BioMed Research International: Epidemiology

[]
BioMed Research International: Epidemiology https://www.hindawi.com The latest articles from Hindawi © 2022 , Hindawi Limited . All rights reserved. Mathematical Model and Analysis on the Impact of Awareness Campaign and Asymptomatic Human Immigrants in the Transmission of COVID-19 Sat, 28 May 2022 05:35:00 +0000 https://www.hindawi.com/journals/bmri/2022/6260262/ In this study, an autonomous type deterministic nonlinear mathematical model that explains the transmission dynamics of COVID-19 is proposed and analyzed by considering awareness campaign between humans and infectives of COVID-19 asymptomatic human immigrants. Unlike some of other previous model studies about this disease, we have taken into account the impact of awareness c between humans and infectives of COVID-19 asymptomatic human immigrants on COVID-19 transmission. The existence and uniqueness of model solutions are proved using the fundamental existence and uniqueness theorem. We also showed positivity and the invariant region of the model system with initial conditions in a certain meaningful set. The model exhibits two equilibria: disease (COVID-19) free and COVID-19 persistent equilibrium points and also the basic reproduction number, which is derived via the help of next generation approach. Our analytical analysis showed that disease-free equilibrium point is obtained only in the absence of asymptomatic COVID-19 human immigrants and disease (COVID-19) in the population. Moreover, local stability of disease-free equilibrium point is verified via the help of Jacobian and Hurwitz criteria, and the global stability is verified using Castillo-Chavez and Song approach. The disease-free equilibrium point is both locally and globally asymptotically stable whenever , so that disease dies out in the population. If , then disease-free equilibrium point is unstable while the endemic equilibrium point exists and stable, which implies the disease persist and reinvasion will occur within a population. Furthermore, sensitivity analysis of the basic reproduction number, with respect to model parameters, is computed to identify the most influential parameters in transmission as well as in the control of COVID-19. Finally, some numerical simulations are illustrated to verify the theoretical results of the model. Alemzewde Ayalew Anteneh, Yezbalem Molla Bazezew, and Shanmugasundaram Palanisamy Copyright © 2022 Alemzewde Ayalew Anteneh et al. All rights reserved. Varietal Screening of Durum Wheat Varieties for Resistance to Pyrenophora tritici-repentis (Tan Spot) under Field Conditions Fri, 27 May 2022 11:50:01 +0000 https://www.hindawi.com/journals/bmri/2022/6433577/ Tan spot disease caused by Pyrenophora tritici-repentis was becoming more bred in Tunisia during the last decade. The search for resistant varieties against the increased virulence diversity of P. tritici-repentis is presently considered as a priority. Seven of the most commercialized durum wheat varieties in Tunisia (cvs. Maâli, Salim, Razzak, Monastir, Khiar, Inrat100, and Sculptur) were inoculated with five characterized fungal strains under field conditions, during two seasons. The variance analysis revealed that strains Ech8F6 and B4.8 used in inoculation are the most virulent ones. These strains hosting ToxB gene caused chlorosis symptom on the tested varieties. The other strains induced necrosis with yellow halo and host ToxA gene were less virulent. The area under disease progress curve values revealed that Maâli is the most vulnerable genotype compared to the new selected varieties Monastir and Inrat100. A variable tolerance rate of the varieties to tan spot disease was also highly visible on yield components. The losses were about 22.2% of the thousand kernel weight in Maâli variety, 35% of spikes/m2 in Inrat100 variety, 32.5% of kernel number/spike, and 25.2% of yield grain in Monastir variety. This effect evaluation of the strains harbouring ToxA and ToxB genes could be responsible for the identification of potentially susceptible genes Tsn1 and Tsc2 representing resistance sources for breeding programs. Salma Tissaoui, Marwa Hassine, Amira Mougou-Hamdane, Ala Eddine Ben Araar, Romdhane Nasraoui, and Bouzid Nasraoui Copyright © 2022 Salma Tissaoui et al. All rights reserved. Insulin Resistance and Biological Aging: The Role of Body Mass, Waist Circumference, and Inflammation Mon, 09 May 2022 10:50:00 +0000 https://www.hindawi.com/journals/bmri/2022/2146596/ The purpose of this investigation was to evaluate the association between insulin resistance and biological aging in a randomly selected sample of 2,596 U.S. women and men. Another key objective was to examine the extent to which the insulin resistance and biological aging association was influenced by differences in body mass, waist circumference, and systemic inflammation. Biological aging was indexed using the length of leukocyte telomeres. The homeostatic model assessment (HOMA) was employed to index insulin resistance. The body mass index (BMI) was used to represent body mass independent of height. Waist circumference was used to assess abdominal adiposity, and C-reactive protein (CRP) was measured to index body-wide inflammation. Insulin resistance and telomere length were both treated as continuous variables. Results revealed that insulin resistance was related significantly with cellular aging, after adjusting for several demographic covariates (,). The association remained significant after controlling for multiple demographic and lifestyle covariates together (,). However, after controlling for BMI, along with the other covariates, insulin resistance was no longer associated with biological aging . After adjusting for differences in waist circumference, along with the demographic and lifestyle covariates, but not BMI, the relationship between insulin resistance and biological aging was negated further . Adjusting for CRP with the demographic and lifestyle covariates, but not BMI or waist circumference, weakened the relationship (,). Evidently, if all adults in the U.S. had the same BMI or waist circumference, there would not be a relationship between insulin resistance and telomere length. It appears that insulin resistance accounts for differences in biological aging mainly because of differences in BMI and waist circumference, especially the latter. Larry A. Tucker Copyright © 2022 Larry A. Tucker. All rights reserved. Serological Surveillance of the H1N1 and H3N2 Swine Influenza A Virus in Chinese Swine between 2016 and 2021 Thu, 28 Apr 2022 13:35:01 +0000 https://www.hindawi.com/journals/bmri/2022/5833769/ Background. Swine influenza A virus (IAV-S) is a common cause of respiratory disease in pigs and poses a major public health threat. However, little attention and funding have been given to such studies. The aim of this study was to assess the prevalence of the Eurasian avian-like H1N1 (EA H1N1), 2009 pandemic H1N1 (pdm/09 H1N1), and H3N2 subtype antibodies in unvaccinated swine populations through serological investigations. Such data are helpful in understanding the prevalence of the IAV-S. Methods. A total of 40,343 serum samples from 17 regions in China were examined using hemagglutination inhibition (HI) tests against EA H1N1, pdm/09 H1N1, and H3N2 IAV-S from 2016 to 2021. The results were analyzed based on a reginal distribution, seasonal distribution, and in different breeding stages. Results. A total of 19,682 serum samples out of the 40,343 were positive for IAV-S (48.79%). The positivity rates to the EA H1N1 subtype, pdm/09 H1N1 subtype, and H3N2 subtype were 24.75% (9,986/40,343), 7.94% (3,205/40,343), and 0.06% (24/40,343), respectively. The occurrences of coinfections from two or more subtypes were also detected. In general, the positivity rates of serum samples were related to the regional distribution and feeding stages. Conclusions. The results of this study showed that the anti-EA H1N1 subtype and pdm/09 H1N1 subtype antibodies were readily detected in swine serum samples. The EA H1N1 subtype has become dominant in the pig population. The occurrences of coinfections from two or more subtypes afforded opportunities for their reassortment to produce new viruses. Our findings emphasized the need for continuous surveillance of influenza viruses. Yuzhong Zhao, Lebin Han, Ting Chen, Haotian Sang, Guofei Ding, Yingchao Li, Bin Wang, Liting Qin, Sidang Liu, Yanmeng Hou, and Yihong Xiao Copyright © 2022 Yuzhong Zhao et al. All rights reserved. Achievements and Visibility of Scientific Publications of All Peruvian Medical Schools: A 5-Year Scientometric Analyses Mon, 25 Apr 2022 08:50:01 +0000 https://www.hindawi.com/journals/bmri/2022/9097379/ Objective. To evaluate the bibliometric profile of the national academic production of public and private medical schools in Scopus after the publication of a new university law (2015–2020). Methods. A descriptive bibliometric study was conducted. The secondary data corresponding to the 42 Peruvian medical schools that had scientific publications in Scopus from 2015 to 2020 were evaluated, and the Affiliation ID of each Peruvian institution was considered. Data were analysed using SciVal. Results. The total production of the Peruvian medical schools was 5406 manuscripts (100%), of which 3018 (56%) were included in the ‘clinical medicine’ category. The total production of publications in Peru from 2015 to 2020 was 21597 manuscripts, of which medical publications accounted for 7950, with only 5406 manuscripts belonging to the Faculties of Medicine of Peru. The Peruvian Journal of Experimental Medicine and Public Health had published the highest number of manuscripts (500 articles), with an approximate publication citation of two. Conclusion. There was a constant increase in the scientific production of Peruvian medical schools from 2015 to 2020. Additionally, it was found that medical publications contribute the most to the total scientific production of Peru. Frank Mayta-Tovalino, Josmel Pacheco-Mendoza, Jesus Bardales-Garcia, Juan Alvitez, Abigail Temoche, Roman Mendoza, and Arnaldo Munive-Degregori Copyright © 2022 Frank Mayta-Tovalino et al. All rights reserved. Assessment of Hepatitis B Vaccination Status and Associated Factors among Healthcare Workers in Bosaso, Puntland, Somalia 2020 Mon, 21 Mar 2022 08:50:00 +0000 https://www.hindawi.com/journals/bmri/2022/9074294/ Introduction. Hepatitis B virus disease is a viral infection caused by the hepatitis B virus (HBV), which is a major public health problem worldwide. According to the World Health Organization (WHO) estimate, two billion people worldwide have serologic evidence of past or present HBV infection. The risk of infection is high among health professionals due to the risk of occupational contact with fluids of infected patients and the risk of needle stick injury. This study is aimed at assessing HBV vaccination coverage and reasons for possible defiance of the vaccine among healthcare workers in Bosaso, Somalia. Methodology. An institution-based cross-sectional study was conducted by using a quantitative approach to identify hepatitis B virus vaccination coverage and reasons for vaccine defiance in Bosaso from September 2020 to November 2020. Healthcare workers (HCWs) in Bosaso city both in public and private health facilities who accepted to participate in this study were interviewed by using a structured questionnaire, and SPSS was used to analyze the collected data. Results. We found that only (16.4%) of HCWs were fully vaccinated. The main reasons for not taking the vaccine by the participants were the unavailability of the vaccine (42%), high vaccine cost (28.7%), lack of time (20.7%), and fear of vaccine side effects (7.5%). The majority (69.7%) of HCWs demonstrated good knowledge about HBV infection. The vaccination uptake was significantly higher among midwives (;;) and individuals aged under 30 years (;;).Conclusion. Our study revealed that vaccination coverage of HCWs in Bosaso was very low because of the unavailability of vaccines, high cost of the vaccine, lack of time, and fear of vaccine side effects. Therefore, the development and implementation of policies related to HBV vaccination are recommended. Nur Ahmed Hussein, Abdiwahid Mohamed Ismail, and Saaid Said Jama Copyright © 2022 Nur Ahmed Hussein et al. All rights reserved. Determination of Human Papillomavirus Type 18 Lineage of E6: A Population Study from Iran Fri, 18 Mar 2022 11:05:01 +0000 https://www.hindawi.com/journals/bmri/2022/2839708/ The epidemiological studies in Iran on HPV18 nucleotide changes are rare. This type of virus is prevalent in the Iranian population. Therefore, in the present study, we aimed to identify the genetic variability in HPV18 in the E6 region to evaluate the prevalence of lineage distribution and sublineages in a sample population in Iran. Overall, 60 HPV18 confirmed cases were investigated between 2019 and 2021. The specimens were collected, and molecular genotyping was done using the Linear Array HPV Genotyping Test. DNA extraction was performed by a viral DNA/RNA kit. The HPV E6 gene was amplified by using type-specific primers designed according to the HPV18 genome prototype sequence. The sequencing of the E6 region was successfully done on 43 samples which were then compared to the reference sequence. The most frequent sublineage of HPV18 in this study was A4 (69.7%), followed by A1 (18.6%) and A3 (11.6%). Neither A2 nor A5 sublineage was not detected in this study. The related nucleotide acid changes according to the main references were as follows: A3: T104C/T232G/T485C/C549A, A4: T104C/T485C/C549A. The predominance of A lineage with the high frequency of A4 sublineage was found in the present research. The importance of sublineages in susceptibility to a progressive form of infection requires to be more investigated among the different population. Mona Sadat Larijani, Mir Davood Omrani, Rahim Soleimani, Anahita Bavand, Amir Houshang Nejadeh, Vahid Ezzatizadeh, Mahboubeh Jamshidi, and Amitis Ramezani Copyright © 2022 Mona Sadat Larijani et al. All rights reserved. Estimating the Proportion of Asymptomatic COVID-19 Cases in an Italian Region with Intermediate Incidence during the First Pandemic Wave: An Observational Retrospective Study Thu, 06 Jan 2022 06:05:03 +0000 https://www.hindawi.com/journals/bmri/2022/3401566/ Early in the COVID-19 pandemic, asymptomatic transmission represented an important challenge for controlling the spread of SARS-CoV-2 through the traditional public health strategies. Further understanding of the contribution of asymptomatic infections to SARS-CoV-2 transmission has been of crucial importance for pandemic control. We conducted a retrospective epidemiological study to characterize asymptomatic COVID-19 cases occurred in the Apulia region, Italy, during the first epidemic wave of COVID-19 outbreak (February 29-July 7, 2020). We analyzed data collected in a regional platform developed to manage surveillance activities, namely, investigation and follow-up of cases and contacts, contact tracing, and laboratory and clinical data collection. We included all asymptomatic cases that were laboratory-confirmed during the appropriate follow-up, defined as persons infected with SARS-CoV-2 who did not develop symptoms/clinical signs of the disease. Between February 29 and July 7, 2020, a total of 4,536 cases were diagnosed with COVID-19 among 193,757 tests performed. The group of persons with asymptomatic SARS-CoV-2 infection consisted of 903 cases; the asymptomatic proportion was 19.9% (95% CI: 18.8-21.1%); this decreased with increasing age (OR: 0.89, 95% CI: 0.83-0.96; ), in individuals with underlying comorbidities (OR: 0.55, 95% CI: 0.41-0.73; ), and in males (OR: 0.69, 95% CI: 0.54-0.87; ). The median asymptomatic SARS-CoV-2 RNA positive period was 19 days (IQR: 14-31) and the cumulative proportion of persons with resolution of infection 14 days after the first positive PCR test was 74%. As the public health community is debating the question of whether asymptomatic and late spreaders could sustain virus transmission in the communities, such cases present unique opportunities to gain insight into SARS-CoV-2 adaptation to human host. This has important implications for future COVID-19 surveillance and prevention. Domenico Martinelli, Francesca Fortunato, Sara Mazzilli, Lucia Bisceglia, Pier Luigi Lopalco, and Rosa Prato Copyright © 2022 Domenico Martinelli et al. All rights reserved. A Machine Learning Approach to Assess Differential Item Functioning in Psychometric Questionnaires Using the Elastic Net Regularized Ordinal Logistic Regression in Small Sample Size Groups Wed, 15 Dec 2021 12:20:00 +0000 https://www.hindawi.com/journals/bmri/2021/6854477/ Assessing differential item functioning (DIF) using the ordinal logistic regression (OLR) model highly depends on the asymptotic sampling distribution of the maximum likelihood (ML) estimators. The ML estimation method, which is often used to estimate the parameters of the OLR model for DIF detection, may be substantially biased with small samples. This study is aimed at proposing a new application of the elastic net regularized OLR model, as a special type of machine learning method, for assessing DIF between two groups with small samples. Accordingly, a simulation study was conducted to compare the powers and type I error rates of the regularized and nonregularized OLR models in detecting DIF under various conditions including moderate and severe magnitudes of DIF (), sample size (), sample size ratio (), scale length (), and weighting parameter (). The simulation results revealed that for and regardless of , the elastic net regularized OLR model with , as compared with the nonregularized OLR model, increased the power of detecting moderate uniform DIF () approximately 35% and 21% for , respectively. Moreover, for and severe uniform DIF (), the average power of the elastic net regularized OLR model with , as compared with the nonregularized OLR model, increased approximately 29.3% and 11.2% for , respectively. In these cases, the type I error rates of the regularized and nonregularized OLR models were below or close to the nominal level of 0.05. In general, this simulation study showed that the elastic net regularized OLR model outperformed the nonregularized OLR model especially in extremely small sample size groups. Furthermore, the present research provided a guideline and some recommendations for researchers who conduct DIF studies with small sample sizes. Vahid Ebrahimi, Zahra Bagheri, Zahra Shayan, and Peyman Jafari Copyright © 2021 Vahid Ebrahimi et al. All rights reserved. Plasma Fatty Acid Composition Was Associated with Apelin Gene Expression in Human Adipose Tissues Wed, 06 Oct 2021 10:50:00 +0000 https://www.hindawi.com/journals/bmri/2021/8846483/ Background. Apelin is an adipokine with an intermediatory role in obesity and insulin resistance, which can be modified by dietary intake. Aims. In this study, we aimed to determine the association of the plasma fatty acid composition with apelin plasma concentration and gene expression in visceral (VAT) and subcutaneous (SAT) adipose tissues. Methods. In this cross-sectional study, we recruited 179 patients aged 19-75 years who were candidates for elective surgery. Through the surgery, SAT and VAT were collected to measure apelin gene expression. Anthropometric measurements, fasting blood samples, and dietary intakes were collected before surgery. Free fatty acids (FFAs) in fasting whole plasma were measured using gas chromatography with flame ionization detection. Linear regression models were used to estimate standardized (STZ ) showing the association of individual and total FFAs with apelin gene expression after adjustment for potential confounding variables. Results. In multivariable analysis, we observed a significant positive association of total plasma free fatty acids (FFAs) (STZ ,), saturated fatty acid (SFA) (STZ ,), and monounsaturated fatty acid (MUFA) (STZ ,) concentrations with apelin gene expression from VAT after controlling for age, sex, body mass index, homeostatic model assessment for insulin resistance (HOMA-IR), physical activity, and energy intake. In the SFA family, there was a direct association with plasma concentration of myristic acid (STZ ,), pentadecanoic acid (,), and heptadecanoic acid (STZ ,) with apelin mRNA expression in VAT. There was no significant association between FFAs and apelin plasma concentration and SAT mRNA levels. Conclusions. In conclusion, circulating plasma FFAs, SFA, and MUFA had a positive association with apelin gene expression in VAT. It seems that plasma fatty acid composition may regulate apelin gene expression in VAT. Emad Yuzbashian, Golaleh Asghari, Nilofar Beheshti, Mehdi Hedayati, Maryam Zarkesh, Parvin Mirmiran, Afsoon Daneshafrooz, and Alireza Khalaj Copyright © 2021 Emad Yuzbashian et al. All rights reserved. An Assessment of Knowledge, Attitude, and Practices of Birth and Death Registration in Kilifi County in the Coastal Region in Kenya Fri, 01 Oct 2021 07:20:00 +0000 https://www.hindawi.com/journals/bmri/2021/9963703/ Background. Countries need vital statistics for social and economic planning. World Health Organization (WHO) recommends at least 80% coverage to use registration data on births and deaths for social and economic planning. However, registration remains low in developing countries. National coverage for Kenya in 2014 was 62.2% for births and 45.7% for deaths, with wide regional differentials. Kilifi County in the coastal region in Kenya reported rates below the national coverage at 56% for births and 41% for deaths in 2013. Objective. To determine level of knowledge and practice and reasons for low coverage of birth and death in Kilifi County. Method. This is a descriptive cross-sectional study that employed multistage cluster random sampling procedure to select a sample of 420 households from which household heads and women with children below five years old were surveyed. Results. Out of the 420 households sampled, about all respondents (99%) were aware of birth registration while death was 77%. Their main sources of information were assistant chiefs at 77% for both birth and death registration and family and friends at 67% for deaths and 52% for births. Coverage for birth registration was 85% and death 63%. More deaths occurred at home (55%) than in hospital (44%) while 55% of deliveries occurred in hospital and 44% at home. Main reasons for not registering death were ignorance (77%) and transport and opportunity cost (21%) while for birth registration were ignorance (42%), travel and opportunity cost (41%), lack of identification documents (9%), and home deliveries (7%). Conclusion. Registration of birth and death has improved in Kilifi County. The drivers are legal and requirements to access social rights. Reasons for not registering are ignorance and opportunity costs. Community should be sensitized on the importance of registration, address home deliveries and deaths, and increase efficiency in registration. Further research is recommended to determine the severity of teenage pregnancy and orphanhood in the county. Samwel Wakibi and Ezekiel Ngure Copyright © 2021 Samwel Wakibi and Ezekiel Ngure. All rights reserved. Family Cohesion Is Associated with the Self-Perceived Need for Dental Treatment among Adolescents Wed, 29 Sep 2021 08:50:00 +0000 https://www.hindawi.com/journals/bmri/2021/4504030/ This study explored the association between family cohesion and self-perceived need for dental treatment among adolescents. A school-based representative cross-sectional study was conducted with 746 students aged 15 to 19 randomly selected from schools in Campina Grande, Brazil. Parents/guardians provided information on sociodemographic data, and students completed questionnaires about the self-perceived need for dental treatment, dental pain, and family cohesion and adaptability (FACES III). Two dentists were trained (kappa >0.80) to diagnosis dental caries using the Nyvad criteria and assess adolescents’ level of functional oral health literacy (BREALD-30). Descriptive analysis was performed, followed by nonadjusted and adjusted robust binary logistic regression for complex samples (). The prevalence of self-perceived need for dental treatment was 88.6%. The presence of dental caries (; IC 95%: 1.22–3.61), tooth loss (; IC 95%: 2.14–116.56), dental pain in the last six months (; IC 95%: 1.06–3.31), and enmeshed family cohesion type (; IC 95%: 3.96–26.4) remained associated with the self-perceived need for dental treatment in the final model. In conclusion, dental caries, dental pain, tooth loss, and family cohesion influenced the self-perceived need for dental treatment in adolescents. Isolda M. L. F. Prata, Ana Flávia Granville-Garcia, Érick T. B. Neves, Larissa C. M. Lima, Laio C. Dutra, Matheus F. Perazzo, Fernanda M. Ferreira, and Saul M. Paiva Copyright © 2021 Isolda M. L. F. Prata et al. All rights reserved. Systematic Review of Setting-Based Interventions for Preventing Childhood Obesity Sun, 26 Sep 2021 06:05:00 +0000 https://www.hindawi.com/journals/bmri/2021/4477534/ Introduction. Child obesity is recognized as one of the major public health problems globally, which demands multicomponent and comprehensive interventions. The objective of this systematic review is to evaluate, synthesize, and combine the existing evidence of various setting-based interventions across developed and developing countries that aim to prevent childhood obesity. Methods. An electronic and systematic search was conducted on setting-based interventions related to childhood obesity both in developed and developing countries. A study was considered eligible if it was a randomized controlled trial that focused on home-based, school-based, or community-based intervention for childhood obesity and published in English from 2010 to 2020. A wide range of electronic bibliographic databases, such as PubMed, Medline, Embase, and ERIC were searched. The various studies were carried out among children aged 4-18 years old. A total of 32 studies were identified; out of which 24 were school-based interventions, and the remaining were nonschool-based. Results. The studies in this review highlighted important school and nonschool-based interventions to avoid obesity among children and adolescents. School-based interventions that had considered both physical activity (PA) and diet along with home elements showed great effectiveness. These findings reveal that the specific intervention components such as nutrition education curriculum, prolonged time for PA, and upgrading self-efficacy of study participants should be considered to prevent obesity across developed and developing countries. However, the findings from nonschool-based interventions were restricted by the scarcity of the studies. Conclusion. Multisetting and multipronged strategies are required to avoid or reduce childhood obesity across the globe. However, additional studies are needed with a large sample size. Further study designs based on theory should be conducted in nonschool settings for the creation of meaningful and detailed guidelines that can support the prevention of obesity in children. Khadijah Angawi and Anood Gaissi Copyright © 2021 Khadijah Angawi and Anood Gaissi. All rights reserved. Dysfunctional Parenting Styles Are Associated with Mental Disorders and Low Self-Efficacy Beliefs in Brazilian Undergraduate Medical Students Wed, 14 Jul 2021 10:20:00 +0000 https://www.hindawi.com/journals/bmri/2021/6372922/ Objective. To investigate the association between parental bonding styles and anxiety, depression, suicidal ideation, and self-efficacy beliefs in undergraduate medical students. Methods. A cross-sectional, self-administered survey involving 315 Brazilian medical students was conducted online. The Parental Bonding Instrument (PBI), the Generalized Anxiety Disorder-7 (GAD-7) scale, the 9-item Patient Health Questionnaire (PHQ-9), the Suicidal Behaviors Questionnaire-Revised (SBQ-R), and the general self-efficacy (GSE) scale were used. The internal consistency of the instruments used in the study was analyzed using Cronbach’s alpha. Multiple logistic regression models were applied, and the odds ratios (OR) and respective 95% confidence intervals (CI) were calculated to determine the association between parental bonding styles and anxiety, depression, suicidal ideation, and general self-efficacy beliefs. Results. In the analysis adjusted for sociodemographic variables, maternal affectionless control was associated with a greater risk of anxiety (; 95% CI: 1.15-5.33), depression (; 95% CI: 3.20-17.78), suicidal ideation (; 95% CI: 1.58-8.27), and low self-efficacy (; 95% CI: 1.76-8.25), while maternal neglectful parenting was associated with depression (; 95% CI: 1.17-8.96) and paternal affectionate constraint with suicidal ideation (; 95% CI: 1.36-7.02). Conclusions. These findings showed dysfunctional parenting styles to be associated with mental illnesses and low self-efficacy in Brazilian undergraduate medical students. This should be taken into consideration when treating medical students with mental disorders. Vânia Meira Siqueira-Campos, Mariana Siqueira Campos De Deus, Larissa Arbués Carneiro, Alessandra Vitorino Naghettini, Maria Amélia Dias Pereira, José Miguel De Deus, and Délio Marques Conde Copyright © 2021 Vânia Meira Siqueira-Campos et al. All rights reserved. Rise and Decay of the COVID-19 Epidemics in the USA and the State of New York in the First Half of 2020: A Nonlinear Physics Perspective Yielding Novel Insights Tue, 18 May 2021 03:20:00 +0000 https://www.hindawi.com/journals/bmri/2021/6645688/ As of December 2020, since the beginning of the year 2020, the COVID-19 pandemic has claimed worldwide more than 1 million lives and has changed human life in unprecedented ways. Despite the fact that the pandemic is far from over, several countries managed at least temporarily to make their first-wave COVID-19 epidemics to subside to relatively low levels. Combining an epidemiological compartment model and a stability analysis as used in nonlinear physics and synergetics, it is shown how the first-wave epidemics in the state of New York and nationwide in the USA developed through three stages during the first half of the year 2020. These three stages are the outbreak stage, the linear stage, and the subsiding stage. Evidence is given that the COVID-19 outbreaks in these two regions were due to instabilities of the COVID-19 free states of the corresponding infection dynamical systems. It is shown that from stage 1 to stage 3, these instabilities were removed, presumably due to intervention measures, in the sense that the COVID-19 free states were stabilized in the months of May and June in both regions. In this context, stability parameters and key directions are identified that characterize the infection dynamics in the outbreak and subsiding stages. Importantly, it is shown that the directions in combination with the sign-switching of the stability parameters can explain the observed rise and decay of the epidemics in the state of New York and the USA. The nonlinear physics perspective provides a framework to obtain insights into the nature of the COVID-19 dynamics during outbreak and subsiding stages and allows to discuss possible impacts of intervention measures. For example, the directions can be used to determine how different populations (e.g., exposed versus symptomatic individuals) vary in size relative to each other during the course of an epidemic. Moreover, the timeline of the computationally obtained stages can be compared with the history of the implementation of intervention measures to discuss the effectivity of such measures. Till D. Frank Copyright © 2021 Till D. Frank. All rights reserved. Factors Associated with Promoted Proliferation of Osteosarcoma by Peptidylarginine Deiminase 4 Mon, 17 May 2021 05:05:00 +0000 https://www.hindawi.com/journals/bmri/2021/5596014/ Osteosarcoma is the most common type of bone malignancy, and the pathogenesis has not been entirely elucidated yet. An important deimination modification enzyme PADI4 (peptidylarginine deiminase 4) has attracted much attention in recent years for its important function in several kinds of human tumors. However, the role of PADI4 on osteosarcoma tumorigenesis remains largely unrevealed. Here, we first assessed the effect of PADI4 on osteosarcoma proliferation by the CCK8 method and colony formation assay. Ectopically expressing PADI4 positively regulates the colony formation capacity of both U2OS and Saos-2 cells. Furthermore, we explored the related mechanism and showed that PADI4 could stimulate Wnt/β-catenin and MEK/ERK signaling in both U2OS and Saos-2 cells. Then, we detected expression of PADI4 in human tissues of osteosarcoma and revealed that differential expression of PADI4 was associated with tumorigenesis of osteosarcoma. Last, we performed the in vivo experiment in nude mice and results also showed PADI4 could affect the tumor growth. In conclusion, this work revealed that PADI4 could upregulate the proliferation of osteosarcoma, mainly via the Wnt/β-catenin and MEK/ERK signaling pathway. This study gives us new insight into the regulation mechanism of osteosarcoma proliferation and highlights PADI4 as a promising target for osteosarcoma diagnosis and treatment. Jianping Guo, Lei Yin, Xuezhong Zhang, Peng Su, and Qiaoli Zhai Copyright © 2021 Jianping Guo et al. All rights reserved. Utilization of Deworming Drugs and Its Individual and Community Level Predictors among Pregnant Married Women in Cameroon: A Multilevel Modeling Thu, 13 May 2021 03:35:00 +0000 https://www.hindawi.com/journals/bmri/2021/6645336/ Background. Although deworming pregnant women is one of the strategies to reduce parasites (roundworms and hookworms) causing anemia and related perinatal and maternal complications, utilization of deworming medication among pregnant women in Cameroon is suboptimal. Comprehensive assessment of individual, household (including women’s autonomy), and community-level factors associated with utilization of deworming medication has not been done so far. Therefore, we investigated the individual/household and community-level factors associated with deworming among pregnant married women in Cameroon. Methods. Our study was limited to pregnant women because they have a greater risk due to increased chances of anemia. We used data from the 2018/19 Cameroon Demographic and Health Survey. Analysis on 5,013 pregnant married women was carried out using multilevel logistic regression. Odds ratios with a 95% confidence interval (CI) were reported. Results. Our findings showed that about 29.8% of pregnant married women received deworming medications. The individual/household level predictors of deworming medications utilization identified in this study were women’s educational level, wealth quintile, and skilled antenatal care. Distance to health facility and region were identified as community-level predictors of deworming medications utilization. Higher odds of receiving deworming medication occurred among educated and wealthier pregnant married women as well as among pregnant married women who had skilled antenatal care or lived in the south region, whereas lower odds were observed among pregnant married women living in the north region. Conclusion. Access to education and economic empowerment of pregnant married women in remote areas and the north region should be the primary focus of the Cameroon government to enhance deworming coverage in the country. Betregiorgis Zegeye, Bright Opoku Ahinkorah, Edward Kwabena Ameyaw, Abdul-Aziz Seidu, and Sanni Yaya Copyright © 2021 Betregiorgis Zegeye et al. All rights reserved. Interaction of Adiponectin Genotypes and Insulin Resistance on the Occurrence of Taiwanese Metabolic Syndrome Mon, 03 May 2021 05:50:00 +0000 https://www.hindawi.com/journals/bmri/2021/5570827/ Backgrounds. Adiponectin (apM1) may affect insulin sensitivity, and tumor necrosis factor (TNF-α) can inhibit the binding of insulin and insulin receptors. However, whether apM1 and TNF-α genes influence the development of metabolic syndrome (MetS) preceded by insulin resistance is unclear. The current study examines the interactions between the apM1 +45 genotypes, TNF-α -308 genotypes, and insulin resistance on the occurrence of MetS. Methods. A total of 329 community residents were recruited, and their personal characteristics were collected. Waist circumference and biochemical markers were examined for determining MetS. Genotypes were identified by the polymerase chain reaction. Results. After adjusting for the confounding effects, compared to apM1 +45 GG and GT genotypes carriers with HOMR-IR less than 2.0, those carriers with HOMA-IR greater than 2.0 had an increased MetS risk (, 95% CI 2.14-8.85). Further, apM1 +45 TT carriers with HOMA-IR greater than 2.0 experienced a higher MetS risk (, 95% CI 2.78-12.54). A significant interaction of the apM1 +45 genotype and insulin resistance on the MetS development was observed ().Conclusion. Our data suggested that apM1 +45 genotypes might modify the effect of insulin resistance on the development of Taiwanese MetS. Chun-Chieh Chen, Yu-Hsiang Wei, Chia-Chen Huang, Shin-Hui Hung, Zeng-Wei Wang, and Ruey-Hong Wong Copyright © 2021 Chun-Chieh Chen et al. All rights reserved. The Evolving Epidemiology of Elderly with Degenerative Valvular Heart Disease: The Guangzhou (China) Heart Study Sat, 24 Apr 2021 06:20:01 +0000 https://www.hindawi.com/journals/bmri/2021/9982569/ Aim. The present study was aimed at investigating the prevalence, incidence, progression, and prognosis of degenerative valvular heart disease (DVHD) in permanent residents aged ≥65 years from Guangzhou, China. Methods. This was a prospective study based on community population. Over a 3-year span, we conducted repeated questionnaires, blood tests, and echocardiographic and electrocardiogram examinations (2018) of a random sample of initially 3538 subjects. Results. The prevalence of DVHD increased with age, average values being 30.6%, 49.2%, and 62.9% in 65-74, 75-84, and ≥85 years of age, respectively. The incidence rate was 1.7%/year. Aortic stenosis was the result of DVHD, and the mean transvalvular pressure gradient increased by 5.6 mmHg/year. The increase of mild aortic stenosis was lower than that of more severe disease, showing a nonlinear development of gradient, but with great individual variations. Mortality was significantly increased in the DVHD group (). Risk factors for higher mortality included age (,), renal insufficiency (,), atrial fibrillation (,), mitral regurgitation (,), and tricuspid regurgitation (,) in a DVHD population. Conclusions. DVHD was highly prevalent among residents in southern China. With the progression of the disease, the mean transvalvular pressure gradient accelerated. DVHD was an independent predictor of death, and the mortality was higher in those with older age, renal insufficiency, atrial fibrillation, mitral regurgitation, and tricuspid regurgitation. Shangfei He, Hai Deng, Junrong Jiang, Fangzhou Liu, Hongtao Liao, Yumei Xue, Murui Zheng, Huoxing Li, and Shulin Wu Copyright © 2021 Shangfei He et al. All rights reserved. The Differences of Population Birth Defects in Epidemiology Analysis between the Rural and Urban Areas of Hunan Province in China, 2014–2018 Wed, 21 Apr 2021 12:20:01 +0000 https://www.hindawi.com/journals/bmri/2021/2732983/ Objectives. To compare the differences of epidemiology analysis in population birth defects (BDs) between the rural and urban areas of Hunan Province in China. Methods. The data of population-based BDs in Liuyang county (rural) and Shifeng district (urban) in Hunan Province for 2014–2018 were analyzed. BD prevalence rates, percentage change, and annual percentage change (APC) by sex and age were calculated to evaluate time trends. Risk factors associated with BDs were assessed using simple and multiple logistic regression analyses. Results. The BD prevalence rate per 10,000 perinatal infants (PIs) was 220.54 (95% CI: 211.26-230.13) in Liuyang and 181.14 (95% CI: 161.18-202.87) in Shifeng. Significant decreasing trends in BD prevalence rates were noted in the female PIs (,) and the total BD prevalence rate in Shifeng (,). Risk factors for BDs were as follows: rural area, male PIs, PIs with gestational weeks, PIs with birth , and migrant pregnancies. Conclusions. We should focus on rural areas, reduce the prevalence of premature and low birth weight infants, and provide maternal healthcare services for migrant pregnancies for BD prevention from the perspective of population-based BD surveillance. Lili Xiong, Qiongying Chen, Aihua Wang, Fanjuan Kong, Donghua Xie, and Zhiqun Xie Copyright © 2021 Lili Xiong et al. All rights reserved. Meta-Analysis of Correlations between Altmetric Attention Score and Citations in Health Sciences Wed, 07 Apr 2021 10:20:01 +0000 https://www.hindawi.com/journals/bmri/2021/6680764/ Introduction. In recent years, several controversial reports of the correlation between altmetric score and citations have been published (range: -0.2 to 0.8). We conducted a meta-analysis to provide an in-depth statistical analysis of the correlation between altmetric score and number of citations in the field of health sciences. Methods. Three online databases (Web of Science, Scopus, and PubMed) were systematically searched, without language restrictions, from the earliest publication date available through February 29, 2020, using the keywords “altmetric,” “citation,” and “correlation.” Grey literature was also searched via WorldCat, Open Grey, and Google Scholar (first 100 hits only). All studies in the field of health sciences that reported on this correlation were included. Effect sizes were calculated using Fisher’s transformation of correlations. Subgroup analyses based on citation source and sampling methods were performed. Results. From 27 included articles, 8 articles comprise several independent studies. The total sample size was 9,943 articles comprised of 35 studies. The overall pooled effect size was 0.19 (95% confidence interval 0.13 to 0.26). Bivariate partial prediction of interaction between effect size, citation source, and sampling method showed a greater effect size with Web of Science compared with Scopus and Dimensions. Egger’s regression showed a marginally nonsignificant publication bias (), and trim-and-fill analysis estimated one missing study in this meta-analysis. Conclusion. In health sciences, currently altmetric score has a positive but weak correlation with number of citations (, 95% C.I 0.12 to 0.25). We emphasize on future examinations to assess changes of correlation pattern between altmetric score and citations over time. Jafar Kolahi, Saber Khazaei, Pedram Iranmanesh, Jeehyoung Kim, Heejung Bang, and Abbasali Khademi Copyright © 2021 Jafar Kolahi et al. All rights reserved. Prevalence and Risk Factors of Gestational Diabetes Mellitus among Women Attending Antenatal Care in Hadiya Zone Public Hospitals, Southern Nation Nationality People Region Wed, 07 Apr 2021 07:35:00 +0000 https://www.hindawi.com/journals/bmri/2021/5564668/ Introduction. In low- and middle-income countries, gestational diabetes mellitus is increasing globally; it is also a double burden of illness for both mothers and children. While gestational diabetes mellitus is recognized in Ethiopia, according to recent diagnostic criteria, information regarding it remains scarce. Objective. To assess the prevalence of gestational diabetes mellitus and associated factors among women attending antenatal care in Hadiya Zone public Hospitals, Southern Ethiopia. Methods. An institution-based cross-sectional research on a total of 470 pregnant mothers was conducted in the Hadiya Region from August 2019 to December 2020. Finally, via the systematic random sampling process, the study subjects were chosen. A two-hour oral glucose tolerance test of 75 g was used to conduct the universal one-step screening and diagnostic technique. Bivariate and multivariate analyses were used to identify factors associated with gestational diabetes mellitus. Results. Gestational diabetes mellitus prevalence was 26.2% (95% CI, 21.8, 30.5). Urban residents (AOR: 2.181; 95% CI: 1.274, 3.733), primary education (AOR:2.286; 95% CI: 1.396, 3.745), without previous history of abortion (AOR: 0.097; 95% CI: 0.048, 0.196), with history of late gestational age in weeks (29-32) (AOR: 0.393; 95% CI: 0.213, 0.723), with no history of coffee drinking (AOR: 2.704; 95% CI: 1.044, 7.006), and adequate dietary diversity (AOR: 2.740; 95% CI: 1.585, 4.739) were significantly associated with gestational diabetes mellitus. Conclusion. In Hadiya Zone public Hospitals, the prevalence of gestational diabetes mellitus among women attending antenatal treatment was higher compared to other studies conducted. The urban residents, primary schooling, no prior history of abortion, late gestational age, no history of coffee drinking, and sufficient dietary diversity were significantly linked with gestational diabetes mellitus. To enhance maternal and child health, reinforcing screening, treatment, and prevention strategies for gestational diabetes mellitus is essential. Yilma Markos Larebo and Niggussie Abebe Ermolo Copyright © 2021 Yilma Markos Larebo and Niggussie Abebe Ermolo. All rights reserved. A Noninvasive Prediction Model for Hepatitis B Virus Disease in Patients with HIV: Based on the Population of Jiangsu, China Tue, 30 Mar 2021 03:35:01 +0000 https://www.hindawi.com/journals/bmri/2021/6696041/ Objective. To establish a machine learning model for identifying patients coinfected with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) through two sexual transmission routes in Jiangsu, China. Methods. A total of 14197 HIV cases transmitted by homosexual and heterosexual routes were recruited. After data processing, 12469 cases (HIV and HBV, 1033; HIV, 11436) were left for further analysis, including 7849 cases with homosexual transmission and 4620 cases with heterosexual transmission. Univariate logistic regression was used to select variables with significant value and odds ratio for multivariable analysis. In homosexual transmission and heterosexual transmission groups, 10 and 6 variables were selected, respectively. For identifying HIV individuals coinfected with HBV, a machine learning model was constructed with four algorithms, including Decision Tree, Random Forest, AdaBoost with decision tree (AdaBoost), and extreme gradient boosting decision tree (XGBoost). The detective value of each variable was calculated using the optimal machine learning algorithm. Results. AdaBoost algorithm showed the highest efficiency in both transmission groups (homosexual transmission group: ,,,, and ; heterosexual transmission group: ,,,, and ). Calculated by AdaBoost algorithm, the detective value of PLA was the highest in homosexual transmission group, followed by CR, AST, HB, ALT, TBIL, leucocyte, age, marital status, and treatment condition; in the heterosexual transmission group, the detective value of PLA was the highest (consistent with the condition in the homosexual group), followed by ALT, AST, TBIL, leucocyte, and symptom severity. Conclusions. The univariate logistics regression combined with the AdaBoost algorithm could accurately screen the risk factors of HBV in HIV coinfection without invasive testing. Further studies are needed to evaluate the utility and feasibility of this model in various settings. Yi Yin, Mingyue Xue, Lingen Shi, Tao Qiu, Derun Xia, Gengfeng Fu, and Zhihang Peng Copyright © 2021 Yi Yin et al. All rights reserved. Association between Sleep Duration, Physical Activity, and Mental Health Disorders: A Secondary Analysis of the National Survey of Children’s Health 2017-2018 Tue, 16 Mar 2021 14:20:01 +0000 https://www.hindawi.com/journals/bmri/2021/5585678/ Background. The purpose of this article was to examine the association of sleep duration and physical activity and their interactions on mental health disorders in American children aged 6-17 years. Methods. Data were analyzed from the combined 2017-2018 National Survey of Children’s health. Ultimately, a total of 36370 children aged 6-17 years were selected as the samples. Weighted logistic regression models were used to estimate odds ratios and 95% confidence intervals. Results. Insufficient sleep duration was associated with an increased risk for current anxiety, depression, and behavior/conduct problems (, 1.991, 1.375; 95% confidence interval: 1.313-1.702, 1.648-2.406, 1.162-1.627). Insufficient physical activity was associated with an increased risk for current anxiety (; 95% confidence interval: 1.230-1.706) and depression (; 95% confidence interval: 1.304-2.329). In addition, additive interactions between sleep duration and physical activity were observed on current anxiety and depression. Conclusions. Insufficient sleep duration and insufficient physical activity in children were associated with mental health disorders. There is a synergistic interaction effect between insufficient sleep duration and insufficient physical activity on current anxiety and current depression. Shiting Xiang, Jie Dong, Xun Li, and Liping Li Copyright © 2021 Shiting Xiang et al. All rights reserved. Meta-analysis: Early Age at Natural Menopause and Risk for All-Cause and Cardiovascular Mortality Tue, 16 Mar 2021 11:20:00 +0000 https://www.hindawi.com/journals/bmri/2021/6636856/ Aims. The aim of this meta-analysis was to comprehensively evaluate the association of early age at natural menopause with the risk for all-cause and cardiovascular mortality. Methods. Literature retrieval was done on August 4, 2020. Article selection and data extraction were completed independently and in duplicate. Early age at natural menopause was grouped into premature menopause (<40 years), early menopause (40-44 years), and relatively early menopause (45-49 years). Effect-size estimates are summarized as hazard ratio (HR) or relative risk (RR) with 95% confidence interval (CI). Results. Sixteen articles involving 321,233 women were meta-analyzed. Overall analyses revealed a statistically significant association of early age at natural menopause with all-cause mortality risk (, 95% CI: 1.03 to 1.14, ;, 95% CI 1.01 to 1.08, ), but not with cardiovascular mortality risk. In dose-response analyses, the association with all-cause mortality was significant for premature menopause with (; 95% CI: 1.01 to 1.21; ) and without (; 95% CI: 1.08 to 1.66; ) considering follow-up intervals. As for cardiovascular mortality, marginal significance was noted for premature menopause after considering follow-up intervals (; 95% CI: 1.00-1.19; ). Subgroup analyses indicated that gender, country, and follow-up periods were possible causes of heterogeneity. There was an overall low probability of publication bias. Conclusions. Our findings indicate that premature menopause is a promising independent risk factor for both all-cause and cardiovascular mortality. Luyao Huan, Xiangling Deng, Mengyang He, Shunhong Chen, and Wenquan Niu Copyright © 2021 Luyao Huan et al. All rights reserved. Association between Coalmine Dust and Mortality Risk of Lung Cancer: A Meta-Analysis Tue, 09 Mar 2021 09:05:00 +0000 https://www.hindawi.com/journals/bmri/2021/6624799/ Background. Evidence on the carcinogenicity of coalmine dust in occupational settings is still conflicting. Therefore, we conducted this research to evaluate the mortality risk of lung cancer for coalminers exposed to occupational dust when compared to population with no or low dust exposure. Methods. Databases of PubMed and Chinese National Knowledge Infrastructure as well as reference lists were searched updated to September 18, 2020. The enrolled articles should report lung cancer mortality risk for coalminers exposed to occupational dust. Basic information was extracted such as the author and publication year, area and ethnicity, the type and estimates of outcome, duration of follow-up, and the study design. The checklists from Agency for Healthcare Research and Quality and the Newcastle-Ottawa Scale were used for the assessment of quality and bias risk for descriptive studies, cohort studies, and case control studies, respectively. The overall relative risks were calculated while Begg’s and Egger’s tests and sensitivity analysis were performed to explore potential heterogeneity sources. Metaregression and subgroup analyses were also conducted to give more detailed information for the correlation between dust exposure and lung cancer mortality. Results. A total of 19 articles with 22 different studies (descriptive study, case control study, and cohort study) including 8909 observed deaths from 1964 to 2017 were enrolled with a significant heterogeneity (,). The pooled relative risk of mortality from lung cancer was 1.16 (1.03-1.30) for coalminers. Results of metaregression analysis indicated that the high heterogeneity among these enrolled studies might be caused by the ethnicity differences (). Subgroup analysis also indicated that the pooled estimate for Asian population in China was 4.94 (3.95-6.17) with and . All these results suggested that exposure to occupational dust would significantly increase the mortality risk of lung cancer, especially for Asian population in China, which should be measured and controlled more strictly. Discussion. This systematic review and meta-analysis provides high-quality evidence that exposure to occupational dust might increase the mortality risk of lung cancer, especially for Asian populations in China. The magnitude of this effect is of major public health importance in view of the ubiquitous existence of coalmining industry in China and even in the world. However, these pooled estimates should be interpreted cautiously because of the high heterogeneity among these publications. Other. This study was supported by the National Key Research and Development Program of China (Grant No. 2016YFC1302501). Linlin Li, Min Jiang, Xuelian Li, and Baosen Zhou Copyright © 2021 Linlin Li et al. All rights reserved. Mortality and Attrition Rates within the First Year of Antiretroviral Therapy Initiation among People Living with HIV in Guangxi, China: An Observational Cohort Study Thu, 11 Feb 2021 14:35:01 +0000 https://www.hindawi.com/journals/bmri/2021/6657112/ Objective. To assess the mortality and attrition rates within the first year of antiretroviral therapy (ART) initiation among people living with human immunodeficiency virus (PLHIV) in rural Guangxi, China. Design. Observational cohort study. Setting. The core treatment indicators and data were collected with standard and essential procedures as per the Free ART Manual guidelines across all the rural health care centers of Guangxi. Participants. 58,115 PLHIV who were under ART were included in the study. Interventions. The data collected included sociodemographic characteristics that consist of age, sex, marital status, route of HIV transmission, CD4 cell count before ART, initial ART regimen, level of ART site, and year of ART initiation. Primary and Secondary Outcome Measures. Mortality and attrition rate following ART initiation. Results. The average mortality rate was 5.94 deaths, and 17.52 attritions per 100 person-years within the first year of ART initiation among PLHIV. The mortality rate was higher among intravenous drug users (Adjusted Hazard Ratio (AHR) 1.27, 95% Confidence Interval (CI) 1.14-1.43), prefecture as a level of ART site (AHR 1.14, 95% CI 1.02-1.28), and county as the level of ART site (AHR 2.12, 95% CI 1.90-2.37). Attrition was higher among intravenous drug users (AHR 1.87, 95% CI 1.75-2.00), the first-line ART containing AZT (AHR 1.09, 95% CI 1.03-1.16), and first-line ART containing LVP/r (AHR 1.34, 95% CI 1.23-1.46). Conclusion. The mortality and attrition rates were both at the highest level in the first year of post-ART; continued improvement in the quality of HIV treatment and care is needed. Jinhui Zhu, Mohammed Adnan Yousuf, Wenmin Yang, Qiuying Zhu, Zhiyong Shen, Guanghua Lan, Yi Chen, Huanhuan Chen, Wensheng Fan, Hui Xing, Yiming Shao, Yuhua Ruan, and Liming Li Copyright © 2021 Jinhui Zhu et al. All rights reserved. Gastrointestinal Nematodes among Residents in Melong, Moungo Division, Littoral Region, Cameroon Tue, 09 Feb 2021 15:35:00 +0000 https://www.hindawi.com/journals/bmri/2021/5368973/ Background. Intestinal parasitic infections are among the most common infections worldwide. The present study was undertaken to provide baseline information on the status of gastrointestinal nematodes in Melong Subdivision, Moungo Division, Littoral Region, Cameroon. Material and Methods. Seven hundred and eighty-eight stool samples were collected in randomly selected quarters in the community of Melong. These stool samples were brought to the Laboratory of Applied Biology and Ecology in the University of Dschang for analysis using the qualitative (simple flotation) and quantitative (Mc Master count) technique. Results. The nematodes identified were Ascaris lumbricoides, hookworm, Trichuris trichiura, and Capillaria hepatica with respective prevalences and intensities of infection of 2.2% and , 1.4% and , 1.0% and , and 0.4%and . The data on the prevalence of nematodes with respect to sex and age showed that females (6.0%) were more infected than males (2.76%) with no significant difference (). Furthermore, with respect to age, adults were more infected than children. The percentage of educational level showed a reduction in the number of parasites in the higher educational level. The prevalence of A. lumbricoides between localities showed a significant difference () with “Quarter 1” harboring most of the nematodes. Cases of double (Ascaris lumbricoides + Trichuris trichiura) and triple (Ascaris lumbricoides + Trichuris trichiura + hookworm) parasitism were encountered with both having a prevalence of 0.3%. According to the fecal concentration of eggs, 63.89% of the infections were light, 5.56% moderate, and 30.56% heavy. Conclusion. A relatively low overall prevalence was obtained in our study, showing that the national deworming campaign is proving effective, but more effort is needed to completely eradicate these parasites for a single infected individual can cause havoc. Yamssi Cedric, Noumedem Anangmo Christelle Nadia, Vincent Khan Payne, M. Sabi Bertrand, and Ngangnang Ghislain Romeo Copyright © 2021 Yamssi Cedric et al. All rights reserved. Scoping Review and Bibliometric Analysis of the Most Influential Publications in Achalasia Research from 1995 to 2020 Mon, 08 Feb 2021 02:50:01 +0000 https://www.hindawi.com/journals/bmri/2021/8836395/ Objective. To identify and evaluate characteristics of the most influential articles in achalasia research during the period 1995-2020. Methods. Articles in Scopus, Web of Science Core Collection (WoSCC), and PubMed were scanned from 1995 to 2020 with achalasia as the keyword. We retrieved the articles that met all criteria by descending order after using EndNote to remove the duplicated references. Our bibliometric analysis highlighted publication year, country, journals, and networks of keywords. Results. Fifteen percent of the top 100 most-cited articles were published in Annals of Surgery. They were performed in 15 countries, and most () were from the USA. The number of citations of the 482 articles ranged from 30 to 953, 38 of which had been published in American Journal of Gastroenterology. Those articles were from 31 countries, and most of the studies () had been performed in the USA. Most of articles () were clinical research. Treatments were hotspots in the field of achalasia in the past years. The most influential title words were “achalasia,” “esophagomyotomy,” “pneumatic dilation,” and “lower esophageal sphincter.” Conclusion. Our study offers a historical perspective on the progress of achalasia research and identified the most significant evolution in this field. Results showed treatment was the most influence aspect in achalasia. Huifang Xia, Shali Tan, Shu Huang, Peiling Gan, Chunyu Zhong, Muhan Lü, Yan Peng, Xian Zhou, and Xiaowei Tang Copyright © 2021 Huifang Xia et al. All rights reserved. Glycemic Control of Diabetes Mellitus Patients in Referral Hospitals of Amhara Region, Ethiopia: A Cross-Sectional Study Mon, 18 Jan 2021 08:35:00 +0000 https://www.hindawi.com/journals/bmri/2021/6691819/ Background. Glycemic control is the level of glucose in diabetes patient. Evidence regarding glycemic control is scarce in resource-limited settings, and this study was conducted to generate information regarding the prevalence and predictors of glycemic control among diabetes mellitus patients attending their care from the referral hospitals of the Amhara region, Ethiopia. Methods. A cross-sectional study design was implemented. A simple random sampling technique was used. Data were collected from March 2018 to January 2020. The data were collected using interviews, chart review, and blood samples. Hemoglobin A1c was measured using high-performance liquid chromatography. Data were entered into Epi-info software and analyzed by SPSS software. Descriptive statistics were used to estimate the prevalence of glycemic control; linear regression was used to identify the predictors of HbA1c. Results. A total of 2554 diabetes patients were included giving for the response rate of 95.83%. The mean age of the study participants was 54.08 years []. The mean HbA1c of the study participants was 7.31% []. Glycemic control was poor in 55.32% [95% CI: 53.4%-57.25%] of diabetes patients. The glycemic control of diabetes patients was determined by BMI (β 0.1; [95% CI: 0.09-0.1]), type 2 diabetes (β -0.14; [95% CI: -0.11-0.16]), age (β 0.22; [95% CI: 0.02-0.024]), duration of the disease (β 0.04; [95% CI: 0.037-0.042]), the presence of hypertension (β 0.12; [95% CI:0.09–0.16]), regular physical exercise (β -0.06; [95% CI: -0.03-0.09]), medication adherence (β -0.16; [95% CI: -0.14-0.18]), and male (β 0.34; [95% CI: 0.31-.037]). Conclusion. The glycemic control of diabetes patients was poor, and it needs the attention of decision-makers. Berhanu Elfu Feleke, Teferi Elfu Feleke, Melkamu Beyene Kassahun, Wondemu Gebrekirose Adane, Netsanet Fentahun, Abel Girma, Alamirew Alebachew, Eyaya Misgan, Hanna Demelash Desyibelew, Mulat Tirfie Bayih, and Omer Seid Copyright © 2021 Berhanu Elfu Feleke et al. All rights reserved. Using the Atherogenic Index of Plasma to Estimate the Prevalence of Ischemic Stroke within a General Population in a Rural Area of China Mon, 14 Dec 2020 05:35:00 +0000 https://www.hindawi.com/journals/bmri/2020/7197054/ Objective. To investigate the relationship between the atherogenic index of plasma (AIP) and ischemic stroke. Design. We collected a range of data from 11,495 residents (aged ≥35 years; 54.28% female) residing in rural areas of northeast China between January and August 2013, including fasting lipid profile and anthropometric parameters. Logistic regression models were used to evaluate the correlation between AIP and ischemic stroke. Category-free analysis was used to determine whether AIP enhanced our capacity to estimate ischemic stroke. Results. Irrespective of gender, AIP was independently associated with the occurrence of ischemic stroke. The prevalence of ischemic stroke increased significantly from the lowest quartile to the highest quartile (females: 10.5%-48.7%, ; males: 22.0%-36.5%, ). After adjusting for age, gender, income, education, smoking, drinking, exercise, hypertension, body mass index (BMI), diabetes, atrial fibrillation, and a family history of stroke, we found that for every 1 standard deviation (SD) increase in AIP, there was a 34.8% and 20.9% increase in the prevalence of stroke for females and males, respectively. Curve fitting was also used to evaluate the linear relationship between AIP and the occurrence of ischemic stroke. Category-free analysis indicated that AIP significantly enhanced our ability to estimate ischemic stroke in both females (NRI (95% confidence interval (CI)): 0.188 (0.105-0.270)) and males (NRI (95% CI): 0.175 (0.017-0.333)). Conclusion. Analyses detected a significant and positive linear relationship between AIP and the prevalence of ischemic stroke. This relationship was independent of a range of conventional risk factors. Chang Wang, Zhi Du, Ning Ye, Songyue Liu, Danxi Geng, Pengbo Wang, and Yingxian Sun Copyright © 2020 Chang Wang et al. All rights reserved. Morocco’s First Biobank: Establishment, Ethical Issues, Biomedical Research Opportunities, and Challenges Tue, 08 Dec 2020 14:50:00 +0000 https://www.hindawi.com/journals/bmri/2020/8812609/ Background. Biobanks are highly organized infrastructures that allow the storage of human biological specimens associated with donors’ personal and clinical data. These infrastructures play a key role in the development of translational medical research. In this context, we launched, in November 2015, the first biobank in Morocco (BRO Biobank) in order to promote biomedical research and provide opportunities to include Moroccan and North African ethnic groups in international biomedical studies. Here, we present the setup and the sample characteristics of BRO Biobank. Methods. Patients were recruited at several departments of two major health-care centers in the city of Oujda. Healthy donors were enrolled during blood donation campaigns all over Eastern Morocco. From each participant, personal, clinical, and biomedical data were collected, and several biospecimens were stored. Standard operating procedures have been established in accordance with international guidelines on human biobanks. Results. Between November 2015 and July 2020, 2446 participants were recruited into the BRO Biobank, of whom 2013 were healthy donors, and 433 were patients. For healthy donors, the median age was 35 years with a range between 18 and 65 years and the consanguinity rate was 28.96%. For patients, the median age was 11 years with a range between 1 day and 83 years. Among these patients, 55% had rare diseases (hemoglobinopathies, intellectual disabilities, disorders of sex differentiation, myopathies, etc.), 13% had lung cancer, 4% suffered from hematological neoplasms, 3% were from the kidney transplantation project, and 25% had unknown diagnoses. The BRO Biobank has collected 5092 biospecimens, including blood, white blood cells, plasma, serum, urine, frozen tissue, FFPE tissue, and nucleic acids. A sample quality control has been implemented and suggested that samples of the BRO Biobank are of high quality and therefore suitable for high-throughput nucleic acid analysis. Conclusions. The BRO Biobank is the largest sample collection in Morocco, and it is ready to provide samples to national and international research projects. Therefore, the BRO Biobank is a valuable resource for advancing translational medical research. Saida Lhousni, Karam Yahya Belmokhtar, Ihab Belmokhtar, Mounia Elidrissi Errahhali, Manal Elidrissi Errahhali, Redouane Boulouiz, Mariam Tajir, Majida Charif, Khawla Zerrouki, Noufissa Benajiba, Maria Rkain, Abdeladim Babakhouya, Hatim Kouismi, Afaf Thouil, Hanane Latrach, Rim Amrani, Sahar Messaoudi, Anass Ayyad, Zaina Sidqi, Khalid Andaloussi Serraj, Siham Hamaz, Habiba Alaoui, Houda Bachir, Yassamine Bentata, Intissar Haddiya, Mohammed Choukri, Rachid Seddik, Amal Bennani, Siham Dikhaye, Bouchra Oneib, Fatima Elghazouani, Omar El Mahi, Adnane Benzirar, Ayat Allah Oufkir, Brahim Housni, Ahmed Mimouni, Hanane Saadi, Mohammed Belahcen, Tijani El Harroudi, Meryem Ouarzane, and Mohammed Bellaoui Copyright © 2020 Saida Lhousni et al. All rights reserved. Dental Caries Prediction Based on a Survey of the Oral Health Epidemiology among the Geriatric Residents of Liaoning, China Mon, 07 Dec 2020 14:05:00 +0000 https://www.hindawi.com/journals/bmri/2020/5348730/ Background. Dental caries is one of the most common chronic diseases observed in elderly patients. The development of preventive strategies for dental caries in elderly individuals is vital. Objective. The objective of the present study was to construct a generalized regression neural network (GRNN) prediction model for the risk assessment of dental caries among the geriatric residents of Liaoning, China. Methods. A stratified equal-capacity random sampling method was used to randomly select 1144 elderly (65-74 years) residents (gender ratio 1 : 1) of Liaoning, China. Data for the oral assessment, including caries characteristics, and questionnaire survey from each participant were collected. Multivariate logistic regression analysis was then performed to identify the independent predictors. GRNN was applied to establish a prediction model for dental caries. The accuracy of the unconditional logistic regression and the GRNN early warning model was compared. Results. A total of 1144 patients fulfilled the requirements and completed the questionnaires. The caries rate was 68.5%, and the main associated factors were toothache history, residence area, smoking, and drinking. We randomly divided the data for the 1144 participants into a training set (915 cases) and a test set (229 cases). The optimal smoothing factor was 0.7, and the area under the receiver operating characteristic curve for the GRNN model was 0.626 (95% confidence interval, 0.544 to 0.708), with a value of 0.002. In terms of consistency, sensitivity, and specificity, the GRNN model was better than the traditional unconditional multivariate logistic regression model. Conclusion. Geriatric (65-74 years) residents of Liaoning, China, have a high rate of dental caries. Residents with a history of toothache and smoking habits are more susceptible to the disease. The GRNN early warning model is an accurate and meaningful tool for screening, early diagnosis, and treatment planning for geriatric individuals with a high risk of caries. Lu Liu, Wei Wu, Si-yu Zhang, Kai-qiang Zhang, Jian Li, Yang Liu, and Zhi-hua Yin Copyright © 2020 Lu Liu et al. All rights reserved. A Mathematical and Statistical Estimation of Potential Transmission and Severity of COVID-19: A Combined Study of Romania and Pakistan Mon, 07 Dec 2020 03:05:00 +0000 https://www.hindawi.com/journals/bmri/2020/5607236/ During the outbreak of an epidemic, it is of immense interest to monitor the effects of containment measures and forecast of outbreak including epidemic peak. To confront the epidemic, a simple SIR model is used to simulate the number of affected patients of coronavirus disease in Romania and Pakistan. The model captures the growth in case onsets, and the estimated results are almost compatible with the actual reported cases. Through the calibration of parameters, forecast for the appearance of new cases in Romania and Pakistan is reported till the end of this year by analysing the current situation. The constant level of number of patients and time to reach this level is also reported through the simulations. The drastic condition is also discussed which may occur if all the preventive restraints are removed. Muhammad Ozair, Takasar Hussain, Mureed Hussain, Aziz Ullah Awan, Dumitru Baleanu, and Kashif Ali Abro Copyright © 2020 Muhammad Ozair et al. All rights reserved. Association between Neck Circumference and the Risk of Decreased Estimated Glomerular Filtration Rate in the General Population of China: A Cross-Sectional Study Tue, 24 Nov 2020 08:35:00 +0000 https://www.hindawi.com/journals/bmri/2020/3496328/ Background. The burden of chronic kidney disease is increasing substantially worldwide. Neck circumference (NC), an anthropometric index for upper-body adiposity, has been recognized as an indicator of cardiometabolic diseases. However, the association between NC and renal dysfunction has not been fully disclosed. Objectives. The aim of this study was to investigate the association between NC and estimated glomerular filtration rate (eGFR) in the general population in China. Methods. A total of 8805 participants (3322 men and 5483 women) were enrolled in this study. Logistic regression analysis was conducted to examine the association between NC and eGFR. The male and female subjects were divided into four groups according to the NC quartiles. The primary outcome was defined as an .Results. Logistic regression analysis revealed that in both sexes, higher NC was significantly associated with a higher risk of decreased eGFR even after fully adjusting for age, other anthropometric indexes, traditional risk factors for chronic kidney diseases, and sociologic risk factors (quartile 1 as a reference; the odds ratios [95% confidence intervals] were as follows: quartile 2, 1.26 [0.99-1.59]; quartile 3, 1.40 [1.07-1.83]; and quartile 4, 1.71 [1.22-2.38], in men; quartile 2, 1.14 [0.95-1.37]; quartile 3, 1.31 [1.03-1.66]; and quartile 4, 1.32 [1.04-1.68], in women). Stratified analyses suggested that the association was significant among subjects with prediabetes or normal serum uric acid levels and those without cardiovascular diseases (CVD). Among subjects with CVD, the association persisted only in males. When the subjects were stratified according to blood pressure or BMI, the association persisted among male subjects with abnormal blood pressure and was strengthened among male subjects who were overweight/obese, while the association disappeared among female subjects. Conclusions. NC is independently associated with the risk of decreased eGFR in the general population in China, indicating that NC could contribute to renal dysfunction risk assessment. Jing Xue, Bing Li, Jie Wang, Songyan Yu, Anping Wang, Ping An, and Yiming Mu Copyright © 2020 Jing Xue et al. All rights reserved. Incidence of Infection of Enterovirus 71 and Coxsackieviruses A6 and A16 among Household Contacts of Index Cases in Dong Thap Province, Southern Vietnam Fri, 20 Nov 2020 13:05:01 +0000 https://www.hindawi.com/journals/bmri/2020/9850351/ Background. Scarce information exists about immunity to hand, foot, and mouth disease (HFMD) among household contacts of index cases in Vietnam and what that means for reducing ongoing HFMD transmission in the community. Methods. We analyzed neutralizing antibodies (NT) and the incidence of enterovirus (EVs) infection among household contacts of index cases in a province where HFMD remains endemic. Throat swab and 2 mL blood samples from household contacts were collected at enrollment, during and after 2 weeks follow-up. Results. The incidence of EV-A71 infection among household contacts was 40/84 (47.6%, 95% Cl: 36.9-58.3%), compared with 106/336 (31.5%, 95% Cl: 26.6-36.5%) for CV-A6 and 36/107 (33.6%, 95% Cl: 24.7-42.6%) for CV-A16. The incidence of CV-A6 infection was fairly constant across ages; in contrast, CV-A71 and CV-A16 had some variation across ages. At baseline, higher geometric mean titer (GMT) of EV-A71, CV-A6, and CV-A16 antibody titers was found for 25-34-year groups (range 216.3 to 305.0) compared to the other age groups. There was a statistically significant difference in GMT values of CV-A6 and CV-A16 between those who had an infection or did not have infection among households with an index case of these serotypes. Conclusions. Our results indicated that adults were becoming infected with HFMD and could be contributing to the transmission. There is, therefore, a need for considering the household setting as an additional target for intervention programs for HFMD. C. Q. Hoang, H. D. Nguyen, N. X. Ho, T. H. T. Vu, T. T. M. Pham, K. T. Nguyen, H. T. Nguyen, L. T. Hoang, H. Clapham, T. T. T. Nguyen, and L. T. Phan Copyright © 2020 C. Q. Hoang et al. All rights reserved. Fuzzy Multidimensional Model to Cluster Dengue Risk in Sri Lanka Thu, 05 Nov 2020 07:20:01 +0000 https://www.hindawi.com/journals/bmri/2020/2420948/ Dengue is the world’s rapidly transmitting mosquito-borne viral disease. It is mostly found in subtropical countries in the world. The annual number of global deaths caused by dengue fever is about 25,000. The Sri Lanka dengue situation is also not different to other countries. In the year 2019, dengue fever caused 120 deaths in Sri Lanka. Most of these deaths were reported from the main administrative district Colombo. Health authorities have to pay their attention to control this new situation. Therefore, identifying the hot spots in the country and implementing necessary actions to control the disease is an important task. This study aims to develop a clustering technique to identify the dengue hot spots in Sri Lanka. Suitable risk factors are identified using expert ideas and reviewing available literature. The weights are derived using Chang’s extent method. These weights are used to prioritize the factors associated with dengue. Using the geometric mean, the interaction between the triggering variable and other variables is calculated. According to the interaction matrices, five dengue risk clusters are identified. It is found that high population movement in the area plays a dominant role to transmit the disease to other areas. Most of the districts in Sri Lanka will reach to moderate risk cluster in the year 2022. I. T. S. Piyatilake and S. S. N. Perera Copyright © 2020 I. T. S. Piyatilake and S. S. N. Perera. All rights reserved. The Evaluation of the Effect of ICT in HIV Prevention in the General Population in China Based on an Information-Motivation-Behavioral Skill Model Thu, 29 Oct 2020 14:35:00 +0000 https://www.hindawi.com/journals/bmri/2020/8786467/ Objectives. With an increase in human immunodeficiency virus (HIV) infection, the application of information and communication technology (ICT) is considered as a helpful solution. The aim of this study is to evaluate the effect of ICT in HIV prevention in the general population based on an information-motivation-behavioral skill (IMB) model. Methods. A national follow-up study on the evaluation of ICT on HIV health education effects before and after large sample intervention was conducted in 16 provinces of China. ICT was used to carry out a six-month educational program on the prevention of HIV for participants using the WeChat platform. The research group conducted a second questionnaire for participants to collect data and built the IMB model using Mplus 7.0 analysis software. Results. A total of 997 questionnaires were sent, and 957 effective questionnaires were recovered, a recovery rate of 96.0%. Before the ICT intervention, the scores of information was , of motivation was , of behavior skills was , and of condom use was . After the ICT intervention, the scores for information (), motivation (), behavior skills (), and condom use () improved significantly. ICT use had a significant regression effect on motivation (,), behavior skills (,), and information (,), while motivation (,), behavior skills (,), and information (,) had a significant regression effect on condom use. Conclusions. The ICT intervention can not only improve information about HIV prevention, motivation, and behavior skills but also promote the use of condoms, so as to achieve the result of promoting behaviors that act to prevent AIDS within the general population. Xia Liang, Jun Yang, Abu S. Abdullah, Zhikui He, and Li Yang Copyright © 2020 Xia Liang et al. All rights reserved. Epidemiology of Thalassemia in Gulf Cooperation Council Countries: A Systematic Review Thu, 29 Oct 2020 13:05:01 +0000 https://www.hindawi.com/journals/bmri/2020/1509501/ Background. Thalassemia has a burden on the healthcare systems of many countries. About 56000 conceptions result in thalassemia, globally. Objective. To assess the epidemiological profile of thalassemia in the Gulf Cooperation Council (GCC) countries. Methods. A systematic search was conducted in MEDLINE/PubMed (National Library of Medicine), CINAHL, and Embase. Relevant observational studies reporting the epidemiology of thalassemia among the GCC population were selected. Data on the prevalence, frequency, and complications of thalassemia were extracted. The quality of the retrieved studies was assessed according to the Newcastle–Ottawa Quality Assessment Scale. Results. Eighteen studies (14 cross-sectional studies, two retrospective observational studies, and two retrospective analysis) with a total of 3343042 participants were included in this systematic review. Of the 18 studies, 11 studies were conducted in Saudi Arabia, two in the Kingdom of Bahrain, one in Kuwait, three in the United Arab Emirates (UAE), and one in Qatar. The prevalence of thalassemia among children below five years of age ranged from 0.25% to 33%, while it was 0.9% in children above five years and from 0.035% to 43.3% among adult thalassemia patients. The most-reported risk factors were consanguineous marriage and high-risk marriage. There was a lack of data regarding mortality rates in thalassemia. Conclusions. Despite the premarital screening and genetic counseling (PMSGC) program for thalassemia, the incidence of high-risk couple marriages in GCC countries cannot be effectively diminished. This study suggested that the PMSGC program should adopt more attention for the high-risk areas, to enhance the level of consciousness about the hemoglobinopathy diseases and the consequences of consanguinity among the at-risk couple. Amani Abu-Shaheen, Humariya Heena, Abdullah Nofal, Doaa A. Abdelmoety, Abdulrahman Almatary, Mohammed Alsheef, and Isamme AlFayyad Copyright © 2020 Amani Abu-Shaheen et al. All rights reserved. An Updated Understanding of the Current Emerging Respiratory Infection: COVID-19 Wed, 28 Oct 2020 07:20:00 +0000 https://www.hindawi.com/journals/bmri/2020/6870512/ According to the World Health Organization (WHO), the COVID-19 pandemic has been declared as a priority disease. Some patients with COVID-19 had symptoms of multiple organ failure and death. The published articles on COVID-19 infection were reviewed. The origin of SARS-CoV-2 is still not completely established. Person-to-person transmission via droplets, probable aerosols, or close contact is considered as the main mode of transmission. With increased mortality due to SARS-CoV-2, valuable clinical indicators or treatments should be further identified and summarized. CT scanning plays an important role in the diagnosis and evaluation of COVID-19 in asymptomatic patients or those with initially negative RT-PCR results. No specific antiviral therapy is recommended, except the main supportive treatments, and effective measures should be taken into consideration to protect important organs and prevent the development of acute respiratory distress syndrome (ARDS) in patients with severe infection. Hai Yuan, Xiaoguang Cao, Xiaoqi Ji, Fangbing Du, Jiawei He, Xuan Zhou, Yanghu Xie, and Yu Zhu Copyright © 2020 Hai Yuan et al. All rights reserved. Current Evidence of 2019 Novel Coronavirus Disease (COVID-19) Ocular Transmission: A Systematic Review and Meta-Analysis Mon, 26 Oct 2020 14:35:00 +0000 https://www.hindawi.com/journals/bmri/2020/7605453/ Objective. To estimate the prevalence rate of ocular symptoms and the positive rate of conjunctival swab samples of patients diagnosed with 2019 Novel Coronavirus Disease (COVID-19). Methods. We performed a systematic review and meta-analysis. A comprehensive literature search was done based on PubMed, Embase, MedRxiv, and the Cochrane Library. The primary outcomes are the prevalence rate of conjunctivitis/conjunctival congestion and the positive rate of conjunctival swab samples. Rates were expressed as proportions with 95% confidence intervals (CIs). Results. A total of 12 studies with 1930 participants were included for meta-analysis. The pooled prevalence rate of conjunctivitis/conjunctival congestion was 8% (95% CI: 5%-12%). 1% (95% CI: 1%-4%) of COVID-19 patients were diagnosed with conjunctivitis/conjunctival congestion as the initial symptom. The pooled positive rate of conjunctival swab samples was 3% (95% CI: 2%-5%). We also assessed other ocular symptoms reported in the 12 studies, including foreign body sensation, increased secretion, and eye itching. The pooled prevalence rates were 6% (95% CI: 3%-10%), 10% (95% CI: 8%-12%), and 9% (95% CI: 7%-10%), respectively. Conclusions. The evidence on the positive rate of conjunctival swab samples and the prevalence rates of ocular symptoms indicated that COVID-19 ocular transmission was possible but less likely. Kai Cao, Brad Kline, Ying Han, Gui-shuang Ying, and Ning Li Wang Copyright © 2020 Kai Cao et al. All rights reserved. Cytomegalovirus and Epstein-Barr Infections: Prevalence and Impact on Patients with Hematological Diseases Mon, 26 Oct 2020 14:20:00 +0000 https://www.hindawi.com/journals/bmri/2020/1627824/ Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) infections are widely distributed throughout the world. EBV is linked to various hematological and autoimmune disorders whereas CMV might play important role in the progression of chronic hematological diseases, such as hemoglobinopathies, lymphomas, myelomas, hemophilia, and aplastic and sickle cell anemia. Both viruses produce a viral homolog of human interleukin-10 that can cause general suppression of immune response, increasing susceptibility to other infections. These viruses can remain latent in the host cells and be reactivated when the host immune system is compromised. Studies showing the impact of CMV and EBV infections on hematological disorders are scarce and unclear in the context of coinfection. This review intends to present the biology, prevalence, and impact of CMV and EBV infections in patients with hematological diseases. Jean de Melo Silva, Renato Pinheiro-Silva, Anamika Dhyani, and Gemilson Soares Pontes Copyright © 2020 Jean de Melo Silva et al. All rights reserved. Stunting and Its Associated Factors among Early Adolescent School Girls of Gondar Town, Northwest Ethiopia: A School-Based Cross-Sectional Study Sat, 24 Oct 2020 12:50:00 +0000 https://www.hindawi.com/journals/bmri/2020/8850074/ Introduction. Stunting is a crucial indicator of long-term chronic undernutrition that reflects a failure to reach a linear growth. Adolescent girls are potentially at a higher risk of stunting as they are traditionally married at an early age in low-income countries. In Ethiopia, stunting has mostly been examined in early childhood, with limited information at the early adolescent age. Therefore, this study is aimed at determining the prevalence of stunting and its associated factors among early adolescent school girls age 10 to 14 in Gondar town. Methods. We conducted a school-based cross-sectional study. A multistage sampling method was used to sample 662 adolescent girls in selected primary schools. A pretested, structured, and interviewer-administered questionnaire was used to collect the required data. Stata Version 14 and WHO Anthro-plus software were used to analyze the data. The bivariable and multivariable logistic regression model was fitted to identify factors associated with stunting. Adjusted Odds Ratio (AOR) with its 95% confidence interval (CI) was calculated, and a value ≤ 0.05 was considered to declare statistically significant variables. Results. The prevalence of stunting was 27.5% [95% CI: 25.5%-29.5%]. The odds of stunting were found to be higher among grade 5 students [AOR; 95% CI: 1.90; 1.13-3.20], those who reported a daily meal frequency of less than three [AOR; 95% CI: 2.37; 1.60-3.50], and those who were from food-insecure families [AOR; 95% CI: 2.52; 1.70-3.73]. Adolescent girls whose mothers were government employees [AOR; 95% CI: 0.48; 0.26–0.89] or merchants [AOR; 95% CI: 0.43; 0.28–0.67] were less likely to be stunted compared to those whose mothers were housewives. Conclusion. Stunting among early adolescent girls is found to be a moderate public health problem. A school-based nutritional program might be helpful to reduce stunting in this group of adolescent girls. Azmera Tamrat, Yigizie Yeshaw, and Abel Fekadu Dadi Copyright © 2020 Azmera Tamrat et al. All rights reserved. Combined Administration of Bisphosphonates, Chemotherapeutic Agents, and/or Targeted Drugs Increases the Risk for Stage 3 Medication-Related Osteonecrosis of the Jaw: A 4-Year Retrospective Study Thu, 15 Oct 2020 15:05:00 +0000 https://www.hindawi.com/journals/bmri/2020/5847429/ Objectives. Patients with stage 3 medication-related osteonecrosis of the jaw (MRONJ) suffer from severe complications. Chemotherapeutic agents and targeted drugs are considered to be associated with the development of MRONJ. However, little is known regarding the association of those agents with stage 3 MRONJ. The purpose of this study is to analyze the comprehensive medication history of patients with advanced-stage MRONJ (stage 2 and stage 3) and evaluate the possible risk factors for stage 3 MRONJ. Patients and Methods. Sixty patients with advanced-stage MRONJ were involved in this retrospective study. Patients with developmental maxillofacial anomalies, previous radiation in the head and neck areas, and jaw bone tumors were excluded from the study. All patients were divided into two groups by their MRONJ stage (stage 2 or stage 3). Demographic and clinical characteristics, comprehensive medication data (bisphosphonates, chemotherapeutic agents, targeted drugs, and immunosuppressive agents), and results of serological biomarkers were recorded and compared between two groups. Univariate and multivariate logistic regressions were performed by SPSS 25.0 for evaluating risk factors of stage 3 MRONJ. Results. Our results indicate that chemotherapy (; 95% CI: 1.03 to 11.38), targeted drugs (; 95% CI: 1.06 to 12.80), and maxillary lesions (; 95% CI: 1.19 to 15.23) increase the risk of stage 3 MRONJ. Conclusion. The outcome of this study justifies that chemotherapeutic agents and targeted drugs are probably risk factors for stage 3 MRONJ. In addition, the osteonecrosis in maxilla is more easily to develop into stage 3 MRONJ. Intense clinical observation is recommended in MRONJ patients with maxillary osteonecrosis and in those who concurrently administered bisphosphonates, chemotherapeutic agents, and/or targeted drugs. This trial is registered with ChiCTR2000032428. Yuqiong Zhou, Yejia Yu, Yueqi Shi, Mengyu Li, Chi Yang, and Shaoyi Wang Copyright © 2020 Yuqiong Zhou et al. All rights reserved. Fuzzy Approach Analyzing SEIR-SEI Dengue Dynamics Wed, 14 Oct 2020 04:20:00 +0000 https://www.hindawi.com/journals/bmri/2020/1508613/ Dengue fever is a mosquito-borne infectious disease threatening more than a hundred tropical countries of the world. The heterogeneity of mosquito bites of human during the spread of dengue virus is an important factor that should be considered while modeling the dynamics of the disease. However, traditional models assumed homogeneous transmission between host and vectors which is inconsistent with reality. Mathematically, we can describe the heterogeneity and uncertainty of the transmission of the disease by introducing fuzzy theory. In the present work, we study transmission dynamics of dengue with the fuzzy SEIR-SEI compartmental model. The transmission rate and recovery rate of the disease are considered as fuzzy numbers. The dynamical behavior of the system is discussed with different amounts of dengue viruses. Also, the fuzzy basic reproduction number for a group of infected individuals with different virus loads is calculated using Sugeno integral. Simulations are made to illustrate the mathematical results graphically. G. Bhuju, G. R. Phaijoo, and D. B. Gurung Copyright © 2020 G. Bhuju et al. All rights reserved. The Association between Neutrophil-to-Lymphocyte Ratio and Diabetic Depression in U.S. Adults with Diabetes: Findings from the 2009-2016 National Health and Nutrition Examination Survey (NHANES) Mon, 12 Oct 2020 11:50:00 +0000 https://www.hindawi.com/journals/bmri/2020/8297628/ Objective. To determine the association between neutrophil-to-lymphocyte ratio (NLR) and clinically relevant depressive symptoms in people with diabetes. Methods. This cross-sectional study was conducted among adults (age >18) with diabetes in the National Health and Nutrition Examination Survey (NHANES) between 2009 and 2016. NLR was calculated from complete blood count. Nine-item Patient Health Questionnaire (PHQ-9) was used to measure depression, with scores ≥10 indicating the presence of clinically relevant symptoms. Multivariable logistic regression was used to calculate the odds ratio (OR) with 95% confidence interval (CI) of clinically relevant depressive symptoms in relation to the NLR. We performed the smooth curve fitting and established a weighted generalized additive model to identify the nonlinearity of NLR and depression in diabetes patients. To account for the nonlinear relationship between NLR and depression in diabetes patients, weighted two-piecewise linear model was applied. Results. We included 2,820 eligible participants, of which 371 (12.4%) had clinically relevant depressive symptoms. In the unadjusted model, the OR (95% CI) of clinically relevant depressive symptoms for the second (NLR 1.75-2.57) and third (NLR >2.57) were 1.24 (0.90, 1.70) and 1.68 (1.23, 2.30), respectively, compared to the reference group (). After controlling for potential confounding factors, NLR was significantly associated with clinically relevant symptoms (, 95% confidence interval: 1.13–1.87; for trend = .0078). Nonlinear relationships were observed, and a two-piecewise linear regression model was established. The inflection point of NLR was 2.87. To the left of the inflection point (), the OR (95% CIs) was 1.33 (1.07–1.66) ().Conclusions. Elevated levels of NLR are independently associated with increased odds of clinically relevant depressive symptoms in people with diabetes. Prospective study is needed to further analyze the role of NLR in depression in diabetic patients. Jie Wang, Depu Zhou, and Xiaokun Li Copyright © 2020 Jie Wang et al. All rights reserved. Increased Risk of Toxoplasma gondii Infection in Patients with Colorectal Cancer in Eastern China: Seroprevalence, Risk Factors, and a Case–Control Study Wed, 07 Oct 2020 06:20:00 +0000 https://www.hindawi.com/journals/bmri/2020/2539482/ The aim of this study was to explore the epidemiology of Toxoplasma gondii infection in patients with colorectal cancer (CRC) in eastern China. Therefore, 287 primary CRC patients and 287 age-matched healthy control subjects were recruited to estimate the seroprevalence of T. gondii and identify the risk factors of infection. Enzyme-linked immunoassays were used to test for anti-T. gondii immunoglobulin G (IgG) and IgM antibodies. Forty-six (16%) samples were positive for anti-T. gondii IgG antibodies in patients with CRC, compared with 26 (9.1%) in the healthy controls, a significant difference (). By contrast, eight (2.8%) patients tested positive for T. gondii IgM antibodies, compared with three (1.1%) in the controls, a difference that was not significant (). Multivariable backward stepwise logistic regression analysis revealed that a rural residence (OR 2.83; 95% CI 1.15–7.01; ) and treatment with chemotherapy (OR 2.16; 95% CI 1.02–4.57; ) were risk factors for T. gondii infection in patients with CRC. Thus, T. gondii infection is serious in patients with CRC, and a rural residence and treatment with chemotherapy are independent risk factors for infection by this parasite. Therefore, medical professionals should be aware of this pathogen in patients with CRC, and the causes of T. gondii infection in these patients need to be explored further. Yang Yu, Dong Guo, Tingting Qu, Shuchao Zhao, Chang Xu, Longlong Wang, Zhongjun Wang, Haiyang Fu, Xiangyan Zhang, and Na Zhou Copyright © 2020 Yang Yu et al. All rights reserved. Anemia and Kidney Function Decline among the Middle-Aged and Elderly in China: A Population-Based National Longitudinal Study Mon, 05 Oct 2020 15:05:00 +0000 https://www.hindawi.com/journals/bmri/2020/2303541/ Chronic kidney disease (CKD) is a public health burden, and anemia is common among patients with CKD. However, less is known regarding the longitudinal association between anemia and deterioration of kidney function among the general population. The China Health and Retirement Longitudinal Study is a nationally representative survey for households with members years. Participants without creatinine and demographic data in 2011 and 2015 were excluded. Anemia was defined according to definitions of the World Health Organization. Rapid decline in kidney function was defined as a ≥16.9% (quartile 3) decline in estimated glomerular filtration rate (eGFR), calculated using the CKD-EPI equation during 2011-2015. Multivariate logistic regression and restricted cubic splines were used to explore their relationship. Altogether, 7210 eligible participants were included in the analysis, with a mean age of years. Rapid decline in kidney function occurred among 1802 (25.0%) participants. Those with kidney function decline were more likely to be older, male, and have anemia, lower eGFRs, hypertension, and cardiovascular disease (). Anemia, or hemoglobin, was independently associated with rapid decline in kidney function after adjusting for potential confounding factors (, 95% CI, 1.32-2.04; , 95% CI, 0.87-0.94, respectively). Restricted cubic splines showed a nonlinear relationship between hemoglobin and rapid decline in kidney function, especially for men with anemia (). In conclusion, anemia is an independent risk factor for progression of kidney function among the middle-aged and elderly population. Attentive management and intervention strategies targeting anemia could be effective to reduce the risk of kidney failure and improve the prognosis of the general population. Chao Yang, Qinqin Meng, Huaiyu Wang, Yafeng Wang, Zaiming Su, Lili Liu, Wenwen Liu, Guilan Kong, Luxia Zhang, Yaohui Zhao, and Ming-Hui Zhao Copyright © 2020 Chao Yang et al. All rights reserved. Clinical Features of COVID-19 Patients with Different Outcomes in Wuhan: A Retrospective Observational Study Mon, 05 Oct 2020 13:20:00 +0000 https://www.hindawi.com/journals/bmri/2020/2138387/ Coronavirus disease 2019 (COVID-19) has caused considerable morbidity and mortality worldwide since December 2019. This retrospective study determined the characteristics and prognostic factors of COVID-19 patients, focusing on inpatients who died or were discharged between 30 December 2019 and 29 February 2020 at Renmin Hospital of Wuhan University. Patients’ medical histories, comorbidities, symptoms, signs, laboratory findings, computed tomography (CT) findings, and clinical management were recorded. All 293 patients were divided into the nonsurviving () and surviving () groups. The median age was older in the nonsurviving group than in the surviving group; most patients were older than 65 years in the nonsurviving group. The incidence rates of lymphopenia, neutrophilia, and leukocytosis were significantly higher in the nonsurviving group than in the surviving group. More patients in the nonsurviving group had increased levels of nonspecific infection markers, abnormal liver and kidney function, cardiac injury, and blood coagulation abnormalities on admission. Immune and inflammatory responses were more severely disturbed in the nonsurviving group than in the surviving group. The incidence rates of complications during hospitalization were higher in the nonsurviving group than in the surviving group. Cox regression results also showed that older age, symptoms of dyspnea, comorbidities, and complications were all predictors of death. Close monitoring and timely treatment are needed for high-risk COVID-19 patients. Zhen Wang, Di Ye, Menglong Wang, Mengmeng Zhao, Dan Li, Jing Ye, Jianfang Liu, Yao Xu, Jishou Zhang, Wei Pan, Menglin Liu, Zhen Luo, and Jun Wan Copyright © 2020 Zhen Wang et al. All rights reserved. Periodontal Disease and Age-Related Macular Degeneration: A Meta-Analysis of 112,240 Participants Tue, 29 Sep 2020 04:35:01 +0000 https://www.hindawi.com/journals/bmri/2020/4753645/ Objective. Epidemiological studies have shown a correlation between periodontal disease (PD) and age-related macular degeneration (AMD). However, the results have been inconsistent, and no relevant meta-analysis has been performed on this topic. Hence, we performed a meta-analysis to evaluate whether the two diseases are related. Material and Methods. The PubMed, Embase, Cochrane Library, and Web of Science databases were searched up to April 20, 2020, for related articles. Two authors independently conducted literature screening and data extraction and then used the Stata 15.1 software to calculate the relative risk (RRs) and 95% confidence intervals (CIs) to assess the association between PD and AMD. Results. A total of 5 observational studies involving 112,240 participants and 5,005 AMD patients were included. The results of meta-analysis using the random-effects model showed that the incidence of AMD in PD patients was 1.35 times that of non-PD patients; the difference was statistically significant (,,). Sensitivity analysis showed that the results were stable. Conclusions. PD patients have a higher risk of AMD, but the causal relationship between PD and AMD has not been confirmed. Further research should be carried out to verify the exact relationship between the two. Xuewen Lv, Weiqi Li, Zhiyu Fang, Xiaofei Xue, and Chunling Pan Copyright © 2020 Xuewen Lv et al. All rights reserved. Sex Differences in the Heterogeneous Dynamic Incidence of Oral Cancer: A Comparison between Taiwan and Thailand Tue, 15 Sep 2020 11:35:01 +0000 https://www.hindawi.com/journals/bmri/2020/9321246/ Background. This study aims at investigating differences in oral cancer (OC) incidence trends between two populations in Taiwan and Thailand. Methods. We used the population-based cancer registry data from Taiwan (1979-2016) and Khon Kaen (KK), Thailand (1985-2016). We performed joinpoint analyses to detect the trend change points for the OC incidence and to quantify the time trends in both sexes and regions. Age-period-cohort curves were plotted to explain the incidence trends. Results. In Taiwan, the estimated annual increases in OC were approximately 6.0% in males, although the increase slowed after 2009, and 2.6% in females. In KK, the OC incidence steadily decreased by -2.5% per year in females, but there was no obvious change in males. A strong period effect observed in those aged 45-69 years in Taiwanese males resulted in a peak incidence in the middle age group. Decreased period and cohort effects were observed in females in KK. Conclusions. Taiwanese males are the predominant sex affected by OC in Taiwan, and the trend has decelerated since 2009. Age, period, and cohort effects were different between males and females in the two regions. Pallop Siewchaisakul, Pongdech Sarakarn, Patravoot Vatanasapt, Sam Li-Sheng Chen, and Amy Ming-Fang Yen Copyright © 2020 Pallop Siewchaisakul et al. All rights reserved. A Cross-Sectional Epidemiological Survey of Work-Related Musculoskeletal Disorders and Analysis of Its Influencing Factors among Coal Mine Workers in Xinjiang Mon, 10 Aug 2020 11:20:01 +0000 https://www.hindawi.com/journals/bmri/2020/3164056/ This study is to investigate the prevalence of work-related musculoskeletal disorders (MSDs) and the influencing factors among coal mine workers employed in on-site operations. The job burnout scale and MSD scale were implemented to investigate a random sample of 1,500 coal mine workers working in on-site operations in Xinjiang, China. In total, 1,325 valid questionnaires were collected, with a recovery rate of 88.33% (1,325/1,500). The rate of job burnout was 90%, of which 39.8% were categorized as mild burnout, 43.8% as moderate burnout, and 6.4% as severe burnout; the average job burnout score was . The annual prevalence of MSDs was 65.6%, with the highest annual prevalence in the waist (50.7%), followed by the neck, shoulder, and knee, and the lowest prevalence in the elbow (18.8%). Of the areas of the body affected by work-related MSDs, the highest proportion of requests for leave of absence was related to the waist, accounting for 25.7% of requests, while the lowest proportion (13.4%) was related to the wrist. In addition, the incidence of MSDs increased with the years of service. The lowest incidence of MSDs was associated with the two-shift and three-group working pattern. The prevalence of MSDs in the neck and waist was higher in women than in men. The prevalence of MSDs in various body parts increased with the years of service. Moreover, multiple logistic regression indicated that three shifts with four groups (, 95% CI: 0.832-1.445), working more than 10 years (, 95% CI: 2.369-5.748), working more than 20 years (, 95% CI: 1.419-6.337), significant bending (, 95% CI: 1.400-3.038), forward neck tilting (, 95% CI: 1.071-2.281), maximum force operation within a short period of time (, 95% CI: 1.164-2.547), repeated movement of upper arms or fingers (, 95% CI: 1.034-2.161), slip or fall incidents (, 95% CI: 1.039-1.216), work under conditions of cold or temperature variations (, 95% CI: 1.342-2.720), mild burnout (, 95% CI: 1.016-2.191), moderate burnout (, 95% CI: 1.267-2.708), and severe burnout (, 95% CI: 1.145-3.496) were risk factors for MSDs. In conclusion, there is a high annual prevalence of MSDs among the coal mine workers employed in on-site operations in Xinjiang, China. Measures to reduce this prevalence are required. Xianting Yong, Fuye Li, Hua Ge, Xuemei Sun, Xiaofan Ma, and Jiwen Liu Copyright © 2020 Xianting Yong et al. All rights reserved. Periodontal Disease and Tooth Loss Are Associated with Lung Cancer Risk Mon, 27 Jul 2020 13:50:02 +0000 https://www.hindawi.com/journals/bmri/2020/5107696/ Background. The associations between periodontal disease, tooth loss, and lung cancer risk remain debatable. Therefore, the purpose of the present study is to evaluate whether periodontal disease and tooth loss are associated with lung cancer risk. Methods. A literature search was performed for relevant studies using PubMed and Embase databases. Risk ratio (RR) with 95% confidence interval (CI) was applied as effect size to summarize the associations between periodontal disease, tooth loss, and lung cancer risk. A further dose-response analysis was also performed. Results. A total of twelve studies comprising 263,238 participants were included. The results indicated that periodontal disease was positively associated with lung cancer risk (,). There was a positive association between tooth loss and lung cancer risk (,). Moreover, there was a significantly linear dose-response relationship between tooth loss and lung cancer risk, and every 5 increment in tooth loss was associated with 10% increased lung cancer risk. Similar results were obtained in subgroup analysis. Conclusions. Periodontal disease and tooth loss are increased risk factors for lung cancer. Prevention and treatment of periodontal disease may be effective potential prevention strategies for lung cancer. You Chen, Bao-ling Zhu, Cong-cong Wu, Rui-fang Lin, and Xi Zhang Copyright © 2020 You Chen et al. All rights reserved. Tuberculosis Chemotherapy Outcome in the Littoral Region of Cameroon: A Meta-analysis of Treatment Success Rate between 2014 and 2016 Wed, 08 Jul 2020 14:20:00 +0000 https://www.hindawi.com/journals/bmri/2020/8298291/ Background. Tuberculosis (TB) is a public health concern, especially in resource-constrained countries like Cameroon. TB drug resistance is a major obstacle to control and prevent. Design. Data from 2014 to 2016 on the outcome of anti-TB treatment in the Littoral Region were reviewed manually and analysed using the meta-analysis concept. The treatment success rates (TSR) were the primary outcome used for this study. The heterogeneity statistics () was computed to orientate the choice of the best statistical model (binary fixed effect or random) to compute pooled value of TSR. Results. Using an intention-to-treat analysis, the pooled proportions of HIV-uninfected TB patients successfully cured from TB were low and slightly decreased by 1% between 2014 and 2016. Regarding HIV-infected TB patients, pooled values of TSR were lower than those of their HIV-negative counterparts with values ranging from 71% (95% CI: 63%-83%; ) in 2014 to 68% (95% CI: 58%-79%; ) in 2016. In addition, no heterogeneity was found in three years (; value = 1). These cure rates were strongly and negatively correlated with the rates of patients lost to follow-up regardless of the year. In HIV-infected patients, the pooled values of ITT analysis-based treatment success rates were 73% (, value = 0.0002), 71% (, value = 0.007), and 68% (, value = 0.004), respectively. The coverage rates with cotrimoxazole (CTX) gradually increased over year ranging from 78.90% in 2014 to 94.17% in 2016, similar to the coverage rate for ARV therapy that was 60.06% in 2014 against 90% in 2016. A positive and statistically significant correlation was found between the success of the anti-TB therapy in HIV-infected patients and coverage rates with CTX and ARV. Conclusion. An improvement in the reduction of percentage of lost to follow-up and coverage with CTX and ARV therapy could greatly increase chances to efficiently control TB in Cameroon. Dorgelesse F. Kouemo Motse, Dickson Shey Nsagha, Dieudonné Adiogo, Loick P. Kojom Foko, Pride M. Teyim, Alain Chichom-Mefire, and Jules C. Nguedia Assob Copyright © 2020 Dorgelesse F. Kouemo Motse et al. All rights reserved. Trends in Prevalence, Awareness, Treatment, and Control of Hypertension in Rural Northeast China: 2008 to 2018 Sun, 28 Jun 2020 10:05:00 +0000 https://www.hindawi.com/journals/bmri/2020/1456720/ Objective. This study is aimed at exploring the trends in the prevalence, awareness, treatment, and control of hypertension in rural northeast China from 2008 to 2018. Methods. Two successive cross-sectional surveys were conducted in Liaoning rural areas in 2008 and 2018, which included 131520 and 10926 representative participants years, respectively. Results. Overall, the age-standardized prevalence of hypertension increased from 44.7% to 53.6%, and male residents showed a faster pace of increase and a 2.1-fold increase than female residents (25.5% vs. 10.6%) from 2008 to 2018. Moreover, the mean systolic and diastolic blood pressures increased by 9.0% and 4.1%, respectively, and the increase rates were greater in men than in women (9.2% vs. 8.9% and 5.3% vs. 3.5%, ). Additionally, the prevalence of stage 2 and above hypertension was significantly higher in men than in women. However, the awareness, treatment, and control rates showed no improvement and remained unacceptably low. Control rates were 3.7% in 2008 and 3.6% in 2018. Even among individuals who received medical treatment, only 8.7% and 10.1% had controlled hypertension in 2008 and 2018, respectively. Conclusions. The prevalence of hypertension and mean blood pressure increased steadily in the past 10 years in rural northeast China, especially in men. However, the awareness, treatment, and control rates of hypertension remained extremely low. Therefore, long-term comprehensive strategies are urgently needed to prevent further development of cardiovascular diseases in these areas. Liying Xing, Shuang Liu, Li Jing, Shuang Li, Yuanmeng Tian, Rui Zhang, Min Lin, Zhi Du, Dong Dai, Lei Shi, and Guowei Pan Copyright © 2020 Liying Xing et al. All rights reserved. A Survey on HIV/AIDS-Related Knowledge, Attitudes, Risk Behaviors, and Characteristics of Men Who Have Sex with Men among University Students in Guangxi, China Mon, 15 Jun 2020 13:35:00 +0000 https://www.hindawi.com/journals/bmri/2020/7857231/ In recent years, the prevalence of human immunodeficiency virus (HIV) infection among Chinese university students has increased significantly, and HIV transmission among men who have sex with men (MSM) comprises more than half of the new cases. There is still a lack of research investigating the incidence of male-to-male sex, the attitudes towards MSM, and the awareness of HIV/AIDS among university students in Guangxi, one of the HIV high-risk areas in China. Therefore, we performed a cross-sectional investigation among 578 male students, recruited by stratified sampling, in universities in Nanning, Guangxi, between January 2016 and March 2017. Researcher-administered anonymous questionnaires were completed. Self-recognition as MSM was found in 8.48% of the subjects. Compared with non-MSM, university student MSM included more people over the age of 20 (), had less migration from other districts of Guangxi (), and the majority were nonmedical students (). In total, 63.25% of the male student participants reported a lack of acceptance of MSM, while 35.47% acknowledged barriers between themselves and acquaintances who were MSM. Overall, 67.30% of the subjects correctly answered questions related to AIDS knowledge. The proportion of MSM subjects who answered the AIDS-related questions completely correctly was significantly lower than that of non-MSM subjects (42.86% vs. 69. 57%, respectively, OR: 0.33), but the self-recognition risk of MSM was significantly higher than that of non-MSM (). Risky behaviors associated with HIV infections, including smoking, alcohol consumption, drug abuse, and inconsistent condom use, were significantly higher among the MSM participants. The percentages of student’s willingness to accept MC and PrEP were 70.93% and 77.51%, respectively. These results raise the alarm that university student MSM in Guangxi, China, require urgent public attention and more effective health education, including the education on MC and PrEP. Jingzhen Lai, Peijiang Pan, Yulun Lin, Li Ye, Long Xie, Yuan Xie, Bingyu Liang, Fangling Zheng, Rongfeng Chen, Liufang Wen, Yuxin Luo, Hao Liang, and Junjun Jiang Copyright © 2020 Jingzhen Lai et al. All rights reserved. A Systematic Review of the Current Hepatitis B Viral Infection and Hepatocellular Carcinoma Situation in Mediterranean Countries Thu, 11 Jun 2020 12:50:01 +0000 https://www.hindawi.com/journals/bmri/2020/7027169/ Viral hepatitis B is a global public health problem affecting nearly two billion subjects; 3.3% of whom are from the WHO (World Health Organization) Eastern Mediterranean Region (EMRO). It induces both acute and chronic hepatic disorders with subsequent liver cirrhosis and hepatocellular carcinoma (HCC) in a considerable percentage of patients based on the age of exposure. In this review, hepatitis B virus (HBV) and HCC prevalence, distribution and prevalence of different genotypes, and male/female infection frequencies in relation to the vaccination status in the Mediterranean countries were reported. Study Design. This systematic review describes the prevalence of hepatitis B infection, genotype distribution of hepatitis B virus, and prevalence and incidence of hepatocellular carcinoma in Mediterranean countries belonging to three different continents: Southern Europe (Spain, France, Italy, Croatia, and Greece), North Africa (Morocco, Algeria, Tunisia, Libya, and Egypt), and the Near East region (Syria, Lebanon, Turkey, Israel, and Palestine). We tried to collect new data from electronic databases: PubMed, ScienceDirect, ResearchGate, Google Scholar, and public health reports between 1980 and 2019. For each publication, we recorded reference, publication year, study characteristics (date, locations, sample size, and study population), and participant characteristics (population group, year, age, and sex). No language limitation was imposed, and articles or reports from non-peer-reviewed sources were not considered for this analysis. The main keywords were HBV prevalence, hepatitis B infection, HBV genotype, and HCC. Inclusion and Exclusion Criteria. Healthy population-based studies included the following sample populations: (i) voluntary blood donors, (ii) pregnant women, (iii) community studies, (iv) hemodialysis patients, (v) hospitalized patients, (vi) healthcare workers, (vii) sex workers, (viii) drug abusers, and (ix) prisoners. We excluded studies from the following special groups who were assumed to be at a special high risk: patients from sexually transmitted disease clinics and thalassemia clinics and professional or paid blood donors. Salma Madihi, Hashim Syed, Fatiha Lazar, Abdelmajid Zyad, and Abdelouaheb Benani Copyright © 2020 Salma Madihi et al. All rights reserved. The Epidemiology of Celiac Disease in the General Population and High-Risk Groups in Arab Countries: A Systematic Review Thu, 04 Jun 2020 16:05:01 +0000 https://www.hindawi.com/journals/bmri/2020/6865917/ Background and Aims. Celiac disease (CD) is possibly the most common autoimmune disorder, which may lead to dietary problems in the Arab region. This paper is aimed at exploring the epidemiology of the celiac disease in Arab countries, including its prevalence, associated risk factors, and clinical patterns. Methods. An extensive search of the literature was conducted from electronic databases such as PubMed, Embase, and Google Scholar. In total, 134 research papers were retrieved. We extracted studies published from January 1996 to December 2019. Our search was limited to studies published in English. Findings. The review included 35 studies with 22,340 participants from 12 countries and demonstrated a wide variation in the prevalence of CD. The highest prevalence among the general population (3.2%) was reported in Saudi Arabia, and the lowest (0.1%) was reported in Tunisia. Women demonstrated a higher prevalence of celiac disease relative to men. The peak age at diagnosis fell between 1 and 3 years and 9-10 years. Most studies focused on type 1 diabetes. Children with type 1 diabetes have a higher prevalence of CD (range from 5.5% to 20%), while the prevalence of CD in Down’s syndrome patients was 1.1% and 10.7% in UAE and Saudi Arabia, respectively. Other autoimmune diseases associated with CD are thyroid disease and irritable bowel disease. The most widely recognized clinical presentation was an inability to flourish and poor weight gain, followed by short stature, abdominal pain, abdominal distension, bloating, and chronic diarrhea. Conclusion. The prevalence of the celiac disease in Arab countries varies with sex and age. However, we found that celiac disease presented similar clinical characteristics independent of the geographic region. Longitudinal population-based studies are needed to better identify the true burden and determinants of celiac disease. Ashraf El-Metwally, Paivi Toivola, Khalid AlAhmary, Salwa Bahkali, Ali AlKhathaami, Munira K. AlSaqabi, Shatha A. Al Ammar, Munazza Jawed, and Saleh M. Alosaimi Copyright © 2020 Ashraf El-Metwally et al. All rights reserved. The Prevalence of Dental Caries in Primary Dentition in 3- to 5-Year-Old Preschool Children in Northern China Mon, 11 May 2020 06:20:00 +0000 https://www.hindawi.com/journals/bmri/2020/5315236/ Objectives. To investigate the prevalence and factors promoting caries in primary dentition of 3-5-year-old children in Northeast China. Materials and Methods. Data of 1,229 children aged 3 to 5 years were randomly selected. The caries prevalence and other indicators were assessed, and the results analyzed by SPSS. A questionnaire was also given to the children’s guardians to ascertain the potential risk factors associated with caries. Results. The decayed, missing, and filled teeth (dmft) index in children aged 3, 4, and 5 years old was 3.17, 5.13, and 6.07, respectively, while the caries prevalence rate was 62.16%, 75.89%, and 87.28% accordingly. The incidence of caries among rural children was higher than that in urban areas. Regarding oral health awareness, it was found that parents in urban areas had more accurate perceptions of oral health problems. It was also noted that the children’s brushing habits were worrying. Family economic and medical resources are not the main causes of serious dental caries in rural areas. Conclusions. The oral health status of children aged 3-5 years is not optimistic. Many parents have a low awareness of oral health. Strengthening the promotion of oral health knowledge is an effective way to change the situation. Kaiqiang Zhang, Jian Li, and Zhenfu Lu Copyright © 2020 Kaiqiang Zhang et al. All rights reserved. Two Time Point Analysis of the Change in Risk and Aging Factors for Major Cancers: A 10-Year Longitudinal Study in China Thu, 07 May 2020 07:50:00 +0000 https://www.hindawi.com/journals/bmri/2020/9043012/ Objective. To quantify the change in risk and aging factors with a two time point analysis for major cancers to assess supportive strategies. Methods. The 2004 and 2015 mortality statistics in China were accessed. The standardized mortality rates of the two periods were used to calculate the ratio of change (RC) value to assess the risk of death associated with time (social development with time) for cancers. The role of age in mortality with time was evaluated by the interaction between time and age using a Poisson regression. Results. In ascending order of RC, the factors were uterus; other malignant neoplasms; esophagus; stomach; skin; liver; leukemia; “lip, oral cavity, and pharynx”; bladder; “colon and rectum”; breast; prostate; lung; ovary; pancreas; “lymphoid, hematopoietic, and related tissue”; and cervix cancers. According to their location on the scatter diagram, the 17 neoplasms could be divided into three groups, comprising undeveloped cancers (including four cancers), developed cancers (including three cancers), and cancers insensitive to social development. Unexpectedly, about 60% (as assessed by type of cancer) and two-thirds (as assessed by constituent ratio of death from all cancers) of cancers did not change with time. Conclusions. Most cancers may be insensitive to social development. Internal factors, including aging, may be a key factor for the occurrence of cancer. Liu Hui Copyright © 2020 Liu Hui. All rights reserved. Interaction of miR-181b and IFNA1 Polymorphisms on the Risk of Systemic Lupus Erythematosus Sat, 25 Apr 2020 06:20:00 +0000 https://www.hindawi.com/journals/bmri/2020/4757065/ Introduction. A previous work has discovered that chromosome 1q32 locus linked to the risk of systemic lupus erythematosus (SLE) and miR-181b located on the susceptibility site with downregulation inversely correlating to its target molecular interferon alpha 1 (IFNA1). The purpose of this study was to investigate the association of miR-181b and IFNA1 polymorphisms with IS risk. Methods. The miR-181b rs322931, IFNA1 rs1332190, and rs10811543 were genotyped using a Multiplex SNaPshot assay. miR-181b expression levels in plasma of SLE patients and controls were analyzed using quantitative PCR. Results. The rs322931 CT, CT/TT, and T allele exerted an increased trend of SLE risk (CT vs. CC: , 95% CI 1.16-2.50, ; CT/TT vs. CC: , 95% CI 1.08-1.95, ; T vs. C: , 95% CI 1.07-1.79, ). Combined genotypes of the rs322931 CT/TT+rs1332190 TT and the rs322931 CC+rs10811543 AG/AA also revealed an increased risk of SLE. Gene-gene interaction analysis showed that a three-locus model consisting of rs322931, rs1332190, and rs10811543 attributed an increased risk of SLE. Further genotype-phenotype analysis revealed that rs322931 CT/TT carriers displayed lower levels of miR-181b. Conclusions. These findings indicate that the miR-181b rs322931 may be singly and jointly responsible for the etiology of SLE by altering miR-181b expression. Yong-Ling He, Jun Yang, Zhi-Neng Zeng, and Xiang Shi Copyright © 2020 Yong-Ling He et al. All rights reserved. Improved Landmark Dynamic Prediction Model to Assess Cardiovascular Disease Risk in On-Treatment Blood Pressure Patients: A Simulation Study and Post Hoc Analysis on SPRINT Data Thu, 23 Apr 2020 13:20:00 +0000 https://www.hindawi.com/journals/bmri/2020/2905167/ Landmark model (LM) is a dynamic prediction model that uses a longitudinal biomarker in time-to-event data to make prognosis prediction. This study was designed to improve this model and to apply it to assess the cardiovascular risk in on-treatment blood pressure patients. A frailty parameter was used in LM, landmark frailty model (LFM), to account the frailty of the patients and measure the correlation between different landmarks. The proposed model was compared with LM in different scenarios respecting data missing status, sample size (100, 200, and 400), landmarks (6, 12, 24, and 48), and failure percentage (30, 50, and 100%). Bias of parameter estimation and mean square error as well as deviance statistic between models were compared. Additionally, discrimination and calibration capability as the goodness of fit of the model were evaluated using dynamic concordance index (DCI), dynamic prediction error (DPE), and dynamic relative prediction error (DRPE). The proposed model was performed on blood pressure data, obtained from systolic blood pressure intervention trial (SPRINT), in order to calculate the cardiovascular risk. Dynpred, coxme, and coxphw packages in the R.3.4.3 software were used. It was proved that our proposed model, LFM, had a better performance than LM. Parameter estimation in LFM was closer to true values in comparison to that in LM. Deviance statistic showed that there was a statistically significant difference between the two models. In the landmark numbers 6, 12, and 24, the LFM had a higher DCI over time and the three landmarks showed better performance in discrimination. Both DPE and DRPE in LFM were lower in comparison to those in LM over time. It was indicated that LFM had better calibration in comparison to its peer. Moreover, real data showed that the structure of prognostic process was predicted better in LFM than in LM. Accordingly, it is recommended to use the LFM model for assessing cardiovascular risk due to its better performance. Mehrab Sayadi, Najaf Zare, Armin Attar, and Seyyed Mohammad Taghi Ayatollahi Copyright © 2020 Mehrab Sayadi et al. All rights reserved. Mortality and Disease Burden of Injuries from 2008 to 2017 in Anhui Province, China Wed, 22 Apr 2020 11:20:00 +0000 https://www.hindawi.com/journals/bmri/2020/7303897/ Objective. To investigate the temporal trends in mortality and disease burden of injuries in Anhui province from 2008 to 2017, so as to provide reference for injury control and prevention. Methods. Data of mortality were collected from 9 national surveillance points in Anhui province during 2008-2017 in the Information System for Death Cause Register and Management. The surveillance data were analyzed by using crude mortality, standardized mortality rate (SMR), potential year of life lost (PYLL), PYLL rate (PYLLR), and average of year life lost (AYLL). Results. There were a total of 44855 people died from injury, accounted for 9.44% of the all-cause mortality, ranked as the fifth leading cause of deaths in the whole population, and denoted the first leading cause of deaths in the 0-44 year’s group. The leading causes of injury deaths were road traffic accidents, suicide, accidental falls, drowning, and poisoning. Road traffic accidents was the primary cause of injury deaths among the male population, while suicide was the dominate cause of injury deaths among the female population. Drowning, traffic accidents, and suicide accounted for the most injury deaths among the population aged 0-14 years, 15-64 years, and above 60 years, respectively. The road traffic accidents accounted for the largest proportion of injury PYLL and PYLLR, and drowning caused the highest AYLL among injury deaths. Conclusion. In Anhui province, road traffic accidents, suicide, accidental falls, drowning, and poisoning were the top five causes of injury deaths that harm the health of local residents; corresponding injury prevention strategies should be formulated. Xiu-Ya Xing, Peng Wang, Zhiwei Xu, Qin He, Rui Li, Ye-Ji Chen, Li-Na Liu, Yan-Mei Mao, Chan-Na Zhao, Yi-Lin Dan, Qian Wu, Hai-Feng Pan, Zhi-Rong Liu, and Wenbiao Hu Copyright © 2020 Xiu-Ya Xing et al. All rights reserved. Genetic Variations in miR-30 Family Member Regulatory Regions Are Associated with Breast Cancer Risk in a Chinese Population Fri, 27 Mar 2020 06:50:00 +0000 https://www.hindawi.com/journals/bmri/2020/8781348/ MicroRNAs (miRNAs) of the miR-30 family are closely linked with tumor metastasis and play key roles in the complex malignant phenotypes of cancers by targeting many tumor-related genes. Deregulated expression of miR-30 family members has been commonly observed in breast cancer. However, associations between the genetic variants in the regulatory region of miR-30 family and the risk of breast cancer are still limited, especially in the Chinese Han population. In the present study, we conducted a case-control analysis wherein 1064 breast cancer patients and 1073 healthy controls underwent genotyping of 10 SNPs in the regulatory region of miR-30 family members. Multivariate logistic regression analyses illustrated that the rs763354 variant in the miR-30a regulatory region was linked with a significant decrease in breast cancer risk in an additive model (, 95% CI: 0.75-0.98, ). Further, eQTL analyses also indicated that this SNP was associated with miR-30a expression levels in breast cancer samples compiled in the TCGA database (). The Kaplan-Meier plotter showed that breast cancer patients with higher miR-30a expression have significantly better outcomes than do patients expressing low levels of this miRNA (, 95% CI: 0.61-0.91, ). Together, these findings suggest that the miR-30a rs763354 SNP is an important regulator of breast cancer risk, thus making it a potentially viable prognostic biomarker and one that can be used to guide therapeutic treatment in affected patients. Jing Zhou, Lijuan Wang, Sijun Liu, Wen Zhou, Yue Jiang, Jiangbo Du, Juncheng Dai, Guangfu Jin, Hongxia Ma, Zhibin Hu, Jiaping Chen, and Hongbing Shen Copyright © 2020 Jing Zhou et al. All rights reserved. Associations between Aquaglyceroporin Gene Polymorphisms and Risk of Stroke among Patients with Hypertension Thu, 26 Mar 2020 13:35:01 +0000 https://www.hindawi.com/journals/bmri/2020/9358290/ Background. Dysregulations of AQP7 and AQP9 were found to be related to lipid metabolism abnormality, which had been proven to be one of the mechanisms of stroke. However, limited epidemiological studies explore the associations between AQP7 and AQP9 and the risk of stroke among patients with hypertension in China. Aims. We aimed to investigate the associations between genetic variants in AQP7 and AQP9 and the risk of stroke among patients with hypertension, as well as to explore gene-gene and gene-environment interactions. Methods. Baseline blood samples were drawn from 211 cases with stroke and 633 matched controls. Genomic DNA was extracted by a commercially available kit. Genotyping of 5 single nucleotide polymorphisms (SNPs) in AQP7 (rs2989924, rs3758269, and rs2542743) and AQP9 (rs57139208, rs16939881) was performed by the polymerase chain reaction assay with TaqMan probes. Results. Participants with the rs2989924 GG genotype were found to be with a 1.74-fold increased risk of stroke compared to those with the AA+AG genotype, and this association remained significant after adjustment for potential confounders (odds ratio (OR): 1.74, 95% confidence interval (CI): 1.23-2.46). The SNP rs3758269 CC+TT genotype was found to be with a 33% decreased risk of stroke after multivariate adjustment (OR: 0.67, 95% CI: 0.45-0.99) compared to the rs3758269 CC genotype. The significantly increased risk of stroke was prominent among males, patients aged 60 or above, and participants who were overweight and with a harbored genetic variant in SNP rs2989924. After adjusting potential confounders, the SNP rs3758269 CT+TT genotype was found to be significantly associated with a decreased risk of stroke compared to the CC genotype among participants younger than 60 years old or overweight. No statistically significant associations were observed between genotypes of rs2542743, rs57139208, or rs16939881 with the risk of stroke. Neither interactions nor linkage disequilibrium had been observed in this study. Conclusions. This study suggests that SNPs rs2989924 and rs3758269 are associated with the risk of stroke among patients with hypertension, while there were no statistically significant associations between rs2542743, rs57139208, and rs16939881 and the risk of stroke being observed. Qingyun Tu, Li Yan, Chun Wang, Aohan Han, Yu Qin, Lan Cui, and Quanyong Xiang Copyright © 2020 Qingyun Tu et al. All rights reserved. Characteristics and Epidemiological Investigation of Paratuberculosis in Dairy Cattle in Tai’an, China Fri, 13 Mar 2020 04:50:00 +0000 https://www.hindawi.com/journals/bmri/2020/3896754/ Paratuberculosis, a chronic and sometimes fatal disease of ruminants, is caused by Mycobacterium avium subsp. paratuberculosis (MAP). In this study, we examined paratuberculosis cases among 2–4-year-old dairy cows at farms in Shandong Province, China. Paratuberculosis cases were diagnosed based on clinical symptoms, pathological autopsy, and histopathological inspection. Characteristics of paratuberculosis in the affected dairy cattle included poor body condition, persistent diarrhea, subcutaneous edema, granulomatous ileitis (multibacillary), mesenteric lymphadenitis, and hepatitis. Acid-fast bacilli from fecal specimens and lymphocytes were putatively identified as MAP based on Ziehl-Neelsen staining, then confirmed using polymerase chain reaction-based testing and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry analyses. Overall, only one MAP strain was isolated from a herd with symptomatic diarrhea. However, analysis of 586 serum samples from nine herds in Tai’an City revealed that 66.7% of herds and 14.2% of animals were seropositive for MAP. Our findings suggest that paratuberculosis is widely prevalent and therefore a significant threat to the dairy industry in Tai’an City, Shandong Province, China. Zilong Cheng, Mengda Liu, Peng Wang, Peng Liu, Meng Chen, Jiandong Zhang, Sidang Liu, and Fangkun Wang Copyright © 2020 Zilong Cheng et al. All rights reserved. Use of Novaluron-Based Autocidal Gravid Ovitraps to Control Aedes Dengue Vector Mosquitoes in the District of Gampaha, Sri Lanka Mon, 02 Mar 2020 03:20:03 +0000 https://www.hindawi.com/journals/bmri/2020/9567019/ Dengue is the most important mosquito-borne viral infection in Sri Lanka causing an enormous social and economic burden in the country. In the absence of therapeutic drugs and the developed vaccines are under investigation, vector control is the best strategy to reduce the disease transmission. Therefore, the development of novel tools to control dengue vector mosquitoes has become the need of the hour. Novaluron is a recently developed Insect Growth Regulator (IGR) which inhibits chitin synthesis in immature stages of insects. The aim of the study was to identify the efficacy of a simple and cost-effective Autocidal Gravid Ovitrap (AGO) developed using Novaluron to control dengue outbreaks in the District of Gampaha, Sri Lanka. Laboratory and semifield experiments were performed to identify the activity range, optimum field dosage, and residual effects of Novaluron following the World Health Organization guidelines, and field experiments were performed in the Ragama Medical Officer of Health (MOH) area. Two study areas 800 m apart were selected and assigned as treated and control areas randomly. In each study area, 30 households were selected randomly. Each household was given two ovitraps, one placed indoors and the other placed outdoors. Mortality and survival counts were recorded separately for one-year time period and data were analyzed using a two-way repeated measures analysis of variance model. During the laboratory experiments, the adult emerging inhibition was 100% in all tested concentrations. The optimum field dosage was 2 ppm and the residual effect was 28 days. In the field experiments, significantly higher mortality counts were recorded in treated areas both indoor- and outdoor-placed AGOs. Two-factor repeated measures ANOVA followed by Tukey’s test confirmed that the mean mortality count is high for the developed AGOs both indoor and outdoor settings. The developed AGO can be deployed to control both indoor and outdoor dengue vector mosquito populations, and in dengue-risk areas, the ovitrap will be supportive to local health authorities to enhance the efficiency of future vector control programs. Gayan P. Withanage, Sameera D. Viswakula, Yasanthi Silva Gunawardene, and Menaka D. Hapugoda Copyright © 2020 Gayan P. Withanage et al. All rights reserved. A Comparative Study of the Bias Correction Methods for Differential Item Functioning Analysis in Logistic Regression with Rare Events Data Tue, 25 Feb 2020 06:05:01 +0000 https://www.hindawi.com/journals/bmri/2020/1632350/ The logistic regression (LR) model for assessing differential item functioning (DIF) is highly dependent on the asymptotic sampling distributions. However, for rare events data, the maximum likelihood estimation method may be biased and the asymptotic distributions may not be reliable. In this study, the performance of the regular maximum likelihood (ML) estimation is compared with two bias correction methods including weighted logistic regression (WLR) and Firth’s penalized maximum likelihood (PML) to assess DIF for imbalanced or rare events data. The power and type I error rate of the LR model for detecting DIF were investigated under different combinations of sample size, moderate and severe magnitudes of uniform DIF (DIF = 0.4 and 0.8), sample size ratio, number of items, and the imbalanced degree (τ). Indeed, as compared with WLR and for severe imbalanced degree (τ = 0.069), there were reductions of approximately 30% and 24% under DIF = 0.4 and 27% and 23% under DIF = 0.8 in the power of the PML and ML, respectively. The present study revealed that the WLR outperforms both the ML and PML estimation methods when logistic regression is used to evaluate DIF for imbalanced or rare events data. Marjan Faghih, Zahra Bagheri, Dejan Stevanovic, Seyyed Mohhamad Taghi Ayatollahi, and Peyman Jafari Copyright © 2020 Marjan Faghih et al. All rights reserved. HIV Prevalence and Factors Influencing the Uptake of Voluntary HIV Counseling and Testing among Older Clients of Female Sex Workers in Liuzhou and Fuyang Cities, China, 2016-2017: A Cross-Sectional Study Mon, 24 Feb 2020 08:05:00 +0000 https://www.hindawi.com/journals/bmri/2020/9634328/ Objective. To compare the prevalence of HIV and associated factors for participating HIV voluntary counseling and testing (VCT) among older clients of female sex workers (CFSWs) in Liuzhou City and Fuyang City in China. Methods. A cross-sectional study was conducted and the study employed 978 male CFSWs, aged 50 years and above from October 2016 to December 2017. All participants were required to complete a questionnaire and provide blood samples for HIV testing. Multivariate logistic regression analysis was used to analyze the influential factors of using VCT program and tested for HIV. Results. The HIV infection prevalence rate was 1.2% and 0.5%, while 52.3% and 54.6% participants had ever utilized VCT service and tested for HIV in Liuzhou City and Fuyang City, respectively. The older CFSWs who ever heard of VCT program were more likely to uptake VCT program in both cities (). Participants, whose marital status was married or cohabiting (), who have stigma against individuals who are living with HIV/AIDS (), whose monthly income is more than 500 yuan (), and whose age is more than 60 years old (), were less likely to visit VCT clinics. Those who are worried about HIV-infected participants were more likely to utilize VCT services in Fuyang City ().Conclusion. Combine strategy will be needed to promote the utilization of VCT service, based on the socioeconomic characteristics of older male CFSWs in different cities of China. Qi Zhang, Yuan-Sheng Fu, Xue-Mei Liu, Zhi-Qiang Ding, Ming-Qiang Li, and Yin-Guang Fan Copyright © 2020 Qi Zhang et al. All rights reserved. The Correlation between Dietary Selenium Intake and Type 2 Diabetes: A Cross-Sectional Population-Based Study on North Chinese Adults Wed, 22 Jan 2020 04:05:01 +0000 https://www.hindawi.com/journals/bmri/2020/8058463/ The relationship between selenium (Se) and type 2 diabetes (T2D) remains controversial. In previous animal and cell studies, Se was found to be insulin mimic and antidiabetic, whereas recent epidemiological and interventional trials have shown an unexpected association between high Se intake and increased risk of T2D. The present study aimed to investigate the significance of dietary Se and T2D in North Chinese adults. A large sample of the population was enrolled through cluster sampling in Northern China (). Information on basic characteristics, anthropometric measures, and dietary Se intake was collected from each subject for analysis. Multivariable logistic regression was used to investigate the association between dietary Se and T2D through adjusted odds ratio (OR) and the corresponding 95% confidence interval (CI). The average nutritional Se intake was 52.43 μg/day, and the prevalence of T2D was 20.4% in the studied population. The OR for developing T2D was 1.66 (95% CI: 1.38, 1.99; for linear trend <0.005), comparing the highest to the lowest quintile of energy-adjusted Se intake in multivariate logistic regression analysis. The mediation analysis discovered that glucose metabolism (indicated by FBG and HbA1c) mediated this association. In conclusion, our research adds further support to the role of high dietary Se in the incidence of T2D. The results also suggested that this association was mediated by glucose metabolism. Sultan Mehmood Siddiqi, Changhao Sun, Xiaoyan Wu, Imranullah Shah, and Anam Mehmood Copyright © 2020 Sultan Mehmood Siddiqi et al. All rights reserved. Epidemiology and Survival Outcomes of Lung Cancer: A Population-Based Study Mon, 30 Dec 2019 02:05:01 +0000 https://www.hindawi.com/journals/bmri/2019/8148156/ Purpose. Lung cancer has been the top-ranking cause of cancer deaths in Taiwan for decades. Limited data were available in global cancer surveillance regarding lung cancer epidemiology in Taiwan, and previous reports are outdated. Patients and Methods. This population-based cohort study extracted data of patients with lung cancer from the Taiwan National Health Insurance database and determined the lung cancer incidence and prevalence during 2002–2014. Histological subtypes were retrieved from the Taiwan Cancer Registry database; survival rates were gathered from the National Death Registry. Average annual percentage changes (APCs) of prevalence, incidence, and overall survival were estimated by joinpoint regression analysis. Results. Age-standardized incidence of lung cancer increased from 45.04 per 100,000 person-years in 2002 to 49.86 per 100,000 person-years in 2014, with an average APC of 0.7 (95% CI = 0.3–1.1; 0.2 in males, 2.0 in females). Lung cancer was more prevalent in male patients, but this increase gradually slowed down. Socioeconomic analysis showed that lung cancer has higher prevalence in patients with higher income level and urban residency. Adenocarcinoma was the most abundant histological subtype in Taiwan (adenocarcinoma-to-squamous cell carcinoma ratio = 4.16 in 2014), with a 2.4-fold increase of incident cases during 2002–2014 (from 43.47% to 64.89% of all lung cancer cases). The 5-year survival rate of lung cancer patients in 2010 was 17.34% (12.60% in male, 25.40% in female), with an average APC of 9.3 (6.3 in male, 11.8 in female) during 2002–2010. Conclusion. Average APCs of prevalence and incidence of lung cancer were 3.1 and 0.7, respectively, during 2002–2014 in Taiwan. The number of female patients and number of patients with adenocarcinoma have increased the most, with incident cases doubling in these years. Facing this fatal malignancy, it is imperative to improve risk stratification, encourage early surveillance, and develop effective therapeutics for lung cancer patients in Taiwan. Huan-Tang Lin, Fu-Chao Liu, Ching-Yang Wu, Chang-Fu Kuo, Wen-Ching Lan, and Huang-Ping Yu Copyright © 2019 Huan-Tang Lin et al. All rights reserved. The Indirect ELISA Trypanosoma evansi in Equids: Optimisation and Application to a Serological Survey including Racing Horses, in Thailand Thu, 05 Dec 2019 06:05:00 +0000 https://www.hindawi.com/journals/bmri/2019/2964639/ Surra, caused by Trypanosoma evansi, is a widely distributed animal trypanosomosis; it affects both domestic and wild mammals with high economic impact. Clinical picture is moderate in bovines but severe in equids. Surra is also an important constraint for international animal trade and movements. Despite its impact, surra remains poorly diagnosed because of low sensitivity tests. To improve epidemiological knowledge of the disease and to secure international movement, efficient diagnosis tools are required. Here, we optimized and applied to equids the OIE-recommended indirect ELISA T. evansi that was validated in other species. Based on 96 positive and 1,382 negative horse reference samples from Thailand, a TG-ROC analysis was conducted to define the cutoff value. ELISA’s sensitivity and specificity were estimated at 97.5% and 100%, respectively, qualifying the test to provide a reliable immune status of equids. The test was then applied on 1,961 horse samples from 18 Thai Provinces; the only scarce positives suggested that horses do not constitute a reservoir of T. evansi in Thailand. All samples from racing horses were negative. Conversely, two outbreaks of surra reported to our laboratory, originating from a bovine reservoir, exhibited high morbidity and lethality rates in horses. Finally, posttreatment follow-ups of infected animals allowed us to provide outbreak management guidelines. Margot Camoin, Arthur Kocher, Piangjai Chalermwong, Sarawut Yangtarra, Ketsarin Kamyingkird, Sathaporn Jittapalapong, and Marc Desquesnes Copyright © 2019 Margot Camoin et al. All rights reserved. Genetic Variants in Group-Specific Component (GC) Gene Are Associated with Breast Cancer Risk among Chinese Women Fri, 15 Nov 2019 12:05:00 +0000 https://www.hindawi.com/journals/bmri/2019/3295781/ The group-specific component (GC) gene, one of the vitamin D pathway genes, seems to play an important role in cancer development. A population-based breast cancer study including 818 cases and 935 controls in a Chinese population was carried out to evaluate the potential associations of four polymorphisms (rs16847024, rs17467825, rs2298850, and rs3755967) in the GC gene with risk of breast cancer. We detected three SNPs with statistically significant effects on breast cancer development after adjusting for age, menopausal status, body mass index (BMI), family history of breast cancer, income, waist circumference, and education (rs17467825: adjusted OR = 0.80, 95% CI = 0.65–0.99; rs2298850: adjusted OR = 0.80, 95% CI = 0.65–0.98; rs3755967: adjusted OR = 0.80, 95% CI = 0.65–0.98). Stratified analysis found that when an individual had a waist circumference <80 cm, rs17467825, rs2298850, and rs3755967 could markedly reduce the risk of breast cancer. Significant interactions between polymorphisms of rs2298850 and rs3755967 and waist circumference were also observed for breast cancer risk. Combined analysis revealed a significant association among the allele numbers of protective effects with decreased breast cancer risk (). These results indicated that, in the GC gene, genetic mutations might be related to breast cancer susceptibility in Chinese women. Fuxing Chen, Zheng Zhu, Fränzel J. B. van Duijnhoven, Meihua Dong, Yun Qian, Hao Yu, Jie Yang, Lan Cui, Renqiang Han, Jian Su, Wencong Du, Jinyi Zhou, and Ming Wu Copyright © 2019 Fuxing Chen et al. All rights reserved. Gender and Age Differences and the Trend in the Incidence and Prevalence of Dementia and Alzheimer’s Disease in Taiwan: A 7-Year National Population-Based Study Mon, 11 Nov 2019 10:05:05 +0000 https://www.hindawi.com/journals/bmri/2019/5378540/ Background. Very few nationwide studies have focused on the variations in the incidence and prevalence of dementia and Alzheimer’s disease (AD) in Asian countries. This study aims to describe the gender and age differences in the incidence and prevalence of dementia and AD in Taiwan. Methods. The data on dementia and AD were acquired from the Taiwan National Health Insurance Research Database from 2004 to 2010. The sex and age-specific rates were standardized, and the differences of gender and age on dementia or AD were assessed using Poisson regression analysis. Results. Over seven years, the prevalence of dementia and AD significantly increased from 4.7 to 7.6 per hundred people (β = 0.0784, ) and 2.3 to 3.5 per hundred people (β = 0.0696, ), respectively. However, the incidence of both dementia and AD decreased but not significantly from 10.9 to 10.7 and 4.9 to 4.6 per thousand person-years, respectively. Noticeably, both incidence and prevalence increased with age and were higher in women than in men. Conclusions. The standardized incidence rates of dementia and AD are much lower than the data reported in some studies from Europe, the US, and Japan. Further studies are warranted to explore which factors are associated with the differences in the incidence of dementia and AD in Taiwan. Chih-Ching Liu, Chung-Yi Li, Yu Sun, and Susan C. Hu Copyright © 2019 Chih-Ching Liu et al. All rights reserved. Diabetes Prevention: Knowledge and Perception of Risk among Italian Population Thu, 31 Oct 2019 09:05:09 +0000 https://www.hindawi.com/journals/bmri/2019/2753131/ The risk perception for developing diabetes has not been well established. The aim of this study is to evaluate knowledge and perception of risk for developing diabetes. A cross-sectional study was conducted among a sample of 527 parents of children attending public schools in Naples (Italy). A self-administered anonymous questionnaire was used to collect the data. In total, 97.3% of participants have heard about diabetes, but only 16.7% knew the main risk and protective factors. This knowledge was statistically significantly higher in those who had close relatives with diabetes. Moreover, those who had middle school or lower and high school education, compared with those who had a college degree or higher, were less knowledgeable. The mean total value of the risk perception for developing diabetes was 1.9. Females those who had more than 40 years of age, those who needed of additional information, those who had a higher BMI, those who had close relatives with diabetes, those who had at least one chronic disease, and those who reported a lower value of self-rated health status were more likely to perceive a higher risk for developing diabetes. Moreover, this perception was statistically significantly lower among those who had a middle school or lower and high school education, compared with those who had a college degree or higher. The knowledge about diabetes needs to be improved, and the low risk perception for developing diabetes among the sample is worrying given the severity of the disease and the preventive measures available. Concetta P. Pelullo, Riccardo Rossiello, Roberto Nappi, Francesco Napolitano, and Gabriella Di Giuseppe Copyright © 2019 Concetta P. Pelullo et al. All rights reserved. Association between Eating Away from Home and Hyperuricemia: A Population-Based Nationwide Cross-Sectional Study in China Thu, 03 Oct 2019 12:05:00 +0000 https://www.hindawi.com/journals/bmri/2019/2792681/ Hyperuricemia (HU) is a risk factor for different kinds of chronic noncommunicable diseases, and eating away from home (EAFH) may play an important role in their development, which has been ignored greatly so far. This study aimed to investigate the association between EAFH and HU in different models. A cross-sectional study involving 8,322 participants of the China Health and Nutrition Survey (CHNS) was conducted. Logistic regression models were used to analyze the data. We found that participants who consumed more away-from-home food had a higher risk for HU, and the adjusted odds ratio (aOR) and 95% confidence interval (CI) (for each increment in grades of EAFH) were 1.11 (1.02, 1.20) in a multiadjusted model (adjusted for age, gender, province, net individual income, body mass index, smoking, leisure-time physical activities, energy intake, and sleep duration). As for stratified analyses, the aOR (95% CI) of EAFH was 1.12 (1.01, 1.24) for men and 1.06 (0.92, 1.21) for women. Similar results can be found in the middle-aged and obese population, with aOR (95% CI) of EAFH as 1.17 (1.05, 1.30) and 1.15 (1.03, 1.29), respectively. In conclusion, EAFH is positively associated with the prevalence of HU. Zifeng Liu, Xiaoting Su, Mianli Xiao, Peien Zhou, Jianwei Guo, Yixiang Huang, and Yiqiang Zhan Copyright © 2019 Zifeng Liu et al. All rights reserved. Comparison of Two Bayesian Methods in Evaluation of the Absence of the Gold Standard Diagnostic Tests Wed, 21 Aug 2019 09:05:00 +0000 https://www.hindawi.com/journals/bmri/2019/1374748/ Objective. The Bayesian model plays an important role in diagnostic test evaluation in the absence of the gold standard, which used the external prior distribution of a parameter combined with sample data to yield the posterior distribution of the test characteristics. However, the correlation between diagnostic tests has always been a problem that cannot be ignored in the Bayesian model evaluation. This study will discuss how different Bayesian model, correlation scenarios, and prior distribution affect the outcome. Methods. The data analyzed in this study was gathered during studies of patients presenting to the Nanjing Chest Hospital with suspected tuberculosis. The diagnostic character of T-SPOT.Tb and KD38 tuberculosis antibody test were evaluated in different Bayesian model, and discharge diagnosis as a gold standard was used to verify the model results in the end. Result. The comparison of four models under the conditional independence situation found that Bayesian probabilistic constraint model was consistent with the Conditional Covariance Bayesian model. The results were mainly affected by prior information. The sensitivity and specificity of the two tests in Conditional Covariance Bayesian model in prior constraint situation were considerably higher than the Bayesian probabilistic constraint model in prior constraint situation. The results of the four models under the conditional dependence situation were similar to the conditional independence situation; was also negative with no prior constraint situation in both model Bayesian probabilistic constraint model and Conditional Covariance Bayesian model. The Deviance Information Criterion of Bayesian probabilistic constraint model was close to model Conditional Covariance Bayesian model, but of Conditional Covariance Bayesian model in Prior constraint situation (=2.40) was higher than the Bayesian probabilistic constraint model in Prior constraint situation (=1.66). Conclusion. The result of Conditional Covariance Bayesian model in prior constraint with conditional independence situation was closest to the result of gold standard evaluation in our data. Both of the two Bayesian methods are the feasible way for the evaluation of diagnostic test in the absence of the gold standard diagnostic. Prior source, priority number, and conditional dependencies should be considered in the method selection, the accuracy of posterior estimation mainly depending on the prior distribution. Taishun Li and Pei Liu Copyright © 2019 Taishun Li and Pei Liu. All rights reserved. Association between Herpes Zoster and Osteoporosis: A Nested Case-Control Study Using a National Sample Cohort Tue, 30 Jul 2019 12:05:00 +0000 https://www.hindawi.com/journals/bmri/2019/4789679/ Objectives. Chronic inflammatory disease might affect osteoporosis; however, few studies have reported the association between herpes zoster and osteoporosis. The goal of this study was to estimate the association between herpes zoster and osteoporosis in Korean residents. Methods. The Korean National Health Insurance Service-National Sample Cohort, which includes individuals aged ≥ 50 years, was assessed from 2002 to 2013. In total, 68,492 osteoporosis participants were matched with 68,492 control participants at a ratio of 1:1 by age, sex, income, and region of residence. We assayed the prior histories of herpes zoster in the osteoporosis and control groups. The diagnoses of herpes zoster and osteoporosis were based on ICD-10 codes and claim codes. Crude and adjusted models of odds ratios (ORs) were explored using conditional logistic regression analyses, and the 95% confidence intervals (CIs) were computed. The participants were stratified according to age, sex, income, and region of residence. Subgroup analyses were performed to investigate the role of age and sex. Results. The rate of herpes zoster in the osteoporosis group (5.1% [3,487/68,492]) was higher than that in the control group (4.0% [2,738/68,492]). The adjusted OR of herpes zoster in the osteoporosis group was 1.17 (95% CI = 1.11-1.24). In the subgroup analyses, the adjusted OR was 1.34 (95% CI = 1.01-1.78) among males aged < 65 years, 1.20 (95% CI = 1.12-1.29) among females aged < 65 years, and 1.19 (95% CI = 1.04-1.36) among males aged ≥ 65 years. Conclusion. The ORs of herpes zoster were increased among the osteoporosis patients. This correlation was reliable in all subgroups by age and sex except group of women ≥ 65 years old. Chanyang Min, Woo Jin Bang, Dong Jun Oh, Songyong Sim, and Hyo Geun Choi Copyright © 2019 Chanyang Min et al. All rights reserved. Prevalence of Obesity and Associated Risk Factors and Cardiometabolic Comorbidities in Rural Northeast China Thu, 25 Jul 2019 12:05:01 +0000 https://www.hindawi.com/journals/bmri/2019/6509083/ Objective. To investigate the epidemiological features of obesity in rural Northeast China. Design. This was a 2017–2018 cross-sectional study of 10,891 participants aged ≥40 years that was designed to investigate the prevalence of obesity in rural areas of Liaoning Province. Demographic data, biochemical parameters, and physical examinations were completed by well-trained personnel. Logistic regression analyses were then carried out to investigate independent risk factors and associated cardiometabolic comorbidities of obesity. Results. The proportions of general obesity only, central obesity only, and combined obesity were 1.0%, 31.3%, and 17.4%, respectively. Overall, 49.8% of our subjects were obese. Female gender, being married, being separated/divorced/widowed, or eating more meat were significantly associated with obesity. Smoking, higher family income, or regular physical exercise were negatively associated with obesity. General obesity only was significantly correlated with hypertension, diabetes, and high triglycerides (OR = 2.79, OR = 2.79, and OR = 3.37, resp.). General obesity only was irrelevant to high total cholesterol, low high-density lipoprotein cholesterol, and high low-density lipoprotein cholesterol, although central obesity only, or combined obesity, was relevant to these factors. Prehypertension and prediabetes showed a positive association with different types of obesity. Conclusions. We identified a high prevalence of general and central obesity in rural Northeast China, with similar independent risk factors. Participants with combined obesity had the highest risk of cardiometabolic comorbidities, indicating that the combined use of both waist circumference and body mass index is useful in practice. Shiwen Yu, Liying Xing, Zhi Du, Yuanmeng Tian, Li Jing, Han Yan, Min Lin, Boqiang Zhang, Shuang Liu, Yaping Pan, and Chen Li Copyright © 2019 Shiwen Yu et al. All rights reserved. Maternal Body Mass Index and Risk of Congenital Heart Defects in Infants: A Dose-Response Meta-Analysis Sun, 07 Jul 2019 09:05:01 +0000 https://www.hindawi.com/journals/bmri/2019/1315796/ Objective. The exact shape of the dose-response relationship between maternal body mass index (BMI) and the risk of congenital heart defects (CHDs) in infants has not been clearly defined yet. This study aims to further clarify the relationship between maternal obesity and the risk of CHDs in infants by an overall and dose-response meta-analysis. Methods. PubMed, Embase, and Web of Science databases were searched to identify all related studies. The studies were limited to human cohort or case-control studies in English language. Random-effect models and dose-response meta-analysis were used to synthesize the results. Heterogeneity, subgroup analysis, sensitivity analysis, and publication bias were also assessed. Results. Nineteen studies with 2,416,546 participants were included in our meta-analysis. Compared with the mothers with normal weight, the pooled relative risks (RRs) of infants with CHDs were 1.08 (95% CI=1.03-1.13) in overweight and 1.23 (95% CI=1.17-1.29) in obese mothers. According to the findings from the linear meta-analysis, we observed an increased risk of infants with CHDs (RR=1.07, 95% CI=1.06-1.08) for each 5 kg/m2 increase in maternal BMI. A nonlinear relationship between maternal BMI and risk of infants with CHDs was also found (p=0.012). Conclusion. The results from our meta-analysis indicate that increased maternal BMI is related to increased risk of CHDs in infants. Xuezhen Liu, Guoyong Ding, Weili Yang, Xia Feng, Yuejin Li, Huamin Liu, Qianqian Zhang, Long Ji, and Dong Li Copyright © 2019 Xuezhen Liu et al. All rights reserved. Postpartum Weight Retention and Cardiometabolic Risk among Saudi Women: A Follow-Up Study of RAHMA Subcohort Mon, 01 Jul 2019 14:05:00 +0000 https://www.hindawi.com/journals/bmri/2019/2957429/ Objectives. This papers aims to investigate the association between different levels of postpartum weight retention (PPWR) and cardiometabolic risk among the Saudi women 12 months postpartum. Methods. This study is a follow-up of subgroup of cohort from Riyadh mother and baby multicenter cohort study. Clinical data were collected from participants 12 months after delivery and included current Body Mass Index (BMI), waist circumference, hip circumference, and blood pressure. In addition the following blood tests done were fasting blood glucose (FBG), glycosylated haemoglobin (HbA1c) levels, and lipids profile to assess the participants’ cardiometabolic risks. The participants were categorized into three groups based on the level of PPWR: weight retention < 3kg; weight retention 3 to < 7kg; and weight retention ≥ 7kg. Subsequently, the prevalence of cardiometabolic risk factors was compared in the three groups to assess the association between different levels of PPWR and cardiometabolic risk factors. Logistic regression was used to test the effect of PPWR in the development of metabolic syndrome and Adjusted Odds Ratio (AOR) was calculated. Results. A total of 115 women participated in this study. Around 35% of the study population retained ≥ 7 kg of weight. The prevalence of cardiometabolic risk factors, including metabolic syndrome (MetS), increases with the increase of PPWR (p<0.01). The prevalence of MetS is 13% with highest frequency in the group with the highest weight retention. The determinants developing MetS were prepregnancy weight; AOR (95% CI); 1.08 (1.02-1.14), P< 0.01, current BMI, AOR (95% CI); 1.30 (1.12-1.51), P< 0.01, and FBG during pregnancy, AOR (95% CI); and 4.82 (1.72-13.48), P < 0.01. Conclusion. Increased weight retention after delivery augments the rate of occurrence of cardiometabolic risk factors. Determinants of the development of MetS in postpartum Saudi women are increased prepregnancy weight, current BMI, and FBG during pregnancy. Hayfaa A. Wahabi, Amel A. Fayed, Shabana Tharkar, Samia A. Esmaeil, and Hanadi Bakhsh Copyright © 2019 Hayfaa A. Wahabi et al. All rights reserved. Multidrug-resistant Staphylococcus aureus Colonization in Healthy Adults Is more Common in Bhutanese Refugees in Nepal than Those Resettled in Ohio Mon, 01 Jul 2019 08:05:02 +0000 https://www.hindawi.com/journals/bmri/2019/5739247/ Although studies have shown that human migration is one of the risk factors for the spread of drug-resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA), surveillance studies examining MRSA among refugee populations in the US are lacking. This study aimed to assess the prevalence and molecular characteristics of S. aureus among Bhutanese refugees living in Nepal and resettled in Northeast Ohio (NEO). One hundred adult Bhutanese refugees from each geographic location were enrolled between August 2015 and January 2016. The participants were interviewed to collect demographic information and potential risk factors for carriage. Nasal and throat swabs were collected for bacterial isolation. All S. aureus isolates were characterized by spa typing and tested for the presence of Panton-Valentine leukocidin (PVL) and mecA genes; selected isolates were tested by multilocus sequence typing (MLST). The overall prevalence of S. aureus was 66.0% and 44.0% in NEO and Nepal, respectively. In Nepal, 5.8% (3/52) of isolates were MRSA and 1.1% (1/88) in NEO. Twenty-one isolates in NEO (23.9%) were multidrug-resistant S. aureus (MDRSA), while 23 (44.2%) in Nepal were MDRSA. In NEO, 41 spa types were detected from 88 S. aureus isolates. In Nepal, 32 spa types were detected from 52 S. aureus isolates. spa types t1818 and t345 were most common in NEO and Nepal, respectively. The overall prevalence of PVL-positive isolates among S. aureus in Nepal and NEO was 25.0% and 10.2%. ST5 was the most common sequence type in both locations. Bhutanese refugees living in Nepal and resettled in NEO had high prevalence of S. aureus and MDRSA. The findings suggest a potential need for CA-MRSA surveillance among the immigrant population in the U S and among people living in Nepal, and a potential need to devise appropriate public health measures to mitigate the risk imposed by community-associated strains of S. aureus and MRSA. Jhalka Kadariya, Dipendra Thapaliya, Sabana Bhatta, Ram Lal Mahatara, Sandra Bempah, Nabin Dhakal, and Tara C. Smith Copyright © 2019 Jhalka Kadariya et al. All rights reserved. House Mice as a Real Sanitary Threat of Human and Animal Leptospirosis: Proposal for Integrated Management Sun, 23 Jun 2019 10:05:01 +0000 https://www.hindawi.com/journals/bmri/2019/3794876/ Leptospirosis is a reemerging zoonosis and ranges in severity from benign to sometimes fatal. In cattle, infection may be responsible for abortion and infertility cases causing economic losses. Humans may be contaminated through direct contact with urine of infected animals or indirectly though interaction with urine-contaminated environment. Many wildlife species living close to cattle, especially commensal rodents may play a role in the transmission of leptospires. Because little is known on the epidemiology of nonmaintenance Leptospira serovars, appropriate management is still limited. On a French farm where human and cattle leptospirosis were detected, the transmission cycle was explored to propose appropriate mitigation measures. For that, commensal rodents present on the farm were trapped and their leptospires carriage was studied by molecular methods. Trapped mice were shown to carry two pathogenic Leptospira species (L. interrogans and L. kirschneri). Since these 2 serogroups were simultaneously detected in the trapped mice and in the cows of this farm, we suspected an initial Leptospira transmission from mice to cows requiring an effective management of mice on this farm. Because resistance to anticoagulant rodenticides due to Vkorc1 mutations has been largely described in rodents and first-generation anticoagulant rodenticides seemed to be inefficient in controlling mice on this farm, susceptibility of these mice to anticoagulants has been characterized by Vkorc1 sequencing. 50% of the trapped mice carried mutations in the Vkorc1 gene leading to severe resistance to first-generation anticoagulants. The management of such mice that are a real sanitary threat can be achieved only by using the most toxic second-generation anticoagulants or nonanticoagulant solutions. Aurélie Marquez, Tristan Ulivieri, Etienne Benoit, Angeli Kodjo, and Virginie Lattard Copyright © 2019 Aurélie Marquez et al. All rights reserved. High Bone Mineral Density of the Lumbar Spine Is Positively Associated with Breast Cancer Thu, 23 May 2019 08:05:01 +0000 https://www.hindawi.com/journals/bmri/2019/8010356/ Objective. The objective of this study was to verify possible associations between bone mineral density (BMD) and breast cancer in recently diagnosed women in the Brazilian Mid-west region, considering the menopausal status of patients. Methods. A case-control study was conducted with 142 cases of breast cancer and 234 controls matched by for age, body mass index (BMI), and menopausal status (pre- and postmenopause), performed in a university hospital in the Brazilian Mid-west. Lumbar spine (L1–L4), femoral neck, and total femur BMD were measured by the dual-energy X-ray absorptiometry (DXA) method. For association, a logistic regression analysis was used. Results. Women in the highest lumbar spine BMD quartile presented had a higher chance of developing breast cancer (OR = 2.31; 1.02–5.25; p = 0.045), after adjusting for the confounding variables. Nonetheless, there were no statistically significant differences in the association between pre- and postmenopause in that quartile and breast cancer. Conclusions. High lumbar spine BMD was positively associated with breast cancer in the total sample. In evaluating the BMD of the femoral neck and total femur, such an association was not observed. Larissa Vaz Gonçalves, Karine Anusca Martins, Jordana Carolina Marques Godinho-Mota, Raquel Machado Schincaglia, Ana Luisa Lima Sousa, and Ruffo Freitas-Junior Copyright © 2019 Larissa Vaz Gonçalves et al. All rights reserved. Single Nucleotide Polymorphisms of CBX4 and CBX7 Decrease the Risk of Hepatocellular Carcinoma Thu, 09 May 2019 07:05:05 +0000 https://www.hindawi.com/journals/bmri/2019/6436825/ Background. The chromobox (CBX) proteins CBX2, CBX4, CBX6, CBX7, and CBX8, also known as Polycomb (Pc) proteins, are canonical components of the Polycomb repressive complex 1 (PRC1). Abundant evidence indicates that abnormal expression of Pc proteins is associated with a variety of tumors, but their role in the pathogenesis of hepatocellular carcinoma (HCC) has not been fully elucidated. In the present study, we performed a case-control study to investigate the relationship between single nucleotide polymorphisms (SNPs) of CBX genes and HCC. Methods. Nine SNPs on CBX genes (rs7217395, rs2036316 of CBX2; rs3764374, rs1285251, rs2289728 of CBX4; rs7292074 of CBX6; and rs710190, rs139394, rs5750753 of CBX7) were screened and genotyped using MassARRAY technology in 334 HCC cases and 321 controls. The association between SNPs and their corresponding gene expressions was analyzed through bioinformatics methods using the Ensembl database and Blood eQTL browser online tools. Results. The results indicated that rs2289728 (G>A) of CBX4 (P = 0.03, OR = 0.56, 95% CI: 0.33-0.94) and rs139394 (C>A) of CBX7 (P = 0.02, OR = 0.55, 95% CI: 0.33-0.90) decreased the risk of HCC. Interaction between rs2036316 and HBsAg increased the risk of HCC (P = 0.02, OR = 6.88, 95% CI: 5.20-9.11), whereas SNP-SNP interaction between rs710190 and rs139394 reduced the risk of HCC (P = 0.03, OR = 0.33, 95% CI: 0.12-0.91). Gene expression analyses showed that the rs2289728 A allele and the rs139394 A allele significantly reduced CBX4 and CBX7 expression, respectively. Conclusion. Our findings suggest that CBX4 rs2289728 and CBX7 rs139394 are protective SNPs against HCC. The two SNPs may reduce the risk of HCC while suppressing the expression of CBX4 and CBX7. Chao Tan, Chunhua Bei, Xiaonian Zhu, Ying Zhang, Linyuan Qin, and Shengkui Tan Copyright © 2019 Chao Tan et al. All rights reserved. Prevalence of Metabolic Syndrome and Its Components in Bamboutos Division’s Adults, West Region of Cameroon Tue, 30 Apr 2019 12:05:01 +0000 https://www.hindawi.com/journals/bmri/2019/9676984/ The prevalence of metabolic syndrome (MetS) and its associated risks remain unappreciated in Bamboutos Division, west region of Cameroon. This study aimed to evaluate the prevalence of MetS, its individual components, and associated risk factors among Bamboutos Division’s adults population using a Joint Interim Statement of the International Diabetes Federation (IDF) Task Force on Epidemiology and Prevention definitions parameters. A cross-sectional study was conducted from May 2016 to May 2018 in Mbouda ADLUCEM Hospital and Mbouda District Hospital, two reference hospitals in Bamboutos Division, west region of Cameroon. Interview, physical and clinical examinations, and lipid and fasting blood glucose measurements were conducted for 604 adults. The definition of MetS proposed by IDF was used. The prevalence of MetS was 32.45% with highly significant female predominance (46.11% for females and 14.01 % for males). In the entire participants, the most common abnormalities were low-HDL (82.78%) and hypertriglyceridemia (53.97%) [p<0.001]. Participants with obesity (OR: 16.34; 95% CI: 9.21-28.96), overweight (OR: 7.45; 95% CI: 4.17-13.30), and highest hs-CRP (hs-CRP >11 mg/l) had a higher risk of developing MetS. The most common MetS component was abdominal obesity (OR: 353.13; 95% CI: 136.16-915.81). MetS is prevalent among Bamboutos Division’s adults in west region of Cameroon and abdominal obesity is the most common MetS component. This study highlights the need for evidence-based prevention, diagnosis, and management of MetS and its associated factors among Bamboutos Division’s adults in Cameroon. Wiliane J. T. Marbou and Victor Kuete Copyright © 2019 Wiliane J. T. Marbou and Victor Kuete. All rights reserved. Occurrence of Selected Zoonotic Fecal Pathogens and First Molecular Identification of Hafnia paralvei in Wild Taihangshan Macaques (Macaca mulatta tcheliensis) in China Wed, 03 Apr 2019 09:05:03 +0000 https://www.hindawi.com/journals/bmri/2019/2494913/ Rhesus macaques (Macaca mulatta) are hosts to a range of zoonotic and potentially zoonotic pathogens. The present study firstly provides a broader investigation of the presence and prevalence of zoonotic fecal pathogens in wild Taihangshan macaques, a subspecies of rhesus macaque in China. A total of 458 fecal samples were collected between September 2015 and November 2016. Fourteen genera of intestinal parasites (four genera of protozoans and ten genera of helminths) and twelve genera of bacteria were tested for using PCR amplification. The overall samples prevalence of parasitic infection was 98.25%. Entamoeba spp. (89.96%), Balantidium coli (70.09%), and Isospora spp. (28.38%) were the most prevalent protozoa, whereas the predominant prevalent helminths were Trichuris sp. (93.23%), Strongyloides spp. (73.36%), and Oesophagostomum sp. (31.66%). Ten genera of intestinal bacteria were detected in samples of rhesus macaques, including Shigella (31.66%), Escherichia coli (29.91%), Klebsiella pneumoniae (28.38%), Leptospira (26.64%), Campylobacter jejuni (18.34%), Salmonella (13.32%), etc. Eight samples (1.75%) were tested Hafnia-positive based on sequences analysis of 16S rRNA and ampC gene. This is the first molecular characterization of Hafnia infection in NHPs. Our cross-sectional prevalence study provides important information for monitoring the potential transmission of zoonotic infections from wild rhesus macaques. Qingxun Zhang, Shuyi Han, Kongshang Liu, Jing Luo, Jiqi Lu, and Hongxuan He Copyright © 2019 Qingxun Zhang et al. All rights reserved. Combined Effect of Secondhand Smoking and Alcohol Drinking on Risk of Persistent Human Papillomavirus Infection Thu, 21 Mar 2019 12:05:00 +0000 https://www.hindawi.com/journals/bmri/2019/5829676/ Tobacco smoking is established as a cofactor of human papillomavirus (HPV) for cervical cancer risk. However, the role of secondhand smoking in cervical carcinogenesis is controversial. We aimed to assess the association between secondhand smoking and high risk- (HR-) HPV persistence, a pivotal event in development of cervical cancer. In total, 9,846 women who underwent health-screening examinations from 2002 to 2011 at the National Cancer Center, Korea, were included. Secondhand smoking was defined as being exposed to secondhand smoke at home or in the workplace. Multivariate logistic regression analysis was used to estimate the odds ratios (OR) and 95% confidence intervals (CIs) for risks of HR-HPV infection at baseline (N, 9,846, negative vs. positive), 1-year persistence (n, 1,237, 1-year negative vs. 1-year persistence), and 2-year persistence (n, 481, 2-year negative vs. 2-year persistence). Active smoking, secondhand smoking, and secondhand smoking in nonactive smokers had no association with these risks. Among alcohol drinkers, secondhand smoking in nonactive smokers had higher risks of HR-HPV infection at baseline (OR = 1.25, 95% CI = 1.05–1.48, p for multiplicative interaction = 0.003), 1-year persistence (1.75, 1.14–2.68, 0.004), and 2-year persistence (2.96, 1.42–6.15, 0.006), when compared to HR-HPV negative, 1-year negative, and 2-year negative categories, respectively. However, among nonalcohol drinkers, there was no association between smoking or secondhand smoking status and these risks. These findings suggest that women exposed to secondhand smoking at home or in the workplace might be at high risk of HR-HPV persistence when it is combined with alcohol drinking, even though neither active smoking nor secondhand smoking independently affects the risk. Sang-Soo Seo, Hea Young Oh, Mi Kyung Kim, Dong Ock Lee, Youn Kyung Chung, Joo-Young Kim, and Chan Wha Lee Copyright © 2019 Sang-Soo Seo et al. All rights reserved. Increased Risk of Coronary Artery Disease in People with a Previous Diagnosis of Carpal Tunnel Syndrome: A Nationwide Retrospective Population-Based Case-Control Study Sun, 03 Mar 2019 13:30:00 +0000 https://www.hindawi.com/journals/bmri/2019/3171925/ Background. Existing literature suggests that an association exists between coronary artery disease (CAD) and carpal tunnel syndrome (CTS), but few researchers have explored whether CTS is a risk for CAD. Materials and Methods. This large case-control study explored the association between CTS and CAD, using health insurance claims data from Taiwan’s National Health Insurance Research Database (NHIRD) between January 2000 and December 2013. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes identified 70,622 patients with CAD (ICD-9-CM codes 410–414; cases); 70,622 patients without CAD were frequency-matched by age, sex, and index year of CAD and served as controls. Results. The likelihood of a previous diagnosis of CTS (ICD-9-CM codes 354.0, 354.1) was significantly higher in the CAD group than in the comparison control group (crude OR: 1.75, 95% CI 1.63-1.89; p<0.0001; adjusted OR: 1.46, 95% CI 1.34-1.58; p<0.0001). Conclusion. A significant positive correlation was observed between CAD and a previous diagnosis of CTS. Yi-Chuan Chang, Jen-Huai Chiang, Ing-Shiow Lay, and Yu-Chen Lee Copyright © 2019 Yi-Chuan Chang et al. All rights reserved. Epidemiology of Maxillofacial Fractures at a Teaching Hospital in Malaysia: A Retrospective Study Wed, 13 Feb 2019 10:05:00 +0000 https://www.hindawi.com/journals/bmri/2019/9024763/ Background/Aim. Epidemiology of maxillofacial fractures (MFF) varies between populations. This study investigated the epidemiology of MFF treated at the Oral and Maxillofacial Surgery (OMFS) Unit, Hospital Universiti Sains Malaysia (USM). Methods. A retrospective review of 473 medical records of patients with MFF treated from June 2013 to December 2015 was conducted. Information on demographic characteristics of patients, aetiology of injury, types of MFF, and treatment was obtained. Descriptive analysis, Pearson's chi-squared test, and multiple logistic regression analysis were conducted. The level of significance was set at 0.05. Results. Most patients treated for MFF were males (82.2%), aged 30 and below (63.1%), and from Malay ethnic (97.4%). Road traffic accident was the most common cause of MFF (83.1%), with motorcycle accident accounting for most injuries (73.6%). Orbital wall fracture was the most frequent MFF type (51.2%). About half of MFF patients (51.4%) were treated conservatively. Patients aged more than 20 years old were at higher odds of sustaining orbital wall fracture (AOR= 1.76; 95% CI: 1.214-2.558; P= 0.003) but were at lower odds of sustaining mandibular fracture (AOR= 0.47; 95% CI: 0.315-0.695; P= 0.001) than patients who are 20 years old and younger. Helmet use among motorcyclists was significantly associated with the nasal, orbital wall, and maxillary sinus wall fractures (P= 0.006, 0.010, and 0.004, respectively). Conclusion. Motorcycle accident was the most common cause of MFF in Kelantan, Malaysia. Ages of patient and helmet use were associated with the type of MFF sustained. This study provides important information to facilitate the planning of MFF prevention strategies among motorcyclists and emphasizes the importance of using a helmet when riding a motorcycle. Maher M. Abosadegh, Norkhafizah Saddki, Badr Al-Tayar, and Shaifulizan Ab. Rahman Copyright © 2019 Maher M. Abosadegh et al. All rights reserved. Kisspeptin Protein in Seminal Plasma Is Positively Associated with Semen Quality: Results from the MARHCS Study in Chongqing, China Wed, 09 Jan 2019 00:05:00 +0000 https://www.hindawi.com/journals/bmri/2019/5129263/ Objectives. To study the associations between kisspeptin levels in seminal plasma and blood plasma and semen quality. Materials and Methods. We conducted a male reproductive health survey in June 2014. A total of 666 volunteers were recruited from colleges in Chongqing, China. All volunteers completed a questionnaire including information on domestic characteristics and some potential confounders. We tested the kisspeptin levels in both blood and seminal plasma. Total seminal kisspeptin was calculated as the concentration of kisspeptin in seminal plasma multiplied by semen volume. Semen samples were tested according to the 2010 World Health Organization’s (WHO) guidelines. Spearman correlation and multivariate linear regression were used to explore the association between kisspeptin concentrations in seminal plasma and blood plasma and semen quality. Potential confounders that were adjusted for included age, abstinence time, body mass index (BMI), grade, and smoking. Results. The median of kisspeptin levels in seminal plasma was 60,000 times higher than kisspeptin in blood plasma (28.0 × 106 pg/ml versus 448.9 pg/ml). Each interquartile range (IQR) of kisspeptin in seminal plasma was associated with a 4.6% (95% confidence interval [CI]: 1.6%–7.6%) increase in sperm concentration. Each IQR of total kisspeptin was associated with a 7.7% (95% CI: 4.4%–11.0%) increase in total sperm number and a 7.8% (95% CI: 4.0%–11.7%) increase in total motile sperm count. Kisspeptin levels were further classified into quartiles and Q1 was set as the reference level. Subjects in the high total kisspeptin group had 57.5% (95% CI: 33.2%–86.2%) higher total sperm number than the reference group. Conclusion. The positive association between kisspeptin levels in seminal plasma and semen quality supported an important role for the KISS1/GPR54 system in male reproductive health. Kisspeptin may be a potential marker of male reproductive health and an alternative strategy for treating infertility. Peng Zou, Xiaogang Wang, Qing Chen, Huan Yang, Niya Zhou, Lei Sun, Hongqiang Chen, Jinyi Liu, Lin Ao, Zhihong Cui, and Jia Cao Copyright © 2019 Peng Zou et al. All rights reserved. Toxoplasma gondii Infection in Dustmen in Northeastern China: A Case-Control Seroprevalence Study Wed, 19 Dec 2018 08:26:28 +0000 https://www.hindawi.com/journals/bmri/2018/3207675/ Background. Toxoplasmosis is caused by an intracellular parasite Toxoplasma gondii, which can infect many hosts including humans. Methods. In order to estimate whether dustmen are more susceptible to T. gondii, a case-control study was conducted containing 332 dustmen from Jilin and Heilongjiang in Northeastern China, as well as 332 general populations from the same regions as control subjects. Serum samples were tested IgG and IgM antibodies to T. gondii using the enzyme-linked immunosorbent assay (ELISA). Results. The overall anti-T. gondii IgG was 15.06% (50/332) in dustmen compared with 9.64% (32/332) in the controls (P = 0.0337). Also, 5 (1.51%) dustmen had anti-T. gondii IgM antibodies compared with 2 (0.60%) control individuals (P = 0.2543). A significant association was only found between dustmen and level of T. gondii IgG in comparison with the control subjects. Seroprevalence of T. gondii IgG antibodies in male dustmen was significant higher than male control subjects (P = 0.0399). Dustmen from Jilin had the significant higher T. gondii IgG rate (P = 0.0143), in comparison with the control subjects from Jilin. Moreover, dustmen raising cat at home had the significant higher T. gondii IgG rate (P = 0.0097), in comparison with the control subjects. Risk factor analysis suggested that raising cat at home and not having habits of washing hand before eating were mainly related to the T. gondii infection in dustmen. Conclusions. This is the first record of seroprevalence of T. gondii infection in dustmen in Jilin and Heilongjiang provinces in Northeastern China. These findings also suggest that the government departments should pay close attention to the toxoplasmosis in dustmen in Northeastern China. Ruo-Lan Jiang, Quan Zhao, Jing Jiang, Xue-Long Chen, Xiao-Xuan Zhang, and Xiang Wu Copyright © 2018 Ruo-Lan Jiang et al. All rights reserved. Single Nucleotide Polymorphisms in miR-122 Are Associated with the Risk of Hepatocellular Carcinoma in a Southern Chinese Population Wed, 19 Dec 2018 07:08:12 +0000 https://www.hindawi.com/journals/bmri/2018/1540201/ Single nucleotide polymorphisms (SNPs) in microRNA may affect its expression and regulation of target genes, which may consequently alter individual susceptibility to cancer. In this study we aimed to investigate associations between miR-122 polymorphisms and hepatocellular carcinoma (HCC) in a southern Chinese population. Three selected SNPs in miR-122 (rs9966765, rs1135519, and rs17669) were genotyped in 1050 HCC patients and 1079 cancer-free controls using Sequenom MassARRAY platform and the associations of the three SNPs and HCC risk were evaluated. We found that individuals with the rs1135519 CC genotypes had a significant increased risk of HCC than those with TT genotypes (adjusted OR=2.71, 95% CI=1.15-6.36, and P=0.022), while the rs9966765 CC genotypes showed a borderline significant association with increased risk of HCC when compared with the GG genotypes (adjusted OR=2.38, 95% CI=0.99-5.75, and P=0.052). There was also a significant increased risk of HCC when combining risk genotypes of these loci, i.e., rs1135519 CC and rs9966765 CC. Compared with the low-risk group (0 risk genotype), the high risk group (1-2 risk genotypes) had significantly increased risk of HCC (OR=1.61, 95% CI=1.05-2.44, and P=0.028). Further genotype-expression analysis revealed that cases carrying the CC genotype of rs1135519 had lower levels of miR-122 expression than those with the TT genotype. Our results suggest that SNP of rs1135519 modulates miR-122 expression and contributes to the genetic susceptibility of HCC, either independently or together with rs9966765 in miR-122. Further well-designed studies with lager sample sizes are needed to confirm our findings. Chunhua Bei, Shun Liu, Xiangyuan Yu, Moqin Qiu, Bo Tang, Weijia Liao, Songqing He, and Hongping Yu Copyright © 2018 Chunhua Bei et al. All rights reserved. Complex Clonal Diversity of Staphylococcus aureus Nasal Colonization among Community Personnel, Healthcare Workers, and Clinical Students in the Eastern Province, Saudi Arabia Tue, 18 Dec 2018 00:00:00 +0000 https://www.hindawi.com/journals/bmri/2018/4208762/ Here, 210 healthy participants including community personnel (70), clinical students (68), and healthcare workers (HCWs) (72) from the eastern region of Saudi Arabia were studied. Sixty-three Staphylococcus aureus isolates were obtained from the nares of 37% of the community personnel and 26% of the clinical students and HCWs. Methicillin-resistant S. aureus (MRSA) was found in 16% (10 isolates) of the 63 isolates; six were from HCWs. Molecular characterization revealed high clonal diversity among the isolates, with 19 different spa types, 12 clonal complexes (CCs), and seven sequence types (STs) detected. The most common strain type was USA900, CC15, and t084, seen in 11 methicillin-susceptible S. aureus (MSSA) isolates. Moreover, three novel spa types in six isolates and one novel ST in two isolates were identified, most from HCWs. Interestingly, 29 isolates were mecA positive by PCR, whereas only 10 isolates were MRSA by disk diffusion (cefoxitin resistant). Of the 19 MSSA mecA-positive isolates, 16 were PBP2a negative, leaving three unique isolates from HCWs that were mecA and PBP2a positive yet cefoxitin susceptible. Our findings highlight the importance of phenotypically and genotypically characterizing S. aureus strains isolated from healthy communities to monitor the risk of possible cross-transmission to hospitalized patients. The identified strains showed a clonal lineage relationship with previously reported S. aureus and MRSA strains acquired from hospital settings. Taghrid S. El-Mahdy, Mohamed H. Al-Agamy, Mohamed Emara, Assem Barakat, and Richard V. Goering Copyright © 2018 Taghrid S. El-Mahdy et al. All rights reserved. Chronic Periodontitis Case Definitions and Confounders in Periodontal Research: A Systematic Assessment Wed, 28 Nov 2018 07:15:51 +0000 https://www.hindawi.com/journals/bmri/2018/4578782/ Case definitions and criteria of periodontal diseases are not yet consistent worldwide. This can affect the accuracy of any comparison made between two studies. This study determines which are the most common chronic periodontitis case definitions as well as confounding variables that have been reported worldwide in periodontal literature. A systematic assessment on periodontal disease classification and confounders was conducted using all publications in MEDLINE, EMBASE, SCOPUS, and Google Scholar between 1965 and October 2017. Screening of eligible studies and data extraction were conducted in duplicate and independently by two reviewers. The search protocol produced 4,218 articles. Out of these, 492 potentially relevant articles were selected for review. Only 351 studies fulfilled the selection criteria. Combination of probing depth and clinical attachment loss was the most common chronic periodontitis case definitions used (121, studies, 34.5%). CPI/CPITN was the most common classification used. Age was the most common confounder studied in periodontal research (303 studies, 86.3%), followed by gender (268 studies, 76.4%) and race (138 studies, 39.3%). Albumin and creatinine were the least common variables studied (1 or 2 studies each). Different case definitions affect the prevalence and treatment consequences of periodontitis. We need to standardize periodontitis case definitions worldwide to avoid difficulties in case diagnosis and prognosis. Further studies need to be done to assess the association between periodontitis and several potential confounders. Zuhair S. Natto, Randa H. Abu Ahmad, Lina T. Alsharif, Hanan F. Alrowithi, Duaa A. Alsini, Hetaf A. Salih, and Nabil F. Bissada Copyright © 2018 Zuhair S. Natto et al. All rights reserved. Associations between Aquaglyceroporin Gene Polymorphisms and Risk of Type 2 Diabetes Mellitus Tue, 27 Nov 2018 06:51:55 +0000 https://www.hindawi.com/journals/bmri/2018/8167538/ Objectives. AQP7 and AQP9 represent glycerol channel in adipose tissue and liver and have been associated with metabolic diseases. We aimed to investigate the associations between genetic variants in AQP7 and AQP9 genes and the risk of type 2 diabetes (T2DM) in Chinese population. Methods. Blood samples were drawn from 400 T2DM patients and 400 age- and gender-matched controls. Genomic DNA was extracted by proteinase K digestion and phenol–chloroform extraction. Genotyping of 5 single nucleotide polymorphisms (SNPs) in AQP7 (rs2989924, rs3758269, and rs62542743) and AQP9 (rs57139208, rs16939881) was performed by the polymerase chain reaction assay with TaqMan probes. Results. The subjects with rs2989924 GA+AA genotypes had 1.47-fold increased risk of T2DM (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.06-2.04), compared to those with GG genotype, and this association remained significant after adjustment for covariates (OR 1.66, 95% CI 1.07-2.57). When compared with rs3758269 CC genotype, the subjects with CT+TT genotypes had 45% decreased T2DM risk after multivariate adjustment (OR 0.55, 95% CI 0.35-0.85). The associations were evident in elder and overweight subjects and those with central obesity. No association was observed between AQP9 SNPs and T2DM risk. Conclusions. AQP7 SNP rs2989924 and rs3758269 were associated with T2DM risk in Chinese Han population. Yijun Wang, Gang Chen, Qingyun Tu, Junxia Wu, Yu Qin, Zheng Zhu, Yi Shen, Li Yan, Aohan Han, Quanyong Xiang, and Chun Wang Copyright © 2018 Yijun Wang et al. All rights reserved. Association of Impaired Vascular Endothelial Function with Increased Cardiovascular Risk in Asymptomatic Adults Tue, 02 Oct 2018 00:00:00 +0000 https://www.hindawi.com/journals/bmri/2018/3104945/ Impaired vascular endothelial function has attracted attention as a prognostic indicator of cardiovascular prevention. The association between impaired endothelial function and cardiovascular risk in the asymptomatic population, however, has been poorly explored. We evaluated the association of brachial artery flow-mediated dilation (FMD) with Framingham-estimated 10-year cardiovascular disease (CVD) risk in subjects free of CVD, especially by cardiovascular risk profiles. In total, 680 adults aged 30-74 years were enrolled from Rongan and Rongshui of Liuzhou, Guangxi, China, through a cross-sectional study in 2015. In the full-adjusted model, the odds ratio for the estimated 10-year CVD risk comparing the low FMD (<6%) with the high FMD (≥10%) was 2.81 (95% confidence interval [CI]: 1.21, 6.53; P for trend = 0.03). In subgroup analyses, inverse associations between FMD and the estimated 10-year CVD risk were found in participants with specific characteristics. The adjusted odds ratios, comparing the 25th and the 75th percentiles of FMD, were 2.77 (95% CI: 1.54, 5.00) for aged ≥60 years, 1.77 (95% CI: 1.16, 2.70) for female, 1.59 (95% CI: 1.08, 2.35) for nonsmokers, 1.74 (95% CI: 1.02, 2.97) for hypertension, 1.59 (95% CI: 1.04, 2.44) for normal glycaemia, 2.03 (95% CI: 1.19, 3.48) for C-reactive protein ≥10 mg/L, and 1.85 (95% CI: 1.12, 3.06) for eGFR <106 mL/minute per 1.73 m2. Therefore, impaired endothelial function is associated with increased CVD risk in asymptomatic adults. This inverse association is more likely to exist in subjects with higher cardiovascular risk. Qiuan Zhong, Qingjiao Nong, Baoyu Mao, Xue Pan, and Liuren Meng Copyright © 2018 Qiuan Zhong et al. All rights reserved. Incidence, Risk Factors, and Epidemiology of Cystic Echinococcosis: A Complex Socioecological Emerging Infectious Disease in Khyber Pakhtunkhwa, Province of Pakistan Wed, 12 Sep 2018 00:00:00 +0000 https://www.hindawi.com/journals/bmri/2018/5042430/ Cystic echinococcosis is a serious zoonotic disease caused by Echinococcus granulosus species complex. The current study is the first attempt to determine the level of infection in domestic livestock and to explore the CE-related knowledge and awareness among livestock farmers in different districts of Khyber Pakhtunkhwa, province of Pakistan. A total of 1297 animals were examined for hydatid cysts including 538 cows, 428 buffaloes, 208 sheep, and 123 goats, at different slaughter houses in different districts of Khyber Pakhtunkhwa in 2 years from September 2015 to September 2017. For epidemiological investigations, prevalence in association with various factors (climate, age, and gender), organ specificity, types of cysts (fertile, sterile, or calcified), and viability of cysts parameters was recorded. Basing on the results obtained, areas with high prevalence were selected for further follow-ups and administration of questionnaires to the farmers and dog owners, to provide baseline data about this parasitic disease and to identify potential areas of emergence with correspondence animal and of public health significance. The finding of this study revealed the presence of CE in livestock of KP, Pakistan. The prevalence of hydatid cysts was the highest in buffaloes (15.88%) followed by cows (15.79%), sheep (15.38%), and goats (3.25%). Our investigation revealed close relationship between prevalence and animal age and gender in different months of the year. These findings also showed the highest prevalence of hydatid cysts in liver (63.49%), followed by lungs (23.80%) and mesentery (2.64%). Fertile and viable cysts were observed in all animal species except goats. The highest percentage of fertile and viable cysts was reported from the liver and lungs of sheep. For evaluation of risk factors, a total of 384 respondents were investigated. The results of current study revealed that 97.9% of farmers are not familiar with CE and transmission of this infection from dogs to human and livestock. The present study shows that CE will continue to be of medical and veterinary importance in Pakistan. Sumbal Haleem, Sadaf Niaz, Naveeda Akhtar Qureshi, Riaz Ullah, Mansour S. Alsaid, Ali S. Alqahtani, and Abdelaaty A. Shahat Copyright © 2018 Sumbal Haleem et al. All rights reserved. Epidemiology of Traffic Fatalities among Motorcycle Users in East Azerbaijan, Iran Sun, 19 Aug 2018 07:03:39 +0000 https://www.hindawi.com/journals/bmri/2018/6971904/ Background. The aim of this study was to determine some epidemiological aspects of motorcycle user traffic fatalities including the crash mechanisms and injury patterns in East Azerbaijan, Iran (2006-2016). Methods. A total of 1840 motorcycle user mortal cases registered in East Azerbaijan forensic medicine database, in Iran, were analyzed over the time period between March 2006 and March 2016. The distribution and associations of both victim- and crash-related variables such as crash mechanism, types of involved vehicles, types of injuries, and demographic characteristics were investigated. Data were analyzed by Stata v.13 statistical software package. Results. Of the 9435 RTI deaths, 1840 (19.5%) were motorcycle users of whom 96.5% were male (mean age of 32.3 ± 18.5 years). The majority of accident mechanisms were motorcycle-vehicle crashes (77.8%), followed by rollover (11.8%). Cars were the leading counterpart crash vehicle comprising about 34.8% of the motorcycle user mortalities. Inner city traffic injuries were the reason for 744 (40.7%) of the motorcycle user mortalities. Head trauma was the main cause of death. About 82% of the victims were motorcycle riders and the remainder were pillion passengers. A decreasing trend of fatal traffic accidents was observed over the study period for both the motorcycle user fatalities and other traffic injuries. The percentage of motorcycle mortalities over all traffic mortalities had a decreasing trend over the past nine years from March 2007 to March 2016 reaching a figure as low as 15.2% through the last year of study. Conclusions. Motorcycle traffic fatalities, although having a decreasing trend during the last decade with a better slope than most other traffic injuries, remain to be a major public health in north-west of Iran. There is a need for effective interventional programs to reduce the burden of motorcycle fatalities. Homayoun Sadeghi-Bazargani, Bahram Samadirad, and Hojjat Hosseinpour-Feizi Copyright © 2018 Homayoun Sadeghi-Bazargani et al. All rights reserved. Incidence of Intestinal Infectious Diseases due to Protozoa and Bacteria in Mexico: Analysis of National Surveillance Records from 2003 to 2012 Sun, 15 Jul 2018 00:00:00 +0000 https://www.hindawi.com/journals/bmri/2018/2893012/ Background. According to national epidemiological surveillance records, in Mexico six intestinal infectious diseases (IID) are among the top infectious communicable diseases. However, their incidence, relative importance, and spatial patterns have not been studied in detail. Aims. We examine the epidemiology of IID due to bacteria and protozoa to identify which diseases are most important at two spatial scales, what is their integrated importance locally, and how their incidence correlates with Human Development Index (HDI). Methods. We retrieved yearly number of new cases of eight IID from the national epidemiological morbidity report from 2003 to 2012 at the national level, by state, and to assess such information at a higher spatial resolution we included the municipalities for Mexico City. However, no comparisons were made to other municipalities due to unavailability of data. We compared incidence, obtained the disease-specific relative importance, and inspected spatial patterns for the integrated incidence. Finally, we tested whether HDI is correlated with incidence. Results. We found that, except for two diseases, the relative importance of the other six IID contrasted not only between the national level and Mexico City, but also among states and municipalities in Mexico City. Besides, at both scales the distribution of the incidence showed disease-specific spatial patterns. Finally, there was a lack of consistent correlation between HDI and individual IID at both scales. Conclusion. Our results emphasize the need for local disease-focused selective models for control and prevention of IID. The maps displaying our analyses of epidemiological similarities may be used in orienting such effort. Daniel Diaz, Aldo M. Vazquez-Polanco, Jesus Argueta-Donohue, Christopher R. Stephens, Francisco Jimenez-Trejo, Santa E. Ceballos-Liceaga, and Natalia Mantilla-Beniers Copyright © 2018 Daniel Diaz et al. All rights reserved. Functional Polymorphisms in IRAKs Are Related to Hepatocellular Carcinoma Risk in Chinese Population Mon, 09 Jul 2018 00:00:00 +0000 https://www.hindawi.com/journals/bmri/2018/1252849/ Background. Interleukin 1 receptor associated kinases (IRAKs) play a central role in TLR signaling pathway. Scarce literature has investigated the association of potential functional genetic variants of IRAKs with Hepatitis B Virus- (HBV-) related hepatocellular carcinoma (HCC). Methods. A case-control study with 1,538 HBV-positive HCC patients and 1,465 chronic HBV carriers was conducted to evaluate the effects of common missense variants of IRAK family members on HCC. Proliferation assays and real-time polymerase chain reactions were carried out to evaluate the functions. Multivariable adjusted logistic regression was adopted to estimate effect size and identify risk factors. Results. Association analysis indicated that rs4251545 A allele of IRAK4 (p.Ala428Thr) was positively associated with HBV-related HCC risk (OR = 1.30, 95% CI: 1.09–1.54, ). Functional annotation indicated that rs4251545 reduced its own expression in liver (). Further molecular functional analysis detected that rs4251545 increased the proliferation rate of L02 cells (). Meanwhile, rs4251545 reduced mRNA expressions of IL-6, IL-8, CXCL-1, and CXCL-2 in L02 cells (). Conclusion. rs4251545 of IRAK4 (p.Ala428Thr) modified the susceptibility to HBV-related HCC via increased proliferation rate and reduced production of inflammatory cytokines and chemokines. Further well-designed experiments are warranted to validate our findings. Hui Wang, Ci Song, Qi Qi, Tongtong Huang, Lijuan Wang, Jianguo Chen, Jian Zhu, Zhibin Hu, and Juncheng Dai Copyright © 2018 Hui Wang et al. All rights reserved. Indicators of Data Quality at the Cancer Registry Zurich and Zug in Switzerland Wed, 13 Jun 2018 08:52:36 +0000 https://www.hindawi.com/journals/bmri/2018/7656197/ Data quality is an important issue in cancer registration. This paper provides a comprehensive overview of the four main data quality indicators (comparability, validity, timeliness, and completeness) for the Cancer Registry Zurich and Zug (Switzerland). We extracted all malignant cancer cases (excluding non-melanoma skin cancer) diagnosed between 1980 and 2014 in the canton of Zurich. Methods included the proportion of morphologically verified cases (MV%), the proportion of DCN and DCO cases (2009–2014), cases with primary site uncertain (PSU%), the stability of incidence rates over time, age-specific incidence rates for childhood cancer, and mortality:incidence (MI) ratios. The DCO rate decreased from 6.4% in 1997 to 0.8% in 2014 and was <5% since 2000. MV% was 95.5% in 2014. PSU% was <3% over the whole period. The incidence rate of all tumours increased over time with site-specific fluctuations. The overall M:I ratio decreased from 0.58 in 1980 to 0.37 in 2014. Overall, data quality of the Cancer Registry Zurich and Zug was acceptable according to the methods presented in this review. Most indicators improved over time with low DCO rates, high MV%, low PSU%, relatively low M:I ratios and age-specific incidence of childhood cancer within reference ranges. Miriam Wanner, Katarina L. Matthes, Dimitri Korol, Silvia Dehler, and Sabine Rohrmann Copyright © 2018 Miriam Wanner et al. All rights reserved. Diversity of Mycobacterium tuberculosis Complex from Cattle Lymph Nodes in Eastern Cape Province Tue, 10 Apr 2018 00:00:00 +0000 https://www.hindawi.com/journals/bmri/2018/3683801/ Tuberculosis (TB) remains a major health challenge in South Africa and the condition in humans has been well researched and documented. However, investigations on the circulating Mycobacterium tuberculosis complex (MTBC) strains from cattle in the Eastern Cape Province of South Africa are insufficient. This study delineated the diversity of MTBC isolates from cows’ lymph nodes. A total of 162 MTBC isolates, collected over a one-year period from cattle lymph nodes from two abattoirs, were submitted to spoligotyping and 12 MIRU-VNTR typing. The spoligotyping results were matched with isolates in the universal spoligotyping database (SITVIT2). Our study identified 27 spoligotype patterns, with 10 shared types assigned to five lineages: the East-Asian (Beijing) was predominant, 17.9%, and East-Asian (Microti) and Latin-American-Mediterranean S were the least detected with 0.6%. Spoligotyping showed a higher clustering rate of 82.1%, with the lowest being the Hunter-Gaston Diversity Index (HGDI) of 0.485; 12 MIRU-VNTR resulted in a clustering rate of 64.8%, showing a higher HGDI of 0.671. The results of this study show a high diversity of MTBC strains in the Eastern Cape Province and clustering rate, which indicates ongoing transmission in the province. Nolwazi Londiwe Bhembe, Godfred Ngu Tanih, Lesley-Anne Caine, Abongile Pekana, Patrick Govender, Uchechukwu Uchechukwu Nwodo, Anthony Ifeayin Okoh, Leonard Vuyani Mabinya, and Ezekiel Green Copyright © 2018 Nolwazi Londiwe Bhembe et al. All rights reserved. Molecular Characterization of Antimicrobial Resistance in Escherichia coli from Rabbit Farms in Tai’an, China Mon, 26 Feb 2018 06:37:44 +0000 https://www.hindawi.com/journals/bmri/2018/8607647/ To investigate the prevalence and resistance against antimicrobials of Escherichia coli (E. coli) in Tai’an, March 2016, a total of 55 E. coli strains were isolated from 60 faecal samples of diarrheic rabbits collected from three rabbit farms in Tai’an. The E. coli isolates were assayed for antimicrobial susceptibility and prevalence of resistance genes and Class I integrons and genotyped using Multilocus Sequence Typing (MLST). All the E. coli isolates were sensitive to ceftazidime, ceftriaxone, imipenem, and amikacin, while 78.2% of the isolates showed resistance against tetracycline, and 65.5% were resistant against ampicillin. The most common resistance gene detected was , present in 98.2% of isolates, followed by (94.6%) and sul2 (58.2%). Class I integrons were detected in 17 out of the 55 (30.9%) E. coli strains. Seven kinds of gene cassette were detected: dfrA17 + aadA5, dfrA1 + catB3 + aacA4, aadA2 + LinF, dfrA1 + aadA1, aadA22, dfrA12 + orfF + addA2, and aadA16 + dfrA27 + arr-3. All the 55 E. coli strains were identified and classified as 13 sequence types (STs); ST302 (22/55, 40.0%) was the most prevalent type, followed by ST370 (12/55, 21.8%). This study showed that E. coli isolated from diarrheic farmed rabbits in the Tai’an area exhibit sometimes very frequent resistance to antimicrobials important to human medicine, which further highlights the need for reasonable use of antibiotics. Xiaonan Zhao, Jie Yang, Zijing Ju, Weishan Chang, and Shuhong Sun Copyright © 2018 Xiaonan Zhao et al. All rights reserved. Questions Frequently Asked of Healthcare Professionals: A 2-Year Data Survey Conducted at a Medical Center Wed, 14 Feb 2018 00:00:00 +0000 https://www.hindawi.com/journals/bmri/2018/4895850/ In this descriptive, retrospective study, we analyzed the types of questions posed by healthcare professionals to drug counselors at a medical center and the types of provision of pharmaceutical advice solicited to improve pharmaceutical care quality and establish clear directions for clinical pharmacist training. We collected 8,558 questions posed by healthcare professionals (physicians, 38%; pharmacists, 39%; nurses, 23%) from the electronic drug information record system from May 2013 to April 2015 in one medical center. Overall, 52% and 45% of calls came from outpatient and inpatient departments, respectively. Telephone was the main route of provision of pharmaceutical advice (total, 6,035 questions; 72%), and hospital/electronic formulary was the main reference type (43%). The top 10 topics were dosage, alternatives, drug name, usage, adverse drug reactions, medication suggestion, drug compatibility, national health insurance criteria, mechanism, and indications. Pharmacological classification inquiries most frequently addressed antimicrobial agents (20%), and vancomycin was the top single drug. Finally, 67% of calls were completed in 5 minutes. Our results suggest that the systematic organization of issues into a searchable database would reduce inquiry durations and improve work efficiency. Furthermore, the availability of various search tools and methods would quickly provide healthcare professionals with provision of drug information needed to improve patient medication safety. Chi-Lien Hou, Ying-Hao Lu, Shun-Ching Chien, Hsu-Hui Chen, and Chung-Yu Chen Copyright © 2018 Chi-Lien Hou et al. All rights reserved. Western Blot-Based Logistic Regression Model for the Identification of Recent HIV-1 Infection: A Promising HIV-1 Surveillance Approach for Resource-Limited Regions Sun, 14 Jan 2018 06:41:45 +0000 https://www.hindawi.com/journals/bmri/2018/4390318/ Objectives. Identifying recent infections is necessary to monitor HIV/AIDS epidemic; however, it needs to be further developed. Methods and Results. Participants were defined as having recent infection or older infection according to the estimated duration of HIV-1 infection and further assigned into training set and validation set according to their entering time points. Western blot (WB) confirmatory test and BED-CEIA were performed. The performance of the two methods on recent HIV-1 diagnosis was evaluated and compared. 81 subjects were enrolled in the training set and 72 in the validation set. Relative grey ratios of p24, p39, p31, p66, gp41, and gp160 were significantly higher in older infected patients of the training set. The present status of p55 was more frequently missing in recently infected patients in both sets. The logistic stepwise regression analysis of WB method shows sensitivity, specificity, and accuracy of 93.02%, 92.11%, and 92.59%. For BED-CEIA, they were 76.74%, 86.84%, and 81.48%. In the validation set, overall agreement rate, sensitivity, and specificity were 88.46%, 84.78%, and 86.11% in the WB-based method and 50.00%, 84.78%, and 72.22% in the BED-CEIA method. Conclusions. WB-based method is a promising approach to predict recent HIV-1 infection, especially in resource-limited regions. Jiegang Huang, Minlian Wang, Chunyuan Huang, Bingyu Liang, Junjun Jiang, Chuanyi Ning, Ning Zang, Hui Chen, Jie Liu, Rongfeng Chen, Yanyan Liao, Li Ye, and Hao Liang Copyright © 2018 Jiegang Huang et al. All rights reserved. A Proposed Approach for Joint Modeling of the Longitudinal and Time-To-Event Data in Heterogeneous Populations: An Application to HIV/AIDS’s Disease Tue, 09 Jan 2018 00:00:00 +0000 https://www.hindawi.com/journals/bmri/2018/7409284/ In recent years, the joint models have been widely used for modeling the longitudinal and time-to-event data simultaneously. In this study, we proposed an approach (PA) to study the longitudinal and survival outcomes simultaneously in heterogeneous populations. PA relaxes the assumption of conditional independence (CI). We also compared PA with joint latent class model (JLCM) and separate approach (SA) for various sample sizes (150, 300, and 600) and different association parameters (0, 0.2, and 0.5). The average bias of parameters estimation (AB-PE), average SE of parameters estimation (ASE-PE), and coverage probability of the 95% confidence interval (CP) among the three approaches were compared. In most cases, when the sample sizes increased, AB-PE and ASE-PE decreased for the three approaches, and CP got closer to the nominal level of 0.95. When there was a considerable association, PA in comparison with SA and JLCM performed better in the sense that PA had the smallest AB-PE and ASE-PE for the longitudinal submodel among the three approaches for the small and moderate sample sizes. Moreover, JLCM was desirable for the none-association and the large sample size. Finally, the evaluated approaches were applied on a real HIV/AIDS dataset for validation, and the results were compared. Narges Roustaei, Seyyed Mohammad Taghi Ayatollahi, and Najaf Zare Copyright © 2018 Narges Roustaei et al. All rights reserved. Prevalence of Low Birth Weight before and after Policy Change to IPTp-SP in Two Selected Hospitals in Southern Nigeria: Eleven-Year Retrospective Analyses Thu, 04 Jan 2018 00:00:00 +0000 https://www.hindawi.com/journals/bmri/2018/4658106/ Background. In 2005, Nigeria changed its policy on prevention of malaria in pregnancy to intermittent preventive treatment with sulphadoxine-pyrimethamine (IPTp-SP). Indicators of impact of effective prevention and control of malaria on pregnancy (MIP) are low birth weight (LBW) and maternal anaemia by parity. This study determined the prevalence of LBW for different gravidity groups during periods of pre- and postpolicy change to IPTp-SP. Methods. Eleven-year data were abstracted from the delivery registers of two hospitals. Study outcomes calculated for both pre- (2000–2004) and post-IPTp-SP-policy (2005–2010) years were prevalence of LBW for different gravidity groups and risk of LBW in primigravidae compared to multigravidae. Results. Out of the 11,496 singleton deliveries recorded within the 11-year period, the prevalence of LBW was significantly higher in primigravidae than in multigravidae for both prepolicy (6.3% versus 4%) and postpolicy (8.6% versus 5.1%) years. The risk of LBW in primigravidae compared to multigravidae increased from 1.62 (1.17–2.23) in the prepolicy years to 1.74 (1.436–2.13) during the postpolicy years. Conclusion. The study demonstrated that both the prevalence and risk of LBW remained significantly higher in primigravidae even after the change in policy to IPTp-SP. Nneka U. Igboeli, Maxwell O. Adibe, Chinwe V. Ukwe, and Nze C. Aguwa Copyright © 2018 Nneka U. Igboeli et al. All rights reserved. High Prevalence of Leptotrichia amnionii, Atopobium vaginae, Sneathia sanguinegens, and Factor 1 Microbes and Association of Spontaneous Abortion among Korean Women Wed, 13 Dec 2017 08:02:45 +0000 https://www.hindawi.com/journals/bmri/2017/5435089/ Objective. The purpose of this study was to (i) determine the cervical microbial composition in different abortion samples and to (ii) investigate the correlation between spontaneous abortion and cervical microbes in Korean women. Methods. We collected cervical swabs from women who had never undergone abortion (), had spontaneous abortion (), and had undergone induced abortion () and subjected those samples to 16S rRNA pyrosequencing. Further, factor analysis and correlation between cervical microbiota and spontaneous abortion were evaluated by logistic regression analysis. Results. In spontaneous abortion women, 16 S rRNA gene sequences showed significant increases in Atopobium vaginae, Megasphaera spp., Gardnerella vaginalis, Leptotrichia amnionii, and Sneathia sanguinegens compared to women in nonabortion group. In multivariate logistic regression analysis, A. vaginae (OD = 11.27; 95% = 1.57–81), L. amnionii (OD = 11.47; 95% = 1.22–107.94), S. sanguinegens (OD = 6.89; 95% = 1.07–44.33), and factor 1 microbes (OD = 16.4; 95% = 1.88–42.5) were strongly associated with spontaneous abortion. Conclusions. This study showed a high prevalence of L. amnionii, A. vaginae, S. sanguinegens, and factor 1 microbes in spontaneous abortion and association with spontaneous abortion in Korean women. Sang Soo Seo, Selvaraj Arokiyaraj, Mi Kyung Kim, Hea Young Oh, Minji Kwon, Ji Sook Kong, Moon Kyung Shin, Ye Lee Yu, and Jae Kwan Lee Copyright © 2017 Sang Soo Seo et al. All rights reserved. A Novel Methicillin-Resistant Staphylococcus aureus t11469 and a Poultry Endemic Strain t002 (ST5) Are Present in Chicken in Ebonyi State, Nigeria Sun, 19 Nov 2017 08:08:47 +0000 https://www.hindawi.com/journals/bmri/2017/2936461/ Background. The changing epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) from a hospital-associated pathogen to an organism commonly found in the community and in livestock reflects an organism well-equipped to survive in diverse environments and adjust to different environmental conditions including antimicrobial use. Methods. We investigated the molecular epidemiology of S. aureus and MRSA in poultry in Ebonyi State, Nigeria. Samples were collected from 1800 birds on 9 different farms within the state. Positive isolates were tested for antibiotic susceptibility and molecular typing. Results. Prevalence in birds was 13.7% (247/1800). MRSA prevalence in poultry was 0.8%. The prevalence of MRSA in broilers and layers was 1.2% and 0.4%, respectively. All tested isolates were susceptible to vancomycin. Molecular analysis of the isolates revealed 3 spa types: t002, t084, and a novel spa type, t11469. The novel spa type t11469 belonged to sequence type ST5. Conclusion. The detection of t002 in chicken suggests the presence of livestock-associated MRSA in poultry in Ebonyi State. The detection of the new spa type t11469 in poultry that has not been characterised to ascertain its pathogenic potential remains a cause for concern, especially as some were found to carry PVL genes, a putative virulence factor in staphylococcal infection. Amos Nworie, Azi S. Onyema, Simon I. Okekpa, Michael O. Elom, Nse O. Umoh, Victor U. Usanga, Gideon A. Ibiam, Boniface N. Ukwah, Lynda C. Nwadi, Chinwe Ezeruigbo, Busayo O. Olayinka, Joseph O. Ehinmidu, Josiah A. Onaolapo, Blake M. Hanson, Shylo E. Wardyn, and Tara C. Smith Copyright © 2017 Amos Nworie et al. All rights reserved. Concentration-Response Relationship between PM2.5 and Daily Respiratory Deaths in China: A Systematic Review and Metaregression Analysis of Time-Series Studies Mon, 16 Oct 2017 08:41:54 +0000 https://www.hindawi.com/journals/bmri/2017/5806185/ The association between the particulate matters with aerodynamic diameter ≤ 2.5 μm (PM2.5) and daily respiratory deaths, particularly the concentration-response pattern, has not been fully examined and established in China. We conducted a systematic review of time-series studies to compile information on the associations between PM2.5 concentration and respiratory deaths and used metaregression to assess the concentration-response relationship. Out of 1,957 studies screened, eleven articles in English and two articles in Chinese met the eligibility criteria. For single-day lags, per 10 μg/m3 increase in PM2.5 concentration was associated with 0.30 [95% confidence interval (CI): 0.10, 0.50] percent increase in daily respiratory deaths; for multiday lags, the corresponding increase in respiratory deaths was 0.69 (95% CI: 0.55, 0.83) percent. Difference in the effects was observed between the northern cities and the south cities in China. No statistically significant concentration-response relationship between PM2.5 concentrations and their effects was found. With increasingly wider location coverage for PM2.5 data, it is crucial to further investigate the concentration-response pattern of PM2.5 effects on respiratory and other cause-specific mortality for the refinement and adaptation of global and national air quality guidelines and targets. Mengying Ren, Xin Fang, Mei Li, Sun Sun, Lu Pei, Qun Xu, Xiaofei Ye, and Yang Cao Copyright © 2017 Mengying Ren et al. All rights reserved. Prevalence and Risk Factors of Asthma, Rhinitis, and Eczema and Their Multimorbidity among Young Adults in Kuwait: A Cross-Sectional Study Wed, 30 Aug 2017 09:32:32 +0000 https://www.hindawi.com/journals/bmri/2017/2184193/ Objective. To estimate the prevalence of allergic diseases and allergic multimorbidity (coexistence) among young adults in Kuwait and to examine associations between risk factors with allergic diseases and allergic multimorbidity. Methods. A cross-sectional study was conducted by enrolling 1,154 students, aged 18–26 years, attending Kuwait University. Participants self-completed a questionnaire on symptoms and clinical history of allergic diseases. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were estimated by applying Poisson regression with robust variance estimation. Results. The prevalence of current asthma, rhinitis, and eczema was estimated to be 11.9% (135/1135), 20.4% (232/1138), and 9.2% (105/1143), respectively. The coexistence of “asthma and rhinitis” (5.1%, 57/1125) was the most frequent allergic multimorbidity. Both maternal history (PR = 3.97, 95% CI: 2.32–6.80) and paternal history (PR = 1.72, 95% CI: 1.10–2.68) of allergy were independently associated with having two or more coexisting allergic diseases. The joint effect of having both maternal and paternal history of allergy was associated with 8.16 times (95% CI: 4.19–15.90) higher risk of allergic multimorbidity. Conclusion. Allergic diseases and allergic multimorbidity are common among young adults in Kuwait and their burden mirrors that of westernized countries. Parental history of allergy is a strong predisposing factor for allergic multimorbidity. Ali H. Ziyab Copyright © 2017 Ali H. Ziyab. All rights reserved. Nonpaternity and Half-Siblingships as Objective Measures of Extramarital Sex: Mathematical Modeling and Simulations Tue, 22 Aug 2017 00:00:00 +0000 https://www.hindawi.com/journals/bmri/2017/3564861/ Background. Understanding the epidemiology of HIV and other sexually transmitted infections (STIs) requires knowledge of sexual behavior, but self-reported behavior has limitations. We explored the reliability and validity of nonpaternity and half-siblings ratios as biomarkers of current and past extramarital sex. Methods. An individual-based Monte Carlo simulation model was constructed to describe partnering and conception in human populations with a focus on Sub-Saharan Africa (SSA). The model was parameterized with representative biological, behavioral, and demographic data. Results. Nonpaternity and half-siblings ratios were strongly correlated with extramarital sex, with Pearson correlation coefficients (PCC) of 0.79 (95% CI: 0.71–0.86) and 0.77 (0.68–0.84), respectively. Age-specific nonpaternity ratios correlated with past extramarital sex at time of conception for different scenarios: for example, PCC, after smoothing by moving averages, was 0.75 (0.52–0.89) in a scenario of steadily decreasing nonmarital sex and 0.39 (0.01–0.73) in a scenario of transient drops in nonmarital sex. Simulations assuming self-reported levels of extramarital sex from Kenya yielded nonpaternity levels lower than global nonpaternity data, suggesting sizable underreporting of extramarital sex. Conclusions. Nonpaternity and half-siblings ratios are useful objective measures of extramarital sex that avoid limitations in self-reported sexual behavior. Ryosuke Omori, Nico Nagelkerke, and Laith J. Abu-Raddad Copyright © 2017 Ryosuke Omori et al. All rights reserved. Exercise for Health and Disease: Time to Move Ahead Mon, 21 Aug 2017 00:00:00 +0000 https://www.hindawi.com/journals/bmri/2017/1460262/ Paulo Gentil, Fabrício Boscolo Del Vecchio, and James Steele Copyright © 2017 Paulo Gentil et al. All rights reserved. Corrigendum to “Molecular Epidemiological Investigation of Porcine kobuvirus and Its Coinfection Rate with PEDV and SaV in Northwest China” Thu, 17 Aug 2017 00:00:00 +0000 https://www.hindawi.com/journals/bmri/2017/9794340/ Chen Wang, Xi Lan, and Bin Yang Copyright © 2017 Chen Wang et al. All rights reserved. Candidemia in the Neonatal Intensive Care Unit: A Retrospective, Observational Survey and Analysis of Literature Data Sun, 13 Aug 2017 07:01:54 +0000 https://www.hindawi.com/journals/bmri/2017/7901763/ We evaluated the epidemiology of Candida bloodstream infections in the neonatal intensive care unit (NICU) of an Italian university hospital during a 9-year period as a means of quantifying the burden of infection and identifying emerging trends. Clinical data were searched for in the microbiological laboratory database. For comparative purposes, we performed a review of NICU candidemia. Forty-one candidemia cases were reviewed (overall incidence, 3.0 per 100 admissions). Candida parapsilosis sensu stricto (58.5%) and C. albicans (34.1%) were the most common species recovered. A variable drift through years was observed; in 2015, 75% of the cases were caused by non-albicans species. The duration of NICU hospitalization of patients with non-albicans was significantly longer than in those with C. albicans (median days, 10 versus 12). Patients with non-albicans species were more likely to have parenteral nutrition than those with C. albicans (96.3% versus 71.4%). Candida albicans was the dominant species in Europe and America (median, 55% and 60%; resp.); non-albicans species predominate in Asia (75%). Significant geographic variation is evident among cases of candidemia in different parts of the world, recognizing the importance of epidemiological data to facilitate the treatment. Giuseppina Caggiano, Grazia Lovero, Osvalda De Giglio, Giovanna Barbuti, Osvaldo Montagna, Nicola Laforgia, and Maria Teresa Montagna Copyright © 2017 Giuseppina Caggiano et al. All rights reserved. Intelligent Physical Exercise Training in a Workplace Setting Improves Muscle Strength and Musculoskeletal Pain: A Randomized Controlled Trial Mon, 07 Aug 2017 00:00:00 +0000 https://www.hindawi.com/journals/bmri/2017/7914134/ Purpose. To assess effects of 1-year Intelligent Physical Exercise Training (IPET) on musculoskeletal health. Methods. Office workers were randomized 1 : 1 to a training group, TG (), or a control group, CG (). TG received 1 h supervised high intensity IPET every week within working hours for 1 year and was recommended to perform 30 min of moderate intensity physical activity for 6 days a week during leisure. The IPET program was based on baseline health measures. Results. No baseline differences were present. An intention-to-treat analysis showed significant between-group effect for muscle strength but not for musculoskeletal pain. However, a per-protocol analysis of those with an adherence of ≥70% demonstrated a significant between-group effect for neck pain during the past three months. Several significant within-group changes were present, where TG and TG ≥ 70% demonstrated clinically relevant pain reductions whereas minimal reductions were seen for CG. Conclusion. IPET and recommendations of moderate intensity physical activity demonstrated significant between-group effect on muscle strength. Interestingly, significant within-group reductions in musculoskeletal pain were seen not only in TG but also in CG. This may underlie the lack of such between-group effect and shows that a possible positive side effect of merely drawing attention can improve musculoskeletal health. Tina Dalager, Just Bendix Justesen, and Gisela Sjøgaard Copyright © 2017 Tina Dalager et al. All rights reserved. Chronic Effects of Resistance Training in Breast Cancer Survivors Tue, 01 Aug 2017 07:30:41 +0000 https://www.hindawi.com/journals/bmri/2017/8367803/ Objective. To analyse effects of resistance training (RT) in breast cancer survivors (BCS) and how protocols and acute variables were manipulated. Methods. Search was made at PubMed, Science Direct, and LILACS. All articles published between 2000 and 2016 were considered. Studies that met the following criteria were included: written in English, Spanish, or Portuguese; BCS who have undergone surgery, chemotherapy, and/or radiotherapy; additional RT only; analysis of muscle performance, body mass composition (BMC), psychosocial parameters, or blood biomarkers. Results. Ten studies were included. PEDro score ranged from 5 to 9. Rest interval and cadence were not reported. Two studies reported continuous training supervision. All reported improvements in muscle strength, most with low or moderate effect size (ES), but studies performed with high loads presented large ES. Five described no increased risk or exacerbation of lymphedema. Most studies that analysed BMC showed no relevant changes. Conclusions. RT has been shown to be safe for BCS, with no increased risk of lymphedema. The findings indicated that RT is efficient in increasing muscle strength; however, only one study observed significant changes in BMC. An exercise program should therefore consider the manipulation of acute and chronic variables of RT to obtain optimal results. Wanderson Divino Nilo dos Santos, Paulo Gentil, Rafael Felipe de Moraes, João Batista Ferreira Júnior, Mário Hebling Campos, Claudio Andre Barbosa de Lira, Ruffo Freitas Júnior, Martim Bottaro, and Carlos Alexandre Vieira Copyright © 2017 Wanderson Divino Nilo dos Santos et al. All rights reserved. Prevalence and Molecular Characterization of Second-Line Drugs Resistance among Multidrug-Resistant Mycobacterium tuberculosis Isolates in Southwest of China Mon, 17 Jul 2017 08:17:58 +0000 https://www.hindawi.com/journals/bmri/2017/4563826/ This study aimed to investigate the prevalence of multidrug-resistant tuberculosis (MDR-TB) isolates resistant to the second-line antituberculosis drugs (SLDs) and its association with resistant-related gene mutations in Mycobacterium tuberculosis (M.tb) isolates from Southwest of China. There were 81 isolates resistant to at least one of the SLDs among 156 MDR-TB isolates (81/156, 51.9%). The rates of general resistance to each of the drugs were as follows: OFX (66/156, 42.3%), KAN (26/156, 16.7%), CAP (13/156, 8.3%), PTO (11/156, 7.1%), PAS (22/156, 14.1%), and AMK (20/156, 12.8%). Therefore, the most predominant pattern was resistant to OFX compared with other SLDs (). The results of sequencing showed that 80.2% OFX-resistant MDR-TB isolates contained gyrA mutation and 88.5% KAN-resistant isolates had rrs mutations with the most frequent mutation being A1401G. These results suggest that improper use of SLDs especially OFX is a real threat to effective MDR-TB treatment not only in China but also in the whole world. Furthermore the tuberculosis control agencies should carry out SLDs susceptibility testing and rapid screening in a broader population of TB patients immediately and the SLDs should be strictly regulated by the administration in order to maintain their efficacy to treat MDR-TB. Y. Hu, L. Xu, Y. L. He, Y. Pang, N. Lu, J. Liu, J. Shen, D. M. Zhu, X. Feng, Y. W. Wang, and C. Yang Copyright © 2017 Y. Hu et al. All rights reserved. Real World Evidence: A Quantitative and Qualitative Glance at Participant Feedback from a Free-Response Survey Investigating Experiences of a Structured Exercise Intervention for Men with Prostate Cancer Mon, 03 Jul 2017 00:00:00 +0000 https://www.hindawi.com/journals/bmri/2017/3507124/ Aim. To explore patient experiences of a structured exercise intervention for men with prostate cancer (PCa). Sample. 41 men with either localised or advanced PCa who had been referred for a structured exercise programme by their physician and then subsequently consented to a telephone survey. Method. Participants underwent a 10-week supervised exercise programme within a large cancer centre hospital consisting of 8 sessions. They then completed a short multiple choice telephone survey, elaborating on their responses where appropriate. Views expressed by participants were analysed using an affinity diagram and common themes were identified. Results. Feedback from our telephone surveys was consistently positive and suggests that the structured exercise intervention provides exercise confidence, motivation to exercise, and social support and promotes positive health behaviour change in the context of exercise. Individual differences arose amongst participants in their perceived utility of the intervention, with 73.3% expressing a preference for structured exercise classes and 19.5% expressing a preference for exercising independently. Conclusion. Design of a structured exercise intervention for patients with PCa should embrace the positive aspects outlined here but consider patients’ individual differences. Ongoing feedback from patients should be utilised alongside traditional study designs to inform intervention design in this area. L. Fox, F. Cahill, C. Burgess, N. Peat, S. Rudman, J. Kinsella, D. Cahill, G. George, A. Santaolalla, and M. Van Hemelrijck Copyright © 2017 L. Fox et al. All rights reserved. The Effect of Small Sample Size on Measurement Equivalence of Psychometric Questionnaires in MIMIC Model: A Simulation Study Tue, 20 Jun 2017 00:00:00 +0000 https://www.hindawi.com/journals/bmri/2017/7596101/ Evaluating measurement equivalence (also known as differential item functioning (DIF)) is an important part of the process of validating psychometric questionnaires. This study aimed at evaluating the multiple indicators multiple causes (MIMIC) model for DIF detection when latent construct distribution is nonnormal and the focal group sample size is small. In this simulation-based study, Type I error rates and power of MIMIC model for detecting uniform-DIF were investigated under different combinations of reference to focal group sample size ratio, magnitude of the uniform-DIF effect, scale length, the number of response categories, and latent trait distribution. Moderate and high skewness in the latent trait distribution led to a decrease of 0.33% and 0.47% power of MIMIC model for detecting uniform-DIF, respectively. The findings indicated that, by increasing the scale length, the number of response categories and magnitude DIF improved the power of MIMIC model, by 3.47%, 4.83%, and 20.35%, respectively; it also decreased Type I error of MIMIC approach by 2.81%, 5.66%, and 0.04%, respectively. This study revealed that power of MIMIC model was at an acceptable level when latent trait distributions were skewed. However, empirical Type I error rate was slightly greater than nominal significance level. Consequently, the MIMIC was recommended for detection of uniform-DIF when latent construct distribution is nonnormal and the focal group sample size is small. Jamshid Jamali, Seyyed Mohammad Taghi Ayatollahi, and Peyman Jafari Copyright © 2017 Jamshid Jamali et al. All rights reserved. The Effects of 6 Months of Progressive High Effort Resistance Training Methods upon Strength, Body Composition, Function, and Wellbeing of Elderly Adults Tue, 06 Jun 2017 09:36:50 +0000 https://www.hindawi.com/journals/bmri/2017/2541090/ Purpose. The present study examined the progressive implementation of a high effort resistance training (RT) approach in older adults over 6 months and through a 6-month follow-up on strength, body composition, function, and wellbeing of older adults. Methods. Twenty-three older adults (aged 61 to 80 years) completed a 6-month supervised RT intervention applying progressive introduction of higher effort set end points. After completion of the intervention participants could choose to continue performing RT unsupervised until 6-month follow-up. Results. Strength, body composition, function, and wellbeing all significantly improved over the intervention. Over the follow-up, body composition changes reverted to baseline values, strength was reduced though it remained significantly higher than baseline, and wellbeing outcomes were mostly maintained. Comparisons over the follow-up between those who did and those who did not continue with RT revealed no significant differences for changes in any outcome measure. Conclusions. Supervised RT employing progressive application of high effort set end points is well tolerated and effective in improving strength, body composition, function, and wellbeing in older adults. However, whether participants continued, or did not, with RT unsupervised at follow-up had no effect on outcomes perhaps due to reduced effort employed during unsupervised RT. James Steele, Kristin Raubold, Wolfgang Kemmler, James Fisher, Paulo Gentil, and Jürgen Giessing Copyright © 2017 James Steele et al. All rights reserved. Detection of Enterocytozoon bieneusi in White Yaks in Gansu Province, China Tue, 06 Jun 2017 06:31:53 +0000 https://www.hindawi.com/journals/bmri/2017/5790181/ Enterocytozoon bieneusi, the most common zoonotic pathogen of microsporidiosis, has been found in various animals and humans, but no information is available concerning the prevalence and genotypes of E. bieneusi in white yaks (Bos grunniens). In the present study, 353 faecal samples from white yaks in Tianzhu Tibetan Autonomous County, Gansu Province, Northwestern China, were collected and examined by PCR amplification of the internal transcribed spacer gene to estimate E. bieneusi prevalence and identify their genotypes. Of the 353 faecal samples, 4 (1.13%) were tested E. bieneusi-positive. Sequences analysis revealed that two known genotypes, namely, I () and BEB4 (), and a novel genotype, namely, WCY1 (), were found in this study. Among them, genotype WCY1 was clustered into Group 1, and genotypes I and BEB4 belonged to Group 2. The present study firstly indicates the existence of E. bieneusi in yaks in Gansu Province, Northwestern China. This is also the first record of E. bieneusi in white yaks. Effective measures should be taken to control E. bieneusi infection in white yaks, other animals, and humans. Jian-Gang Ma, Nian-Zhang Zhang, Jun-Ling Hou, Yang Zou, Gui-Xue Hu, Xing-Quan Zhu, and Dong-Hui Zhou Copyright © 2017 Jian-Gang Ma et al. All rights reserved. Effects of an Intensive Lifestyle Intervention to Treat Overweight/Obese Children and Adolescents Mon, 05 Jun 2017 07:33:41 +0000 https://www.hindawi.com/journals/bmri/2017/8573725/ Objective. The purpose of the present study is to examine the effects of a multidisciplinary lifestyle intervention to treat overweight/obese children and adolescents. The main outcome was cardiometabolic risk based on the waist-to-height ratio (WHTR) measurement. Secondary outcomes were () changes in body composition; () adherence to a Mediterranean diet; and () physical performance. Method. The study involved 74 overweight/obese children or adolescents. The intervention was multidisciplinary including nutrition, exercise, and psychological aspects based on a family-based approach; it was delivered for six months for children and three months for adolescents. Before and after the intervention, several anthropometric measures (height, body weight, body mass index or BMI, waist circumference, and body composition), cardiometabolic risk index (waist-to-height ratio or WHTR), and nutrition habits of the participants and their families were evaluated. In addition, a set of functional motor fitness tests was performed to evaluate physical performance measures. Results. After the intervention both children and adolescents showed a significant reduction in body weight, BMI, waist circumference, fat mass, and WHTR index and an improvement of fat-free mass, adherence to the Mediterranean diet, and physical fitness performance. Conclusion. A family-based multidisciplinary approach is effective in the short term in ameliorating the health status, the nutrition habits, and physical performance in children and adolescents. Claudia Ranucci, Roberto Pippi, Livia Buratta, Cristina Aiello, Vincenza Gianfredi, Natalia Piana, Elisa Reginato, Alberto Tirimagni, Emanuele Chiodini, Emilia Sbroma Tomaro, Alessio Gili, Pierpaolo De Feo, Carmine Fanelli, and Claudia Mazzeschi Copyright © 2017 Claudia Ranucci et al. All rights reserved. Protein Supplementation to Augment the Effects of High Intensity Resistance Training in Untrained Middle-Aged Males: The Randomized Controlled PUSH Trial Thu, 01 Jun 2017 08:28:50 +0000 https://www.hindawi.com/journals/bmri/2017/3619398/ High intensity (resistance exercise) training (HIT) defined as a “single set resistance exercise to muscular failure” is an efficient exercise method that allows people with low time budgets to realize an adequate training stimulus. Although there is an ongoing discussion, recent meta-analysis suggests the significant superiority of multiple set (MST) methods for body composition and strength parameters. The aim of this study is to determine whether additional protein supplementation may increase the effect of a HIT-protocol on body composition and strength to an equal MST-level. One hundred and twenty untrained males 30–50 years old were randomly allocated to three groups: (a) HIT, (b) HIT and protein supplementation (HIT&P), and (c) waiting-control (CG) and (after cross-over) high volume/high-intensity-training (HVHIT). HIT was defined as “single set to failure protocol” while HVHIT consistently applied two equal sets. Protein supplementation provided an overall intake of 1.5–1.7 g/kg/d/body mass. Primary study endpoint was lean body mass (LBM). LBM significantly improved in all exercise groups (); however only HIT&P and HVHIT differ significantly from control (). HIT diverges significantly from HIT&P () and nonsignificantly from HVHIT (), while no differences were observed for HIT&P versus HVHIT (). In conclusion, moderate to high protein supplementation significantly increases the effects of a HIT-protocol on LBM in middle-aged untrained males. Andreas Wittke, Simon von Stengel, Michael Hettchen, Michael Fröhlich, Jürgen Giessing, Michael Lell, Michael Scharf, Michael Bebenek, Matthias Kohl, and Wolfgang Kemmler Copyright © 2017 Andreas Wittke et al. All rights reserved. Dual Epidemics of Club Drug Use and Sexually Transmitted Infections among Chinese Female Sex Workers: New Challenges to STI Prevention Tue, 30 May 2017 00:00:00 +0000 https://www.hindawi.com/journals/bmri/2017/2093421/ Objectives. To evaluate club drug use and its potential association with STI among female sex workers (FSWs) in China. Methods. From November 2008 to January 2009, participants were recruited at sex work venues in five cities for a questionnaire survey. Free testing for syphilis, Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (NG) was provided. Logistic regression models were used to assess factors associated with club drug use and its association with STI. Results. A total of 1604 eligible FSWs were included. The overall prevalence of any STI infection and club drug use in the past 12 months was 22.6% and 7.4%, respectively. STI prevalence was significantly higher among club drug users (33.1%) than among nonusers (21.7%, ). Multivariable logistic regression found that club drug use was associated with younger age (AOR 2.4, 95% CI 1.0, 6.0), higher education, having injected drugs (AOR 24.4, 95% CI 6.2, 96.8), and having had STI symptoms (AOR 2.2, 95% CI 1.4, 3.4). Conclusions. Club drug use and STI were highly prevalent among FSWs in China, especially among young FSWs. Club drug users had more risk behaviors and higher STI rates. A coordinated risk reduction framework is urgently needed to address the dual epidemic of drug use and STI. Jing Li, Xiang-dong Gong, Xiaoli Yue, and Ning Jiang Copyright © 2017 Jing Li et al. All rights reserved. Personalized Consent Flow in Contemporary Data Sharing for Medical Research: A Viewpoint Tue, 30 May 2017 00:00:00 +0000 https://www.hindawi.com/journals/bmri/2017/7147212/ Background. Health data personally collected by individuals with wearable devices and smartphones is becoming an important data source for healthcare, but also for medical research. Objective. To describe a new consent model that allows people to control their personally collected health data and determine to what extent they want to share these for research purposes. Methods. We developed, in close collaboration with patients, researchers, healthcare professionals, privacy experts, and an accredited Medical Ethical Review Committee, an innovative concept called “personalized consent flow” within a research platform connected to a personal health record. The development was an iterative process with informal meetings, semistructured interviews, and surveys. The final concept of the personalized consent flow was reviewed by patients and improved and approved by the same patients in a focus group. Results. This concept could result in optimal control for individual users, since they will answer questions about how they will share data. Furthermore, it enables users to collect data for specific studies and add expiration dates to their data. This work facilitates further discussion about dynamic and personalized consent. A pilot study with the personalized consent model is currently being carried out. Ester A. Rake, Marleen M. H. J. van Gelder, David C. Grim, Barend Heeren, Lucien J. L. P. G. Engelen, and Tom H. van de Belt Copyright © 2017 Ester A. Rake et al. All rights reserved. Prevalence of Malnutrition and Associated Factors among Children in Rural Ethiopia Wed, 17 May 2017 08:17:05 +0000 https://www.hindawi.com/journals/bmri/2017/6587853/ Background. Child malnutrition continues to be the leading public health problem in developing countries. In Ethiopia, malnutrition is a leading cause of child illness and death. Recently the composite index of anthropometric failure (CIAF) has been implemented to measure the prevalence of malnutrition. This index presents a more complete picture compared with the previous conventional indices. In this study, CIAF was used to determine the prevalence of malnutrition among children aged 0–59 months in rural Ethiopia. Methods. Data was extracted from the 2014 Ethiopian Mini Demographic and Health Survey (EMDHS) for this study. A total of 3095 children were included in the analysis. The composite index of anthropometric failure (CIAF) was used to measure the nutritional status of the children. Logistic regression was fitted, to identify factors associated with malnutrition among children in rural Ethiopia, using STATA 13. Result. The prevalence of malnutrition among rural children in Ethiopia was 48.5%. Age of the children, preceding birth interval, educated status of mother, wealth status, and region were factors independently associated with nutritional status of children in rural Ethiopia. Conclusion. The prevalence of malnutrition among children in rural Ethiopia was high. A child older than 12 months, having uneducated mother, living in a household with poor wealth status, born with short birth interval, and living in some region of the country are associated with increased odds of being malnourished. Neima Endris, Henok Asefa, and Lamessa Dube Copyright © 2017 Neima Endris et al. All rights reserved. Psychosocial and Environmental Correlates of Sedentary Behaviors in Spanish Children Thu, 27 Apr 2017 00:00:00 +0000 https://www.hindawi.com/journals/bmri/2017/4728924/ Purpose. To evaluate children’s psychosocial and environmental factors associated with sedentary behavior (SB). Method. The study involved a total of 420 children (mean 9.2 years; 52.9% girls) from the community of Madrid, Spain. SB and physical activity (PA) were objectively measured using accelerometers. TV viewing and potential correlates were assessed by questionnaire. Mixed-model regression analysis, adjusted for clustering within school locations, evaluated the relation of each independent variable with SBs. Results. Girls showed higher levels of SB than boys, whereas boys reported more TV viewing ( in all cases). Regression analysis showed that MVPA levels were negatively related to objective SB measurement in both boys and girls (). Parent and friend support to PA were negatively associated with SB on weekdays in boys and girls, respectively (). In the boys’ group, parental professional level was a positive predictor of SB on weekend days (). Boys with more positive neighborhood perceptions spent less time watching TV (), whereas mother’s leisure-time PA level was a negative correlate of TV viewing in girls’ group (). Conclusion. Different psychosocial and environmental correlates of SB were identified. Present findings are promising targets for interventions to improve children’s health. S. Aznar, M. T. Lara, A. Queralt, and J. Molina-Garcia Copyright © 2017 S. Aznar et al. All rights reserved. Seroprevalence and Risk Factors of Bluetongue Virus Infection in Tibetan Sheep and Yaks in Tibetan Plateau, China Sun, 23 Apr 2017 06:42:59 +0000 https://www.hindawi.com/journals/bmri/2017/5139703/ Bluetongue (BT), caused by bluetongue virus (BTV), is an arthropod-borne viral disease in ruminants. However, information about BTV infection in yaks in China is limited. Moreover, no such data concerning BTV in Tibetan sheep is available. Therefore, 3771 serum samples were collected from 2187 Tibetan sheep and 1584 yaks between April 2013 and March 2014 from Tibetan Plateau, western China, and tested for BTV antibodies using a commercially available ELISA kit. The overall seroprevalence of BTV was 17.34% (654/3771), with 20.3% (443/2187) in Tibetan sheep and 13.3% (211/1584) in yaks. In the Tibetan sheep group, the seroprevalence of BTV in Luqu, Maqu, Tianzhu, and Nyingchi Prefecture was 20.3%, 20.8%, 20.5%, and 19.1%, respectively. The seroprevalence of BTV in different season groups varied from 16.5% to 23.4%. In the yak group, BTV seroprevalence was 12.6%, 15.5%, and 11.0% in Tianzhu, Maqu, and Luqu counties, respectively. The seroprevalence in different seasons was 12.6%, 15.5%, 15.4%, and 9.0% in spring, summer, autumn, and winter, respectively. The season was the major risk factor concerning BTV infection in yaks (). The date of the BTV seroprevalence in Tibetan sheep and yaks provides baseline information for controlling BT in ruminants in western China. Jian-Gang Ma, Xiao-Xuan Zhang, Wen-Bin Zheng, Ying-Tian Xu, Xing-Quan Zhu, Gui-Xue Hu, and Dong-Hui Zhou Copyright © 2017 Jian-Gang Ma et al. All rights reserved. Indigenous Wildlife Rabies in Taiwan: Ferret Badgers, a Long Term Terrestrial Reservoir Wed, 12 Apr 2017 08:05:42 +0000 https://www.hindawi.com/journals/bmri/2017/5491640/ The emerging disease of rabies was confirmed in Taiwan ferret badgers (FBs) and reported to the World Organization for Animal Health (OIE) on July 17, 2013. The spread of wildlife rabies can be related to neighborhood countries in Asia. The phylogenetic analysis was conducted by maximum likelihood (ML) methods and the Bayesian coalescent approach based on the glycoprotein (G) and nucleoprotein (N) genes. The phylogeographic and spatial temporal dynamics of viral transmission were determined by using SPREAD, QGIS. Therefore, the origin and the change with time of the viruses can be identified. Results showed the rabies virus of FB strains in Taiwan is a unique clade among other strains in Asia. According to the phylogeographic coalescent tree, three major genotypes of the FB rabies virus have circulated in three different geographical areas in Taiwan. Two genotypes have distributed into central and southern Taiwan between two ecological river barriers. The third genotype has been limited in southeastern Taiwan by the natural mountain barrier. The diversity of FB rabies viruses indicates that the biological profile of FBs could vary in different geographical areas in Taiwan. An enhanced surveillance system needs to be established near the currently identified natural barriers for early warnings of the rabies virus outbreak in Taiwan. Yu-Ching Lan, Tzai-Hung Wen, Chao-chin Chang, Hsin-Fu Liu, Pei-Fen Lee, Chung-Yuan Huang, Bruno B. Chomel, and Yi-Ming A. Chen Copyright © 2017 Yu-Ching Lan et al. All rights reserved. Blood Lead Levels and Risk Factors among Preschool Children in a Lead Polluted Area in Taizhou, China Wed, 29 Mar 2017 07:41:31 +0000 https://www.hindawi.com/journals/bmri/2017/4934198/ Objective. To determine the blood lead levels and identify related risk factors among preschool children in a lead polluted area (Taizhou, China) and provide theoretical support for prevention of lead pollution. Methods. A stratified-clustered-random sampling method was used to determine the survey sample. Blood lead levels were determined by the tungsten atomizer absorption spectrophotometer. Results. A total of 2,018 subjects (average age of 59 months; 1,087 boys and 931 girls) were included. The arithmetic mean, geometric mean, and median blood lead levels of the preschool children were 56.4 μg/L, 48.9 μg/L, and 46 μg/L. A total of 8.8% children had blood lead levels >100 μg/L and 43.9% had blood lead levels >50 μg/L. Mother’s education level, father’s occupation, decorative tableware, exposure to makeup, and the residential floor were all risk factors for elevated blood lead levels (odds ratios of 1.42, 1.21, 1.11, 1.19, and 1.27, resp.), while hand washing before eating food was a protective factor (odds ratio of 0.88). Conclusions. The blood lead levels of preschool children in Taizhou were higher than in other areas in China and in developed countries. Therefore, policies ensuring lead-based industries are not placed in close proximity to residential areas are required. Zhenyan Gao, Jia Cao, Jin Yan, Ju Wang, Shizhong Cai, and Chonghuai Yan Copyright © 2017 Zhenyan Gao et al. All rights reserved. Different Types of Physical Activity and Fitness and Health in Adults: An 18-Year Longitudinal Study Wed, 29 Mar 2017 00:00:00 +0000 https://www.hindawi.com/journals/bmri/2017/1785217/ Objective. The aim of this study is to examine the relationship between different types of daily life physical activity (PA) and physical fitness (PF) and health throughout adulthood. Methods. A total of 723 men and women, aged 28–76 years, participated 1681 times during four measurement points from 1992 to 2010 in this study. We assessed self-reported PA, anthropometrics, physical health status (HS), and PF in each study year. Hierarchical linear modeling (HLM) was used to analyze the measures. Results. PF and HS worsened with increasing age while sports activity (SA) declined. The modeling showed that sex, age, and SES play important roles concerning PA, PF, and HS. Athletes show higher HS and HF than nonathletes. Habitual activity (HA) also showed a positive relationship with PF and HS, but effects were lower than for SA. Work related activity (WRA) showed no meaningful relationship with PF or HS. Conclusions. Comparable amounts of PA can lead to different effects on PF or HS. Our findings underline the importance of contexts, content, and purposes of PA when health or fitness benefits are addressed. Simply moving your body is not enough. Steffen C. E. Schmidt, Susanne Tittlbach, Klaus Bös, and Alexander Woll Copyright © 2017 Steffen C. E. Schmidt et al. All rights reserved. Evaluation of Mobile Phone and Cordless Phone Use and Glioma Risk Using the Bradford Hill Viewpoints from 1965 on Association or Causation Thu, 16 Mar 2017 00:00:00 +0000 https://www.hindawi.com/journals/bmri/2017/9218486/ Objective. Bradford Hill’s viewpoints from 1965 on association or causation were used on glioma risk and use of mobile or cordless phones. Methods. All nine viewpoints were evaluated based on epidemiology and laboratory studies. Results. Strength: meta-analysis of case-control studies gave odds ratio (OR) = 1.90, 95% confidence interval (CI) = 1.31–2.76 with highest cumulative exposure. Consistency: the risk increased with latency, meta-analysis gave in the 10+ years’ latency group OR = 1.62, 95% CI = 1.20–2.19. Specificity: increased risk for glioma was in the temporal lobe. Using meningioma cases as comparison group still increased the risk. Temporality: highest risk was in the 20+ years’ latency group, OR = 2.01, 95% CI =1.41–2.88, for wireless phones. Biological gradient: cumulative use of wireless phones increased the risk. Plausibility: animal studies showed an increased incidence of glioma and malignant schwannoma in rats exposed to radiofrequency (RF) radiation. There is increased production of reactive oxygen species (ROS) from RF radiation. Coherence: there is a change in the natural history of glioma and increasing incidence. Experiment: antioxidants reduced ROS production from RF radiation. Analogy: there is an increased risk in subjects exposed to extremely low-frequency electromagnetic fields. Conclusion. RF radiation should be regarded as a human carcinogen causing glioma. Michael Carlberg and Lennart Hardell Copyright © 2017 Michael Carlberg and Lennart Hardell. All rights reserved. Testing for HIV/STIs in China: Challenges, Opportunities, and Innovations Sun, 19 Feb 2017 08:11:07 +0000 https://www.hindawi.com/journals/bmri/2017/2545840/ Huachun Zou, Lei Zhang, Eric P. F. Chow, Weiming Tang, and Zixin Wang Copyright © 2017 Huachun Zou et al. All rights reserved. Impact of Physical Activity on Cognitive Decline, Dementia, and Its Subtypes: Meta-Analysis of Prospective Studies Tue, 07 Feb 2017 00:00:00 +0000 https://www.hindawi.com/journals/bmri/2017/9016924/ The association of physical activity with dementia and its subtypes has remained controversial in the literature and has continued to be a subject of debate among researchers. A systematic review and meta-analysis of longitudinal studies on the relationship between physical activity and the risk of cognitive decline, all-cause dementia, Alzheimer’s disease, and vascular dementia among nondemented subjects are considered. A comprehensive literature search in all available databases was conducted up until April 2016. Well-defined inclusion and exclusion criteria were developed with focus on prospective studies ≥ 12 months. The overall sample from all studies is 117410 with the highest follow-up of 28 years. The analyses are performed with both Bayesian parametric and nonparametric models. Our analysis reveals a protective effect for high physical activity on all-cause dementia, odds ratio of 0.79, 95% CI (0.69, 0.88), a higher and better protective effect for Alzheimer’s disease, odds ratio of 0.62, 95% CI (0.49, 0.75), cognitive decline odds ratio of 0.67, 95% CI (0.55, 0.78), and a nonprotective effect for vascular dementia of 0.92, 95% CI (0.62, 1.30). Our findings suggest that physical activity is more protective against Alzheimer’s disease than it is for all-cause dementia, vascular dementia, and cognitive decline. Chris B. Guure, Noor A. Ibrahim, Mohd B. Adam, and Salmiah Md Said Copyright © 2017 Chris B. Guure et al. All rights reserved. Maternal Prepregnancy BMI and Glucose Level at 24–28 Gestational Weeks on Offspring’s Overweight Status within 3 Years of Age Mon, 30 Jan 2017 10:06:42 +0000 https://www.hindawi.com/journals/bmri/2017/7607210/ Objective. To examine the relative impact of maternal prepregnancy body mass index (BMI) and glucose level at 24–28 gestational weeks on offspring’s overweight status from birth to 3 years of age in China. Methods. Health care records of 21,354 mother-child pairs were collected. The single and joint associations of maternal prepregnancy BMI and glucose level at 24–28 gestational weeks with 0–3-year-old offspring’s overweight status were assessed. Results. The odds ratios (95% confidence intervals) of offspring’s macrosomia at birth and overweight/obesity at the 12th month, 24th month, and 36th month were 1.12 (1.11–1.13), 1.05 (1.04–1.06), 1.07 (1.06–1.08), and 1.11 (1.10–1.12) for each 1-unit increase (km/m2) in maternal prepregnancy BMI and 1.13 (1.10–1.17), 1.01 (0.99–1.03), 0.99 (0.96–1.01), and 1.00 (0.97–1.02) for each 1-unit increase (mmol/L) in maternal glucose level at 24–28 gestational weeks, respectively. The positive association of maternal glucose level with macrosomia at birth was similar between prepregnancy normal weight (BMI < 24 kg/m2) and overweight (BMI ≥ 24 kg/m2); however, the positive association of high maternal glucose level with childhood overweight was only seen among prepregnancy normal weight mothers but not among overweight mothers. Conclusions. The impact of maternal gestational hyperglycemia on offspring’s overweight before 3 years of age can be modified by prepregnancy BMI. Weiqin Li, Leishen Wang, Nan Li, Wei Li, Huikun Liu, Shuang Zhang, Gang Hu, and Junhong Leng Copyright © 2017 Weiqin Li et al. All rights reserved. The Use of Antidepressants, Anxiolytics, and Hypnotics in People with Type 2 Diabetes and Patterns Associated with Use: The Hoorn Diabetes Care System Cohort Mon, 23 Jan 2017 09:46:16 +0000 https://www.hindawi.com/journals/bmri/2017/5134602/ Objective. With depression being present in approximately 20% of people with type 2 diabetes mellitus (T2DM), we expect equally frequent prescription of antidepressants, anxiolytics, and hypnotics. Nevertheless, prescription data in people with T2DM is missing and the effect of depression on glycaemic control is contradictory. The aim of this study was to assess the prevalence of antidepressants, anxiolytics, and/or hypnotics use in a large, managed, primary care system cohort of people with T2DM and to determine the sociodemographic characteristics, comorbidities, T2DM medication, and metabolic control associated with its use. Method. The prevalence of antidepressants, anxiolytics, and/or hypnotics use in the years 2007–2012 was assessed in the Hoorn Diabetes Care System Cohort from the Netherlands. Results. From the 7016 people with T2DM, 500 people (7.1%) used antidepressants only, 456 people (6.5%) used anxiolytics and/or hypnotics only, and 254 people (3.6%) used a combination. Conclusion. We conclude that in our managed, primary care system 17% of all people with T2DM used antidepressants, anxiolytics, and/or hypnotics. Users of antidepressants, anxiolytics, and/or hypnotics were more often female, non-Caucasian, lower educated, and more often treated with insulin. R. Mast, S. P. Rauh, L. Groeneveld, A. D. Koopman, J. W. J. Beulens, A. P. D. Jansen, M. Bremmer, A. A. W. A. van der Heijden, P. J. Elders, J. M. Dekker, G. Nijpels, J. G. Hugtenburg, and F. Rutters Copyright © 2017 R. Mast et al. All rights reserved. Human Papillomavirus Positivity in the Anal Canal in HIV-Infected and HIV-Uninfected Men Who Have Anal Sex with Men in Guangzhou, China: Implication for Anal Exams and Early Vaccination Wed, 04 Jan 2017 09:34:27 +0000 https://www.hindawi.com/journals/bmri/2017/2641259/ Background. The epidemiology of HPV in men who have sex with men (MSM) in Guangzhou, China, had not been reported previously. Methods. HIV-infected and HIV-uninfected MSM were recruited from a Guangzhou-based MSM clinic in 2013. Sociodemographic characteristics and sexual behaviors were collected. An anal cytological sample was taken for HPV testing. Results. We recruited 79 HIV-infected and 85 HIV-uninfected MSM. The median age was 26 years in both groups. The positivities of anal HPV of any type (81.0% versus 48.2%), any high risk type (50.6% versus 27.1%), any low risk type (55.7% versus 31.8%), and any 9-valent vaccine type (74.7% versus 36.5%) were all significantly higher among HIV-infected compared to that among HIV-negative MSM ( for all < 0.05). The great majority of HPV-infected MSM were infected with 9-valent vaccine types (59 out of 64 HIV-infected and 31 out of 41 HIV-uninfected). Anal bacterial infections were associated with higher anal HPV positivity and greater number of anal HPV types. Conclusion. Sexually active MSM in Guangzhou, especially those infected with HIV, had high and multiple HPV detections. The majority of these cases were potentially preventable by HPV vaccine. Regular anal exams and early HPV vaccination are warranted in this population. Xuqi Ren, Wujian Ke, Heping Zheng, Ligang Yang, Shujie Huang, Xiaolin Qin, Bin Yang, and Huachun Zou Copyright © 2017 Xuqi Ren et al. All rights reserved. Internet-Based Sex-Seeking Behavior Promotes HIV Infection Risk: A 6-Year Serial Cross-Sectional Survey to MSM in Shenyang, China Sun, 25 Dec 2016 09:17:59 +0000 https://www.hindawi.com/journals/bmri/2016/2860346/ HIV prevalence is still rapidly increasing among Chinese men who have sex with men (MSM). The Internet also makes it easier for MSM to have casual partners. This study aims to evaluate the trend of Internet-based sex-seeking behavior of MSM and its impact on HIV prevalence, the distribution of HIV subtype strains, and transmitted drug resistance rates. A serial cross-sectional study was conducted from 2009 to 2014. Of the 1,981 MSM, 50.5% (1,000/1,981) mainly sought homosexual partners through the Internet (Internet-based MSM, IBM). The proportion of IBM among total MSM subjects increased from 43.3% to 61.5% (). HIV prevalence of IBM increased from 5.7% to 20.7%, while that of non-Internet-based MSM (NIBM) increased from 7.0% to 14.7%. A relative higher proportion of NIBM were infected with HIV CRF01_AE subtype than IBM (79.5% versus 72.2%, ). Multivariable analysis found IBM had a significantly higher HIV prevalence than NIBM (13.2% versus 10.5%, aOR = 1.4, 95% CI [1.0–1.9]). Being a migrant non-Shenyang resident MSM (aOR = 1.9, 95% CI [1.3–2.9]) and occasionally/never using condoms with casual homosexual partners (aOR = 1.7, 95% CI [1.1–2.6]) were two distinct risk factors for HIV infection in IBM. More efforts should be targeted towards developing interventions aimed at IBM, particularly migrant MSM and who engage in UAI with casual homosexual partners. Shi Pan, Jun-Jie Xu, Xiao-Xu Han, Jing Zhang, Qing-Hai Hu, Zhen-Xing Chu, Yan-Qiu Hai, Xiang Mao, Yan-Qiu Yu, Wen-Qing Geng, Yong-Jun Jiang, and Hong Shang Copyright © 2016 Shi Pan et al. All rights reserved. Gaps in the Continuum of HIV Care: Long Pretreatment Waiting Time between HIV Diagnosis and Antiretroviral Therapy Initiation Leads to Poor Treatment Adherence and Outcomes Thu, 22 Dec 2016 06:42:26 +0000 https://www.hindawi.com/journals/bmri/2016/2648923/ Background. Criteria for antiretroviral treatment (ART) were adjusted to enable early HIV treatment for people living HIV/AIDS (PLHIV) in China in recent years. This study aims to determine how pretreatment waiting time after HIV confirmation affects subsequent adherence and outcomes over the course of treatment. Methods. A retrospective observational cohort study was conducted using treatment data from PLHIV in Yuxi, China, between January 2004 and December 2015. Results. Of 1,663 participants, 348 were delayed testers and mostly initiated treatment within 28 days. In comparison, 1,315 were nondelayed testers and the median pretreatment waiting time was 599 days, but it significantly declined over the study period. Pretreatment CD4 T-cell count drop (every 100 cells/mm3) contributed slowly in CD4 recovery after treatment initiation (8% less, ) and increased the risk of poor treatment adherence by 15% (ARR = 1.15, 1.08–1.25). Every 100 days of extensive pretreatment waiting time increased rates of loss to follow-up by 20% (ARR = 1.20, 1.07–1.29) and mortality rate by 11% (ARR = 1.11, 1.06–1.21), based on multivariable Cox regression. Conclusion. Long pretreatment waiting time in PLHIV can lead to higher risk of poor treatment adherence and HIV-related mortality. Current treatment guidelines should be updated to provide ART promptly. Shu Su, Shifu Li, Shunxiang Li, Liangmin Gao, Ying Cai, Jincui Fu, Chunyuan Guo, Jun Jing, Liang Chen, Limin Mao, Feng Cheng, and Lei Zhang Copyright © 2016 Shu Su et al. All rights reserved. Depression and HIV Risk Behaviors among Female Sex Workers in Guangdong, China: A Multicenter Cross-Sectional Study Tue, 20 Dec 2016 09:22:59 +0000 https://www.hindawi.com/journals/bmri/2016/6986173/ Background. Our study aimed to assess the burden of depression and evaluate factors associated with depression and status of HIV risk behaviors among female sex workers (FSWs) in Guangdong, China. Method. We recruited FSWs from massage parlors, saunas, restaurants, hotels, hair salons, and streets in Guangdong, China, in 2014. Information on demographic characteristics, HIV testing history, and sexual behaviors was collected using a questionnaire. A blood sample was collected to test for HIV, syphilis, and HCV. A participant was defined as being depressed if she obtained 6 points or above using the 12-item General Health Questionnaire. Results. Among the 653 participants, 41.7% were 21–30 years old and 43.6% married. Overall, 52.4% were found to be depressed. FSWs who had correct syphilis related knowledge [aOR = 1.45; 95% CI: 1.04–2.03] and had primary sex partner (1.63, 1.14–2.33) were more likely to be depressed. FSWs who did not use a condom during their last sex with the primary sex partner were less likely to be depressed (0.47, 0.31–0.71). Conclusion. Our study observed high level of depression and HIV risk behaviors among Chinese FSWs. Future interventions should integrate mental health services in comprehensive interventions to prevent depression among Chinese FSWs. Hongcheng Shen, Huachun Zou, Shujie Huang, Fengying Liu, Peizhen Zhao, Lei Chen, Ye Zhang, Xiaomin Luo, Weiming Tang, Heping Zheng, and Bin Yang Copyright © 2016 Hongcheng Shen et al. All rights reserved. The Functional Haplotypes of CHRM3 Modulate mRNA Expression and Associate with Bladder Cancer among a Chinese Han Population in Kaohsiung City Wed, 07 Dec 2016 11:06:50 +0000 https://www.hindawi.com/journals/bmri/2016/4052846/ Bladder cancer is one of the major cancer types and both environmental factors and genetic background play important roles in its pathology. Kaohsiung is a high industrialized city in Taiwan, and here we focused on this region to evaluate the genetic effects on bladder cancer. Muscarinic acetylcholine receptor M3 (CHRM3) was reported as a key receptor in different cancer types. CHRM3 is located at 1q42-43 which was reported to associate with bladder cancer. Our study attempted to delineate whether genetic variants of CHRM3 contribute to bladder cancer in Chinese Han population in south Taiwan. Five selected SNPs (rs2165870, rs10802789, rs685550, rs7520974, and rs3738435) were genotyped for 30 bladder cancer patients and 60 control individuals and genetic association studies were performed. Five haplotypes (GTTAT, ATTGT, GCTAC, ACTAC, and ACCAC) were found significantly associated with low CHRM3 mRNA level and contributed to increased susceptibility of bladder cancer in Kaohsiung city after rigid 10000 consecutive permutation tests. To our knowledge, this is the first genetic association study that reveals the genetic contribution of CHRM3 gene in bladder cancer etiology. Chiang-Ting Wang, Tsung-Ming Chen, Chien-Tai Mei, Chun-Feng Chang, Li-Lian Liu, Kuo-Hsun Chiu, Tsung-Meng Wu, Yu-Ching Lan, Wen-Sheng Liu, Ya-Huey Chen, and Yi-Mei Joy Lin Copyright © 2016 Chiang-Ting Wang et al. All rights reserved. Early Sexual Debut and HIV Infection among Men Who Have Sex with Men in Shenzhen, China Mon, 28 Nov 2016 14:26:41 +0000 https://www.hindawi.com/journals/bmri/2016/2987472/ Studies investigating the association between early sexual debut and human immunodeficiency virus (HIV) infection have mainly focused on Africans or females but rarely on men who have sex with men (MSM) in China. This study, therefore, mainly aimed at exploring the association between early sexual debut and HIV infection among MSM in Shenzhen, China. A total of 533 MSM were enrolled in this study using a convenience sampling method. Information about sociodemographic characteristics and risky sexual behaviors was collected. It was found that the prevalence of HIV infection was 24.2% among this study population and 66.4% of the MSM reported having had vaginal sexual intercourse with females. The mean ages at first vaginal sexual intercourse, first anal sexual intercourse, and first sexual intercourse were 21.38, 22.43, and 19.87 years, respectively. Multivariable logistic regression analyses showed that the MSM who experienced early anal sexual debut were more likely to be infected with HIV than those who did not. The results indicate that HIV infection is quite prevalent among MSM in Shenzhen. Early and efficient intervention strategies should be taken, and the MSM experiencing early anal sexual debut should be given special attention. Ruiwei Xu, Wenjie Dai, Guanglu Zhao, Dan Tu, Lin Yang, Feng Wang, Yumao Cai, Lina Lan, Hongzhuan Tan, Aizhong Liu, Tiejian Feng, and Atipatsa C. Kaminga Copyright © 2016 Ruiwei Xu et al. All rights reserved. Evaluating the Primary Prevention of Ischemic Stroke of Oral Antithrombotic Therapy in Head and Neck Cancer Patients with Radiation Therapy Mon, 21 Nov 2016 14:33:35 +0000 https://www.hindawi.com/journals/bmri/2016/6205158/ Although previous studies demonstrated the risk of ischemic stroke (IS) in patients with head and neck cancer (HNC), the impact of oral antithrombotic therapy (OAT) on this risk has not yet been assessed. We aimed to evaluate the effectiveness and safety of OAT in patients with HNC treated with RT. This retrospective cohort study was performed using the National Health Insurance Research Database of Taiwan. A total of 37,638 patients diagnosed with HNC included in the study were classified as users and nonusers of OAT. Primary outcome was IS or transient ischemic attack (TIA), and secondary outcomes were death and major bleeding. The Cox proportional hazards model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). There was no significant difference in the risk of IS or TIA between patients on continuous OAT and nonusers (adjusted HR, 0.812; 95% CI, 0.199–3.309). The risk of major bleeding was not significantly different between the groups. From a national population database, we did not find an association between OAT and decreasing risk of ischemic stroke/TIA or increasing hazard of major bleeding. Chin-Wei Hsu, Yaw-Bin Huang, Chen-Chun Kuo, and Chung-Yu Chen Copyright © 2016 Chin-Wei Hsu et al. All rights reserved. HIV-1 Epidemiology, Genetic Diversity, and Primary Drug Resistance in the Tyumen Oblast, Russia Sun, 13 Nov 2016 12:30:46 +0000 https://www.hindawi.com/journals/bmri/2016/2496280/ Introduction. Specific molecular epidemic features of HIV infection in Tyumen Oblast (TO), Russia, were studied. Methods. The genome sequences encoding HIV-1 protease-reverse transcriptase, integrase, and major envelope protein were examined for 72 HIV-1 specimens isolated from the TO resident infected in 2000–2015. Results. The recorded prevalence of HIV-1 subtype A (A1) is 93.1%; HIV-1 subtype B continues to circulate in MSM risk group (1.4%). Solitary instances of HIV-1 recombinant forms, CRF63_02A1 (1.4%) and CRF03_AB (1.4%), were detected as well as two cases of HIV-1 URF63_A1 (2.8%). Phylogenetic analysis showed no HIV-1 clustering according to the duration of infection and risk groups but revealed different epidemic networks confirming that HIV infection spread within local epidemic foci. A high incidence of CXCR4-tropic HIV-1 variants and a higher rate of secondary mutations influencing the virus fitness (K20R, L10V, and I) are observed among the virus specimens isolated from newly infected individuals. Conclusions. The current HIV-1 epidemic in TO develops within the local epidemic networks. Similar to the previous period, HIV-1 subtype A is predominant in TO with sporadic cases of importation of HIV-1 recombinant forms circulating in adjacent areas. Natalya M. Gashnikova, Ekaterina M. Astakhova, Mariya P. Gashnikova, Evgeniy F. Bocharov, Svetlana V. Petrova, Olga A. Pun’ko, Alexander V. Popkov, and Aleksey V. Totmenin Copyright © 2016 Natalya M. Gashnikova et al. All rights reserved. Comorbidity in Adult Patients Hospitalized with Type 2 Diabetes in Northeast China: An Analysis of Hospital Discharge Data from 2002 to 2013 Tue, 25 Oct 2016 07:35:31 +0000 https://www.hindawi.com/journals/bmri/2016/1671965/ This study aims to evaluate the comorbidity burden and patterns among adult patients hospitalized with a diagnosis of type 2 diabetes mellitus (T2DM) in Northeast China using hospital discharge data derived from the electronic medical record database between 2002 and 2013. 12.8% of 4,400,892 inpatients aged ≥18 had a diagnosis of T2DM. Sex differences in prevalence varied among those aged <50, 50–59, and ≥60. Twenty-seven diseases were determined as major comorbidities of T2DM. Essential hypertension was the most common comorbidity of T2DM (absolute cooccurrence risk, 58.4%), while T2DM was also the most popular comorbidity of essential hypertension. Peripheral and visceral atherosclerosis showed the strongest association (relative cooccurrence risk, RCoR 4.206). For five leading comorbidities among patients aged ≥40, male patients had a stronger association with disorders of lipid metabolism than female patients (RCoR 2.779 versus 2.099), and female patients had a stronger association with chronic renal failure than male patients (RCoR 2.461 versus 2.155). Leading comorbidities, except chronic renal failure, had declining associations with T2DM with increased age. Collectively, hospital discharge data can be used to estimate disease prevalence and identify comorbidities. The findings provided comprehensive information on comorbidity patterns, helping policy makers and programs in public health domains to estimate and evaluate the epidemic of chronic diseases. Hui Chen, Yaoyun Zhang, Di Wu, Chunxiu Gong, Qing Pan, Xiao Dong, Yonghui Wu, Kuan Zhang, Shiping Wang, Jianbo Lei, and Hua Xu Copyright © 2016 Hui Chen et al. All rights reserved. Prevalence of HIV Antiretroviral Drug Resistance and Its Impacts on HIV-1 Virological Failures in Jiangsu, China: A Cross-Sectional Study Tue, 11 Oct 2016 14:52:22 +0000 https://www.hindawi.com/journals/bmri/2016/1752437/ Antiretroviral therapy (ART) has been shown to improve survival of patients with Human Immunodeficiency Virus (HIV) infection and to reduce HIV-1 transmission. Therefore, the Chinese central government initiated a national program to provide ART free of charge to HIV-1 patients. We conducted a cross-sectional survey in Jiangsu province to determine the level of drug resistance (DR) in HIV-1 infected patients and the correlates of DR in virological failures in 2012. Approximately 10.4% of the HIV-1 patients in the study experienced virological failure after one year of ART and were divided into drug sensitive and drug resistant groups based on genotype determination. The viral loads (VLs) in the drug resistant group were significantly lower than the drug sensitive group. There were two independent predictors of virological failure: male gender and increasing duration of treatment. The primary mutations observed in the study were against nucleoside reverse transcriptase inhibitors (NRTIs) which were M184V (79.45%) and K103N (33.70%) in nonnucleoside reverse transcriptase inhibitors (NNRTIs). The overall rate of DR in Jiangsu province is still relatively low among treated patients. However, close monitoring of drug resistance in male patients in the early stages of treatment is vital to maintaining and increasing the benefits of HIV ART achieved to date. Ying Zhou, Jing Lu, Jinge Wang, Hongjing Yan, Jianjun Li, Xiaoqin Xu, Zhi Zhang, Tao Qiu, Ping Ding, Gengfeng Fu, Xiping Huan, and Haiyang Hu Copyright © 2016 Ying Zhou et al. All rights reserved. Prevalence and Risk Factors of Colonization with Staphylococcus aureus in Healthy Pet Cats Kept in the City Households Wed, 28 Sep 2016 15:29:11 +0000 https://www.hindawi.com/journals/bmri/2016/3070524/ Staphylococcus aureus, especially methicillin-resistant S. aureus (MRSA), is a significant pathogen in both human medicine and veterinary medicine. The importance of pets as reservoirs of human infections is still poorly understood. This article provides detailed information of a cross-sectional study of a S. aureus colonization in clinically healthy indoor cats. The study systematically assessed a number of different anatomical locations for the S. aureus colonization and the influence of a range of potential risk factors on the value of the final S. aureus colonization rate. The incidence rates observed for cats with at least one site positive for S. aureus or MRSA were 17.5% and 6.63%, respectively. The following risk factors were identified: one or more owners working in the healthcare industry (human or veterinary); dogs being kept with the cat under investigation; treatment of the cat under investigation with antibiotics or chemotherapeutics during the previous year. In conclusion, this study revealed a higher prevalence of MRSA than what has previously been reported in healthy pets. A combination of anatomical locations from which the samples were collected had a major influence on the final value of the S. aureus colonization rate. Karolina Bierowiec, Katarzyna Płoneczka-Janeczko, and Krzysztof Rypuła Copyright © 2016 Karolina Bierowiec et al. All rights reserved. Late Presentation of HIV Infection: Prevalence, Trends, and the Role of HIV Testing Strategies in Guangzhou, China, 2008–2013 Tue, 27 Sep 2016 12:58:01 +0000 https://www.hindawi.com/journals/bmri/2016/1631878/ Background. The prevalence, trends, and the role of different HIV testing strategies in late presentation of HIV infection in China were unknown. Methods. Data of newly reported HIV cases in Guangzhou between 2008 and 2013 was analyzed to examine the prevalence, trends, and characteristics of late presentation of HIV infection by three types of HIV testing strategies. Results. Overall, 53.2% (1412/2653) and 27.3% (724/2653) met the criteria of late presentation and presentation with advanced HIV disease. The overall trend of late presentation of HIV infection within the study period was declining. Late presentation was 62.9% in 2008 and dropped to 43.3% in 2013 (); presentation with advanced HIV disease was 40.3% in 2008 and dropped to 15.2% in 2013 (). Of the three testing strategies, PITC presented higher odds of both late presentation [AOR (95% CI): PITC versus VCT: 1.37 (1.09, 1.73); PITC versus MHT: 3.09 (2.16, 4.42)] and presentation with advanced HIV disease [AOR (95% CI): PITC versus VCT: 1.65 (1.29, 2.11); PITC versus MHT: 13.14 (8.47, 20.39)]. Conclusions. Although the late presentation of HIV infection was declining, it was still high in Guangzhou. The worse situation among PITC cases urges the policy adjustment in medical settings to increase early HIV diagnosis. Weibin Cheng, Weiming Tang, Zhigang Han, Thitikarn May Tangthanasup, Fei Zhong, Faju Qin, and Huifang Xu Copyright © 2016 Weibin Cheng et al. All rights reserved. Maternal and Neonatal and Child Health Priorities in Africa and Asia Sun, 18 Sep 2016 13:44:16 +0000 https://www.hindawi.com/journals/bmri/2016/9107970/ Sten H. Vermund, Renu Garg, Ying-Ru Lo, Emily K. Sheldon, and Kasonde Mwinga Copyright © 2016 World Health Organization. All rights reserved. Comment on “Toxoplasma gondii Infection in Pregnant Women: A Seroprevalence and Case-Control Study in Eastern China” Wed, 14 Sep 2016 09:41:32 +0000 https://www.hindawi.com/journals/bmri/2016/5412168/ Siddharudha Shivalli and Soujanya Kaup Copyright © 2016 Siddharudha Shivalli and Soujanya Kaup. All rights reserved. Low Neonatal Mortality and High Incidence of Infectious Diseases in a Vietnamese Province Hospital Thu, 11 Aug 2016 11:19:50 +0000 https://www.hindawi.com/journals/bmri/2016/2087042/ Background. Neonatal deaths constitute the majority of child mortality in Vietnam, but studies are scarce and focus on community settings. Methods. During a 12-month period, all sick neonates admitted to a pediatric department in a province hospital were studied. Potential risk factors of death covering sociodemographic factors, pregnancy history, previous neonatal period, and status on admission were registered. The neonates were followed up until discharge or death or until 28 completed days of age if still hospitalized or until withdrawal of life support. The main outcome was neonatal death. Results. The neonatal mortality was 4.6% (50/1094). In a multivariate analysis, four associated risk factors of death were extremely low birth weight ( (2.3–233.4)), no cry at birth ( (1.3–9.4)), and cyanosis ( (1.2–8.7)) and shock ( (2.5–61.5)) on admission. The major discharge diagnoses were infection, prematurity, congenital malformations, and asphyxia in 88.5% (936/1058), 21.3% (225/1058), 5.0% (53/1058), and 4.6% (49/1058), respectively. In 36, a discharge diagnosis was not registered. Conclusion. Infection was the main cause of neonatal morbidity. Asphyxia and congenital malformations were diagnosed less frequently. The neonatal mortality was 4.6%. No sociodemographic factors were associated with death. Extreme low birth weight, no cry at birth, and cyanosis or shock at admission were associated with death. Binh T. T. Ho, Alexandra Y. Kruse, Hue T. H. Le, Phuong N. Cam, and Freddy K. Pedersen Copyright © 2016 Binh T. T. Ho et al. All rights reserved. A Retrospective Observational Study to Assess Prescription Pattern in Patients with Type B Aortic Dissection and Treatment Outcome Mon, 01 Aug 2016 05:58:14 +0000 https://www.hindawi.com/journals/bmri/2016/5173898/ Aortic dissection is a life-threatening condition. However, the use of medication to treat it remains unclear in our population, particularly in patients with a type B aortic dissection (TBAD) who do not receive surgery. This retrospective cohort study evaluated antihypertensive prescription patterns and outcomes in patients with nonsurgical TBAD. We reviewed the hospital records of patients with TBAD at a medical center in Taiwan from January 2008 to June 2013 to assess the baseline information, prescribing pattern, event rate, and clinical effectiveness of different antihypertensive treatment strategies. A Cox proportional hazards model was used to estimate outcomes in different antihypertensive strategies. The primary endpoints were all-cause mortality and hospital admission for an aortic dissection. We included 106 patients with a mean follow-up period of 2.75 years. The most common comorbidity was hypertension followed by dyslipidemia and diabetes mellitus. Study endpoints mostly occurred within 6 months after the index date. Over 80% of patients received dual or triple antihypertensive strategies. Patients treated with different treatment strategies did not have a significantly increased risk of a primary outcome compared with those treated with a monotherapy. We found no significant difference in the primary outcome following the use of different antihypertensive medication regimes. Kuang-Ming Liao, Chung-Yu Chen, Shih-Han Wang, Jiann-Woei Huang, Chen-Chun Kuo, and Yaw-Bin Huang Copyright © 2016 Kuang-Ming Liao et al. All rights reserved. Molecular Characterization of High-Risk Human Papillomavirus in Women in Bobo-Dioulasso, Burkina Faso Wed, 20 Jul 2016 11:42:27 +0000 https://www.hindawi.com/journals/bmri/2016/7092583/ High-risk human papillomavirus (HPV) is found in over 99% of cervical cancers. The aim of this study was to determine the prevalence of HPV in a population of women in Bobo-Dioulasso and to identify the high-risk types present in these women. From May to June, 2015, 181 women who came for consultation at the Souro Sanou University Hospital of Bobo-Dioulasso have been included in this study. Uterine endocervical swabs have been taken in these women. DNA obtained by extraction from the samples thus collected was used to determine the prevalence of high-risk human papillomavirus genotypes through real-time PCR. The age of the women ranged from 20 to 56 years with a mean of years. The prevalence of infection by high-risk HPV types was 25.4% (46/181). The most common high-risk HPV genotypes were HPV 39 (18.5%), HPV 52 (16.7%), HPV 18 (14.8%), and HPV 35 (13.0%). HPV 16 which is included in the HPV vaccines was not found in the population studied. This type of study which is the first one in Bobo-Dioulasso has showed a high prevalence of genotypes HPV 39, HPV 52, and HPV 35 which are not yet covered by a vaccine. Ina Marie Angèle Traore, Théodora Mahoukèdè Zohoncon, Adama Dembele, Florencia W. Djigma, Dorcas Obiri-Yeboah, Germain Traore, Moussa Bambara, Charlemagne Ouedraogo, Yves Traore, and Jacques Simpore Copyright © 2016 Ina Marie Angèle Traore et al. All rights reserved. Outcome of Home-Based Early Intervention for Autism in Sri Lanka: Follow-Up of a Cohort and Comparison with a Nonintervention Group Wed, 22 Jun 2016 06:59:22 +0000 https://www.hindawi.com/journals/bmri/2016/3284087/ This paper presents the outcome of a home-based autism intervention program (HBAIP) in 18- to 40-month-old children newly diagnosed and treatment naïve. Intervention was exclusively implemented at home. Outcome was measured at 3 months and 6 months after intervention and compared with a group of newly diagnosed children with autism who were >40 months at intake but had not received any autism specific clinical management. Aim was also to estimate whether natural development would contribute to gain in skills and compare with the effect of intervention. Five selected parameters of behavior representing social interaction and social communication were used to assess outcome. Results showed a statistically significant improvement between preintervention and postintervention in all the measured parameters. The effect size was large when compared to preintervention and gains were indicated by changes in mean scores and values within a narrow confidence interval. Highest gains were in first 3 months of postintervention which continued up to 6 months. Although the comparison group was more advanced in the measured skills at intake, they were significantly below the level reached by experimental group at 3 months and 6 months after intervention. This study was registered in the Sri Lanka Clinical Trials Registry (SLCTR/2009/011). Hemamali Perera, Kamal Chandima Jeewandara, Sudarshi Seneviratne, and Chandima Guruge Copyright © 2016 Hemamali Perera et al. All rights reserved. Turning Disaster into an Opportunity for Quality Improvement in Essential Intrapartum and Newborn Care Services in the Philippines: Pre- to Posttraining Assessments Wed, 15 Jun 2016 09:34:06 +0000 https://www.hindawi.com/journals/bmri/2016/6264249/ Background. On 8 November 2013, supertyphoon Haiyan made landfall in the Philippines, severely disrupting health service delivery. Reestablishment of essential services for birthing mothers and their newborns became high priority. Methodology. Following a baseline assessment, an Essential Intrapartum and Newborn Care (EINC) training package was implemented and posttraining assessments (1 and 3 months after training) were undertaken. Results. Baseline assessments ( facilities) revealed gaps in provider’s skill and shortage of life-saving commodities. Facilities lacked newborn bags/masks (9%), towels (6%), and magnesium sulfate (39%). Service providers lacked skills in partograph use (54%), antenatal steroid (44%) use, and breastfeeding initiation (50%). At 3 months after training ( facilities), dramatic increases in correct partograph use (to 92%), antenatal steroid use (to 98%), breastfeeding initiation (to 86%), kangaroo mother care (to 94%), availability of magnesium sulfate (to 94%), and bag/masks (to 88%) were documented. Gaps persisted for skills in assisted vaginal delivery and removal of placental fragments. Conclusion. Health services were severely disrupted after supertyphoon Haiyan. Our study demonstrates that essential birthing services and quality improvements to strengthen local health systems can be restored in a timely manner even in immediate postdisaster settings. M. S. Castillo, M. A. Corsino, A. P. Calibo, W. Zeck, D. S. Capili, L. C. Andrade, K. A. Reyes, R. C. Alfonso, M. B. Ponferrada, and M. A. Silvestre Copyright © 2016 M. S. Castillo et al. All rights reserved. First Report of Bovine Leukemia Virus Infection in Yaks (Bos mutus) in China Thu, 02 Jun 2016 12:46:10 +0000 https://www.hindawi.com/journals/bmri/2016/9170167/ Enzootic bovine leukosis (EBL) is a chronic lymphosarcoma disease of cattle caused by bovine leukemia virus (BLV). No information is available concerning the epidemiology of BLV infection in yaks (Bos mutus). One thousand five hundred and eighty-four serum samples from 610 black yaks and 974 white yaks from Gansu province, northwest China, were collected between April 2013 and March 2014 and tested for BLV antibodies using a commercially available ELISA kit. The overall BLV seroprevalence in yaks was 21.09% (334/1584), with 24.26% (148/610) black yaks and 19.10% (186/974) white yaks yielding positive results. Risk factor analysis indicated that with the exception of breed (OR = 1.36, 95% CI = 1.06–1.73, ), the age, region, gender, farm, and the numbers of pregnancies were not considered as risk factors for the presence of BLV in yaks included in this study. This is the first report of BLV infection in yaks in China, which provides information for controlling BLV infection in yaks. Jian-Gang Ma, Wen-Bin Zheng, Dong-Hui Zhou, Si-Yuan Qin, Ming-Yang Yin, Xing-Quan Zhu, and Gui-Xue Hu Copyright © 2016 Jian-Gang Ma et al. All rights reserved. Prenatal Maternal Anxiety as a Risk Factor for Preterm Birth and the Effects of Heterogeneity on This Relationship: A Systematic Review and Meta-Analysis Thu, 19 May 2016 12:04:38 +0000 https://www.hindawi.com/journals/bmri/2016/8312158/ Background. Systematic reviews (SR) and meta-analyses (MA) that previously explored the relationship between prenatal maternal anxiety (PMA) and preterm birth (PTB) have not been comprehensive in study inclusion, failing to account for effects of heterogeneity and disagree in their conclusions. Objectives. This SRMA provides a summary of the published evidence of the relationship between PMA and PTB while examining methodological and statistical sources of heterogeneity. Methods. Published studies from MEDLINE, CINAHL, PsycINFO, and EMBASE, until June 2015, were extracted and reviewed. Results. Of the 37 eligible studies, 31 were used in this MA; six more were subsequently excluded due to statistical issues, substantially reducing the heterogeneity. The odds ratio for PMA was 1.70 (95% CI 1.33, 2.18) for PTB and 1.67 (95% CI 1.35, 2.07) for spontaneous PTB comparing higher levels of anxiety to lower levels. Conclusions. Consistent findings indicate a significant association between PMA and PTB. Due to the statistical problem of including collinear variables in a single regression model, it is hard to distinguish the effect of the various types of psychosocial distress on PTB. However, a prenatal program aimed at addressing mental health issues could be designed and evaluated using a randomised controlled trial to assess the causal nature of different aspects of mental health on PTB. M. Sarah Rose, Gianella Pana, and Shahirose Premji Copyright © 2016 M. Sarah Rose et al. All rights reserved. Molecular Epidemiological Investigation of Porcine kobuvirus and Its Coinfection Rate with PEDV and SaV in Northwest China Mon, 16 May 2016 13:58:40 +0000 https://www.hindawi.com/journals/bmri/2016/7590569/ Porcine kobuvirus (PKV) has circulated throughout China in recent years. Although many studies have detected it throughout the world, its molecular epidemiology has not been characterized in northwest China. To understand its prevalence, 203 fecal samples were collected from different regions of Gansu Province and tested with reverse transcription-polymerase chain reaction. In this study, we tested these samples for PKV, porcine epidemic diarrhea virus (PEDV), and sapovirus and analyzed the amplified 2C gene fragments of PKV. Overall, 126 (62.1%) samples were positive for PKV. Of the 74 piglets samples among the 203 fecal samples, 65 (87.8%) were positive for PKV. PKV infection was often accompanied by PEDV, but the relationship between the two viruses must be confirmed. A phylogenetic analysis indicated that the PKV strains isolated from the same regions clustered on the same branches. This investigation shows that PKV infections are highly prevalent in pigs in northwest China, especially in piglets with symptoms of diarrhea. Chen Wang, Xi Lan, and Bin Yang Copyright © 2016 Chen Wang et al. All rights reserved. Herpes Simplex Virus Type 1 and Type 2 Infection Increases Atherosclerosis Risk: Evidence Based on a Meta-Analysis Tue, 19 Apr 2016 13:33:46 +0000 https://www.hindawi.com/journals/bmri/2016/2630865/ Objective. The aim of our study was to evaluate the relation of herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) infection with the risk of atherosclerosis (AS). Methods. A systematic literature search was performed through three electronic databases. The pooled odds ratio (OR) and corresponding 95% confidence interval (CI) were used to assess the effect of HSV-1 and HSV-2 infection on AS risk. Results. 17 studies were available for meta-analysis of HSV-1 infection and AS risk and seven studies for meta-analysis of HSV-2 infection and AS risk. Subjects exposed to HSV-1 infection exhibited an increased risk of AS (OR = 1.77; 95% CI: 1.40–2.23; ). And consistent elevated AS risks for HSV-1 positive subjects were found in all subgroup analysis of disease type, region, male proportion, and age. HSV-2 positive subjects demonstrated significantly increased AS risk (OR = 1.37; 95% CI: 1.13–1.67; ). In subgroup analysis, elevated AS risks were only observed in myocardial ischemia group, male proportion >60% group, and age ≤60-year-old group. Conclusion. Our meta-analysis indicated that HSV-1 and HSV-2 infection could increase the risk of contracting AS. Yu peng Wu, Dan dan Sun, Yun Wang, Wen Liu, and Jun Yang Copyright © 2016 Yu peng Wu et al. All rights reserved. Chlamydia trachomatis Infection in Pregnancy: The Global Challenge of Preventing Adverse Pregnancy and Infant Outcomes in Sub-Saharan Africa and Asia Wed, 06 Apr 2016 12:45:32 +0000 https://www.hindawi.com/journals/bmri/2016/9315757/ Screening and treatment of sexually transmitted infections (STIs) in pregnancy represents an overlooked opportunity to improve the health outcomes of women and infants worldwide. Although Chlamydia trachomatis is the most common treatable bacterial STI, few countries have routine pregnancy screening and treatment programs. We reviewed the current literature surrounding Chlamydia trachomatis in pregnancy, particularly focusing on countries in sub-Saharan Africa and Asia. We discuss possible chlamydial adverse pregnancy and infant health outcomes (miscarriage, stillbirth, ectopic pregnancy, preterm birth, neonatal conjunctivitis, neonatal pneumonia, and other potential effects including HIV perinatal transmission) and review studies of chlamydial screening and treatment in pregnancy, while simultaneously highlighting research from resource-limited countries in sub-Saharan Africa and Asia. Kristina Adachi, Karin Nielsen-Saines, and Jeffrey D. Klausner Copyright © 2016 Kristina Adachi et al. All rights reserved. Call to Action for Nurses/Nursing Wed, 06 Apr 2016 08:30:23 +0000 https://www.hindawi.com/journals/bmri/2016/3127543/ The 13 million nurses worldwide constitute most of the global healthcare workforce and are uniquely positioned to engage with others to address disparities in healthcare to achieve the goal of better health for all. A new vision for nurses involves active participation and collaboration with international colleagues across research practice and policy domains. Nursing can embrace new concepts and a new approach—“One World, One Health”—to animate nursing engagement in global health, as it is uniquely positioned to participate in novel ways to improve healthcare for the well-being of the global community. This opinion paper takes a historical and reflective approach to inform and inspire nurses to engage in global health practice, research, and policy to achieve the Sustainable Development Goals. It can be argued that a colonial perspective currently informs scholarship pertaining to nursing global health engagement. The notion of unidirectional relationships where those with resources support training of those less fortunate has dominated the framing of nursing involvement in low- and middle-income countries. This paper suggests moving beyond this conceptualization to a more collaborative and equitable approach that positions nurses as cocreators and brokers of knowledge. We propose two concepts, reverse innovation and two-way learning, to guide global partnerships where nurses are active participants. Shahirose S. Premji and Jennifer Hatfield Copyright © 2016 Shahirose S. Premji and Jennifer Hatfield. All rights reserved. Acceptability and Feasibility of Sexually Transmitted Infection Testing and Treatment among Pregnant Women in Gaborone, Botswana, 2015 Mon, 28 Mar 2016 06:30:17 +0000 https://www.hindawi.com/journals/bmri/2016/1251238/ Introduction. Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) are curable sexually transmitted infections (STIs) that can cause adverse maternal and birth outcomes. Most countries do not conduct routine testing during antenatal care. We present data on the acceptability and feasibility of testing and treating pregnant women for STIs in an antenatal clinic in Gaborone, Botswana. Materials and Methods. We offered CT, NG, and TV testing using self-collected vaginal swabs to eligible pregnant women. Participants received same-day test results. Those who tested positive were given treatment. Results. Among the 225 women who were eligible and recruited, 200 (89%) agreed to participate. The median age of our study sample was 30 years; most were unmarried (77%), with a median gestational age of 27 weeks and a 23% HIV prevalence. All participants received their results with at least 72% () on the same day. Thirty participants (15%) tested positive for an STI, all were treated, and 24 (80%) were treated on the same day. Conclusion. The acceptability of STI testing was high, and the intervention was feasible. This study provides support for continued research into STI prevalence, cost-effectiveness, and the association of STIs with adverse maternal and infant outcomes. Adriane Wynn, Doreen Ramogola-Masire, Ponatshego Gaolebale, Neo Moshashane, Ogechukwu Agatha Offorjebe, Kaitlin Arena, Jeffrey D. Klausner, and Chelsea Morroni Copyright © 2016 Adriane Wynn et al. All rights reserved. Prenatal Evaluation of MicroRNA Expressions in Pregnancies with Down Syndrome Thu, 24 Mar 2016 08:46:17 +0000 https://www.hindawi.com/journals/bmri/2016/5312674/ Background. Currently, the data available on the utility of miRNAs in noninvasive prenatal testing is insufficient in the literature. We evaluated the expression levels of 14 miRNAs located on chromosome 21 in maternal plasma and their utility in noninvasive prenatal testing of Down Syndrome. Method. A total of 56 patients underwent invasive prenatal testing; 23 cases were carrying Down Syndrome affected fetuses, and 33 control cases carrying unaffected, normal karyotype fetuses were included for comparison. Indications for invasive prenatal testing were advanced maternal age, increased risk of Down Syndrome in screening tests, and abnormal finding in the sonographic examination. In both the study and control groups, all the pregnant women were at 17th and 18th week of gestation. miRNA expression levels were measured using real-time RT-PCR. Results. Significantly increased maternal plasma levels of miR-3156 and miR-99a were found in the women carrying a fetus with Down Syndrome. Conclusion. Our results provide a basis for multicenter studies with larger sample groups and microRNA profiles, particularly with the microRNAs which were found to be variably expressed in our study. Through this clinical research, the utility of microRNAs in noninvasive prenatal testing can be better explored in future studies. Biray Erturk, Emin Karaca, Ayca Aykut, Burak Durmaz, Ahmet Guler, Baris Buke, Ahmet Ozgur Yeniel, Ahmet Mete Ergenoglu, Ferda Ozkinay, Mehmet Ozeren, Mert Kazandi, Fuat Akercan, Sermet Sagol, Cumhur Gunduz, and Ozgur Cogulu Copyright © 2016 Biray Erturk et al. All rights reserved. “I Always Worry about What Might Happen Ahead”: Implementing Safer Conception Services in the Current Environment of Reproductive Counseling for HIV-Affected Men and Women in Uganda Tue, 08 Mar 2016 07:11:10 +0000 https://www.hindawi.com/journals/bmri/2016/4195762/ Background. We explored healthcare provider perspectives and practices regarding safer conception counseling for HIV-affected clients. Methods. We conducted semistructured interviews with 38 providers (medical and clinical officers, nurses, peer counselors, and village health workers) delivering care to HIV-infected clients across 5 healthcare centres in Mbarara District, Uganda. Interview transcripts were analyzed using content analysis. Results. Of 38 providers, 76% were women with median age 34 years (range 24–57). First, we discuss providers’ reproductive counseling practices. Emergent themes include that providers (1) assess reproductive goals of HIV-infected female clients frequently, but infrequently for male clients; (2) offer counseling focused on “family planning” and maternal and child health; (3) empathize with the importance of having children for HIV-affected clients; and (4) describe opportunities to counsel HIV-serodiscordant couples. Second, we discuss provider-level challenges that impede safer conception counseling. Emergent themes included the following: (1) providers struggle to translate reproductive rights language into individualized risk reduction given concerns about maternal health and HIV transmission and (2) providers lack safer conception training and support needed to provide counseling. Discussion. Tailored guidelines and training are required for providers to implement safer conception counseling. Such support must respond to provider experiences with adverse HIV-related maternal and child outcomes and a national emphasis on pregnancy prevention. Lynn T. Matthews, Francis Bajunirwe, Jasmine Kastner, Naomi Sanyu, Cecilia Akatukwasa, Courtney Ng, Rachel Rifkin, Cecilia Milford, Lizzie Moore, Ira B. Wilson, David R. Bangsberg, Jennifer A. Smit, and Angela Kaida Copyright © 2016 Lynn T. Matthews et al. All rights reserved. Associations of Genetic Variants at Nongenic Susceptibility Loci with Breast Cancer Risk and Heterogeneity by Tumor Subtype in Southern Han Chinese Women Sun, 28 Feb 2016 14:27:53 +0000 https://www.hindawi.com/journals/bmri/2016/3065493/ Current understanding of cancer genomes is mainly “gene centric.” However, GWAS have identified some nongenic breast cancer susceptibility loci. Validation studies showed inconsistent results among different populations. To further explore this inconsistency and to investigate associations by intrinsic subtype (Luminal-A, Luminal-B, ER−&PR−&HER2+, and triple negative) among Southern Han Chinese women, we genotyped five nongenic polymorphisms (2q35: rs13387042, 5p12: rs981782 and rs4415084, and 8q24: rs1562430 and rs13281615) using MassARRAY IPLEX platform in 609 patients and 882 controls. Significant associations with breast cancer were observed for rs13387042 and rs4415084 with OR (95% CI) per-allele 1.29 (1.00–1.66) and 0.83 (0.71–0.97), respectively. In subtype specific analysis, rs13387042 (per-allele adjusted OR = 1.36, 95% CI = 1.00–1.87) and rs4415084 (per-allele adjusted OR = 0.82, 95% CI = 0.66–1.00) showed slightly significant association with Luminal-A subtype; however, only rs13387042 was associated with ER−&PR−&HER2+ tumors (per-allele adjusted OR = 1.55, 95% CI = 1.00–2.40), and none of them were linked to Luminal-B and triple negative subtype. Collectively, nongenic SNPs were heterogeneous according to the intrinsic subtype. Further studies with larger datasets along with intrinsic subtype categorization should explore and confirm the role of these variants in increasing breast cancer risk. Huiying Liang, Hong Li, Xuexi Yang, Lujia Chen, Anna Zhu, Minying Sun, Changsheng Ye, and Ming Li Copyright © 2016 Huiying Liang et al. All rights reserved. Mathematical Model for an Effective Management of HIV Infection Sun, 28 Feb 2016 07:25:11 +0000 https://www.hindawi.com/journals/bmri/2016/4217548/ Human immunodeficiency virus infection destroys the body immune system, increases the risk of certain pathologies, damages body organs such as the brain, kidney, and heart, and causes death. Unfortunately, this infectious disease currently has no cure; however, there are effective retroviral drugs for improving the patients’ health conditions but excessive use of these drugs is not without harmful side effects. This study presents a mathematical model with two control variables, where the uninfected CD4+T cells follow the logistic growth function and the incidence term is saturated with free virions. We use the efficacy of drug therapies to block the infection of new cells and prevent the production of new free virions. Our aim is to apply optimal control approach to maximize the concentration of uninfected CD4+T cells in the body by using minimum drug therapies. We establish the existence of an optimal control pair and use Pontryagin’s principle to characterize the optimal levels of the two controls. The resulting optimality system is solved numerically to obtain the optimal control pair. Finally, we discuss the numerical simulation results which confirm the effectiveness of the model. Oladotun Matthew Ogunlaran and Suares Clovis Oukouomi Noutchie Copyright © 2016 Oladotun Matthew Ogunlaran and Suares Clovis Oukouomi Noutchie. All rights reserved. Evaluating Religious Influences on the Utilization of Maternal Health Services among Muslim and Christian Women in North-Central Nigeria Wed, 24 Feb 2016 09:41:55 +0000 https://www.hindawi.com/journals/bmri/2016/3645415/ Introduction. Uptake of antenatal services is low in Nigeria; however, indicators in the Christian-dominated South have been better than in the Muslim-dominated North. This study evaluated religious influences on utilization of general and HIV-related maternal health services among women in rural and periurban North-Central Nigeria. Materials and Methods. Targeted participants were HIV-positive, pregnant, or of reproductive age in the Federal Capital Territory and Nasarawa. Themes explored were utilization of facility-based services, provider gender preferences, and Mentor Mother acceptability. Thematic and content approaches were applied to manual data analysis. Results. Sixty-eight (68) women were recruited, 72% Christian and 28% Muslim. There were no significant religious influences identified among barriers to maternal service uptake. All participants stated preference for facility-based services. Uptake limitations were mainly distance from clinic and socioeconomic dependence on male partners rather than religious restrictions. Neither Muslim nor Christian women had provider gender preferences; competence and positive attitude were more important. All women found Mentor Mothers highly acceptable. Conclusion. Barriers to uptake of maternal health services appear to be minimally influenced by religion. ANC/PMTCT uptake interventions should target male partner buy-in and support, healthcare provider training to improve attitudes, and Mentor Mother program strengthening and impact assessment. Maryam Al-Mujtaba, Llewellyn J. Cornelius, Hadiza Galadanci, Salome Erekaha, Joshua N. Okundaye, Olusegun A. Adeyemi, and Nadia A. Sam-Agudu Copyright © 2016 Maryam Al-Mujtaba et al. All rights reserved. Coxiella burnetii Seroprevalence and Risk Factors in Cattle Farmers and Farm Residents in Three Northeastern Provinces and Inner Mongolia Autonomous Region, China Thu, 04 Feb 2016 13:32:47 +0000 https://www.hindawi.com/journals/bmri/2016/7059196/ Little is known about Coxiella burnetii infection among cattle farmers and farm residents in China. Thus, the present study was conducted to detect the seroprevalence of C. burnetii infection and estimate associated risk factors among cattle farmers and farm residents in China. A cross-sectional study was designed, and sera of 362 people living or working on 106 cattle farms were tested for C. burnetii IgG and IgM antibodies by immunofluorescence assay. Overall C. burnetii seroprevalence was 35.6% (129/362, 95% CI: 30.70–40.57), and 112 participants had experienced a past infection and seventeen (4.7%) had experienced a relatively recent infection. In the final combined multilevel model, the following activities were significantly associated with presence of antibodies against C. burnetii: milking cattle, providing general healthcare to cattle, providing birth assistance, contact dead-born animals, urbanization, and presence of mice and/or rats in the stable. Moreover, presence of disinfection equipment was a significant protective factor. This is the first study addressing the seroprevalence and risk factors of C. burnetii infection in cattle farmers and farm residents in three northeastern provinces and Inner Mongolia Autonomous Region, China. Wu-Wen Sun, Wei Cong, Mao-Hui Li, Chun-Feng Wang, Xiao-Feng Shan, and Ai-Dong Qian Copyright © 2016 Wu-Wen Sun et al. All rights reserved. Status of Human Papillomavirus Infection in the Ethnic Population in Yunnan Province, China Sun, 27 Dec 2015 13:52:39 +0000 https://www.hindawi.com/journals/bmri/2015/314815/ HPV genotypes have distinct distributions among various ethnic populations worldwide. In December 2013, 237 and 159 cervical samples were collected from Hani and Han ethnic women, respectively, in Mojiang, a rural county in southern Yunnan. The overall HPV infection rate (21.1%) among the Hani women was significantly higher than that among the Han women (12.6%). The high-risk (HR) and low-risk (LR) HPV and single- and multiple-genotype infection rates among the Hani women were 11.0%, 4.6%, 15.6%, and 5.5%, respectively. HPV-16 (3.8%) was the most prevalent genotype among the Hani women, followed by HPV-52 (1.7%), HPV-31 (0.8%), and HPV-33 (0.8%). Comparatively, the Han women had lower infection rates of high-risk (8.2%), low-risk (1.2%), single-genotype (9.4%), and multiple-genotype HPV infections (3.1%). HPV-16 (3.1%) was also the predominant genotype among the Han women, followed by HPV-52 (1.3%), HPV-33 (0.6%), HPV-44 (0.6%), and HPV-54 (0.6%). The area background, number of children, and past history of STIs were recognized as potential risk factors for HPV infection. Rural background, age, education level, number of children, and illness history were significantly associated with HPV infection among the Hani women. These findings highlight the urgent need for HPV prevention and control strategies in Yunnan, particularly for the Hani ethnic women. Zulqarnain Baloch, Lei Yue, Tao Yuan, Yue Feng, Wenlin Tai, Yanqing Liu, Binghui Wang, Xiao Li, Li Liu, A-Mei Zhang, Xiaomei Wu, and Xueshan Xia Copyright © 2015 Zulqarnain Baloch et al. All rights reserved. Temporal Trends and Predictors of Modern Contraceptive Use in Lusaka, Zambia, 2004–2011 Sun, 27 Dec 2015 09:20:01 +0000 https://www.hindawi.com/journals/bmri/2015/521928/ Introduction. Although increasing access to family planning has been an important part of the global development agenda, millions of women continue to face unmet need for contraception. Materials and Methods. We analyzed data from a repeated cross-sectional community survey conducted in Lusaka, Zambia, over an eight-year period. We described prevalence of modern contraceptive use, including long-acting reversible contraception (LARC), among female heads of household aged 16–50 years. We also identified predictors of LARC versus short-term contraceptive use among women using modern methods. Results and Discussion. Twelve survey rounds were completed between November 2004 and September 2011. Among 29,476 eligible respondents, 17,605 (60%) reported using modern contraception. Oral contraceptive pills remained the most popular method over time, but use of LARC increased significantly, from less than 1% in 2004 to 9% by 2011 (). Younger women (OR: 0.46, 95% CI: 0.34, 0.61) and women with lower levels of education (OR: 0.70, 95% CI: 0.56, 0.89) were less likely to report LARC use compared to women using short-term modern methods. Conclusions. Population-based assessments of contraceptive use over time can guide programs and policies. To achieve reproductive health equity and reduce unmet contraceptive need, future efforts to increase LARC use should focus on young women and those with less education. Nancy L. Hancock, Carla J. Chibwesha, Marie C. D. Stoner, Bellington Vwalika, Sujit D. Rathod, Margaret Phiri Kasaro, Elizabeth M. Stringer, Jeffrey S. A. Stringer, and Benjamin H. Chi Copyright © 2015 Nancy L. Hancock et al. All rights reserved. Structural Determinants in Family Planning Service Utilization in Ethiopia: EDHS 2011 Analysis Wed, 09 Dec 2015 07:42:44 +0000 https://www.hindawi.com/journals/bmri/2015/495745/ Family planning coverage has improved in Ethiopia in the last decade, though fertility is still about 5.8 in the rural setup. In this paper, the major structural determinants of family planning service were analyzed using a multilevel model from 8906 individual women observation in the 2011 EDHS data. The results show that there is a big variation in family planning use both at the individual and between group levels. More than 39% of the variation in FP use is explained by contextual cluster level differences. Most of the socioeconomic predictors; respondent’s education, ethnicity, and partners’ education as well as employment status and urbanization were found to be significant factors that affect FP use. Similarly health extension visit and media access were found to be strong factors that affect FP service at both individual and cluster levels. This evidence concludes that addressing these contextual factors is very crucial to strengthen FP use and fertility reduction in the nation, beyond individual behavioral changes. Jembere Gizachew Balew, Yongtae Cho, Clara Tammy Kim, and Woorim Ko Copyright © 2015 Jembere Gizachew Balew et al. All rights reserved. Polycyclic Aromatic Hydrocarbons Concentrations in Drinking Water in Villages along the Huai River in China and Their Association with High Cancer Incidence in Local Population Tue, 24 Nov 2015 09:46:24 +0000 https://www.hindawi.com/journals/bmri/2015/762832/ This study aims to evaluate the carcinogenic risk of PAHs in the drinking water of counties along the Huai River in China and study their associations with high cancer incidence in local population. We investigated 20 villages with high cancer incidence rates as the risk group and 20 villages with low rates as the control group. Water samples from each village were collected in the winter and summer seasons to analyze the concentrations of 16 PAHs. The carcinogenic risks of the PAHs were calculated for each village using a health risk assessment approach. Results showed that PAHs concentrations in 27.2% of the water samples were higher than the allowable values in China. However, no significant difference in water PAHs concentrations was observed between the risk and control groups (), and no correlation was found between water PAHs concentrations and cancer incidence in these villages. The average upper bound carcinogenic risks were less than in both groups. In conclusion, PAHs were present in the drinking water of the studied villages, but their carcinogenic risks remained within acceptable limits. PAHs in local drinking water might not be the major environmental cause of the high cancer incidences. En chun Pan, Hong Sun, Qiu jin Xu, Qin Zhang, Lin fei Liu, Xiao dong Chen, and Yan Xu Copyright © 2015 En chun Pan et al. All rights reserved. Predicting 30-Day Readmissions: Performance of the LACE Index Compared with a Regression Model among General Medicine Patients in Singapore Mon, 23 Nov 2015 16:01:45 +0000 https://www.hindawi.com/journals/bmri/2015/169870/ The LACE index (length of stay, acuity of admission, Charlson comorbidity index, CCI, and number of emergency department visits in preceding 6 months) derived in Canada is simple and may have clinical utility in Singapore to predict readmission risk. We compared the performance of the LACE index with a derived model in identifying 30-day readmissions from a population of general medicine patients in Singapore. Additional variables include patient demographics, comorbidities, clinical and laboratory variables during the index admission, and prior healthcare utilization in the preceding year. 5,862 patients were analysed and 572 patients (9.8%) were readmitted in the 30 days following discharge. Age, CCI, count of surgical procedures during index admission, white cell count, serum albumin, and number of emergency department visits in previous 6 months were significantly associated with 30-day readmission risk. The final logistic regression model had fair discriminative ability c-statistic of 0.650 while the LACE index achieved c-statistic of 0.628 in predicting 30-day readmissions. Our derived model has the advantage of being available early in the admission to identify patients at high risk of readmission for interventions. Additional factors predicting readmission risk and machine learning techniques should be considered to improve model performance. Lian Leng Low, Kheng Hock Lee, Marcus Eng Hock Ong, Sijia Wang, Shu Yun Tan, Julian Thumboo, and Nan Liu Copyright © 2015 Lian Leng Low et al. All rights reserved. Toxoplasma gondii Infection in Pregnant Women: A Seroprevalence and Case-Control Study in Eastern China Sun, 11 Oct 2015 08:06:07 +0000 https://www.hindawi.com/journals/bmri/2015/170278/ Very limited information is available concerning the epidemiology of T. gondii infection in pregnant women in eastern China. Therefore, a case-control study was conducted to estimate the seroprevalence of toxoplasmosis in this population group and to identify risk factors and possible routes of contamination. Serum samples were collected from 965 pregnant women and 965 age-matched nonpregnant control subjects in Qingdao and Weihai between October 2011 and July 2013. These were screened with enzyme linked immunoassays for the presence of anti-Toxoplasma IgG and anti-Toxoplasma IgM antibodies. 147 (15.2%) pregnant women and 167 (17.3%) control subjects were positive for anti-T. gondii IgG antibodies, while 28 (2.9%) pregnant women and 37 (3.8%) controls were positive for anti-T. gondii IgM antibodies (). There was no significant difference between pregnant women and nonpregnant controls with regard to the seroprevalence of either anti-T. gondii IgG or IgM antibodies. Multivariate analysis showed that T. gondii infection was associated with location, cats in home, contact with cats and dogs, and exposure to soil. The results indicated that the seroprevalence of T. gondii infection in pregnant women is high compared to most other regions of China and other East Asian countries with similar climatic conditions. Wei Cong, Xiao-Yan Dong, Qing-Feng Meng, Na Zhou, Xiang-Yang Wang, Si-Yang Huang, Xing-Quan Zhu, and Ai-Dong Qian Copyright © 2015 Wei Cong et al. All rights reserved. Colorectal Cancer: Advances in Prevention and Early Detection Wed, 07 Oct 2015 12:15:53 +0000 https://www.hindawi.com/journals/bmri/2015/518068/ Anne Miles, Fränzel van Duijnhoven, Amy McQueen, and Raymond Oliphant Copyright © 2015 Anne Miles et al. All rights reserved. Piloting the Impact of Three Interventions on Guaiac Faecal Occult Blood Test Uptake within the NHS Bowel Cancer Screening Programme Wed, 07 Oct 2015 09:16:12 +0000 https://www.hindawi.com/journals/bmri/2015/928251/ This study evaluated the impact of three interventions on uptake of the guaiac faecal occult blood test (gFOBT) in Greater London. The interventions were designed to improve awareness and understanding of the NHS Bowel Cancer Screening Programme (BCSP) and assist stool sampling. Logistic regression analysis of BCSP London data ( invitees aged 60–74) compared uptake at 12 weeks between intervention groups and a control group, sent kits as usual between January-April 2013 and January-April 2014. An endorsement flyer, included with gFOBT kits, had no impact on uptake (). In 60–69-year-olds, there was a small but significant increase in modelled uptake amongst invitees sent both the flyer and a kit enhancement pack compared with controls (45.1% versus 43.4%, , ). In North East London, the flyer together with outdoor advertising was associated with a small but significant increase (45.6% versus 43.4%, , ). The largest increases were seen when all three interventions (flyer, pack, and advertising) were combined (49.5% versus 43.4%, , ). The increased uptake in the intervention groups was largest in “first-timers” and smaller amongst previous nonresponders and previously screened invitees. Becky White, Emily Power, Monika Ciurej, Siu Hing Lo, Katherine Nash, and Nick Ormiston-Smith Copyright © 2015 Becky White et al. All rights reserved. A Media and Clinic Intervention to Increase Colorectal Cancer Screening in Ohio Appalachia Mon, 05 Oct 2015 09:36:41 +0000 https://www.hindawi.com/journals/bmri/2015/943152/ Objective. To test the effectiveness of a colorectal cancer (CRC) screening intervention among adults living in Ohio Appalachia. Methods. We conducted a group-randomized trial of a county-level intervention among adults living in 12 Ohio Appalachian counties who received a media campaign and clinic intervention focused on either CRC screening or fruits and vegetables. Participants’ percentage within CRC screening guidelines was assessed with cross-sectional surveys conducted annually for four years, and validated with medical record review of screening. Results. On average, screening data were obtained on 564 intervention and 559 comparison participants per year. There was no difference in the Wave 4 CRC screening rates of intervention and comparison counties (35.2% versus 31.4%). Multivariate analyses found that high perceived risk of CRC, willingness to have a CRC test if recommended by a doctor, doctor recommendation of a CRC screening test, and patient-physician communication about changes in bowel habits, family history of CRC, and eating fruits and vegetables were significant () predictors of being within CRC screening guidelines. Conclusions. The intervention was not effective in increasing CRC rates among Ohio Appalachian adults. Future research should determine how media and clinic-based interventions can be modified to improve CRC screening rates among this underserved population. Jessica L. Krok-Schoen, Mira L. Katz, Jill M. Oliveri, Gregory S. Young, Michael L. Pennell, Paul L. Reiter, Jesse J. Plascak, Michael D. Slater, Janice L. Krieger, Cathy M. Tatum, and Electra D. Paskett Copyright © 2015 Jessica L. Krok-Schoen et al. All rights reserved. Pathologic Assessment of Rectal Carcinoma after Neoadjuvant Radio(chemo)therapy: Prognostic Implications Mon, 05 Oct 2015 08:10:42 +0000 https://www.hindawi.com/journals/bmri/2015/574540/ Neoadjuvant radio(chemo)therapy is increasingly used in rectal cancer and induces a number of morphologic changes that affect prognostication after curative surgery, thereby creating new challenges for surgical pathologists, particularly in evaluating morphologic changes and tumour response to preoperative treatment. Surgical pathologists play an important role in determining the many facets of rectal carcinoma patient care after neoadjuvant treatment. These range from proper handling of macroscopic specimens to accurate microscopic evaluation of pathological features associated with patients’ prognosis. This review presents the well-established pathological prognostic indicators and discusses challenging features in order to provide both surgical pathologists and treating physicians with a checklist that is useful in a neoadjuvant setting. Monirath Hav, Louis Libbrecht, Liesbeth Ferdinande, Karen Geboes, Piet Pattyn, and Claude A. Cuvelier Copyright © 2015 Monirath Hav et al. All rights reserved. Mycobacterium avium Subspecies paratuberculosis and Bovine Leukemia Virus Seroprevalence and Associated Risk Factors in Commercial Dairy and Beef Cattle in Northern and Northeastern China Sun, 04 Oct 2015 14:30:46 +0000 https://www.hindawi.com/journals/bmri/2015/315173/ Mycobacterium avium subspecies paratuberculosis (MAP) and bovine leukemia virus (BLV) are important pathogens, commonly responsible for economical loss to cattle farms all over the world, yet their epidemiology in commercial dairy and beef cattle in China is still unknown. Thus, from September 2013 to December 2014, a large-scale seroprevalence study was conducted to determine the seroprevalence and identify herd-level risk factors associated with MAP and BLV infection. The source sample was 3674 cattle from 113 herds in northern and northeastern China. Antibodies against MAP and BLV were detected using ELISA tests. At animal-level, the seroprevalence of antibodies against MAP and BLV was 11.79% (433/3674) and 18.29% (672/3674), respectively. At herd-level, the seroprevalence of antibodies against MAP and BLV was 20.35% and 21.24% (24/113), respectively. Herd size was identified to be associated with MAP infection while herd size and presence of cattle introduced from other farms were significantly associated with BLV infection. Further research is needed to confirm these findings and improve the knowledge of the epidemiology of these two pathogens in these regions and elsewhere in China. Wu-Wen Sun, Wen-Fa Lv, Wei Cong, Qing-Feng Meng, Chun-Feng Wang, Xiao-Feng Shan, and Ai-Dong Qian Copyright © 2015 Wu-Wen Sun et al. All rights reserved. Awareness of Lifestyle and Colorectal Cancer Risk: Findings from the BeWEL Study Sun, 04 Oct 2015 14:04:00 +0000 https://www.hindawi.com/journals/bmri/2015/871613/ It is estimated that 47% of colorectal cancers (CRC) could be prevented by appropriate lifestyles. This study aimed to identify awareness of the causes of CRC in patients who had been diagnosed with a colorectal adenoma through the Scottish Bowel Screening Programme and subsequently enrolled in an intervention trial (using diet and physical activity education and behavioural change techniques) (BeWEL). At baseline and 12-month follow-up, participants answered an open-ended question on factors influencing CRC development. Of the 329 participants at baseline, 40 (12%) reported that they did not know any risk factors and 36 (11%) failed to identify specific factors related to diet and activity. From a potential knowledge score of 1 to 6, the mean score was 1.5 (SD 1.1, range 0 to 5) with no difference between intervention and control groups. At follow-up, the intervention group had a significantly greater knowledge score and better weight loss, diet, and physical activity measures than the control group. Awareness of relevant lifestyle factors for CRC remains low in people at increased risk of the disease. Opportunities within routine NHS screening to aid the capability (including knowledge of risk factors) of individuals to make behavioural changes to reduce CRC risk deserve exploration. Annie S. Anderson, Stephen Caswell, Maureen Macleod, Angela M. Craigie, Martine Stead, Robert J. C. Steele, and The BeWEL Team Copyright © 2015 Annie S. Anderson et al. All rights reserved. The Relationship between Neighborhood Immigrant Composition, Limited English Proficiency, and Late-Stage Colorectal Cancer Diagnosis in California Sun, 04 Oct 2015 13:25:01 +0000 https://www.hindawi.com/journals/bmri/2015/460181/ Despite the availability of effective early detection technologies, more than half (61%) of colorectal cancers in the United States and 55% in California are identified at an advanced stage. Data on colorectal cancer patients (,030) diagnosed from 2005 to 2007 were obtained from the California Cancer Registry. Multivariate analyses found a relationship among neighborhood concentration of recent immigrants, neighborhood rates of limited English proficiency, and late-stage colorectal cancer diagnosis. Hispanics living in neighborhoods with a greater percentage of recent immigrants (compared to the lowest percentage) had greater odds (OR 1.57, 95% CI 1.22, 2.02) of late-stage diagnosis whereas Hispanics living in neighborhoods with the highest percentage of limited English proficiency (compared to the lowest percentage) had lower odds (OR .71, 95% CI .51, .99) of late-stage diagnosis. These relationships were not observed for other ethnic groups. Results highlight the complex relationship among race/ethnicity, neighborhood characteristics, and colorectal cancer stage at diagnosis. Cynthia M. Mojica, Beth A. Glenn, Cindy Chang, and Roshan Bastani Copyright © 2015 Cynthia M. Mojica et al. All rights reserved. Missed Opportunities for the Diagnosis of Colorectal Cancer Sun, 04 Oct 2015 10:20:02 +0000 https://www.hindawi.com/journals/bmri/2015/285096/ Objective. To examine patient and medical characteristics which predict a missed diagnostic opportunity (MDO) for colorectal cancer (CRC). Methods. The sample consisted of 252 patients diagnosed with Stages 1–4 CRC who were diagnosed in the prior six months, had experienced symptoms prior to diagnosis, and were not diagnosed through routine screening. Systematic review of all medical records prior to patients’ diagnosis was conducted. An MDO was defined as a clinical encounter where, even in the presence of presumptive CRC symptoms, the CRC diagnostic process is not started. Results. 92 patients (36.5%) experienced an MDO. Almost 80% of alternate diagnoses were other GI-GU diseases, including hemorrhoids and diverticulitis. Stomach pain, anemia, and constipation were the most common symptoms experienced by the MDO group. These symptoms, and weight loss and vomiting, were more likely to be noted in the charts of the MDO patients (). Independent risk factors for MDO included age (<50) [OR = 2.29 (1.14–4.60), ] and female sex [OR = 2.19 (1.16–4.16), ]. Each additional physician seen, more than doubled the MDO risk [OR = 2.05 (1.53–2.74), ]. Conclusions. Females, younger patients, and those consulting more physicians were all more likely to experience an MDO. Continued increased training of physicians to enhance knowledge of who is vulnerable to CRC is needed in addition to an increased focus to adherence to screening recommendations. Laura A. Siminoff, Heather L. Rogers, and Sonja Harris-Haywood Copyright © 2015 Laura A. Siminoff et al. All rights reserved. Developments in Screening Tests and Strategies for Colorectal Cancer Sun, 04 Oct 2015 09:26:52 +0000 https://www.hindawi.com/journals/bmri/2015/326728/ Background. Worldwide, colorectal cancer (CRC) is the third most common cancer in men and second most common in women. It is the fourth most common cause of cancer mortality. In the United States, CRC is the third most common cause of cancer and second most common cause of cancer mortality. Incidence and mortality rates have steadily fallen, primarily due to widespread screening. Methods. We conducted keyword searches on PubMed in four categories of CRC screening: stool, endoscopic, radiologic, and serum, as well as news searches in Medscape and Google News. Results. Colonoscopy is the gold standard for CRC screening and the most common method in the United States. Technological improvements continue to be made, including the promising “third-eye retroscope.” Fecal occult blood remains widely used, particularly outside the United States. The first at-home screen, a fecal DNA screen, has also recently been approved. Radiological methods are effective but seldom used due to cost and other factors. Serum tests are largely experimental, although at least one is moving closer to market. Conclusions. Colonoscopy is likely to remain the most popular screening modality for the immediate future, although its shortcomings will continue to spur innovation in a variety of modalities. Justin L. Sovich, Zachary Sartor, and Subhasis Misra Copyright © 2015 Justin L. Sovich et al. All rights reserved. Social Cognitive Mediators of Sociodemographic Differences in Colorectal Cancer Screening Uptake Sun, 04 Oct 2015 09:18:25 +0000 https://www.hindawi.com/journals/bmri/2015/165074/ Background. This study examined if and how sociodemographic differences in colorectal cancer (CRC) screening uptake can be explained by social cognitive factors. Methods. Face-to-face interviews were conducted with individuals aged 60–70 years () living in England as part of a population-based omnibus survey. Results. There were differences in screening uptake by SES, marital status, ethnicity, and age but not by gender. Perceived barriers (stand. , ), social norms (stand. , ), and screening knowledge (stand. , ) had independent associations with uptake. SES differences in uptake were mediated through knowledge, social norms, and perceived barriers. Ethnic differences were mediated through knowledge. Differences in uptake by marital status were primarily mediated through social norms and to a lesser extent through knowledge. Age differences were largely unmediated, except for a small mediated effect via social norms. Conclusions. Sociodemographic differences in CRC screening uptake were largely mediated through social cognitive factors. Impact. Our findings suggest that multifaceted interventions might be needed to reduce socioeconomic inequalities. Ethnic differences might be reduced through improved screening knowledge. Normative interventions could emphasise screening as an activity endorsed by important others outside the immediate family to appeal to a wider audience. Siu Hing Lo, Jo Waller, Charlotte Vrinten, Lindsay Kobayashi, and Christian von Wagner Copyright © 2015 Siu Hing Lo et al. All rights reserved. Breast Cancer by Age at Diagnosis in the Gharbiah, Egypt, Population-Based Registry Compared to the United States Surveillance, Epidemiology, and End Results Program, 2004–2008 Thu, 01 Oct 2015 07:00:55 +0000 https://www.hindawi.com/journals/bmri/2015/381574/ Objective. Although breast cancers (BCs) in young women often display more aggressive features, younger women are generally not screened for early detection. It is important to understand the characteristics of young onset breast cancer to increase awareness in this population. This analysis includes all ages, with emphasis placed on younger onset BC in Egypt as compared to the United States. Methods. BC cases in the Gharbiah cancer registry (GCR), Egypt, were compared to those in the Surveillance, Epidemiology, and End Results (SEER) database. This analysis included 3,819 cases from the GCR and 273,019 from SEER diagnosed 2004–2008. Results. GCR cases were diagnosed at later stages, with <5% diagnosed at Stage I and 12% diagnosed at Stage IV. 48% of all SEER cases were diagnosed at Stage I, dropping to 30% among those ≤40. Significant differences in age, tumor grade, hormone receptor status, histology, and stage exist between GCR and SEER BCs. After adjustment, GCR cases were nearly 45 times more likely to be diagnosed at stage III and 16 times more likely to be diagnosed at stage IV than SEER cases. Conclusions. Future research should examine ways to increase literacy about early detection and prompt therapy in young cases. Jennifer A. Schlichting, Amr S. Soliman, Catherine Schairer, Joe B. Harford, Ahmed Hablas, Mohamed Ramadan, Ibrahim Seifeldin, and Sofia D. Merajver Copyright © 2015 Jennifer A. Schlichting et al. All rights reserved. Following Up Crack Users after Hospital Discharge Using Record Linkage Methodology: An Alternative to Find Hidden Populations Sun, 06 Sep 2015 09:58:14 +0000 https://www.hindawi.com/journals/bmri/2015/973857/ This paper presents the probabilistic record linkage (PRL) methodology as an alternative way to find or follow up hard-to-reach population as crack users. PRL was based on secondary data from public health information systems and the strategy used from standardization; phonetic encoding and the rounds of matching data were described. A total of 293 patient records from medical database and two administrative datasets obtained from Ministry of Health Information Systems were used. Patient information from the medical database was the identifiers to the administrative datasets containing data on outpatient treatment and hospital admissions. 40% of patient records were found in the hospital database and 12% were found in the outpatient database; 95% of the patients were hospitalized up to 5 times, and only 10 out of them had outpatient information. The record linkage methodology by linking government databases may help to address research questions about the path of patients in the care network without spending time and financial resources with primary data collection. Veralice Maria Gonçalves, Rosemeri Pedroso, Antônio Marcos dos Santos, Lisia Von Diemen, and Flavio Pechansky Copyright © 2015 Veralice Maria Gonçalves et al. All rights reserved. Heterogeneity of Breast Cancer Associations with Common Genetic Variants in FGFR2 according to the Intrinsic Subtypes in Southern Han Chinese Women Thu, 03 Sep 2015 06:46:16 +0000 https://www.hindawi.com/journals/bmri/2015/626948/ GWAS have identified variation in the FGFR2 locus as risk factors for breast cancer. Validation studies, however, have shown inconsistent results by ethnics and pathological characteristics. To further explore this inconsistency and investigate the associations of FGFR2 variants with breast cancer according to intrinsic subtype (Luminal-A, Luminal-B, ER−&PR−&HER2+, and triple negative) among Southern Han Chinese women, we genotyped rs1078806, rs1219648, rs2420946, rs2981579, and rs2981582 polymorphisms in 609 patients and 882 controls. Significant associations with breast cancer risk were observed for rs2420946, rs2981579, and rs2981582 with OR (95% CI) per risk allele of 1.19 (1.03–1.39), 1.24 (1.07–1.43), and 1.17 (1.01–1.36), respectively. In subtype specific analysis, above three SNPs were significantly associated with increased Luminal-A risk in a dose-dependent manner ; however, only rs2981579 was associated with Luminal-B, and none were linked to ER−&PR− subtypes (ER−&PR−&HER2+ and triple negative). Haplotype analyses also identified common haplotypes significantly associated with luminal-like subtypes (Luminal-A and Luminal-B), but not with ER−&PR− subtypes. Our results suggest that associations of FGFR2 SNPs with breast cancer were heterogeneous according to intrinsic subtype. Future studies stratifying patients by their intrinsic subtypes will provide new insights into the complex genetic mechanisms underlying breast cancer. Huiying Liang, Xuexi Yang, Lujia Chen, Hong Li, Anna Zhu, Minying Sun, Haitao Wang, and Ming Li Copyright © 2015 Huiying Liang et al. All rights reserved. A Population-Based Model to Consider the Effect of Seasonal Variation on Serum 25(OH)D and Vitamin D Status Tue, 01 Sep 2015 07:25:38 +0000 https://www.hindawi.com/journals/bmri/2015/168189/ Background. We elaborated a model that predicts the centiles of the 25(OH)D distribution taking into account seasonal variation. Methods. Data from two Swiss population-based studies were used to generate (CoLaus) and validate (Bus Santé) the model. Serum 25(OH)D was measured by ultra high pressure LC-MS/MS and immunoassay. Linear regression models on square-root transformed 25(OH)D values were used to predict centiles of the 25(OH)D distribution. Distribution functions of the observations from the replication set predicted with the model were inspected to assess replication. Results. Overall, 4,912 and 2,537 Caucasians were included in original and replication sets, respectively. Mean (SD) 25(OH)D, age, BMI, and % of men were 47.5 (22.1) nmol/L, 49.8 (8.5) years, 25.6 (4.1) kg/m2, and 49.3% in the original study. The best model included gender, BMI, and sin-cos functions of measurement day. Sex- and BMI-specific 25(OH)D centile curves as a function of measurement date were generated. The model estimates any centile of the 25(OH)D distribution for given values of sex, BMI, and date and the quantile corresponding to a 25(OH)D measurement. Conclusions. We generated and validated centile curves of 25(OH)D in the general adult Caucasian population. These curves can help rank vitamin D centile independently of when 25(OH)D is measured. Philippe Vuistiner, Valentin Rousson, Hugues Henry, Pierre Lescuyer, Olivier Boulat, Jean-Michel Gaspoz, Vincent Mooser, Peter Vollenweider, Gerard Waeber, Jacques Cornuz, Fred Paccaud, Murielle Bochud, and Idris Guessous Copyright © 2015 Philippe Vuistiner et al. All rights reserved. Khat (Catha edulis Forsk.) Dependence Potential and Pattern of Use in Saudi Arabia Mon, 24 Aug 2015 11:39:55 +0000 https://www.hindawi.com/journals/bmri/2015/604526/ Background. Catha edulis Forsk. (Khat) is used for its psychoactive effects among people in Africa and the Arabian Peninsula, although its utilization is illegal in some countries such as Saudi Arabia. This study examined the pattern of Khat use and assessed the applicability of the Drug Abuse Screening Test-10 (DAST-10) to measure Khat dependence. Methods. A pretested questionnaire was used to gather data from 603 respondents. Variables included demographic characteristics, pattern of use, reasons for Khat chewing, and DAST-10. Stepwise-logistic regression was used to explore predictors of Khat dependence. Results. The majority of the respondents were married, had a secondary school level of education, were employed, were younger than 35 years old, and were living in rural areas. Many chewers gave more than one reason for using Khat. It was mainly used to increase mental capacity, physical strength, and social entertainment, as well as enhance cheerfulness and orgasms. Statistical modeling of Khat dependence suggested that the most significant predictors were residence (OR = 1.67, ), frequency of Khat chewing (OR = 4.8, ), age of starting Khat chewing (OR = 1.15, ), and time of Khat effect (OR = 1.15, ). Conclusion. Our study provides important information on the pattern of Khat use and its potential to cause dependence. Siddig Ibrahim Abdelwahab, Rashad Mohammed Alsanosy, Bahaa-eldin E. A. Rahim, Syam Mohan, Sara Taha, Manal Mohamed Elhassan, and Maged El-Setouhy Copyright © 2015 Siddig Ibrahim Abdelwahab et al. All rights reserved. Prevalence and Genotyping of Cryptosporidium Infection in Pet Parrots in North China Sun, 26 Jul 2015 14:20:53 +0000 https://www.hindawi.com/journals/bmri/2015/549798/ Cryptosporidiosis is a worldwide zoonosis caused by Cryptosporidium spp., sometimes leading to severe diarrhea in humans and animals. In the present study, 311 parrots, belonging to four species, namely, Budgerigars (Melopsittacus undulatus), Lovebirds (Agapornis sp.), Alexandrine parakeets (Psittacula eupatria), and Cockatiel (Nymphicus hollandicus), from Beijing and Weifang cities, were examined for Cryptosporidium spp. infection. Blood samples of each bird were examined using enzyme linked immunosorbent assay (ELISA) and fecal samples were examined by Sheather’s sugar flotation technique. Prevalence of Cryptosporidium infection were 3.22% (10/311) and 0.64% (2/311) by ELISA and Sheather’s sugar flotation technique, respectively. Seroprevalence of Cryptosporidium infection in different breeds varied from 0 to 15.39%. Sequencing analysis showed that both positive samples from fecal samples belonged to Cryptosporidium avian genotype V. This is the first report of Cryptosporidium avian genotype V in Budgerigars. The results of the present study provided foundation-data for prevention and control of cryptosporidiosis in pet birds in China. Xiao-Xuan Zhang, Nian-Zhang Zhang, Guang-Hui Zhao, Quan Zhao, and Xing-Quan Zhu Copyright © 2015 Xiao-Xuan Zhang et al. All rights reserved. Using Sibling Designs to Understand Neurodevelopmental Disorders: From Genes and Environments to Prevention Programming Wed, 15 Jul 2015 10:05:37 +0000 https://www.hindawi.com/journals/bmri/2015/672784/ Neurodevelopmental disorders represent a broad class of childhood neurological conditions that have a significant bearing on the wellbeing of children, families, and communities. In this review, we draw on evidence from two common and widely studied neurodevelopmental disorders—autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD)—to demonstrate the utility of genetically informed sibling designs in uncovering the nature and pathogenesis of these conditions. Specifically, we examine how twin, recurrence risk, and infant prospective tracking studies have contributed to our understanding of genetic and environmental liabilities towards neurodevelopmental morbidity through their impact on neurocognitive processes and structural/functional neuroanatomy. It is suggested that the siblings of children with ASD and ADHD are at risk not only of clinically elevated problems in these areas, but also of subthreshold symptoms and/or subtle impairments in various neurocognitive skills and other domains of psychosocial health. Finally, we close with a discussion on the practical relevance of sibling designs and how these might be used in the service of early screening, prevention, and intervention efforts that aim to alleviate the negative downstream consequences associated with disorders of neurodevelopment. Mark Wade, Heather Prime, and Sheri Madigan Copyright © 2015 Mark Wade et al. All rights reserved. Effects of Surface Inclination on the Vertical Loading Rates and Landing Pattern during the First Attempt of Barefoot Running in Habitual Shod Runners Wed, 15 Jul 2015 06:51:49 +0000 https://www.hindawi.com/journals/bmri/2015/240153/ Barefoot running has been proposed to reduce vertical loading rates, which is a risk factor of running injuries. Most of the previous studies evaluated runners on level surfaces. This study examined the effect of surface inclination on vertical loading rates and landing pattern during the first attempt of barefoot running among habitual shod runners. Twenty habitual shod runners were asked to run on treadmill at 8.0 km/h at three inclination angles (0°; +10°; −10°) with and without their usual running shoes. Vertical average rate (VALR) and instantaneous loading rate (VILR) were obtained by established methods. Landing pattern was decided using high-speed camera. VALR and VILR in shod condition were significantly higher () in declined than in level or inclined treadmill running, but not in barefoot condition (). There was no difference () in the landing pattern among all surface inclinations. Only one runner demonstrated complete transition to non-heel strike landing in all slope conditions. Reducing heel strike ratio in barefoot running did not ensure a decrease in loading rates (). Conversely, non-heel strike landing, regardless of footwear condition, would result in a softer landing (). W. An, M. J. Rainbow, and R. T. H. Cheung Copyright © 2015 W. An et al. All rights reserved. Musculoskeletal Injuries and Training Patterns in Junior Elite Orienteering Athletes Wed, 15 Jul 2015 06:11:34 +0000 https://www.hindawi.com/journals/bmri/2015/259531/ Findings about the relation between musculoskeletal injuries and training patterns in orienteering athletes are sparse. Therefore, the musculoskeletal injuries and training patterns of 31 Swiss elite orienteering athletes aged 18-19 years were analyzed in a retrospective study. Individual training diaries and medical records were used to assess training data and injury history, respectively. Group comparisons and a multiple linear regression (MLR) were performed for statistical analysis. The junior elite orienteering athletes performed 7.38 ± 2.00 training sessions weekly, with a total duration of 455.75 ± 98.22 minutes. An injury incidence rate (IIR) of 2.18 ± 2.13 injuries per 1000 hours of training was observed. The lower extremity was affected in 93% of all injuries, and the knee (33%) was the most commonly injured location. The MLR revealed that gender and six training variables explained 60% of the variance in the injury severity index in this study. Supported by the low IIR in the observed age group, the training protocol of the junior elite orienteering athletes was generally adequate. In comparison to elite track, marathon, and orienteering athletes, the junior elite athletes performed less high-intensity interval training (HIIT). However, more frequent HIIT seems to be a protective factor against injuries. Lilian Roos, Wolfgang Taube, Peter Zuest, German Clénin, and Thomas Wyss Copyright © 2015 Lilian Roos et al. All rights reserved. Effectiveness of the First Dose of BCG against Tuberculosis among HIV-Infected, Predominantly Immunodeficient Children Mon, 29 Jun 2015 09:25:03 +0000 https://www.hindawi.com/journals/bmri/2015/275029/ The objective of this study was to estimate the protective effect of Bacille Calmette-Guérin (BCG) vaccine against tuberculosis among (predominantly immunodeficient) HIV-infected children in Angola. A hospital-based case-control study was conducted with 230 cases, children coinfected with tuberculosis, and 672 controls, HIV-infected children from the same hospital, aged 18 months to 13 years. The presence of a vaccination scar was taken as a proxy marker for BCG vaccination. The crude effectiveness was 8% (95% CI: −26 to 32) and the adjusted effectiveness was 30% (95% CI: −75 to 72). The present study suggests that BCG does not have a protective effect against tuberculosis among immunodeficient HIV-infected children. Since BCG is no longer given to HIV-infected children, the study may not be replicated. Accepting that these findings should be considered with caution, they are nonetheless likely to be the last estimate of BCG efficacy in a sufficiently powered study. Joaquim C. V. D. Van-Dunem, Laura C. Rodrigues, Luiz Claudio Arraes Alencar, Maria de Fátima Pessoa Militão-Albuquerque, and Ricardo Arraes de Alencar Ximenes Copyright © 2015 Joaquim C. V. D. Van-Dunem et al. All rights reserved. Epidemiology of Neonatal Sepsis and Implicated Pathogens: A Study from Egypt Thu, 04 Jun 2015 12:54:04 +0000 https://www.hindawi.com/journals/bmri/2015/509484/ Prospective analytic study was conducted in NICUs of three Egyptian Neonatal Network (EGNN) participants in Mansoura Hospitals in Egypt over a period of 18 months from March 2011 to August 2012. By using EGNN 28-day discharge form, all demographic, clinical, and laboratory data were recorded and studied. During the study period, 357 neonates were diagnosed as suspected sepsis with an incidence of 45.9% (357/778) among the admitted neonates at the three neonatal intensive care units. 344 neonates (sex ratio = 1.3:1) were enrolled in the study in which 152 (44.2%) were classified as early onset sepsis EOS (≤72 hr) and 192 (55.8%) as late onset sepsis LOS (>72 hr). Among the LOS cases, 33.9% (65/192) were caused by nosocomial infections. In 40.7% (140/344), sepsis was confirmed by positive blood culture. The total mortality rate for the proven neonatal sepsis was 51% (25/49) and 42.9% (39/91) for EOS and LOS, respectively. Coagulase negative staphylococci were predominant isolates in both EOS and LOS, followed by Klebsiella pneumoniae. Most of the bacterial isolates had low sensitivity to the commonly used empiric antibiotics. However, 70.1% (89/127) exhibited multidrug resistance. Best sensitivities among Gram-positive isolates were found against imipenem, ciprofloxacin, vancomycin, and amikacin. Eman M. Rabie Shehab El-Din, Mohamed M. Adel El-Sokkary, Mohamed Reda Bassiouny, and Ramadan Hassan Copyright © 2015 Eman M. Rabie Shehab El-Din et al. All rights reserved. Evaluation of an Indirect-ELISA Test for Trypanosoma evansi Infection (Surra) in Buffaloes and Its Application to a Serological Survey in Thailand Mon, 25 May 2015 13:39:34 +0000 https://www.hindawi.com/journals/bmri/2015/361037/ Surra, caused by Trypanosoma evansi, is a neglected disease due to frequent subclinical evolution, especially in bovines in Asia. However, acute and chronic signs are regularly observed, with significant sanitary and economic impacts. In this study, we evaluated and applied an indirect-ELISA test for the detection of anti-T. evansi immunoglobulin G in buffaloes using antibovine conjugate. Based on buffalo reference sera from the Philippines, a two-graph receiver operating characteristics analysis (TG-ROC) was conducted to define an optimal cut-off value; sensitivity and specificity were estimated at 92.5% and 94.2%, respectively. A cross-sectional serological survey was carried out in the major buffalo breeding areas of Thailand; 892 buffaloes from 8 provinces were sampled in North, Northeastern, and Southern Thailand. Seropositive buffaloes were found in all 8 provinces, on 20.3% of farms for an overall prevalence of 12.2% (95% CI 10.2–14.5%). Nearly one-third of the sampled population was exposed to infection. Broader sampling would be necessary but is not possible in the southern half-wild breeding systems. According to our results, buffaloes may constitute a large and robust reservoir for T. evansi, which is a permanent threat to other livestock such as cattle and horses as well as wild animals such as elephants in Southest Asia. Arthur Kocher, Marc Desquesnes, Ketsarin Kamyingkird, Sarawut Yangtara, Emilye Leboucher, Pranee Rodtian, Alan Dargantes, and Sathaporn Jittapalapong Copyright © 2015 Arthur Kocher et al. All rights reserved. Acute Leukemia in Children Wed, 20 May 2015 06:57:52 +0000 https://www.hindawi.com/journals/bmri/2015/787194/ Juan Manuel Mejía-Aranguré and Richard J. Q. McNally Copyright © 2015 Juan Manuel Mejía-Aranguré and Richard J. Q. McNally. All rights reserved. Maternal Alcohol Consumption during Pregnancy and Early Age Leukemia Risk in Brazil Mon, 18 May 2015 14:20:47 +0000 https://www.hindawi.com/journals/bmri/2015/732495/ Objectives. To investigate the association between the maternal alcohol consumption during pregnancy and early age leukemia (EAL) in offspring. Methods. Datasets were analyzed from a case-control study carried out in Brazil during 1999–2007. Data were obtained by maternal interviews using a standardized questionnaire. The present study included 675 children (193 acute lymphoid leukemia (ALL), 59 acute myeloid leukemia (AML), and 423 controls). Unconditional logistic regression was performed, and adjusted odds ratios (adj. OR) on the association between alcohol consumption and EAL were ascertained. Results. Alcohol consumption was reported by 43% of ALL and 39% of AML case mothers and 35.5% of controls’. Beer consumption before and during pregnancy was associated with ALL in crude analysis (OR = 1.54, 95% CI, 1.08–2.19), although in adjusted analysis no statistical significance was found. For weekly intake of ≤1 glass (adj. OR = 1.30, 95% CI, 0.71–2.36) and ≥1 glass/week (adj. OR = 1.47, 95% CI, 0.88–2.46) a potential dose-response was observed ( trend < 0.03). Conclusion. This study failed to support the hypothesis of an increased risk of EAL associated with maternal alcohol intake during pregnancy, neither with the interaction with tobacco nor with alcohol consumption. Jeniffer Dantas Ferreira, Arnaldo Cézar Couto, Mariana Emerenciano, Maria S. Pombo-de-Oliveira, and Sergio Koifman Copyright © 2015 Jeniffer Dantas Ferreira et al. All rights reserved.
Source