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Background: Given the importance of intracranial stenosis as a cause of recurrent ischemic stroke and the lack of evidence supporting a clear choice for prevention of recurrent ischemic events, a computer simulation model for prog...
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Background: Given the importance of intracranial stenosis as a cause of recurrent ischemic stroke and the lack of evidence supporting a clear choice for prevention of recurrent ischemic events, a computer simulation model for prognostic prediction could be used to improve decision making. Aims: The aim of the following study is to compare the long-term effect of aspirin, clopidogrel and clopidogrel plus aspirin for prevention of recurrent stroke due to atherosclerotic intracranial artery stenosis. Setting and Design: The cohort consisted of 206 patients from 2006 to 2011. Materials and Methods: A two-state Markov model was used to predict the prognosis of patients with stroke or transient ischemic attack (TIA) caused by angiographically verified 50-99% stenosis of a major intracranial artery to receive aspirin, clopidogrel, or dual therapy. Statistical Analysis: Two tests were used: Pearson Chi-square test or Fisher's exact test (for percentages) and Kruskal Wallis test (for rank order data). Results: In the 10-year Markov cohort analysis, 36.24% of patients who were treated with clopidogrel plus aspirin developed to recurrent stroke while the probability for patients in the aspirin group and clopidogrel group was 42.60% and 48.39% respectively. Patients with clopidogrel plus aspirin had the highest quality-adjusted life years, followed by aspirin and clopidogrel. Conclusion: To prevent recurrent stroke in patients with intracranial artery stenosis, especially in those patients with a history of TIA or coronary artery disease, medical therapy with clopidogrel plus aspirin should be considered in preference to aspirin alone.
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Objective To systematically review articles describing complications of abortion in settings where abortions are thought to be unsafe and to determine the incidence of severe acute maternal morbidity (SAMM) attributed to abortion ...
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Objective To systematically review articles describing complications of abortion in settings where abortions are thought to be unsafe and to determine the incidence of severe acute maternal morbidity (SAMM) attributed to abortion at the population level. Methods We searched relevant databases using search terms related to abortion and complications. We included population-representative studies that listed complications of abortion. We extracted data on the definitions and numbers of severe complications and SAMM, and we report abortion complication rates (per 100000 women of reproductive age) and ratios (per 100000 live births) for SAMM, severe complications and any complications. Results We included 15 studies representing eleven countries (six in Africa, four in Asia and one in Latin America). We found a median abortion ratio of SAMM of 237 (range 91-1892) per 100000 live births and a median abortion ratio of severe complications of 596 (range 435-5298). There was a great degree of heterogeneity between definitions and study populations. Conclusions The burden of SAMM attributed to abortion is much greater than what is reported for deaths caused by abortion. However, the great heterogeneity in definitions makes it difficult to draw firm conclusions. We call for future work on the burden of unsafe abortion to use strict definitions of SAMM.
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Objectives: (i) To estimate the prevalence burden of placenta praevia in each world region, and (ii) to investigate potential sources of heterogeneity. Methods: Systematic review of the literature and random-effects meta-analysis....
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Objectives: (i) To estimate the prevalence burden of placenta praevia in each world region, and (ii) to investigate potential sources of heterogeneity. Methods: Systematic review of the literature and random-effects meta-analysis. Potential sources of heterogeneity were investigated using meta-regression. Results: The overall prevalence of placenta praevia was 5.2 per 1000 pregnancies (95% CI: 4.5-5.9). However, there was evidence of regional variation (P = 0.0001); prevalence was highest among Asian studies (12.2 per 1000 pregnancies; 95% CI: 9.5-15.2) and lower among studies from Europe (3.6 per 1000 pregnancies; 95% CI: 2.8-4.6), North America (2.9 per 1000 pregnancies; 95% CI: 2.3-3.5) and Sub-Saharan Africa (2.7 per 1000 pregnancies; 95% CI: 0.3-11.0). The prevalence of major placenta praevia was 4.3 per 1000 pregnancies (95% CI: 3.3-5.4). Conclusion: The prevalence of placenta praevia is low at around 5 per 1000 pregnancies. There is some evidence suggestive of regional variation in its prevalence, but it is not possible to determine from existing data whether this is due to true ethnic differences or other unknown factor(s).
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Objectives: To assess what makes a good piece of medical reporting in newspapers, to quantify what is being reported on in the major British newspapers, to identify the sources of the news threads, and to assess how these are repo...
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Objectives: To assess what makes a good piece of medical reporting in newspapers, to quantify what is being reported on in the major British newspapers, to identify the sources of the news threads, and to assess how these are reported. Study design: Development and validation of a tool to assess the quality of reporting of health-related articles, and assessment of the quality of these articles in British newspapers. Methods: Eight national daily newspapers from the UK were reviewed for 20 days over a 2-month period. All articles reporting newly emerging research pertaining to health in humans were included and reviewed independently by two raters. A descriptive analysis was performed. Subsequently, a quality assessment tool for use by a non-expert was developed and validated to objectively assess the quality of a newspaper article on a health-related topic. Results: The quality assessment tool was found to have good internal consistency and inter-rater reliability. The Daily Mail published almost twice as many articles as its nearest rival, The Daily Express, and over eight times as many articles as The Guardian. Articles in The Times were, on average, more than twice as long as those in The Sun and The Daily Telegraph. The highest quality articles were in The Times and The Independent, with the lowest quality articles in The Sun. The quality scores of anonymous articles were significantly lower than those attributed to named journalists. Conclusions: There are significant differences in the quality of reporting within and between major daily UK newspapers, with anonymous articles being the poorest quality, and widespread reliance on press releases from the major UK scientific journals.
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Aims: To examine the evidence of association between intimate partner physical or sexual violence (IPV) victimization and alcohol consumption in women. Methods: We conducted a systematic review and meta-analysis of cross-sectional...
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Aims: To examine the evidence of association between intimate partner physical or sexual violence (IPV) victimization and alcohol consumption in women. Methods: We conducted a systematic review and meta-analysis of cross-sectional and longitudinal studies released before 6 June 2013. Studies providing an estimate of association between violence and alcohol consumption or alcohol use disorders were eligible for inclusion. Quality was assessed and random effects meta-analyses used to generate pooled odds ratios (OR) where appropriate. Higgins I2 where P<0.10 was taken to indicate heterogeneity. Results: Fifty-five studies providing 102 estimates of association met the inclusion criteria. Most estimates were not controlled for partner alcohol use and other key confounders. Seven longitudinal studies provided 12 estimates of the association between alcohol and subsequent IPV; nine of 12 estimates showed a direction of increased odds of subsequent IPV, pooled OR=1.27 [95% confidence interval (CI)=1.07-1.52], I2=0%, P=0.437. Nine longitudinal studies provided 15 estimates of association between IPV and subsequent alcohol use; 14 of 15 estimates showed a direction of increased odds of subsequent alcohol use, pooled OR=1.25 (95% CI 1.02-1.52), I2=0%, P=0.751. Cross-sectional studies showed an association between IPV and alcohol use, pooled OR=1.80, 95% CI 1.58-2.06, but with substantial heterogeneity, I2=60.8%, P<0.0001. Definition of alcohol use partly accounted for heterogeneity in cross-sectional estimates. Conclusions: There is a clear positive association between alcohol use and intimate partner physical or sexual violence victimization among women, suggesting a need for programming and research that addresses this link. However, the temporal direction of the association remains unclear. Longitudinal studies with multiple waves of data collection are needed.
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Objective: To review evidence from sub-Saharan Africa for the association between the practice or promotion of essential newborn care behaviours and neonatal survival. Methods: We searched MEDLINE for English language, peer-review...
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Objective: To review evidence from sub-Saharan Africa for the association between the practice or promotion of essential newborn care behaviours and neonatal survival. Methods: We searched MEDLINE for English language, peer-reviewed literature published since 2005. The study population was neonates residing in a sub-Saharan Africa country who were not HIV positive. Outcomes were all-cause neonatal or early neonatal mortality or one of the three main causes of neonatal mortality: complications of preterm birth, infections and intrapartum-related neonatal events. Interventions included were the practice or promotion of recommended newborn care behaviours including warmth, hygiene, breastfeeding, resuscitation and management of illness. We included study designs with a concurrent comparison group. Study quality was assessed using the Cochrane EPOC or Newcastle-Ottawa tools and summarised using GRADE. Results: Eleven papers met the search criteria and most were at low risk of bias. We found evidence that delivering on a clean surface, newborn resuscitation, early initiation and exclusive breastfeeding, Kangaroo Mother Care (KMC) for low-birthweight babies, and distribution of clean delivery kits were associated with reduced risks of neonatal mortality or the main causes of neonatal mortality. There was evidence that training community birth attendants in resuscitation and administering antibiotics, and establishing women's groups can improve neonatal survival. Conclusion: There is a remarkable lack of robust evidence from sub-Saharan Africa on the association between practice or promotion of newborn care behaviours and newborn survival.
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There has been growing international concern about rape in fragile or volatile countries, especially those involved in armed conflicts; indeed, this concern has inspired the United Nations Security Council to issue nine sexual-vio...
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There has been growing international concern about rape in fragile or volatile countries, especially those involved in armed conflicts; indeed, this concern has inspired the United Nations Security Council to issue nine sexual-violence-related resolutions since 2000. Sexual violence is a human-rights abuse that often results in severe health consequences, including acute and longer-term psychological problems, such as depression, anxiety, and post-traumatic stress disorder (PTSD). In addition to the short- and long-term effects on survivors and their families, the aftermath of widespread sexual violence can affect the community at large.
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Multiple imputation based on chained equations (MICE) is an alternative missing genotype method that can use genetic and nongenetic auxiliary data to inform the imputation process. Previously, MICE was successfully tested on stron...
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Multiple imputation based on chained equations (MICE) is an alternative missing genotype method that can use genetic and nongenetic auxiliary data to inform the imputation process. Previously, MICE was successfully tested on strongly linked genetic data. We have now tested it on data of the HBA2 gene which, by the experimental design used in a malaria association study in Tanzania, shows a high missing data percentage and is weakly linked with the remaining genetic markers in the data set. We constructed different imputation models and studied their performance under different missing data conditions. Overall, MICE failed to accurately predict the true genotypes. However, using the best imputation model for the data, we obtained unbiased estimates for the genetic effects, and association signals of the HBA2 gene on malaria positivity. When the whole data set was analyzed with the same imputation model, the association signal increased from 0.80 to 2.70 before and after imputation, respectively. Conversely, postimputation estimates for the genetic effects remained the same in relation to the complete case analysis but showed increased precision. We argue that these postimputation estimates are reasonably unbiased, as a result of a good study design based on matching key socio-environmental factors.
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Campylobacter jejuni is the leading cause of human bacterial gastroenteritis worldwide, but source attribution of the organism is difficult. Previously, DNA microarrays were used to investigate isolate source, which suggested a no...
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Campylobacter jejuni is the leading cause of human bacterial gastroenteritis worldwide, but source attribution of the organism is difficult. Previously, DNA microarrays were used to investigate isolate source, which suggested a non-livestock source of infection. In this study we analysed the genome content of 162 clinical, livestock and water and wildlife (WW) associated isolates combined with the previous study. Isolates were grouped by genotypes into nine clusters (C1 to C9). Multilocus sequence typing (MLST) data demonstrated that livestock associated clonal complexes dominated clusters C1-C6. The majority of WW isolates were present in the C9 cluster. Analysis of previously reported genomic variable regions demonstrated that these regions were linked to specific clusters. Two novel variable regions were identified. A six gene multiplex PCR (mPCR) assay, designed to effectively differentiated strains into clusters, was validated with 30 isolates. A further five WW isolates were tested by mPCR and were assigned to the C7-C9 group of clusters. The predictive mPCR test could be used to indicate if a clinical case has come from domesticated or WW sources. Our findings provide further evidence that WWC.jejuni subtypes show niche adaptation and may be important in causing human infection.
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Barely 20 years ago, such a high proportion of childhood deaths globally was attributable to measles that the going estimate of more than 1 million measles-related deaths per year was almost certainly an underestimate. Pediatric w...
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Barely 20 years ago, such a high proportion of childhood deaths globally was attributable to measles that the going estimate of more than 1 million measles-related deaths per year was almost certainly an underestimate. Pediatric wards in the developing world were filled with patients with mea-sles and its complications, and measles continued to be a major cause of blindness globally. All this occurred despite the remarkable progress that had been achieved during the 1980s in bringing routine immunizations, including a single dose of measles vaccine, to the poorest countries of the world, culminating in the achievement of the global Universal Childhood Immunization goals in 1990.
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