Generalized Poisson Hurdle Model for Count Data and Its Application in Ear Disease

For count data, though a zero-inflated model can work perfectly well with an excess of zeroes and the generalized Poisson model can tackle over- or under-dispersion, most models cannot simultaneously deal with both zero-inflated or zero-deflated data and over- or under-dispersion. Ear diseases are important in healthcare, and falls into this kind of count data. This paper introduces a generalized Poisson Hurdle model that work with count data of both too many/few zeroes and a sample variance not equal to the mean. To estimate parameters, we use the generalized method of moments. In addition, the asymptotic normality and efficiency of these estimators are established. Moreover, this model is applied to ear disease using data gained from the New South Wales Health Research Council in 1990. This model performs better than both the generalized Poisson model and the Hurdle model.

Ready Player Two: A randomised controlled pilot trial investigating the feasibility of using games to improve healthy lifestyle knowledge in youth (9-16 years) at risk for type two diabetes. (Preprint)

UNSTRUCTURED Objective: To determine the comparative use and knowledge effects of two prototype serious games for health on healthy lifestyle knowledge in youth aged 9-16 years at risk for type 2 diabetes (T2D). Methods: A three-arm parallel randomized controlled pilot trial was undertaken to assess use of the game, and the effect of the game on healthy lifestyle and T2D diabetes knowledge. Participants were allocated to ‘Diabetic Jumper’ (n=7), ‘Ari and Friends’ (n=8), or a control game (n=8). All participants completed healthy lifestyle and T2D knowledge questionnaires at baseline, immediately after game play, and four weeks after game play. Game attitudes and preferences were also assessed. The primary outcome was the use of the game, specifically, the number of minutes played over four weeks. Results: There were no statistical differences in healthy lifestyle knowledge or diabetes knowledge over time or across games. Only one participant accessed the game for an extended period, playing the game for a total of 33 min over 4 weeks. Conclusion: Two prototype serious were unsuccessful at sustaining long-term play outside a clinic environment. However, the potential for these games to be used as stimulus to engage young people with healthy lifestyle and diabetes knowledge in a clinic setting should be further explored. Suggested improvements for future studies are discussed. Trial Registration: Australia New Zealand Clinical Trials Registry, ACTRN12619000380190. Registered 11 March 2019, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377123 Funding: The trial was funded by a Health Research Council of New Zealand Feasibility grant.

Manalagi Talanoa A Community-Centred Approach to Research on the Health and Wellbeing of Pacific Rainbow LGBTIQA+ MVPFAFF Communities in Aotearoa New Zealand

The talanoa reported in this paper explores the way the Manalagi Project – recently funded by the Health Research Council of New Zealand – has been designed to empower the health and wellbeing of our Pacific Rainbow LGBTIQA+ MVPFAFF communities. Community-driven, co-designed and embedded, the Manalagi Project adopts a Pacific-centred holistic approach to wellbeing and research. Positioned at the beginning of its community consultation phase, this talanoa between the two lead researchers, one who is an academic and the other a community practitioner, documents the genealogy of the project embedded in lived experiences and relationality through talanoa. It speaks to the importance and timeliness of the project; the suitability of the research team; and intervenes in conversations around how we can activate Pacific research methodologies and praxis to empower our communities to achieve their health and wellbeing aspirations. The findings from this talanoa demonstrate the criticality in adopting intersectional approaches to understanding the differentiated and contextualised health and wellbeing needs of diverse Pacific communities.

Health research funding and its output in Pakistan

Background: Health research is very important for formulating evidence-based policies. Aims: To assess the health research funding and its output in the last 5 fiscal years (2013–14 to 2018) in Pakistan. Methods: Information about health research funding was retrieved from 3 major local agencies, the Higher Education Commission, the Pakistan Science Foundation and the Pakistan Health Research Council. Details of funding from international donors were retrieved and the number of publications was estimated from Pubmed and Pakmedinet. Results: A total of 1261.6 million Pakistan rupees (Rs) (US$ 8.4 million) was spent on health research in the last 5 fiscal years, the majority from local donors (P < 0.02). Overall funding increased from Rs 104.7 million in 2013–14 to Rs 349.8 million 2017–18. In publications data, 24 796 original articles were published, including 16 137 Medline and 8659 non-Medline indexed. Overall there was a gradual increase in the number of publications per year, statistically significant for Medline indexed journals. Research funding had a strong correlation (Cronbach α 0.88) with publications. Conclusion: Health research funding directly affects health research output. The funding on health research should be considered an investment rather than expenditure.

An ethnographic study of a Nepalese village with single kidney: A research protocol (Preprint)

BACKGROUND Kidney selling is a global phenomenon with higher-income countries functioning as recipients and lower-income countries as donors, reflecting the gaps due to poverty and vulnerability. Over the years, an increasing number of residents in a village near the capital city of Nepal have sold their kidneys and yet the factors embedded in local social, cultural, political, and individual context driving kidney selling are poorly understood. OBJECTIVE The aim of this study is to explore the drivers of kidney selling, and its consequences in Hokse village in Central Nepal using ethnographic methods and multi-stakeholder consultations. METHODS An ethnographic approach along with in-depth interviews and key informant interviews will be conducted among the residents and kidney sellers in the village. Relevant participants in the village will be selected purposively using a snowball approach. The number of participants will be predicated on the principles of data saturation. In addition, consultations with relevant stakeholders will be conducted at various levels, which will include authorities within the village, outside, and policymakers. All interviews will be conducted face to face, audio recorded for transcription, and subjected to a thematic analysis. RESULTS The research has received ethical approval from the Mahidol University Central Institutional Review Board (MU-CIRB), Thailand and Nepal Health Research Council (NHRC), Nepal. The findings will be disseminated through peer-reviewed publications. CONCLUSIONS In conclusion, this study aims to study explore the reason of kidney selling from the Hokse village and understand the perspectives from the multiple stakeholders.

Trend and Patterns of Research Proposals Submitted for Ethical Review in Nepal Health Research Council

Background: The characteristics of research proposals submitted to the Nepal Health Research Council reflect the trend of health-related researches being conducted in Nepal. The objective of the study was to analyze research proposals submitted for the ethical review in Nepal Health Research Council from 2017 to 2019.Methods: A retrospective record review of research proposals received over three years from 2017 to 2019 were analyzed. A total of 2,305 research proposals was included in the study. The number of research studies per year, types of study design, priority area of research, and rejected proposal were the intended variables for the study. Results: 91.45% (503), 92.19% (748), and 755 (80.1%) of received proposals were approved from Ethical Review Board in 2017, 2018 and 2019. The number of research proposals increased every year (550 in 2017, 812 in 2018, and 943 in 2019). Among the approved proposals non-communicable disease (n=150;15.90%) in 2019} was the topmost prioritized area in all three years followed by reproductive health [93 (9.86%) in 2019] and communicable disease [67 (7.10%) in 2019] respectively. Quantitative research was more than two-third in all the years. Among the approved proposals, more than half were for an academic purpose [ 610 (64.69%)]. The reason for the rejection of the proposal was the conduction of research before ethical approval [2 (0.36%) in 2017, 2 (0.25%) in 2018, and none in 2019].Conclusions: There was a rising trend of research proposals for ethical clearance being submitted to the Nepal Health Research Council. Research related to non-communicable disease followed by reproductive health was the commonest one. Keywords: Ethical approval; ethical review board; research proposals; record review

Changes and Compromises in Health Choices during COVID-19 Lockdown in Kathmandu Valley: A Descriptive Cross-sectional Study

Introduction: Nepal government enforced a lockdown as a social distancing measure to curb the COVID-19 pandemic. The lockdown has led to compromises in day to day choices like food, exercise, sleep, self-care routines and utilization of healthcare facilities - directly and indirectly influencing aspects of health. Identification of compromised health choices can assist in better planning of inevitable future crises. Methods: This is a cross-sectional descriptive study based on an online self -administered questionnaire, done using CHERRIES criteria, conducted from March 30, 2020, to July 31, 2020. Ethical approval for the study was obtained from the Institutional Review Committee of Nepal Health Research Council (Registration number: 2119; 300/2020 P). Descriptive statistics was used for analysis. Results: Our study had 51% (340) female and 48.7% (325) male participants. A total of 67.9% (112) reported decreased consumption of tobacco and 53.6% (178) reported decreased consumption of alcohol during the lockdown period. Participants who reported that they would have visited a hospital if they had a flu-like illness increased from 22.6% (151) pre-pandemic to 58.6% (391) post-pandemic. Increase in news consumption was reported by 79.2% (528). Out of 6.4% (43) participants with a chronic condition, 69.8% (30) reported having missed follow up due to the lockdown. Conclusions: The health of an individual is determined by various choices s/he makes on a day to day basis. Many of those choices are in turn influenced by the availability and accessibility of commodities. Lessons learned from the affected lives due to COVID-19 can be used in proper planning of inevitable future crises.

The power and limitations of genomics to track COVID-19 outbreaks: a case study from New Zealand

SummaryBackgroundReal-time genomic sequencing has played a major role in tracking the global spread and local transmission of SARS-CoV-2, contributing greatly to disease mitigation strategies. After effectively eliminating the virus, New Zealand experienced a second outbreak of SARS-CoV-2 in August 2020. During this August outbreak, New Zealand utilised genomic sequencing in a primary role to support its track and trace efforts for the first time, leading to a second successful elimination of the virus.MethodsWe generated the genomes of 80% of the laboratory-confirmed samples of SARS-CoV-2 from New Zealand’s August 2020 outbreak and compared these genomes to the available global genomic data.FindingsGenomic sequencing was able to rapidly identify that the new COVID-19 cases in New Zealand belonged to a single cluster and hence resulted from a single introduction. However, successful identification of the origin of this outbreak was impeded by substantial biases and gaps in global sequencing data.InterpretationAccess to a broader and more heterogenous sample of global genomic data would strengthen efforts to locate the source of any new outbreaks.FundingThis work was funded by the Ministry of Health of New Zealand, New Zealand Ministry of Business, Innovation and Employment COVID-19 Innovation Acceleration Fund (CIAF-0470), ESR Strategic Innovation Fund and the New Zealand Health Research Council (20/1018 and 20/1041).

Coronary flow reserve can explain some of FFR and iFR discrepancies. Results from international, multicenter and prospective trial

Background The trial collected prospective data from physiology measurements of borderline lesions in five Czech, one Japan and one Argentinian cathlabs. The main purposes were to analyze diagnostic agreement between FFR (fractional flow reserve) and iFR (instantaneous wave free ratio) examinations and to find possible explanations for discrepant results. Methods FFR and iFR examinations were analyzed using Philips-Volcano console and coronary flow reserve (CFR) was analyzed by using Combomap machine Philips-Volcano. Hyperemia for FFR and CFR measurements was induced by intracoronary administration of adenosine. We used CFR as a truth for comparison between FFR and iFR, because CFR has higher impact on patients prognosis than pressures indices. Results Data were collected from February 2016 to June 2019 and the database includes 1.789 examinations from 1.492 patients (282 of them, 15.8%, with ACS). CFR were measured in 343 lesions in 293 patients. (ACS 31.2%). Overall correlation between FFR and iFR is high (R=0.86 p&lt;0.0001). The FFR/iFR discrepancy occurred in 84 measurements (24.5%), more frequently it was FFRp (positive) / iFRn (negative) type of discrepancy (65, 18.9%) compare to FFRn/iFRp (19, 5.5%) one. There was no difference in occurrence of FFR/iFR discrepancy in stable patients and ACS ones (25.1%vs. 22.4%, p=0.59). The CFR correlated better with iFR than with FFR (R=0.56, p&lt;0.0001 vs. R= 0.36, p&lt;0.0001) (see table). In lesions with FFRp/iFRn type of discrepancy we found substantially higher CFR value compared to FFR/iFR agreement group (2.4±0.7 vs. 1.5±0.5, p&lt;0.0001). Unlike to FFRn/iFRp discrepancy, where CFR value was similar with agreement group (1.4±0.1 vs. 1.5±0.1, p=0.25) Conclusion The FFR/iFR discrepancy occurred in almost one quarter of examinations. Correlation between CFR and iFR is better than between CFR and FFR. High flow is probably one of the main reason for FFRp/iFRn type of discrepancy. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Czech Health Research Council

Lifestyle, behavior, perception and practices of Nepalese during lockdown due to COVID-19 pandemic

Introduction: COVID-19 infection is caused by a new strain of SARS CoV-2 virus, which transmits directly from person-to-person and has become a pandemic. To counteract this, actions related to mass quarantines or stay-at-home orders have been used termed as lockdown. This study aims to study lifestyle, behaviour, perception and practice of people regarding during the lockdown. Methods: An online survey was conducted with structured questionnaire in Google forms after ethical approval from Nepal Health Research Council (Ref-2631). The attributes of knowledge, attitude and practices were explored using multiple-choice questions and results were statistically analysed using Microsoft excel. Results: Five hundred fifty-five respondents completed the survey with 280 (50.5%) males and 275 (49.5%) female. The knowledge regarding viral pandemic was increased in 496 (89.3%) respondents. 424 (76.4%) people developed stress due to pandemic. Three hundred fifty three (63.6%) were adversely affected by professional works or suffered economic loss in business. More than 42% participants are using their time for study in personal development, online classes etc. Conclusions: The knowledge of viral pandemic as well as personal hygiene habits have improved in majority of people but many also developed stress. They were convinced that lockdown lowered transmission of infection which in turn affected lifestyle behaviour and practices. Practicing social distancing becomes too difficult for the poor in the absence of proper social security system and government support. E-Learning has become more acceptable due to lockdown. Further studies with in-person interviews are warranted.