A globally networked hybrid approach to public health capacity training for maternal health professionals in low and middle income countries

Background:MundoComm is a current NIH-funded project for sustainable public health capacity building in community engagement and technological advances aimed at improving maternal health issues.Two to four teams are selected annually,each consisting of three healthcare professionals and one technical person from specific low and middle income countries(LMICs)including Costa Rica,Dominican Republic,Honduras,and other LMICs.MundoComm is a course with three parts:in-person workshops,online modules,and mentored community engagement development.Two annual 1-week on-site“short courses”convened in Costa Rica are supplemented with six monthly online training modules using the Moodle®online platform for e-learning,and mentored project development.The year-long course comprises over 20 topics divided into the six modules-each module further segmented into 4 week-long assignments,with readings and assigned tasks covering different aspects of community-engaged interventions.The content is peer reviewed by experts in the respective fields from University of Rochester,UCIMED in Costa Rica,and faculty from Costa Rica and the Dominican Republic who maintain regular contact with the trainees to mentor learning and project progress.The purpose of this paper is to report the first year results of the MundoComm project.Methods:Both quantitative and qualitative feedback(using online data capturing forms)assess baseline and posttraining knowledge and skills in public health project strategies.Results:The course currently has one team each in Costa Rica,the Dominican Republic,and Honduras for a total of 12 trainees.The course and modules include best practices in information and communication technologies(ICTs),ethical reviews,community engagement,evidence-based community interventions,and e-Health strategies.To maximize successful and culturally appropriate training approaches,the multi-media didactic presentations,flexible distance learning strategies,and the use of tablets for offline data collection are offered to trainees,and then feedback from trainees and other lessons learned aid in the refinement of subsequent curricular improvements.Conclusions:Through remark and discussion,the authors report on 1)the feasibility of using a globally networked learning environment(GNLE)plus workshop approach to public health capacity training and 2)the capacity of LMIC teams to complete the MundoComm trainings and produce ICT-based interventions to address a maternal health issue in their respective regions.

Inquiry Based on Evidence and its Practices in Two Healthcare Facilities of Bujumbura

Background: Inquiry evidence-based practice (IBP) improves healthcare quality, reliability, and patient outcomes as well as reduces variations in care and costs. IBP and its practice in health care promote also many advantages, such as improvements of practices based on the attitudes and cognitive ideas. This study aims to assess the inquiry based on evidence (IBP) and its practices in two Health Care Facilities (HCFs) of Bujumbura to help the practitioners to understand its importance. Methods: A cross-sectional study design was used to analyze the importance of IBP and its practice in these two hospitals. The probability-sampling technique was used also to select 104 nurses from the Military Hospital of Kamenge and 55 nurses from the Van Norman Clinic. A questionnaire was used to collect data with two mains components, demographic data and knowledge and attitudes addressing the following parameters: evidence practice during inquiry, nursing theory, current analysis in nursing care oriented the evidence, prioritization of care, rational diagnostic, monitoring and assessment. Results: The findings from this study revealed a poor knowledge and attitude among participants towards Inquiry Based Practice. In all variables, participants were scoring less than 10%. However, majority of participants (76.5%) know the indicators of patients’ satisfaction with nursing interventions through survey-based practice and 74.1% argued to analyze their information collected. Conclusion: This study revealed a weak awareness on IBP and its importance during nursing practice among participants as for almost all variables, participants were scoring less than 10%, except for the indicators of patients’ satisfaction with nursing interventions through survey-based practice (76.5%). Therefore, in-service training and curriculum revision had been highlighted and recommended another to provide the best rational diagnosis and achieve the patient’s outcomes.

“I Felt Defeated. I Felt Helpless”: Social Determinants of Health Influencing the Cancer Survivorship of a Young Latina Mother

Social determinants of health (SDOH) contribute to cancer disparities among young Latina women (<50 years) residing in the counties along the US-Mexico border. These SDOH are particularly burdensome to young Latina mothers diagnosed with cancer while they are raising school-age children. Conexiones, a culturally adapted program designed to improve mother and child adjustment to maternal cancer, was piloted with diagnosed Latina mothers residing in border counties in New Mexico and Texas. The purpose of this case analysis was to highlight the SDOH affecting a young Latina mother’s cancer survivorship in the U.S.-Mexico border region. The participant’s Conexiones education sessions were recorded, transcribed, translated to English, back translated to Spanish to establish accuracy, and inductively coded. The participant’s baseline survey indicated she was a young (<50 years), married, Spanish-speaking Latina mother diagnosed with breast cancer while raising a teenage daughter. Seventeen SDOH themes affecting the participant’s cancer experience were identified in the cancer-related emotional triggers she reported across five Conexiones sessions. These themes were organized using Yanez’s conceptual model of determinants of cancer outcomes in Hispanics (i.e., socioeconomic, healthcare, cultural context, and psychosocial). Findings provide direction for cultural adaptations of evidence-based programs.

Relationship of general trust with individual health and life related factors among frail elderly residents at home in Hokkaido rural areas in Japan

General Trust (GT), defined as a default expec-tation of other people’s trustworthiness, is assumed to be a predictor for promotion of health and welfare in individuals as well as for strengthening of social capital in the community. An improvement of health and quality of life of the elderly is recently a crucial agenda. Thus, the purpose of the study was to explore which factors regarding health and life associated with GT among frail elderly people living at homes in Japanese rural area. The study selected the subjects who were designated within three mildest degrees in seven stages of long-term care levels and who met at an item and more in the national basic check-list. 209 participants were interviewed by trained health personnel using a structured questionnaire. GT was measured by a dichotomous outcome of inquiring “do you trust people in general?”. In the univariable analysis, educational status (p = 0.004), activity competence index including instrumental activity of daily living (IADL) (p = 0.020), Mini-Mental State Examination (MMSE) (p = 0.029) and Self-rating Depression Scale (SDS) (p = 0.010) were significantly related to GT. By logistic regression analysis using a stepwise method with a like-lihood ratio, educational status alone was sig-nificantly associate with GT (p = 0.010, odds ratio = 1.195 [95% confidence interval;1.043 - 1.371]). Health related factors had nothing to do with GT. Our finding suggested that the higher educated elderly might have had more opportunities to encounter the others and more indispensability to deliberately discern their trustworthiness than the lower, and consequently had higher GT through social intelligence being strengthened.

Parent and friend influences on the multiple health behavior of Pacific Islander adolescents

Youth obesity has increased dramatically in the United States, disproportionally affecting Hawaiian populations. The primary research objective was to describe the influence of parent and friends on the dietary, physical activity, and sedentary behaviors of Pacific Islander high school students. Data were collected from classrooms within a private high school on the Hawaiian island Oahu. Participants were Pacific Islander adolescents attending a high school in Hawaii. Participating adolescents completed a questionnaire, followed by a corresponding focus group;specifically reporting the social-level influences on their dietary and activity behaviors. Adolescents then interviewed their parent/guardian, asking questions relative to their perceived health-related influence. Participating adolescents (N = 60) were 53% female with a mean age of 16.93 (SD = 0.63), and their parents/guardians (N = 47) were 75% female with a mean age of 46.72 (SD = 5.11). Outcomes revealed parents/ guardians as the dominant influence on adolescents’ dietary behaviors, and time spent with parents was almost exclusively sedentary. In comparison, adolescents were more active with friends, but shared less healthy dietary habits. Results provide groundwork for similar examinations and culturally tailored interventions among similar adolescent populations.

Healthcare providers’ perceptions on screening for Intimate Partner Violence in healthcare: A qualitative study of four health centres in Uganda

The current qualitative study explored the perceptions of healthcare providers on screening for Intimate Partner Violence (IPV) in healthcare in Uganda, to develop a conceptual framework for factors likely to hinder/promote IPV screening in the country. Using purposive sampling, the study enlisted 54 healthcare workers (doctors and nurses) from four hospitals (i.e. Gulu referral hospital, Iganga referral hospital, Lacor hospital, Anaka hospital) to participate in eight focus group discussions. Data was thematically analysed using Template Analysis. The study found support for an ecological framework suggesting a complex interaction of factors at the individual (e.g. poor skills in detection of IPV by health workers and unwillingness to disclose abuse by patients), organisational (e.g. understaffing and lack of protocols for IPV screening) and societal (e.g. societal acceptance of abuse of women and poor policy on IPV management) levels as potential barriers to the practice of IPV screening in healthcare Uganda. These findings have important implications on further training of healthcare workers to adequately screen for IPV, re-organisation of the healthcare system so that it is fully-fledged to accommodate IPV screening and improved collaboration between the health sector and other community advocates in IPV management. These initiatives should run concurrently with a concerted community sensitization effort aimed at modifying attitudes towards IPV among care providers and recipients a like, as well as preparing the general population to will-fully disclose IPV to healthworkers. Study limitations and implications for further research are discussed.

Readiness to Screen for Domestic Violence against Women in Healthcare Uganda: Associations with Demographic, Professional and Work Environmental Factors

Aim: We assessed demographic, professional and work environmental determinants of readiness to screen for Intimate Partner Violence among healthcare practitioners in healthcare Uganda. Methods: The Domestic Violence Healthcare Provider Survey Scale and the Demand-Control-Support questionnaire was administered to a random sample of 376 health care providers (n = 279 valid responses) from Gulu, Anaka, Lacor and Iganga hospital situated in northern and eastern Uganda. Correlation tests, t-tests, ANOVA and Multiple Linear regression were used to analyse the data. Results: Male care providers were more likely than female peers to blame the victim for the occurrence of Intimate Partner Violence in a relationship. Participants from Lacorhospital graded a lower self-efficacy and a poorer support network with regard to screening for Intimate partner violence, and a higher propensity to blame the victim when contrasted with other hospitals. Doctors experienced a lower self-efficacy with regard to IPV screening than other professions. Blaming the victim for abuse was associated with a high work load and low support at work. In addition, with increasing work control and support, participants’ appraisal of system support and self-efficacy increased. Conclusion: Gender, profession, facility of work, work demand, control and support are important determinants of the readiness to screen for IPV in healthcare Uganda, and should inform strategy for the introduction and implementation of routine IPV inquiry in healthcare Uganda.

Intensive TB Case Finding in Unsafe Settings: Testing an Outreach Peer Education Intervention for Increased TB Case Detection among Displaced Populations and Host Communities in South-Kivu Province, Democratic Republic of Congo

Introduction: The Democratic Republic of Congo (DRC) is one of the high-burden TB countries in the world. The most affected provinces were North and South Kivu where displacements of the population favor transmission of infections. Delays in diagnosis are often causes for excessive mortality among TB patients. Aim of the Study: The study aimed to test an intervention designed to increase detection of TB cases in internally displaced persons and their host communities in South Kivu province. Methods: The project used a quasi-experimental method, with prospective data collection every six months. Two peri-urban districts were selected and designated as intervention and control districts respectively. Twenty peer educators were selected among prospective TB suspects who sought care in health facilities. The peer educators were trained and encouraged to actively influence, identify and refer potential TB suspects to health centers. The data on new TB suspects seen and cases diagnosed in both districts were collected and compared over two and a half years period. Results: This pilot study has demonstrated that the intervention has had some positive effects on both the number of persons suspected with TB who were diagnosed using either microscopy or clinical assessment. Even in terms of case detection, the study demonstrated that the number of cases detected in the intervention district was at least twice the number of cases detected in the control district. Conclusion: Nonprofessional educators can influence TB case detection even in unstable settings, but their effectiveness is dependent on the security situation. National TB control programs need to adapt community mobilization strategies to local developments even in unsafe settings.

The Association of World Health Organisation (WHO) Safe Community Programme with Death Rate from Motorcycle Accidents in Iran

Background: Many developing countries are facing the problem of rapidly rising death rate from fatal accidents involving motorcycles. Objective: To determine the effect of participation and implementation of the World Health Organization (WHO) Safe Community Programme on death rate from fatal motorcycle accidents. Methods: Motorcycle’ fatal accident data were obtained from forensic medicine departments and hospital records in 11 cities located in three provinces in Iran during 2006-2007. Data were analyzed using chi-square and ANOVA tests. Fidelity of the data was safeguarded by using national security coding for each individual involved in the accident. Results: The highest death rate was found in the Fars province followed by Khorasan and Bushehr provinces. In Fars province, the highest mortality rate was found in Niriz city, which did not implement the Safe Community Programme and the lowest death rate was reported from Arsanjan city participating in Safe Community. Similar results were found in the Khorasan province. In Busher province, the highest death rate was found in Busher city participating in the program and the lowest in Genaveh city—not participating in the program. Among sex and age groups, males aged 19 - 39 years old had a highest death rate. Half of the death occurred at the accident scene—25% during a transfer to the hospital and 25% of death occurred at the hospital. Conclusions: The Safe Community Programme is a promising model to prevent death from fatal motorcycle accidents in urban areas in Iran.

Clinical Preceptor’s Role in the Development of Nursing Training Based on Professional and Competency Frameworks in Two Health Care Facilities of Bujumbura

Background: The aim of clinical preceptors is to support the development of expertise related to the preceptorship of groups of trainees among nurses in clinical settings by the acquisition and use of theoretical knowledge, know-how and know-that. The support of students remains a major problem in hospitals, because the requirements of the preceptors according to the standards are not considered. The lack of guidelines on nursing preceptorships, theoretical application based on the professional curriculum, and professional expertise were the main problems assessed in the two Health Care (HUCK, VNC) in this study. The purpose of this study is to assess the knowledge of nurses and learners during their preceptorship practices and to contribute to the direction of evidence-based preceptorship. Method: A descriptive cross-sectional study design was used in this study during the 3-month period. A sample of 121 nurses as well as 56 learners were selected from 381 nurses and 80 learners using Alain Bouchard’s formula. A questionnaire developed according to the guidelines of Ernestine Wiedenbach’s theory of care, was distributed. The data were analyzed using the Microsoft Excel and the software program version 16 (SPSS-16). Results: The current study found that the majority of nurses do not know the importance of the clinical tutor. The results state that students experience clinical practice problems, thus clinical preceptorship is required. Nurses showed that there are different barriers often encountered during their practices. The overall nurse preceptorship process is not optimal and the average of 97.6% of nurses does not have expertise in coaching interns in clinical settings. Conclusion: Although that nurses have some experience at work, they express their weakness based on a low level of education, a lack of knowledge and trained professionals on the job, and clinical preceptorship guidelines.

Cultivating global health professionals: evaluation of a training course to develop international consulting service competence in China

Background:China’s accelerating development and increasingly important role in global health engagement create a great demand for global health professionals including international consulting experts.This study reported the detailed development and evaluation of an international consulting training for global health workforce.Methods:Based on Kirkpatrick’s model,a mixed-methods approach was used to evaluate the effectiveness of the training.Quantitative and qualitative data on participants’reaction,learning,and application of the learned knowledge and skills were collected by a training evaluation survey at the ending of training and a follow-up interview in three months after the training.Results:Thirty-six participants attended the training and 34 of them completed quantitative investigation.The training satisfaction evaluations were positive,for which participants rated the training program highly and over 90%of them agreed with the usefulness of the training.About knowledge and skills change,participants showed improved consulting knowledge and skills from pre-to post-training(P<0.001).A total of 23 participants accepted follow-up interview,and most participants applied knowledge and skills learned from the training in their daily work or study.However,only 30.4%of participants applied their learning in the consulting program.The largest barrier of application was the lack of consulting opportunities.In addition,almost all the participants reported that they would be glad to attend more training courses in the future.Conclusion:The international consulting training program was well-received,and was feasible to improve the consulting service competence of global health professionals.According to participants’feedback,it is essential to develop and expand consulting training in the field of global health.

Nursing Theory and Its Practices in Two Health Care Facilities of Bujumbura

Introduction: Nursing theory provides a systematic explanation and description of nursing phenomena. It is very important during nursing practice in healthcare facilities (HCFs) because it guides nurses on how to collect data, which data to collect, decide how to interpret the data through the perspective of the theorist, how to plan and implement care, how to make a change and how to evaluate the patient’s outcomes. This study aims to illustrate how nursing theory can be applied during the implementation of nursing care in HCFs of Burundi by orienting the nurses to understand its application during practice. Methods: A cross-sectional study design was used to assess the use of nursing theories in healthcare facilities. A purposive sampling method was used also to select 81 nurses working full and part by applying Alain Bouchard’s formula and the questionnaire was used as the data collection instrument. Results: The current study had revealed a poor knowledge among the participants on the use of nursing theory in these two HCFs as for all variables, their average scores were almost 24.1% whilst those who had no notion related to nursing theory reach a percentage of 75.9%. Conclusion: The study findings were slightly poor as for all variables, they scored less than 40%. Therefore, the use of theories to guide their practice was highly recommended to enhance the patients’ outcomes based on the use of scientific-based experts which could result from continuous education.

The intentions,needs,advantages and barriers:a survey of twenty-nine countries participating in the“Belt and Road Initiative”health cooperation

Background:China launched the Belt and Road Initiative(BRI)aiming to develop a mutually-beneficial,sustainable trade model with partner countries.The processes of international health exchanges are key parts of how this model can be sustained into the future.This paper aims to contribute to broader understanding by exploring various intentions,needs,advantages and barriers of BRI countries and then define ways China can achieve better health cooperation.Methods:In this study,a survey questionnaire was developed to investigate the perspectives of 60 international experts from 29 BRI countries.The survey was distributed and collected during the“Belt and Road High-level Meeting for Health Cooperation”,held in Beijing in August 2017.The data were entered into EpiData 3.0 by two team members respectively and analyzed with SPSS22.0.Results:Altogether 58 valid questionnaires were obtained.More than 93%of participants showed their willingness to be part of BRI health cooperation.Frist,three key areas were identified,which are broadly defined as BRI country“needs”:(1)“Develop health industries”;(2)“Prevent and control infectious diseases”;and(3)“Provide health services”.Second,three“advantages”of participating in BRI Health Cooperation were found:(1)“The establishment of a long-term partnership”;(2)“Quality investment and financing system”;and(3)“The convenience of cooperation”.Third,two main cross-cultural“barriers”for cooperation were encountered:(1)“Cultural differences”;and(2)“Lack of communication platforms”.Conclusion:In this study,we have identified priority fields that China can collaborate with BRI countries and show its leadership.It is suggested that successful health cooperation between China and other BRI countries should focus on maximizing present health-industry partnerships,investment and financing,as well as overcoming cultural and communication barriers.

Voluntary Work for Public Health——Older Volunteers’ Participation in a Norwegian Society ——Motivation Factors for Participating——Enrich Life and Positive for Health

Today there is a decreasing interest in contributing to general organizations. The purpose of this study is to examine participation in volunteer work in a municipality in Norway. The main focus is determinants of motivation factors for participation as well as non-participation. A first step was to conduct a focus group interview. The second step was to make questions for a survey based on the results of the focus group interview in order to provide an overall direction for the survey. A questionnaire was sent to six local organisations in a municipality in Norway. Analysis: Multivariate logistic and linearly regression analysis. Result: The total model was statistical significant, indicating that the model was able to distinguish between volunteers who reported to be respectively happy or not happy. The model explained 36% to 62% of the variance in this variable. The variables made a statistical significant contribution to the model. The strongest predictor of being happy was the variable “energy”. The variable “positive for my health” was the second strongest predictor. “Income” has a reverse association, meaning that the volunteers are less likely to be reported to be happy when their income increases. Network and illness explain years in voluntary work. Conclusion and implications for public health nurses: The present study shows the effectiveness of volunteering for elderly. Thus, it is an important element in public health nurses work to include strategies that focus on program stimulating elderly citizens in the municipality to stay healthy physically and psychologically.

Type 2 Diabetes—Hard to Select a Healthy Choice

Introduction: The use of foods containing high levels of sugar is increasing all the time. This is a risk factor for increased incidence of type 2 diabetes. There are few studies that have investigated the availability of low-sugar müsli products in grocery stores. Purpose: The study aims to identify which types of müsli contain high respectively low levels of sugar, and which brands are involved. Methods: The material consists of both qualitative interviews and observations from five grocery stores: City Gross, Hemköp, Ica Maxi, Stora Coop and Willy’s in Helsingborg, Sweden. The qualitative interviews had a semi-structured character and were recorded. The interviews took approx. 20 minutes and a textual analysis was conducted of the results. Data from observation was analyzed based on brand, nutritional composition and flavors, and also, where low sugar products were placed on store shelves. Results: The grocery stores provided together brands from AXA, Coop, Finax, Frebaco, Garant, ICA, Risenta, Saltå Kvarn och Urtekram, in total 24 müsli products. Of these products, 19 were high in sugar. The observation reveals that müsli products with high sugar content (17 - 29 g per 100 g müsli) are more prominently displayed than those with low sugar content. From the interviews with the store managers, it became clear that it would be valuable to highlight healthy müsli products on the shelves. However, central bureaucracy puts obstacles to such measures. Discussion: The study emphasizes the need for increased visibility of low-sugar products and proposes solutions such as negotiating with responsible person at the head office in Stockholm. Several reviews have shown that if the grocery store raises the prices of unhealthy food, the consumer is willing to purchase healthier müsli and other products. Conclusion: This study shows the need for grocery stores to upgrade healthy müsli products along with advertising to be able to influence customer’s shopping habits. Also, further research is needed how type 2 diabetes is affected by high intakes of food products with high sugar content.

Multilocular thymic cysts-a diagnostic challenge on computed tomography

A recent case report provided a patient scenario,wherein,a 39-year-old male patient presented with occasional palpitations,headache,and fever.Evaluation of tumor markers did not show any abnormal results.Subsequently,a computed tomography(CT)scan was undertaken,and its findings were affirmative of thymic cancer.Finally,the postoperative histopathological assessment of the mass,after its resection,confirmed it as an anterior mediastinal multilocular thymic cyst(MTC),with concurrent acute upper respiratory tract infection and acute myocarditis.Accordingly,this case report advocates the need for a preoperative histopathological examination with CT imaging to minimize the risk of confusing an MTC with a malignant thymic tumor.

Consequences of Helicobacter pylori infection in children

Although evidence is emerging that the prevalence of Helicobacter pylori (H. pylori) is declining in all age groups, the understanding of its disease spectrum continues to evolve. If untreated, H. pylori infection is lifelong. Although H. pylori typically colonizes the hu-man stomach for many decades without adverse con-sequences, children infected with H. pylori can manifest gastrointestinal diseases. Controversy persists regarding testing (and treating) for H. pylori infection in children with recurrent abdominal pain, chronic idiopathic thrombocytopenia, and poor growth. There is evidence of the role of H. pylori in childhood iron deficiency anemia, but the results are not conclusive. The possibility of an inverse relationship between H. pylori and gastroesophageal reflux disease, as well as childhood asthma, remains a controversial question. A better understanding of the H. pylori disease spectrum in childhood should lead to clearer recommendations about testing for and treating H. pylori infection in children who are more likely to develop clinical sequelae.

Prevalence and Early Signs of Autism Spectrum Disorder(ASD) among 18-36 Month Old Children in Tianjin of China

Objective The aim of this study is to estimate the prevalence of autism spectrum disorder （ASD） among 18-36 month old children in the Tianjin Municipality of China, and to identify early signs of autistic children and the predictability of each individual symptom. Methods A total of 8 000 children were screened to do a questionnaire based on CHAT modified to include more early signs of autism at the age of 28-36 months. Then the at-risk children were reexamined 1.5 years later and ASD children were identified based on DSM-IV. Early signs of autism were analyzed retrospectively by using discriminant function analysis performed among ASD children, children not followed up and children followed up but failing to meet ASD criteria. Results Three hundred and sixty seven children were screened as being at-risk to ASD, and 22 of them were identified as having ASD in the subsequent diagnosis. The prevalence of ASD was 27.5 per 10 000 in Tianjin of China with a male to female ratio of 4：1. Items addressing social interactions and communications had higher predictability than other items to distinguish autistic children from non-autistic ones. Pretend play, functional play, showing and reading parents＇ facial expressions distinguished autistic children from those not followed up, nevertheless those followed up but failing to meet ASD criteria were not included.Conclusion The prevalence of ASD found in our study was lower than that reported in some studies by western researchers. Autism has its specific symptoms, such as deficits in social awareness, social relatedness, and social referencing.

Genetic association and epistatic interaction of the interleukin-10 signaling pathway in pediatric inflammatory bowel disease

To study the genetic association and epistatic interaction of the interleukin (IL)-10 and IL-10/STAT3 pathways in pediatric inflammatory bowel disease (IBD). METHODSA total of 159 pediatric inflammatory IBD patients (Crohn’s disease, n = 136; ulcerative colitis, n = 23) and 129 matched controls were studied for genetic association of selected single nucleotide polymorphisms (SNPs) of the IL-10 gene and the genes IL10RA, IL10RB, STAT3, and HO1, from the IL-10/STAT3 signaling pathway. As interactions between SNPs from different loci may significantly affect the associated risk for disease, additive (a) and dominant (d) modeling of SNP interactions was also performed to examine high-order epistasis between combinations of the individual SNPs. RESULTSThe results showed that IL-10 rs304496 was associated with pediatric IBD (P = 0.022), but no association was found for two other IL-10 SNPs, rs1800872 and rs2034498, or for SNPs in genes IL10RA, IL10RB, STAT3, and HO1. However, analysis of epistatic interaction among these genes showed significant interactions: (1) between two IL-10 SNPs rs1800872 and rs3024496 (additive-additive P = 0.00015, Bonferroni P value (Bp) = 0.003); (2) between IL-10RB rs2834167 and HO1 rs2071746 (dominant-additive, P = 0.0018, Bp = 0.039); and (3) among IL-10 rs1800872, IL10RB rs2834167, and HO1 rs2071746 (additive-dominant-additive, P = 0.00015, Bp = 0.005), as well as weak interactions among IL-10 rs1800872, IL-10 rs3024496, and IL-10RA (additive-additive-additive, P = 0.003; Bp = 0.099), and among IL10RA, IL10RB, and HO1 genes (additive-dominant-additive, P = 0.008, Bp = 0.287). CONCLUSIONThese results indicate that both the IL-10 gene itself, and through epistatic interaction with genes within the IL-10/STAT3 signaling pathway, contribute to the risk of pediatric IBD.

Marked elevation of B-type natriuretic peptide in patients with heart failure and preserved ejection fraction

Marked elevations of B-type natriuretic peptide （BNP） are not generally seen in patients with heart failure and preserved ejection fraction （HFpEF）. The objective of this study was to examine the clinical and laboratory characteristics of a large cohort of patients with HFpEF and markedly elevated BNP. A retrospective examination of 421 inpatients at a university hospital admitted with a diagnosis of HFpEF was performed. Clinical and echocardiographic data in 4 groups of patients with levels of BNP ≤ 100 pg/mL, 100-400 pg/mL, 400-1,000 pg/mL and 〉 1,000 pg/mL were compared. Patients with HFpEF and BNP 〉 1,000 pg/mL （28% of the population） were characterized by impaired renal function and greater use of anti-hypertensive medications. A subset of these patients with BNP 〉 1,000 pg/mL had normal renal function （21%） and were significantly older, more frequently female, and tended to have lower ejection fractions. Conversely, patients with HFpEF and BNP ≤100 pg/mL were younger and had preserved renal function. BNP was inversely related to the likelihood of subsequent admission for heart failure, but not to myocardial infarction or death. In conclusion： BNP 〉 1,000 pg/mL is seen in almost 1/3 of patients hospitalized with HFpEF. This elevation of BNP often reflects impaired renal function, but can also be seen in patients with preserved renal function but relatively impaired systolic function.