Spatio-Temporal Trend and Geographic Disparity of Infertility Prevalence in Burkina Faso, 2011 to 2020

Background: Infertility affected 10% to 25% of couples globally, and about half of the infertility cases were reported in sub-Saharan Africa. Infertility poses significant social, cultural, and health challenges, particularly for women who often face stigmatization. However, comprehensive and nationally representative data, including prevalence, temporal trends, and risk factors, are lacking, prompting a study in Burkina Faso to address the need for informed policies and programs in infertility care and management. Objectives: This study aims to better understand the spatiotemporal trend of infertility prevalence in Burkina Faso. Methodology: This is a retrospective population-based study of women infertility from healthcare facilities in Burkina Faso, during January 2011 to December 2020. We calculated the prevalence rates of infertility and two disparity measures, and examined the spatiotemporal trend of infertility. Results: Over the 10-year period (2011 to 2020), 143,421 infertility cases were recorded in Burkina Faso healthcare facilities, resulting of a mean prevalence rate of 3.61‰ among childbearing age women and 17.87‰ among women who consulted healthcare facilities for reproductive issues (except contraception). The findings revealed a significant increase of infertility, with the prevalence rate varied from 2.75‰ in 2011 to 4.62‰ in 2020 among childbearing age women and from 13.38‰ in 2011 to 26.28‰ in 2020 among women who consulted healthcare facilities for reproductive issues, corresponding to an estimate annual percentage change of 8.31% and 9.80% respectively. There were significant temporal and geographic variations in the prevalence of infertility. While relative geographic disparity decreased, absolute geographic disparity showed an increasing trend over time. Conclusion: The study highlights an increasing trend of infertility prevalence and significant geographic variation in Burkina Faso, underscoring the urgent necessity for etiologic research on risk factors, psychosocial implications, and economic consequences to inform effective interventions and mitigate the socioeconomic impact of infertility.

Utilization of Hot Spotting to Identify Community Needs and Coordinate Care for High-Cost Patients in Memphis, TN

In 2006, Methodist Le Bonheur Healthcare (MLH) created the Congregational Health Network (CHN, TM pending) which works closely with clergy in the most under-served zip codes of the city to improve access to care and overall health status of the population. To best coordinate CHN resources around high-utilization and address the largest health needs in the community, MLH applied hot spotting and geographic information system (GIS) spatial analysis techniques. These techniques were coupled with the community health needs assessment process at MLH and qualitative, participatory research findings captured in collaboration with church and other community partners. The methodology, which we call “participatory hot spotting,” is based upon the Camden Model, which leverages hot spotting to assess and prioritize community need in the provision of charity care, but adds a participatory, qualitative layer. In this study, spatial analysis was employed to evaluate hospital-based inpatient and outpatient utilization and define costs of charity care for the health system by area of residence. Ten zip codes accounted for 56% of total system charity care costs. Among these, the largest zip code, as defined by a percentage of total charity costs, contributed 18% of the inpatient utilization and 17% of the cost. Further, this zip code (38109) contributed 69% of the inpatient and 76% of the outpatient charity care volume and accounted for 75% of inpatient and 76% of outpatient charity care costs for the system. These findings were combined with grassroots intelligence that enabled a partnership with clergy and community members and Cigna Healthcare to better coordinate care in a place-based population health management strategy. Presentations of the analytics have subsequently been made to HHS and the CDC, referred to by some as the “Memphis Model”.

Statistical Assessment of Neighborhood Socioeconomic Deprivation Environment in Spatial Epidemiologic Studies

Neighborhood socioeconomic deprivation has been associated with health behaviors and outcomes. However, neighborhood socioeconomic status has been measured inconsistently across studies. It remains unclear whether appropriate socioeconomic indicators vary over geographic areas and geographic levels. The aim of this study is to compare the composite socioeconomic index to six socioeconomic indicators reflecting different aspects of socioeconomic environment by both geographic areas and levels. Using 2000 U.S. Census data, we performed a multivariate common factor analysis to identify significant socioeconomic resources and constructed 12 composite indexes at the county, the census tract, and the block group levels across the nation and for three states, respectively. We assessed the agreement between composite indexes and single socioeconomic variables. The component of the composite index varied across geographic areas. At a specific geographic region, the component of the composite index was similar at the levels of census tracts and block groups but different from that at the county level. The percentage of population below federal poverty line was a significant contributor to the composite index, regardless of geographic areas and levels. Compared with non-component socioeconomic indicators, component variables were more agreeable to the composite index. Based on these findings, we conclude that a composite index is better as a measure of neighborhood socioeconomic deprivation than a single indicator, and it should be constructed on an area- and unit-specific basis to accurately identify and quantify small-area socioeconomic inequalities over a specific study region.

Association of hypertension and plant-based dietary patterns on cognitive impairment: a nationwide cohort study in China

This study investigated the association of hypertension with cognitive impairment and determined whether better adherence to plant-based diet(PBD)patterns may modify the association.We analyzed 4485 elderly individuals with normal cognition at baseline from the Chinese Longitudinal Healthy Longevity Survey(2011−2018).Cognitive function was assessed by the Mini-mental State Examination(MMSE),and cognitive impairment was defined as an MMSE score below 18 points.Diet patterns were assessed using the overall plant-based diet index(PDI),healthful plant-based diet index(hPDI),and unhealthful plant-based diet index(uPDI)derived from a simplified food frequency questionnaire(FFQ).Blood pressure was measured through physical examination.Cox proportional hazard regression and restricted cubic spline were performed.Participants with hypertension had an increased risk of cognitive impairment compared with normal group.The associations between hypertension and cognitive impairment were more pronounced among participants with lower PDI than those with higher PDI,among participants with lower hPDI than those with higher hPDI,and among participants with higher uPDI than those with lower uPDI.A healthful PBD pattern may attenuate hypertension-induced cognitive impairment,while an unhealthful PBD pattern may exacerbate hypertensioninduced cognitive impairment in elderly.Adherence to healthful PBD pattern could be used to prevent or mitigate adverse neurological effects in the hypertensive population.

Blood and urine biomarkers in prostate cancer:Are we ready for reflex testing in men with an elevated prostate-specific antigen?

Objective:There is no consensus on the role of biomarkers in determining the utility of prostate biopsy in men with elevated prostate-specific antigen(PSA).There are numerous biomarkers such as prostate health index,4Kscore,prostate cancer antigen 3,ExoDX,SelectMDx,and Mi-Prostate Score that may be useful in this decision-making process.However,it is unclear whether any of these tests are accurate and cost-effective enough to warrant being a widespread reflex test following an elevated PSA.Our goal was to report on the clinical utility of these blood and urine biomarkers in prostate cancer screening.Methods:We performed a systematic review of studies published between January 2000 and October 2020 to report the available parameters and cost-effectiveness of the aforementioned diagnostic tests.We focus on the negative predictive value,the area under the curve,and the decision curve analysis in comparing reflexive tests due to their relevance in evaluating diagnostic screening tests.Results:Overall,the biomarkers are roughly equivalent in predictive accuracy.Each test has additional clinical utility to the current diagnostic standard of care,but the added benefit is not substantial to justify using the test reflexively after an elevated PSA.Conclusions:Our findings suggest these biomarkers should not be used in binary fashion and should be understood in the context of pre-existing risk predictors,patient’s ethnicity,cost of the test,patient life-expectancy,and patient goals.There are more recent diagnostic tools such as multi-parametric magnetic resonance imaging,polygenic single-nucleotide panels,IsoPSA,and miR Sentinel tests that are promising in the realm of prostate cancer screening and need to be investigated further to be considered a consensus reflexive test in the setting of prostate cancer screening.

低脂肪饮食模式与浸润型乳腺癌风险的妇女健康初步随机对照饮食改良试验

Context: The hypothesis that a low- fat dietary pattern can reduce breast cancer risk has existed for decades but has never been tested in a controlled intervention trial. Objective: To assess the effects of undertaking a low- fat dietary pattern on breast cancer incidence. Design and Setting: A randomized, controlled, primary prevention trial conducted at 40 US clinical centers from 1993 to 2005. Participants: A total of 48 835 postmenopausal women, aged 50 to 79 years, without prior breast cancer, including 18.6% of minority race/ethnicity, were enrolled. Interventions: Women were randomly assigned to the dietary modification intervention group (40% [n = 19 541]) or the comparison group (60% [n = 29 294]). The intervention was designed to promote dietary change with the goals of reducing intake of total fat to 20% of energy and increasing consumption of vegetables and fruit to at least 5 servings daily and grains to at least 6 servings daily. Comparison group participants were not asked to make dietary changes. Main Outcome Measure: Invasive breast cancer incidence. Results: Dietary fat intake was significantly lower in the dietary modification intervention group compared with the comparison group. The difference between groups in change from baseline for percentage of energy from fat varied from 10.7% at year 1 to 8.1% at year 6. Vegetable and fruit consumption was higher in the intervention group by at least 1 serving per day and a smaller, more transient difference was found for grain consumption. The number of women who developed invasive breast cancer (annualized incidence rate) over the 8.1- year average follow- up period was 655 (0.42% ) in the intervention group and 1072 (0.45% ) in the comparison group (hazard ratio, 0.91; 95% confidence interval, 0.83- 1.01 for the comparison between the 2 groups). Secondary analyses suggest a lower hazard ratio among adherent women, provide greater evidence of risk reduction among women having a high- fat diet at baseline, and suggest a dietary effect that varies by hormone receptor characteristics of the tumor. Conclusions: Among postmenopausal women, a low- fat dietary pattern did not result in a statistically significant reduction in invasive breast cancer risk over an 8.1- year average follow- up period. However, the nonsignificant trends observed suggesting reduced risk associated with a low- fat dietary pattern indicate that longer, planned, nonintervention follow- up may yield a more definitive comparison.

A cluster-randomized trial comparing two SWITCH implementation support strategies for school wellness intervention effectiveness

Background:The School Wellness Integration Targeting Child Health(SWITCH)intervention has demonstrated feasibility as an implementation approach to help schools facilitate changes in students’physical activity(PA),sedentary screen time(SST),and dietary intake(DI).This study evaluated the comparative effectiveness of enhanced(individualized)implementation and standard(group-based)implementation.Methods:Twenty-two Iowa elementary schools participated,with each receiving standardized training(wellness conference and webinars).Schools were matched within region and randomized to receive either individualized or group implementation support.The PA,SST,and DI outcomes of 1097 students were assessed at pre-and post-intervention periods using the Youth Activity Profile.Linear mixed models evaluated differential change in outcomes by condition,for comparative effectiveness,and by gender.Results:Both implementation conditions led to significant improvements in PA and SST over time(p<0.01),but DI did not improve commensurately(p value range:0.02‒0.05).There were no differential changes between the group and individualized conditions for PA(p=0.51),SST(p=0.19),or DI(p=0.73).There were no differential effects by gender(i.e.,non-significant condition-by-gender interactions)for PA(p_(for interaction)=0.86),SST(p_(for interaction)=0.46),or DI(p_(for interaction)=0.15).Effect sizes for both conditions equated to approximately 6 min more PA per day and approximately 3 min less sedentary time.Conclusion:The observed lack of difference in outcomes suggests that group implementation of SWITCH is equally effective as individualized implementation for building capacity in school wellness programming.Similarly,the lack of interaction by gender suggests that SWITCH can be beneficial for both boys and girls.Additional research is needed to understand the school-level factors that influence implementation(and outcomes)of SWITCH.

Cost-Effectiveness Analysis of Combined Chinese Medicine and Western Medicine for Ischemic Stroke Patients

Objective： To evaluate the cost-effectiveness of combining Chinese medicine （CM） with Western medicine （WM） for ischemic stroke patients. Methods： Hospitalization summary reports between 2006 and 2010 from eight hospitals in Beijing were used to analyze the length of stay （LOS）, cost per stay （CPS）, and outcomes at discharge. Results： Among 12,009 patients （female, 36.44%; mean age, 69.98 ＋ 13.06 years old）, a substantial number of patients were treated by the WM_Chinese patent medicine （CPM）_Chinese herbal medicine （CHM） （38.90%）; followed by the WM_CPM （32.55%）, the WM （24.26%）, and the WM_CHM （4.15%）. With adjustment for confounding variables, LOS of the WM_CPM_CHM group was about 10 days longer than that of the WM group, and about 6 days longer than that of the WM_CPM group or the WM_CHM group （P〈0.01）; CPS of the WM_CPM_CHM group was United States dollar （USD） 1,288 more than that of the WM group, and about USD 600 more than that of the WM_CPM group or the WM_CHM group （P〈0.01）. Compared with the WM group, odd ratio （OR） of recovered and improved outcome of the WM_CPM CHM group was the highest [OR： 12.76, 95% confidence intervals （CI）： 9.23, 17.64, P〈0.01], OR of death outcome of the WM_CPM_CHM group was the lowest （OR： 0.08, 95% CI： 0.05, 0.12, P〈0.01）. There was no significant difference between LOS, CPS and OR of the WM_CPM group and those of the WM_CHM group （P〉0.05）. Cost/effectiveness and incremental cost- effectiveness ratio of the WM_CPM_CHM group were robustly higher than those of the WM group. Conclusion： Compared with WM alone, supplementing CPM and CHM to WM provides significant health benefits of improving the chance of recovered and improved outcome, and reducing the death rate, at an expense of longer LOS and higher CPS.

iPhone手机客户端戒烟程序的内容分析及发展策略研究

目的在新媒体时代,以iPhone手机为例,检验手机客户端戒烟程序(app)的效度,为戒烟app开发和应用提供发展策略及建议。方法从101款app中筛选出27款与戒烟相关的app,根据《中国临床戒烟指南(2015年版)》进行评分和评价。结果27款app与指南相关程度较低,平均依从性指数为14.6分(总分46.0分),其中最高分为36.5分;app与其他社交类软件互动较弱,48.15%的app未关联社交支持系统;app以计算类和日历类为主,29.63%的app开发出新类型。结论应结合《中国临床戒烟指南》开发戒烟app,并在理念设计上考量本土文化因素;增强app的互动性,发展互联网社区、熟人网络的支持和监督机制;增强app的新颖性、趣味性、便捷性,满足不同烟民群体的诉求;力求临床实践的整合及对app效果的验证;这些将是戒烟app未来的发展方向。