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Bychkovska O, Egen C, Strøm V, Juocevicius A, Tederko P, Arora M, Rizzo Battistella L, Engkasan JP, Gemperli A. Barriers and Facilitators to Healthcare Service Access among Persons with Spinal Cord Injury (SCI). Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Despite having a high healthcare need, persons with complex conditions are less likely to receive comprehensive care. Individuals with SCI experience difficulties accessing services 2-4 times more than the general population. There is little agreement concerning the factors that influence these access restrictions. Few studies focus on health system impact on characteristics on access.
Objective
To outline barriers and facilitators to service access among persons with SCI across 22 countries in terms of health system characteristics
Methods
InSCI(2017): 1st community survey on experience of persons with SCI, 12591 participants, 22 countries (Australia, Brazil, China, France, Germany, Greece, Indonesia, Italy, Japan, Lithuania, Malaysia, Morocco, the Netherlands, Norway, Poland, Romania, South Africa, South Korea, Spain, Switzerland, Thailand, USA).
Data analysis
1. Hierarchical cluster analysis based on Gower distance (to group systems by access restrictions: Acceptability, Approachability, Availability, Affordability, Appropriateness).
2. Generalized linear mixed-effects decision tree (to explore the association of system characteristics and access, including WHO and OECD system indicators (e.g. UHC index, expenditure, human resources). Missing values were imputed with missforest.
Results
12% of persons with SCI reported having an access restriction, most of them (7%) with Availability. By country, the highest unmet needs were reported in Poland (25%), Germany, Lithuania, and Romania (13).
1. Cluster analysis: 7 health systems clusters (groups) were identified.
2. By June 2022, we will have the results of the second analysis: the association of system characteristics with access and how it is modified by socio-demographic and medical factors.
Expected conclusions
The study identifies factors a country could modify in order to improve access and strengthen the system for persons with SCI/disability, that might be relevant to general population as well.
Key messages
• Persons with SCI often experience similar access restrictions across countries, incl. those with high-performing health systems. System strengthening in this area is further required in all countries.
• Health systems are fragmented, e.g. healthcare quality and access inside a country differs by region, urban/rural setting etc., hence, the systems are challenging to classify.
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Affiliation(s)
- O Bychkovska
- Health Service Research Unit, Swiss Paraplegic Research, University of Lucerne , Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne , Lucerne, Switzerland
- Swiss School of Public Health , Zurich, Switzerland
| | - C Egen
- Department of Rehabilitation, The Hannover Medical School , Hannover, Germany
| | - V Strøm
- Research Department, Sunnaas Rehabilitation Hospital , Alværn, Norway
| | - A Juocevicius
- Department of Rehabilitation, Vilnius University , Vilnius, Lithuania
| | - P Tederko
- Department of Rehabilitation, Medical University of Warsaw , Warsaw, Poland
| | - M Arora
- Rehabilitation Department, University of Sydney , Sydney, Australia
| | - L Rizzo Battistella
- Department of Physical and Rehab Medicine, University of São Paulo , São Paulo, Brazil
| | - JP Engkasan
- Department of Rehabilitation Medicine, Universiti of Malaya , Malaya, Malaysia
| | - A Gemperli
- Health Service Research Unit, Swiss Paraplegic Research, University of Lucerne , Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne , Lucerne, Switzerland
- Center for Primary and Community Care, University of Lucerne , Lucerne, Switzerland
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Ronca E, Scheel-Sailer A, Koch HG, Gemperli A. Health care utilization in persons with spinal cord injury: part 2-determinants, geographic variation and comparison with the general population. Spinal Cord 2017; 55:828-833. [PMID: 28462934 DOI: 10.1038/sc.2017.38] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/11/2017] [Accepted: 03/14/2017] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional survey. OBJECTIVES To investigate annual rates and geographic variation of health care utilization in persons with spinal cord injury (SCI), and to identify factors associated with health care utilization. SETTING Community setting, entire country of Switzerland. METHODS Annual rates of planned and emergency visits to the general practitioner (GP), planned and emergency outpatient clinic visits and in-patient hospitalizations were compared between individuals with chronic SCI, over 16 years of age residing in Switzerland between late 2011 and early 2013 and a population sample (2012) of the Swiss general population. Risk factors for increased health service utilization were identified by means of regression models adjusted for spatial variation. RESULTS Of 492 participants (86.2% response rate), 94.1% visited a health care provider in the preceding year, with most persons visiting GPs (88.4%) followed by outpatient clinics (53.1%) and in-patient hospitals (35.9%). The increase in utilization as compared with the general population was 1.3-, 4.0- and 2.9-fold for GP, outpatient clinic and in-patient hospital visit, respectively. GP utilization was highest in persons with low income (incidence rate ratio (IRR) 1.85) and old age (IRR 2.62). In the first 2 years post injury, health service visits were 1.7 (GP visits) to 5.8 times (emergency outpatient clinic visits) more likely compared with those later post injury. CONCLUSIONS People with SCI more frequently use health services as compared with the general population, across all types of medical service institutions. GP services were used most often in areas where availability of specialized outpatient clinic services was low.
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Affiliation(s)
- E Ronca
- Rehabilitation Services and Care Unit, Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | | | - H G Koch
- Swiss Paraplegics Association, Nottwil, Switzerland
| | - A Gemperli
- Rehabilitation Services and Care Unit, Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
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Gemperli A, Ronca E, Scheel-Sailer A, Koch HG, Brach M, Trezzini B. Health care utilization in persons with spinal cord injury: part 1—outpatient services. Spinal Cord 2017; 55:823-827. [DOI: 10.1038/sc.2017.44] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/22/2017] [Accepted: 03/23/2017] [Indexed: 12/11/2022]
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Speroni C, Gobbi D, Gemperli A, Merlani P, Pagnamenta A. Potential predictors of visiting hours policies in the intensive care setting. Minerva Anestesiol 2015; 81:1338-1345. [PMID: 25479469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Restrictions on visiting hours in the intensive care unit (ICU) are usually adopted worldwide. Current knowledge shows that these limitations are not necessary. In order to identify potential variables that are associated with restricted visiting times we carried out an observational study on visiting policy. METHODS We conducted a questionnaire-based nationwide survey among all certified adult Swiss ICUs. An electronic questionnaire was sent by e-mail between May and June 2012 to all chief nurses. Length of permitted visiting time was taken as main endpoint to assess the association with different potential predictor variables using simple and multiple linear regression analysis. RESULTS Response rate was 73 of 75 ICUs (97%). Only two ICUs (3%) have an unrestricted visiting policy. Median daily visiting time was 8 hours (range: 1.5 to 24 hours; interquartile range: 6-10 hours). Simple and multiple linear regression analysis demonstrated a significant effect in visiting hours between Italian- and French-speaking parts of Switzerland with 4.0 hours longer visiting hours in the former (P=0.039) without identifying other predictors. CONCLUSION Swiss ICUs have less restrictive visiting policies compared to other Western countries; nevertheless very few Swiss ICUs have unrestricted visitations. Neither medical type of ICU, nor ICU infrastructure was determining the visiting policy in Swiss intensive care setting. Cultural factors, as captured by the linguistic areas are the only identified predictors of visiting hours. Since the current policy is not justified by clinical outcomes but based only on cultural settings, it needs to be definitively reconsidered and unrestricted visiting policies must become the rule rather than the exception.
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Affiliation(s)
- C Speroni
- Intensive Care Unit, Department of Intensive Care Medicine of the Ente Ospedaliero Cantonale (EOC), Regional Hospital Mendrisio, Mendrisio, Switzerland -
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Süssmuth SD, Müller VM, Geitner C, Landwehrmeyer GB, Iff S, Gemperli A, Orth M. Fat-free mass and its predictors in Huntington's disease. J Neurol 2015; 262:1533-40. [PMID: 25904208 DOI: 10.1007/s00415-015-7753-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 04/14/2015] [Accepted: 04/15/2015] [Indexed: 12/18/2022]
Abstract
The causes of weight loss in Huntington's disease (HD) are not entirely clear. The aim was to identify risk factors that are associated with a loss of metabolically active tissues, i.e. fat-free mass. A consecutive cohort of non-diabetic HD participants (manifest HD, n = 43; CAG: mean 43.6.0 ± 3.6; preHD, n = 10; CAG: mean 41.4 ± 1.4) and 36 healthy controls was recruited. Twenty-five HD participants were early-stage HD (UHDRS Total Functional Capacity [TFC] stages I and II), 12 mid-stage HD (TFC stage III), and 6 participants were in late-stage HD (TFC stages IV and V). Food intake, basic metabolic rate and glucose homeostasis were assessed. In addition, fat-free mass was determined using bioelectric impedance analysis, and leptin, insulin and ghrelin as key metabolic regulators. Sex ratio and age were similar in HD participants (71 % women; age 50.6 ± 10.9) and controls (66 % women; age 46.4 ± 14.5). Body mass index (BMI) was lower in HD participants than controls (median 24.1 vs. 25.9, p = 0.04). However, fat-free mass and basic metabolic rate were not statistically different between groups and showed no association with disease burden. In controls and HD participants, leptin was the most important predictor of fat-free mass. While BMI was lower in HD participants, fat-free mass was similar to controls with leptin as its most important predictor. Leptin levels and fat-free mass measurements using bioelectric impedance analysis may be good screening tools to identify HD patients at risk for weight loss.
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Affiliation(s)
- S D Süssmuth
- Department of Neurology, Ulm University, Oberer Eselsberg 45/1, 89081, Ulm, Germany
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Gerger H, Munder T, Gemperli A, Nüesch E, Trelle S, Jüni P, Barth J. Integrating fragmented evidence by network meta-analysis: relative effectiveness of psychological interventions for adults with post-traumatic stress disorder. Psychol Med 2014; 44:3151-3164. [PMID: 25066766 DOI: 10.1017/s0033291714000853] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND To summarize the available evidence on the effectiveness of psychological interventions for patients with post-traumatic stress disorder (PTSD). METHOD We searched bibliographic databases and reference lists of relevant systematic reviews and meta-analyses for randomized controlled trials that compared specific psychological interventions for adults with PTSD symptoms either head-to-head or against control interventions using non-specific intervention components, or against wait-list control. Two investigators independently extracted the data and assessed trial characteristics. RESULTS The analyses included 4190 patients in 66 trials. An initial network meta-analysis showed large effect sizes (ESs) for all specific psychological interventions (ESs between -1.10 and -1.37) and moderate effects of psychological interventions that were used to control for non-specific intervention effects (ESs -0.58 and -0.62). ES differences between various types of specific psychological interventions were absent to small (ES differences between 0.00 and 0.27). Considerable between-trial heterogeneity occurred (τ²= 0.30). Stratified analyses revealed that trials that adhered to DSM-III/IV criteria for PTSD were associated with larger ESs. However, considerable heterogeneity remained. Heterogeneity was reduced in trials with adequate concealment of allocation and in large-sized trials. We found evidence for small-study bias. CONCLUSIONS Our findings show that patients with a formal diagnosis of PTSD and those with subclinical PTSD symptoms benefit from different psychological interventions. We did not identify any intervention that was consistently superior to other specific psychological interventions. However, the robustness of evidence varies considerably between different psychological interventions for PTSD, with most robust evidence for cognitive behavioral and exposure therapies.
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Affiliation(s)
- H Gerger
- Institute of Social and Preventive Medicine (ISPM),University of Bern,Switzerland
| | - T Munder
- Institute of Social and Preventive Medicine (ISPM),University of Bern,Switzerland
| | - A Gemperli
- Department of Clinical Research, CTU Bern,University of Bern,Switzerland
| | - E Nüesch
- Institute of Social and Preventive Medicine (ISPM),University of Bern,Switzerland
| | - S Trelle
- Department of Clinical Research, CTU Bern,University of Bern,Switzerland
| | - P Jüni
- Institute of Social and Preventive Medicine (ISPM),University of Bern,Switzerland
| | - J Barth
- Institute of Social and Preventive Medicine (ISPM),University of Bern,Switzerland
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Gerbase MW, Keidel D, Imboden M, Gemperli A, Bircher A, Schmid-Grendelmeier P, Bridevaux PO, Berger W, Schindler C, Rochat T, Probst-Hensch N. Effect modification of immunoglobulin E-mediated atopy and rhinitis by glutathione S-transferase genotypes in passive smokers. Clin Exp Allergy 2011; 41:1579-86. [PMID: 21729179 DOI: 10.1111/j.1365-2222.2011.03807.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Experimental studies suggest that glutathione S-transferase (GST) genotypes modify nasal allergen responses induced by secondhand smoke (SHS) exposure. OBJECTIVE We aimed to investigate whether GSTs affected systemic IgE and allergic rhinitis (AR) in SHS-exposed individuals from a population-based cohort. METHODS Analyses comprised 2309 never-smokers from the Swiss study on air pollution and health in adults cohort, reporting SHS status at baseline and 11 years later. Outcomes were defined by total serum IgE≥100 kU/L, specific serum IgE determined by Phadiatop® ≥0.35 kU/L and self-reported AR. GSTP1 Ile105Val, GSTM1 and GSTT1 gene deletion genotypes were identified at the follow-up survey. RESULTS After adjustment for relevant covariates, the homozygous GSTP1 105-Val genotype was negatively associated with high total IgE and high-specific IgE by Phadiatop®, notably in subjects persistently exposed to SHS (OR: 0.20, 95% CI 0.05-0.75; P=0.02, for high total IgE and OR: 0.29, 95% CI 0.10-0.89; P=0.03, for high specific IgE by Phadiatop®). Carrying at least one copy of the GSTM1 gene (non-null) showed a similar association for high specific IgE by Phadiatop® (OR: 0.41, 95% CI 0.22-0.76; P=0.004). No significant associations were found between GSTs and rhinitis. CONCLUSION AND CLINICAL RELEVANCE In this large cohort, homozygosity for GSTP1 105-Val or carrying the GSTM1 non-null genotype decreased the risk of high total IgE or high specific IgE using Phadiatop® by nearly half in subjects exposed to SHS, as compared with subjects carrying opposite alleles. These findings underline the value of genetic susceptibility when evaluating the effects of environmental exposure on allergic illness. The potential long-term effects of persistent SHS exposure in genetically vulnerable individuals may be of public health relevance.
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Affiliation(s)
- M W Gerbase
- Division of Pulmonary Medicine, University Hospitals of Geneva, Geneva, Switzerland.
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Deubelbeiss U, Gemperli A, Schindler C, Baty F, Brutsche MH. Prevalence of sarcoidosis in Switzerland is associated with environmental factors. Eur Respir J 2009; 35:1088-97. [PMID: 19897550 DOI: 10.1183/09031936.00197808] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The current study aimed to investigate incidence, prevalence and regional distribution of sarcoidosis in Switzerland with respect to environmental exposures. All sarcoidosis patients hospitalised between 2002 and 2005 were identified from the Swiss hospital statistics from the Swiss Federal Office for Statistics (Neuchâtel, Switzerland). Regional exposure characteristics included the regional distribution of different industrial sectors, agriculture and air quality. Co-inertia analysis, as well as a generalised linear model, was applied. The prevalence of "ever-in-life" diagnosed sarcoidosis, currently active sarcoidosis and sarcoidosis requiring hospitalisation was 121 (95% CI 93-149), 44 (95% CI 34-54) and 16 (95% CI 10-22) per 100,000 inhabitants, respectively. The mean annual incidence of sarcoidosis was 7 (95% CI 5-11) per 100,000 inhabitants. The regional workforce in the metal industry, water supply, air transport factories and the area of potato production, artificial meadows (grassland) and bread grains were positively associated with the frequency of sarcoidosis. The prevalence of sarcoidosis was higher than assumed based on former international estimates. Higher frequency was found in regions with metal industry and intense agriculture, especially production of potatoes, bread grains and artificial meadows.
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Affiliation(s)
- U Deubelbeiss
- Dept of Pneumology, University Hospital Basel, Basel, Switzerland
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Ackermann-Liebrich U, Schindler C, Frei P, Probst-Hensch NM, Imboden M, Gemperli A, Rochat T, Schmid-Grendemeier P, Bircher AJ. Sensitisation to Ambrosia in Switzerland: a public health threat on the wait. Swiss Med Wkly 2009; 139:70-5. [PMID: 19204839 DOI: 10.4414/smw.2009.12489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Ambrosia artemisiifolia (short name = Ambrosia common ragweed) pollen is a potent allergen and has recently been found in Switzerland, spreading from the southwest of the country. The aim of this study is to describe Ambrosia sensitisation rates in the population-based SAPALDIA cohort (Swiss Study on Air Pollution And Lung Diseases In Adults) and to test whether an increase in these rates could be observed. METHODS Among the 6345 participants from 8 areas who provided blood samples in 1991 and 2002, 5823 had valid results for specific IgE against common inhalant allergens tested with Phadiatop. In 2002 Ambrosia sensitisation was measured and positive tests were analysed for Artemisia vulgaris (mugwort). Blood samples taken in 1991 in Ticino and Geneva were also tested for Ambrosia. RESULTS Sensitisation rate (Phadiatop) did not increase significantly between the two surveys and sensitisation was found in 30% of the participants. A proportion of 7.9% showed specific IgE to Ambrosia pollen. The sensitisation rate in Lugano and Geneva had not changed substantially since 1991. Among those sensitised to Ambrosia 82% also showed specific IgE against Artemisia, suggesting a high rate of cross-reactivity. Only 1.3% were sensitized to Ambrosia alone. The incidence of asthma or hay fever in participants with specific IgE to Ambrosia pollen was not higher than in the general study population. CONCLUSION Currently Ambrosia pollen does not appear to be an important cause of inhalant allergies in Switzerland. Sensitisation rates are low and have not increased since 1991. Due to cross-reactivity Ambrosia sensitisation may be a consequence of primary sensitisation to Artemisia. Elimination of Ambrosia plants is nevertheless mandatory to avoid a future increase.
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Affiliation(s)
- U Ackermann-Liebrich
- Institute of Social and Preventive Medicine, University of Basel, Basel, Switzerland.
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Abstract
Geographic mapping of the distribution of malaria is complicated by the limitations of the available data. The most widely available data are from prevalence surveys, but these surveys are generally carried out at arbitrary locations and include nonstandardized and overlapping age groups. To achieve comparability between different surveys, the authors propose the use of transmission models, particularly the Garki model, to convert heterogeneous age prevalence data to a common scale of estimated entomological inoculation rates, vectorial capacity, or force of infection. They apply this approach to the analysis of survey data from Mali, collected in 1965-1998, extracted from the Mapping Malaria Risk in Africa database. They use Bayesian geostatistical models to produce smooth maps of estimates of the entomological inoculation rates obtained from the Garki model, allowing for the effect of environmental covariates. Again using the Garki model, they convert kriged entomological inoculation rates values to age-specific malaria prevalence. The approach makes more efficient use of the available data than do previous malaria mapping methods, and it produces highly plausible maps of malaria distribution.
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Affiliation(s)
- A Gemperli
- Biostatistics and Basic Epidemiology Group, Department of Public Health and Epidemiology, Swiss Tropical Institute, Basel, Switzerland.
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Abdulla S, Gemperli A, Mukasa O, Armstrong Schellenberg JRM, Lengeler C, Vounatsou P, Smith T. Spatial effects of the social marketing of insecticide-treated nets on malaria morbidity. Trop Med Int Health 2005; 10:11-8. [PMID: 15655009 DOI: 10.1111/j.1365-3156.2004.01354.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Randomized controlled trials have shown that insecticide-treated nets (ITNs) have an impact on both malaria morbidity and mortality. Uniformly high coverage of ITNs characterized these trials and this resulted in some protection of nearby non-users of ITNs. We have now assessed the coverage, distribution pattern and resultant spatial effects in one village in Tanzania where ITNs were distributed in a social marketing programme. The prevalence of parasitaemia, mild anaemia (Hb <11 g/dl) and moderate/severe anaemia (Hb <8 g/dl) in children under five was assessed cross-sectionally. Data on ownership of ITNs were collected and inhabitants' houses were mapped. One year after the start of the social marketing programme, 52% of the children were using a net which had been treated at least once. The ITNs were rather homogeneously distributed throughout the village at an average density of about 118 ITNs per thousand population. There was no evidence of a pattern in the distribution of parasitaemia and anaemia cases, but children living in areas of moderately high ITN coverage were about half as likely to have moderate/severe anaemia (OR 0.5, 95% CI: 0.2, 0.9) and had lower prevalence of splenomegaly, irrespective of their net use. No protective effects of coverage were found for prevalence of mild anaemia nor for parasitaemia. The use of untreated nets had neither coverage nor short distance effects. More efforts should be made to ensure high coverage in ITNs programmes to achieve maximum benefit.
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Affiliation(s)
- S Abdulla
- Ifakara Health Research and Development Centre (IHRDC), Ifakara, Tanzania.
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Gemperli A, Vounatsou P, Kleinschmidt I, Bagayoko M, Lengeler C, Smith T. Spatial patterns of infant mortality in Mali: the effect of malaria endemicity. Am J Epidemiol 2004; 159:64-72. [PMID: 14693661 DOI: 10.1093/aje/kwh001] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A spatial analysis was carried out to identify factors related to geographic differences in infant mortality risk in Mali by linking data from two spatially structured databases: the Demographic and Health Surveys of 1995-1996 and the Mapping Malaria Risk in Africa database for Mali. Socioeconomic factors measured directly at the individual level and site-specific malaria prevalence predicted for the Demographic and Health Surveys' locations by a spatial model fitted to the Mapping Malaria Risk in Africa database were examined as possible risk factors. The analysis was carried out by fitting a Bayesian hierarchical geostatistical logistic model to infant mortality risk, by Markov chain Monte Carlo simulation. It confirmed that mother's education, birth order and interval, infant's sex, residence, and mother's age at infant's birth had a strong impact on infant mortality risk in Mali. The residual spatial pattern of infant mortality showed a clear relation to well-known foci of malaria transmission, especially the inland delta of the Niger River. No effect of estimated parasite prevalence could be demonstrated. Possible explanations include confounding by unmeasured covariates and sparsity of the source malaria data. Spatial statistical models of malaria prevalence are useful for indicating approximate levels of endemicity over wide areas and, hence, for guiding intervention strategies. However, at points very remote from those sampled, it is important to consider prediction error.
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Affiliation(s)
- A Gemperli
- Swiss Tropical Institute, Basel, Switzerland.
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Hauser H, Dyer JH, Nandy A, Vega MA, Werder M, Bieliauskaite E, Weber FE, Compassi S, Gemperli A, Boffelli D, Wehrli E, Schulthess G, Phillips MC. Identification of a receptor mediating absorption of dietary cholesterol in the intestine. Biochemistry 1998; 37:17843-50. [PMID: 9922151 DOI: 10.1021/bi982404y] [Citation(s) in RCA: 189] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Here we show that scavenger receptor class B type I is present in the small-intestine brush border membrane where it facilitates the uptake of dietary cholesterol from either bile salt micelles or phospholipid vesicles. This receptor can also function as a port for several additional classes of lipids, including cholesteryl esters, triacylglycerols, and phospholipids. It is the first receptor demonstrated to be involved in the absorption of dietary lipids in the intestine. In liver and steroidogenic tissues, the physiological ligand of this receptor is high-density lipoprotein. We show that binding of high-density lipoprotein and apolipoprotein A-I to the brush border membrane-resident receptor inhibits uptake of cholesterol (sterol) into the brush border membrane from lipid donor particles. This finding lends further support to the conclusion that scavenger receptor BI catalyzes intestinal cholesterol uptake. Our findings suggest new therapeutic approaches for limiting the absorption of dietary cholesterol and reducing hypercholesterolemia and the risk of atherosclerosis.
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Affiliation(s)
- H Hauser
- Institute of Biochemistry, Swiss Federal Institute of Technology, ETH Centre, Zurich.
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