scholarly journals Risk of hypertension in school-aged children with different parental risk: a longitudinal study from childhood to young adulthood

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Parisa Amiri ◽  
Marjan Rezaei ◽  
Sara Jalali-Farahani ◽  
Mehrdad Karimi ◽  
Leila Cheraghi ◽  
...  
Keyword(s):  
High Risk ◽  
Weight Status ◽  
Cumulative Effect ◽  
Incidence Rates ◽  
School Age Children ◽  
Crude Incidence ◽  
Maternal Characteristics ◽  
Metabolic Characteristics ◽  
School Aged Children ◽  
Parental Characteristics

Abstract Background Although previous studies have shown the relationship between different parental factors and children’s blood pressure status, there is limited data on the cumulative effect of these factors. Considering parental socio-demographic, behavioral and cardio-metabolic characteristics, the current study aimed to distinguish parental risk clusters and their impact on the incidence of hypertension in school-age children over 13 years. Methods Parental characteristics of 1669 children, including age, education, employment, smoking, physical activity, metabolic syndrome (MetS), hypertension (HTN), weight status, and diabetes were considered to categorize parents into low and high-risk clusters. Crude incidence rates (per 10,000 person-years) of HTN in children were assessed in each maternal and paternal cluster. Using Cox proportional hazard model, results on the association between parental risk clusters and HTN incidence in children were reported in five different models. Results Mean age of children was 13.96 ± 2.89 years, and 51.2% (n = 854) were girls. MetS, HTN, and weight status were the most important factors distinguishing low and high-risk parental clusters, respectively. Crude incidence rates (per 10,000 person-years) of HTN were 86 (95% CI: 71–106) and 38 (95% CI, 29–52) in boys and girls, respectively. Moreover, incidence rates (per 10,000 person-years) of HTN were 50 (95% CI, 40–63) and 80 (95% CI, 64–102) in maternal low and high-risk clusters, respectively. The incidence rates (per 10,000 person-years) of HTN in paternal low and high-risk clusters were 53 (95% CI, 41–70) and 68 (95% CI, 56–84), respectively. Conclusion Our findings underscore the prognostic value of maternal characteristics in predicting the incidence of HTN in their offspring. The current results could be valuable in planning related programs to prevent hypertension in similar communities.

scholarly journals Risk of hypertension in school-aged children with different parental risk: A longitudinal study from childhood to young adulthood

2020 ◽  
Author(s):  
Parisa Amiri ◽  
Marjan Rezaei ◽  
Sara Jalali-Farahani ◽  
Mehrdad Karimi ◽  
Leila Cheraghi ◽  
...  
Keyword(s):  
High Risk ◽  
Weight Status ◽  
Cumulative Effect ◽  
Incidence Rates ◽  
School Age Children ◽  
Crude Incidence ◽  
Maternal Characteristics ◽  
School Aged Children ◽  
Cox Proportional Hazard ◽  
Parental Characteristics

Abstract Background: Although previous studies have shown the relationship between different parental factors and children's blood pressure status, there is limited data on the cumulative effect of these factors. Considering parental socio-demographic, behavioral and cardio-metabolic factors, the current study aimed to distinguish parental risk clusters and their effects on the incidence of hypertension in school-age children over thirteen years.Methods: Parental characteristics of 1669 children including age, education, employment, smoking, physical activity, metabolic syndrome (MetS), hypertension (HTN), weight status and diabetes were considered to categorize parents into low and high risk clusters. Crude incidence rates (per 10,000 person-years) of HTN in children were assessed in each maternal and paternal clusters. Using Cox proportional hazard model, results on association between parental risk clusters and HTN incidence in children were reported in five different models. Results: Mean age of children was 13.96±2.89 years and 51.2% (n=854) of them were girls. MetS, HTN and weight status were the most important factors distinguishing low and high risk parental clusters respectively. Crude incidence rates (per 10,000 person-years) of HTN were 86 (95% CI: 71-106) and 38 (95% CI: 29-52), in boys and girls, respectively. Moreover, incidence rates (per 10,000 person-years) of HTN were 50 (95% CI: 40-63) and 80 (95% CI: 64-102) in maternal low and high risk clusters, respectively. The incidence rates (per 10,000 person-years) of HTN in paternal low and high risk clusters were 53 (95% CI: 41-70) and 68 (95% CI: 56-84), respectively.Conclusion: Our findings underscore the prognostic value of maternal characteristics in predicting the incidence of HTN in their offspring. The current results could be valuable in planning related programs to prevent hypertension in similar communities.

scholarly journals Estimating the effect of the 2005 change in BCG policy in England: a retrospective cohort study, 2000 to 2015

2019 ◽  
Vol 24 (49) ◽  
Author(s):  
Sam Abbott ◽  
Hannah Christensen ◽  
Nicky J. Welton ◽  
Ellen Brooks-Pollock
Keyword(s):  
High Risk ◽  
Labour Force ◽  
Demographic Data ◽  
Credible Interval ◽  
Incidence Rates ◽  
School Age Children ◽  
School Age ◽  
Bcg Vaccination ◽  
The Uk ◽  
The Impact

Background In 2005 in England, universal Bacillus Calmette–Guérin (BCG) vaccination of school-age children was replaced by targeted BCG vaccination of high-risk neonates. Aim Estimate the impact of the 2005 change in BCG policy on tuberculosis (TB) incidence rates in England. Methods We conducted an observational study by combining notifications from the Enhanced Tuberculosis Surveillance system, with demographic data from the Labour Force Survey to construct retrospective cohorts relevant to both the universal and targeted vaccination between 1 January 2000 and 31 December 2010. We then estimated incidence rates over a 5-year follow-up period and used regression modelling to estimate the impact of the change in policy on TB. Results In the non-United Kingdom (UK) born, we found evidence for an association between a reduction in incidence rates and the change in BCG policy (school-age incidence rate ratio (IRR): 0.74; 95% credible interval (CrI): 0.61 to 0.88 and neonatal IRR: 0.62; 95%CrI: 0.44 to 0.88). We found some evidence that the change in policy was associated with an increase in incidence rates in the UK born school-age population (IRR: 1.08; 95%CrI: 0.97 to 1.19) and weaker evidence of an association with a reduction in incidence rates in UK born neonates (IRR: 0.96; 95%CrI: 0.82 to 1.14). Overall, we found that the change in policy was associated with directly preventing 385 (95%CrI: −105 to 881) cases. Conclusions Withdrawing universal vaccination at school age and targeting vaccination towards high-risk neonates was associated with reduced incidence of TB. This was largely driven by reductions in the non-UK born with cases increasing in the UK born.

scholarly journals Physical activity risk behaviour in school-aged children is associated with overweight and maternal characteristics

Kinesiology ◽  
2021 ◽  
Vol 53 (2) ◽  
pp. 309-317
Author(s):  
Sanja Musić Milanović ◽  
Helena Križan ◽  
Laura Pavičić ◽  
Maja Lang Morović ◽  
Mario Baić
Keyword(s):  
Physical Activity ◽  
School Children ◽  
Weight Status ◽  
Formal Education ◽  
Risk Behaviour ◽  
Childhood Overweight ◽  
Risk Behaviours ◽  
Active Play ◽  
Maternal Characteristics ◽  
School Aged Children

Given the importance of physical activity for the prevention of overweight, this study sought to determine the type and number of physical activity risk behaviours that were associated with overweight in Croatian school children and their association with maternal characteristics – mothers’ formal education, employment, and weight status. This paper used data from the Croatian Childhood Obesity Surveillance Initiative study from 2015/2016. During an eight-week period anthropometric measurements of children were taken. Data on children’s physical activity risk behaviours and their mothers’ characteristics were provided by the mothers of 4,045 children from the second and third grade (median age 8.6) who were included in the analysis. Insufficient active play outdoors, excessive screen time and exhibiting two or three physical activity risk behaviours were significantly associated with childhood overweight. Children of less educated mothers had lower odds for insufficient active play outdoor and higher odds for insufficient frequenting of a sports or dancing club and exhibiting one, two or three physical activity risk behaviours. Children of mothers who were overweight had higher odds for insufficient sleeping, insufficient frequenting of a sports or dancing club and exhibiting two risk behaviours. Children of unemployed mothers had higher odds for insufficient frequenting of a sports or dancing club and for exhibiting two or three risk behaviours. Physical activity risk behaviours in school children were associated with overweight, as well as maternal characteristics. This finding should be taken into consideration when planning and implementing health promotion and childhood overweight prevention activities.

scholarly journals TRANSMISSION-BASED PRECAUTION EDUCATION ON KNOWLEDGE AND HANDWASHING PRACTICES IN SCHOOL-AGED CHILDREN IN THE ERA OF PANDEMI COVID-19

2021 ◽  
Vol 2 (2) ◽  
pp. 28-35
Author(s):  
Lingga Curnia Dewi ◽  
Ika Nur Pratiwi ◽  
Rr Dian Tristiana
Keyword(s):  
High Risk ◽  
Hand Hygiene ◽  
Infectious Diseases ◽  
School Children ◽  
Hand Washing ◽  
School Age Children ◽  
School Age ◽  
School Aged Children ◽  
Knowledge And Practice ◽  
Hygiene Education

Washing hands is important to prevent various infectious diseases, including Covid-19. School-age children are a population at risk who must practice proper hand hygiene. This study aims to examine the effect of Transmission-Based Precaution (TBP) on knowledge and practice of hand washing in school age children. A total of 20 schoolchildren living in Islamic boarding schools participated in this study. Education is carried out in one meeting. The data was collected by filling out a questionnaire on knowledge and hand washing practices pre and post education. The results showed that providing TPB education increased knowledge about hand washing (p = 0.010), but it was not significant for hand washing practices (p = 0.282). Increasing knowledge should also pay attention to the attitude of school children in hand washing behavior. The process of providing education will be more embedded in school children after repeatedly implementing hand washing properly. The teachers and classmates involved can participate in hygiene education to encourage the hand washing behavior of students in areas at high risk of infectious diseases, especially Covid-19.

scholarly journals Estimating the effect of the 2005 change in BCG policy in England: A retrospective cohort study

2019 ◽  
Author(s):  
Sam Abbott ◽  
Hannah Christensen ◽  
Nicky Welton ◽  
Ellen Brooks-Pollock
Keyword(s):  
High Risk ◽  
Negative Binomial ◽  
Labour Force ◽  
Incidence Rates ◽  
School Age Children ◽  
List Type ◽  
School Age ◽  
Bcg Vaccination ◽  
The Uk ◽  
The Impact

ABSTRACTBackgroundIn 2005, England changed from universal Bacillus Calmette–Guérin (BCG) vaccination of school-age children to targeted BCG vaccination of high-risk children at birth.MethodsWe combined notification data from the Enhanced Tuberculosis Surveillance system, with demographic data from the Labour Force Survey to construct retrospective cohorts of individuals in England relevant to both the universal, and targeted vaccination programmes between Jan 1, 2000 and Dec 31, 2010. For each cohort, we estimated incidence rates over a 5 year follow-up period and used Poisson and Negative Binomial regression models in order to estimate the impact of the change in policy on TB.ResultsIn the non-UK born, we found evidence for an association between a reduction in incidence rates and the change in BCG policy (school-age IRR: 0.74 (95%CI 0.61, 0.88), neonatal IRR: 0.62 (95%CI 0.44, 0.88)). We found some evidence that the change in BCG policy was associated with a increase in incidence rates in the UK born school-age population (IRR: 1.08 (95%CI 0.97, 1.19)) and weaker evidence of an association with a reduction in incidence rates in UK born neonates (IRR: 0.96 (95%CI 0.82, 1.14)). Overall, we found that the change in BCG policy was associated with directly preventing 385 (95% CI −105, 881) TB cases.ConclusionsWithdrawing universal vaccination at school-age and targeting BCG vaccination towards high-risk neonates was associated with reduced incidence of TB in England. This was largely driven by reductions in the non-UK born. There was a slight increase in UK born school-age cases.Key MessagesThere is little existing literature on the impact of withdrawing universal school-age BCG vaccination and introducing high-risk neonatal BCG vaccination on TB incidence rates in the populations directly affected by the vaccination programmes.There was strong evidence that the change in policy was associated with a decrease in TB incidence rates in non-UK born neonates and school-age children. In the UK born individuals, there was some evidence that the change in policy was associated with an increase in TB incidence rates in those relevant to the universal school-age scheme, with little evidence of a decrease in incidence rates in those relevant to the high-risk neonatal vaccination scheme.Overall the change in vaccination policy was associated with preventing TB cases, mainly in the non-UK born.These results provide an important evaluation of the direct effects of both withdrawing and implementing a BCG vaccination programme in a low incidence, high income, country and are relevant to several other countries that have made similar changes to their vaccination programmes.

Language-Based Difficulties in School-Age Children with Reading Disabilities

2019 ◽  
Author(s):  
Kaitlyn Price ◽  
Karen Wigg ◽  
Virginia Misener ◽  
Antoine Clarke ◽  
Natalie Yeung ◽  
...  
Keyword(s):  
Reading Disabilities ◽  
Word Reading ◽  
Speech Sound ◽  
Reading Difficulties ◽  
Receptive Language ◽  
School Age Children ◽  
Speech And Language ◽  
School Aged Children ◽  
Increased Risk ◽  
Language Difficulties

Background: Reading disabilities (RD) are the most common learning disabilities, affecting 3-7% of school-aged children in North America. RD is associated with increased risk for comorbid language-based disorders including early language delay (ELD), speech sound disorders, and language impairments. Despite decades of research on the relationship between RD and these disorders, questions remain as to the strength of their associations. This study is the first of this size to assess all four disorders in a sample of children with RD. Method: We examined the association these disorders in a large, well-characterized family-based sample, recruited for reading difficulties in school-aged children. Parents of 492 families (674 children) completed a questionnaire that queried ELD, and current speech and language difficulties in their children. Children were also directly assessed for multiple quantitative measures of language and reading. Children were divided into three groups: Reading Disabled (RD), Intermediate Readers (IR), and Typical Readers (TR). Results: We found that the parents of the RD and IR groups reported significantly more ELD and current speech and expressive/receptive language difficulties in their children, compared with the TR group. When examined further, we found ELD was associated with poorer performance on word reading and decoding tasks, as well as with speech and language difficulties. Conclusion: The results demonstrate multiple significant associations between reading difficulties, ELD, speech and language, especially in children with severe RD. The results add to research supporting comorbidity between these disorders and will help inform teachers and psychologists when assessing and treating children’s language-based disabilities.

Differentiation of endemic areas by incidence rates of tick-borne infectious diseases as the basis for choosing prevention strategy and tactics

2019 ◽  
pp. 56-61
Author(s):  
N.V. Rudakov ◽  
N.A. Penyevskaya ◽  
D.A. Saveliev ◽  
S.A. Rudakova ◽  
C.V. Shtrek ◽  
...  
Keyword(s):  
High Risk ◽  
Infectious Diseases ◽  
Population Based ◽  
Preventive Therapy ◽  
Incidence Rates ◽  
Prevention Strategy ◽  
Individual Risk ◽  
The Individual ◽  
Integral Assessment ◽  
Very High

Research objective. Differentiation of natural focal areas of Western Siberia by integral incidence rates of tick-borne infectious diseases for determination of the strategy and tactics of their comprehensive prevention. Materials and methods. A retrospective analysis of official statistics for the period 2002-2018 for eight sub-federal units in the context of administrative territories was carried out. The criteria of differentiation were determined by means of three evaluation scales, including long-term mean rates of tick-borne encephalitis, tick-borne borreliosis, and Siberian tick-borne typhus. As a scale gradation tool, we used the number of sample elements between the confidence boundaries of the median. The integral assessment was carried out by the sum of points corresponding to the incidence rates for each of the analyzed infections. Results. The areas of low, medium, above average, high and very high risk of tick-borne infectious diseases were determined. Recommendations on the choice of prevention strategy and tactics were given. In areas of very high and high incidence rates, a combination of population-based and individual prevention strategies is preferable while in other areas a combination of high-risk and individual strategies is recommended. Discussion. Epidemiologic zoning should be the basis of a risk-based approach to determining optimal volumes and directions of preventive measures against natural focal infections. It is necessary to improve the means and methods of determining the individual risk of getting infected and developing tick-borne infectious diseases in case of bites, in view of mixed infection of vectors, as well as methods of post-exposure disease prevention (preventive therapy).

scholarly journals Could age increase the strength of inverse association between ultraviolet B exposure and colorectal cancer?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Vidya Lakshmi Purushothaman ◽  
Raphael E. Cuomo ◽  
Cedric F. Garland ◽  
Timothy K. Mackey
Keyword(s):  
Colorectal Cancer ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Age Groups ◽  
Incidence Rates ◽  
Ultraviolet B ◽  
Inverse Association ◽  
Crude Incidence ◽  
Age Dependent ◽  
Uvb Exposure

Abstract Background Vitamin D has been identified as a potential protective factor in the development of colorectal cancer (CRC). We expect to see a stronger association of ultraviolet B (UVB) exposure and CRC crude rates with increasing age since chronic vitamin D deficiency leads to sustained molecular changes that increase cancer risk. The DINOMIT (disjunction, initiation, natural selection, overgrowth, metastasis, involution, and transition) model postulates various stages of cancer development due to vitamin D deficiency and the associated latency period. The purpose of this study is to examine this age-dependent inverse relationship globally. Methods In this ecological study, a series of linear and polynomial regression tests were performed between country-specific UVB estimates adjusted for cloud cover and crude incidence rates of CRC for different age groups. Multiple linear regression was used to investigate the association between crude incidence rates of colorectal cancer and UVB estimate adjusting for urbanization, skin pigmentation, smoking, animal consumption, per capita GDP, and life expectancy. Statistical analysis was followed by geospatial visualization by producing choropleth maps. Results The inverse relationship between UVB exposure and CRC crude rates was stronger in older age groups at the country level. Quadratic curve fitting was preferred, and these models were statistically significant for all age groups. The inverse association between crude incidence rates of CRC and UVB exposure was statistically significant for age groups above 45 years, after controlling for covariates. Conclusion The age-dependent inverse association between UVB exposure and incidence of colorectal cancer exhibits a greater effect size among older age groups in global analyses. Studying the effect of chronic vitamin D deficiency on colorectal cancer etiology will help in understanding the necessity for population-wide screening programs for vitamin D deficiency, especially in regions with inadequate UVB exposure. Further studies are required to assess the need for adequate public health programs such as selective supplementation and food fortification.

scholarly journals Estimating the burden of hyperkalaemia in the UK in high-risk patient populations

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P McEwan ◽  
L Hoskin ◽  
K Badora ◽  
D Sugrue ◽  
G James ◽  
...  
Keyword(s):  
Clinical Practice ◽  
High Risk ◽  
Patient Outcomes ◽  
Real World ◽  
High Risk Patient ◽  
Incidence Rates ◽  
Funding Source ◽  
Eligible Population ◽  
Increased Risk ◽  
The Uk

Abstract Background Patients with chronic kidney disease (CKD), heart failure (HF), resistant hypertension (RHTN) and diabetes are at an increased risk of hyperkalaemia (HK) which can be potentially life-threatening, as a result of cardiac arrhythmias, cardiac arrest leading to sudden death. In these patients, renin-angiotensin-aldosterone system inhibitors (RAASi), are used to manage several cardiovascular and renal conditions, and are associated with an increased risk of HK. Assessing the burden of HK in real-world clinical practice may concentrate relevant care on those patients most in need, potentially improving patient outcomes and efficiency of the healthcare system. Purpose To assess the burden of HK in a real-world population of UK patients with at least one of: RHTN, Type I or II diabetes, CKD stage 3+, dialysis, HF, or in receipt of a prescription for RAASi. Methods Primary and secondary care data for this retrospective study were obtained from the UK Clinical Practice Research Datalink (CPRD) and linked Hospital Episode Statistics (HES). Eligible patients were identified using READ codes defining the relevant diagnosis, receipt of indication-specific medication, or, in the case of CKD, an estimated glomerular filtration rate (eGFR) ≤60 ml/min/1.73m2 within the study period (01 January 2008 to 30 June 2018) or in the five-year lookback period (2003–2007). The index date was defined as 01 January 2008 or first diagnosis of an eligible condition or RAASi prescription, whichever occurred latest. HK was defined as K+ ≥5.0 mmol/L; thresholds of ≥5.5 mmol/L and ≥6.0 mmol/L were explored as sensitivity analyses. Incidence rates of HK were calculated with 95% confidence intervals (CI). Results The total eligible population across all cohorts was 931,460 patients. RHTN was the most prevalent comorbidity (n=317,135; 34.0%) and dialysis the least prevalent (n=4,415; 0.5%). The majority of the eligible population were prescribed RAASi during follow-up (n=754,523; 81.0%). At a K+ threshold of ≥5.0 mmol/L, the dialysis cohort had the highest rate of HK (501.0 events per 1,000 patient-years), followed by HF (490.9), CKD (410.9), diabetes (355.0), RHTN (261.4) and the RAASi cohort (211.2) (Figure 1). This pattern was still observed at alternative threshold definitions of HK. Conclusion This large real-world study of UK patients demonstrates the burden of hyperkalaemia in high-risk patient populations from the UK. There is a need for effective prevention and treatment of HK, particularly in patients with CKD, dialysis or HF where increased incidence rates are observed which in turn will improve patient outcomes and healthcare resource usage. Figure 1. Rates of HK by condition Funding Acknowledgement Type of funding source: Private company. Main funding source(s): AstraZeneca

Long-term outcomes of Japan-specific dosage of rivaroxaban in high-risk patients with non-valvular atrial fibrillation: analysis from the XAPASS

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Ikeda ◽  
S Ogawa ◽  
T Kitazono ◽  
J Nakagawara ◽  
K Minematsu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
High Risk ◽  
Major Bleeding ◽  
Factor Xa ◽  
Incidence Rates ◽  
Funding Source ◽  
High Risk Patients ◽  
Reduced Dose ◽  
Risk Patients

Abstract Background XAPASS is a real-world, prospective, single-arm, observational study conducted as a post-marketing surveillance mandated by the health authority in Japan. Nowadays, direct oral anticoagulant therapy using factor Xa or thrombin inhibitor has been the standard of care for patients with non-valvular atrial fibrillation (NVAF) to prevent ischemic stroke. However, the clinical impact of reduced dosage (approved dose of 15 or 10 mg once daily in Japan is relatively reduced compared to global dosage) factor Xa inhibitor rivaroxaban in high-risk patients remains unclear. Purpose The present sub-analysis of XAPASS was carried out to assess long-term safety and effectiveness of reduced-dose rivaroxaban in high-risk NVAF patients for bleeding and thromboembolism. Methods All patients with NVAF who were newly started on rivaroxaban were eligible for surveillance. The principal safety outcome was a composite of major and non-major bleeding events, and the primary effectiveness outcome was a composite of ischaemic stroke, haemorrhagic stroke, non-central nervous system systemic embolism (non-CNS SE), and myocardial infarction (MI). In this present sub-analysis, high-risk patients were defined as those who had two of the following three risk factors: elderly (≥75 years old), low body weight (≤50 kg), and renal impairment (CrCl <50 mL/min). Results In total, 11,308 patients were enrolled between April 2012 and June 2014 from 1,419 hospitals, and overall data were analysed from 10,664 patients from whom data were collected. Among them, 3,694 patients matched the criteria for the high-risk patients defined in this sub-analysis, and 6,970 patients did not match the criteria (non-high-risk patients). The mean treatment duration was 791±673 days in the high-risk patients and 944±709 days in the non-high-risk patients. Mean patient age was 80.9±5.5 years and 69.0±9.0 years at baseline, respectively. Mean CHADS2 score was 2.8 and 1.8, and CHA2DS2-VASc score was 4.4 and 2.9, respectively. The rates of CHADS2 component comorbidities were lower in the non-high-risk patients except for diabetes mellitus. The incidence rates of any bleeding, major bleeding, and the primary effectiveness outcomes were 4.8, 1.6, and 2.1%/patient-year in the high-risk patients. The incidence rates of these clinical events in the non-high-risk patients were 3.3, 0.9, and 1.0%/patient-year, respectively. Conclusions Incidence rates of long-term bleeding and thromboembolism were higher in the high-risk patients than in the non-high-risk patients. However, the rates of these outcomes using the Japan-specific reduced dose were not so high. Furthermore, the balance between safety and effectiveness outcomes was within an acceptable range. The present study provides useful information for physicians to stratify high-risk patients using the reduced dose in daily clinical practice. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Bayer Yakuhin Ltd.

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