scholarly journals Impact of Insecticide Resistance on P. falciparum Vectors’ Biting, Feeding, and Resting Behaviour in Selected Clusters in Teso North and South Subcounties in Busia County, Western Kenya

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Edward K. Githinji ◽  
Lucy W. Irungu ◽  
Paul N. Ndegwa ◽  
Maxwell G. Machani ◽  
Richard O. Amito ◽  
...  
Keyword(s):  
Insecticide Resistance ◽  
Human Blood ◽  
World Health ◽  
Assay Method ◽  
Genotypic Frequency ◽  
Western Kenya ◽  
Resting Behaviour ◽  
Significant Difference ◽  
Homozygous Resistant ◽  
The Impact

Introduction. Behavioural resistance to insecticides restrains the efficacy of vector control tools against mosquito-transmitted diseases. The current study is aimed at determining the impact of insecticide resistance on major malaria vectors’ biting, feeding, and resting behaviour in areas with and areas without insecticide resistance in Teso North and Teso South, Busia County, Western Kenya. Methods. Mosquito larvae were sampled using a dipper, reared into 3-5-day-old female mosquitoes [4944] which were exposed to 0.75% permethrin and 0.05% deltamethrin using World Health Organization tube assay method. Blood meal, species identification, and kdr Eastgene PCRs were also performed on adult mosquitoes sampled using mosquito collection methods [3448]. Biting, feeding, resting, and exiting behaviours of field-collected mosquitoes from five selected clusters were analysed. Results. The lowest Kdr genotypic frequency (SS) proportion was found in female Anophelines collected in Kengatunyi at 58% while Rwatama had the highest genotypic frequency at 93%, thus susceptible and resistant clusters, respectively. The peak hour for mosquito seeking a human bite was between 0300 and 0400 hrs in the resistant cluster and 0400-0500 hrs in the susceptible cluster. The heterozygous mosquitoes maintained the known 2100-2200 hrs peak hour. There was a higher proportion of homozygous susceptible vectors (86.4%) seeking humans indoor than outdoor bitters (78.3%). Mosquito blood meals of human origin were 60% and 87% in susceptible Kengatunyi and resistant Rwatama cluster, respectively. There was significant difference between homozygous-resistant vectors feeding on human blood compared to homozygous susceptible mosquitoes (p≤0.05). The proportion of bovine blood was highest in the susceptible cluster. A higher proportion of homozygous-resistant anophelines were feeding and resting indoors. No heterozygous mosquito was found resting indoor while 4.2% of the mosquitoes were caught while exiting the house through the window. Discussion. A shift in resistant Anopheles gambiae sl highest peak hour of aggressiveness from 2100-2200 hrs to 0300-0400 hrs is a key change in its biting pattern. Due to the development of resistance, mosquitoes no longer have to compete against the time the human host enters into the formerly lethal chemical and or physical barrier in the form of long-lasting insecticide-treated net. No heterozygous LS mosquito rested indoors possibly due to disadvantages of heterozygosity which could have increased their fitness costs as well as energy costs in the presence of the insecticidal agents in the treated nets. Conclusions and recommendations. Out of bed biting by female mosquitoes and partial susceptibility may contribute to residual malaria transmission. Insecticide-resistant vectors have become more endophagic and anthropophillic. Hence, insecticidal nets, zooprophylaxis, and novel repellents are still useful chemical, biological, and physical barriers against human blood questing female mosquitoes. Further studies should be done on genetic changes in mosquitoes and their effects on changing mosquito behaviour.

scholarly journals Species Composition, Phenotypic and Genotypic Resistance Levels in Major Malaria Vectors in Teso North and Teso South Subcounties in Busia County, Western Kenya

2020 ◽  
Vol 2020 ◽  
pp. 1-17 ◽  
Author(s):  
Edward K. Githinji ◽  
Lucy W. Irungu ◽  
Paul N. Ndegwa ◽  
Maxwell G. Machani ◽  
Richard O. Amito ◽  
...  
Keyword(s):  
Species Composition ◽  
Insecticide Resistance ◽  
Anopheles Gambiae ◽  
Selection Pressure ◽  
Sensu Stricto ◽  
Allelic Frequency ◽  
Assay Method ◽  
Genotypic Frequency ◽  
Western Kenya ◽  
Significant Difference

Introduction. Knockdown resistance (kdr) is strongly linked to pyrethroid insecticide resistance in Anopheles gambiae in Africa, which may have vital significance to the current increased use of pyrethroid-treated bed net programmes. The study is aimed at determining species composition, levels of insecticide resistance, and knockdown patterns in Anopheles gambiae sensu lato in areas with and areas without insecticide resistance in Teso North and Teso South subcounties, Western Kenya. Materials and Methods. For WHO vulnerability tests, mosquito larvae were sampled using a dipper, reared into 3-5-day-old female mosquitoes (4944 at 100 mosquitoes per insecticide) which were exposed to 0.75% permethrin, 0.05% deltamethrin, and 0.1% bendiocarb using the WHO tube assay method. Species identification and kdr East gene PCRs were also performed on randomly selected mosquitoes from the collections; including adult mosquitoes (3448) sampled using standard collection methods. Results. Anopheles gambiae sensu stricto were the majority in terms of species composition at 78.9%. Bendiocarb caused 100% mortality while deltamethrin had higher insecticidal effects (77%) on female mosquitoes than permethrin (71%). Susceptible Kengatunyi cluster had higher proportion of An. arabiensis (20.9%) than resistant Rwatama (10.7%). Kengatunyi mosquitoes exposed to deltamethrin had the highest KDT50 R of 8.2. Both Anopheles gambiae sensu stricto and Anopheles arabiensis had equal S allelic frequency of 0.84. Indoor resting mosquitoes had 100% mortality rate after 24 h since exposure. Overall SS genotypic frequency in Teso North and Teso South subcounties was 79.4% against 13.7% homozygous LL genotype and 6.9% heterozygous LS genotype. There was a significant difference (ρ<0.05) in S allele frequencies between Kengatunyi (0.61) and Rwatama (0.95). Mosquito samples collected in 2013 had the highest S allelic frequency of 0.87. Discussion. Most likely, the higher the selection pressure exerted indoors by insecticidal nets, the higher were the resistance alleles. Use of pyrethroid impregnated nets and agrochemicals may have caused female mosquitoes to select for pyrethroid resistance. Different modes of action and chemical properties in different types of pyrethroids aggravated by a variety of edaphic and climatic factors may have caused different levels of susceptibility in both indoor and outdoor vectors to pyrethroids and carbamate. Species composition and populations in each collection method may have been influenced by insecticide resistance capacity in different species. Conclusions and Recommendations. Both phenotypic and genotypic insecticide resistance levels have been confirmed in Teso North and Teso South subcounties in Western Kenya. Insecticide resistance management practices in Kenya should be fast tracked and harmonized with agricultural sector agrochemical-based activities and legislation, and possibly switch to carbamate use in order to ease selection pressure on pyrethroids which are useable in insecticidal nets and indoor residual spray due to their low human toxicity. The implication of such high resistance levels in mosquitoes collected in Teso subcounties is that resistance is likely to persist and or even increase if monomolecules of permethrin and deltamethrin or both continue to be used in all net- and nonnet-based mosquito control purposes. Usage of mutually reinforcing piperonyl butoxide (PBO) that prohibits particular enzymes vital in metabolic activities inside mosquito systems and has been integrated into pyrethroid-LLINs to create pyrethroid-PBO nets is an extremely viable option.

Household and Population-Level Behavioural Changes Due to COVID-19 Pandemic: A Smart Thermostat Based Comparative Data Analysis

2021 ◽  
Vol 10 (1) ◽  
pp. 1-6
Author(s):  
Kirti Sundar Sahu ◽  
Arlene Oetomo ◽  
Niloofar Jalali ◽  
Plinio P. Morita
Keyword(s):  
Data Analysis ◽  
Population Level ◽  
World Health ◽  
Motion Sensors ◽  
Household Level ◽  
Work From Home ◽  
Significant Difference ◽  
Health Organization ◽  
Smart Thermostat ◽  
The Impact

The World Health Organization declared the coronavirus outbreak as a pandemic on March 11, 2020. To inhibit the spread of COVID-19, governments around the globe, including Canada, have implemented physical distancing and lockdown measures, including a work-from-home policy. Canada in 2020 has developed a 24-Hour Movement Guideline for all ages laying guidance on the ideal amount of physical activity, sedentary behaviour, and sleep (PASS) for an individual in a day. The purpose of this study was to investigate changes on the household and population-level in lifestyle behaviours (PASS) and time spent indoors at the household level, following the implementation of physical distancing protocols and stay-at-home guidelines. For this study, we used 2019 and 2020 data from ecobee, a Canadian smart Wi-Fi thermostat company, through the Donate Your Data (DYD) program. Using motion sensors data, we quantified the amount of sleep by using the absence of movement, and similarly, increased sensor activation to show a longer duration of household occupancy. The key findings of this study were; during the COVID-19 pandemic, overall household-level activity increased significantly compared to pre-pandemic times, there was no significant difference between household-level behaviours between weekdays and weekends during the pandemic, average sleep duration has not changed, but the pattern of sleep behaviour significantly changed, specifically, bedtime and wake up time delayed, indoor time spent has been increased and outdoor time significantly reduced. Our data analysis shows the feasibility of using big data to monitor the impact of the COVID-19 pandemic on the household and population-level behaviours and patterns of change.

scholarly journals Impact of rs2414096 polymorphism of CYP19 gene on susceptibility of polycystic ovary syndrome and hyperandrogenism in Kashmiri women

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sairish Ashraf ◽  
Shayaq Ul Abeer Rasool ◽  
Mudasar Nabi ◽  
Mohd Ashraf Ganie ◽  
Shariq R. Masoodi ◽  
...  
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Clinical Manifestations ◽  
Additive Model ◽  
Genotypic Frequency ◽  
Ovary Syndrome ◽  
Significant Difference ◽  
Cyp19 Gene ◽  
Reproductive Endocrine ◽  
The Impact

AbstractPolycystic ovary syndrome (PCOS) is the most common reproductive endocrine disorder in pre-menopausal women having complex pathophysiology. Several candidate genes have been shown to have association with PCOS. CYP19 gene encodes a key steroidogenic enzyme involved in conversion of androgens into estrogens. Previous studies have reported contradictory results with regard to association of SNP rs2414096 in CYP19 gene with PCOS and hyperandrogenism in different ethnic populations. Present study was aimed to investigate the impact of SNP rs2414096 polymorphism of CYP19 gene on susceptibility of PCOS and hyperandrogenism in Kashmiri women. Further we also studied the genotypic-phenotypic association for various clinical and biochemical parameters of this polymorphism. Case control study. 394 PCOS cases diagnosed on the basis of Rotterdam criteria and age matched 306 healthy women. We found a significant differences in genotypic frequency (χ2 = 18.91, p < 0.05) as well as allele frequency (OR 0.63, CI 0.51–0.78, χ2 = 17.66, p < 0.05) between PCOS women and controls. The genotype–phenotype correlation analysis showed a significant difference in FG score (p = 0.047) and alopecia (p = 0.045) between the three genotypes. Also, the androgen excess markers like DHEAS (p < 0.001), Androstenedione (p < 0.001), Testosterone (p < 0.001) and FAI (p = 0.005) were significantly elevated in GG genotype and showed a significant difference in additive model in PCOS women. rs2414096 polymorphism of CYP19 gene is associated with the risk of PCOS as well as with clinical and biochemical markers of hyperandrogenism, hence suggesting its role in clinical manifestations of PCOS in Kashmiri women.

scholarly journals Impact of the Emerging COVID-19 Pandemic on the Consumption of Multivitamins (C, D and Zinc) by the Saudi Arabian Population

2021 ◽  
pp. 11-20
Author(s):  
Duaa Mohamed Bakhshwin ◽  
Abdulaziz Bakhshwin
Keyword(s):  
Vitamin D ◽  
Vitamin C ◽  
World Health ◽  
Saudi Population ◽  
Viral Spread ◽  
Significant Difference ◽  
Before And After ◽  
Zinc Supplements ◽  
Vitamin D Supplements ◽  
The Impact

Background: On March 11, 2020, the World Health Organization (WHO) announced the Coronavirus outbreak officially as a pandemic. This pandemic has led to new measurements to prevent viral spread. The measures included decreasing the person’s mobility outside homes with subsequent changes in the lifestyles, particularly in physical activity and eating habits. It has been noticed that consumption of some vitamins may help in preventing or reducing the symptoms of viral infection. Those vitamins include vitamin C, D and zinc. There is a common observation that the general public believes that the use of vitamins, especially vitamins C, D and zinc, reduces the chance of acquiring COVID-19. Objectives: The aim of this study was to determine the impact of COVID-19 pandemic on taking vitamins supplements by the Saudi general population in order to explore their believes regarding the protective value of these vitamins against COVID-19 infection. Subjects and Methods: This cross-sectional study was conducted using a self-administrated questionnaire that was designed, uploaded to the Google form and distributed online to the general Saudi population through the social media (Whatsapp, Twitter) as well as through email between August and December 2020. Statistical Packaged of Social Sciences program (SPSS) for Windows (version 17.0., Chicago: SPSS Inc) was used to analyze the data. A significant difference was considered when the p value is < 0.05. Student t-test and Chi-square (χ2) test were used to compare the studied variables as appropriate. Results: A total of 1043 participants were included in this study (64.9% females, 35.1% males). The mean age for them was 35.3±14.78 years. Only 9.3% (97 participants) were diagnosed to have COVID-19. About 28% of the participants were in contact with COVID-19 cases. Among participants diagnosed to have COVID-19 infection, (13% versus 29%) were taking vitamin C and (2% versus 15%) were taking zinc supplements daily during the 6 months before and after the pandemic, respectively, while (20% versus 25%) were taking vitamin D supplements weekly during the 6 months before and after the pandemic, respectively. Among participants who were in contact with COVID-19 cases, (8% versus 20%) and (3% versus 11%) were taking vitamin C and zinc supplements daily during the 6 months before and after the pandemic, respectively, while (14% versus 16%) were taking vitamin D supplements weekly during the 6 months before and after the pandemic Conclusion: The interest of taking multivitamin by Saudi population, such as vitamins C and D, zinc increased during and after the pandemic compared to that before it. There is no scientific evidence based on previous studies confirmed the role of dietary supplementation and multivitamins in preventing COVID-19 infection, therefore, effective education on the rationale use of vitamins during COVID-19 pandemic should be emphasized at local and/or national levels.

scholarly journals The Impact of COVID-19 Infection on the Quality of Life of Health Care Workers

2021 ◽  
Author(s):  
Sadeel Shanshal ◽  
Harith Kh. Al-Qazaz
Keyword(s):  
Quality Of Life ◽  
Sleep Quality ◽  
Psychological Health ◽  
World Health ◽  
World Health Organization Quality ◽  
Significant Difference ◽  
Males And Females ◽  
The Mean ◽  
The Impact

Abstract Background: COVID-19 pandemic has negatively affected the entire world and one of its impacts was the increased level of stress and anxiety, especially among healthcare workers. Therefore, this study aims at evaluating the quality of life (QoL) and sleep quality of healthcare professionals in Iraq.Methods: This study assessed the QoL and sleep quality by using World Health Organization Quality of Life Instruments (WHOQOL-BREF) and the Insomnia Severity Index (ISI) respectively. The questionnaires were administered through an online cross-sectional survey targeted at workers in medical fields in Iraq from 1st to 20th of August 2021. Results: Three hundred medical health workers participated, and females constituted 75.3%. The two questionnaires had very good internal consistency. The highest scoring domain was the social relationships, followed by physical health. Significant difference was found in the mean scores of psychological health domain between males and females, with higher scores observed in males. The mean of the total ISI score was 11.58 ± 6.88 with a range between 0 and 27. Severe insomnia was observed in only 9.7% of the participants. A significant negative correlation (r = -0.118) was found between age and ISI scores of the participants. Significant differences were found between males and females with higher ISI mean score observed among males. Conclusion: The quality of life and sleep pattern can be impacted by COVID-19 infection with the psychological aspect of QoL being the most affected and some degrees of insomnia being observed in many participants.

scholarly journals Resting behaviour of malaria vectors in a highland and a lowland site of western Kenya: Implication on malaria vector control measures

2019 ◽  
Author(s):  
Maxwell G. Machani ◽  
Eric Ochomo ◽  
Fred Amimo ◽  
Jackline Kosgei ◽  
Stephen Munga ◽  
...  
Keyword(s):  
Insecticide Resistance ◽  
Vector Control ◽  
Malaria Vector ◽  
Control Measures ◽  
Malaria Vectors ◽  
Western Kenya ◽  
Sporozoite Rate ◽  
Resting Behaviour ◽  
Outdoor Resting ◽  
Indoor And Outdoor

AbstractBackgroundUnderstanding the interactions between increased insecticide resistance in field malaria vector populations and the subsequent resting behaviour patterns is important for planning adequate vector control measures in a specific context and sustaining the current vector interventions. The aim of this study was to investigate the resting behavior, host preference and infection with Plasmodium falciparum sporozoites by malaria vectors in different ecological settings of western Kenya with different levels of insecticide resistance.MethodsIndoor and outdoor resting Anopheline mosquitoes were sampled during the dry and rainy seasons in Kisian (lowland site) and Bungoma (highland site), both in western Kenya. WHO tube bioassay was used to determine levels of phenotypic resistance of first generation offspring (F1 progeny) of malaria vectors resting indoors and outdoors to deltamethrin. PCR-based molecular diagnostics were used for mosquito speciation, genotype for resistance mutations and to determine specific host blood meal origins. Enzyme-linked Immunosorbent Assay (ELISA) was used to determine mosquito sporozoite infections.ResultsOverall, 3,566 female Anopheles mosquitoes were collected with Anopheles gambiae s.l [In Bungoma, An. gambiae s.s (90.9%), An arabiensis (7.6%) and in Kisian, An. gambiae s.s (38.9%), An. arabiensis (60.2%)] being the most abundant species (74.7%) followed by An. funestus s.l (25.3%). The majority of An. gambiae s.l (85.4 and 58%) and An. funestus (96.6 and 91.1%) were caught resting indoors in Bungoma and Kisian respectively.Vgsc-1014S was observed at a slightly higher frequency in An. gambiae s.s hereafter(An. gambiae) resting indoor than outdoor (89.7 vs 84.6% and 71.5 vs 61.1%) in Bungoma and Kisian respectively. For An. arabiensis, Vgsc-1014S was 18.2% indoor and outdoor (17.9%) in Kisian. In Bungoma, the Vgsc-1014S was only detected in An. arabiensis resting indoors with a frequency of 10%. The Vgsc-1014F mutation was only present in An. gambiae resting indoors from both sites, but at very low frequencies in Kisian compared to Bungoma (0.8 and 9.2% respectively. In Bungoma, the sporozoite rates for An. funestus, An. gambiae, and An. arabiensis resting indoors were 10.9, 7.6 and 3.4 % respectively. For outdoor resting, An. gambiae and An. arabiensis in Bungoma, the sporozoite rates were 4.7 and 2.9 % respectively.Overall, in Bungoma, the sporozoite rate for indoor resting mosquitoes was 8.6% and 4.2% for outdoors. In Kisian the sporozoite rate was 0.9% for indoor resting An. gambiae. None of the outdoor collected mosquitoes in Kisian tested positive for sporozoite infections.ConclusionThe study reports high densities of insecticide-resistant An. gambiae and An. funestus resting indoors and the persistence of malaria transmission indoors with high entomological inoculation rates (EIR) regardless of the use of Long-lasting insecticidal nets (LLINs). These findings underline the difficulties of controlling malaria vectors resting and biting indoors using the current interventions. Supplemental vector control tools and implementation of sustainable insecticide resistance management strategies are needed in western Kenya.

scholarly journals The Invisible Enemy that Stopped the World: The Impact of the COVID‑19 Pandemic on Psychiatric Hospitalizations in a Portuguese Department

2021 ◽  
Vol 7 (2) ◽  
pp. 50-56
Author(s):  
Joana Freitas ◽  
Mariana Marinho ◽  
Liliana Castro ◽  
Catarina Fonseca ◽  
Marieta Osório
Keyword(s):  
Mental Health ◽  
Mental Health Problems ◽  
Health Department ◽  
International Classification Of Diseases ◽  
World Health ◽  
Chi Square ◽  
Psychiatric Hospitalizations ◽  
Significant Difference ◽  
The World ◽  
The Impact

Introduction: The World The World Health Organization declared the coronavirus outbreak a pandemic on March 11th 2020. Since then, the containment measures are leading to increasing mental health problems in the general population and worsening of some pre‑existing psychiatric conditions. To our knowledge, there are no studies characterizing the impact of the COVID‑19 pandemic on psychiatric hospitalizations across the world. We aim to compare the number and characteristics of the hospitalizations in the mental health department of a Portuguese psychiatric hospital from March 2nd 2019 to October 31st 2019 with those that occurred in the same period in 2020. Methods: We conducted a retrospective observational study including all patients admitted to hospital during these periods (n=805). Sociodemographic data, clinical characteristics and information about the context of hospitalization were collected. Statistical analysis was performed using t Student Test, Mann‑Whitney and Chi‑square. Results: In the pandemic period there was a marked reduction in the number of psychiatric hospitalizations. There was a statistically significant difference in the median length of stay and in the percentage of involuntary hospitalizations between the two periods. In 2019, the most frequent International Classification of Diseases (10th Revision) diagnostic categories were F30‑F39 (mood disorders) and in 2020 were F20‑F29 (schizophrenia, schizotypal and delusional disorders). Conclusion: The reorganization of services and the decrease in admissions through the emergency department may explain these results.

Periodontal Health Status and its Impact on the Quality of Life among Diabetics attending Medical and Dental Out Patient Departments of a Tertiary Care Centre of Nepal

2021 ◽  
Vol 5 (1) ◽  
pp. 3-9
Author(s):  
T. Bhagat ◽  
A. Shrestha ◽  
J. Rimal ◽  
R. Maskey ◽  
S.K. Agrawal ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Oral Health ◽  
World Health ◽  
Diabetic Patients ◽  
Periodontal Health ◽  
Periodontal Status ◽  
Periodontal Index ◽  
Significant Difference ◽  
The Impact

Background: Diabetics are more prone to periodontal diseases leading to poor oral function affecting their quality of life. The objective of the study was to assess the impact of periodontal health on the quality of life among diabetics using the short version of the Oral Health Impact Profile (OHIP -14). Methods: It was a descriptive cross-sectional study. Data was collected using translated and validated Nepalese version of OHIP-14 questionnaire and clinical examination for periodontal status (Community Periodontal Index and Loss of Attachment index) was done using mouth mirror and World Health Organization probe under natural light. Data was entered and analyzed using SPSS version 11.5. Mann- Whitney U test and Kruskal-Wallis tests were used to compare OHIP-14 scores between genders and periodontal status respectively. Statistical significance was established at p<0.05. Results: One hundred and forty-five subjects with confirmed diabetes participated in the study. Overall, 41% were male participants were as 59% were females. Majority of the participants had calculus with CPI score 1 (n=131, 90.3%) and another majority had loss of attachment 3-5 mm with LOA score 1 (n=55, 37.9%). There was no significant difference in mean scores between two genders (p=0.231). The OHIP scores among participants with highest CPI and LOA scores had statistically significant difference (p=0.011 and p=0.006 respectively). Conclusions: Periodontal status was poor among diabetics with significant impact on their oral health related quality of life. Glycemic control along with periodontal maintenance is required to enhance quality of life among such patients. This might be possible with comprehensive medical approach for diabetic patients.

The Effect of Cyberspace-based Education on the Well-Being of Caregivers of Elderly People with Dementia

2021 ◽  
Vol 14 ◽  
Author(s):  
Yadollah Abolfathi Momtaz ◽  
Parisa Mollaei ◽  
Parisa Taheri-Tanjani
Keyword(s):  
Elderly People ◽  
Negative Impact ◽  
Intervention Group ◽  
Well Being ◽  
World Health ◽  
Control Group ◽  
People With Dementia ◽  
Age Related ◽  
Significant Difference ◽  
The Impact

Introduction: One of the consequences of aging is the prevalence of chronic and age-related diseases, such as dementia. Caring for patients with dementia has a negative impact on the caregiver's well-being. This study aimed to examine the impact of cyberspace-based education on the well-being of caregivers of demented elderly people. Methods: This experimental study was done on a sample of 86 caregivers of elderly with dementia in 2018. The study sample was selected from memory clinic of Taleghani Hospital and randomly assigned into groups (intervention n = 43, control n = 43 groups). The well-being was measured using the World Health Organization - Five Well-Being Index (WHO-5), before and two months after the intervention. Cyberspace-based educational intervention was conducted for one month. The SPSS software version 23 was employed in data analysis. Results: The mean age of the caregivers in the intervention and control groups were (M = 51.95, SD = 10.90) and (M = 51.36, SD = 15.12) respectively. No significant difference was found between two groups in terms of age, gender and level of education. The results of analysis showed that while the well-being of the intervention group was significantly increased (t (38) = -11.38, P<0.001) the well-being in the control group was significantly reduced ( t(36) =4.71 , P<0.001). Conclusion: The findings showed that cyberspace-based education can improve the well-being of caregivers of the elderly with dementia.

Validation of Genomic-Based Risk Models in Myelofibrosis and Proposal of Age-Independent Disease-Specific Models

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 1947-1947
Author(s):  
Andrew Kuykendall ◽  
Chetasi Talati ◽  
Najla Al Ali ◽  
Eric Padron ◽  
David Sallman ◽  
...  
Keyword(s):  
Research Funding ◽  
Risk Groups ◽  
World Health ◽  
Cell Transplant ◽  
Risk Models ◽  
Significant Difference ◽  
Mutation Data ◽  
The Impact ◽  
Disease Specific ◽  
Age Independent

Abstract Background: Prognostication in MF has historically been based on age, symptoms and hematologic features at presentation. Newer models include cytogenetic and genomic data given their independent prognostic value. In 2014, two prognostic models incorporating gene mutation data were proposed: a "mutation enhanced" IPSS (MIPSS) and a genetics-based prognostic scoring system (GPSS) model; the former using mutation data to enrich standard prognostic inputs, while the latter eschewed classic prognostic inputs for a score comprised solely of cytogenetics, mutation data, and age (Vannucchi, Blood, 2014 and Tefferi, Blood, 2014). In this study, we aimed to validate these risk models as well as propose age-independent models to better capture disease-specific prognosis. Methods: This was a single institution, retrospective study of confirmed MF patients seen between 2/2001 and 6/2016. Definitions of primary myelofibrosis (PMF), post-essential thrombocythemia myelofibrosis (post-ET MF) and post-polycythemia vera myelofibrosis (post-PV MF) were according to World Health Organization 2016 criteria and the International Working Group for Myeloproliferative Neoplasms, Research and Treatment, respectively. Mutation and cytogenetic data were assessed from review of electronic medical record. Prognostic scores were calculated on first presentation to our facility. Survival curves were generated using Kaplan-Meier method and compared using the log-rank test. Results: We identified 103 and 97 patients with available data to calculate MIPSS and GPSS scores respectively. The cohorts were 60% male, with median age 72 years at presentation. The majority of patients had a diagnosis of PMF (80%), with a small component of post-ET MF (13%) and post-PV MF (7%). Assigning scores based on MIPSS, 4% of patients were low-risk (LR), 8% intermediate-1 (IR1), 60% intermediate-2 (IR2), and 28% high-risk (HR). The model successfully differentiated between IR2 and HR with median overall survival (OS) 134 and 26 months, respectively (p = 0.0001) (figure 1A). No significant difference in OS was seen between LR/IR1 groups and IR2 (p = 0.58). Using GPSS, 1% of patients were classified as LR, 13% IR1, 25% IR2, and 61% HR. GPSS performed well in delineating between HR and intermediate risk (combined IR1 and IR2) (median OS 44 vs 134 mo, p = 0.02); however it did not distinguish HR from IR2 (p = 0.09) nor between IR1 and IR2 (p = 0.71) (figure 1B). To more specifically assess disease-specific prognosis and better divide risk scores among our patient population, new models were created. Given that age is a negative risk factor for OS independent of disease state, this input was removed. First, an age-independent MIPSS score was created with four risk groups defined: LR (score 0-0.5), IR1 (score 1-1.5), IR2 (2-3), and HR (score 3.5+). Fifteen percent of patients were classified as LR, 32% IR1, 48% IR2, and 6% HR. This system distinguished significantly between IR2 and HR (median OS 98.0 vs 13.5 mo, p = 0.006), while providing improved differentiation between IR1 and IR2 risk groups (median OS not reached vs. 98 months, p = 0.09) (figure 1C). Next, we aimed to create a truly disease-specific model based on the GPSS. Age was omitted and the impact of SRSF2 mutation was enhanced from 1 point to 1.5 points given its greater weighted impact on OS compared to ASXL1 mutation in our database. Values for other inputs remained consistent with GPSS. Using cytogenetic information (CY) and mutation data (M) as the sole inputs a CYM score was created. This yielded four risk groups defined as LR (0 points), IR1 (1-2.5 points), IR2 (3-5 points) and HR (5.5+ points). Seven percent of patients were classified as LR, 28% IR1, 56% IR2, and 9% HR. This model differentiated between IR2 disease and HR disease effectively (median OS 98 vs 15.2 mo., p < 0.0001). No significant difference was observed between IR1 and IR2 disease (figure 1D). Conclusion: Using previously proposed molecular-based models, we were able to validate their utility in the setting of advanced disease; however, insufficient capture of lower risk categories impaired its validity in that setting. We propose age-independent models to better characterize disease-specific risk in an effort to identify patients who many benefit from allogeneic stem cell transplant and/or clinical trial referral. These models merit testing in larger cohorts with longer follow-up to determine their clinical validity. Disclosures Lancet: Celgene: Consultancy, Research Funding; Amgen: Consultancy; Seattle Genetics: Consultancy; Quantum First: Consultancy; Biopath Holdings: Consultancy; Baxalta: Consultancy; Pfizer: Research Funding; Kalo Bios: Consultancy; Karyopharm: Consultancy; Jazz Pharmaceuticals: Consultancy; ERYtech: Consultancy; Boehringer-Ingelheim: Consultancy; Novartis: Consultancy. Sweet:Pfizer: Speakers Bureau; Novartis: Consultancy, Speakers Bureau; Ariad: Consultancy, Speakers Bureau; Incyte Corporation: Research Funding; Karyopharm: Honoraria, Research Funding. Komrokji:Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Consultancy, Speakers Bureau.

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