The role of nurses in the prevention of cervical cancer: Cervical screening, an unkept promise by the majority of women in Nigeria

Cervical cancer remains a major public health problem accounting for continuous female death in developing countries.Cervical cancer is the second most common cancer in women globally with an estimated number of 500,000 new cases of cervical cancer and 273,000 mortalities annually.Cervical screening is the best cancer screening test in the history of medicine and most cost-effective of all medical screening tests.The study review aimed to highlight methods of cervical cancer prevention,identify the uptake of cervical screening among women,and explain the role of nurses in uptake of cervical screening.Cervical cancer is preventable and easily treatable if it is detected at early stages,but poor information on prevention and access to screening and treatment contributes to 90%of deaths.In the developing countries such as Nigeria,a large proportion of cervical cancers are diagnosed in advanced stages,with poor rates of survival.The three main methods for preventing cervical cancer are through primary prevention(human papillomavirus vaccination and health education),secondary prevention(cervical screening,early detection of precancerous lesions,and treatment),and tertiary prevention(measures to slow the progression or recurrence,surgical removal,radiotherapy,and chemotherapy).Nurses can help improve the acceptability of this neglected promise by focusing on health education on cervical screening and vaccination in prenatal clinics and infant welfare clinics where there are more women.Inclusion of cyberspace could also serve as a successful and popular platform for this health teaching.All nurses/midwives must preach and fervently work toward the WHO 90–70–90 plan for eradicating cervical cancer.

Advances in Early Prevention of Alzheimer’s Disease in the Aged

Alzheimer’s disease (AD) is a progressive neurodegenerative disease, is one of the leading causes of death in the aging population, and has become a serious public problem endangering the physical and mental health of the elderly. The disease not only affects the health of the elderly and the quality of life in their later years, but also brings heavy financial and emotional burden to the family and society. The specific mechanism of AD is still unclear, and the current treatments focus on improving mental function and slowing down memory loss. The early diagnosis of AD is difficult and there is no cure for it, so the early prevention is particularly important. This review will introduce the major treatment, potential risk factors and summarize the relevant research about early preventions of AD, such as regular physical sports, reasonable nutritional diet, certain social activities and so on, and expect to provide a new direction for the improvement of AD.

Primary prevention of cardiovascular disease in older adults in China

Over the past two decades, the percentage of Chinese who is 60 years or older has increased from 5.2% in 1995 to 10.5% in 2015. Approximately 16% of the population in China was 60 years old and above in 2015. Since 1990, cardiovascular disease(CVD) has been the leading cause of death in China. Cardiovascular medications of older adults are usually more complicated than younger age groups due to polypharmacy, the presence of comorbidities and more susceptible to treatmentrelated adverse outcomes. Therefore, effective primary prevention of CVD for older adults is important in sustaining the health of older adults and reducing the burden of the healthcare system. Proper management of CVD-related risk factors, such as hypertension, dyslipidemia, diabetes and obesity, can remarkably reduce risks of CVDs in older Chinese. These risk factors can be modified by managing blood pressure, glucose and lipids via lifestyle modifications or receiving medications. Smoking cessation, healthy diets, strict alcohol intake and moderate physical exercise are examples of recommended lifestyle changes for remarkably recovering health conditions of older adults who have hypertension, dyslipidemia, obesity, diabetes or complications. Treatment prescriptions of older adults, in general, are recommended to be individualized and to be initiated at a low dose. The future directions for better primary CVD prevention in older adults include establishing guidelines for primary prevention of CVD for different older adults and further research on better management strategies of CVD risks for elderly Chinese.

Imperfect preventive maintenance for numerical control machine tools with log-linear virtual age process

Based on the log-linear virtual age process, an imperfect preventive maintenance policy for numerical control(NC)machine tools with random maintenance quality is proposed. The proposed model is a combination of the Kijima type virtual age model and the failure intensity adjustment model. Maintenance intervals of the proposed hybrid model are derived when the failure intensity increase factor and the restoration factor are both random variables with uniform distribution. The optimal maintenance policy in infinite time horizon is presented. A numerical example is given when the failures of NC machine tools are described by the log-linear process. Finally, a discussion is presented to show how the optimal results depend on the different cost parameters.

Factors Influencing Preventive Behaviors of Mothers for Diarrhea in Children Aged 1-5 Years in Buol District, Indonesia

This study aims to determine the factors related with mothers＇ behaviors in preventing diarrhea in children aged 1-5 years inBuol District. This was a cross-sectional survey design with health belief model as the conceptual framework. A total of 300mothers were selected by using purposive sampling method based on criteria. Mothers were interviewed by using astructured questionnaire during October to November 2015. A chi-square （X^2） test was used to determine a significantassociation between independent variables and dependent variable. The finding showed that 68.3% of mothers hadgood behaviors in preventing diarrhea. The factors significantly related to mothers＇ behaviors included perceivedsusceptibility to diarrhea, perceived severity of diarrhea, perceived benefits of diarrhea prevention behaviors, and perceivedbarriers of diarrhea prevention behaviors CP 〈 .01, p 〈 .01, p 〈 .01, and p 〈 .01 respectively）. Further, mothers had highperception to comply with diarrhea prevention behaviors. Those who perceived that diarrhea prevention behaviors werehighly beneficial to their children had good behaviors in preventing diarrhea. However, taking certain actions must considernegative aspects.

The Effectiveness of Hyperlipidemia Prevention Intervention Designed to Affect Behavior Change: Focus on Changes in Health Behavior

Hyperlipidemia prevention intervention for behavior change was conducted on subjects in their 30s and 40s to evaluate changes in health behavior and investigate the effectiveness of these changes, with respect to early prevention and improvement of disease. Subjects were middle-aged individuals aged 30 - 49, suffering from serum lipid abnormalities. Intervention designed to affect behavior change was implemented for 3 weeks in 11 employees (nine males, two females) at five workplaces. Intervention mainly consisted of improving self-efficacy. The study’s purpose was explained and the written consent was obtained from subjects. Subjects filled questionnaires (characteristics, history of present illness, health behavior, self-efficacy scale for prevention of hyperlipidemia, etc.) both before and after intervention. Subjects recorded their physical activity using accelerometers and dietary intake photographically. Each subject created realistic behavior goals and recorded their progress using self-monitoring charts. Data were analyzed using descriptive statistics;therefore, pre- and post-intervention data were compared. Physical activity and achievement rate of goals during the first week and over the next 2 - 3 weeks were compared. Health behavior scores showed modification of behavior in a desirable direction after intervention compared with those before intervention. No significant difference in self-efficacy before and after intervention was observed. However, the subscale for diet was significantly higher after intervention compared with that before intervention. Steps, total calories, and activity calories were increased in the second and third weeks compared with those in the first week. Three weeks of intervention resulted in health behavior changing in a desirable direction. We infer that intervention in the form of self-monitoring using accelerometers that make physical activity visible was effective in leading to behavior change.

The Optimization of Preventive Maintenance Scheduling for Production Machine of Production System in Finite Time Horizon

The recursion relation of preventive maintenance (PM) cycle is built up concerning the concept of effective age and age setback factor proposed in this paper, which illustrates the dynamic relationship between failure rate and preventive maintenance activity. And the nonlinear optimal PM policy model satisfying the reliability constraints in finite time horizon following Weibull distribution is proposed. The model built in this paper avoids the shortcoming of steady analytical PM model in infinite time horizon and can be used to aid scheduling the maintenance plan and providing decision supporting for job shop scheduling.

Venous thromboembolism prophylaxis in hospitalized elderly patients： Time to consider a ＇MUST＇ strategy

Venous thromboembolism （VTE） is the commonest cause of preventable death in hospitalized patients. Elderly patients have higher risk of VTE because of the high prevalence of predisposing co-morbidities and acute illnesses. Clinical diagnosis of VTE in the elderly patient is particularly difficult and, as such, adequate VTE prophylaxis is of pivotal importance in reducing the mortality and morbidities of VTE. Omission of VTE prophylaxis is, however, very common despite continuous education. A simple way to overcome this problem is to implement universal VTE prophylaxis for all hospitalized elderly patients instead of selective prophylaxis for some patients only according to individual＇ s risk of VTE. Although pharmacological VTE prophylaxis is effective for most patients, a high prevalence of renal impairment and drug interactions in the hospitalized elderly patients suggests that a multimodality approach may be more appropriate. Mechanical VTE prophylaxis, including calf and thigh compression devices and/or an inferior vena cava filter, are often underutilized in hospitalized elderly patients who are at high-risk of bleeding and VTE. Because pneumatic compression devices and thigh length stockings are virtually risk free, mechanical VTE prophylaxis may allow early or immediate implementation of VTE prophylaxis for all hospitalized elderly patients, regardless of their bleeding and VTE risk. Although the cost-effectiveness of this Multimodality Universal STat （＇MUST＇） VTE prophylaxis approach for hospitalized elderly patients remains uncertain, this strategy appears to offer some advantages over the traditional ＇selective and single-modal＇ VTE prophylaxis approach, which often becomes ＇hit or miss＇ or not implemented promptly in many hospitalized elderly patients. A large clustered randomized controlled trial is, however, needed to assess whether early, multimodality, universal VTE prophylaxis can improve important clinical outcomes of hospitalized elderly patients.

The strategic framework of tuberculosis control and prevention in the elderly:a scoping review towards End TB targets

With the rapid pace of population ageing,tuberculosis(TB)in the elderly increasingly becomes a public health challenge.Despite the increasing burden and high risks for TB in the elderly,targeted strategy has not been well understood and evaluated.We undertook a scoping review to identify current TB strategies,research and policy gaps in the elderly and summarized the results within a strategic framework towards End TB targets.Databases of Embase,MEDLINE,Global health and EBM reviews were searched for original studies,review articles,and policy papers published in English between January 1990 and December 2015.Articles examining TB strategy,program,guideline or intervention in the elderly from public health perspective were included.Nineteen articles met the inclusion criteria.Most of them were qualitative studies,issued in high-and middle-income countries and after 2000.To break the chain of TB transmission and reactivation in the elderly,infection control,interventions of avoiding delay in diagnosis and containment are essential for preventing transmission,especially in elderly institutions and aged immigrants;screening of latent TB infection and preventive therapy had effective impacts on reducing the risk of reactivation and should be used less reluctantly in older people;optimizing early case-finding with a high index of suspicion,systematic screening for prioritized high-risk groups,initial empirical and adequate follow-up treatment with close monitoring and evaluation,as well as enhanced programmatic management are fundamental pillars for active TB elimination.Evaluation of TB epidemiology,risk factors,impacts and cost-effectiveness of interventions,adopting accurate and rapid diagnostic tools,shorter and less toxic preventive therapy,are critical issues for developing strategy in the elderly towards End TB targets.TB control strategies in the elderly were comprehensively mapped in a causal link pathway.The framework and principals identified in this study will help to evaluate and improve current program,develop targeted strategy,as well as raise more discussions on the research priority settings and policy transitions.Given the scarceness of policy and evaluated interventions,as well as the unawareness of shifting TB epidemiology and strategy especially in developing countries,the increasing need of a ready TB program for the elderly warrants further research.

Blood Pressure Balance as a Marker for Early Detection of Cerebral Infarction and a Criterion for Inclusion/Exclusion from Acupuncture Treatment

Background: Early detection of cerebral infarction (CI) by home acupuncturists might be helpful in reducing stroke mortality. We compared vital signs of patients who developed CI and those who did not to ascertain if blood pressure balance is a useful marker for the early detection of CI and for distinguishing cases with potentially effective/ineffective acupuncture treatment. Methods: In this retrospective study, vital signs such as body temperature, pulse, and blood pressure, were simultaneously obtained from the right and left arms of patients who received weekly acupuncture treatment. We focused on the differences between values obtained from the right and left arms (the balance) and compared the values of patients who developed CI [CI (+)] (n = 18) and those of age-/gender-matched patients who did not [CI (−)] (n = 18). Results: Left/right blood pressure was significantly more unbalanced in the CI (+) group than in the CI (−) group, especially immediately before the onset of CI. Moreover, all CIs occurred on the side with a lower blood pressure. Discussion and Conclusions: Blood pressure balance might aid in the early detection of CI and to determine whether treatment with traditional or modern medicine is more appropriate. Acupuncture may thus help maintain patients’ quality of life.

Wheelchair Seating: Peak Pressure Distribution in Young versus Elderly Healthy Controls

Background: People may use a wheelchair when they need assistance with mobility. Some users have to remain seated in their wheelchair for most of their awake time and for a lot of activities. The need for a well fitted and supportive wheelchair is important and, for those who use the wheelchair for many hours, peak pressure distribution is of interest to prevent pressure ulcers and discomfort. Aim: To describe how high local peak pressures may be distributed over risk areas for pressure ulcers in different wheelchair settings. Methods: Two groups of healthy adults were recruited (40 elderly and 30 younger individuals). Two standard models of manual wheelchairs were used together with two types of wheelchair cushions. Results: The elderly group had a higher peak pressure over the ischial tuberosity and increased posterior pelvic rotation in the shaped seat cushion. Both groups had higher peak pressure over the trochanter in the shaped seat cushion. Peak pressure was also higher over the coccyx for the elderly in the shaped seat cushion compared with the plain cushion;this was lower for the younger group. Discussion: The results indicate that age might influence the important physical prerequisites when fitting a wheelchair to an individual.

Reduced efficacy of single-dose albendazole against Ascaris lumbricoides, and Trichuris trichiura, and high reinfection rate after cure among school children in southern Ethiopia: a prospective cohort study

Background Mass drug administration(MDA)program of albendazole to at-risk populations as preventive chemo-therapy is the core public health intervention to control soil-transmitted helminths(STHs).Achieving this goal relies on drug effectiveness in reducing the parasite reservoirs in the community and preventing reinfection.We assessed the effcacy of albendazole against STH parasite infection and reinfection status after cure.Methods A total of 984 schoolchildren infected with at least one type of STH parasite(hookworm,Ascaris lumbri-coides,Trichuris trichiura)in southern Ethiopia were enrolled and received albendazole and praziquantel in MDA campaign conducted from January to March 2019.Stool exams at week-4 and at week-8 of post-MDA were done using Kato Katz technique.The primary outcome was effcacy assessed by cure rate(CR)and fecal egg reduction rates(ERRs)at four weeks of post-MDA.The secondary outcome was reinfection status defined as parasite egg positivity at eight weeks among those who were cured at 4 weeks of post-MDA.Group comparisons in CR and related factors were assessed with chi-square or Fisher's exact tests.Predictors of CR were examined through univariate and multi-variate regression analyses.Results The overall CR and ERR for hookworm infection were 97.2%(95%CI:94.6-99.4)and 97.02%,respectively.The overall CR and ERR for A.lumbricoides were 71.5%(95%CI:68.3-74.6)and 84.5% respectively.The overall CR and ERR and for T.trichiura were 49.5%(95%CI:44.8-54.2)and 68.3%,respectively.The CR among moderate T.trichiura infec-tion intensity was 28.6%.Among children cured of hookworm,A.lumbricoides and T.trichiura at week 4 post-MDA,4.6%,18.3% and 52.4% became reinfected at week-8 post-MDA,respectively.Significantly lower CR(36.6%)and higher reinfection after cure(60.6%)among A.lumbricoides and T.trichiura coinfected children than A.lumbricoides only(CR=69.6%,reinfection rate=15.1%)or T.trichiura only infected children(CR=55.6%,reinfection rate=47.1%)was observed.Pre-treatment coinfection with≥two types of STH parasites was significantly associated with re-infec-tion after cure.Conclusion Albendazole MDA is efficacious against hookworm but has reduced efficacy against A.lumbricoides and is not effective against T.trichiura.The low drug efficacy and high reinfection rate after cure underscore the need for alternative treatment and integration of other preventive measures to achieve the target of eliminating STHs as a public health problem by 2030.

Optimal Preventive Maintenance Policy with Consideration of Production Wait

In this paper, we consider the replacement of a single unit with catastrophic failure mode. Besides replaced at a preset time, the unit is also replaced at failure time or if it encounters a production wait and its age has reached a threshold. The joint preventive maintenance interval and threshold optimization problem are formulated with the objective of minimizing the expected cost per unit time in long run. A numerical example is presented to illustrate the applicability of the model.