Cumulative effects of excess high-normal alanine aminotransferase levels in relation to new-onset metabolic dysfunction-associated fatty liver disease in China

BACKGROUND Within the normal range,elevated alanine aminotransferase(ALT)levels are associated with an increased risk of metabolic dysfunction-associated fatty liver disease(MAFLD).AIM To investigate the associations between repeated high-normal ALT measurements and the risk of new-onset MAFLD prospectively.METHODS A cohort of 3553 participants followed for four consecutive health examinations over 4 years was selected.The incidence rate,cumulative times,and equally and unequally weighted cumulative effects of excess high-normal ALT levels(ehALT)were measured.Cox proportional hazards regression was used to analyse the association between the cumulative effects of ehALT and the risk of new-onset MAFLD.RESULTS A total of 83.13%of participants with MAFLD had normal ALT levels.The incidence rate of MAFLD showed a linear increasing trend in the cumulative ehALT group.Compared with those in the low-normal ALT group,the multivariate adjusted hazard ratios of the equally and unequally weighted cumulative effects of ehALT were 1.651[95%confidence interval(CI):1.199-2.273]and 1.535(95%CI:1.119-2.106)in the third quartile and 1.616(95%CI:1.162-2.246)and 1.580(95%CI:1.155-2.162)in the fourth quartile,respectively.CONCLUSION Most participants with MAFLD had normal ALT levels.Long-term high-normal ALT levels were associated with a cumulative increased risk of new-onset MAFLD.

The impact of the Rural Minimum Living Standard Guarantee(Rural Dibao)Program on child nutrition outcomes

The Rural Minimum Living Standard Guarantee(Rural Dibao)is an important unconditional cash transfer program to alleviate poverty in rural China.Despite the importance of children’s nutrition in breaking poverty cycles,little is known about the impact of Rural Dibao on child nutrition outcomes.Using China Family Panel Studies(CFPS),this paper examines the effects of Rural Dibao on child nutrition outcomes and investigates potential pathways and heterogeneous effects.We exploit propensity score matching and difference-in-differences techniques to evaluate the effects of the Rural Dibao program on child nutrition outcomes.Our results suggest that Rural Dibao significantly impacts the nutrition outcomes of children up to 15 years of age.Specifically,our results suggest that Rural Dibao improves child height-to-age z-scores by 1.05 standard deviations and lowers the probability of stunting by 11.9 percentage points.Additional analyses suggest that increased protein intake is the main pathway through which Rural Dibao participation contributes to better nutrition outcomes.We also find that the effect of the program is more pronounced among girls,children who are non-left-behind or live with highly educated mothers,and those from low-income families and poor areas.Our findings suggest that Rural Dibao participation helps improve child nutrition outcomes through improving diet quality.

Exploring the association of paid sick leave with healthcare utilization and health outcomes in the United States:a rapid evidence review

Objective:Paid sick leave(PSL)laws mandate employers give workers paid time off when they are sick or injured.This current study aims to examine whether access to PSL is associated with healthcare utilization and health outcomes and to summarize the types of utilization and outcomes which have been reported to be associated with PSL.Methods:We conducted a rapid evidence review.Our search of seven databases,including Medline,Embase,PsycINFO,Cochrane Library,CINAHL,Scopus,and JSTOR,on September 21,2020,identified 757 studies,30 of which were retained.Results:Previous evidence is mostly provided by cross-sectional studies with survey data.In this study,evidence suggests that PSL is significantly associated with some types of healthcare utilization and health outcomes.In terms of healthcare utilization,findings indicate PSL is associated with an increase in the use of some preventive sendees and a decrease in the use of emergency care;while findings are mixed regarding associations of PSL with health provider visits and the use of mammograms and pap smears.As for health outcomes,findings suggest PSL is associated with improved mental and self-rated health,decreased incidence of influenza-like illness,and lower occupational injuries and mortality rates.Conclusion:PSL may be an effective tool in improving some healthcare utilization and health outcomes.Future research could help identify mechanisms through which PSL access works and identify what policy components lead to better outcomes.

Healthy life expectancy with cardiovascular disease among Chinese rural population based on the prospective cohort study

BACKGROUND Limited research has explored the impact of cardiovascular disease(CVD)on healthy life expectancy(HLE)especially in resource-limited areas.This study aimed to investigate the association between CVD and HLE in Chinese rural population.METHODS This study included 11,994 participants aged 45 years and older from the baseline and follow-up surveys of the Henan rural cohort study.Healthy status was measured via a Visual Analogue Scale.The multistate Markov model was applied to estimate the association between CVD and transitions in health,unhealthiness and death.Gender-specific total life expectancy,HLE and unhealthy life expectancy were calculated by the multistate life table method.RESULTS During a mean follow-up time of 3.85(3.84–3.86)years,there were 588 deaths recorded.For individuals with CVD,the risk of switching from health to unhealthiness status was increased by 71%[hazard ratio(HR)=1.71,95%CI:1.42–2.07],the chance of recovery was reduced by 30%(HR=0.70,95%CI:0.60–0.82).Men aged 45 years without CVD could gain an extra 7.08(4.15–10.01)years of HLE and lose 4.00(1.60–6.40)years of unhealthy life expectancy compared to their peers with CVD,respectively.The corresponding estimates among women were 8.62(5.55–11.68)years and 5.82(2.59–9.04)years,respectively.CONCLUSIONS This study indicated that CVD was significantly associated with poorer health status and lower HLE among Chinese rural population.It is an important public health policy to adopt targeted measures to reduce the CVD burden and enhance the quality of life and HLE in resource-limited areas.

Molecular characterization of canine parvovirus type 2(CPV2)reveals a high prevalence of the CPV2c genotype among dogs sufering from diarrhea

Canine parvovirus 2(CPV-2)is a highly contagious virus in dogs that typically causes hemorrhagic enteritis and a high mortality rate in unvaccinated puppies.The genetic variability and antigenic diversity of CPV-2 hinder its efective prevention of infection by vaccination.To investigate the epidemiology and genetic characteristics of CPV-2 in China,rectal swabs from afected dogs were collected from diferent animal clinics in Kunshan from 2022 to 2023.Preliminary detection and capsid gene sequencing of CPV-2 were performed using previously described primers and protocols.The overall detection rate for CPV-2 was 16.5%(33/200).A signifcant association was found between the CPV-2-positivity and clinical signs,age,breed and vaccination status.Sequence analysis revealed the presence of CPV-2c genotypes in all positive samples,which were genetically similar to other Asian CPV-2c strains.Notably,four key mutations(A5G,F267Y,Y324I and Q370R)were detected in all isolates,and one novel mutation(I447M)was detected in three CPV-2 isolates.These mutations in the CPV-2 strains could impact vaccine efcacy and the efectiveness of the virus immune evasion.Surprisingly,no recombination events were observed between the identifed CPV-2c strains and reference strains from China.Our data revealed that amino acid residues 324,426 and 440 of VP2 may under strong selection pressure.This pattern of genetic variation in the CPV-2 lineage warrants continuous laboratory-based surveillance programs in other parts of China to better understand the pattern of seasonal distribution and association between emerging genotypes and the intensity of disease severity.

Mechanism of Gegen Qinlian Decoction in Treating Type 2 Diabetes Mellitus Complicated with NAFLD Based on Network Pharmacology

[Objectives]To explore the mechanism of Gegen Qinlian Decoction in treating type 2 diabetes mellitus(T2DM)complicated with non-alcoholic fatty liver disease(NAFLD)by analyzing the effective components of Gegen Qinlian Decoction.[Methods]TCMSP database was used to analyze the active components of Gegen Qinlian Decoction,and pubchem and Swiss ADME databases were also used to predict drug targets,extract T2DM complicated with NAFLD targets from OMIM and Genecards databases.Venny plot was drawn to obtain intersection targets,and finally Cytoscape was used to make core target maps and drug-target-disease network maps.Using DAVID and Metascape database to analyze the intersection targets,the gene ontology information of Go and KEGG was obtained.Microbial informatics technology was used to visualize GO,and Cytoscape was used to make drug-target-disease network map-enrichment pathway map.[Results]The network pharmacological analysis showed that Gegen Qinlian Decoction acted on the key targets of type 2 diabetes mellitus complicated with non-alcoholic fatty liver disease,such as ALB and ALT1,through many components,and achieved the purpose of treating this disease.The chemical constituents of the drug include formononetin,5-hydroxyisomucronulatol-2,5-2-O-glucoside,cholesteryl laurate,isoliquiritigenin,etc.[Conclusions]This study provides a new idea and theoretical support for future drug research and clinical practice.

Assessment of Public Health Risks Associated with Naphthalene Entering Residences and Commercial Space from Vapor Intrusion at MGP Sites

Naphthalene, a constituent of coal tar, is a contaminant frequently found at former manufactured gas plants (MGP). Development at these sites has resulted in residential and commercial areas with potential exposures from vapor intrusion adversely affecting indoor air of residences and buildings. Naphthalene is routinely analyzed in soil vapor intrusion assessments for properties overlying and surrounding former MGP sites. The United States Environmental Protection Agency (EPA) has a proposed unit risk factor and the State of California has promulgated a unit risk factor for naphthalene. Naphthalene exposure from vapor intrusion is potentially a public health risk. The purpose of this study was to evaluate three sites located in the northeast United States to determine the frequency of naphthalene detection in indoor air. A total of 79 properties were included in the study. A total of 546 indoor air samples were analyzed for naphthalene on 161 occasions. Naphthalene concentrations ranged from 0.26 to 51 μg/m3 of air. Only 3 of the 546 indoor air samples detected naphthalene above the ninety-fifth percentile background value of 12 μg/m3 of air. Risk analysis indicated naphthalene vapor intrusion was not a public health risk among the 79 properties built on or near the former MGP sites.

Evaluating the Effectiveness of Targeted Public Health Control Strategies for Chlamydia Transmission in Omaha, Nebraska: A Mathematical Modeling Approach

Objectives: Sexually Transmitted Infections (STIs) have a great public health impact globally. STIs are one of the most critical health problems in the United States of America (USA). Here, we present a mathematical model for testing several interventions that are designed for various communities in order to control the Chlamydia epidemic. Study Design: Based on a community sexual behavior survey, we constructed and parameterized a mathematical disease transmission model to estimate the spread dynamics of Chlamydia in young adults in the northern part of Omaha, Nebraska. Methods: A differential equations based continuous time simulation model is run for various scenarios. The model considers only one age group i.e., 19 - 25 ages, which is considered as the highest risk group for this sexually transmitted disease. Our model assumes homogeneous mixing within this age group and use published estimates to model mixing rates between individuals. Results: The presented model quantified the potential value of screening and treatment programs for Chlamydia in reducing the burden of disease in this specific community. By increasing the screening and treatment rates from 35% to 85%, great public health benefit can be achieved in two years, i.e., total cases reduction around 9% just in this considered age group. Conclusions: Computational results show that behavioral change based interventions on prevention have some effect on reducing the prevalence in the targeted age group;however, more benefit can be obtained with frequent screening and treatment programs.

Anemia and Its Associated Risk Factors at the Time of Antiretroviral Therapy Initiation in Public Health Facilities of Arba Minch Town, Southern Ethiopia

Background: Anemia is the most common hematologic abnormality in HIV patients and is associated with disease progression and decreased survival. This study aims to describe the prevalence and predictors of anemia in HIV positive patients at the time of ART initiation at public health facilities of Arba Minch town, Southern Ethiopia. Methods: A total of 411 adults (?15 years) HIV positive patients with complete information on hemoglobin levels and CD4 count and clinical characteristics registered from 2006 to 2013 were assessed for anemia prevalence and risk factors at the ART clinic of the Arba Minch hospital and health center. The measurements of Hemoglobin and CD4 + T cell count were performed using standard methodology at baseline of ART initiation. Results: A total of 411 HIV positive patients (195 males and 216 females) with a mean ± SD age of 33.9 ± 9.0 years were assessed. Hemoglobin levels were between 6.0 and 16.5 mg/dL. The overall prevalence of anemia at the time of ART initiation was 52.3%;with 28.1%, 22.9% and 1.3% mild, moderate and severe anemia respectively. The overall prevalence of anemia was 62.4% among males and 46.7% among females (P < 0.001). An increased risk of anemia was seen in males (adjusted OR = 2.78, 95% CI = 1.77 - 4.35);low CD4 cell counts (adjusted OR = 3.48, 95% CI = 2.09 - 5.79);and history of TB (adjusted OR = 2.89, 95% CI = 1.28 - 6.54). Conclusions: Anemia in HIV-positive patients was highly prevalent at the time of ART initiation. Male gender, low CD4 count and history of TB were associated with higher risk of baseline anemia.

Investigation on quality of life of hospitalized patients in China with digestive system malignancy

Background:The purpose of this study is to evaluate the quality of life(QoL)of hospitalized patients in China suffering from digestive system malignancies and to identify potential risk factors for a decrease in QoL.Methods:The European Organization for Research and Treatment Core Quality of Life questionnaire(EORTC QLQ-C30)was applied to evaluate the QoL of 23,519 patients with six digestive malignancies(esophageal cancer,gastric cancer,colorectal cancer,liver cancer,biliary tract cancer,and pancreatic cancer).A t test or analysis of variance was employed to analyze the total EORTC QLQ-C30 scale scores and domain scores of the EORTC QLQ-C30 scale among patients in different subgroups.Results:The average QoL score was 50.4±10.8.The tumor type,age,sex,and TNM stage all had an impact on QoL ratings.Colorectal cancer patients had a better total QoL score(49.3±10.3)and scores in the domains of functioning,withmilder symptoms,except for diarrhea.Patients with biliary tract cancer(54.2±12.3)and pancreatic cancer(54.2±12.3)reported a poorer QoL,significant functional impairment,and more pronounced symptoms.Patients with esophageal cancer experienced the most severe financial difficulties(35.2±27.5).Patients aged≥65 years,women,and those with TNM stage III/IV reported lower QoL.In addition,the disparities in total QoL scores and scores in specific domains were significant among patients with some types of tumors,and based on ethnicity,educational level,occupation,treatment(s)received,and place of residence.Conclusions:There is a need to focus on elderly individuals,those with low educational levels,and patients with progressivemalignant tumors and to improve routine disease monitoring and symptom management to enhance the quality of life for patients with malignancies of the digestive system.

Health Disparities among the Western, Central and Eastern Rural Regions of China after a Decade of Health Promotion and Disease Prevention Programming

Summary： Health disparities between the western, central and eastern regions of rural China, and the impact of national health improvement policies and programming were assessed. A total of 400 counties were randomly sampled. ANOVA and Logistic regression modeling were employed to estimate differ- ences in health outcomes and determinants. Significant differences were found between the western, central and eastern rural regions in community infrastructure and health outcomes. From 2000 to 2010, health indicators in rural China were improved significantly, and the infant mortality rate （IMR）, mater- nal mortality rate （MMR） and under 5 mortality rate （U5MR） had fallen by 62.79%, 71.74% and 61.92%, respectively. Central rural China had the greatest decrease in IMR （65.05%）; whereas, western rural China had the greatest reduction in MMR （72.99%） but smallest reduction in U5MR （57.36%）. Despite these improvements, Logistic regression analysis showed regional differences in key health outcome indicators （odds ratios）： IMR （central： 2.13; western： 5.31）, U5MR （central： 2.25; western： 5.69）, MMR （central： 1.94; western： 3.31）, and prevalence of infectious diseases （central： 1.62; western： 3.58）. The community infrastructure and health outcomes of the western and central rural regions of China have been improved markedly during the first decade of the 21st century. However, health dis- parities still exist across the three regions. National efforts to increase per capita income, community empowerment and mobilization, community infrastructure, capacity of rural health facilities, and health literacy would be effective policy options to attain health equity.

The effect of self-employment on health, access to care, and health behavior

The focus of this paper is to investigate the role self-employment conceptualized as a lifestyle factor on health, access to health care, and health behaviors. We analyze rich data on 13,435 working adults in the US, who are either selfemployed or salaried workers. Outcomes include physical and mental health perception, validated indexes of physical and mental health, and medical conditions;access-to-care measures such as a barrier to obtaining necessary health care;and health behaviors such as smoking, physical activity and body mass index. Instrumental variables methods are used to correct for selection into self-employment. We find that self-employment is positively associated with perceived physical health, and is negatively associated with having diabetes, high blood pressure, high cholesterol and arthritis. No mental health outcome is significantly associated with self-employment. There is no significant difference between self-employed and wage-earning individuals with regard to access to care. Self-employed individuals are less likely to smoke, and are more likely to participate in physical activity and have normal-weight. We conclude that despite lack of health insurance, self-employed persons in the US are as healthy as wage-earners, do not experience a greater barrier to access to care, and are more likely to engage in healthy behavior.

Satisfaction of Village Doctors with the Township and Village Health Services Integration Policy in the Western Minority-inhabited Areas of China

Township and Village Health Services Integration Management（TVHSIM） is an essential form of China＇s two-tiered health service integration plan at the township and village level. Its main purpose, also one of the target goals in China＇s new healthcare reform, is to gradually integrate rural health services and appropriately allocate rural health resources. This study aims to assess the village doctors＇ satisfaction with the TVHSIM and provide scientific base to further improve TVHSIM. A cross-sectional study was carried out in which 162 village doctors from Qinghai, Inner Mongolia and Xinjiang in western China were interviewed. Descriptive analysis, independent t-test, one-way ANOVA, Spearman rank correlation and multiple linear regression were used to analyze the difference and relevance between village doctors＇ personal characteristics and their satisfaction with TVHSIM and six subscales. Village doctors with different years of practice, social insurance status and essential medical knowledge level showed statistically significant differences in their satisfaction levels（all P〈0.05）. Age（P〈0.05） and years of practice（P〈0.01） were negatively correlated with Drug and Medical Device Management and Financing Management. Essential medical knowledge level（P〈0.05） was negatively correlated with Operations Management as well. However, social insurance status（P〈0.05） was positively correlated with Human Resources Management and Drug and Medical Device management. Gender, age and years of practice respectively had significant influence on village doctors＇ satisfaction with TVHSIM（P〈0.01）. In conclusion, in order to further promote TVHSIM policy in rural China, a well-rounded social insurance model for village doctors is urgently needed. In addition, the development of TVHSIM is regionally imbalanced. Efficient and effective measures aiming at rationalizing gender and age structure and enhancing essential medical training should be carefully considered.

Real-world 10-year retrospective study of the guidelines for diagnosis and treatment of primary liver cancer in China

BACKGROUND Hepatocellular carcinoma(HCC) is a common malignant tumor worldwide. Many regions across the world have issued various HCC diagnosis and treatment protocols to improve the diagnosis and targeted treatment of patients with HCC. However, real-world studies analysing the practice, application value, and existing problems of the China Liver Cancer(CNLC) staging system are scarce.AIM To analyze the current situation and problems associated with the Guidelines for Diagnosis and Treatment of Primary Liver Cancer in China.METHODS We collected the medical records of all patients with HCC admitted to the First Affiliated Hospital of Zhengzhou University from January 1, 2011 to December 31, 2019, and recorded the hospitalization information of those patients until December 31, 2020. All information on the diagnosis and treatment of the target patients was recorded, and their demographic and sociological characteristics, CNLC stages, screening situations, and treatment methods and effects were analyzed. The survival status of the patients was obtained from follow-up data.RESULTS This study included the medical records of 3022 patients with HCC. Among these cases, 304 patients were screened before HCC diagnosis;their early-stage diagnosis rate was 69.08%, which was significantly higher than that of patients with HCC who were diagnosed without screening and early detection(33.74%). Herein, patients with no clinical outcome at discharge were followed up, and the survival information of 1128 patients was obtained. A Cox model was used to analyse independent risk factors affecting overall survival, which were revealed as age > 50 years, no screening, alpha-fetoprotein > 400 ng/mL, Child–Pugh grade B, and middle and late CNLC stages. Based on the Cox model survival analysis, in our study, patients with HCC identified via screening had significant advantages in overall and tumorfree survival after hepatectomy.CONCLUSION Early diagnosis and treatment can be achieved by screening groups at high risk for HCC based on the guidelines;however, real-world compliance is poor.

Comparison of Microdroplet Digital PCR Assays with Real-time Fluorescence Quantitative PCR for Clostridioides difficile Detection

Clostridioides difficile(C.difficile),is an anaerobic Gram-positive bacterium found in the human intestine.Prolonged use of antibacterial drugs can result in C.difficile infection(CDI)[1],which is one of the most important hospital-acquired diseases affecting all wards.Isolation-and-culture-based identification and the cell cytotoxicity neutralization assay(CCNA)are considered the“gold standard”for detecting toxins or pathogenic strains[2],with long and time-consuming incubation times.Fluorescent quantitative polymerase chain reaction(PCR)is commonly used in clinical laboratory tests[3].However,the sensitivity,accuracy,and resolution of detection are limited by low-copy target gene molecules and subtle differences in template concentration.As C.difficile is distributed in feces in the natural environment and the sample matrix is complex,it is difficult to detect pathogens at low levels.Accurately quantifying C.difficile and implementing effective measures to combat C.difficile infections are of utmost importance.

Analysis of the sensory threshold between paretic and nonparetic sides for healthy rehabilitation in hemiplegic patients after stroke

The purpose of this study was to investigate the differences in the sensory threshold between the paretic and nonparetic sides of hemiplegic patients. 28 patients who were hemiplegic post-stroke (14 men and 14 women) participated in the electrical sensory and pain thresholds study;22 patients who were hemiplegic post-stroke (13 men, 9 women) participated in a study measureing the sensory threshold with light touch. Electrical sensory and pain thresholds were measured in the forearm via transcutaneous electrical nerve stimulation. The light-touch threshold was measured in the forearm using monofilaments. The light-touch, electrical sensory, and pain thresholds for the paretic side were significantly higher than for the nonparetic side in our population, respectively. In both the nonparetic and paretic sides, the male group generally showed higher thresholds for pain and sensation than did the female group. These results suggest that the different evaluations of sensory thresholds performed in this study for healthy rehabilitation will be a valuable clinical tool in hemiplegic patients after stroke.

Analysis of occupational noise for the healthy life according to the job characteristics

Noise is known that the physical risk factors defined as any unwanted sound. It can induce the health problems such as hearing loss or annoyance. The objective of this study was to assess the occupational noise exposure of nine groups for twenty peoples according to job characteristics and to compare the noise level by different variables. Personal noise levels were measured for three times using by dosimeters for each participant in Korea. The mean time weighted average noise level (TWA) of total was 73.2 ± 11.5 dBA by American conference of governmental industrial hygienists (ACGIH) standard. Especially, Korean classical music students were highly exposed to 93.2 ± 6.2 dBA but, office workers were 63.2 ± 6.6 dBA. In case of peak sound pressure level (Lpeak), Korean classical music students and firefighters were exposed to the highest level of 151.8 dBC and 145.8 dBC during playing and dispatching, respectively. The analysis of noise level showed that Leq had positive correlations between TWA by ministry of employment and labour (MOEL) (r = 0.98, p < 0.01) and TWA by ACGIH (r = 0.98, p < 0.01). Unlikely other groups, the noise exposure level of the Korean classical music students were exceeded the ACGIH standard. These results suggest that Korean classical music students were exposed high noise level and some solutions are need to reduce the noise exposure level such as using hearing protect device.

Managing Public Health Risks Using Air Monitoring at a Former Manufactured Gas Plant Site

Monitoring emissions from a former Manufactured Gas Plant (MGP) site during remediation was used to manage risks associated with inhalation of Volatile Organic Compounds (VOCs) and contaminated particulates acting as an exposure conduit for Polycyclic Aromatic Hydrocarbons (PAHs) and heavy metals. This risk management case study presents a USEPA-approved air monitoring program implemented to manage public health risks during remediation at a former MGP site located in the southeast United States. Risk-based Acceptable Air Concentrations (AACs) were developed and a sampling regimen established to monitor potential emissions to maintain contaminant concentrations below the AACs. The exposure duration used was based on a twelve-month project duration and an exposure time of 24 hours per day;equations, toxicity values and sources were based on USEPA’s Regional Screening Levels. A total 535 twenty-four hour time weighted samples (269 VOC samples and 266 PAH samples) were collected over the project duration. Only minor levels of VOCs and PAHs were detected and no results were above the AACs. These timeweighted averages demonstrate that the real-time air monitoring and control measures implemented at the site effectively maintained concentrations below the AACs and were protective of public health.

Evaluation of Occupational Risk Factors for Healthcare Workers through Analysis of the Florida Workers’ Compensation Claims Database

The purpose of this study is to evaluate occupational risk factors for nurses and CNAs by analyzing the Florida workers’ compensation claims database. Risk factors for the cause of injury, nature of injury, body part injured, and demographic and lifestyle factors were evaluated for a sample of CNAs, nurses, and restaurant servers. The results identified falls, lifting, being struck, and pushing and pulling as major causes for injury among nurses and CNAs as compared to servers. Regarding the nature of injury, sprains and strains constituted the majority of claims for nurses and CNAS with the lower back being the body part most commonly injured in a claim. The results of this study indicate that nurses and CNAs are at far greater risk for physical injury than injury or illness from chemical or biological exposures. It is recommended that emphasis must be placed on interventions for musculoskeletal injuries such as falls and lifting, taking into account environmental factors such as age and lifestyle factors that further exacerbate risk for injury.

Evaluating the Quality of Malaria-Related Health Information in the Nigerian Internet Context

Background: Patients and public are increasingly relying on Internet for health information. Health care providers are using internet for dissemination of health information. However, health information available on internet is not well regulated, and information quality varies greatly. Malaria is the leading cause of death and disease in many developing countries and has serious health burden around the world. The Internet could become a major resource for malaria education and information in Africa. This may potentially save millions of lives. The purpose of this study is to evaluate the quality of malaria health and treatment information available on the internet provided by the Nigerian context. Methods: Two key terms (malaria & treatment) were entered into three search engines: Google, Yahoo! and Bing. In order to retrieve articles as if the searches were conducted in Nigeria, the Local Area Network (LAN) settings were changed to a Nigerian proxy server, with a local Internet Protocol address. Three raters evaluated the quality of information using the DISCERN [9] instrument criteria. Kendall’s concordance coefficient (W) was calculated to determine the level of agreement among the three raters. Results: Thirty-eight websites evaluated, and the highest inter-rater average score was attributed to the Patient.co.uk website, followed by Wikipedia web site and Malaria Site. The “Home Remedies for You” website received the lowest score. Most evaluated websites were .com domains. The highest average score was given to .co.uk domains while .int had the lowest score. Conclusions: Improving the quality of malaria-related health information could lead to empowering communities, engaging and assisting them to strengthen their health and social information sharing and support.