Challenges faced by medical officers in providing healthcare services at upazila health complexes and district hospitals in Bangladesh - a qualitative study

Background

Upazila Health Complexes (UHCs) and District Hospitals (DHs) play a crucial role in the healthcare delivery system of Bangladesh. But very few research has been conducted to find out the prevailing challenges of the medical officers working in these tiers. The objective of the study was to identify the challenges faced by medical officers in providing healthcare services at UHCs and DHs.

Methods

In-depth interviews of 51 medical officers from 17 UHCs and nine DHs were done between March and April 2021. All participants were purposively sampled. Data were transcribed verbatim and analysed using thematic analysis.

Findings

Inadequate service rooms, unavailability of proper medical equipment, poor housing conditions, lack of public amenities, shortage of health workforce, lack of laboratory services, and excessive workload were the common challenges mentioned by the medical officers in providing healthcare services in UHCs and DHs. Lack of workplace safety, security, and undue pressure from local political leaders and journalists made the work environment fearful. The absence of proper implementation of policy related to higher education, posting, transfer, and promotion was also stated as challenge for the medical officers.

Interpretation

Infrastructural improvements along with increased safety and security of the doctors at their workplace and transparent implementation of reformed policies are essential to reduce the workplace challenges of medical officers in UHCs and DHs of Bangladesh.

Funding

The study was funded by Hospital Services Management, Directorate General Of Health Services (DGHS), Mohakhali, Dhaka, and Bangabandhu Sheikh Mujib Medical University.

PdSe2/MoSe2: a promising van der Waals heterostructure for field effect transistor application

The field-effect transistor (FET) is a fundamental component of semiconductors and the electronic industry. High on-current and mobility with layer-dependent features are required for outstanding FET channel material. Two-dimensional materials are advantageous over bulk materials owing to their higher mobility, high ON/OFF ratio, low tunneling current, and leakage problems. Moreover, two-dimensional heterostructures provide a better way to tune electrical properties. In this work, the two distinct possibilities of PdSe2/MoSe2heterostructure have been employed through mechanical exfoliation and analyzed their electrical response. These diffe approaches to heterostructure formation serve as crucial components of our investigation, allowing us to explore and evaluate the unique electronic properties arising from each design. This work demonstrates that the heterostructure possesses a better ON/OFF ratio of ∼5.78 × 105, essential in switching characteristics. Moreover, MoSe2provides a defect-free interface to PdSe2, resulting in a higher ON current of ∼10μA and mobility of ∼63.7 cm2V-1s-1, necessary for transistor applications. In addition, comprehending the process of charge transfer occurring at the interface between transition metal dichalcogenides is fundamental for advancing next-generation technologies. This work provides insights into the interface formed between the PdSe2and MoSe2that can be harnessed in transistor applications.

Types and distribution of cancer patients attending in a tertiary care hospital of Bangladesh

Bangladesh, similar to other countries is experiencing an increased burden of cancer. Absence of a national cancer registry has created a gap in the information regarding the presentation of cancer statistics of the country. The objective of this study was to assess the types and distribution of the cancer patients attending a tertiary academic medical center hospital in Bangladesh. A cross-sectional study was conducted among all the confirmed cancer patients attending the in-patient and out-patient, and daycare facilities in Bangabandhu Sheikh Mujib Medical University in October, 2019. A validated questionnaire, recommended by International Agency for the Cancer Registry was used to collect data. Written informed consent was obtained from every respondent. This study had received its ethical clearance from Institutional Review Board of BSMMU. Among the 1656 respondents, 78.8% were adult and 25.2% were from paediatric age groups. Leading cancer for adult males were lung cancer (9.6%), leukaemia (9.4%) and lymphoma (9.0%); and breast cancer (28.1%), thyroid cancer (16.1%), and cervical cancer (12.2%) for females. Leukaemia was the most frequent cancer in the paediatric group for both males (71.5%) and females (66.5%). Establishing a hospital-based cancer registry with high quality data in an academic medical center setting is feasible and can set the stage for establishing nationwide hospital-based as well as establishing a popula- tion-based cancer registry in Bangladesh, which is necessary to identify and tackle the rising burden of cancer in this country. BSMMU J 2022; 15(1): 43-49

Compliance of healthcare workers with the infection prevention and control guidance in tertiary care hospitals: quantitative findings from an explanatory sequential mixed-methods study in Bangladesh

OBJECTIVES

To assess healthcare workers' (HCWs) compliance with the infection prevention and control (IPC) practices and identify the factors influencing this compliance using the Health Belief Model as the theoretical framework.

DESIGN

Quantitative data from an explanatory sequential mixed-methods study were employed in this research.

PARTICIPANTS AND SETTINGS

From 17 May to 30 August 2020, 604 physicians and nurses working at six randomly selected tertiary care facilities in Dhaka City in Bangladesh took part in this study.

PRIMARY AND SECONDARY OUTCOME MEASURES

Compliance with the WHO's guidance on IPC measures, as well as the associated factors, was the primary outcome.

RESULTS

A mean compliance score of 0.49 (±0.25) was observed on a 0-1 scale. HCWs were most compliant with the medical mask wearing guidelines (81%) and were least compliant with the high-touch surface decontamination regulations (23%). Compliance with the IPC guidance was significantly associated with increasing age, female sex, working as a nurse, having non-communicable diseases and history of exposure to patients with COVID-19. Perceived benefits (B=0.039, 95% CI 0.001 to 0.076), self-efficacy (B=0.101, 95% CI 0.060 to 0.142) and cues to action (B=0.045, 95% CI 0.002 to 0.088) were positively associated with compliance. Compliance with IPC guidance was 0.061 times greater among participants who reported low perceived barriers compared with those with high perceived barriers.

CONCLUSION

Overall, compliance with IPC guidance among HCWs was unsatisfactory. As self-efficacy exerted the greatest contribution to compliance, it should be emphasised in any endeavour to improve HCWs' IPC adherence. Such interventions should also focus on perceived barriers, including unreliability of the information sources, unsafe working places and unavailability of protective equipment and cues to action, including trust in the administration and availability of adequate IPC guidance.

Challenges for tuberculosis control at selected primary healthcare centers in Bangladesh: A mixed-method study

BACKGROUND

The national tuberculosis control program in Bangladesh is progressing to end tuberculosis (TB) epidemic by 2035. Despite improved diagnostic and treatment facilities, the disease burden remains high. This mixed-method study aimed to identify existing challenges for successfully implementing the tuberculosis control program in primary healthcare centers (PHCs) of Bangladesh.

METHODS

Qualitative data were collected by observing six PHCs and interviewing TB patients (n = 12) and healthcare providers (n = 12). Quantitative data were collected by interviewing 94 TB patients. Data were integrated through a narrative approach.

RESULTS

Mean patient and health system delay were 99.0 (SD = 98.7) and 42.9 (SD = 79.9) days respectively. Patient delay was related to poor care-seeking behavior, unfamiliarity with tuberculosis symptoms, and unavailability of healthcare facilities. About 74 percent of patients sought initial treatment from village doctors or drug vendors. Health system delay was related to inadequate manpower, unskilled staff, and limited diagnostic facilities. Every second patient reported non-adherence to the directly observed treatment short-course (DOTS) guideline. DOTS provider's inaccessibility, inadequate incentive, and unreasonable patient demand lead to non-adherence. Insufficient administrative and structural facilities for infection control were observed at the selected facilities.

CONCLUSIONS

This study provides an insight into the recent challenges in TB control at PHCs in Bangladesh.

Assessment of risk perception and risk communication regarding COVID-19 among healthcare providers: An explanatory sequential mixed-method study in Bangladesh

Background: Any public health emergency demands adequate risk communication with the vulnerable population along with their optimized perception about the impending risk to ensure proper risk management and crisis control. Hence, we conducted this study to explore healthcare providers’ perceptions regarding risks of coronavirus disease 2019 (COVID-19), as well as how they are being communicated to about the risk, and how they practice risk reduction measures.

Methods: We conducted a two-phased explanatory sequential mixed-method study among physicians and nurses from randomly selected tertiary healthcare facilities in Dhaka, the capital of Bangladesh. In the first phase, we assessed the general pattern and quantifiable measures of risk perception, risk communication, and infection prevention practices quantitatively. We performed multiple linear regression analyses to explore how much variability of risk perception was predicted by risk communication methods and contents. In the second phase, we collected qualitative data for in-depth understanding and exploration of participants’ experiences and insights regarding COVID-19 risk through interviews and document reviews. We manually performed thematic content analysis of the qualitative data. Finally, we triangulated findings from both phases to illustrate the research objectives.

Discussion: Based on the psychometric dimensions of risk perception and psycho-social theory of the health belief model, perceptions of COVID-19 risk among healthcare providers were evaluated in this study. The relationship between risk perception and infection prevention and control practices among healthcare providers were also investigated. The explanatory sequential design of this study is expected to generate hypotheses on how risk perception is being shaped in a time of uncertainty and, thus, will help to build a proper risk communication strategy for the healthcare providers

Age and sex differences in factors associated with hypertension among an urban poor population in Bangladesh

This study explores the differences in factors associated with hypertension between younger and older subjects in an urban slum community in Bangladesh. We analyzed the data of 1,008 men and 1,001 women obtained from a cross-sectional survey conducted between October 2015 and April 2016. Multivariable logistic regression models were stratified by age (18 to 44 and 45 to 64 years) in men and women separately. The multivariable model included age (continuous) and the following categorical variables simultaneously: education duration, marital status, tobacco smoking, smokeless tobacco use, total physical activity, body mass index (BMI), waist circumference, and the blood levels of glycated hemoglobin (HbA1c), triglycerides, high- and low-density lipoprotein (HDL and LDL) cholesterol. Hypertension was defined as the presence of either blood pressure ≥140/90 mmHg or the use of antihypertensive medication. The prevalence of hypertension was 13.0% (younger men), 14.6% (younger women), 35.6% (older men), and 38.7% (older women). In younger men, higher waist circumference and increased LDL cholesterol levels were significantly associated with hypertension. In older men, physical activity was the only significant factor that was inversely associated with hypertension. In younger women, higher BMI, increased HbA1c, triglycerides, and LDL cholesterol levels were associated with hypertension. In older women, a higher HbA1c was the only factor significantly associated with hypertension. These findings suggest that public health interventions to prevent hypertension may require different approaches according to sex and age groups within the poor urban population in Bangladesh.

Dietary salt intake and its correlates among adults in a slum area in Dhaka, Bangladesh: a cross-sectional study

High dietary salt intake increases the risk of noncommunicable diseases (NCDs). NCDs are increasing among the urban poor in Bangladesh, but the data of their dietary salt intake are yet scarce. This study aimed to explore the amount of dietary salt intake among adults in an urban slum area in Dhaka, Bangladesh. A cross-sectional community-based study was conducted. We randomly selected 100 residents (39 men and 61 women) aged 20–59 years without history of NCDs. A modified World Health Organization standard instrument was used for behavioral risk factor assessment and physical measurements. Dietary salt intake was estimated from the measurement of sodium (Na) excretion in spot urine samples.The estimated mean dietary salt intake was 7.8 ± 2.5 g/day, and the mean Na/potassium (K) ratio in urine was 4.9 ± 3.4. More than half (54%) of them always took additional salt in their meals, but only 6% of them consumed 5 or more servings of fruits and vegetables per day. A quarter of them perceived salt reduction not at all important. Increased mean salt intakes were marginally associated with lower waist circumference and lower waist-hip ratio. Dietary salt intake among urban slum residents was higher than the recommended level of 5 g/day; however, its association with NCD risk factors was not significant. Further studies are required to identify the urban poor specific factors.

Influence of Parental Factors on Tobacco Smoking among Male Adolescents

In Bangladesh, more than one-fifth (20.5 percent) of the total population, that is 30.68 million is adolescents. Most of the adult smokers initiate smoking in their adolescent period. This study aimed to investigate parental influencing factors for the initiation of tobacco smoking in adolescence period among 15-19 years old college students of Dhaka city, Bangladesh. This was an unmatched case-control study. The information was collected from 91 ever-smokers in the case group and 91 never-smokers in the control group. The respondents were 11th and 12th-grade male college students selected from two colleges of Dhaka city, Bangladesh. The results were analysed using univariate, bivariate and multivariate analysis. Parental control variable was categorized by using Likert Scale. Around 68.7 percent (n=57) respondents were 18-19 years old who were ever-smoker and about 44 percent (n=40) ever-smokers initiated smoking at or below the age of 16. Father's smoking status was found significant (p value <0.05) in bivariate analysis. In binary logistic regression, respondents who received intermediate to low control from their father compared to high control (OR 3.35, 95% CI 1.08-10.38, p value 0.035), respondents who received intermediate to low control from their mother compared to high control (OR 3.73, 95% CI 1.07-13.05, p value 0.039), and presence of any smoking member in their family compared to who did not have (OR 6.23, 95% CI 2.57-15.12, p value 0.001) found significantly higher odds of being ever-smoker. Respondents whose mother passed up to 8 hours in a day with them compared to mothers who gave limited time (less than 1 hour) in a day was found significantly lower odds (OR 0.07, 95% CI 0.01-0.65, p value 0.019) which was a protective factor of being ever-smoker. The result of the study concludes that parental influencing factors had a significant role in tobacco smoking of college-going male adolescents. Parent focused tobacco prevention program may be effective to reduce tobacco smoking prevalence. Further interventional studies are required.

Factors associated with the nutritional status of the older population in a selected area of Dhaka, Bangladesh

Background

Globally, older population (aged ≥60 years) comprise 11% of the total population, and 23% of them are malnourished. Lack of knowledge and education, adverse dietary habits, depression or psychological disorders, poor oral and dental health, disability, and diseases are the reported factors responsible for malnutrition among them. Geriatric people comprise 7.5% of the total population of Bangladesh, and almost a quarter are malnourished. But there is scarce data on the factors associated with the nutritional status of the older population in Bangladesh.

Methods

A cross-sectional study was conducted among 125 older individuals (male 59, female 66) living in three villages of Uttarkhan, Dhaka, Bangladesh, to identify the factors associated with their nutritional status. The Mini Nutritional Assessment scale, Geriatric Depression Scale-Short Form, and Geriatric Oral Health Assessment Index were used for assessing the nutritional status, mental health status, and oral health quality of the respondents, respectively. Information on socio-demographic characteristics, comorbidities and dietary factors, and food behaviors were gathered by a pretested semi-structured questionnaire. Ethical approval was obtained from the Institutional Review Board of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.

Results

The participants’ mean age was 67.9 ± 7.1 years. Most of them (53.6%) had no formal education. Among the respondents, 22.0% male and 28.8% female were malnourished. The proportion of malnourished and at risk of malnutrition among the respondents living without a partner were 28.6 and 65.3%, respectively. A significantly (p < 0.05) higher odds of having depression (OR 15.6; 95% CI 3.1–78.1), poor oral health (OR 7.3; 95% CI 1.3–41.8), and no formal education (OR 6.5; 95% CI 1.3–32.1) was observed among the malnourished respondents. Though it was not statistically significant, among the malnourished, 31.3, 25.0 and 25.0% avoided highly oily food, beef/mutton, and sugary food, respectively.

Conclusions

More than two-thirds of the older population were malnourished or at risk of malnutrition, where the female respondents were more vulnerable. Depression, inadequate oral health, and lack of education were negatively associated with the nutritional status of the older population.

Reversible synthesis of GO: Role of differential bond structure transformation in fine-tuning photodetector response

The controlled modification of graphene's electronic band structure poses serious challenges. In the present work, we study the effect of sp ² cluster size variation on the electronic band gap and photoconductive properties of reduced graphene oxide (RGO). This is achieved by performing reversible functionalization of RGO with oxygen species. The reversible functionalization of RGO results in its partial transformation to graphene oxide (GO) so that the size of the sp ² clusters within the sp ³ matrix varies, thereby affecting the π-π* band structure and photoconductive properties. The study reveals: (1) incremental creation/elimination of oxygenated surface bonds' related energy states within the π-π^* band; (2) customized tuning of the sp ²/sp ³ ratio; (3) the presence/absence of oxygenated states impacts the optical transition processes both from band-to-band and oxygenated states; and (4) the incremental addition/depletion of surface states in a tunable manner directly influences the carrier transport in the photoconductive device. Experiments show a two-stage transformation of RGO electronic properties with changing oxygen functionalities: oxidation (Stage I) and decomposition or erosion (Stage II). Sp ² cluster size variation induced bandgap change was analyzed by Raman and photoluminescence studies, indicating the possibility for photodetection in a specific band encompassing NIR to UV, depending on the sp ²/sp ³ ratio. Energy-dispersive x-ray spectroscopy and Fourier transform infrared studies confirm the surface oxygenation/de-oxygenation during plasma treatment, and XRD confirms partial transformation of RGO to GO and its amorphization at higher plasma exposure times. In addition, the photodetector performance is optimized in terms of carrier generation-recombination and carrier-lattice scattering. Thus, manipulating better photoconductive response is possible through suitable handling of the parameters involved in the plasma treatment process. This is the first study on the influence of the sp ²/sp ³ ratio-induced lattice structure evolution on photodetection.

WS2 Quantum Dots on e-Textile as a Wearable UV Photodetector: How Well Reduced Graphene Oxide Can Serve as a Carrier Transport Medium?

We document the fabrication and investigations of a novel photodetector based on a WS₂ quantum dots and reduced graphene oxide (RGO) (WS₂-QDs/RGO) heterostructure. The proposed photodetector is simple, scalable, cost-effective, and flexible and works in an ambient environment. An enhanced photodetection efficiency is observed due to the superior electronic properties of WS₂-QDs and excellent electrical as well as thermal properties of the carrier transportation medium, RGO. For device fabrication, GO and WS₂-QDs were separately synthesized via different chemistry followed by decorating WS₂-QDs on RGO coated cotton textile. Characterization studies confirm the transformation of exfoliated WS₂-2D flakes into WS₂-0D quantum dots and graphene oxide (GO) to RGO. The optimized photodetection performance of WS₂-QDs/RGO demonstrates its photoresponsivity of 5.22 mA W^-1 at 1.4 mW mm^-2 power density of a 405 nm illumination source. Other sensor parameters such as photosensitivity (∼20.2%), resolution (∼0.031 mW mm^-2 μA^-1), response time (1.57 s), recovery time (1.83 s), and specific detectivity (∼1.6 × 10⁶ jones) are found for WS₂-QDs/RGO sensor, and a few of these parameters are comparable and even superior to some of the devices as reported. Photosensing mechanism is explained in terms of charge transfer caused by appropriate band alignment across the interface between WS₂-QDs and RGO, where dimensionality and quantum confinement of nanostructures synergistically enhance the overall performance of the heterostructure. The device flexibility is examined through bending, stretching, and twisting experiments and successfully demonstrated its potentiality. Sensor performance even after being soaked in water and subsequent drying shows the possibility of reuse. The attributes of flexibility, high sensitivity and responsivity, superior resolution, and cost-effectiveness of our novel flexible photodetector indicate its promising potential for flexible and wearable optical detectors operating in UV band. Although negative photoconductance of the WS₂-QDs/RGO sensor is a major cause for not allowing the sensor to show its best performance, a trade-off is made with improved device design to qualify the expectations of being a competitive device, and this has been demonstrated with experimental facts.

Inter-dependency between surface morphology and sensitive low RH detection: exploration of an intricate mechanism to extend the lower detection limit

The water vapor molecular dynamics inside a pore structure control both molecular adsorption and desorption processes and the limit of minimum detection (LOD). Pore morphology design, and a higher concentration of electrolyte-driven anions, in accordance with the kinetics of water vapor molecules, is reported here, as the ultimate answer to extremely low relative humidity (RH) detection. In this report, a series of samples were prepared by anodization in different voltage windows, related to specific electrolyte solutions. The sensing attributes comprised: (i) a LOD of ∼3 RH%, (ii) excellent response time (6 s) and recovery time (54 s), and (iii) a hysteresis loss of ∼0.36%, with sustained stability over the period of one year; all these occurring in a sample with a pore diameter ∼5 nm ±3 nm. Interestingly, the LOD extend towards a lower RH% with a decrease in pore diameter; and a suitable explanation is given for the entire range of humidity level, in terms of the molecular mean free path, loss of kinetic energy due to scattering inside the pores, and subsequent overall loss of Brownian energy of the molecules. It is inferred from the sensing response characteristics that pore morphology and lower detection limit are interrelated; therefore, a further extension in LOD from extremely low RH% to trace levels, needs careful engineering of the pore morphology and parameters related to molecular kinetics.

New Concept in Humidity Sensing: Role of Molecular Brownian Energy and Probabilistic Mean Free Path to differentiate RH- and Trace Level Detection

A break in the traditional pore morphology approach in anodic alumina is presented here to see its niche merit over the conventional sensors for water vapor detection. The cylindrical pore structure was replaced with a normal cone for trace-level and inverse cone for RH-level detection. The normal conical pore was fabricated by sheer manipulation of the reaction rates of electrolytes, anodic polarization, rate and time; the procedure was reversed in the case of the inverse cone structure. A sensor with a normal cone geometry exhibits excellent response at the ppm level and slightly extended to low RH level with a detection range of 120 ppm-30% RH, having response and recovery times of 6 and 255 s, measured at 120 ppm. Lowering of the minimum detection limit further requires alteration of the conical geometric parameters, in tandem with the molecular dynamics of water vapor molecules within the pore. In contrast, a sensor developed from an inverse conical structure shows response only at the RH level, from 20% RH to 90% RH with response and recovery times of less than 60 s over the entire range. Limitations such as nonlinear response, large response-recovery time, and high hysteresis as observed in conventional anodic alumina-based humidity sensors have been removed. The sensor response in conical and inverse conical pore morphologies is compared with that of standard sensors having a cylindrical pore morphology, with a top pore diameter identical with that of the reported sensors. The standard sensors were found to detect in the RH range only, with response and recovery times below 20s. The sensing mechanisms in both structures have been suitably demonstrated and ratified with experimental data. Trace level detection is interpreted with the statistical probabilistic approach in the light of the kinetic theory of gases and Brownian energy. A correlation between top surface pore diameter (through which water molecules enter) and the optimized mean free path of vapor molecule is established, and its effectiveness has been demonstrated for humidity detection at a trace level. The results are encouraging, and the same concept may be tried for the detection of other gaseous stimuli, including organic vapors.

Association of biomass fuel smoke with respiratory symptoms among children under 5 years of age in urban areas: results from Bangladesh Urban Health Survey, 2013

BACKGROUND

Little is known regarding the effect of exposure to biomass fuel smoke inhalation on respiratory symptoms in the Bangladeshi population which is a major health hazard in most of the developing countries. This study aims to explore the association between respiratory symptoms and biomass fuel smoke exposure among children under 5 years of age.

METHODS

Data were extracted from the Bangladesh Urban Health Survey conducted in 2013. A total of 10,575 mothers with at least one surviving children were selected. Respiratory symptoms among children under 5 years of age were considered as the primary outcome. Sequential multiple logistic regression models were used to observe the association between respiratory symptoms and biomass fuel smoke exposure adjusting the effect of residential factors and mother and child characteristics.

RESULTS

Around 40% of the mothers exclusively used biomass fuel irrespective of the kitchen location and 54% of them were habituated in indoor cooking. The prevalence of respiratory symptoms of under-five children among in-house and outdoor biomass fuel users was 23.0% and 21.9%, respectively. Results of fitted multiple logistic regression models showed that the odds of having respiratory symptoms among children under 5 years of age were increased due to in-house biomass fuel use [OR = 1.18; 95% CI, 1.04-1.36] compared with the non-biomass user. An increased risk of respiratory symptoms was also significantly associated with mother's birth complication [OR = 1.51; 95% CI, 1.36-1.67], non-government organization (NGO) membership of mothers [OR = 1.32; 95% CI, 1.16-1.51], age of the child (6-23m) [OR = 1.29; 95% CI, 1.10-1.52], and nutritional status (stunting) [OR = 1.18; 95% CI, 1.06-1.31].

CONCLUSION

This study found the use of in-house biomass fuel as a significant risk factor associated with respiratory symptoms of children under 5 years of age. More longitudinal studies should be designed to establish a causal relationship between HAP (household air pollution) and respiratory symptoms among children with more direct measures of HAP and clinical procedure.

An ultrafast quantum thermometer from graphene quantum dots

We report an ultra-sensitive temperature sensor derived from graphene quantum dots (GQDs) embedded in a self-standing reduced graphene oxide (RGO) film. The GQDs are obtained as a natural derivative during synthesis of GO to RGO. A fundamental study on low temperature transport mechanisms reveals the applicability of temperature zone specific 'variable range hopping (VRH)' conduction models, i.e. Mott-VRH, Efros-Shklovskii-VRH and activation energy supported VRH. On the basis of transport behavior and confirmed by characterization analyses, the RGO film is modeled as GQD arrays where graphitic (sp²) domains behave as QDs and oxygenated (sp³) domains between interdots act as tunneling barriers. Temperature dependent resistance and current-voltage (I-V) characteristics indicate high sensitivity where sensor resistance changes by almost six orders of magnitude as the temperature is varied between 300 and 12 K. In convection mode, the developed temperature sensor shows a temperature coefficient of resistance (TCR) of ∼-1999% K^-1 in the 300-77 K temperature range, which is much higher than the TCR values reported so far. Additionally, the sensor exhibits an extremely fast response (∼0.3 s) and recovery (0.8 s) time; and such high TCR leads to ultra high resolution of ∼ μK. The sensor shows excellent repeatability with negligible drift over several cycles. These studies are crucial for modern day thermal management and sensitive cryogenic applications.

Children's exposure to physical abuse from a child perspective: A population-based study in rural Bangladesh

Background

Although child physical abuse (CPA) is considered as a major global public health problem, it has not yet been recognized as such in Bangladesh. Very few studies have assessed the prevalence and victims’ characteristics of multiple forms of CPA.

Objective

This population-based study assessed the prevalence of CPA committed by adults in a rural area of Bangladesh and examined its association with demographic and socio-contextual factors.

Methods

Data were obtained using ISPCAN Child Abuse Screening Tool for Children (ICAST-C) in a random sample of 1416 children (49% girls, 51% boys) aged 11 to 17 years by face-to-face interviews during March-April 2017. The response rate was 91.5%. To estimate predictors of CPA, physical abuse was categorized into frequent and less frequent groups.

Results

The prevalence of at least one form (≥ 1), two forms (≥2) and three or more forms (≥ 3) of CPA were estimated approximately to 99%, 95% and 83% in their lifetime and 93%, 79%, and 57% in the past year respectively. Hitting (except on buttocks), standing/kneeling and slapping were the most common physical abuse whereas given drugs or alcohol, pinched, burned or scalded, beaten-up and locked up were less reported. Female children were faced severe forms of CPA more than that of males. Male children, younger age groups, witnessing adults using weapons at home, bullied by siblings and low level of maternal education were found to be significant risk factors for both ≥ 1 form and ≥ 2 forms of frequent CPA whereas adding also adult shouting in a frightening way was found as a significant risk factor for ≥ 2 forms of frequent CPA.

Conclusion

Self-reported prevalence of CPA is extremely common in the Bangladeshi rural society. The prevalence was associated with demographic and socio-contextual characteristics of the children such as being younger, witnessing domestic violence and maternal low education. The findings provide evidence to support parents and policy-makers to take effective measures to implement policy and programme on alternative up-bringing methods and creating awareness of negative effects of CM which in turn help Bangladesh to line up with UN Convention on the Rights of the Child, which the country signed in 1990.

Evaluation of Fixation for Distal Humeral Diaphyseal Fracture by Locking Compression Plate

Treatment of extra-articular distal humeral shaft fractures with plating techniques is often difficult. The recent development of LCP has improved the surgical treatment of fractures by overcoming the few drawbacks of older fixators. The aim of this prospective observational study was to assess the effectiveness of osteosynthesis of extra-articular diaphyseal fractures of the distal third of the humerus using a single locking compression plate (LCP) and was conducted from July 2016 to June 2018 at the National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh. Thirty (30) patients with closed fracture distal 3rd extra-articular humeral shaft fractures were treated by open reduction and internal fixation by locking compression plate. Two cases were excluded from the evaluation of final outcome due to their discontinued follow up. Detailed clinical conditions of all patients, technical difficulty with the implant, postoperative hospital stay period were recorded. Patients were followed up at 2nd week, 4th week, then 4 weekly upto 6 months. The patients were evaluated clinically and radiologically for outcomes. The progresses of healing as well as occurrence of complications were recorded. The range of motion of the shoulder and elbow were evaluated according to the criteria by Rommens grading. Functional evaluation was made according to the criteria by Modified Constant and Murley Scoring System. Union was achieved in all the patients after a mean of 15 weeks (range 12-20 weeks). There were no complications like deep infection, nonunion, malunion, implant failure, or nerve injury occurs in any of the patients. Two patients had transient radial nerve palsy. Two patients developed superficial infection. All patients were relieved pain postoperatively. Functional outcome were excellent in 10 patients, good in 15 patients which constituted 89% satisfactory results. The study has shown that the LCP is an effective, dependable solution for the management of distal third diaphyseal fractures of the humerus.

Single-wall carbon nanotube based electrochemical immunoassay for leukemia detection

A label-free electrochemical immunosensor is fabricated using high quality single-walled carbon nanotube for early detection of leukemia cells. It is based on P-glycoprotein (P-gp) expression level detection; by effective surface immune-complex formation with the monoclonal anti-P-glycoprotein antibodies bound to an epoxy modified nanotube surface. The expression level of P-gp on the leukemia cell surface detected by cyclic voltammetry is in good agreement with immunofluorescence microscopy studies. The proposed biosensor could be used for the detection of P-gp expressing cells within a linear range of 1.5 × 10³ cells/mL - 1.5 × 10⁷ cells/mL where lowest detection limit is found to be 19 cells/mL. A calibration plot of peak current v/s the logarithm of concentration of leukemia K562 cells is found linear with a regression coefficient of 0.935. This strategy promises high sensitivity, low-cost, fast, and repeatable recognition of cancer cells. The immunosensor was stable for three weeks and showed good precision with the relative standard deviation (RSD) of 3.57% and 2.12% assayed at the cell concentrations of 1.5 × 10³ and 1.5 × 10⁵ cells mL^-1 respectively. The proposed single-wall carbon nanotube based immunosensor showed better analytical performance in comparison to similar leukemia electrochemical sensors reported.

Non-pharmacological interventions for the prevention of hypertension in low-income and middle-income countries: protocol for a systematic review and meta-analysis

INTRODUCTION

In recent times, hypertension has become one of the major public health concerns in both the developed and the developing world and is responsible for death due to heart diseases and stroke. The increasing trend of the prevalence of hypertension in low-income and middle-income countries (LMICs) and it's catastrophic consequences have made the phenomenon important to continue to investigate interventions for its prevention and control. Different dietary and lifestyle-related approaches have been recommended for the prevention of hypertension. The aim of this proposed review is to explore the available non-pharmacological interventions tried for the prevention of hypertension in LMICs.

METHODS AND ANALYSIS

Eight electronic databases will be searched covering the period between 1990 and 2016 to identify relevant studies and will be screened by two independent reviewers. The searched articles will be included for full-text extraction applying definitive inclusion and exclusion criteria. Appropriate critical appraisal tools including the Cochrane Handbook for Systematic Reviews of Interventions will be used to assess the risk of bias. Disagreement between the two reviewers will be resolved by a third reviewer. Narrative synthesis of the findings will be provided along with summaries of the intervention effect. A meta-analysis will be undertaken using the random-effects model where applicable. Heterogeneity between the studies will be assessed, and sensitivity analysis will be conducted based on study quality.

ETHICS AND DISSEMINATION

Approval from the institutional review board has been taken for this review. Findings will be summarised in a single manuscript.This review is an attempt to explore the available non-pharmacological approaches for the prevention of hypertension in LMICs. Findings from the review will highlight effective non-pharmacological measures for the prevention of hypertension to guide policy for future strategies.

PROSPERO REGISTRATION NUMBER

CRD42017055423.

Prevalence of non-communicable disease risk factors among poor shantytown residents in Dhaka, Bangladesh: a community-based cross-sectional survey

OBJECTIVES

This study aims to describe the prevalence of non-communicable disease (NCD) risk factors among the urban poor in Bangladesh.

DESIGN

We conducted a community-based cross-sectional epidemiological study.

SETTING

The study was conducted in a shantytown in the city of Dhaka. There were 8604 households with 34 170 residents in the community. Those households were categorised into two wealth strata based on the housing structure.

PARTICIPANTS

The study targeted residents aged 18-64 years. A total of 2986 eligible households with one eligible individual were selected by simple random sampling stratified by household wealth status. A total of 2551 residents completed the questionnaire survey, and 2009 participated in the subsequent physical and biochemical measurements.

OUTCOME MEASURES

A modified WHO survey instrument was used for assessing behavioural risk factors and physical and biochemical measurements, including glycated haemoglobin (HbA1c). The prevalence of NCD risk factors, such as tobacco use, fruit and vegetable intake, overweight/obesity, hypertension, diabetes (HbA1c ≥6.5%) and dyslipidaemia, was described according to household wealth status and gender differences.

RESULTS

The prevalence of current tobacco use was 60.4% in men and 23.5% in women. Most of them (90.8%) consumed more than 1 serving of fruits and vegetables per day; however, only 2.1% consumed more than 5 servings. Overweight/obesity was more common in women (39.2%) than in men (18.9%), while underweight was more common in men (21.0%) than in women (7.1%). The prevalence of hypertension was 18.6% in men and 20.7% in women. The prevalence of diabetes was 15.6% in men and 22.5% in women, which was much higher than the estimated national prevalence (7%). The prevalence of raised total cholesterol (≥190 mg/dL) was 25.7% in men and 34.0% in women.

CONCLUSION

The study identified that tobacco use, both overweight and underweight, diabetes, hypertension and dyslipidaemia were prevalent among the urban poor in Bangladesh.

Can mHealth improve access to safe blood for transfusion during obstetric emergency?

PURPOSE

Of the 99% maternal deaths that take place in developing countries, one-fourth is due to postpartum hemorrhage (PPH). PPH accounts for one-third of all blood transfusions in Bangladesh where the transfusion process is lengthy as most facilities do not have in-house blood bank facilities. In this context, the location where blood is obtained and the processes of obtaining blood products are not standardized, leading to preventable delays in collecting blood, when it is needed. This study evaluated the effectiveness of an online Blood Information Management Application (BIMA) system for reducing lag time in the blood transfusion process.

PATIENTS AND METHODS

The study was conducted in a public medical college hospital in Dhaka, Bangladesh, and in two proximate, licensed blood banks between January 2014 and March 2015, using a before after design. A total of 310 women (143 before and 177 after), who needed emergency blood transfusion during their perinatal period, as determined by a medical professional, were included in the study. A median linear regression model was employed to assess the adjusted effect of BIMA on transfusion time.

RESULTS

After the introduction of BIMA, the median duration between the identified need for blood and blood transfusion reduced from 152 to 122 minutes (P<0.05). For PPH specifically, the reduction was from 175 to 113 minutes (P<0.05). After introducing BIMA and after adjusting for criteria such as maternal age, education, parity, duty roster of providers, and reasons for blood transfusion, a 24 minute reduction in the time was observed between the identified need for blood and transfusion (P<0.001).

CONCLUSION

BIMA was effective in reducing delays in blood transfusion for emergency obstetric patients. This pilot study suggests that implementing BIMA is one mechanism that has the potential to streamline blood transfusion systems in Bangladesh.

Barriers to Timely and Safe Blood Transfusion for PPH Patients: Evidence from a Qualitative Study in Dhaka, Bangladesh

BACKGROUND AND OBJECTIVES

In Bangladesh, postpartum hemorrhage (PPH) is the leading cause of maternal mortality accounting for 31% of all blood transfusions in the country. Although safe blood transfusion is one of the 8 signal functions of Comprehensive Emergency Obstetric Care (CEmOC) strategy, most of the designated public sector CEmOC facilities do not have on-site blood storage system. Emergent blood is mainly available from external blood banks. As a result, emergent patients are to rely on an unregulated network of brokers for blood which may raise question about blood safety. This study explored lived experiences of patients' attendants, managers, providers, and blood brokers before and after the implementation of an on-line Blood Information and Management Application (BIMA) in regards to barriers and facilitators of blood transfusion for emergent patients.

METHODS

Data were collected at Dhaka Medical College Hospital (DMCH), a tertiary-level teaching hospital before (January 2014) and after (March 2015) the introduction of an online BIMA system. Data collection methods included 24 key informant interviews (KIIs) and 40 in-depth interviews (IDIs). KIIs were conducted with formal health service providers, health managers and unlicensed blood brokers. IDIs were conducted with the relatives and husbands of women who suffered PPH, and needed emergency blood.

RESULTS

Patients' attendants were unaware of patients' blood type and availability of blood in emergency situation. Newly introduced online BIMA system could facilitate blood transfusion process for poor patients at lower cost and during any time of day and night. However, service providers and service recipients were heavily dependent on a network of unlicensed blood brokers for required blood for emergent PPH patients. Blood collected through unlicensed blood brokers is un-screened, unregulated and probably unsafe. Blood brokers feel that they are providing a needed service, acknowledged a financial incentive and unaware about safety of blood that they supply.

CONCLUSIONS

Ensuring safe and timely blood transfusion is necessary to end preventable maternal mortality. In a context where facilities have no on-site blood, and both providers and patient attendants are heavily dependent on an unregulated cadre of unlicensed blood brokers, access to timely safe blood transfusion is seriously threatened. BIMA is a promising intervention to reduce inefficiencies in obtaining blood, but steps must be taken to ensure buy-in from current purveyors of blood, and to increase the acceptance of the intervention.

Overexpression of sonic hedgehog in the triple negative breast cancer: clinicopathological characteristics of high burden breast cancer patients from Bangladesh

Dysregulation of Hedgehog (Hh) signaling pathway has been documented in mammary gland development and breast cancer (BC) progression. Despite the remarkable progress in therapeutic interventions, BC related mortality in Bangladesh increased in the last decade. Triple negative breast cancer (TNBC) still presents a critical therapeutic challenge. Thus effective targeted therapy is urgently needed. In this study, we report the clinicopathological characteristics and prognosis of BC patients from Bangladesh. Routine immunohistochemical analysis and high throughput RNA-Seq data from the TCGA library were used to analyze the expression pattern and association of high and low level of Shh expression in a collection of BC patients with a long-term follow-up. High levels of Shh were observed in a subset of BC tumors with poor prognostic pathological features. Higher level of Shh expression correlated with a significantly poorer overall survival of patients compared with patients whose tumors expressed a low level of Shh. These data support the contention that Shh could be a novel biomarker for breast cancer that is involved in mediating the aggressive phenotype of BC. We propose that BC patients exhibiting a higher level of Shh expression, representing a subset of BC patients, would be amenable to Shh targeted therapy.

Sonic hedgehog (Shh) signaling promotes tumorigenicity and stemness via activation of epithelial-to-mesenchymal transition (EMT) in bladder cancer

Activation of the sonic hedgehog (Shh) signaling pathway controls tumorigenesis in a variety of cancers. Here, we show a role for Shh signaling in the promotion of epithelial-to-mesenchymal transition (EMT), tumorigenicity, and stemness in the bladder cancer. EMT induction was assessed by the decreased expression of E-cadherin and ZO-1 and increased expression of N-cadherin. The induced EMT was associated with increased cell motility, invasiveness, and clonogenicity. These progression relevant behaviors were attenuated by treatment with Hh inhibitors cyclopamine and GDC-0449, and after knockdown by Shh-siRNA, and led to reversal of the EMT phenotype. The results with HTB-9 were confirmed using a second bladder cancer cell line, BFTC905 (DM). In a xenograft mouse model TGF-β1 treated HTB-9 cells exhibited enhanced tumor growth. Although normal bladder epithelial cells could also undergo EMT and upregulate Shh with TGF-β1 they did not exhibit tumorigenicity. The TGF-β1 treated HTB-9 xenografts showed strong evidence for a switch to a more stem cell like phenotype, with functional activation of CD133, Sox2, Nanog, and Oct4. The bladder cancer specific stem cell markers CK5 and CK14 were upregulated in the TGF-β1 treated xenograft tumor samples, while CD44 remained unchanged in both treated and untreated tumors. Immunohistochemical analysis of 22 primary human bladder tumors indicated that Shh expression was positively correlated with tumor grade and stage. Elevated expression of Ki-67, Shh, Gli2, and N-cadherin were observed in the high grade and stage human bladder tumor samples, and conversely, the downregulation of these genes were observed in the low grade and stage tumor samples. Collectively, this study indicates that TGF-β1-induced Shh may regulate EMT and tumorigenicity in bladder cancer. Our studies reveal that the TGF-β1 induction of EMT and Shh is cell type context dependent. Thus, targeting the Shh pathway could be clinically beneficial in the ability to reverse the EMT phenotype of tumor cells and potentially inhibit bladder cancer progression and metastasis.

Proteinuria is an independent risk factor for ischemic stroke among diabetic patients

This study was done to assess the relationship between proteinuria and ischemic stroke in subjects with diabetes mellitus, and to determine whether proteinuria is an independent risk factor for stroke. This comparative study was conducted in Mymensingh Medical College Hospital from January 2009 to June 2010. It was done to establish the relationship between proteinuria (Microalbuminuria) and ischemic stroke among diabetic patients. Other risk factors were also assessed. Patients were divided in Group A - diabetic patients with ischemic stroke (n=50) and Group B diabetic patients without stroke (n=50). Mean age of the Group A & B were 60.16±8.33 and 57.19±7.73 years (p=0.068). Mean Blood sugar (2 hours after Break Fast) was 14.68±4.32mmol/L in Group A and 14.75±4.02mmol/L in Group B (p>0.05). Albumin Creatinine ratio was abnormal in 84.0% in Group A and 22.0% in Group A (p=0.001) [Odds ratio (95%CI) = 18.61 (6.78-51.09)]. Logistic regression analysis has also shown that microalbuminuria (ACR) is an independent risk factor for ischemic stroke (p=0.001), [Odds ratio (95%CI) = 19.811(5.915-66.348)]. In diabetic patients increased urinary protein is a risk factor for stroke. Estimation of urinary protein (Microalbuminuria) may be used as a predictor for ischemic stroke in patients with diabetes.

Photo-induced electrochemical anodization of p-type silicon: achievement and demonstration of long term surface stability

Surface stability is achieved and demonstrated by porous silicon (PS) fabricated using a wavelength-dependent photo-electrochemical (PEC) anodization technique. During anodization, the photon flux for all wavelengths was kept constant while only the effect of light wavelength on the surface morphology of PS was investigated. PS optical sensors were realized, characterized and tested using a photoluminescence (PL) quenching technique. An aliphatic chain of alcohols (methanol to n-octanol) was detected in the range of 10-200 ppm. Long term surface stability was observed from samples prepared under red (750-620 nm) and green illumination (570-495 nm), where the PL quenching cycles evoke the possibility of using PS for stable sensor device applications. This study provides a route for preparing highly sensitive organic vapour sensors with a precise selection of the fabrication parameters and demonstrating their prolonged performance.

Understanding work-related injuries in children: a perspective in West Virginia using the state-managed workers' compensation system

BACKGROUND/PURPOSE

Little data exist that defines the consequences of occupational injuries in children. Traditional assessment of work-related injury is coupled with disability payments based on salary, which give little insight into etiology and severity. The authors hypothesize that the risk and pattern of occupational injuries in young workers are different then adults.

METHODS

Claims from 1996 through 2000 were analyzed from the West Virginia Bureau of Workers Compensation. To define the significance of an injury, child and adult groups were subdivided into injuries that required surgery (ie, serious injuries). Current Procedural Terminology (CPT) codes for anesthesia and surgical procedures were cross referenced with the claims to ensure group designation. Relative risks (RR) were used to compare groups.

RESULTS

Between 1996 and 2000, 364,063 claims were submitted, 14,093 in workers < or =19 years of age. Two hundred seventy claims in children required surgery. Serious injuries in children occur more often in boys 2.2x mainly in the (16 to 24 hours) evening (48% v 23.13%; P <.05) and in July/August (26.5 v 18.4; P <.001). Falls were the main mechanism of injury. Proportionately fingers (1.70x) and hands (1.64x, 1.6 to 1.7) were injured in children. Lacerations (3.4x), fractures (1.4x), and amputations (3.75x) frequently resulted in general anesthetic procedures, and the RR of these injuries were increased versus adults. Service, manufacturing, construction, and agriculture were the main injury-related occupations in children.

CONCLUSIONS

For any job category, injuries in children have unique features, tend to be more serious, and require a surgical intervention proportionately more frequently than adults.

Cholesterol screening among children and their parents

BACKGROUND

The Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) project is designed to test the hypothesis that universal cholesterol screening of prepubertal schoolchildren is effective in identifying children and their parents at risk of developing premature coronary heart disease (CHD) in a high-risk rural population.

METHODS

Seven hundred nine fifth-grade schoolchildren from seven rural Appalachian counties participated in a school-based cholesterol screening program. Family history of premature CHD, anthropometric and blood pressure measurement, tobacco smoke exposure, dietary history, and physical activity levels were collected.

RESULTS

One-fourth (174) of the children were "presumptively" dyslipidemic upon measurement of nonfasting finger-stick blood cholesterol (FSC). Subsequent fasting lipid profile obtained for 63 of these children and 79 of their parents confirmed the presence of dyslipidemia in 37 children (59%) and 52 parents (66%). Among confirmed dyslipidemic children, family history was not a good predictor of dyslipidemia (sensitivity 21.6%). FSC levels were significantly correlated with fasting total cholesterol of children and their parents.

CONCLUSIONS

Universal nonfasting FSC screening of prepubertal schoolchildren is effective in identifying dyslipidemic children and their parents, whereas family history has low sensitivity in predicting children with elevated blood cholesterol concentrations.

Incidence and risk of work-related fracture injuries: experience of a state-managed workers' compensation system

Incidence rates of occupational fractures at various anatomic sites and associated risk factors have not been well documented. We identified 3490 work-related fractures from a West Virginia Workers Compensation database that occurred between July 1, 1994, and June 30, 1995. The annual incidence rate was 55 per 10,000 workers, which is substantially higher than the work-related fracture rates reported previously. The incidence rate of fracture was highest in the agricultural sector, followed by the mining, construction, and manufacturing sectors (202.0, 165.2, 116.7, and 88.0 per 10,000 workers, respectively). The age-specific gender distribution comparing fracture and non-fracture injuries showed a bimodal distribution, with greater proportions of female employees at the younger and older age groups. Fracture of the phalanges was the most common, followed by fractures of the foot bone and carpal bone (15.8, 9.5, and 7.9 per 10,000 workers, respectively). In a multiple logistic regression analysis, age, gender, occupation, caught in-between objects, fall, struck by or against object, and vehicle collision were significant independent predictors of fracture (all sites combined). We believe work-related fractures to be a bigger problem than previously reported. The association among gender, age, occupation, and causes of fractures identified in this study will be useful in developing gender- and occupation-specific prevention intervention.

Gender differences in work-related injury/illness: analysis of workers compensation claims

BACKGROUND

Risk of work-related injuries/illnesses among females has not been well documented. This study compares compensable work-related injuries/illnesses between females and males across all major industrial sectors and occupations using a state-managed Workers Compensation database.

METHODS

Incidence rates were calculated by dividing the number of compensable injuries/illnesses among West Virginia Workers Compensation claimants by the total number of female and male workers in each specific industry class (based on SIC codes). Gender-specific denominators for occupations were estimated using 1990 U.S. Census data.

RESULTS

The overall injury/illness rate was significantly lower in females than males (5. 5 vs. 11.5 per 100 employees), a trend that extended to all major industrial classes with the exception of service and agricultural sectors. The distribution of types of injury/illness varied by gender, occupation, and industry with significantly higher risk of carpal tunnel syndrome, burn, sprain, and fracture in females compared to males.

CONCLUSIONS

Female workers have a greater risk of specific injury/illness compared to males in various industries. Further research will be needed to understand the role of differential job-tasks within each occupation in explaining the risk difference.

Epidemiology of work-related burn injuries: experience of a state-managed workers' compensation system

BACKGROUND

Population-based incidence rates of work-related burn injuries and associated risk factors specific to anatomic sites and degree of burn are not known.

METHODS

Using a state-managed workers' compensation database, we estimated incidence rates of work-related burn injuries and identified high-risk occupations and associated exposures.

RESULTS

The annual incidence rate of occupational burn was 26.4 per 10,000 workers, with the highest rate observed in the manufacturing sector for males and in the service sector for females. Welders, cooks, laborers, food service workers, and mechanics had higher incidence rates of burn injury compared with other occupations. Wrist and hand burns accounted for a majority of burn injuries, with females experiencing greater incidence of these distal upper extremity burns (8.9 in females and 6.7 in males per 10,000 workers, respectively). Third-degree burns (incidence rate, 1.3 per 10,000 workers) were also most frequently observed in the upper extremities compared with other anatomic sites. The majority of wrist and hand burns were caused by hot liquids/ objects, whereas the majority of eye burns were associated with chemical exposures. Younger cooks and food service workers were at greater risk of burn than older coworkers.

CONCLUSION

Specific occupations are associated with degree of burn, anatomic site, and exposures. This information will be useful for targeted intervention among high-risk occupations and work groups.

Epidemiology of compensable work-related ocular injuries and illnesses: incidence and risk factors

Incidence rates of work-related compensable ocular injuries/illnesses and associated risk factors were estimated by using a state-managed workers' compensation database. The annual incidence rate was estimated to be 537 per 100,000 employees. The majority of the ocular injuries and illnesses resulted from foreign bodies in the external eye (incidence rate 194 per 100,000 employees). Incidence rates for superficial eye injury, atopic conjunctivitis, burn, keratitis, chronic conjunctivitis, and contusion were 168.3, 30.9, 28.0, 23.4, 17.9, and 15.3 per 100,000 employees, respectively. The highest incidence rate was observed in the agricultural sector, with male employees having higher rates than female employees. Cooks, housekeepers, and food service workers had higher risk of atopic conjunctivitis (relative risk, 3.2 to 7.3) compared with other workers. The majority of the atopic conjunctivitis illnesses and burn injuries were associated with chemical exposures. Reduction of exposures and targeted intervention among high-risk workers should reduce the incidence of work-related ocular injuries and illnesses.

Prevalence of small lung opacities in populations unexposed to dusts. A literature analysis

OBJECTIVES

Despite the wide use of the International Labor Organization (ILO) system for reading chest radiographs, little information is available regarding the prevalence of abnormalities in populations unexposed to dusts. Prevalence studies of radiographic changes consistent with dust inhalation, as classified by the system, would be more meaningful if there were better understanding regarding the extent of abnormalities in unexposed populations.

DESIGN

To determine small opacity prevalence in unexposed populations, a review of articles published since 1970 that used the ILO system to classify radiographs of the unexposed, either as subjects or control subjects, was performed. Criteria for inclusion in this review included ascertainment of the lack of exposure of subjects to occupational dusts, and independent reading of radiographs by at least two readers certified in the ILO system (B readers) or experienced in its use. A total of eight published articles presenting data on nine study populations were included in this study.

RESULTS

The prevalence of small opacities graded 1/0 or greater varied widely, with a range from 0.21 to 11.7%. A meta-analysis of the published data yielded a population prevalence of 5.3% (95% confidence interval [CI] = 2.9 to 7.7%). The prevalence was significantly greater in Europe than in North America (Europe, 11.3%; 95% CI = 10.1 to 12.5%; North America, 1.6%; 95% CI = 0.6 to 2.6%). A subset of the studies contained information on gender that showed greater prevalence of lung opacities in male subjects than female subjects (male subjects, 5.5%; 95% CI = 3.4 to 7.6%; female subjects, 3.5%; 95% CI = 1.3 to 5.8%). Based on estimated age information, the studies were divided into two strata (mean age < 50 years vs > or = 50 years). The age-specific pooled prevalence was higher in the studies with mean age > or = 50 years than studies with mean age < 50 years in both Europe (11.7% vs 9.6%) and North America (2.3% vs 0.6%). Prevalence of lung opacities remained significantly higher in Europe and North America in each age stratum. The large difference in the prevalence between Europe and North America could not be explained on the basis of age, gender, or smoking history, although available age and smoking data are less robust.

CONCLUSIONS

These results indicate that a background level of opacities consistent with the radiographic appearance of pneumoconiosis exists in populations considered to be free of occupational dust exposure. Environmental and unaccounted occupational exposures, as well as reader variability, all may play a role in the determination of small opacity prevalence in these subjects and may explain the large differences between Europe and North America. Thorough ascertainments of occupational and environmental exposures are essential to determine the true significance of opacities in populations who are not exposed to dust.

Declining FEV1 and chronic productive cough in cigarette smokers: a 25-year prospective study of lung cancer incidence in Tecumseh, Michigan

A community-based study has been reviewed to assess whether impaired forced expiratory volume in 1 s (FEV1) and/or the symptoms of chronic cough and sputum production predict the incidence of lung cancer, after controlling for age, sex, cigarette smoking history, and the dietary intake of carotenoids and retinoids. A cohort of 2099 women and 1857 men, 25 years of age or older, were first examined from 1962 to 1965. As of 1987, there were 60 validated lung cancers diagnosed in men (1.83 per 1000 person-years) and 17 in women (0.39 per 1000 person-years). The incidence density of lung cancer in current smokers at baseline, when compared with never smokers, was increased 5.34 (95% confidence interval, 1.74, 16.38) times in women and 4.11 (95% confidence interval, 1.63, 10.34) times in men. The risk of lung cancer increased in women and men in relation to the average daily intensity of exposure in current smokers and the duration of smoking history (< 20 years, > or = 20 years) in current and ex-smokers. When stratified by cigarette smoking intensity, subjects with chronic cough and phlegm experienced a future risk of lung cancer that was more than 3 times higher than that in the nonsymptomatic subgroup. Among the smoking women and men at entry, those in the lowest quartile of the percent predicted FEV1, after controlling for the average number of cigarettes smoked per day, experienced a risk of lung cancer that was 2.7 times that of subjects in the highest quartile. With each 10% decrease in percent predicted FEV1, the risk of lung cancer increased 1.17 times (0.96, 1.42), after controlling for age, sex, and cigarette smoking intensity at baseline. The average annual decline in FEV1 as estimated between 1962 and 1965 and 1967 and 1969 was a significant independent predictor of future lung cancer incidence after controlling for cigarette smoking history; the slope of the regression line indicated that with each decline in FEV1 of 100 ml/year, lung cancer incidence density increased 1.16 per 1000 person-years (95% confidence interval, 0.30, 2.01). Controlling for potential confounding by quartile distribution of calorie-adjusted dietary intake of vitamin A, beta-carotene, cholesterol, and fat did not weaken or alter the fundamental relationship with impaired pulmonary function. Rapidly declining ventilatory function in conjunction with persistent symptoms of chronic bronchitis in current smokers is predictive of the increased risk of lung cancer and correlates with cumulative levels of exposure to cigarette smoking.(ABSTRACT TRUNCATED AT 400 WORDS)

Risk factors for diarrhoeal deaths: a case-control study at a diarrhoeal disease hospital in Bangladesh

The study of diarrhoeal mortality risk has been limited to descriptive epidemiological investigations. This is the first case-control study in this area, and our results show that certain risk factors are predictive of diarrhoeal deaths. We have compared the disease history, associated complications, signs, symptoms and laboratory values of 346 patients who died on the medical wards of Dhaka Hospital and that for 346 matched controls to identify the risk factors for mortality. Patients presenting with oedema, severe dehydration or convulsion were found to have a risk of mortality two times higher than controls. Several laboratory results were compared by a matched pair analysis, demonstrating that hyponatraemia (less than 130 mmol/L), hypobicarbonaemia (less than 20 mmol/L) and raised anion gap (greater than 14.9 mmol/L) were moderately associated with mortality. However, hypoproteinaemia (less than 50 gm/L) was strongly associated. For children less than 10 years of age, both hyper- and hyponatraemia were found to be associated with mortality, and the nutritional status of the children modified the effect of hypernatraemia on diarrhoeal mortality. The strong association between diarrhoeal death and hypoproteinaemia may be due to the effect of the pre-existing malnutrition of these patients and/or their loss of protein during shigella infection. The various risk factors that we have identified could be used as a prognostic guide by physicians treating such patients.

Morbidity and mortality in a diarrhoeal diseases hospital in Bangladesh

Records of all patients who were admitted to or who died in Dhaka hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) between July 1980 and 30th June 1981 were reviewed to identify epidemiological characters associated with in-hospital diarrhoeal diseases-related deaths. Information on aetiological agents, age, sex, major complications, nutritional status and level of dehydration were analysed. Over the one-year period, 3251 patients were admitted to the medical wards and 400 died. Children under five made up 72% of patients admitted and 77% of those who died. All patients were cultured for enteric vibrios, Salmonella and Shigella; 25% of the patients had at least one of these organisms. Shigella was most common and was isolated from 13% of the patients and 19% of those who died. Case-fatality rates in patients with Shigella and Vibrio cholerae non-OI (NAG) were significantly higher than other enteric pathogens (V. cholerae OI, Salmonella typhi and mixed). Case fatality for Vibrio cholerae non-OI was higher than Shigella (25.8% and 17.2%) but the difference was not statistically significant. Among those who died 21% were severely dehydrated and 50% had various complications. Patients with V. cholerae OI were significantly more dehydrated than other groups (P less than 0.05 by chi 2 test). The patients who died with Shigella were significantly more malnourished and had more frequent associated complications than other non-Shigella diarrhoea patients (P less than 0.01 by chi 2 test). Overall our observations indicate that Shigella and Vibrio cholerae non-OI are associated with unusually high case fatality.(ABSTRACT TRUNCATED AT 250 WORDS)