Investigating the spatial and temporal variation of vape retailer provision in New Zealand: A cross-sectional and nationwide study

Smoking rates have decreased in Aotearoa New Zealand in recent years however, vaping has shown a dramatic upward trend especially among young people; up to 10% of young New Zealanders are now regular vapers. Importantly, the long-term health consequences for their future life are largely unknown. The accessibility of vape retailers is important, particularly in relation to the youths' daily activities and places such as schools where they spend a considerable amount of time and socialise. Despite this, we know little about the spatial patterning of vape retailers and even less of their socio-spatial patterning around schools. This ecological study utilised data from the New Zealand Specialist Vape Retailers register on nationwide vape retailer locations and combined them with whole-population sociodemographic characteristics and primary and secondary school data. We identified the prevalence of vape retailers and their spatial distribution by area-level deprivation, ethnicity and urban-rural classification by using descriptive statistics and (spatial) statistical modelling on the area-, school- and individual students-level (using disaggregated data on students). We found that almost 97% of all vape retailers are located within 1,600m (∼20-min walk) and 29% within 400m (∼5-min walk) of schools. Our research also identified increasing inequities by deprivation and ethnicity both for the overall population and particularly for students in the most deprived areas who experience a disproportionate presence and increase of new vape store retailers that disadvantage schools and students in these areas. This difference was particularly prominent for Pasifika populations in major urban environments.

Remission of T2DM by digital twin technology with reduction of cardiovascular risk: interim results of randomised controlled clinical trial

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): TWIN HEALTH INC

Background

 Twin Precision Treatment (TPT) is a novel intervention designed to improve glycemia and reverse T2D using a Whole-Body Digital Twin (WBDT) platform powered by Artificial Intelligence and the Internet of Things. Technology enabled precision nutrition, a combination of macro, micro and biota nutrients, along with Continuous Glucose Monitoring (CGM) have been demonstrated to be a key for reversal of diabetes. WBDT platform captures 174 health markers and 3000 daily data points through a panel of blood tests and connected devices that measure weight, physical activity, sleep and BP. CGM is used initially and then the algorithm predicts personalized glucose responses from multiple inputs. Nutritional, physical activity and sleep counseling is through an app or phone to provide individualized meal plans that balance 87 macro, micro and probiotic nutrients to reduce glucotoxicity and lipotoxicity. Program physicians titrate medications and monitor metabolic outcomes. 

Purpose

 To assess the initial change, in glycemic, extra glycemic, cardiovascular parameters for patients who completed 3 months longitudinal follow up.

Methods

 We performed an interim analysis [n = 173, 139 TWIN Intervention arm (T), 34 Control group (C)] of ongoing randomized controlled trial of TPT across India

Results

 The mean age (years) in the T was 43.04 (±8.6, 95% CI 41.57 to 44.52) which was significantly less as compared to the C 51.4 (±9.6, 95% CI 48.3 to 54.5); p < 0.0001. The mean duration of diabetes (years) in the T was 3.5 (±2.6) which was comparable to the C 4.3 (±2.6); p = 0.12 ns. In the T there were 113 male (84.3%) and 21 female (15.6%) as compared to C, 15 male (38.4%) and 24 female (61.5%); p < 0.0001. The difference of change for HbA1c (%), small dense LDL-C sdLDL (mg/dL), TG/HDL Ratio, HOMA 2IR (%), Visceral Adiposity Index (VAI), Systolic BP (mmHg), BMI (kg/m2), Framingham Risk Score (%), in T when compared to C, were significant. The mean reduction HbA1c, sdLDL, HOMA 2IR, VAI, SBP, BMI, FRS in T was -3.2 % (8.8 to 5.6), -14.1 mg/dL, (52.6 to 38.5), -0.9 % (1.9 to 1), -2.3 (4.6 to 2.3), -10.3mmHg (128.4 to 118.1), -2.9 kg/m2 (27.1 to 24.2), -7.9% (16 to 8.1), respectively. (figure) At baseline in T, mean daily intake of medication was 1.7 which reduced significantly (p < 0.0001) to 0.05. 96 patients in T were able to stop anti-diabetic medications

Discussion

 The initial results are an early indicator for the translation of the scientific rationale for the technological intervention, through digital twin technology, powered by Internet of Things and Artificial Intelligence, as a modality to enable reversal of diabetes. TPT appears to have potential to mitigate the cardiovascular risk as assessed by Framingham Risk Score and modulate the non glycemic parameters, including BMI and SBP. However, larger, long-term studies would yield precise insights for the durability of the significant change that has been observed in this study Abstract Figure. Comparison for the Change in the Glycemi

Effect of 3 Days of Oral Azithromycin on Young Children With Acute Diarrhea in Low-Resource Settings: A Randomized Clinical Trial

Importance

World Health Organization (WHO) guidelines do not recommend routine antibiotic use for children with acute watery diarrhea. However, recent studies suggest that a significant proportion of such episodes have a bacterial cause and are associated with mortality and growth impairment, especially among children at high risk of diarrhea-associated mortality. Expanding antibiotic use among dehydrated or undernourished children may reduce diarrhea-associated mortality and improve growth.

Objective

To determine whether the addition of azithromycin to standard case management of acute nonbloody watery diarrhea for children aged 2 to 23 months who are dehydrated or undernourished could reduce mortality and improve linear growth.

Design, Setting, and Participants

The Antibiotics for Children with Diarrhea (ABCD) trial was a multicountry, randomized, double-blind, clinical trial among 8266 high-risk children aged 2 to 23 months presenting with acute nonbloody diarrhea. Participants were recruited between July 1, 2017, and July 10, 2019, from 36 outpatient hospital departments or community health centers in a mixture of urban and rural settings in Bangladesh, India, Kenya, Malawi, Mali, Pakistan, and Tanzania. Each participant was followed up for 180 days. Primary analysis included all randomized participants by intention to treat.

Interventions

Enrolled children were randomly assigned to receive either oral azithromycin, 10 mg/kg, or placebo once daily for 3 days in addition to standard WHO case management protocols for the management of acute watery diarrhea.

Main Outcomes and Measures

Primary outcomes included all-cause mortality up to 180 days after enrollment and linear growth faltering 90 days after enrollment.

Results

A total of 8266 children (4463 boys [54.0%]; mean [SD] age, 11.6 [5.3] months) were randomized. A total of 20 of 4133 children in the azithromycin group (0.5%) and 28 of 4135 children in the placebo group (0.7%) died (relative risk, 0.72; 95% CI, 0.40-1.27). The mean (SD) change in length-for-age z scores 90 days after enrollment was -0.16 (0.59) in the azithromycin group and -0.19 (0.60) in the placebo group (risk difference, 0.03; 95% CI, 0.01-0.06). Overall mortality was much lower than anticipated, and the trial was stopped for futility at the prespecified interim analysis.

Conclusions and Relevance

The study did not detect a survival benefit for children from the addition of azithromycin to standard WHO case management of acute watery diarrhea in low-resource settings. There was a small reduction in linear growth faltering in the azithromycin group, although the magnitude of this effect was not likely to be clinically significant. In low-resource settings, expansion of antibiotic use is not warranted. Adherence to current WHO case management protocols for watery diarrhea remains appropriate and should be encouraged.

Trial Registration

ClinicalTrials.gov Identifier: NCT03130114.

Expert consensus on the minimum clinical standards of practice for Nigerian physiotherapists working in intensive care units: A modified Delphi study

BACKGROUND

Management of patients in intensive care units (ICUs) needs staff with a recommended level of expertise and experience owing to the life-threatening nature of illnesses, injuries and complications that these patients present with. There are no specific guidelines governing physiotherapy practice in ICUs in Nigeria. Hence, there is a need to have expert consensus on the minimum clinical standard of practice for physiotherapists working in ICUs as a first step to proposing/developing guidelines in the future.

OBJECTIVES

To assess the expert consensus on the minimum clinical standard of practice for physiotherapists working in ICUs in Nigeria.

METHODS

Physiotherapists with working experience in Nigerian ICUs were purposively recruited into the present study using a modified Delphi technique. A questionnaire comprising 222 question items on the role of physiotherapy in critical care was adopted and administered to the participants over three rounds of Delphi procedure (online). Participants checked either 'essential', 'not essential' or 'unsure' for each question item. For each question item to be considered 'essential' or 'not essential', a consensus agreement ≥70% had to be met. Questions without consensus were further modified by providing definition or clarification and presented in subsequent rounds. Data were analysed descriptively.

RESULTS

We recruited 26 expert physiotherapists who consented to the study and completed the first round of the study. The majority of the physiotherapists (n=24) remained in the study after the third round. A total of 178 question items were adjudged to be 'essential' after the first round, and a further 15 and three additional items were subsequently adjudged to be as 'essential' after modifying the outstanding question items during the second and third rounds, respectively. No consensus was reached for 24 items. None of the question items were ranked as 'not essential' after all the rounds.

CONCLUSION

Expert consensus was achieved for a substantial number of question items regarding knowledge and skills for assessment, condition and treatment items of the questionnaire by experienced critical care physiotherapists in Nigeria.

Risk factors assessment of bovine tuberculosis among abattoir personnel in Gombe State, Northeastern Nigeria: A One-Health approach

Aim: Bovine tuberculosis (bTB) is an important milk-borne zoonosis that affects cattle production and poses serious threat to public health. This study aimed at assessing the risk factors as well as the level of awareness, attitude, and practices of abattoir personnel toward bTB in Gombe Township Abattoir, Gombe State. Materials and Methods: A prospective survey was conducted between October 2015 and December 2015. During the survey, a total of 112 close-ended structured questionnaires were administered to the abattoir personnel to assess their level of awareness of bTB. Results: Of these respondents, the majority were males (79%), butchers (49%) and about 40% were under the productive age brackets of 26-35 years. Majority of the respondents (85.7%) were aware of the zoonotic nature of the disease. However, only a few of the respondents (44.6%) wear personal protective equipments (PPEs) clothes while handling or in contact with carcasses during the slaughtering process. Only a few among the respondents (24.1% and 31.2%) consumed unpasteurized milk and unaware of eating of improperly cooked meat as a risk factor of bTB, respectively. About 75.7% of the respondents believed that the habit of eating and drinking inside the abattoir and during slaughtering operations has no any significant effects on their health. The results obtained show a statistically significant association between respondents' awareness of bTB and their occupational status, duration of exposure to cattle carcasses, and knowledge about the disease (p<0.05); and the odds of being aware of bTB was 10.0, 5.07, and 4.2, respectively. Conclusion: This study demonstrates the need for public health authorities to intervene in bTB prevention and control through the creation of avenues for enlightenment on the zoonotic risk associated with bTB. The risk factors associated with bTB transmission as indicated by the personnel's practice and awareness levels in Gombe township abattoir are preventable through the use of PPEs clothing.

Community pharmacist perceptions of the loss of resale price maintenance

Focal points

Critical incidents contributing to the initiation of substance use and abuse among women attending drug rehabilitation centres in Trinidad and Tobago

The aim of this study was to determine the critical incidents that contribute to the initiation of substance use and abuse among women in Trinidad and Tobago. Twenty women were randomly selected from 46 women currently attending 43 drug rehabilitation centres, Narcotics Anonymous and Alcoholics Anonymous groups in Trinidad and Tobago. In-depth semi-structured interviews using the critical incident technique were conducted. Interviews were recorded, transcribed and analyzed. Concepts, categories and themes were determined by team study and group discussion. The critical incidents that influenced women to initiate the use and abuse of substances fell into eight major themes: factors intrinsic to the individual woman, family factors, social and environmental factors, life stresses, relationship issues, abuse, peer pressure and substance use and abuse as a coping mechanism. The results imply that the factors contributing to the initiation of substance use and abuse among women in Trinidad and Tobago are many and complex. As such any attempt to address this issue requires a broad-based approach. Such an approach should address family use of such substances, societal acceptance of them, availability, the self-esteem of the individual woman and her ability to cope with peer and internal stresses.

Novel use of bovine zeta-crystallin as a conformational DNA probe to characterize a phase transition zone and terminally differentiating fiber cells in the adult canine ocular lens

Using a novel immunocytochemical staining method, we aimed to characterize the phase transition zone (PTZ) (approximatly 100 microm) in adult ocular lenses and the process of terminal differentiation (denucleation) within normal fiber cells. The binding to DNA of zeta-(zeta) crystallin (Z-DNA-binding protein) and anti-double-stranded (ds-)-B-DNA antibody probes was found to decline gradually throughout denucleating fibers, with a precipitous decrease occurring at about 100 microm (PTZ). Nuclei of superficial fiber cells (in front of the PTZ) showed the highest DNA probe-binding values, followed by middle fibers (MF) and deep fibers (DF). With the use of zeta-crystallin, anti-ds-B-DNA antibody, and anti-single stranded (ss-) DNA antibody probes, it was possible to reveal a loss of reactivity of fiber cell ds-DNA. Ss-DNA antibody binding was seen initially in the MF and reached its highest intensity level in the DF. The pattern of zeta-crystallin probe-DNA reactivity correlates with the loss of anti-B-DNA antibody staining and decreased eosin-protein staining. These data suggest that a reorganization of DNA and intracellular protein supramolecular order in normal adult lenses occurs at a depth of about 100 microm (PTZ).

Building communication networks: international network for the study and prevention of emerging antimicrobial resistance

The global nature of antimicrobial resistance and the failure to control the emergence of resistant organisms demand the implementation of a global surveillance program involving both developed and developing countries. Because of the urgent need for infection control interventions and for rapid distribution of information about emerging organisms, we initiated the International Network for the Study and Prevention of Emerging Antimicrobial Resistance (INSPEAR). Its main objectives are to serve as an early warning system for emerging antimicrobial-drug resistant pathogens, to facilitate rapid distribution of information about emerging multidrug-resistant pathogens to hospitals and public health authorities worldwide, and to serve as a model for the development and implementation of infection control interventions.