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AbdulHussein A, Butt ZA, Dimitrov S, Cozzarin B. Factors Associated With Worsened Mental Health of Health Care Workers in Canada During the COVID-19 Pandemic: Cross-Sectional Survey Study. Interact J Med Res 2024; 13:e50064. [PMID: 38358785 PMCID: PMC10905361 DOI: 10.2196/50064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 11/26/2023] [Accepted: 01/12/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Health care workers (HCWs) in Canada have endured difficult conditions during the COVID-19 pandemic. Many worked long hours while attending to patients in a contagious environment. This introduced an additional burden that may have contributed to worsened mental health conditions. OBJECTIVE In this study, we examine the factors associated with worsened mental health conditions of HCWs as compared to before the start of the pandemic. METHODS We use data from a survey of HCWs by Statistics Canada. A regression model is used to estimate the odds ratios (ORs) of worsened mental health after the start of the pandemic. The estimated odds ratio (OR) is associated with different independent variables that include demographics (age, sex, immigration status, and geographic area), occupational factors (work status, occupational group, and exposure category), and different access levels to personal protective equipment (PPE). RESULTS Of 18,139 eligible participants surveyed, 13,990 (77.1%) provided valid responses. We found that HCWs younger than 35 years old were more likely (OR 1.14, 95% CI 1.03-1.27; P=.01) to exhibit worsened mental health as compared to the reference group (35-44 years old). As for sex, male HCWs were less likely (OR 0.76, 95% CI 0.67-0.86; P<.001) to exhibit worsened mental health as compared to female HCWs. Immigrant HCWs were also less likely (OR 0.57, 95% CI 0.51-0.64; P<.001) to exhibit worsened mental health as compared to nonimmigrant HCWs. Further, HCWs working in Alberta had the highest likelihood of exhibiting worsened mental health as compared to HCWs working elsewhere (Atlantic provinces, Quebec, Manitoba, Saskatchewan, Ontario, British Columbia, and Northern Territories). Frontline workers were more likely (OR 1.26, 95% CI 1.16-1.38; P<.001) to exhibit worsened mental health than nonfrontline HCWs. Part-time HCWs were less likely (OR 0.85, 95% CI 0.76-0.93; P<.001) to exhibit worsened mental health than full-time HCWs. HCWs who reported encountering COVID-19 cases were more likely (OR 1.55, 95% CI 1.41-1.70; P<.001) to exhibit worsened mental health as compared to HCWs who reported no contact with the disease. As for PPE, HCWs who never had access to respirators, eye protection, and face shields are more likely to exhibit worsened mental health by 1.31 (95% CI 1.07-1.62; P<.001), 1.51 (95% CI 1.17-1.96; P<.001), and 1.41 (95% CI 1.05-1.92; P=.02) than those who always had access to the same PPE, respectively. CONCLUSIONS Different HCW groups experienced the pandemic differently based on their demographic and occupational backgrounds as well as access to PPE. Such findings are important to stakeholders involved in the planning of personalized support programs and aid mental health mitigation in future crises. Certain groups require more attention.
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Affiliation(s)
- Ali AbdulHussein
- Department of Management Science, Faculty of Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Zahid Ahmad Butt
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | - Stanko Dimitrov
- Department of Management Science, Faculty of Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Brian Cozzarin
- Department of Management Science, Faculty of Engineering, University of Waterloo, Waterloo, ON, Canada
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Wang K, Cao S, Kaur J, Ghafurian M, Butt ZA, Morita P. Heart rate prediction with contactless active assisted living technology: a smart home approach for older adults. Front Artif Intell 2024; 6:1342427. [PMID: 38282903 PMCID: PMC10811001 DOI: 10.3389/frai.2023.1342427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 12/29/2023] [Indexed: 01/30/2024] Open
Abstract
Background As global demographics shift toward an aging population, monitoring their heart rate becomes essential, a key physiological metric for cardiovascular health. Traditional methods of heart rate monitoring are often invasive, while recent advancements in Active Assisted Living provide non-invasive alternatives. This study aims to evaluate a novel heart rate prediction method that utilizes contactless smart home technology coupled with machine learning techniques for older adults. Methods The study was conducted in a residential environment equipped with various contactless smart home sensors. We recruited 40 participants, each of whom was instructed to perform 23 types of predefined daily living activities across five phases. Concurrently, heart rate data were collected through Empatica E4 wristband as the benchmark. Analysis of data involved five prominent machine learning models: Support Vector Regression, K-nearest neighbor, Random Forest, Decision Tree, and Multilayer Perceptron. Results All machine learning models achieved commendable prediction performance, with an average Mean Absolute Error of 7.329. Particularly, Random Forest model outperformed the other models, achieving a Mean Absolute Error of 6.023 and a Scatter Index value of 9.72%. The Random Forest model also showed robust capabilities in capturing the relationship between individuals' daily living activities and their corresponding heart rate responses, with the highest R2 value of 0.782 observed during morning exercise activities. Environmental factors contribute the most to model prediction performance. Conclusions The utilization of the proposed non-intrusive approach enabled an innovative method to observe heart rate fluctuations during different activities. The findings of this research have significant implications for public health. By predicting heart rate based on contactless smart home technologies for individuals' daily living activities, healthcare providers and public health agencies can gain a comprehensive understanding of an individual's cardiovascular health profile. This valuable information can inform the implementation of personalized interventions, preventive measures, and lifestyle modifications to mitigate the risk of cardiovascular diseases and improve overall health outcomes.
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Affiliation(s)
- Kang Wang
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Shi Cao
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Jasleen Kaur
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Moojan Ghafurian
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Zahid Ahmad Butt
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Plinio Morita
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
- Centre for Digital Therapeutics, Techna Institute, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
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Gorar ZA, Butt ZA. Impact of hepatitis B birth dose on immune response in Pakistani children: an open-label, non-inferiority randomized controlled trial, implications for achieving SDG target. Infect Dis (Lond) 2024; 56:1-10. [PMID: 37712585 DOI: 10.1080/23744235.2023.2258208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Despite presence of hyperendemic areas, the national immunisation schedule in Pakistan does not include a hepatitis B birth dose, placing newborns at an additional risk of acquiring hepatitis B. This study aimed to assess the impact of adding hepatitis B birth dose in existing national vaccination schedule. METHODS An open label, randomised controlled non-inferiority trial enrolled 296 healthy near-term mothers to intervention and control groups. Newborns in the intervention group received a hepatitis B birth dose along with routine immunisation vaccines, while control group newborns received vaccinations under the national schedule. Seroprotection was measured and compared at birth and 8 weeks after administering the third dose of pentavalent vaccine. The risk ratio of seroprotection was computed and compared with the delta value set at 5%. RESULTS The study found that 95.8% of infants in the intervention group achieved seroprotection, which was significantly higher than the control group's 58.7%. The difference in risk ratio of seroprotection was 1.62 (CI95: 1.37-1.93), with the upper limit of the CI below the delta margin, confirming non-inferiority. The time interval between birth and the first hepatitis B immunisation shot was a predictor of seroprotection, with an odds ratio of 1.79 (CI95: 1.01-2.9). CONCLUSION Our study indicates that adding a hepatitis B birth dose to the immunisation schedule in Pakistan is non-inferior to the existing one. This can also contribute towards Pakistan's achievement of the SDG target of reducing hepatitis B surface antigen seroprevalence in children under 5 years of age. TRIAL REGISTRATION NUMBER NCT04870021.
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Affiliation(s)
| | - Zahid Ahmad Butt
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
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Rotolo B, Bin Noon G, Chen HH, Butt ZA. Public Attitudes Towards Vaccine Passports in Alberta During the "Pandemic of the Unvaccinated": A Qualitative Analysis of Reddit Posts. Int J Public Health 2023; 68:1606514. [PMID: 38188127 PMCID: PMC10766830 DOI: 10.3389/ijph.2023.1606514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/12/2023] [Indexed: 01/09/2024] Open
Abstract
Objective: The goal of this study is to understand the attitudes and beliefs towards mandatory vaccination policies in Alberta, Canada in September 2021, during the fourth wave of COVID-19. Methods: 9400 posts between 1st September and 30th September 2021 were collected from the subreddit r/Alberta with Pushshift.io. Posts and comments were manually screened to determine their relevance to research objectives, and then coded using inductive coding and iterative qualitative analysis methods. Results: Inductive coding methods yielded five key themes: 1) opinions related to autonomy and consent, 2) concerns about COVID-19 vaccine passport enforcement, 3) concerns about government, 4) concerns about the logistics of passports, and 5) opinions relating to the necessity of passports to prevent lockdowns. Conclusion: Overall, the data presented favorable opinions towards an Albertan vaccine passport within r/Alberta. Anti-vaccine and anti-mandate opinions were often less extreme than those present in the literature, although this may be due to r/Alberta subreddit moderators removing those more extreme comments. Most reservations were due to issues of bodily autonomy, though concerns about the government and logistics also played a meaningful role.
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Affiliation(s)
- Bobbi Rotolo
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Black AP, Wallace J, Binka M, Butt ZA. Correction: The challenges of viral hepatitis elimination: a global response to a global problem. BMC Public Health 2023; 23:1229. [PMID: 37370060 DOI: 10.1186/s12889-023-16096-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Affiliation(s)
- Antony P Black
- Laboratory for Vaccine-Preventable Diseases, Institut Pasteur du Laos, Vientiane, Laos.
| | - Jack Wallace
- Burnet Institute, Melbourne, Australia.
- Centre for Social Research in Health, UNSW, Kensington, Australia.
| | - Mawuena Binka
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.
| | - Zahid Ahmad Butt
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada.
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Lotto M, Zakir Hussain I, Kaur J, Butt ZA, Cruvinel T, Morita PP. Analysis of Fluoride-Free Content on Twitter: Topic Modeling Study. J Med Internet Res 2023; 25:e44586. [PMID: 37338975 DOI: 10.2196/44586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/18/2023] [Accepted: 06/07/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Although social media has the potential to spread misinformation, it can also be a valuable tool for elucidating the social factors that contribute to the onset of negative beliefs. As a result, data mining has become a widely used technique in infodemiology and infoveillance research to combat misinformation effects. On the other hand, there is a lack of studies that specifically aim to investigate misinformation about fluoride on Twitter. Web-based individual concerns on the side effects of fluoridated oral care products and tap water stimulate the emergence and propagation of convictions that boost antifluoridation activism. In this sense, a previous content analysis-driven study demonstrated that the term fluoride-free was frequently associated with antifluoridation interests. OBJECTIVE This study aimed to analyze "fluoride-free" tweets regarding their topics and frequency of publication over time. METHODS A total of 21,169 tweets published in English between May 2016 and May 2022 that included the keyword "fluoride-free" were retrieved by the Twitter application programming interface. Latent Dirichlet allocation (LDA) topic modeling was applied to identify the salient terms and topics. The similarity between topics was calculated through an intertopic distance map. Moreover, an investigator manually assessed a sample of tweets depicting each of the most representative word groups that determined specific issues. Lastly, additional data visualization was performed regarding the total count of each topic of fluoride-free record and its relevance over time, using Elastic Stack software. RESULTS We identified 3 issues by applying the LDA topic modeling: "healthy lifestyle" (topic 1), "consumption of natural/organic oral care products" (topic 2), and "recommendations for using fluoride-free products/measures" (topic 3). Topic 1 was related to users' concerns about leading a healthier lifestyle and the potential impacts of fluoride consumption, including its hypothetical toxicity. Complementarily, topic 2 was associated with users' personal interests and perceptions of consuming natural and organic fluoride-free oral care products, whereas topic 3 was linked to users' recommendations for using fluoride-free products (eg, switching from fluoridated toothpaste to fluoride-free alternatives) and measures (eg, consuming unfluoridated bottled water instead of fluoridated tap water), comprising the propaganda of dental products. Additionally, the count of tweets on fluoride-free content decreased between 2016 and 2019 but increased again from 2020 onward. CONCLUSIONS Public concerns toward a healthy lifestyle, including the adoption of natural and organic cosmetics, seem to be the main motivation of the recent increase of "fluoride-free" tweets, which can be boosted by the propagation of fluoride falsehoods on the web. Therefore, public health authorities, health professionals, and legislators should be aware of the spread of fluoride-free content on social media to create and implement strategies against their potential health damage for the population.
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Affiliation(s)
- Matheus Lotto
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Irfhana Zakir Hussain
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Department of Data Science and Business Systems, School of Computing, College of Engineering and Technology, SRM Institute of Science and Technology, Kattankulathur, India
| | - Jasleen Kaur
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Zahid Ahmad Butt
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Thiago Cruvinel
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Plinio P Morita
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
- eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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7
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Morita PP, Zakir Hussain I, Kaur J, Lotto M, Butt ZA. Tweeting for Health Using Real-time Mining and Artificial Intelligence-Based Analytics: Design and Development of a Big Data Ecosystem for Detecting and Analyzing Misinformation on Twitter. J Med Internet Res 2023; 25:e44356. [PMID: 37294603 PMCID: PMC10337356 DOI: 10.2196/44356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/09/2023] [Accepted: 03/14/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Digital misinformation, primarily on social media, has led to harmful and costly beliefs in the general population. Notably, these beliefs have resulted in public health crises to the detriment of governments worldwide and their citizens. However, public health officials need access to a comprehensive system capable of mining and analyzing large volumes of social media data in real time. OBJECTIVE This study aimed to design and develop a big data pipeline and ecosystem (UbiLab Misinformation Analysis System [U-MAS]) to identify and analyze false or misleading information disseminated via social media on a certain topic or set of related topics. METHODS U-MAS is a platform-independent ecosystem developed in Python that leverages the Twitter V2 application programming interface and the Elastic Stack. The U-MAS expert system has 5 major components: data extraction framework, latent Dirichlet allocation (LDA) topic model, sentiment analyzer, misinformation classification model, and Elastic Cloud deployment (indexing of data and visualizations). The data extraction framework queries the data through the Twitter V2 application programming interface, with queries identified by public health experts. The LDA topic model, sentiment analyzer, and misinformation classification model are independently trained using a small, expert-validated subset of the extracted data. These models are then incorporated into U-MAS to analyze and classify the remaining data. Finally, the analyzed data are loaded into an index in the Elastic Cloud deployment and can then be presented on dashboards with advanced visualizations and analytics pertinent to infodemiology and infoveillance analysis. RESULTS U-MAS performed efficiently and accurately. Independent investigators have successfully used the system to extract significant insights into a fluoride-related health misinformation use case (2016 to 2021). The system is currently used for a vaccine hesitancy use case (2007 to 2022) and a heat wave-related illnesses use case (2011 to 2022). Each component in the system for the fluoride misinformation use case performed as expected. The data extraction framework handles large amounts of data within short periods. The LDA topic models achieved relatively high coherence values (0.54), and the predicted topics were accurate and befitting to the data. The sentiment analyzer performed at a correlation coefficient of 0.72 but could be improved in further iterations. The misinformation classifier attained a satisfactory correlation coefficient of 0.82 against expert-validated data. Moreover, the output dashboard and analytics hosted on the Elastic Cloud deployment are intuitive for researchers without a technical background and comprehensive in their visualization and analytics capabilities. In fact, the investigators of the fluoride misinformation use case have successfully used the system to extract interesting and important insights into public health, which have been published separately. CONCLUSIONS The novel U-MAS pipeline has the potential to detect and analyze misleading information related to a particular topic or set of related topics.
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Affiliation(s)
- Plinio Pelegrini Morita
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
- Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Centre for Digital Therapeutics, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Irfhana Zakir Hussain
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
- Department of Data Science and Business Systems, School of Computing, College of Engineering and Technology, SRM Institute of Science and Technology, Kattankulathur, India
| | - Jasleen Kaur
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | - Matheus Lotto
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo,, Bauru, Brazil
| | - Zahid Ahmad Butt
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
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Black AP, Wallace J, Binka M, Butt ZA. The challenges of viral hepatitis elimination: a global response to a global problem. BMC Public Health 2023; 23:1042. [PMID: 37264379 DOI: 10.1186/s12889-023-15960-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/23/2023] [Indexed: 06/03/2023] Open
Affiliation(s)
- Antony P Black
- Laboratory for Vaccine-Preventable Diseases, Institut Pasteur du Laos, Vientiane, Laos.
| | - Jack Wallace
- Burnet Institute, Melbourne, Australia.
- Centre for Social Research in Health, UNSW, Kensington, Australia.
| | - Mawuena Binka
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.
| | - Zahid Ahmad Butt
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
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AlShurman BA, Tetui M, Nanyonjo A, Butt ZA, Waite NM, Vernon-Wilson E, Wong G, Grindrod K. Understanding the COVID-19 Vaccine Policy Terrain in Ontario Canada: A Policy Analysis of the Actors, Content, Processes, and Context. Vaccines (Basel) 2023; 11:vaccines11040782. [PMID: 37112694 PMCID: PMC10143674 DOI: 10.3390/vaccines11040782] [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] [Received: 02/26/2023] [Revised: 03/22/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
(1) Background: Canada had a unique approach to COVID-19 vaccine policy making. The objective of this study was to understand the evolution of COVID-19 vaccination policies in Ontario, Canada, using the policy triangle framework. (2) Methods: We searched government websites and social media to identify COVID-19 vaccination policies in Ontario, Canada, which were posted between 1 October 2020, and 1 December 2021. We used the policy triangle framework to explore the policy actors, content, processes, and context. (3) Results: We reviewed 117 Canadian COVID-19 vaccine policy documents. Our review found that federal actors provided guidance, provincial actors made actionable policy, and community actors adapted policy to local contexts. The policy processes aimed to approve and distribute vaccines while continuously updating policies. The policy content focused on group prioritization and vaccine scarcity issues such as the delayed second dose and the mixed vaccine schedules. Finally, the policies were made in the context of changing vaccine science, global and national vaccine scarcity, and a growing awareness of the inequitable impacts of pandemics on specific communities. (4) Conclusions: We found that the triad of vaccine scarcity, evolving efficacy and safety data, and social inequities all contributed to the creation of vaccine policies that were difficult to efficiently communicate to the public. A lesson learned is that the need for dynamic policies must be balanced with the complexity of effective communication and on-the-ground delivery of care.
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Affiliation(s)
- Bara’ Abdallah AlShurman
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON N2L 3G5, Canada
| | - Moses Tetui
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON N2L 3G5, Canada
- School of Pharmacy, University of Waterloo, Kitchener, ON N2G 1C5, Canada
- Department of Epidemiology and Global Health, Umeå University, 907 37 Umeå, Sweden
| | - Agnes Nanyonjo
- Lincoln International Institute for Rural Health, University of Lincoln, Brayford Way, Brayford, Pool, Lincoln LN6 7TS, UK
| | - Zahid Ahmad Butt
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON N2L 3G5, Canada
| | - Nancy M. Waite
- School of Pharmacy, University of Waterloo, Kitchener, ON N2G 1C5, Canada
| | | | - Ginny Wong
- School of Pharmacy, University of Waterloo, Kitchener, ON N2G 1C5, Canada
| | - Kelly Grindrod
- School of Pharmacy, University of Waterloo, Kitchener, ON N2G 1C5, Canada
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Nazia N, Law J, Butt ZA. Modelling the spatiotemporal spread of COVID-19 outbreaks and prioritization of the risk areas in Toronto, Canada. Health Place 2023; 80:102988. [PMID: 36791508 PMCID: PMC9922578 DOI: 10.1016/j.healthplace.2023.102988] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 12/16/2022] [Accepted: 02/09/2023] [Indexed: 02/16/2023]
Abstract
Modelling the spatiotemporal spread of a highly transmissible disease is challenging. We developed a novel spatiotemporal spread model, and the neighbourhood-level data of COVID-19 in Toronto was fitted into the model to visualize the spread of the disease in the study area within two weeks of the onset of first outbreaks from index neighbourhood to its first-order neighbourhoods (called dispersed neighbourhoods). We also model the data to classify hotspots based on the overall incidence rate and persistence of the cases during the study period. The spatiotemporal spread model shows that the disease spread to 1-4 neighbourhoods bordering the index neighbourhood within two weeks. Some dispersed neighbourhoods became index neighbourhoods and further spread the disease to their nearby neighbourhoods. Most of the sources of infection in the dispersed neighbourhood were households and communities (49%), and after excluding the healthcare institutions (40%), it becomes 82%, suggesting the expansion of transmission was from close contacts. The classification of hotspots informs high-priority areas concentrated in the northwestern and northeastern parts of Toronto. The spatiotemporal spread model along with the hotspot classification approach, could be useful for a deeper understanding of spatiotemporal dynamics of infectious diseases and planning for an effective mitigation strategy where local-level spatially enabled data are available.
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Affiliation(s)
- Nushrat Nazia
- School of Public Health Sciences, University of Waterloo, 200 University Ave W., Waterloo, ON, N2L3G1, Canada.
| | - Jane Law
- School of Public Health Sciences, University of Waterloo, 200 University Ave W., Waterloo, ON, N2L3G1, Canada; School of Planning, University of Waterloo, 200 University Ave W., Waterloo, ON, N2L3G1, Canada.
| | - Zahid Ahmad Butt
- School of Public Health Sciences, University of Waterloo, 200 University Ave W., Waterloo, ON, N2L3G1, Canada.
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Saqib K, Qureshi AS, Butt ZA. COVID-19, Mental Health, and Chronic Illnesses: A Syndemic Perspective. Int J Environ Res Public Health 2023; 20:3262. [PMID: 36833955 PMCID: PMC9962717 DOI: 10.3390/ijerph20043262] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The COVID-19 pandemic is an epidemiological and psychological crisis; what it does to the body is quite well known by now, and more research is underway, but the syndemic impact of COVID-19 and mental health on underlying chronic illnesses among the general population is not completely understood. METHODS We carried out a literature review to identify the potential impact of COVID-19 and related mental health issues on underlying comorbidities that could affect the overall health of the population. RESULTS Many available studies have highlighted the impact of COVID-19 on mental health only, but how complex their interaction is in patients with comorbidities and COVID-19, the absolute risks, and how they connect with the interrelated risks in the general population, remain unknown. The COVID-19 pandemic can be recognized as a syndemic due to; synergistic interactions among different diseases and other health conditions, increasing overall illness burden, emergence, spread, and interactions between infectious zoonotic diseases leading to new infectious zoonotic diseases; this is together with social and health interactions leading to increased risks in vulnerable populations and exacerbating clustering of multiple diseases. CONCLUSION There is a need to develop evidence to support appropriate and effective interventions for the overall improvement of health and psychosocial wellbeing of at-risk populations during this pandemic. The syndemic framework is an important framework that can be used to investigate and examine the potential benefits and impact of codesigning COVID-19/non-communicable diseases (NCDs)/mental health programming services which can tackle these epidemics concurrently.
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Affiliation(s)
- Kiran Saqib
- School of Public health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Afaf Saqib Qureshi
- Whiting School of Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Zahid Ahmad Butt
- School of Public health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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AlShurman BA, Butt ZA. Proposing a New Conceptual Syndemic Framework for COVID-19 Vaccine Hesitancy: A Narrative Review. Int J Environ Res Public Health 2023; 20:1561. [PMID: 36674314 PMCID: PMC9864682 DOI: 10.3390/ijerph20021561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Discussions regarding syndemics have dominated research in recent years. Vaccine hesitancy has also been propelled to the forefront. In this narrative review, we aim to frame a novel syndemic framework to understand the interaction between vaccine hesitancy, COVID-19, and negative health outcomes. METHODS A non-systematic electronic search was conducted in PubMed and Google Scholar. Search criteria were limited to articles published between November 2019 and June 2022. Articles related to the COVID-19 syndemic and vaccine hesitancy were included. RESULTS Our review revealed that the adherence to COVID-19 regulations-although they were effective in preventing COVID-19 transmission, cases, and deaths-created a dynamically unstable 'vicious cycle' between undesirable health, economic, and social outcomes. The "accumulation" of complex stressors decreased individuals' cognitive flexibility and hindered them from making decisions and getting vaccinated. Furthermore, it increased individuals' risk of acquiring COVID-19, losing their employment, increasing poverty, and decreasing healthcare utilization. We illustrated how the amalgamation of sociodemographic and contextual factors associated with COVID-19 might impact people's vaccine decisions, making them more hesitant toward COVID-19 vaccination. Failing to receive vaccinations increases the chances of COVID-19 transmission, hospitalization, and other negative health outcomes. CONCLUSIONS Understanding the interaction between these factors is essential to provide policymakers with inspiration to set appropriate interventions for promoting COVID-19 vaccination acceptance to decrease the overall burden of pandemics.
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Affiliation(s)
| | - Zahid Ahmad Butt
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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13
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Hassan M, Butt ZA. Applying the syndemic framework to cancer research for effective cancer control in low- and middle-income countries. Ecancermedicalscience 2023; 17:1532. [PMID: 37138967 PMCID: PMC10151077 DOI: 10.3332/ecancer.2023.1532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Indexed: 05/05/2023] Open
Abstract
Cancer burden is increasing rapidly globally, especially in low- and middle-income countries (LMICs), which already face a double burden of infectious diseases and other non-communicable diseases (NCDs). LMICs also struggle with poor social determinants of health, leading to cancer health disparities, such as delayed diagnoses and increased death rates due to cancer. Contextually, relevant research needs to be prioritised in these regions to ensure feasible, evidence-based healthcare planning and delivery for cancer prevention and control. A syndemic framework has been used to study the disease clustering of infectious diseases and NCDs across varied social contexts to understand how diseases interact adversely and how the wider environmental context and other socioeconomic factors contribute to poor health outcomes within specific populations. We propose using this model to study the 'syndemic of cancers' in the disadvantaged population of LMICs and suggest ways for the clear operationalisation of the syndemic framework through multidisciplinary evidence-generation models for the delivery of integrated, socially conscious interventions for effective cancer control.
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Affiliation(s)
- Mariam Hassan
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore 54000, Pakistan
| | - Zahid Ahmad Butt
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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14
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Lotto M, Hanjahanja-Phiri T, Padalko H, Oetomo A, Butt ZA, Boger J, Millar J, Cruvinel T, Morita PP. Ethical principles for infodemiology and infoveillance studies concerning infodemic management on social media. Front Public Health 2023; 11:1130079. [PMID: 37033062 PMCID: PMC10076562 DOI: 10.3389/fpubh.2023.1130079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/07/2023] [Indexed: 04/11/2023] Open
Abstract
Big data originating from user interactions on social media play an essential role in infodemiology and infoveillance outcomes, supporting the planning and implementation of public health actions. Notably, the extrapolation of these data requires an awareness of different ethical elements. Previous studies have investigated and discussed the adoption of conventional ethical approaches in the contemporary public health digital surveillance space. However, there is a lack of specific ethical guidelines to orient infodemiology and infoveillance studies concerning infodemic on social media, making it challenging to design digital strategies to combat this phenomenon. Hence, it is necessary to explore if traditional ethical pillars can support digital purposes or whether new ones must be proposed since we are confronted with a complex online misinformation scenario. Therefore, this perspective provides an overview of the current scenario of ethics-related issues of infodemiology and infoveillance on social media for infodemic studies.
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Affiliation(s)
- Matheus Lotto
- Department of Pediatric Dentistry, Orthodontics, and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | | | - Halyna Padalko
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Arlene Oetomo
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Zahid Ahmad Butt
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Jennifer Boger
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Jason Millar
- Faculty of Engineering, School of Engineering Design and Teaching Innovation, University of Ottawa, Ottawa, ON, Canada
| | - Thiago Cruvinel
- Department of Pediatric Dentistry, Orthodontics, and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Plinio P. Morita
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
- Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
- Centre for Digital Therapeutics, Techna Institute, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- *Correspondence: Plinio P. Morita,
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15
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Evans A, AlShurman BA, Sehar H, Butt ZA. Monkeypox: A Mini-Review on the Globally Emerging Orthopoxvirus. Int J Environ Res Public Health 2022; 19:15684. [PMID: 36497758 PMCID: PMC9737955 DOI: 10.3390/ijerph192315684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
Monkeypox is a zoonotic infectious disease belonging to the orthopoxvirus family that has predominantly occurred in West and Central Africa since it was initially discovered in 1958. In May 2022, a global outbreak of monkeypox began to occur on an international scale, with case numbers still rising as this review is being written. This mini review sought to analyze the existing literature on monkeypox published from 2017 onward to provide epidemiological context to current outbreaks. PubMed and Google Scholar databases were used to gather both peer-reviewed and grey literature on the routes of transmission, case definitions, clinical characteristics, diagnosis, management, prevention, vaccination, and epidemiology of monkeypox. Epidemiological studies indicate that the age of onset of monkeypox has increased over time. Antivirals, such as Tecovirimat and Brincidofovir, are recommended to manage confirmed cases of monkeypox. Although mass vaccination is not currently recommended, the smallpox vaccine can be used as a preventative measure for at-risk groups, such as men who have sex with men and frontline healthcare workers. Further peer-reviewed research addressing animal reservoirs and sexual transmission dynamics is needed.
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16
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Nazia N, Law J, Butt ZA. Spatiotemporal clusters and the socioeconomic determinants of COVID-19 in Toronto neighbourhoods, Canada. Spat Spatiotemporal Epidemiol 2022; 43:100534. [PMID: 36460444 PMCID: PMC9411108 DOI: 10.1016/j.sste.2022.100534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/19/2022] [Accepted: 08/24/2022] [Indexed: 12/15/2022]
Abstract
The aim of this study is to identify spatiotemporal clusters and the socioeconomic drivers of COVID-19 in Toronto. Geographical, epidemiological, and socioeconomic data from the 140 neighbourhoods in Toronto were used in this study. We used local and global Moran's I, and space-time scan statistic to identify spatial and spatiotemporal clusters of COVID-19. We also used global (spatial regression models), and local geographically weighted regression (GWR) and Multiscale Geographically weighted regression (MGWR) models to identify the globally and locally varying socioeconomic drivers of COVID-19. The global regression model identified a lower percentage of educated people and a higher percentage of immigrants in the neighbourhoods as significant predictors of COVID-19. MGWR shows the best fit model to explain the variables affecting COVID-19. The findings imply that a single intervention package for the entire area would not be an effective strategy for controlling COVID-19; a locally adaptable intervention package would be beneficial.
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Affiliation(s)
- Nushrat Nazia
- School of Public Health Sciences, University of Waterloo, 200 University Ave W., Waterloo, ON N2L3G1, Canada,Corresponding author at: School of Public Health Sciences, University of Waterloo, 200 University Ave W., Waterloo, ON N2L3G1, Canada
| | - Jane Law
- School of Public Health Sciences, University of Waterloo, 200 University Ave W., Waterloo, ON N2L3G1, Canada,School of Planning, University of Waterloo, 200 University Ave W., Waterloo, ON N2L3G1, Canada
| | - Zahid Ahmad Butt
- School of Public Health Sciences, University of Waterloo, 200 University Ave W., Waterloo, ON N2L3G1, Canada
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17
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Huang SH, Tsao SF, Chen H, Bin Noon G, Li L, Yang Y, Butt ZA. Topic Modelling and Sentiment Analysis of Tweets Related to Freedom Convoy 2022 in Canada. Int J Public Health 2022; 67:1605241. [PMID: 36387289 PMCID: PMC9649435 DOI: 10.3389/ijph.2022.1605241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/14/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives: This study aimed to investigate public discourses and sentiments regarding the Freedom Convoy in Canada on Twitter. Methods: English tweets were retrieved from Twitter API from 15 January to 14 February 2022 when the Freedom Convoy occurred. Unsupervised topic modelling and sentiment analysis were applied to identify topics and sentiments for each topic. Results: Five topics resulted from the topic modelling, including convoy support, political arguments toward the current prime minister, lifting vaccine mandates, police activities, and convoy fundraising. Overall, sentiments for each topic began with more positive or negative sentiments but approached to neutral over time. Conclusion: The results show that sentiments towards the Freedom Convoy generally tended to be positive. Five topics were identified from the data collected, and these topics highly correlated with the events of the convoy. Our study also demonstrated that a mixed approach of unsupervised machine learning techniques and manual validation could generate timely evidence.
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Affiliation(s)
- Shih-Hsio Huang
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | - Shu-Feng Tsao
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | - Helen Chen
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | - Gaya Bin Noon
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | - Lianghua Li
- Faculty of Science, University of Waterloo, Waterloo, ON, Canada
| | - Yang Yang
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | - Zahid Ahmad Butt
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
- *Correspondence: Zahid Ahmad Butt,
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18
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Hassan M, Butt ZA. Cancer research in Pakistan: Opportunities, challenges and the way forward. J Cancer Policy 2022; 34:100358. [PMID: 36007874 DOI: 10.1016/j.jcpo.2022.100358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/19/2022] [Indexed: 11/15/2022]
Abstract
Chronic disease disparities, in low and middle income countries (LMICs), need to be addressed through research to improve health equity. Most LMICs including Pakistan have a huge burden of non communicable disease (NCDs) like cancer and a high number of deaths due to cancer. National Cancer Control Programmes are recommended for countries with high cancer burden like Pakistan to ensure systematic implementation of evidence based strategies for cancer control however there is limited capacity for evidence generation through research. We describe the existing status for cancer registries and research in Pakistan and suggest a syndemic framework to prioritize contextually relevant research which can advance cancer health equity for Pakistani population.
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Affiliation(s)
- Mariam Hassan
- Clinical Research Office, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Pakistan.
| | - Zahid Ahmad Butt
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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19
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Nazia N, Law J, Butt ZA. Identifying spatiotemporal patterns of COVID-19 transmissions and the drivers of the patterns in Toronto: a Bayesian hierarchical spatiotemporal modelling. Sci Rep 2022; 12:9369. [PMID: 35672355 PMCID: PMC9172088 DOI: 10.1038/s41598-022-13403-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/24/2022] [Indexed: 01/08/2023] Open
Abstract
Spatiotemporal patterns and trends of COVID-19 at a local spatial scale using Bayesian approaches are hardly observed in literature. Also, studies rarely use satellite-derived long time-series data on the environment to predict COVID-19 risk at a spatial scale. In this study, we modelled the COVID-19 pandemic risk using a Bayesian hierarchical spatiotemporal model that incorporates satellite-derived remote sensing data on land surface temperature (LST) from January 2020 to October 2021 (89 weeks) and several socioeconomic covariates of the 140 neighbourhoods in Toronto. The spatial patterns of risk were heterogeneous in space with multiple high-risk neighbourhoods in Western and Southern Toronto. Higher risk was observed during Spring 2021. The spatiotemporal risk patterns identified 60% of neighbourhoods had a stable, 37% had an increasing, and 2% had a decreasing trend over the study period. LST was positively, and higher education was negatively associated with the COVID-19 incidence. We believe the use of Bayesian spatial modelling and the remote sensing technologies in this study provided a strong versatility and strengthened our analysis in identifying the spatial risk of COVID-19. The findings would help in prevention planning, and the framework of this study may be replicated in other highly transmissible infectious diseases.
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Affiliation(s)
- Nushrat Nazia
- School of Public Health Sciences, University of Waterloo, 200 University Ave., Waterloo, ON, N2L3G1, Canada.
| | - Jane Law
- School of Public Health Sciences, University of Waterloo, 200 University Ave., Waterloo, ON, N2L3G1, Canada
- School of Planning, University of Waterloo, 200 University Ave., Waterloo, ON, N2L3G1, Canada
| | - Zahid Ahmad Butt
- School of Public Health Sciences, University of Waterloo, 200 University Ave., Waterloo, ON, N2L3G1, Canada
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20
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Lotto M, Sá Menezes T, Zakir Hussain I, Tsao SF, Ahmad Butt Z, P Morita P, Cruvinel T. Characterization of misleading fluoride information on Instagram: An infodemiology study (Preprint). J Med Internet Res 2022; 24:e37519. [PMID: 35588055 PMCID: PMC9164089 DOI: 10.2196/37519] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/01/2022] [Accepted: 04/14/2022] [Indexed: 12/18/2022] Open
Abstract
Background Online false or misleading oral health–related content has been propagated on social media to deceive people against fluoride’s economic and health benefits to prevent dental caries. Objective The aim of this study was to characterize the false or misleading fluoride-related content on Instagram. Methods A total of 3863 posts ranked by users’ total interaction and published between August 2016 and August 2021 were retrieved by CrowdTangle, of which 641 were screened to obtain 500 final posts. Subsequently, two independent investigators analyzed posts qualitatively to define their authors’ interests, profile characteristics, content type, and sentiment. Latent Dirichlet allocation analysis topic modeling was then applied to find salient terms and topics related to false or misleading content, and their similarity was calculated through an intertopic distance map. Data were evaluated by descriptive analysis, the Mann-Whitney U test, the Cramer V test, and multiple logistic regression models. Results Most of the posts were categorized as misinformation and political misinformation. The overperforming score was positively associated with older messages (odds ratio [OR]=3.293, P<.001) and professional/political misinformation (OR=1.944, P=.05). In this context, time from publication, negative/neutral sentiment, author’s profile linked to business/dental office/news agency, and social and political interests were related to the increment of performance of messages. Although political misinformation with negative/neutral sentiments was typically published by regular users, misinformation was linked to positive commercial posts. Overall messages focused on improving oral health habits, side effects, dentifrice containing natural ingredients, and fluoride-free products propaganda. Conclusions False or misleading fluoride-related content found on Instagram was predominantly produced by regular users motivated by social, psychological, and/or financial interests. However, higher engagement and spreading metrics were associated with political misinformation. Most of the posts were related to the toxicity of fluoridated water and products frequently motivated by financial interests.
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Affiliation(s)
- Matheus Lotto
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Tamires Sá Menezes
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Irfhana Zakir Hussain
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Department of Data Science and Business Systems, School of Computing, College of Engineering and Technology, SRM Institute of Science and Technology, Kattankulathur, India
| | - Shu-Feng Tsao
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Zahid Ahmad Butt
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Plinio P Morita
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
- eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Thiago Cruvinel
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
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21
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Tsao SF, MacLean A, Chen H, Li L, Yang Y, Butt ZA. Public Attitudes During the Second Lockdown: Sentiment and Topic Analyses Using Tweets From Ontario, Canada. Int J Public Health 2022; 67:1604658. [PMID: 35264920 PMCID: PMC8900133 DOI: 10.3389/ijph.2022.1604658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/03/2022] [Indexed: 12/23/2022] Open
Abstract
Objective: This study aimed to explore topics and sentiments using tweets from Ontario, Canada, during the second wave of the COVID-19 pandemic. Methods: Tweets were collected from December 5, 2020, to March 6, 2021, excluding non-individual accounts. Dates of vaccine-related events and policy changes were collected from public health units in Ontario. The daily number of COVID-19 cases was retrieved from the Ontario provincial government’s public health database. Latent Dirichlet Allocation was used for unsupervised topic modelling. VADER was used to calculate daily and average sentiment compound scores for topics identified. Results: Vaccine, pandemic, business, lockdown, mask, and Ontario were six topics identified from the unsupervised topic modelling. The average sentiment compound score for each topic appeared to be slightly positive, yet the daily sentiment compound scores varied greatly between positive and negative emotions for each topic. Conclusion: Our study results have shown a slightly positive sentiment on average during the second wave of the COVID-19 pandemic in Ontario, along with six topics. Our research has also demonstrated a social listening approach to identify what the public sentiments and opinions are in a timely manner.
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Affiliation(s)
- Shu-Feng Tsao
- School of Public Health SciencesUniversity of Waterloo, Waterloo, ON, Canada
| | - Alexander MacLean
- Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Helen Chen
- School of Public Health SciencesUniversity of Waterloo, Waterloo, ON, Canada
| | - Lianghua Li
- Faculty of Science, University of Waterloo, Waterloo, ON, Canada
| | - Yang Yang
- School of Public Health SciencesUniversity of Waterloo, Waterloo, ON, Canada
| | - Zahid Ahmad Butt
- School of Public Health SciencesUniversity of Waterloo, Waterloo, ON, Canada
- *Correspondence: Zahid Ahmad Butt,
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22
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Saqib K, Khan AF, Butt ZA. Machine Learning Methods for Predicting Postpartum Depression: Scoping Review. JMIR Ment Health 2021; 8:e29838. [PMID: 34822337 PMCID: PMC8663566 DOI: 10.2196/29838] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Machine learning (ML) offers vigorous statistical and probabilistic techniques that can successfully predict certain clinical conditions using large volumes of data. A review of ML and big data research analytics in maternal depression is pertinent and timely, given the rapid technological developments in recent years. OBJECTIVE This study aims to synthesize the literature on ML and big data analytics for maternal mental health, particularly the prediction of postpartum depression (PPD). METHODS We used a scoping review methodology using the Arksey and O'Malley framework to rapidly map research activity in ML for predicting PPD. Two independent researchers searched PsycINFO, PubMed, IEEE Xplore, and the ACM Digital Library in September 2020 to identify relevant publications in the past 12 years. Data were extracted from the articles' ML model, data type, and study results. RESULTS A total of 14 studies were identified. All studies reported the use of supervised learning techniques to predict PPD. Support vector machine and random forest were the most commonly used algorithms in addition to Naive Bayes, regression, artificial neural network, decision trees, and XGBoost (Extreme Gradient Boosting). There was considerable heterogeneity in the best-performing ML algorithm across the selected studies. The area under the receiver operating characteristic curve values reported for different algorithms were support vector machine (range 0.78-0.86), random forest method (0.88), XGBoost (0.80), and logistic regression (0.93). CONCLUSIONS ML algorithms can analyze larger data sets and perform more advanced computations, which can significantly improve the detection of PPD at an early stage. Further clinical research collaborations are required to fine-tune ML algorithms for prediction and treatment. ML might become part of evidence-based practice in addition to clinical knowledge and existing research evidence.
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Affiliation(s)
- Kiran Saqib
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Amber Fozia Khan
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Zahid Ahmad Butt
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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23
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AlShurman BA, Khan AF, Mac C, Majeed M, Butt ZA. What Demographic, Social, and Contextual Factors Influence the Intention to Use COVID-19 Vaccines: A Scoping Review. Int J Environ Res Public Health 2021; 18:9342. [PMID: 34501932 PMCID: PMC8431323 DOI: 10.3390/ijerph18179342] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/21/2021] [Accepted: 08/31/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND During the COVID-19 crisis, an apparent growth in vaccine hesitancy has been noticed due to different factors and reasons. Therefore, this scoping review was performed to determine the prevalence of intention to use COVID-19 vaccines among adults aged 18-60, and to identify the demographic, social, and contextual factors that influence the intention to use COVID-19 vaccines. METHODS This scoping review was conducted by using the methodological framework for scoping review outlined by Arksey and O'Malley. A search strategy was carried out on four electronic databases: PubMed, Scopus, CINAHL, and PsycINFO. All peer-reviewed articles published between November 2019 and December 2020 were reviewed. Data were extracted to identify the prevalence of, and factors that influence, the intention to use COVID-19 vaccines. RESULTS A total of 48 relevant articles were identified for inclusion in the review. Outcomes presented fell into seven themes: demographics, social factors, vaccination beliefs and attitudes, vaccine-related perceptions, health-related perceptions, perceived barriers, and vaccine recommendations. Age, gender, education level, race/ethnicity, vaccine safety and effectiveness, influenza vaccination history, and self-protection from COVID-19 were the most prominent factors associated with intention to use COVID-19 vaccines. Furthermore, the majority of studies (n = 34/48) reported a relatively high prevalence of intention to get vaccinated against COVID-19, with a range from 60% to 93%. CONCLUSION This scoping review enables the creation of demographic, social, and contextual constructs associated with intention to vaccinate among the adult population. These factors are likely to play a major role in any targeted vaccination programs, particularly COVID-19 vaccination. Thus, our review suggests focusing on the development of strategies to promote the intention to get vaccinated against COVID-19 and to overcome vaccine hesitancy and refusal. These strategies could include transparent communication, social media engagement, and the initiation of education programs.
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Affiliation(s)
- Bara’ Abdallah AlShurman
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (B.A.A.); (A.F.K.); (C.M.)
| | - Amber Fozia Khan
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (B.A.A.); (A.F.K.); (C.M.)
| | - Christina Mac
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (B.A.A.); (A.F.K.); (C.M.)
| | - Meerab Majeed
- Faculty of Health Sciences, McMaster University, Hamilton, ON L8N 3Z5, Canada;
| | - Zahid Ahmad Butt
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (B.A.A.); (A.F.K.); (C.M.)
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Jeong D, Karim ME, Wong S, Wilton J, Butt ZA, Binka M, Adu PA, Bartlett S, Pearce M, Clementi E, Yu A, Alvarez M, Samji H, Velásquez García HA, Abdia Y, Krajden M, Janjua NZ. Impact of HCV infection and ethnicity on incident type 2 diabetes: findings from a large population-based cohort in British Columbia. BMJ Open Diabetes Res Care 2021; 9:9/1/e002145. [PMID: 34099439 PMCID: PMC8186745 DOI: 10.1136/bmjdrc-2021-002145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/09/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Increasing evidence indicates that chronic hepatitis C virus (HCV) infection is associated with higher risk of diabetes. Previous studies showed ethnic disparities in the disease burden of diabetes, with increased risk in Asian population. We described the incidence of type 2 diabetes related to HCV infection and assessed the concurrent impact of HCV infection and ethnicity on the risk of diabetes. RESEARCH DESIGN AND METHODS In British Columbia Hepatitis Testers Cohort, individuals were followed from HCV diagnosis to the earliest of (1) incident type 2 diabetes, (2) death or (3) end of the study (December 31, 2015). Study population included 847 021 people. Diabetes incidence rates in people with and without HCV were computed. Propensity scores (PS) analysis was used to assess the impact of HCV infection on newly acquired diabetes. PS-matched dataset included 117 184 people. We used Fine and Gray multivariable subdistributional hazards models to assess the effect of HCV and ethnicity on diabetes while adjusting for confounders and competing risks. RESULTS Diabetes incidence rates were higher among people with HCV infection than those without. The highest diabetes incidence rate was in South Asians with HCV (14.7/1000 person-years, 95% CI 12.87 to 16.78). Compared with Others, South Asians with and without HCV and East Asians with HCV had a greater risk of diabetes. In the multivariable stratified analysis, HCV infection was associated with increased diabetes risk in all subgroups: East Asians, adjusted HR (aHR) 3.07 (95% CI 2.43 to 3.88); South Asians, aHR 2.62 (95% CI 2.10 to 3.26); and Others, aHR 2.28 (95% CI 2.15 to 2.42). CONCLUSIONS In a large population-based linked administrative health data, HCV infection was associated with higher diabetes risk, with a greater relative impact in East Asians. South Asians had the highest risk of diabetes. These findings highlight the need for care and screening for HCV-related chronic diseases such as type 2 diabetes among people affected by HCV.
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Affiliation(s)
- Dahn Jeong
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Mohammad Ehsanul Karim
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Stanley Wong
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - James Wilton
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Zahid Ahmad Butt
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Mawuena Binka
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Prince Asumadu Adu
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Sofia Bartlett
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Margo Pearce
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Emilia Clementi
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Amanda Yu
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Maria Alvarez
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Hasina Samji
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - Younathan Abdia
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Mel Krajden
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Naveed Zafar Janjua
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, British Columbia, Canada
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Binka M, Butt ZA, McKee G, Darvishian M, Cook D, Wong S, Yu A, Alvarez M, Samji H, Wong J, Krajden M, Janjua NZ. Differences in risk factors for hepatitis B, hepatitis C, and human immunodeficiency virus infection by ethnicity: A large population-based cohort study in British Columbia, Canada. Int J Infect Dis 2021; 106:246-253. [PMID: 33771673 DOI: 10.1016/j.ijid.2021.03.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Addressing the needs of ethnic minorities will be key to finding undiagnosed individuals living with hepatitis B (HBV), hepatitis C (HCV), or human immunodeficiency virus (HIV). To inform screening initiatives in British Columbia (BC), Canada, the factors associated with HBV and/or HCV and/or HIV infection among different ethnic groups within a large population-based cohort were assessed. METHODS Persons diagnosed with HBV, HCV, or HIV in BC between 1990 and 2015 were grouped as East Asian, South Asian, Other Visible Minority (African, Central Asian, Latin American, Pacific Islander, West Asian, unknown ethnicity), and Not a Visible Minority, using a validated name-recognition software. Factors associated with infection within each ethnic group were assessed with multivariable multinomial logistic regression models. RESULTS Participants included 202 521 East Asians, 126 070 South Asians, 65 210 Other Visible Minorities, and 1 291 561 people who were Not a Visible Minority, 14.4%, 3.3%, 4.5%, and 6.3% of whom had HBV and/or HCV and/or HIV infections, respectively. Injection drug use was most prevalent among infection-positive people who were Not a Visible Minority (22.1%), and was strongly associated with HCV monoinfection, HBV/HCV coinfection, and HCV/HIV coinfection, but not with HBV monoinfection among visible ethnic minorities. Extreme material deprivation and social deprivation were more prevalent than injection drug use or problematic alcohol use among visible ethnic minorities. CONCLUSIONS Risk factor distributions varied among persons diagnosed with HBV and/or HCV and/or HIV of differing ethnic backgrounds, with lower substance use prevalence among visible minority populations. This highlights the need for tailored approaches to infection screening among different ethnic groups.
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Affiliation(s)
- Mawuena Binka
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.
| | - Zahid Ahmad Butt
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey McKee
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Maryam Darvishian
- British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Darrel Cook
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Stanley Wong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Maria Alvarez
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Hasina Samji
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Naveed Zafar Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Rozi S, Zahid N, Roome T, Lakhdir MPA, Sawani S, Razzak A, Butt ZA. Effectiveness of a School Based Smokeless Tobacco Intervention: A Cluster Randomized Trial. J Community Health 2020; 44:1098-1110. [PMID: 31267293 DOI: 10.1007/s10900-019-00689-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
To assess the effectiveness of intervention in improving knowledge, attitude and perception regarding smokeless tobacco (SLT) use and its harmful effects and intention to quit SLT among school going adolescents. A school-based cluster randomized control trial was carried out in 18 secondary schools targeting male and female students from grades 6 to 10 in Karachi. Primary outcome was knowledge about hazards of smokeless tobacco (SLT) and secondary outcomes were attitude and Perception about hazards of SLT, and intention to quit SLT. We enrolled 738 participants in intervention group and 589 in the control group. Mean score of knowledge significantly improved in intervention as compared to control group (P value < 0.01). Intention to quit was found to be proportionately higher (33%) in the intervention group as compared to control group. Generalized estimating equations were used to assess the association of factors with knowledge regarding harmful effects of SLT use. Significant predictors of increase in knowledge score were found in children: who had seen any anti SLT messages on social media in the past 30 days, who were getting information regarding harmful effects of SLT use in school or textbooks and who had friends using SLT. A school-based intervention was effective in increasing knowledge regarding the harmful effects of SLT use and intention to quit SLT use among school adolescents. Introduction of such educational programmes on a regular basis in schools or as part of school curriculum can have an impact on reducing prevalence of SLT use.Trial Registration NCT03418506. https://register.clinicaltrials.gov/NCT03418506 .
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Affiliation(s)
- Shafquat Rozi
- Department of Community Health Sciences, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.
| | - Nida Zahid
- Department of Surgery, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Talat Roome
- Department of Pathology, Dow University of Health Sciences, University Road, Karachi, 75270, Pakistan
| | - Maryam Pyar Ali Lakhdir
- Department of Community Health Sciences, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Sobiya Sawani
- Department of Community Health Sciences, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Anam Razzak
- Department of Pathology, Dow University of Health Sciences, University Road, Karachi, 75270, Pakistan
| | - Zahid Ahmad Butt
- School of Population and Public Health, University of British Columbia, Vancouver, V6T 1Z4, Canada
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Rossi C, Jeong D, Wong S, McKee G, Butt ZA, Buxton J, Wong J, Darvishian M, Bartlett S, Samji H, Yu A, Binka M, Alvarez M, Adu PA, Tyndall M, Krajden M, Janjua NZ. Sustained virological response from interferon-based hepatitis C regimens is associated with reduced risk of extrahepatic manifestations. J Hepatol 2019; 71:1116-1125. [PMID: 31433302 DOI: 10.1016/j.jhep.2019.07.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 06/26/2019] [Accepted: 07/22/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS HCV infection is associated with several extrahepatic manifestations (EHMs). We evaluated the impact of sustained virological response (SVR) on the risk of 7 EHMs that contribute to the burden of extrahepatic disease: type 2 diabetes mellitus, chronic kidney disease or end-stage renal disease, stroke, ischemic heart disease, major adverse cardiac events, mood and anxiety disorders, and rheumatoid arthritis. METHODS A longitudinal cohort study was conducted using data from the British Columbia Hepatitis Testers Cohort, which included ~1.3 million individuals screened for HCV. We identified all HCV-infected individuals who were treated with interferon-based therapies between 1999 and 2014. SVR was defined as a negative HCV RNA test ≥24 weeks post-treatment or after end-of-treatment, if unavailable. We computed adjusted subdistribution hazard ratios (asHR) for the effect of SVR on each EHM using competing risk proportional hazard models. Subgroup analyses by birth cohort, sex, injection drug exposure and genotype were also performed. RESULTS Overall, 10,264 HCV-infected individuals were treated with interferon, of whom 6,023 (59%) achieved SVR. Compared to those that failed treatment, EHM risk was significantly reduced among patients with SVR for type 2 diabetes mellitus (asHR 0.65; 95%CI 0.55-0.77), chronic kidney disease or end-stage renal disease (asHR 0.53; 95% CI 0.43-0.65), ischemic or hemorrhagic stroke (asHR 0.73; 95%CI 0.49-1.09), and mood and anxiety disorders (asHR 0.82; 95%CI 0.71-0.95), but not for ischemic heart disease (asHR 1.23; 95%CI 1.03-1.47), major adverse cardiac events (asHR 0.93; 95%CI 0.79-1.11) or rheumatoid arthritis (asHR 1.09; 95% CI 0.73-1.64). CONCLUSIONS SVR was associated with a reduction in the risk of several EHMs. Increased uptake of antiviral therapy may reduce the growing burden of EHMs in this population. LAY SUMMARY We estimated the rates of chronic comorbidities other than liver disease between those who were cured and those who failed treatment for hepatitis C virus (HCV) infection. Our findings showed that the rates of these non-liver diseases were largely reduced for those who were cured with interferon-based treatments. Early HCV treatments could provide many benefits in the prevention of various HCV complications beyond liver disease.
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Affiliation(s)
- Carmine Rossi
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dahn Jeong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stanley Wong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Geoffrey McKee
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zahid Ahmad Butt
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jane Buxton
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maryam Darvishian
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sofia Bartlett
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hasina Samji
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Mawuena Binka
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maria Alvarez
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Prince Asumadu Adu
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Tyndall
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Naveed Zafar Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
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Ullah I, Ahmad W, Shah AA, Shahzada A, Tahir Z, Qazi O, Hasan F, Ayub N, Badar M, Butt ZA, Basit S. Detection of rifampicin resistance of Mycobacterium tuberculosis using multiplex allele specific polymerase chain reaction (MAS-PCR) in Pakistan. Infect Genet Evol 2019; 71:42-46. [PMID: 30890494 DOI: 10.1016/j.meegid.2019.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 02/10/2019] [Accepted: 03/14/2019] [Indexed: 10/27/2022]
Abstract
Drug resistance in tuberculosis (TB) is a major public health challenge in developing countries such as Pakistan. Multiplex allele specific polymerase chain reaction (MAS-PCR) is a DNA amplification method that could contribute to rapid detection and control of drug resistant tuberculosis (DR-TB) in Pakistan. The purpose of this study was to test the utility of MAS-PCR to detect resistance in Pakistan. Drug susceptibility testing (DST) was used to identify rifampicin resistant and susceptible clinical isolates from TB cases in Pakistan. MAS-PCR was used to detect the most frequent mutations in the gene rpoB among 213 resistant and 37 susceptible isolates. Among 213 clinical isolates, MAS-PCR identified mutation D435Y (Asp435Tyr) in 24 (11.3%) cases, H445Y (His445Tyr) in 14 (6.6%), S450L (Ser450Leu) in 124 (58.2%) and S450W (Ser450Trp) in 18 (8.4%) cases. MAS-PCR did not detect known mutations in 33 (15.5%) cases. Among 12 cases, a novel mutation at codon 434 (Met434Ile) and a common variant at codon 435 (Asp435Tyr) was detected in rpoB gene which is indicative of double mutation. In 4 isolates, a novel mutation at codon 432 (Gln432Pro) was identified. In an additional 4 isolates, mutations Met434Val and His445Asn were identified. Moreover, a mutation in rpoB (Leu452Pro) was found in 5 isolates. DNA sequencing confirmed the absence of mutations in rpoB in the 8 remaining isolates. MAS-PCR had 88.3% sensitivity and 100% specificity using DST as the reference, which suggested that this method could be implemented as an initial marker for screening of multi-drug resistant tuberculosis (MDR-TB) in Pakistan.
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Affiliation(s)
- Irfan Ullah
- Gomal Centre of Biochemistry and Biotechnology, Gomal University, Dera Ismail Khan, Khyber Pakhtunkhwa, Pakistan; Programmatic Management of Drug resistant TB Unit, TB Culture Laboratory, Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Khyber Pakhtunkhwa, Pakistan.
| | - Waqas Ahmad
- Department of Mathematic, University of Science and Technology, Bannu, Khyber Pakhtunkhwa, Pakistan
| | - Aamer Ali Shah
- Department of Microbiology, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Amir Shahzada
- Nutrition Division, National Institute of Health, Islamabad, Pakistan
| | - Zarfishan Tahir
- Department of Bacteriology, Institute of Public Health, Jail Road, Lahore, Pakistan
| | - Obaidullah Qazi
- Department of Bacteriology, Institute of Public Health, Jail Road, Lahore, Pakistan
| | - Fariha Hasan
- Department of Microbiology, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Najma Ayub
- Department of Microbiology, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Muhammad Badar
- Gomal Centre of Biochemistry and Biotechnology, Gomal University, Dera Ismail Khan, Khyber Pakhtunkhwa, Pakistan
| | - Zahid Ahmad Butt
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sulman Basit
- Center for genetics and inherited diseases, Taibah University Almadinah Almunawwarrah, Saudi Arabia
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Kyu HH, Maddison ER, Henry NJ, Mumford JE, Barber R, Shields C, Brown JC, Nguyen G, Carter A, Wolock TM, Wang H, Liu PY, Reitsma M, Ross JM, Abajobir AA, Abate KH, Abbas K, Abera M, Abera SF, Abera Hareri H, Ahmed M, Alene KA, Alvis-Guzman N, Amo-Adjei J, Andrews J, Ansari H, Antonio CA, Anwari P, Asayesh H, Atey TM, Atre S, Barac A, Beardsley J, Bedi N, Bensenor I, Beyene AS, Butt ZA, Cardona PJ, Christopher D, Dandona L, Dandona R, Deribe K, Deribew A, Ehrenkranz R, El Sayed Zaki M, Endries A, Feyissa TR, Fischer F, Gai R, Garcia-Basteiro AL, Gebrehiwot TT, Gesesew H, Getahun B, Gona P, Goodridge A, Gugnani H, Haghparast-Bidgoli H, Hailu GB, Hassen HY, Hilawe E, Horita N, Jacobsen KH, Jonas JB, Kasaeian A, Kedir MS, Kemmer L, Khader Y, Khan E, Khang YH, Khoja AT, Kim YJ, Koul P, Koyanagi A, Krohn KJ, Kumar GA, Kutz M, Lodha R, Magdy And El Razek H, Majdzadeh R, Manyazewal T, Memish Z, Mendoza W, Mezgebe HB, Mohammed S, Ogbo FA, Oh IH, Oren E, Osgood-Zimmerman A, Pereira D, Plass D, Pourmalek F, Qorbani M, Rafay A, Rahman M, Rai RK, Rao PC, Ray SE, Reiner R, Reinig N, Safiri S, Salomon JA, Sandar L, Sartorius B, Shamsizadeh M, Shey M, Shifti DM, Shore H, Singh J, Sreeramareddy CT, Swaminathan S, Swartz SJ, Tadese F, Tedla BA, Tegegne BS, Tessema B, Topor-Madry R, Ukwaja KN, Uthman OA, Vlassov V, Vollset SE, Wakayo T, Weldegebreal S, Westerman R, Workicho A, Yonemoto N, Yoon SJ, Yotebieng M, Naghavi M, Hay SI, Vos T, Murray CJL. The global burden of tuberculosis: results from the Global Burden of Disease Study 2015. Lancet Infect Dis 2018; 18:261-284. [PMID: 29223583 PMCID: PMC5831985 DOI: 10.1016/s1473-3099(17)30703-x] [Citation(s) in RCA: 202] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/30/2017] [Accepted: 10/02/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND An understanding of the trends in tuberculosis incidence, prevalence, and mortality is crucial to tracking of the success of tuberculosis control programmes and identification of remaining challenges. We assessed trends in the fatal and non-fatal burden of tuberculosis over the past 25 years for 195 countries and territories. METHODS We analysed 10 691 site-years of vital registration data, 768 site-years of verbal autopsy data, and 361 site-years of mortality surveillance data using the Cause of Death Ensemble model to estimate tuberculosis mortality rates. We analysed all available age-specific and sex-specific data sources, including annual case notifications, prevalence surveys, and estimated cause-specific mortality, to generate internally consistent estimates of incidence, prevalence, and mortality using DisMod-MR 2.1, a Bayesian meta-regression tool. We assessed how observed tuberculosis incidence, prevalence, and mortality differed from expected trends as predicted by the Socio-demographic Index (SDI), a composite indicator based on income per capita, average years of schooling, and total fertility rate. We also estimated tuberculosis mortality and disability-adjusted life-years attributable to the independent effects of risk factors including smoking, alcohol use, and diabetes. FINDINGS Globally, in 2015, the number of tuberculosis incident cases (including new and relapse cases) was 10·2 million (95% uncertainty interval 9·2 million to 11·5 million), the number of prevalent cases was 10·1 million (9·2 million to 11·1 million), and the number of deaths was 1·3 million (1·1 million to 1·6 million). Among individuals who were HIV negative, the number of incident cases was 8·8 million (8·0 million to 9·9 million), the number of prevalent cases was 8·9 million (8·1 million to 9·7 million), and the number of deaths was 1·1 million (0·9 million to 1·4 million). Annualised rates of change from 2005 to 2015 showed a faster decline in mortality (-4·1% [-5·0 to -3·4]) than in incidence (-1·6% [-1·9 to -1·2]) and prevalence (-0·7% [-1·0 to -0·5]) among HIV-negative individuals. The SDI was inversely associated with HIV-negative mortality rates but did not show a clear gradient for incidence and prevalence. Most of Asia, eastern Europe, and sub-Saharan Africa had higher rates of HIV-negative tuberculosis burden than expected given their SDI. Alcohol use accounted for 11·4% (9·3-13·0) of global tuberculosis deaths among HIV-negative individuals in 2015, diabetes accounted for 10·6% (6·8-14·8), and smoking accounted for 7·8% (3·8-12·0). INTERPRETATION Despite a concerted global effort to reduce the burden of tuberculosis, it still causes a large disease burden globally. Strengthening of health systems for early detection of tuberculosis and improvement of the quality of tuberculosis care, including prompt and accurate diagnosis, early initiation of treatment, and regular follow-up, are priorities. Countries with higher than expected tuberculosis rates for their level of sociodemographic development should investigate the reasons for lagging behind and take remedial action. Efforts to prevent smoking, alcohol use, and diabetes could also substantially reduce the burden of tuberculosis. FUNDING Bill & Melinda Gates Foundation.
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Habiba U, Ormsby GM, Butt ZA, Afghani T, Asif M. Knowledge and practices of teachers associated with eye health of primary school children in Rawalpindi, Pakistan. Taiwan J Ophthalmol 2017; 7:28-33. [PMID: 29018751 PMCID: PMC5525601 DOI: 10.4103/tjo.tjo_11_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Teachers' perspectives on eye health can be limited, particularly in developing countries. The aim of this study was to assess teachers' knowledge and practices associated with eye health of primary students in Rawalpindi, Pakistan. METHODS This was a cross-sectional survey of primary school teachers. Simple random sampling technique was used to select 443 participants from 34 private and 17 public schools. A self-administered questionnaire was used. RESULTS Teachers' knowledge ranged from "high" (35.89%), "moderate" (49.89%), and "low" (14.22%). Teachers' practices associated with students' eye health ranged from "high" (10.16%), "moderate" (23.02%), and "low" (66.82%). The teachers' knowledge index scores increased 4.28 points with successive age groups and increased 2.41 points with each successive level of education. For teachers whose close relatives experienced eye disease, their knowledge index score was 4.51 points higher than those teachers whose relatives never had any eye disease. Teachers' age, education level, and their close relatives experiencing eye disease were significant predictors of their knowledge (R2 = 0.087, P < 0.001). Female teachers' practices index score was 10.35 points higher than the male teachers and public school teachers had 10.13 points higher than the private school teachers. Teachers' gender and type of school were significant predictors of their practices (R2 = 0.06, P < 0.001). CONCLUSION There was a significant gap among primary school teachers' knowledge and practices related to students' eye health. Innovative strategies are needed to improve how teachers address students' eye health issues in the classroom.
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Affiliation(s)
- Ume Habiba
- Department of Public Health, Directorate of Medical Sciences, Government College University, Faisalabad, Pakistan.,Al-Shifa School of Public Health, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Gail M Ormsby
- Avondale College of Higher Education and Lifestyle Research Centre, NSW Cooranbong, Australia.,Centre for Eye Research Australia, University of Melbourne, East Melbourne, Australia
| | - Zahid Ahmad Butt
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Tayyab Afghani
- Al-Shifa School of Public Health, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Muhammad Asif
- Department of Public Health, Directorate of Medical Sciences, Government College University, Faisalabad, Pakistan.,Al-Shifa School of Public Health, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
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Butt ZA, Shrestha N, Wong S, Kuo M, Gesink D, Gilbert M, Wong J, Yu A, Alvarez M, Samji H, Buxton JA, Johnston JC, Cook VJ, Roth D, Consolacion T, Murti M, Hottes TS, Ogilvie G, Balshaw R, Tyndall MW, Krajden M, Janjua NZ. A syndemic approach to assess the effect of substance use and social disparities on the evolution of HIV/HCV infections in British Columbia. PLoS One 2017; 12:e0183609. [PMID: 28829824 PMCID: PMC5568727 DOI: 10.1371/journal.pone.0183609] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 08/08/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Co-occurrence of social conditions and infections may affect HIV/HCV disease risk and progression. We examined the changes in relationship of these social conditions and infections on HIV and hepatitis C virus (HCV) infections over time in British Columbia during 1990-2013. METHODS The BC Hepatitis Testers Cohort (BC-HTC) includes ~1.5 million individuals tested for HIV or HCV, or reported as a case of HCV, HIV, HBV, or tuberculosis linked to administrative healthcare databases. We classified HCV and HIV infection status into five combinations: HIV-/HCV-, HIV+monoinfected, HIV-/HCV+seroconverters, HIV-/HCV+prevalent, and HIV+/HCV+. RESULTS Of 1.37 million eligible individuals, 4.1% were HIV-/HCV+prevalent, 0.5% HIV+monoinfected, 0.3% HIV+/HCV+ co-infected and 0.5% HIV-/HCV+seroconverters. Overall, HIV+monoinfected individuals lived in urban areas (92%), had low injection drug use (IDU) (4%), problematic alcohol use (4%) and were materially more privileged than other groups. HIV+/HCV+ co-infected and HIV-/HCV+seroconverters were materially most deprived (37%, 32%), had higher IDU (28%, 49%), problematic alcohol use (14%, 17%) and major mental illnesses (12%, 21%). IDU, opioid substitution therapy, and material deprivation increased in HIV-/HCV+seroconverters over time. In multivariable multinomial regression models, over time, the odds of IDU declined among HIV-/HCV+prevalent and HIV+monoinfected individuals but not in HIV-/HCV+seroconverters. Declines in odds of problematic alcohol use were observed in HIV-/HCV+seroconverters and coinfected individuals over time. CONCLUSIONS These results highlight need for designing prevention, care and support services for HIV and HCV infected populations based on the evolving syndemics of infections and social conditions which vary across groups.
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Affiliation(s)
- Zahid Ahmad Butt
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nabin Shrestha
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stanley Wong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Margot Kuo
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mark Gilbert
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Jason Wong
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Maria Alvarez
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Hasina Samji
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Jane A. Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - James C. Johnston
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Victoria J. Cook
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - David Roth
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Theodora Consolacion
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Michelle Murti
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Fraser Health, Surrey, British Columbia, Canada
| | - Travis S. Hottes
- BCCDC Public Health Laboratory, Vancouver, British Columbia, Canada
| | - Gina Ogilvie
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Robert Balshaw
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Mark W. Tyndall
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Mel Krajden
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- BCCDC Public Health Laboratory, Vancouver, British Columbia, Canada
| | - Naveed Z. Janjua
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
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Janjua NZ, Islam N, Wong J, Yoshida EM, Ramji A, Samji H, Butt ZA, Chong M, Cook D, Alvarez M, Darvishian M, Tyndall M, Krajden M. Shift in disparities in hepatitis C treatment from interferon to DAA era: A population-based cohort study. J Viral Hepat 2017; 24:624-630. [PMID: 28130810 DOI: 10.1111/jvh.12684] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 12/22/2016] [Indexed: 12/15/2022]
Abstract
We evaluated the shift in the characteristics of people who received interferon-based hepatitis C virus (HCV) treatments and those who received recently introduced direct-acting antivirals (DAAs) in British Columbia (BC), Canada. The BC Hepatitis Testers Cohort includes 1.5 million individuals tested for HCV or HIV, or reported cases of hepatitis B and active tuberculosis in BC from 1990 to 2013 linked to medical visits, hospitalization, cancer, prescription drugs and mortality data. This analysis included all patients who filled at least one prescription for HCV treatment until 31 July 2015. HCV treatments were classified as older interferon-based treatments including pegylated interferon/ribavirin (PegIFN/RBV) with/without boceprevir or telaprevir, DAAs with RBV or PegIFN/RBV, and newer interferon-free DAAs. Of 11 886 people treated for HCV between 2000 and 2015, 1164 (9.8%) received interferon-free DAAs (ledipasvir/sofosbuvir: n=1075; 92.4%), while 452 (3.8%) received a combination of DAAs and RBV or PegIFN/RBV. Compared to those receiving interferon-based treatment, people with HIV co-infection (adjusted odds ratio [aOR]: 2.96, 95% CI: 2.31-3.81), cirrhosis (aOR: 1.77, 95% CI: 1.45-2.15), decompensated cirrhosis (aOR: 1.72, 95% CI: 1.31-2.28), diabetes (aOR: 1.30, 95% CI: 1.10-1.54), a history of injection drug use (aOR: 1.34, 95% CI: 1.09-1.65) and opioid substitution therapy (aOR: 1.30, 95% CI: 1.01-1.67) were more likely to receive interferon-free DAAs. Socio-economically marginalized individuals were significantly less likely (most deprived vs most privileged: aOR: 0.71, 95% CI: 0.58-0.87) to receive DAAs. In conclusion, there is a shift in prescription of new HCV treatments to previously excluded groups (eg HIV-co-infected), although gaps remain for the socio-economically marginalized populations.
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Affiliation(s)
- N Z Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - N Islam
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - J Wong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - E M Yoshida
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - A Ramji
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - H Samji
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Z A Butt
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - M Chong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - D Cook
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - M Alvarez
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - M Darvishian
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - M Tyndall
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - M Krajden
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
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Buledi R, Butt ZA, Ahmed J, Alizai AA. Status of cold chain in routine immunisation centres of the Expanded Programme on Immunisation in Quetta, Pakistan. J PAK MED ASSOC 2017; 67:739-744. [PMID: 28507363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To determine the status of cold chain and knowledge and practices of health workers about cold chain maintenance in routine immunisation health centres. METHODS This cross-sectional study was conducted in Quetta, Pakistan, from May to July 2012, and comprised health facilities in the district. We interviewed the staff responsible for vaccine storage and cold chain maintenance and used a checklist to assess cold chain maintenance of routine expanded programme on immunisation vaccines. SPSS 16 was used for data analysis.. RESULTS Of the 42 health facilities, staff of 13(30%) wrongly indicated that measles and Bacillus Calmette-Guérin were cold sensitive vaccines. Temperature of the ice-lined refrigerators was not maintained twice daily in 18(43%) centres. There were no voltage stabilisers and standby power generators in 31(74%) and 38(90%) centres, respectively. Vaccine arrangement was found to be inappropriate in ice-lined refrigerators of 38(90%) centres and ice packs were incorrectly used in carriers in 22(52%) centres. Vaccine stock was not charted in 39(93%) centres. Moreover, 4(10%) facilities did not have dedicated expanded programme on immunisation rooms whereas about 5(12%) and 33(79%) had no vaccinator and separate expanded programme on immunisation incharge appointed. Also, 32(76%) centres did not have a female vaccinator appointed. CONCLUSIONS Although the majority of health staff had adequate knowledge, there were weaknesses in practice of maintaining the cold chain.
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Affiliation(s)
- Rahim Buledi
- Provincial Health Department, Government of Baluchistan, Pakistan
| | - Zahid Ahmad Butt
- Department of Public Health Pakistan Institute of Ophthalmology Al Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Jamil Ahmed
- Department of Family and Community Medicine College of Medicine and Medical Sciences Arabian Gulf University, Bahrain
| | - Aamir Akram Alizai
- Country Nutrition Coordinator, Islamabad, Pakistan MERLIN (Medical Emergency Relief International)
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Ullah I, Javaid A, Masud H, Ali M, Basit A, Ahmad W, Younis F, Yasmin R, Khan A, Jabbar A, Husain M, Butt ZA. Rapid detection of Mycobacterium tuberculosis and rifampicin resistance in extrapulmonary tuberculosis and sputum smear-negative pulmonary suspects using Xpert MTB/RIF. J Med Microbiol 2017; 66:412-418. [PMID: 28425873 DOI: 10.1099/jmm.0.000449] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is a serious public health problem in developing countries such as Pakistan. Rapid diagnosis of TB and detection of drug resistance are very important for timely and appropriate management of multidrug-resistant TB (MDR-TB). OBJECTIVE The purpose of this study was to determine the diagnostic efficacy of the Xpert MTB/RIF assay for rapid diagnosis of TB and detection of rifampicin (RIF) resistance in extrapulmonary and smear-negative pulmonary TB suspects. METHODS A total of 98 bronchoalveolar lavage fluid (BALF) and 168 extrapulmonary specimens were processed by Xpert MTB/RIF. Culture results are considered as the gold standard for diagnosis of TB, and drug susceptibility testing for detection of RIF resistance. Diagnostic efficacy was measured in terms of sensitivity, specificity and positive and negative predictive values. RESULTS The Xpert MTB/RIF assay detected 40 (40.8 %) of 98 BALF of presumptive pulmonary TB and 60 (35.7 %) of 168 extrapulmonary specimens. Sensitivity and specificity of the Xpert MTB/RIF assay for detection of TB was 86 and 88.4 %, respectively. The positive predictive value was 71.5 % while negative predictive value was 95.1 %. CONCLUSION The Xpert MTB/RIF assay is a rapid and simple technique with high sensitivity and specificity for diagnosing TB and detecting drug resistance in extrapulmonary and smear-negative TB cases.
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Affiliation(s)
- Irfan Ullah
- Programmatic Management of Drug resistant TB Unit, TB Culture Laboratory, Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Pakistan.,Department of Microbiology, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Arshad Javaid
- Programmatic Management of Drug resistant TB Pulmonology, Lady Reading Hospital, Peshawar, Pakistan
| | - Haleema Masud
- Al-Shifa School of Public Health, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Mazhar Ali
- Programmatic Management of Drug resistant TB Pulmonology, Lady Reading Hospital, Peshawar, Pakistan
| | - Anila Basit
- Programmatic Management of Drug resistant TB Pulmonology, Lady Reading Hospital, Peshawar, Pakistan
| | - Waqas Ahmad
- Department of Mathematics, University of Science and Technology, Bannu, Pakistan
| | - Faisal Younis
- Programmatic Management of Drug resistant TB Unit, TB Culture Laboratory, Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Pakistan
| | - Rehana Yasmin
- Department of Animal Sciences, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Afsar Khan
- Programmatic Management of Drug resistant TB Pulmonology, Lady Reading Hospital, Peshawar, Pakistan
| | - Abdul Jabbar
- Department of Medical lab Technology, University of Haripur, Haripur, Pakistan
| | - Masroor Husain
- Department of Biotechnology, University of Science and Technology, Bannu, Pakistan
| | - Zahid Ahmad Butt
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Rozi S, Butt ZA, Zahid N, Wasim S, Shafique K. Association of tobacco use and other determinants with pregnancy outcomes: a multicentre hospital-based case-control study in Karachi, Pakistan. BMJ Open 2016; 6:e012045. [PMID: 27650766 PMCID: PMC5051420 DOI: 10.1136/bmjopen-2016-012045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The study aimed to identify the effects of maternal tobacco consumption during pregnancy and other factors on birth outcomes and obstetric complications in Karachi, Pakistan. DESIGN A multicentre hospital-based case-control study. SETTING Four leading maternity hospitals of Karachi. PARTICIPANTS A random sample of 1275 women coming to the gynaecology and obstetric department of selected hospitals for delivery was interviewed within 48 hours of delivery from wards. Cases were women with adverse birth outcomes and obstetric complications, while controls were women who had normal uncomplicated delivery. PRIMARY AND SECONDARY OUTCOME MEASURES Adverse birth outcomes (preterm delivery, low birth weight, stillbirth, low Apgar score) and obstetric complications (antepartum haemorrhage, caesarean section, etc). RESULTS Final multiple logistic regression analysis revealed that with every 1 year increase in age the odds of being a case was 1.03 times as compared with being a control. Tobacco use (adjusted OR (aOR): 2.24; 95% CI 1.56 to 3.23), having no slits in the kitchen (proxy indicator for indoor air pollution) (aOR=1.90; 95% CI 1.05 to 3.43), gravidity (aOR=0.83; 95% CI 0.73 to 0.93), non-booked hospital cases (aOR=1.87; 95% CI 1.38 to 2.74), history of stillbirth (aOR=4.06; 95% CI 2.36 to 6.97), miscarriages (aOR=1.91; 95% CI 1.27 to 2.85) and preterm delivery (aOR=6.04; 95% CI 2.52 to 14.48) were significantly associated with being a case as compared with control. CONCLUSIONS This study suggests that women who had adverse pregnancy outcomes were more likely to have exposure to tobacco, previous history of adverse birth outcomes and were non-booked cases. Engagement of stakeholders in tobacco control for providing health education, incorporating tobacco use in women in the tobacco control policy and designing interventions for tobacco use cessation is warranted. Prenatal care and health education might help in preventing such adverse events.
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Affiliation(s)
- Shafquat Rozi
- Department of Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan
| | - Zahid Ahmad Butt
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nida Zahid
- Department of Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan
| | - Saba Wasim
- Faculty of Biostatistics, College of Science and Health Professions, King Saud Bin Abdulaziz University, Riyadh, Saudi Arabia
| | - Kashif Shafique
- School of Public Health, Dow University of Health Sciences, Karachi, Sindh, Pakistan
- Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK
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Janjua NZ, Butt ZA, Mahmood B, Altaf A. Towards safe injection practices for prevention of hepatitis C transmission in South Asia: Challenges and progress. World J Gastroenterol 2016; 22:5837-5852. [PMID: 27433097 PMCID: PMC4932219 DOI: 10.3748/wjg.v22.i25.5837] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 06/05/2016] [Accepted: 06/15/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To summarize the available information about injection use and its determinants in the South Asian region.
METHODS: We searched published and unpublished literature on injection safety in South Asia published during 1995-2016 using the keywords “injection”“unsafe injection” and “immunization injection” and combined these with each of the countries and/or their respective states or provinces in South Asia. We used a standardized questionnaire to abstract the following data from the articles: the annual number of injections per capita, the proportion of injections administered with a reused syringe or needle, the distribution of injections with respect to prescribers and providers and determinants of injection use.
RESULTS: Although information is very limited for certain countries (i.e., Bhutan, Maldives and Sri Lanka), healthcare injection use is very common across South Asia, with cross-country rates ranging from 2.4 to 13.6 injections/person/year. Furthermore, recent studies show that 5% to 50% of these injections are provided with reused syringes, thus creating potential to transmission of blood-borne pathogens. Qualified and unqualified practitioners, especially in the private sector, are the major drivers behind injection use, but patients also prefer injections, especially among the rural, poor or uneducated in certain countries. According to available data, Pakistan and India have recently taken steps towards achieving safe injection. Potential interventions include the introduction of reuse prevention devices, and patient-, community- and patient/community and provider-centered interventions to change population and practitioner behavior.
CONCLUSION: Injection use is common in South Asian countries. Multilevel interventions aiming at patients, providers and the healthcare system are needed to reduce injection use and reuse.
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Saeed A, Butt ZA, Malik T. INVESTIGATION OF MEASLES OUTBREAK IN A DISTRICT OF BALOCHISTAN PROVINCE, PAKISTAN. J Ayub Med Coll Abbottabad 2015; 27:900-903. [PMID: 27004349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Measles is a communicable viral disease which is a major public health problem and a leading cause of morbidity and mortality in the developing countries including Pakistan with implications for outbreaks. An outbreak was reported from Ibrahim Khan Village of Manzari union council (UC), Pishin District by medical officer during polio campaign on 15th April 2014. A team was sent to investigate the outbreak and suggest control measures. METHODS Rapid assessment of outbreak was done by collecting data from house-to-house from April 16th-20th, 2014. Case was defined as "a person of any age, resident of village Ibrahim Khan village with non-vesicular maculopapular rash and fever along with one of the symptoms of cough, coryza and conjunctivitis from April 4th-20th, 2014". Routine immunization (RI) was assessed through recall and immunization cards and BCG scars were checked. Line list was developed and data was analyzed. RESULTS Fifty-five cases (attack rate = 11.27%) including 4 deaths (Case Fatality Rates = 7.27%) were found. Mean age of children was 47 months (4-132 Months). Age-group 0-5 years was most affected (n = 48, 87.27%). Along-with maculopapular rash and fever. Other predominant symptoms were: coryza (n = 52, 95%), conjunctivitis (n = 51, 92%) and pneumonia (n = 42, 77%). RI status assessment showed that none of these children had been immunized. About 56.36% of the respondents were unaware about RI, 16.36% mentioned that vaccinator had not visited their homes, 14.54% reported that health facility is far away and 12.72% reported that even if they could get access to a health facility, the vaccines were not available. CONCLUSION Functionalization of EPI centre, vaccinations of all children and mass education was strongly recommended. Surveillance system for vaccine preventable diseases (VPDs) should be strengthened to prevent such outbreaks. Outreach activity must be carried out regularly to reach scattered population.
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Roz S, Ahmad Butt Z, Wasim S, Zahid N. Factors associated with adverse pregnancy outcomes and obstetric complications: a case control study. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv176.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Maleki K, Hamadeh RR, Gholami J, Mandil A, Hamid S, Butt ZA, Bin Saeed A, El Kheir DYM, Saleem M, Maqsoud S, Safi N, Abdul-Majeed BA, Majdzadeh R. Correction: The Knowledge Translation Status in Selected Eastern-Mediterranean Universities and Research Institutes. PLoS One 2015; 10:e0130916. [PMID: 26070090 PMCID: PMC4467493 DOI: 10.1371/journal.pone.0130916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Saeed A, Butt ZA. Assessment of the work environment of faculty of a Medical College in Pakistan. J Ayub Med Coll Abbottabad 2014; 26:577-581. [PMID: 25672191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Extensive research is done on nursing work environments but less is known about the job conditions and environments of other health professionals. This study was aimed to fill this information gap by highlighting the factors affecting the work environment and stressors causing turnover of staff. METHODS A cross sectional study was conducted in Bolan Medical College Quetta for the assessment of working environment of the faculty from 22nd April to 22nd July 2012. All permanent teaching staff was included. A structured questionnaire was adopted fromI health sciences association of Alberta (HSSA), 2006 work Environment Survey. An observational check list for assessment of the physical environment /infrastructure and other general physical stuff was used. RESULTS The faculty menibers were-not-satisfied with the security and safety of their work place but were satisfied with salaries, employer, and management. Work teams and relationship between employees and employers were respectful with good communication. Majority found their work times stressful and opportunities for on job trainings and professional development, adequate tools, equipment and conditions were mostly lacking. CONCLUSIONS The overall working environment is not that good and few areas need serious attention like: professional development, trainings, adequate equipment, and security.
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Usman S, Butt ZA, Rattani S, Somani N. Application of Neurobiologic Risk Score in a tertiary care hospital in Pakistan. J Pediatr Nurs 2007; 22:419-23. [PMID: 17889736 DOI: 10.1016/j.pedn.2007.08.014] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Many health-care institutions are equipped to provide high-quality care to high-risk neonates. Purpose of this study was to assess validity of a tool using Neurobiologic Risk Score in our setting. This tool is applicable in our setting, although further studies should be initiated to determine development delay.
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Affiliation(s)
- Shamim Usman
- School of Nursing, The Aga Khan University, Karachi, Pakistan.
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Butt ZA, Strauss ME. Relationship of family and personal history to the occurrence of depression in persons with Alzheimer's disease. Am J Geriatr Psychiatry 2001; 9:249-54. [PMID: 11481132] [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] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
The authors tested the associations of family history and personal history of depression with mood disorders among patients with Alzheimer's disease (AD; N=161). Considered individually, a positive family history and a positive personal history each conferred increased risk for depression in AD. Conjointly, neither family nor personal history accounted for a substantial amount of the variance in syndromal depression after the onset of AD. Most depressed AD patients in this sample did not have a positive family history or a previous episode of depression. Our understanding of the etiology and course of depression and dementia may be augmented with further neuropsychological and brain-imaging studies of the neuropathological substrates shared by these illnesses.
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Affiliation(s)
- Z A Butt
- University Alzheimer Center, Department of Neurology and Research Institute, University Hospitals of Cleveland and Case Western Reserve University, OH, USA.
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Stern SL, Williams T, Dixon SL, Clement JA, Butt ZA, Schwartzbaum JA, Busch K. Do health professionals' attitudes interfere with the treatment of depression? Depress Anxiety 2000; 9:151-5. [PMID: 10431679] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
Might the attitudes of health care professionals help to explain why most persons with a depressive disorder do not receive adequate care? To assess this question, the authors surveyed the faculty and staff of a midwestern university. One hundred percent of the social workers who responded found psychotherapy or counseling to be extremely or quite effective in treating persons with a major depressive episode, compared to 55% of the psychologists and 31% of the psychiatrists. For medication, the corresponding figures were 88% of psychiatrists, 64% of psychologists, and 46% of social workers. Many respondents noted problems with interprofessional communication, while most psychiatrists felt that individuals treated by two or more professionals for their depression usually receive poorer care. If future studies indicate that nonmedical therapists who view antidepressants as relatively ineffective are less likely to refer depressed clients for medication evaluation, these findings might help to explain why many depressed individuals who could benefit from medication do not receive it. Concerns about interprofessional communication, as well as psychiatrists' beliefs about the quality of care received by persons treated by more than one professional, might also explain why joint treatment occurs less often than would be desirable. The authors discuss some of the implications that these findings may have for the education of health care professionals.
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Affiliation(s)
- S L Stern
- Department of Psychiatry, University of Texas Health Science Center at San Antonio 78284-7792, USA.
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Bell RWD, Butt ZA, Gardner RFM. Letter. Eye (Lond) 1997. [DOI: 10.1038/eye.1997.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Dunlop MG, Farrington SM, Bubb VJ, Cunningham C, Wright M, Curtis LJ, Butt ZA, Wright E, Fleck BW, Redhead D, Mitchell R, Rainey JB, Macintyre IM, Carter DC, Wyllie AH. Extracolonic features of familial adenomatous polyposis in patients with sporadic colorectal cancer. Br J Cancer 1996; 74:1789-95. [PMID: 8956794 PMCID: PMC2077219 DOI: 10.1038/bjc.1996.631] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
We have investigated the occurrence of attenuated extracolonic manifestations (AEMs) of familial adenomatous polyposis (FAP) in patients with non-polyposis colorectal cancer. In a prospective case-control study, we observed that significantly more colorectal cancer patients exhibited AEM than did age and sex-matched controls (19.5% vs 7.5%, P < 0.004). However patients with AEMs do not have occult FAP, as we found no heterozygous adenomatous polyposis coli (APC) gene mutations despite extensive analysis of constitutional DNA. Genome-wide DNA replication errors (RERs) occur in a proportion of colorectal cancers, particularly right-sided lesions and in almost all tumours from hereditary non-polyposis colorectal cancer (HNPCC) patients. As AEMs have been reported in familial colon cancer cases, we investigated the relationship of AEMs to tumour RER phenotype. There was indeed an excess of AEMs in patients with right-sided tumours (30.2% of 53 patients vs 14.7% of 116 patients, P < 0.03) and in those with RER tumours (3 out of 12 patients with RER tumours vs none out of 21 patients with non-RER tumours, P < 0.05). Two patients with AEM were from HNPCC families compared with none of those without AEM (P < 0.05). The association of AEMs with colorectal cancer is intriguing, and we speculate that it may be a manifestation of mutational mosaicism of the APC gene, perhaps associated with a constitutional defect in DNA mismatch pair.
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Affiliation(s)
- M G Dunlop
- University of Edinburgh, Department of Clinical Surgery, Royal Infirmary, UK
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Abstract
The injection of local anaesthetic solutions is frequently a painful and unpleasant experience for patients. A double-masked randomised controlled trial was performed to study the potential benefit of warming lignocaine during local anaesthetic minor surgical procedures on the eyelids. The pain of subcutaneous injection of 1.5 ml of 2% lignocaine at room temperature (cold) and body temperature (warm) was compared in 60 patients during the surgical incision of solitary meibomian cysts of one eyelid. Patients were randomly allocated to receive either warm or cold lignocaine. Pain was assessed subjectively by the use of a linear analogue pain scale ranging from 0 to 100. The median pain score for the group receiving cold anaesthetic (19.5) was found to be greater than that for the warm group (10.0; p = 0.02). In conclusion, the simple process of warming lignocaine to 37 degrees C was found to reduce the pain associated with its injection significantly. It is recommended that this technique be more widely adopted in order to minimise patients' discomfort.
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Affiliation(s)
- R W Bell
- Princess Alexandra Eye Pavilion, Royal Infirmary of Edinburgh, UK
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Abstract
AIMS To test if the simple technique of warming lignocaine reduces the pain of injection during local anaesthetic cataract surgery. METHODS Sixty patients undergoing peribulbar local anaesthesia for cataract surgery were allocated randomly to receive either warm (37 degrees C) or cold (room temperature) plain 2% lignocaine for the injection. Pain was assessed subjectively by asking the patients to score their pain from 0 (no pain) to 10 (most severe pain imaginable). RESULTS The mean pain score for the warm group was 2.3 (SD 1.3) in comparison with a mean score of 5.5 (1.0) for the cold group (p < 0.01). CONCLUSIONS The process of warming lignocaine to 37 degrees C has been found to reduce significantly the pain of injection during peribulbar local anaesthesia. It is recommended that this technique be more widely adopted in order to minimise patient's discomfort.
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Affiliation(s)
- R W Bell
- Princess Alexandra Eye Pavilion, Royal Infirmary of Edinburgh
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Kehinde EO, Petermann A, Morgan JD, Butt ZA, Donnelly PK, Veitch PS, Bell PR. Triple therapy and incidence of de novo cancer in renal transplant recipients. Br J Surg 1994; 81:985-6. [PMID: 7922092 DOI: 10.1002/bjs.1800810718] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.8] [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: 01/27/2023]
Abstract
Some 27 (5.5 per cent) of 492 renal transplant recipients developed de novo cancer between January 1975 and December 1991. Patients administered triple therapy of prednisolone, cyclosporin A and azathioprine had a significantly higher incidence of cancer (seven of 40 patients; 17.5 per cent) than those given prednisolone with cyclosporin (14 of 319; 4.4 per cent) and azathioprine with prednisolone (six of 133; 4.5 per cent) (P = 0.005). In a prospective study between January 1989 and December 1992, 110 renal transplant patients were randomized into three immunosuppressive regimens at the time of transplantation. The incidence of cancer in patients receiving low-dose cyclosporin, azathioprine and prednisolone was three of 45, in those given high-dose cyclosporin and prednisolone none of 23 and in those administered high-dose cyclosporin, nifedipine and prednisolone one of 29. The addition of azathioprine to ongoing maintenance cyclosporin and prednisolone therapy is useful in a subgroup of patients with graft dysfunction, but there are possibly higher risks in the development of de novo carcinoma.
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Affiliation(s)
- E O Kehinde
- Renal Transplant Unit, Leicester General Hospital, UK
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Affiliation(s)
- Z A Butt
- Department of Urology, Leicester General Hospital, UK
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