Hepatitis C Virus Is Associated With Increased Mortality Among Incarcerated Hospitalized Persons in Massachusetts

Hepatitis C virus (HCV) is curable, but incarcerated populations face barriers to treatment. In a cohort of incarcerated hospitalized patients in Boston, Massachusetts, HCV infection was associated with increased mortality. Access to HCV treatment in carceral settings is crucial to avoid unnecessary death and to support HCV elimination efforts.

PENINGKATAN PENGETAHUAN KESEHATAN MELALUI EDUKASI PENATALAKSANAAN KEGAWATDARURATAN

Education related to emergency cases and their management are very important and practical; in order to increase the number of people, particularly students, who are trained in handling first aid in emergency cases. The purposes of this event are to provide an insight and understanding as well as to socialize first aid skills on emergency cases to lay people. By understanding health and safety factors, positively they can help to prevent unnecessary death. Emergency education and first aid training can increase public knowledge about the potential cases, so that people can implement them in daily life. This will definitely have an impact in increasing positive attitudes on the community. The event is held online using Zoom platform, on Saturday, September 24, 2021 and were attended by 339 participants, mostly medical students. Before and after the presentation, a pretest and a post-test are conducted to assess the knowledge of attending participants regarding emergency education. In general, the participants have better understanding about emergency cases and first aid training after the event.Kegiatan Penyuluhan Kesehatan Masyarakat (PKM) berupa edukasi terkait kasus gawat darurat serta tatalaksananya tentunya merupakan hal yang sangat penting dan bermanfaat. Sasaran kegiatan ini adalah terjadinya peningkatan jumlah orang yang terlatih, terutama dikalangan mahasiswa, dalam melakukan tindakan pertolongan pertama pada kasus gawat darurat. Tujuan kegiatan ini adalah memberikan wawasan serta pemahaman kepada masyarakat dan mensosialisasikan sejak dini kegiatan pertolongan pertama pada kasus kegawatdaruratan. Dengan demikan, pertolongan dapat dilakukan dengan memperhatikan unsur kesehatan serta keselamatan dengan tujuan dapat mencegah terjadinya kematian. Edukasi serta pelatihan ini dapat meningkatkan pengetahuan masyarakat mengenai kasus gawat darurat yang berdampak pada peningkatan sikap yang positif pada masyarakat, khususnya dalam kasus kegawatdaruratan serta penatalaksanaannya sehingga masyarakat dapat menerapkan dalam kehidupan sehari-hari. Kegiatan PKM ini dilakukan secara daring (online) dengan menggunakan platformZoom pada hari Sabtu tanggal 25 September 2021 dan diikuti oleh 339 peserta yang sebagian besar dari kalangan mahasiswa Fakultas Kedokteran. Sebelum dan sesudah penyampaian materi edukasi kasus kegawatdaruratan, dilakukan pretest untuk menilai pengetahuan awal peserta dan post-test bagi peserta untuk menilai pengetahuan setelah mengikuti edukasi terkait kegawatdaruratan. Secara garis besar, terdapat peningkatan pemahaman peserta mengenai tatalaksana kasus kegawatdaruratan (first aid) setelah dilakukan penyuluhan.

The Systemic Exclusion of Native Americans from Cancer Clinical Trials.

Introduction: A major source of health care disparities derives from the underrepresentation of ethnic minorities in clinical trials. The inclusion of ethnic minorities is necessary to generalize the results in terms of efficacy and toxicology of medications in cancer treatment. Methodology: In this retrospective study, 80 cancer clinical trials with an aggregate of 278,470 participants performed within the last ten years were selected at random. The number of ethnic minorities participating and inclusion of them in the results were evaluated. Results: Only, 42.5% of cancer clinical trials reported the ethnic background of participants in their trials while even less 5% reported the efficacy or toxicology of the therapeutic intervention for ethnic minorities. Whites, Hispanics, African Americans, and Native Americans make up 60.1%, 18.5%, 13.4% and 1.5% of the population they made up 85.3%, 2.54%, 7.6% and 0.12% of the participants that reported ethnicity, respectively. Out of 278,470 participants in cancer clinicals trials only 133 (0.048%) could be identified as Native American . Conclusion: Native Americans were nearly completely excluded from cancer clinical trials. African Americans and Hispanics were greatly underrepresented. Cancer Clinical trials may not be generalizable and have been inherently racist in the United States. This has led to the unnecessary death and suffering of Native Americans from cancer.

An Accidental Nutritionist

My career as an accidental nutritionist began with my immersion in cholera control, a cyclone disaster, a smallpox epidemic, and formal training in ophthalmology and epidemiology. Interest in blindness prevention inexplicably led me to (re)pioneer the effects, treatment, and prevention of vitamin A deficiency, while faced with intense criticism by many leading scientists in the nutrition community. The resulting efforts by the World Health Organization and UNICEF in support of programs for the global control of vitamin A deficiency still face vocal opposition by some senior scientists, despite having been estimated to have saved tens of millions of children from unnecessary death and blindness. This entire journey was largely an accident!

Additional Extension of the Mathematical Model for BCG Immunotherapy of Bladder Cancer and Its Validation by Auxiliary Tool

Immunotherapy with bacillus Calmette–Guérin (BCG) is a classic treatment for superficial bladder cancer. Although BCG instillation is a well-established protocol, some patients do not respond to this treatment. To model improvement of this protocol, Bunimovich-Mendrazitsky (B-M) et al. provided a platform for in silico testing of modified protocols of BCG instillation and combination with IL-2. The purpose of this work is to improve and further develop this BCG model describing the tumor–immune interactions occurring in the bladder in response to BCG and IL-2 therapies, based on novel clinical data.To validate this BCG model, we used the results of BCG treatment of 10 patients with bladder cancer 3-5 years ago. Individual data for each patient was entered to simulate the model. As a result, a treatment protocol was obtained which coincided with the protocol assigned by the doctor. In addition, cancer cell growth graphs were obtained from the model simulations, which coincided with the clinical conclusions of the patient’s treatment outcome. Moreover, the program provides a more optimal treatment protocol for each patient.We show that calculated protocols from the model can prevent excess side effects of immunotherapy and even of unnecessary death for some patients, informing the clinical potential of our model.

Subspecialty pediatric neurosurgery training: a skill-based training model for neurosurgeons in low-resourced health systems

There is inadequate pediatric neurosurgical training to meet the growing burden of disease in low- and middle-income countries (LMIC). Subspecialty expertise in the management of hydrocephalus and spina bifida—two of the most common pediatric neurosurgical conditions—offers a high-yield opportunity to mitigate morbidity and avoid unnecessary death. The CURE Hydrocephalus and Spina Bifida (CHSB) fellowship offers an intensive subspecialty training program designed to equip surgeons from LMIC with the state-of-the-art surgical skills and equipment to most effectively manage common neurosurgical conditions of childhood. Prospective fellows and their home institution undergo a comprehensive evaluation before being accepted for the 8-week training period held at CURE Children’s Hospital of Uganda (CCHU) in Mbale, Uganda. The fellowship combines anatomy review, treatment paradigms, a flexible endoscopic simulation lab, daily ward and ICU rounds, radiology rounds, and clinic exposure. The cornerstone of the fellowship is the unique operative experience that includes a high volume of endoscopic third ventriculostomy with choroid plexus cauterization, myelomeningocele closure, and ventriculoperitoneal shunting, among many other procedures performed at CCHU. Upon completion, fellows return to their home institution to establish or rejuvenate a robust pediatric practice as part of a worldwide network of CHSB trainees committed to the care of underserved children. To date, the fellowship has graduated 33 surgeons from 20 different LMIC who are independently performing thousands of hydrocephalus and spina bifida operations each year.

Post-Hurricane Vital Statistics Expose Fragility of Puerto Rico’s Health System

ImportanceHurricane Maria made landfall in Puerto Rico on September 20, 2017. As recently as May of this year (2018), the official death count was 64. After a study describing a household survey reported a much higher death count estimate, as well as evidence of population displacement, extensive loss of services, and a prolonged death rate the government released death registry data. These newly released data will permit a better understanding of the effects of this hurricane.ObjectiveProvide a detailed description of the effects on mortality of Hurricane Maria and compare to other hurricanes.DesignWe fit a statistical model to mortality data that accounts for seasonal and non-hurricane related yearly effects. We then estimated the deviation from the expected death rate as a function of time.SettingWe fit this model to 1985-2018 Puerto Rico daily data, which includes the dates of hurricanes Hugo, Georges, and Maria, 2015-2018 Florida daily data, which includes the dates of Hurricane Irma, 2002-2004 Louisiana monthly data, which includes the date of Hurricane Katrina, and 2000-2016 New Jersey monthly data, which includes the date of Hurricane Sandy.ResultsWe find a prolonged increase in death rate after Maria and Katrina, lasting at least 207 and 125 days, resulting in excess deaths estimates of 3,400 (95% CI, 3,100-3,700), and 1,800 (95% CI, 1,600-2100) respectively, showing that Maria had a more long term damaging impact. Surprisingly, we also find that in 1998, Georges had a comparable impact to Katrina’s with a prolonged increase of 106 days resulting in 1,400 (95% CI, 1,200-1,700) excess deaths. For Hurricane Maria, we find sharp increases in a small number of causes of deaths, including diseases of the circulatory, endocrine and respiratory system, as well as bacterial infections and suicides.Conclusion and RelevanceOur analysis suggests that since at least 1998, Puerto Rico’s health system has been in a precarious state. Without a substantial intervention, it appears that if hit with another strong hurricane, Puerto Ricans will suffer the unnecessary death of hundreds of its citizens.Key PointsQuestion: How does the effect of Hurricane Maria on mortality in Puerto Rico compare to the effect of other hurricanes in Puerto Rico and other United States jurisdictions?Findings: We estimate about 3,000 excess deaths after Maria, a higher toll than Katrina. Only other comparable effect was after Georges, also in Puerto Rico. For Georges and Maria, we observe a prolonged death rate increase of more than 10% lasting several months. The causes of death that increased after Maria are consistent with a collapsed health systemMeaning: Puerto Rico’s health system does not appear to be ready to withstand another strong hurricane.

An exploration of the knowledge, attitudes and beliefs of Xhosa men concerning traditional circumcision

Background: The practice of traditional circumcision is associated with considerable morbidity and mortality, yet there is a paucity of literature that provides an understanding of the cultural values that influence men to choose traditional rather than medical circumcision.The aim of this study was to better understand the culture surrounding traditional circumcision, with a view to addressing morbidity and mortality rates associated with the Xhosa male initiation rituals.We explored Xhosa men’s perceptions regarding the need for the risks and the social pressure to undergo traditional circumcision, the impact of non-initiation or failed initiation and the perceived barriers to obtaining medical help for the complications of traditional circumcisions.Methods: Individual in-depth interviews were conducted with 10 purposively sampled teenagers and adult men. The interviews were recorded, translated, transcribed and analysed using the framework method.Results: Traditional circumcision was seen as essential to Xhosa culture. Participants rationalised many reasons for participating, including personal growth and development, family and peer pressure, independence and knowledge gained, a connection with ancestors and initiation into manhood. Despite publicity of the dangers of traditional circumcision and the hardships they have to endure, most young men still saw this process as necessary and worthwhile.Conclusion: Traditional initiation and circumcision are here to stay. The majority of boys still trust the elders and supernatural processes to guide them. However, some participants welcomed government initiatives to reduce human error causing unnecessary death and suffering. Current systems to prevent morbidity and mortality are insufficient and should be prioritised.