TB screening, prevention and treatment cascade in a Malawi prison.

BACKGROUND Incarcerated individuals, especially in high HIV and TB burden settings, are at increased risk of latent TB infection and/or TB disease. We implemented a comprehensive HIV-TB intervention in a Malawi prison and studied its feasibility.METHODS Between February and December 2019, consenting individuals underwent screening for HIV, TB infection and TB disease. HIV-positive individuals without TB disease were treated with a fixed-dose combination of isoniazid, cotrimoxazole and vitamin B6 (INH-CTX-B6). HIV-negative persons with TB infection received 12 weeks of isoniazid and rifapentine (3HP).RESULTS Of 1,546 consenting individuals, 1,498 (96.9%) were screened and 1,427 (92.3%) included in the analysis: 96.4% were male, the median age was 31 years (IQR 25-38). Twenty-nine (2.1%) participants were diagnosed with TB disease, of whom 89.7% started and 61.5% completed TB treatment. Of the 1,427 included, 341 (23.9%) were HIV-positive, of whom 98.5% on antiretroviral therapy and 95% were started on INH-CTX-B6. Among 1,086 HIV-negative participants, 1,015 (93.5%) underwent the tuberculin skin test (TST), 670 (65.9%) were TST-positive, 666 (99.4%) started 3HP and 570 (85.5%) completed 3HP treatment.CONCLUSION A comprehensive TB screening and treatment package among incarcerated individuals was acceptable and feasible, and showed high prevalence of HIV, TB disease and TB infection. Treatment uptake was excellent, but treatment completion needs to be improved. Greater investment in comprehensive HIV-TB services, including access to shorter TB regimens and follow-up upon release, is needed for incarcerated individuals.

A novel approach for discovering human behavior patterns using unsupervised methods.

BACKGROUND: As is well known, elderly people gradually lose the ability of self-care. The decline can be reflected in changes in their daily life behavior. A solution to assess their health status is to design sensor-enhanced living environments to observe their behavior, in which unobtrusive sensors are usually used. With respect to information extraction from the dataset collected by means of these kinds of sensors, unsupervised methods have to be relied on for practical application. Under the assumption that human lifestyle is associated with health status, this study intends to propose a novel approach to discover behavior patterns using unsupervised methods. METHODS: To evaluate the feasibility of this approach it was applied to datasets collected in the GAL-NATARS study. The study is part of the Lower Saxony research network Design of Environments for Aging (GAL) and conducted in subjects' home environments. The subjects recruited in GAL-NATARS study are older people (age ≥ 70 years), who are discharged from hospital to live alone again at their homes after treatment of a femoral fracture. RESULTS: The change of lifestyle regularity is measured. By analyzing the correlation between the extracted information and medical assessment results of four subjects, two of them exhibited impressive association and the other two showed less association. CONCLUSIONS: The approach may provide complementary information for health assessment; however, the dominant relationship between the change of behavior patterns and the health status has to be shown and datasets from more subjects must be collected in future studies. LIMITATIONS: Merely environmental data were used and no wearable sensor for activity detection or vital parameter measurement is taken into account. Therefore, this cannot comprehensively reflect reality.

Multimodal sensor-based fall detection within the domestic environment of elderly people.

BACKGROUND: Falls represent a major threat to the health of the elderly and are a growing burden on the healthcare systems. With the growth of the elderly population within most societies efficient fall detection becomes increasingly important; however, existing fall detection systems still fail to produce reliable results. OBJECTIVES: A study was carried out on sensor-based fall detection, analysis of falls with the help of fall protocols and the analysis of user acceptance of fall detection sensor technology through questionnaires. MATERIAL AND METHODS: A total of 28 senior citizens were recruited from a German community-dwelling population. The primary goal was a sensor-based detection of falls with accelerometers, video cameras and microphones. Details of the falls were analyzed with the help of medical geriatric assessments and standardized fall protocols. The study duration was 8 weeks and required a maximum of nine visits per subject. RESULTS: The study participants were 28 subjects with a mean age of 74.3 and a standard deviation (SD) of ± 6.3 years of which 12 were male and 16 female. A total of 1225.7 measurement days were recorded from all participants and the algorithms detected 2.66 falls per day. During the study period 15 falls occurred and 12 of these falls were correctly recognized by the fall detection system. CONCLUSION: Current fall detection technologies work well under laboratory conditions but it is still problematic to produce reliable results when these technologies are applied to real life conditions. Acceptance towards the sensors decreased after study participation although the system was generally perceived as useful or very useful.

GAL@Home: a feasibility study of sensor-based in-home fall detection.

BACKGROUND: A considerable proportion of falls occur within the domestic environment. Sensor-based identification of falls in seniors' homes could help them to remain autonomous and self-sufficient in their own homes. The objective of this study was to evaluate fall detection systems within the home environment using optical and accelerometric sensor systems. METHODS: Portable triaxial accelerometers and optical sensors were used to detect falls in subjects with known problems of mobility and a recent fall history. RESULTS: Three subjects were investigated with the system. Overall nine falls occurred during the study period. Four falls were recorded by the accelerometric system and one fall by the optical system. Subjects with increased risk of falling as measured with mobility and fall risk assessments tend to fall more frequently. CONCLUSION: The study shows that there is a considerably large difference between fall-detector evaluation studies in domestic environments and in laboratory trials.

Defining the user requirements for wearable and optical fall prediction and fall detection devices for home use.

One of the major problems in the development of information and communication technologies for older adults is user acceptance. Here we describe the results of focus group discussions that were conducted with older adults and their relatives to guide the development of assistive devices for fall detection and fall prevention. The aim was to determine the ergonomic and functional requirements of such devices and to include these requirements in a user-centered development process. A semi-structured interview format based on an interview guide was used to conduct three focus group discussions with 22 participants. The average age was 75 years in the first group, 68 years in the second group and 50 years in the third group (relatives). Overall, participants considered a fall prediction system to be as important as a fall detection system. Although the ambient, unobtrusive character of the optical sensor system was appreciated, wearable inertial sensors were preferred because of their wide range of use, which provides higher levels of security. Security and mobility were two major reasons for people at risk of falling to buy a wearable and/or optical fall prediction and fall detection device. Design specifications should include a wearable, non-stigmatising sensor at the user's wrist, with an emergency option in case of falling.

Ambient neighbourhood noise and children's mental health.

OBJECTIVES: To investigate the relation between typical ambient noise levels (highway, rail, road) and multiple mental health indices of school children considering psychosocial and biological risk factors as potential moderators. METHODS: With a two stage design strategy (representative sample and extreme sample) two cross sectional samples (n=1280; n=123) of primary school children (age 8-11) were studied. Individual exposure to noise at home was linked with two indices of mental health (self reporting by the child on a standard scale and rating by the teacher of classroom adjustment on a standard scale). Noise exposure was modelled firstly according to Austrian guidelines with the aid of a geographical information system and then calibrated and corrected against measurements from 31 locations. Information on potential confounders and risk factors was collected by mothers and controlled in regression modelling through a hierarchical forward stepping procedure. Interaction terms were also analysed to examine subgroups of children at risk-for example, low birth weight and preterm birth. RESULTS: Noise exposure was significantly associated in both samples with classroom adjustment ratings. Child self reported mental health was significantly linked to ambient noise only in children with a history of early biological risk (low birth weight and preterm birth). CONCLUSIONS: Exposure to ambient noise was associated with small decrements in children's mental health and poorer classroom behaviour. The correlation between mental health and ambient noise is larger in children with early biological risk.

[Effectiveness of acupuncture in the treatment of pain from osteoarthritis of the knee]. / Efectividad de la acupuntura en el tratamiento del dolor en la artrosis de rodilla.

AIM: To determine the effectiveness of acupuncture in controlling pain from arthritis of the knee. DESIGN: Systematic review. DATA SOURCES: MedLine, the Cochrane Library. STUDY SELECTION: Of the 9 studies located, only 4 met the inclusion criteria. All were controlled, randomized clinical trials that studied the effect of acupuncture only in the knee joint. DATA EXTRACTION: Primary outcome variables were intensity of pain, overall measure (general improvement, proportion of patients who recovered, subjective improvement in symptoms) and functional status. As secondary outcome measures we used objective physiological measures (range of knee movement, muscle strength, time needed to walk a certain distance, time needed to climb a certain number of stairs), general health status, and other information such as medication needed and side effects. RESULTS: There was moderately strong evidence that acupuncture was more effective in treating knee joint pain than no treatment. The difference can be explained by its marked placebo effect. CONCLUSIONS: There is currently insufficient evidence to recommend acupuncture as a treatment for pain from osteoarthritis of the knee. Additional, better designed studies are needed to determine the actual role of acupuncture in this disease.

Efectividad de la acupuntura en el tratamiento del dolor en la artrosis de rodilla / Effectiveness of acupuncture in the treatment of pain from osteoarthritis of the knee

Objetivo. Determinar la efectividad de la acupuntura en el control del dolor de la artrosis de rodilla. Diseño. Revisión sistemática. Fuentes de datos. MEDLINE, The Cochrane Library. Selección de estudios. De los 9 estudios encontrados, sólo 4 superaron los criterios de selección. Se trata de ensayos clínicos controlados aleatorios que estudian el efecto de la acupuntura únicamente en la articulación de la rodilla. Extracción de datos. Los indicadores de resultado primarios valorados son: intensidad del dolor, medición global (mejoría general, proporción de pacientes recuperados, mejoría subjetiva de los síntomas) y estado funcional. Son considerados indicadores de resultado secundarios: mediciones fisiológicas objetivas (amplitud del movimiento de la rodilla, fuerza muscular, tiempo para caminar una determinada distancia, tiempo para escalar una altura determinada), estado general de salud y otros datos, como la necesidad de utilizar medicación o los efectos secundarios. Resultados. Existe una evidencia moderada sobre la efectividad de la acupuntura en el tratamiento del dolor de la gonartrosis frente al no tratamiento, que puede ser explicada por su fuerte efecto placebo. Conclusiones. En la actualidad no existe suficiente evidencia para recomendar la acupuntura como tratamiento del dolor de la gonartrosis. Son necesarios nuevos estudios, y mejor diseñados, para determinar el verdadero papel de la acupuntura en esta enfermedad (AU)

Community noise exposure and stress in children.

Although accumulating evidence over the past two decades points towards noise as an ambient stressor for children, all of the data emanate from studies in high-intensity, noise impact zones around airports or major roads. Extremely little is known about the nonauditory consequences of typical, day-to-day noise exposure among young children. The present study examined multimethodological indices of stress among children living under 50 dB or above 60 dB (A-weighted, day-night average sound levels) in small towns and villages in Austria. The major noise sources were local road and rail traffic. The two samples were comparable in parental education, housing characteristics, family size, marital status, and body mass index, and index of body fat. All of the children were prescreened for normal hearing acuity. Children in the noisier areas had elevated resting systolic blood pressure and 8-h, overnight urinary cortisol. The children from noisier neighborhoods also evidenced elevated heart rate reactivity to a discrete stressor (reading test) in the laboratory and rated themselves higher in perceived stress symptoms on a standardized index. Furthermore girls, but not boys, evidenced diminished motivation in a standardized behavioral protocol. All data except for the overnight urinary neuroendocrine indices were collected in the laboratory. The results are discussed in the context of prior airport noise and nonauditory health studies. More behavioral and health research is needed on children with typical, day-to-day noise exposure.

The psychological cost of aircraft noise for children.

Psychological effects of aircraft noise exposure on children have only recently been addressed in the References. The current study took advantage of a natural experiment caused by the opening of a major new airport, exposing children in a formerly quiet area to aircraft noise. In this prospective longitudinal investigation, which employed non-exposed control groups, effects of aircraft noise prior to and subsequent to inauguration of the new airport as well as effects of chronic noise and its reduction at the old airport (6 and 18 month post relocation), were studied in 326 children aged 9 to 13 years. The psychological health of children was investigated with a standardized quality of life scale as well as with a motivational measure derived from the Glass and Singer stress aftereffects paradigm. In addition a self report noise annoyance scale was used. In the children studied at the two airports over three time points, results showed a significant decrease of total quality of life 18 month after aircraft noise exposure as well as a motivational deficits operationalized by fewer attempts to solve insoluble puzzles in the new airport area. Parallel shifts in children's attributions for failure were also noted. At the old airport parallel impairments were present before the airport relocation but subsided there after. These findings are in accord with reports of impaired psychological health after noise exposure and indicate the relevance of monitoring psychological parameters as a function of environmental stressors among children.

Assembly and processing of procollagen V (AB) in chick blood vessels and other tissues.

The biosynthesis and processing of type V procollagens was investigated in chick embryo blood vessels labeled with radioactive amino acids. Monomeric, pepsin-sensitive pro alpha 1 V and pro alpha 2 V chains are slowly assembled into triple helically folded molecules. A small proportion of these procollagen V molecules contain interchain disulfide bridges, and the disulfide-linked heterodimer and heterotrimer (pro alpha 1 V)2pro alpha 2 V were found. A relatively fast conversion of procollagen V to p-collagen V is followed by slow change to collagen V. This time course is similar to the processing of procollagen III and is much slower than the rate of appearance of type I collagen in blood vessels. A combination of sedimentation and electrophoretic analyses was used to measure the relative size of the type V chains and to demonstrate attachment of noncollagenous peptides (Mr = 33,000) to p alpha 2 V by disulfide linkage. Similar quantitative pulse-chase studies were made with calvaria and crop. As the same unusual features of assembly and processing of type V chains were seen in muscle, bone, and blood vessels, we conclude that these are characteristic of type V collagen biosynthesis.