 -
Digital Health 2024Virtual care for chronic conditions has seen uptake due to COVID-19. Evaluation of virtual models is important to ensure evidence-based practice. There is a paucity of...
Effectiveness of an interprofessional assessment and management approach for people with chronic low back disorders delivered via virtual care: A randomized controlled trial pilot intervention.
OBJECTIVE
Virtual care for chronic conditions has seen uptake due to COVID-19. Evaluation of virtual models is important to ensure evidence-based practice. There is a paucity of research in the use of virtual care for management of chronic back disorders. The objective of this study was to evaluate effectiveness of a team-based virtual care model for back disorder assessment where a physical therapist uses virtual care to join a nurse practitioner and patient in a rural Saskatchewan, Canada community.
METHODS
Sixty-four rural adults with chronic back disorders were randomly allocated to receive either: (1) team-based virtual care ( = 24); (2) care from an urban physical therapist travelling to community ( = 20); or (3) care from a rural nurse practitioner ( = 20). The team-based care group involved a nurse practitioner located with a rural patient, and a physical therapist joining using virtual care. The physical therapist alone and the nurse practitioner alone groups received in-person assessments. Groups with a physical therapist involved had follow-up treatments by in-person physical therapy. Outcomes over six months included pain, disability, back beliefs, satisfaction, quality-adjusted health status and management-related costs.
RESULTS
There were no significant differences for pain, disability, back beliefs and satisfaction between groups. The average cost per patient for implementing in-person physical therapist assessment ($135) was higher compared with the team over virtual care ($118) and NP care ($59).
CONCLUSION
Primary outcomes were not different by group. Physical therapist alone was more costly than other groups. Future research should include more participants, longer follow-up time and refined cost parameters.
TRIAL REGISTRATION
ClinicalTrials.gov NCT02225535; https://clinicaltrials.gov/ct2/show/NCT02225535 (Archived by WebCite at http://www.webcitation.org/6lqLTCNF7).
PubMed: 38846367
DOI: 10.1177/20552076241260569 -
Health Expectations : An International... Jun 2024Parent carers of children with special educational needs or disabilities are at risk of poorer health and wellbeing outcomes because of the distinct and challenging...
INTRODUCTION
Parent carers of children with special educational needs or disabilities are at risk of poorer health and wellbeing outcomes because of the distinct and challenging circumstances they face. Evaluations of interventions promoting the health of parent carers should focus on measuring the aspects of health and wellbeing which are most relevant to this group. As part of a programme of research on parent carer-focused interventions, this study aimed to understand which aspects of health and wellbeing are perceived by parent carers as most meaningful and important.
METHODS
A qualitative study using semistructured online interviews was conducted. A purposive sample of parent carers was interviewed about relevant health and wellbeing outcomes. Transcripts were analysed thematically.
RESULTS
Thirty parent carers were interviewed, 19 of whom had experienced a health-promoting intervention, either as participants (n = 14) or facilitators (n = 5). Three main themes were identified: 'self, identity and beliefs'; 'social connections and support' and 'health-promoting practices and outcomes.' Each theme encompassed the challenges participants faced, and the changes that helped them overcome these challenges. 'Self-identity' challenges focused on the overwhelming nature of the parental care role and the emotional impact of this. Changes were brought about by developing a positive mindset, increasing confidence, and reconnecting with aspects of their identity which were important to them before they became parent carers. Challenges related to 'social connections' reflected parent carers' isolation. Change was brought about through increased peer support and peer interactions. Parent carers experienced challenges in terms of 'health-promoting activities' because they lacked free time and experienced poor physical health. Changes were brought about by engagement in health-promoting activities of various kinds.
CONCLUSION
Parent carers view health and wellbeing in terms of overcoming the common challenges they face as a group. These challenges reflect the ways in which their physiological and psychological needs are often unmet. Researchers interested in measuring parent carer health and wellbeing should consider the specific challenges this group face, as well as theoretical frameworks which can make sense of these challenges, such as self-determination theory.
PATIENT OR PUBLIC CONTRIBUTION
Our team carries out patient and public involvement (PPI) through a Family Faculty group facilitated by a Family Involvement Co-ordinator (A. McD.) who is herself a parent carer. A study-specific PPI working group was established which included members of the Family Faculty. The PPI group advised on various aspects of the research as reported in the paper. The manuscript was co-authored by the team's Family Involvement Co-ordinator (A. McD.).
Topics: Humans; Caregivers; Female; Male; Parents; Disabled Children; Qualitative Research; Child; Adult; Social Support; Middle Aged; Interviews as Topic; Adolescent; Health Status
PubMed: 38845158
DOI: 10.1111/hex.14085 -
PloS One 2024Persons with disabilities are disadvantaged in accessing sexual and reproductive health services, including condoms. In this study, we investigated whether condom access...
Differences in condom access and use and associated factors between persons with and without disabilities receiving social cash transfers in Luapula province, Zambia-A cross-sectional study.
Persons with disabilities are disadvantaged in accessing sexual and reproductive health services, including condoms. In this study, we investigated whether condom access and use and their associated factors differed between persons with and without disabilities. We used data from adults in households receiving the Government of Zambia social cash transfers (SCT) in four districts of Luapula province. Condom access and use was the outcome. Disability, defined by the Washington Group Short Set Questions on Disability, was the main predictor. We performed logistic regression analyses to determine the associations between condom access and use and disability. In multivariable analyses, we controlled for covariates including age, sex, marital status, poverty status, HIV testing, and receiving the SCT. The sample comprised 1,143 people aged 16-49, with a median age of 21 years (interquartile range 18-28); 57.4% (n = 656) were female, 86.5% (n = 989) accessed and used condoms, and 17.9% (n = 205) were disabled, rating themselves with a 3 or a 4 on a scale of 1 = "not limited" to 4 = "cannot at all" in performing any of the six daily functions (seeing, hearing, walking, cognition, self-care, or communicating). Nearly sixty percent(58.5% (n = 120)) of persons with disabilities were female, 79.5% (n = 163) reported being very poor, 87.8% (n = 180) reported receiving SCT, and 86.3% (n = 177) reported accessing and using condoms. Condom access and use did not differ between persons with and without disabilities (adjusted odds ratio: 1.09; 95% confidence interval [CI]: 0.60-1.98]). We found no differences between persons with and without disabilities in condom access and use. We established that individual-level factors such as age, sex, marital status, and knowledge of being HIV positive might play a more important role in condom access and use than disability. Condom promotion interventions should account for these factors.
Topics: Humans; Female; Male; Zambia; Condoms; Adult; Adolescent; Cross-Sectional Studies; Disabled Persons; Young Adult; Middle Aged; HIV Infections; Health Services Accessibility
PubMed: 38843144
DOI: 10.1371/journal.pone.0302182 -
Frontiers in Public Health 2024Children with disability face many barriers to participating in community sports. Little Athletics Australia aims to increase fair and meaningful inclusion via a new...
Children with disability face many barriers to participating in community sports. Little Athletics Australia aims to increase fair and meaningful inclusion via a new structure which will enable all children to take part in the same contest by competing for their 'personal best' score. Named the True Inclusion Method (TIM), this new structure will be piloted in 13 sites across six states. Formative evaluation of this pilot will critique TIM and its implementation using observations of events, and interviews and surveys with child athletes with and without disability, their parents/carers and Little Athletics volunteers. Implementation outcomes are acceptability, appropriateness, adoption, feasibility and fidelity. Qualitative data will be analysed thematically. TIM is designed to encourage inclusive participation by children with disability in sporting events, and to improve the competitive experience for children by celebrating personal achievement and fostering fun.
Topics: Humans; Child; Disabled Children; Australia; Sports; Male; Female; Pilot Projects; Adolescent; Program Evaluation
PubMed: 38841685
DOI: 10.3389/fpubh.2024.1403866 -
Journal of Dental Anesthesia and Pain... Jun 2024Excessive fear of dental procedures leads to disruptive behavior during dental examinations and treatments. Dental examinations and treatments of these patients usually...
BACKGROUND
Excessive fear of dental procedures leads to disruptive behavior during dental examinations and treatments. Dental examinations and treatments of these patients usually require additional techniques, such as sedation. The most commonly used techniques are inhalation of nitrous oxide, infusion of propofol with fentanyl, and premedication and infusion of midazolam.
METHODS
A prospective observational epidemiological study was conducted on patients who required sedoanalgesia techniques for dental exploration and procedures. The reasons for the inability of patients to cooperate (excessive fear or intellectual disability), age, sex, weight, systemic pathology, oral pathology, treatment performed, time of intervention, anesthetic technique performed, and occurrence of complications were recorded.
RESULTS
In total, 218 patients were studied. Sixty-five patients came for fear of dental treatment and 153 for presenting with a diagnosis of intellectual disability and not collaborating in the treatment with local anesthesia. The average age of all patients was 30.54 ± 17.30 years. The most frequent oral pathologies found in patients with excessive fear were tartar (6.8%) and wisdom teeth (6.4%), followed by missing teeth (5%). In patients with disabilities, a combination of tartar and cavities appeared most frequently (41.3%), followed by cavities (15.6%). The most frequently used sedoanalgesia technique was the infusion of propofol with fentanyl in both groups of patients, followed by nitrous oxide.
CONCLUSION
The combination of propofol and fentanyl was the most frequently used alternative in patients who were unable to collaborate because of intellectual disability or carry out longer or more complex treatments. Inhaled nitrous oxide and midazolam were the sedative techniques of choice for simpler oral treatments, such as tartrectomies, shallow obturations, and shorter interventions, or in younger patients.
PubMed: 38840648
DOI: 10.17245/jdapm.2024.24.3.173 -
BMC Geriatrics Jun 2024There is limited understanding regarding prospective associations of insomnia symptoms and trajectories with functional disability. We aimed to investigate the...
BACKGROUND
There is limited understanding regarding prospective associations of insomnia symptoms and trajectories with functional disability. We aimed to investigate the associations of insomnia symptoms and trajectories with functional disability.
METHOD
A total of 13 197 participants were eligible from the Health and Retirement Study. Insomnia symptoms included non-restorative sleep, difficulty initiating sleep, early morning awakening, and difficulty maintaining sleep. We also identified four distinct trajectories of insomnia symptoms: low, decreasing, increasing, and high insomnia symptoms. Functional status was assessed through activities of daily living (ADL) and instrumental activities of daily living (IADL).
RESULTS
Participants experiencing one (HR, 1.21; 95% CI, 1.13-1.29), two (HR, 1.43; 95% CI, 1.29-1.57), or three to four (HR, 1.41; 95% CI, 1.25-1.60) insomnia symptoms had a higher risk of ADL disability than asymptomatic respondents. Similarly, participants with one or more insomnia symptoms had a higher risk of IADL disability. Furthermore, using the trajectory with low insomnia symptoms as the reference, decreasing insomnia symptoms (HR, 1.22; 95% CI, 1.12-1.34), increasing insomnia symptoms (HR, 1.21; 95% CI, 1.05-1.41), and high insomnia symptoms (HR, 1.36; 95% CI, 1.18-1.56) were all associated with an increased risk of ADL disability.
CONCLUSION
Both a single measurement and dynamic trajectory of insomnia symptoms are associated with the onset of ADL disability. Increased awareness and management of insomnia symptoms may contribute to the prevention of functional disability occurrence.
Topics: Humans; Sleep Initiation and Maintenance Disorders; Female; Male; Prospective Studies; Aged; Activities of Daily Living; Middle Aged; Disabled Persons; Cohort Studies; Disability Evaluation; Risk Factors
PubMed: 38840066
DOI: 10.1186/s12877-024-05108-9 -
Journal of UOEH 2024Hansen's disease not only causes problems for patients in the workplace, but also increases the possibility of transmission to other workers. This case report discusses...
Hansen's disease not only causes problems for patients in the workplace, but also increases the possibility of transmission to other workers. This case report discusses the fitness-to-work assessment for a Hansen's disease patient with a disability. A 19-year-old female, who worked as an online shop warehouse staff, presented at our hospital with a wound on her left hand accompanied by numbness. The patient's activity indicated mild limitations with a SALSA score of 25. A seven-step process for evaluating fitness to work was conducted. These steps involved assessing the patient's medical condition, disability, job demands, risks, and tolerance to determine the appropriate work status. This patient was declared fit to work with a note as online shop warehouse staff. She must take care of herself by maintaining good personal hygiene and consulting a doctor regularly, in addition to educating other workers about her condition and avoiding stigma. Routine examinations are also an important part of treating leprosy in the workplace.
Topics: Humans; Female; Leprosy; Young Adult; Disabled Persons; Work Capacity Evaluation
PubMed: 38839289
DOI: 10.7888/juoeh.46.215 -
PloS One 2024To explore the relationship between hand grip strength (HGS) and blood pressure in physically disabled individuals over 50 years old.
OBJECTIVES
To explore the relationship between hand grip strength (HGS) and blood pressure in physically disabled individuals over 50 years old.
METHODS
The research adopts a cross-sectional survey, and the data comes from the "2022-2023 Physical Health Monitoring and Scientific and Technological Services for Physical Disabilities" jointly carried out by Beijing Sport University and China Disabled Sports Management Center. Select physically disabled individuals over 50 years old and collect physical fitness measurement data. HGS was measured and adjusted based on body weight and waist circumference, with standard normal conversion. The relationship between HGS and blood pressure was analyzed using multiple linear regression, and further logistic regression was used to analyze the relationship between standard HGS and the risk of abnormal blood pressure.
RESULTS
695 disabled individuals participated in the experiment, including 402 males (57.84%) and 293 females (42.16%). Multiple linear regression analysis found that for each standard deviation increase in the standardized Z-value of relative HGS, the systolic and diastolic blood pressure of male individuals decreased by 2.391 mmHg (P = 0.008) and 1.229 mmHg (P = 0.025); decreased by 2.336 mmHg (P = 0.026) and 1.585 mmHg (P = 0.008), respectively, for female. The increase in HGS reduced the risk of hypertension in physical disabilities in males [OR = 0.820 95%CIs (0.670, 0.952)] (P = 0.003) and females [OR = 0.735 95%CIs (0.472, 0.986)] (P = 0.007).
CONCLUSION
The HGS of middle-aged and elderly physically disabled individuals negatively correlates with blood pressure, indicating the importance of increasing muscle strength (HGS) in preventing blood pressure.
Topics: Humans; Male; Female; Middle Aged; Hypertension; Hand Strength; Cross-Sectional Studies; China; Aged; Disabled Persons; Blood Pressure
PubMed: 38838024
DOI: 10.1371/journal.pone.0300314 -
Frontiers in Medicine 2024Many physicians feel uncomfortable caring for patients with intellectual and developmental disabilities (IDD). While some residency training programs include lecture...
BACKGROUND
Many physicians feel uncomfortable caring for patients with intellectual and developmental disabilities (IDD). While some residency training programs include lecture content on IDD, few provide structured experiences with individuals with IDD. One strategy for improving comfort is "contact theory:" increasing interactions with "dissimilar" people can lead to decreased negative attitudes toward that population.
OBJECTIVE
Evaluate the impact of an interactive session on resident physicians' comfort with adults with IDD.
METHODS
Small groups of resident physicians and artists with IDD collaborated on art projects during the noon conference. A prospective pre-post-intervention survey, including the validated Interaction with Disabled Persons Scale (IDP), evaluated residents' comfort with patients with IDD before and after the session.
RESULTS
53 residents completed both pre- and post-conference surveys. Mean IDP scores decreased from 78.7 (10.9) to 75.8 (9.5; < 0.01), indicating decreasing discomfort. The mean level of comfort interacting with individuals with IDD increased from uncomfortable 3.6 (1.2), before the intervention, to comfortable 4.4 (1.2) after the intervention ( = <0.01). The mean level of comfort treating individuals with IDD increased from uncomfortable 3.5 (1.1) to comfortable 4.1 (1.3) after the intervention ( < 0.01).
DISCUSSION
Providing resident physicians with real-life connections with people with IDD was associated with increased comfort. If statistically significant improvements occurred after one session, future studies should evaluate if additional experiences with people with IDD could have more substantial, lasting impacts on future doctors' comfort with and willingness to care for patients with IDD.
PubMed: 38835795
DOI: 10.3389/fmed.2024.1264958