scholarly journals The Health Determinants of Accessibility to Clubfoot Treatment in LMICs: A Global Exploration of Barriers and Solutions

2021 ◽  
Vol 10 (2) ◽  
pp. 241-250
Author(s):  
Sharaf Sheik-Ali ◽  
Sergio M Navarro ◽  
Evan J Keil ◽  
Evan Keil ◽  
Walter Johnson ◽  
...  

Background: Clubfoot or Congenital Talipes Equinovarus (CTEV) treatment in newborn infants involves simple, non-invasive manipulation and is primarily managed non-surgically if identified early. In low- and middle-income countries (LMICs), less than 15% of patients with CTEV access treatment. This cross-sectional questionnaire study conducted descriptive and regression analysis of institutional reasons for CTEV management in LMICs. Methods: A cross-sectional study was undertaken of 1,489 medical institutions in 62 LMICs. Data were evaluated from the “World Health Organization Situation Analysis tool” database. We analyzed characteristics of institutions that manage and did not manage CTEV. With the use of a multivariate linear regression model, we identified a set of factors linked to referral for non-management of CTEV. Results: A total of 72.7% (1,083/1,395) of institutions surveyed did not manage CTEV. The most common reason cited for not managing CTEV was a lack of sufficient skills, 92.1% (668/725, P<0.001). A total of 39.4% (286/725) of institutions also cited a lack of functioning equipment as a reason. Multivariate linear regression analysis showed lack of training, lack of supplies, and lack of functioning equipment were most closely related to non-management of CTEV. Conclusion and Global Health Implications: We identified that failure to manage CTEV may result from a lack of skills and medical equipment. Increasing the capacity of sustainable training programs may reduce the presently available skill deficit in treating CTEV in LMICs and provide improved health outcomes for those with CTEV. While considerable progress has been made in building capacity for the treatment and management of CTEV in LMICs, structured training programs that support conservative manipulative methods to manage CTEV should be initiated globally.   Copyright © 2021 Sheik-Ali et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

2021 ◽  
pp. 039156032110637
Author(s):  
Valerio Di Paola ◽  
Angelo Totaro ◽  
Giacomo Avesani ◽  
Benedetta Gui ◽  
Andrea Boni ◽  
...  

Purpose: Our aim was to explore the relation between FA and ADC, number and length of the periprostatic neurovascular fibers (PNF) by means of 1.5 T Diffusion Tensor Imaging (DTI) imaging through a multivariate linear regression analysis model. Methods: For this retrospective study, 56 patients (mean age 63.5 years), who underwent 1.5-T prostate MRI, including DTI, were enrolled between October 2014 and December 2018. Multivariate regression analysis was performed to evaluate the statistically significant correlation between FA values (dependent variable) and ADC, the number and the length of PNF (independent variables), if p-value <0.05. A value of 0.5 indicated poor agreement; 0.5–0.75, moderate agreement; 0.75–0.9, good agreement; 0.61–0.80, good agreement; and 0.9–1.00, excellent agreement. Results: The overall fit of the multivariate regression model was excellent, with R2 value of 0.9445 ( R2 adjusted 0.9412; p < 0.0001). Multivariate linear regression analysis showed a statistically significant correlation ( p < 0.05) for all the three independent variables. The r partial value was −0.9612 for ADC values ( p < 0.0001), suggesting a strong negative correlation, 0.4317 for the number of fiber tracts ( p < 0.001), suggesting a moderate positive correlation, and −0.306 for the length of the fiber tracts ( p < 0.05), suggesting a weak negative correlation. Conclusions: Our multivariate linear regression model has demonstrated a statistically significant correlation between FA values of PNF with other DTI parameters, in particular with ADC.


2020 ◽  
Vol 45 (3) ◽  
pp. 442-454 ◽  
Author(s):  
Sang Hyuk Kim ◽  
Hyang Ki Min ◽  
Sung Woo Lee

Introduction: Thyroid function is evaluated by thyroid stimulating hormone (TSH) and free thyroxine (fT4). Although many studies have indicated an intimate relationship between thyroid hormones and kidney functions, reports about the simultaneous evaluation of TSH and fT4 are rare. Objective: We aimed to analyze the association between TSH and kidney function, with emphasis on a potential nonlinear relationship, and identify an independent relationship between fT4 and kidney function. Methods: We reviewed the data of 7,061 subjects in the Korea National Health and Nutrition Examination Surveys who were randomly subsampled for thyroid function evaluation between 2013 and 2015. A total of 5,578 subjects were included in the final analysis, after excluding people <18 years old, and those with a short fasting time, abnormal fT4 levels, and thyroid disease or related medications. Creatinine-based estimated glomerular filtration rate (eGFR) was used to define kidney function. Results: A 1 mmol/L increase of logarithmic TSH was associated with decreased eGFR (β: –1.8; 95% CI –2.3 to –1.2; p < 0.001), according to multivariate linear regression analysis. On the multivariate generalized additive model plot, TSH demonstrated an L-shaped relationship with eGFR, showing a steeper slope for 0–4 mIU/L of TSH. A 1 µg/dL increase of fT4 was also associated with decreased eGFR (β: –7.0; 95% CI –0.94 to –4.7; p < 0.001) on the multivariate linear regression analysis; this association was reversed after adjusting for age. On the mediation analysis, the indirect effect via age and direct effect per 1 µg/dL increase of fT4 on eGFR was 9.9 (8.1 to 11.7, p < 0.001) and –7.1 (–9.3 to –4.8, p < 0.001), respectively. Conclusions: Increased TSH was associated with decreased eGFR, particularly in the reference range. The direct effect of increased fT4 was decreased eGFR, which may be affected indirectly by age.


2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
João N. Beato ◽  
João Esteves-Leandro ◽  
David Reis ◽  
Manuel Falcão ◽  
Vítor Rosas ◽  
...  

Purpose. To analyze and compare corneal structural and biomechanical properties, characterized by corneal hysteresis (CH) and resistance factor (CRF), between patients with and without type 2 diabetes mellitus (DM), and determine the main ocular variables that influence them. Methods. Sixty diabetic and 48 age- and sex-matched non-DM patients were enrolled in this cross-sectional study. The DM group was analyzed according to DM duration (<or ≥ 10 years), HbA1c levels (<or ≥ 7%), and presence of retinopathy. CH and CRF were evaluated using the Ocular Response Analyzer® (ORA). Central corneal thickness (CCT) was determined by Scheimpflug tomography (Pentacam® HR). Intraocular pressure was obtained with ORA (IOPcc) and Goldmann applanation tonometry (IOP-GAT). Univariate and multivariate linear regression analyses were performed to evaluate the relationship between demographical, clinical, and ocular variables with the biomechanical properties. Results. There were no statistically significant differences in the CH and the CRF between DM and non-DM groups (p=0.637 and p=0.439, respectively). Also, there was no statistical difference between groups for the CCT, IOPcc, or IOP-GAT. Multivariate linear regression analysis showed that CH was positively associated with CCT (p<0.001) and negatively associated with IOPcc (p<0.001), while CRF was positively associated with CCT (p<0.001) and IOPcc (p=0.014). Conclusion. The CCT and IOPcc were found to be the main parameters that affect corneal biomechanical properties both in diabetics and controls. In this study, there was no significant effect of DM type 2 on corneal biomechanics.


1986 ◽  
Vol 32 (7) ◽  
pp. 1279-1284 ◽  
Author(s):  
J Valsamis ◽  
J Van Peborgh ◽  
H Brauman

Abstract We evaluated the relative contribution to the diagnosis of hyperparathyroid disease from current laboratory indices of parathyroid function--plasma calcium (I), phosphate (II), carboxy-terminal (III) and predominantly amino-terminal (IV) radioimmunoassays of parathyrin, the urinary excretion ratios of cyclic adenosine monophosphate (cAMP) to creatinine (V) or to glomerular filtrate (VI), and the ratio of the nephrogenous fraction of cAMP to glomerular filtrate (VII)--in 224 subjects: 40 with surgically proven hyperparathyroid disease, the others normoparathyroid. The decreasing order of sensitivity was I greater than VI greater than VII greater than V greater than III greater than IV greater than II; all these indices differed significantly between normoparathyroid and hyperparathyroid patients. The decreasing order of specificity was VII, III greater than I greater than IV greater than V, II greater than VI. Discriminant multivariate linear regression analysis was performed in a subset of 58 subjects (17 hyper- and 41 normoparathyroid) from the population studied here, chosen because all of the laboratory indices were determined for each subject. The classification accuracy was 98.3% for combining I, VII, and III (r = 0.908), or I and V (r = 0.893), or I and VII (r = 0.889). The other variables did not add to the precision of classification.


2020 ◽  
Vol 10 (4) ◽  
pp. 239-249
Author(s):  
Abbas Ghafouri ◽  
◽  
Fariba Mohammadi ◽  
Behnaz Ganji ◽  
◽  
...  

Purpose: Several tests have been proposed as injury predictor inventories in various sports; however, it is important to recognize which test is more appropriate to predict the injuries of a particular sport. Therefore, the present study aimed to investigate the relationship between selected functional tests and lower limb injuries in elite male wushu athletes. Methods: In total, 40 wushu player were recruited from the national league (Mean±SD age: 25.1±4.9 y, weight: 67.3±7.7 kg, height: 175.3±4.7 cm). Functional Movement Screening (FMS), Tuck jump, single and double leg squats, Star Excursion Balance Test (SEBT), and Stork balance tests were performed in this research. All of the study variables were measured before the national competition, and after the competition, the rate of the injuries were assessed. The correlation between them was evaluated, subsequently. Descriptive data were used to describe the collected results. Besides, multivariate linear regression analysis was used to explore the relationship between the study variables. Results: Multivariate linear regression analysis data suggested that LESS, stroke balance test, single-leg squat, and SEBT failed to predict lower extremities injuries; however, Tuck jump, FMS, and double leg squat could predict lower extremities injuries. Conclusion: Based on the collected results, among the studied tests, trainers and researchers are suggested to employ the Tuck jump, FMS, and double leg squat tests to predict injuries in wushu male players; this test can also be used to prevent injuries in players.


2021 ◽  
Author(s):  
Yongfeng Wang ◽  
Yuan Zhang ◽  
Yunyi Yang ◽  
Lihui Tu ◽  
Jigao Yang ◽  
...  

Abstract Background: Depression is a potential factor affecting semen quality. However, the relationship between depression and semen quality remains to be fully elucidated. We investigated the association between depression and semen quality in men during the COVID-19 pandemic.Methods: Cross‐sectional, participants completed a questionnaire assessing lifestyle factors the Patient Health Questionnaire-9 (PHQ-9) was used to evaluate the psychological depression status of subjects. Semen quality assessment implements the requirements of the fifth edition of the World Health Organization (WHO )manual ,multivariable logistic regression analysis and linear regression analysis were conducted to assess the associations between depression and semen quality.Results: Of the 896 participants, 173 were depressed (19.30%). A Linear regression model was fitted to assess the strength and significant level of the association between depressive symptoms and semen quality. After adjusting for potential confounders, depression was significantly associated with 9.27 (95% confidence interval [CI] 3.39, 15.15), 0.57(95% CI 0.27, 0.87), 62.20 (95% CI 32.93, 91.48), and 12.96 (95% CI 10.55, 15.37) reduction in sperm concentration, sperm volume, total sperm count, and progressive motility, respectively. Which are consistent with the logistic regression analysis results. The semen concentration and total sperm count were linearly correlated with depression scores, whereas the semen volume and progressive motility of sperm were nonlinearly correlated with depression scores.Conclusions: Depression were associated with lower levels of semen concentration, semen volume, total sperm count, and progressive motility, which could affect male reproductive health.


2020 ◽  
Vol 14 ◽  
pp. 117822342097784
Author(s):  
Abdulmohsen Alkushi ◽  
Ahmad Omair ◽  
Haitham Arabi ◽  
Emad Masuadi ◽  
Omalkhair Abualkhair

Background: Oncotype Dx is used to predict the long-term recurrence risk in patients with estrogen receptor (ER)-positive and human epidermal growth factor receptor 2 (HER2)-negative invasive breast cancer (BC). This study aimed at establishing a correlation between clinicopathological parameters and recurrence score (RS), subsequently improving predictability and ultimately justifying the use of the multigene assay. Materials and methods: A retrospective analysis of the pathology and clinical data of 114 female patients with BC who had Oncotype Dx testing between 2012 and 2019. The pathological parameters included are tumor cell type, tumor grade, pathological stage, and mitotic index (MI). The expression of ER, progesterone receptor (PR), HER2, and Ki67 was assessed by immunohistochemistry. A univariate and multivariate linear regression analysis was performed to assess the correlation between these parameters and the RS. Results: In univariate analysis, age (˂40 years), higher tumor grade, and low PR expression were significantly associated with higher RS ( P = .02; ˂.001; and ˂.001, respectively). Both MI and Ki67 were also strongly correlated with an increase in the RS with a P value of .01 (Spearman correlation 0.34 and 0.33). In multivariate linear regression analysis, age, MI, and Ki67 lost their significance, but both higher grade and PR remained significantly associated with a higher RS along with the tumor stage ( P ˂ .001; ˂.001; and .04, respectively). Conclusions: Tumor grade and PR immunohistochemical expression are the main predictors of RS in our study population. Other clinicopathological features were not significant predictors of change in RS in multivariate analysis.


Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Yan Liu ◽  
Qiaobing Sun ◽  
Yixiao Zhao ◽  
Yinong Jiang

The Correlation between Left Atrial-Left Ventricular-Arterial Coupling and Circadian Rhythm of Blood Pressure in Hypertension Objective: Hypertension induces left atrial (LA) and left ventricular (LV) dysfunction, and arterial stiffness increased. In this study, we further investigated the association between LA-LV-arterial coupling and circadian rhythm of blood pressure (BP) in essential hypertension (HT). Design and Methods: We enrolled 289 HT patients which were evaluated by 2 dimensional speckle tracking echocardiography (2D-STE), ambulatory 24-hour BP monitoring (ABPM) and carotid-femoral pulse wave velocity (PWV). According to BP patterns, these patients were divided into two groups, which included dippers (n=109), patients with a >10% reduction in BP at nighttime; non-dippers (n=180), patients with a <10% reduction in BP at nighttime. 2D-STE based LA and LV strains were studied and the following parameters were measured, LV global longitudinal strain (GLS), LA reservoir strain (LA S-S ), LA conduit strain (LA S-E ), and LA booster pump strain (LA S-A ). LA stiffness index (LASI) defined as the ratio of E/e' to LA S-S , and PWV-to-GLS ratio (PWV/GLS) were calculated to reflect LA-LV-arterial coupling. Furthermore, we also explored the correlation between LASI (or PWV/GLS) and ambulatory blood pressure indexes. The related factors were evaluated by multivariate linear regression analysis to find the independent factors. Results: LASI was significantly higher in non-dippers (0.35±0.24) than dippers (0.29±0.12) ( p <0.05). PWV/GLS was significantly higher in non-dippers (-90.30±34.13) than dippers (-79.62±25.84) ( p <0.05). LA S-S , LA S-A and LV GLS were significantly lower in non-dippers than dippers ( p <0.05). Multivariate linear regression analysis revealed that LV mass index (LVMI), PWV/GLS, nighttime mean SBP (n-SBP) and nighttime mean DBP (n-DBP) were independently correlated with LASI; LASI and n-SBP were independently correlated with PWV/GLS. Conclusions: LA and LV myocardial mechanics, and LA-LV-arterial coupling were associated with circadian rhythm of BP. Nocturnal systolic BP was the independent risk factor of abnormal LA-LV-arterial coupling in HT.


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