scholarly journals Pre-diagnostic drop out of presumptive TB patients and its associated factors at Bugembe Health Centre IV in Jinja, Uganda

2020 ◽  
Vol 20 (2) ◽  
pp. 633-640
Author(s):  
Godfrey Ekuka ◽  
Ismael Kawooya ◽  
Edward Kayongo ◽  
Ronald Ssenyonga ◽  
Frank Mugabe ◽  
...  
Keyword(s):  
Associated Factors ◽  
Health Centre ◽  
Significant Proportion ◽  
Final Diagnosis ◽  
Drop Out ◽  
Population Characteristics ◽  
Dropping Out ◽  
Keywords Tuberculosis ◽  
Male Patients ◽  
The Individual

Background: Drop out of presumptive TB individuals before making a final diagnosis poses a danger to the individual and their community. We aimed to determine the proportion of these presumptive TB drop outs and their associated factors in Bugembe Health Centre, Jinja, Uganda. Methods: We used data from the DHIS2, presumptive and laboratory registers of Bugembe Health Centre IV for 2017. Descriptive statistics were used to summarize the population characteristics. A modified Poisson regression model via the generalized linear model (GLM) with log link and robust standard errors was used for bivariate and multivariate analysis. Results: Among the 216 registered presumptive TB patients who were less than 1% of patients visiting the outpatients’ department, 40.7% dropped out before final diagnosis was made. Age and HIV status were significantly associated with pre-diagnostic drop out while gender and distance from the health center were not. Conclusion: A high risk to individuals and the community is posed by the significant proportion of presumptive TB pa- tients dropping out before final diagnosis. Health systems managers need to consider interventions targeting young persons, male patients, HIV positive persons. Keywords: Tuberculosis (TB); Pre-diagnostic drop out; Presumptive TB; SORT IT.

scholarly journals Estimating Determinants of Attrition in Eating Disorder Communities on Twitter: An Instrumental Variables Approach

10.2196/10942 ◽  
2019 ◽  
Vol 21 (5) ◽  
pp. e10942 ◽  
Author(s):  
Tao Wang ◽  
Emmanouil Mentzakis ◽  
Markus Brede ◽  
Antonella Ianni
Keyword(s):  
Social Networks ◽  
Instrumental Variables ◽  
Online Communities ◽  
Negative Emotions ◽  
Drop Out ◽  
Population Characteristics ◽  
Causal Effects ◽  
Dropping Out ◽  
Eating Disordered ◽  
Network Centralities

Background The use of social media as a key health information source has increased steadily among people affected by eating disorders (EDs). Research has examined characteristics of individuals engaging in online communities, whereas little is known about discontinuation of engagement and the phenomenon of participants dropping out of these communities. Objective This study aimed to investigate the characteristics of dropout behaviors among eating disordered individuals on Twitter and to estimate the causal effects of personal emotions and social networks on dropout behaviors. Methods Using a snowball sampling method, we collected a set of individuals who self-identified with EDs in their Twitter profile descriptions, as well as their tweets and social networks, leading to 241,243,043 tweets from 208,063 users. Individuals’ emotions are measured from their language use in tweets using an automatic sentiment analysis tool, and network centralities are measured from users’ following networks. Dropout statuses of users are observed in a follow-up period 1.5 years later (from February 11, 2016 to August 17, 2017). Linear and survival regression instrumental variables models are used to estimate the effects of emotions and network centrality on dropout behaviors. The average levels of attributes among an individual’s followees (ie, people who are followed by the individual) are used as instruments for the individual’s attributes. Results Eating disordered users have relatively short periods of activity on Twitter with one half of our sample dropping out at 6 months after account creation. Active users show more negative emotions and higher network centralities than dropped-out users. Active users tend to connect to other active users, whereas dropped-out users tend to cluster together. Estimation results suggest that users’ emotions and network centralities have causal effects on their dropout behaviors on Twitter. More specifically, users with positive emotions are more likely to drop out and have shorter lasting periods of activity online than users with negative emotions, whereas central users in a social network have longer lasting participation than peripheral users. Findings on users’ tweeting interests further show that users who attempt to recover from EDs are more likely to drop out than those who promote EDs as a lifestyle choice. Conclusions Presence in online communities is strongly determined by the individual’s emotions and social networks, suggesting that studies analyzing and trying to draw condition and population characteristics through online health communities are likely to be biased. Future research needs to examine in more detail the links between individual characteristics and participation patterns if better understanding of the entire population is to be achieved. At the same time, such attrition dynamics need to be acknowledged and controlled when designing online interventions so as to accurately capture their intended populations.

Abstract WP346: Factors Associated With TPA Refusal via Telestroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Rene Malazarte ◽  
Amanda Jagolino-Cole ◽  
Christy Ankrom ◽  
Liang Zhu ◽  
Michele Joseph ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Associated Factors ◽  
Historical Data ◽  
Final Diagnosis ◽  
Factors Associated ◽  
Black Patients ◽  
Male Patients ◽  
Mild Stroke ◽  
Race Ethnicity ◽  
Stroke Mimic

Introduction: tPA refusal occurs 4-8% when offered in-person for acute ischemic stroke (AIS). Telestroke (TS) has increased tPA use for AIS, but entails non-traditional patient-physician interaction. Refusal accounts for 16-18% of reasons patients do not receive tPA via TS. We report tPA refusal incidence and associated factors in our TS network. Methods: We identified patients in our TS registry (9/2015-12/2018) who were offered tPA for suspected AIS within 4.5 hrs of symptom onset. We compared demographics, clinical characteristics, and outcomes associated with tPA refusal. Results: Of 1242 patients offered tPA in our TS network, 101 (8%) refused. Of 1376 patients that did not receive tPA, refusal accounted for 7% (101/1376). Patients refusing tPA were younger than those that accepted (median age 61 vs 66, p=0.01) (Table 1). Male patients were less likely to decline tPA (OR 0.65, CI 0.43-0.98), and non-Hispanic black patients were more likely (OR 1.86, CI 1.18-2.93). tPA refusal was associated with mild stroke (median NIHSS 3 vs 7, p<0.0001) and prior ischemic stroke (OR 1.66, CI 1.06-2.60). Patients with final diagnosis of stroke vs stroke mimic were less likely to refuse tPA (OR 0.23, CI 0.15-0.36). Insurance status and baseline functional status were similar among patients who accepted and refused tPA. Patients who accepted tPA were more likely discharged to inpatient rehab. tPA was primarily refused for risk of adverse effects and mild/improving symptoms. Conclusion: Refusal contributes to lower utilization of tPA. Our incidence of refusal was comparable to historical data in non-TS settings. While some factors associated with tPA refusal via TS are consistent with historical data on tPA refusal in-person, differences in patient age, gender, and race/ethnicity still warrant further investigation. Specifically, studies are needed to understand if tPA refusal is related to care delivered via TS, or if patients are more reluctant due to perceived risks of tPA via TS.

scholarly journals Decision-Making Processes Among Potential Dropouts in Vocational Education and Training and Adult Learning

2018 ◽  
Vol 5 (2) ◽  
pp. 112-129 ◽  
Author(s):  
Vibe Aarkrog ◽  
Bjarne Wahlgren ◽  
Christian Hougaard Larsen ◽  
Kristina Mariager-Anderson ◽  
Susanne Gottlieb
Keyword(s):  
Decision Making ◽  
Adult Learning ◽  
Educational Programme ◽  
Drop Out ◽  
Vocational Education And Training ◽  
Dropping Out ◽  
Decision Making Processes ◽  
Students Attitudes ◽  
The Individual ◽  
And Training

Context: Aiming at gaining knowledge about students' thoughts and actions in deciding to stay in or drop out of an educational programme, an empirical study was conducted on dropout among 18-24-year-old students in VET and basic general adult learning. Approach: In order to pursue this aim, the study combined two sets of data: weekly student surveys and interviews with these same students. While the surveys provide a weekly snapshot of the students' thoughts regarding the probability of them continuing in the programme, their satisfaction with the educational programme as a whole, the specific lessons they attend, and the atmosphere at the school, the interviews contribute with detailed descriptions of the students' thoughts on the same matters.Findings: Based on the students' answers over an eight-week period, it was possible to trace a graph illustrating changes in the students' attitudes. These graphs can be placed within four categories of development: the stable, the positive, the unstable, and the negative. The latter can furthermore be differentiated as reflecting a stable decline, a fluctuating decline, or a sudden decline. In the interviews, the aim was to elicit the individual students' thoughts and actions at the points when their graphs took a turn. Conclusions: The findings show that the students' thoughts and actions concern matters both inside and outside the school. Furthermore, seemingly trivial matters in the students' lives are shown to have a potentially decisive influence on the students' thoughts about staying in or dropping out of a programme. These findings confirm the importance of focusing on students' decision-making processes in research on dropout. However, further research is needed to increase understanding of processes leading to decisions to drop out of education, including the qualification of methods to capture these processes.

Retrospective Diagnosis of Pontocerebellar Hypoplasia Type 1B in a Family with Two Deceased Newborn Children

2020 ◽  
Author(s):  
Irena Bradinova ◽  
Silvia Andonova ◽  
Alexey Savov
Keyword(s):  
Clinical Signs ◽  
Final Diagnosis ◽  
Population Based ◽  
Neuromuscular Disorder ◽  
Population Characteristics ◽  
High Risk Population ◽  
Pontocerebellar Hypoplasia ◽  
Clinical Genetic ◽  
Retrospective Diagnosis ◽  
Newborn Children

AbstractPontocerebellar hypoplasia type 1B is a severe autosomal recessive neurologic disorder characterized by a combination of cerebellar and spinal motor neuron degeneration beginning at birth. Pontocerebellar hypoplasia type 1B is caused by mutations in EXOSC3 gene. High prevalence of the p.Gly31Ala mutation was found recently, especially in the Roma ethnic minority. We present a young Bulgarian Roma family with two deceased newborn children manifesting severe neuromuscular disorder including severe muscle weakness, respiratory distress, and multiple joint contractures. Based on the clinical signs and family's population characteristics, DNA testing for the previously described EXOSC3 in Bulgarian Roma mutation c.92G > C; p.Gly31Ala was performed on blood samples of both parents and they were found to be heterozygous carriers. This finding indirectly confirmed the diagnosis of pontocerebellar hypoplasia type B in the deceased offspring. Knowledge of population-specific molecular bases of genetic conditions was the key to final diagnosis in the presented family. Designing of population-based clinical-genetic panels may be a powerful diagnostic tool for patients with such origin. Preconception carrier screening in high-risk population groups is a feasible option to discuss.

Dropout from an internet-delivered CBT Intervention for Adults with Depression and Anxiety: A Qualitative Study (Preprint)

2020 ◽  
Author(s):  
Kate Lawler ◽  
Caroline Earley ◽  
Ladislav Timulak ◽  
Angel Enrique ◽  
Derek Richards
Keyword(s):  
Online Communication ◽  
Structured Interview ◽  
Routine Care ◽  
Drop Out ◽  
Group Differences ◽  
Dropping Out ◽  
Completion Rates ◽  
Depression And Anxiety ◽  
Lower Treatment ◽  
Perceived Change

BACKGROUND Treatment dropout continues to be reported from iCBT interventions and lower completion rates are generally associated with lower treatment effect sizes. However, evidence is emerging to suggest that completion of a pre-defined number of modules is not always necessary for clinical benefit nor considerate of the needs of each individual patient. OBJECTIVE The study aimed to carry out a qualitative analysis of patients’ experiences of an iCBT intervention in a routine care setting in order to achieve a deeper insight into the phenomenon of dropout. METHODS Fifteen purposively sampled participants (8 female) from a larger parent RCT were interviewed via telephone using a semi-structured interview schedule that was developed from the existing literature and research on dropout in iCBT. Data was analysed using the descriptive-interpretive approach. RESULTS The experience of treatment leading to dropout can be understood in terms of ten domains: Relationship to Technology, Motivation to Start, Background Knowledge and Attitudes towards iCBT, Perceived Change in Motivation, Usage of the Programme, Changes due to the Intervention, Engagement with Content, Experience Interacting with the Supporter, Experience of Online Communication and Termination of the Supported Period. CONCLUSIONS Patients who drop out of treatment can be distinguished in terms of their change in motivation: those who felt ready to leave treatment early and those who had negative reasons for dropping out. These two groups of participants have different treatment experiences, revealing potential attributes and non-attributes of dropout. The reported between group differences should be examined further to consider those attributes that are strongly descriptive of the experience and regarded with less importance those that have become loosely affiliated.

scholarly journals Vascular and haemodynamic issues of brain ageing

2021 ◽  
Author(s):  
Lucy Beishon ◽  
Rebecca H. Clough ◽  
Meeriam Kadicheeni ◽  
Tamara Chithiramohan ◽  
Ronney B. Panerai ◽  
...  
Keyword(s):  
Significant Proportion ◽  
Cerebrovascular Diseases ◽  
Healthy Ageing ◽  
Cognitive Stimulation ◽  
High Morbidity ◽  
Age Related ◽  
Brain Ageing ◽  
Haemodynamic Changes ◽  
Normal Ageing ◽  
The Individual

AbstractThe population is ageing worldwide, thus increasing the burden of common age-related disorders to the individual, society and economy. Cerebrovascular diseases (stroke, dementia) contribute a significant proportion of this burden and are associated with high morbidity and mortality. Thus, understanding and promoting healthy vascular brain ageing are becoming an increasing priority for healthcare systems. In this review, we consider the effects of normal ageing on two major physiological processes responsible for vascular brain function: Cerebral autoregulation (CA) and neurovascular coupling (NVC). CA is the process by which the brain regulates cerebral blood flow (CBF) and protects against falls and surges in cerebral perfusion pressure, which risk hypoxic brain injury and pressure damage, respectively. In contrast, NVC is the process by which CBF is matched to cerebral metabolic activity, ensuring adequate local oxygenation and nutrient delivery for increased neuronal activity. Healthy ageing is associated with a number of key physiological adaptations in these processes to mitigate age-related functional and structural declines. Through multiple different paradigms assessing CA in healthy younger and older humans, generating conflicting findings, carbon dioxide studies in CA have provided the greatest understanding of intrinsic vascular anatomical factors that may mediate healthy ageing responses. In NVC, studies have found mixed results, with reduced, equivalent and increased activation of vascular responses to cognitive stimulation. In summary, vascular and haemodynamic changes occur in response to ageing and are important in distinguishing “normal” ageing from disease states and may help to develop effective therapeutic strategies to promote healthy brain ageing.

scholarly journals Bullying and Its Associated Individual, Peer, Family and School Factors: Evidence from Malaysian National Secondary School Students

2021 ◽  
Vol 18 (13) ◽  
pp. 7208
Author(s):  
Vikneswaran Sabramani ◽  
Idayu Badilla Idris ◽  
Halim Ismail ◽  
Thiyagar Nadarajaw ◽  
Ezarina Zakaria ◽  
...  
Keyword(s):  
Quantitative Research ◽  
Associated Factors ◽  
Cross Sectional Study ◽  
School Students ◽  
School Factors ◽  
Cross Sectional ◽  
Public School Students ◽  
Distress Level ◽  
Physical Health Problems ◽  
The Individual

Adolescents involved in bullying can be at risk of developing behavioural problems, physical health problems and suicidal ideation. In view of this, a quantitative research design using a cross-sectional study was conducted to determine the prevalence of bullying and associated individual, peer, family and school factors. The study involved 4469 Malaysian public-school students who made up the response rate of 89.4%. The students were selected using a randomized multilevel sampling method. The study found that 79.1% of student respondents were involved in bullying as perpetrators (14.4%), victims (16.3%), or bully–victims (48.4%). In a multivariate analysis, the individual domain showed a significant association between students’ bullying involvement and age (OR = 1.38; 95% CI 1.12–1.70), gender (OR = 1.73; 95% CI 1.47–0.91), ethnicity (OR = 0.66; 95% CI 0.47–0.91), duration of time spent on social media during the weekends (OR = 1.43; 95% CI 1.09–1.87) and psychological distress level (OR = 2.55; 95% CI 1.94–3.34). In the peer domain, the significantly associated factors were the number of peers (OR = 0.69; 95% CI 0.56–0.86) and frequency of quarrels or fights with peers (OR = 2.12; 95% CI 1.24–3.26). Among the items in the school domain, the significantly associated factors were students being mischievous in classrooms (OR = 1.52; 95% CI 1.06–2.06), student’s affection towards their teachers (OR = 1.53; 95% CI 1.06–2.20), frequency of appraisal from teachers (OR = 1.49; 95% CI 1.16–1.94), frequency of friends being helpful in classrooms (OR = 1.92; 95% CI 1.09–3.38) and frequency of deliberately skipping class (OR = 2.91; 95% CI 2.90–1.72). As a conclusion, the study revealed high levels and widespread bullying involvement among students in Malaysia. As such, timely bullying preventions and interventions are essential, especially in terms of enhancing their mental health capacity, which substantially influences the reduction in the prevalence rates of bullying involvement among students in Malaysia.

Concerns and difficulties associated with the COVID-19 pandemic among older adults with cancer in Mexico.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 12042-12042
Author(s):  
Sofia Sánchez-Román ◽  
Yanin Chavarri Guerra ◽  
Andrea Morales Morales Alfaro ◽  
Daniela Ramirez Maza ◽  
Andrea de la O Murillo ◽  
...  
Keyword(s):  
Older Adults ◽  
Developing Countries ◽  
Medical Care ◽  
Cancer Care ◽  
Significant Proportion ◽  
Stage Iv ◽  
Well Being ◽  
Public Hospitals ◽  
The Individual

12042 Background: The COVID-19 pandemic has impacted the well-being of people not only due to the disease but also because of stay-at-home orders, social distancing, unemployment, and different kinds of loses. Older adults have particularly suffered during the pandemic, with increased health-related concerns and anxiety leading to increased vulnerability. However, little is known about the effects of the pandemic on older adults with cancer living in developing countries. They are facing issues related to their diagnosis and treatment, as well as the effects of the pandemic on their care and on the well-being of their families. To improve care for this vulnerable population, we studied the concerns and difficulties associated with COVID-19 among older Mexican adults with cancer. Methods: We included patients age ≥65 with the 10 most common tumors in Mexico according to GLOBOCAN and within 3-24 months of cancer diagnosis at two public hospitals in Mexico City. Patients were contacted telephonically and asked to complete a survey reporting the difficulties encountered during the COVID-19 pandemic and to rate their concerns associated with cancer care management using a 0-10 Likert-type scale, with higher ratings meaning increased concerns. Focused interviews were used to describe the individual experience of selected patients and their relatives related to COVID-19 and cancer care. Results: Between April 20, 2020 and December 1, 2021, 67 patients (mean age 71.9, min 65, max 90; 35.8% female; 62.7% living with a partner) were included. The most common tumors were prostate (43%), colon (16%), and lung (12%). 46% had Stage IV disease, and 61% had a life expectancy of more than a year. Twenty-five percent of patients reported encountering at least one difficulty in obtaining cancer care due to the COVID-19 pandemic. 43% of the patients reported difficulties with accessing follow-up cancer care; 39% reported issues with obtaining medications, including chemotherapy; and 34% reported problems obtaining medical care in general, including oncology visits. Regarding concerns, 33% of the patients reported being “very worried” or “extremely worried” about the COVID-19 pandemic. The most relevant concerns were related to getting infected with COVID-19 (or having a family member who became infected) (mean rating 7.9, SD 2.9); not being able to pay for cancer treatments or medical care (mean rating 6.9, SD 3.5); and worsening of cancer due to delayed care during the pandemic (mean rating 6.6, SD 3.7). Conclusions: A significant proportion of older adults with cancer in Mexico faced difficulties obtaining cancer treatment and follow-up care during the COVID-19 pandemic. Their most relevant concerns included getting infected, financial losses, and progression of disease. Creating systems to provide continued cancer care for vulnerable populations in developing countries is essential to face the COVID-19 pandemic.

scholarly journals Clinical Presentation and Treatment Outcome of Abdominal Tuberculosis

2014 ◽  
Vol 15 (2) ◽  
pp. 131-134
Author(s):  
Oliur Rahman ◽  
Anwarul Kabir ◽  
Prodip Kumar Biswas ◽  
AMM Shoriful Islam ◽  
AB Siddik ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Clinical Presentation ◽  
Abdominal Distension ◽  
Abdominal Tuberculosis ◽  
Final Diagnosis ◽  
Drop Out ◽  
Low Grade ◽  
College Hospital ◽  
Abdominal Lymph Node ◽  
Female Ratio

Background: Tuberculosis is common in our country. It commonly affects the lungs but in up to one third of the cases involve other organs. Abdominal tuberculosis is one of the important extrapulmonary tuberculosis.It has varied presentation, frequently mimicking other common and rare diseases. Materials and Methods:It is a prospective observational study done to see the clinical presentation and treatment outcome of abdominal tuberculosis in medicine, surgery and gastroenterology department Sylhet M A G Osmani Medical College Hospital during Jan 2008-Dec2008. Sample was collected purposively. All patients were undergone detailed history, clinical examination, relevant investigation and follow up till the end of six months anti tubercular chemotherapy.Data recorded in predesigned record form. Statistical analysis was done with SPSS software. All data presented as percentage or mean. Result: From the 50 cases of abdominal TB, 26 (52%) were male and 24 (48%) were female. Male and female ratio was 1.04:1. Here most of the patients were in the age of 21-30 years and mean age was 29.3 years,majority of them were from poor socioeconomic status(18%) had associated pulmonary tuberculosis.The common presentation exhibited by the patients were weight loss (100%), low grade fever (88%), abdominal pain (86%), bowel disturbance (84%), anorexia (80%), nausea and vomiting (70%), abdominal distension (46%), , ascites (42%).Most of the patients were anaemic with raised ESR.Ultrasonography revealed ascites,abdominal lymphadenopathy and thick walled bowel. Colonoscopy found nodularity and ulceration with narrowing. Ascitic fluid was exudative with predominant lymphocyte count. Laparoscopy and laparotomy revealed tubercle on the intestine and the mesentery with thickening and bowel stricture. All the biopsy reports were consistent with tuberculosis. Site of involvement in decreasing frequency were ileocaecal (44%), peritoneal (16%), abdominal lymph node (8%), ascending colon (8%), small bowel (6%),transverse colon (4%), sigmoid colon (2%), rectum (2%), gastric (2%) and duodenal (2%) but multiple site in 6%.The treatment was given as per the WHO guidelines with category I drugs and found- 86% cured with anti TB alone, 4% needed surgery for intestinal obstruction along with anti TB, and 10% drop out from follow up.Conclusion:The clinical presentations of abdominal TB appear not specific for the condition. Thus, careful approach and supportive results are required in order to issue the final diagnosis. If diagnosed early, it can be treated successfully with the conventional anti-TB drugs. DOI: http://dx.doi.org/10.3329/jom.v15i2.20686 J MEDICINE 2014; 15 : 131-134

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