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The Impact of Travel Time on Geographic Distribution of Dialysis Patients  [PDF]
Saori Kashima, Masatoshi Matsumoto, Takahiko Ogawa, Akira Eboshida, Keisuke Takeuchi
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0047753
Abstract: Backgrounds The geographic disparity of prevalence rates among dialysis patients is unclear. We evaluate the association between travel time to dialysis facilities and prevalence rates of dialysis patients living in 1,867 census areas of Hiroshima, Japan. Furthermore, we study the effects of geographic features (mainland or island) on the prevalence rates and assess if these effects modify the association between travel time and prevalence. Methods The study subjects were all 7,374 people that were certified as the “renal disabled” by local governments in 2011. The travel time from each patient to the nearest available dialysis facility was calculated by incorporating both travel time and the capacity of all 98 facilities. The effect of travel time on the age- and sex-adjusted standard prevalence rate (SPR) and 95% confidence intervals (CIs) at each census area was evaluated in two-level Poisson regression models with 1,867 census areas (level 1) nested within 35 towns or cities (level 2). The results were adjusted for area-based parameters of socioeconomic status, urbanity, and land type. Furthermore, the SPR of dialysis patients was calculated in each specific subgroup of population for travel time, land type, and combination of land type and travel time. Results In the regression analysis, SPR decreased by 5.2% (95% CI: ?7.9–?2.3) per 10-min increase in travel time even after adjusting for potential confounders. The effect of travel time on prevalence was different in the mainland and island groups. There was no travel time-dependent SPR disparity on the islands. The SPR among remote residents (>30 min from facilities) in the mainland was lower (0.77, 95% CI: 0.71–0.85) than that of closer residents (≤30 min; 0.95, 95% CI: 0.92–0.97). Conclusions The prevalence of dialysis patients was lower among remote residents. Geographic difficulties for commuting seem to decrease the prevalence rate.
Preventions and Controls on Congenital Transmissions of Zika: Mathematical Analysis  [PDF]
Nita H. Shah, Zalak A. Patel, Bijal M. Yeolekar
Applied Mathematics (AM) , 2017, DOI: 10.4236/am.2017.84040
Abstract: Vector-borne diseases threat lives of millions of people in many countries of the world. Zika is one of the vector-borne diseases which initially spread by the bite of an infected Aedes species mosquito (Ae. aegypti and Ae. albopictus) and then it transmits vertically from a pregnant woman to her fetus or from an infected human to their sexual partners. The congenital transmission of Zika virus (ZIKV) results in new born with microcephaly and other neurological abnormalities. The control of infected mosquitos is the best efficient way to control spread of ZIKV. Spraying insecticide is the safest and easiest way to control mosquitos, but sometimes it is cost worthy for long period of spraying. Controlled prevention from the vector bites can also help to control disease spread. To control congenital transmission and sexual transmission of ZIKV, preventions should be taken to reduce/stop pregnancy rate and safe heterosexual transmission among adults. Also, there is no specific treatment available for Zika disease. Treatment is aimed at relieving symptoms with rest, fluids and medications. Controlled combinations of rest, fluids and medications will help to recover early. As costs are incorporated with spraying, preventions and treatment, our aim is to minimise the total cost associated by controlling spraying, preventions and treatment. To fulfil this purpose a mathematical model is developed with disease dynamics in nine compartments namely Susceptible human child, Susceptible human male, Susceptible human female, Infected human child, Infected human male, Infected human female, Recovered human, Susceptible vector and Infected vector including vertical transmission of Zika disease. Numerical simulations have been carried out to optimise controls, and basic reproduction number and stability are calculated.
The Potential Impact of Incentives on Managed Lane Travel  [PDF]
Namoo A. Han, Mark W. Burris
Journal of Transportation Technologies (JTTs) , 2018, DOI: 10.4236/jtts.2018.84014
Abstract: The use of managed lanes to control and maximize freeway throughput is increasing. One way of encouraging more managed lane use is through the implementation of incentives. In the Dallas-Fort Worth area, a managed lane is being added to the I-30 (Tom Landry freeway) and incentives to maximize the use of this lane were planned. Since the managed lanes were not yet open and the incentives were hypothetical, a stated preference survey was used to gauge the potential impact of the incentives on traveler behavior. The stated preference questions were designed using Db-efficient and random adaptive designs. The incentives were chosen by looking at other programs around the country and through discussion with transportation experts. Once ready, the survey was administered online to travelers in the area and a total of 898 usable responses were gathered. From the responses, a mixed-logit model was developed to describe and predict traveler behavior. From the model, elasticities were calculated to predict the impact of the incentives on mode choice. The model found that incentives with discounts and free trips (a transit fare discount, express bus service to downtown, a free trip for every X number of paid trips, and a discount offered to select businesses) were more effective at encouraging managed lane use. The other incentives (gift card worth $5 for every X number of trips and $5 in credit for every X number of trips taken by transit) had less of an impact.
Monitoring the impact of decentralised chronic care services on patient travel time in rural Africa - methods and results in Northern Malawi
Houben Rein MGJ,Van Boeckel Thomas P,Mwinuka Venance,Mzumara Peter
International Journal of Health Geographics , 2012, DOI: 10.1186/1476-072x-11-49
Abstract: Background Decentralised health services form a key part of chronic care strategies in resource-limited settings by reducing the distance between patient and clinic and thereby the time and costs involved in travelling. However, few tools exist to evaluate the impact of decentralisation on patient travel time or what proportion of patients attend their nearest clinic. Here we develop methods to monitor changes in travel time, using data from the antiretroviral therapy (ART) roll-out in a rural district in North Malawi. Methods Clinic position was combined with GPS information on the home village of patients accessing ART services in Karonga District (North Malawi) between July 2005 and July 2009. Potential travel time was estimated as the travel time for an individual attending their nearest clinic, and estimated actual travel time as the time to the clinic attended. This allowed us to calculate changes in potential and actual travel time as new clinics opened and track the proportion and origin of patients not accessing their nearest clinic. Results The model showed how the opening of further ART clinics in Karonga District reduced median potential travel time from 83 to 43 minutes, and median actual travel time fell from 83 to 47 minutes. The proportion of patients not attending their nearest clinic increased from 6% when two clinics were open, to 12% with four open. Discussion Integrating GPS information with patient data shows the impact of decentralisation on travel time and clinic choice to inform policy and research questions. In our case study, travel time decreased, accompanied by an increased uptake of services. However, the model also identified an increasing proportion of ART patients did not attend their nearest clinic.
Cultural Sensitivity Associated with Domestic Travel Study Program: Long-Term Impact  [PDF]
Jessica R. Eosso, Marie Fanelli Kuczmarski, Ryan T. Pohlig, Laura M. Lessard, Sandra D. Baker
Creative Education (CE) , 2019, DOI: 10.4236/ce.2019.101008
Abstract: Domestic and international travel study programs have grown in length and popularity since they began in 1923. Regardless of the field of study, the goal of most programs is to enhance student cultural sensitivity. The purpose of this study was to explore the contribution of an undergraduate food-focused domestic travel study program on long-term cultural sensitivity based on the ASKED model. A travel study program focused on transcultural food and cuisine was initiated in 1987 and as of 2017, implemented 22 times. The program length varied between 3 and5 weeks and was offered in two locations in the United States. A survey developed to explore the long-term impact of the program incorporated the ASKED model of cultural competence. This model includes five domains: cultural awareness, skill, knowledge, encounters, and desire. The survey was validated and found to be reliable. University of Delaware alumni who participated in the travel study program (n = 461) and a comparison group of alumni (n = 402) who did not participate in the program were invited to complete the survey. The majority of respondents majored in nutrition and dietetics. Alumni who participated in the travel study program had significantly higher total cultural sensitivity scores and also higher scores on 3 domains, namely cultural skill, knowledge, and desire compared to those that did not. Of the 11 program activities participants were asked to rank as contributors to cultural sensitivity, dining experiences and farm to table tours were rated as the top two, respectively. The study findings provided evidence that a short-term, domestic travel study program enhanced long-term cultural sensitivity. Since domestic programs may be a more cost-effective option and align more closely with employment opportunities in healthcare than international travel programs for college graduates, educators should provide opportunities and encourage dietetic students to participate in these travel programs.
Impact of oxidative stress on pregnancy outcome in albino rats  [PDF]
R.S. Al-Naemi,Q.H. Abdullah,S.A. Ibrahim
Iraqi Journal of Veterinary Sciences , 2012,
Abstract: Accumulative reports documented that oxidative stress is implicated in many human and animal diseases. However, the reports concerning the effect of oxidative stress on pregnancy outcome are limited and scarce. The objective of this study was to determine the impact of oxidative stress on pregnancy outcome and to assess the antioxidant effect of vitamin C and E on oxidative stress parameters in blood and placental tissue samples in experimental pregnant animals model exposed to oxidative stress. Wister Albino rats were used in this work to investigate the effects of oxidative stress exposure (addition of H2O2 to the drinking water) on pregnancy outcome. Rats were divided into 5 groups, as follows: Group I (included 7 normal pregnant rats which served as control group). Group II (exposed to 1 % H2O2) included 7 pregnant rats, the rats were allowed to become pregnant and received (1% H2O2) in drinking water from day 7th till the day 19th of pregnancy. Group III (exposed to 3% H2O2) included 8 pregnant rats. Same as group 2, but the rats were exposed to a higher concentration of H2O2 (3%) in drinking water. Group IV (included 8 pregnant rats). Pregnant rats received vitamins C and E without induction of oxidative stress. Group V (included 8 pregnant rats).induction of oxidative stress by 1% H2O2 with vitamins supplementation in the pregnant rats. Serum total antioxidants capacity (TAC), serum and placental tissue oxidative stress biomarker; 8-iso prostaglandin F2α (8-Isoprostane) were measured using specific ELISA kits. Also placental tissues of pregnant rats were isolated and put directly in 10% formalin prepared for histopathological examination. Results revealed a significant decrease in the median values of the body weight and total serum antioxidants capacity (TAC) in groups II and III of rats compared with the control group. A significant higher median value of TAC obtained in the groups IV and V when compared with the control group. Significant higher levels of serum and tissue Isoprostane observed in both groups II and III compared with control group. Histopathological, oxidative stress induced macroscopically degenerative with microscopical appearance of vasculitis and hemorrhage within decidua. Data of the present study demonstrated that imbalance oxidative stress status in pregnant rats occurred due to exposure to oxidant, which played an important role in the pathogenesis of abnormal pregnancy outcome. In addition antioxidants supplementation (vitamins E and C) were valuable in reducing this stress.
Modeling the impact of air, sea, and land travel restrictions supplemented by other interventions on the emergence of a new influenza pandemic virus
Chong Ka Chun,Ying Zee Benny Chung
BMC Infectious Diseases , 2012, DOI: 10.1186/1471-2334-12-309
Abstract: Background During the early stages of a new influenza pandemic, travel restriction is an immediate and non-pharmaceutical means of retarding incidence growth. It extends the time frame of effective mitigation, especially when the characteristics of the emerging virus are unknown. In the present study, we used the 2009 influenza A pandemic as a case study to evaluate the impact of regulating air, sea, and land transport. Other government strategies, namely, antivirals and hospitalizations, were also evaluated. Methods Hong Kong arrivals from 44 countries via air, sea, and land transports were imported into a discrete stochastic Susceptible, Exposed, Infectious and Recovered (SEIR) host-flow model. The model allowed a number of latent and infectious cases to pass the border, which constitutes a source of local disease transmission. We also modeled antiviral and hospitalization prevention strategies to compare the effectiveness of these control measures. Baseline reproduction rate was estimated from routine surveillance data. Results Regarding air travel, the main route connected to the influenza source area should be targeted for travel restrictions; imposing a 99% air travel restriction delayed the epidemic peak by up to two weeks. Once the pandemic was established in China, the strong land connection between Hong Kong and China rendered Hong Kong vulnerable. Antivirals and hospitalization were found to be more effective on attack rate reductions than travel restrictions. Combined strategies (with 99% restriction on all transport modes) deferred the peak for long enough to establish a vaccination program. Conclusion The findings will assist policy-makers with decisions on handling similar future pandemics. We also suggest regulating the extent of restriction and the transport mode, once restriction has been deemed necessary for pandemic control. Although travel restrictions have yet to gain social acceptance, they allow time for mitigation response when a new and highly intrusive virus emerges.
Assessing the Impact of Pregnancy on Sexuality Using the Pregnancy Sexual Response Inventory  [PDF]
Hajrullah Fejza, Ejona Icka, Minire Alilaj, Magbule Elezi, Albina Fejza, Liridona Jemini
Advances in Sexual Medicine (ASM) , 2018, DOI: 10.4236/asm.2018.82002
Abstract: Introduction: Pregnancy is a state when body undergoes biopsychosocial and hormonal changes which affect pregnant women and her partner. The aim of this study was assessing the changes in sexual life of pregnant women and their partners. Methods: A descriptive cross-sectional study carried out at 8 public hospitals in Kosovo. Mostly, pregnant women in third trimester attending hospitals between July and December 2017 were eligible. The questionnaires have been distributed and supervised by the Kosovo Midwife Association, while have been fulfilled by pregnant women in the delivery room or in their rest rooms. Categorical data were expressed by percentage and comparisons were made by the T-test. Statistical significance was considered as p < 0.05. Results: Out of 1510 participants, who took part in this study, it is shown that the majority of them were between the age of 18 and 35. Only 7.7% were under 18 years old. The 66.2% of the surveyed women have previously planned their pregnancies. The frequency of sexual intercourse per week shows a considerable changing among participants in the study. The number of women who are not satisfied with their sexual lives has increased from 7.9% before the pregnancy to 18.6% during pregnancy. The number of women who have never or rarely experienced orgasm has increased from 9.6% to 16.4% while the percentage of those who have often experienced orgasm before pregnancy has decreased from 38% to 22.5% during pregnancy. From the analyzed parameters only the sexual desire has not undergone changes before and during pregnancy. Moreover, the sexual desire has shown increase, into the option once a day. Conclusion and Recommendation: Apart of sexual desire which remains the same all other parameters have been decreased during the pregnancy. The role of health professionals in consulting sexual activity problems needs to be improved.
Impact of deliberate termination of pregnancy on the natural population dynamics  [PDF]
Stoj?in Sne?ana
Zbornik Matice Srpske za Drustvene Nauke , 2010, DOI: 10.2298/zmsdn1031397s
Abstract: Deliberate interruption of pregnancy is a very important social problem. The artificial abortion is a dominant procedure in the methods of birth control. The terminations of unwanted pregnancies are in direct correlation with the birth-rate and thus influence the rate of natural increase. The aim of this paper is to show influence of artificial abortion on natural population dynamics. This paper analyzes two sources of data: statistical and empirical research. .
Zika Virus Screening in the Kenyan Olympic Team Attending the 2016 Olympic Games in Brazil  [PDF]
John N. Waitumbi, Neha Buddhdev, George Awinda, Lucy Kanyara, Zephania Irura, Victor Ofula, Limbaso Konongoi, Rosemary Sang
Open Journal of Preventive Medicine (OJPM) , 2018, DOI: 10.4236/ojpm.2018.86017
Abstract: The 2016 Olympic Games happened at the time of heightened fears of Zika virus (ZIKV) that was causing microcephaly in newborns in Brazil. To avert or track introduction of ZIKV in Kenya, the Ministry of Health developed a public health response that involved screening of the Kenyan contingent before and after traveling to Brazil. Of the 92 team members that were screened, all but one tested negative for ZIKV IgM and IgG. The sero-positive individual had high IgM serum titers before and after travel to Brazil. When tested for potential antibody cross-reactivity to other flaviviruses that have been reported in Kenya, the sample showed high IgM cross-reactivity to West Nile, Tick-Borne Encephalitis and Yellow Fever Virus. Our data support the low risk predictions of acquiring ZIKV that were made before the Games and will help inform risk assessments for personnel traveling to endemic regions under similar circumstances in the future.
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