Monthly Archives: July 2021

The Status Quo in Health Risk Assessment of Chronic Diseases and Challenges Faced by China

DOI: 10.31038/IMROJ.2021621

Abstract

As a key technology for chronic disease management, risk assessment plays an important role in chronic disease prevention and control. This paper aims to summarize the status quo in risk assessment of chronic disease in recent years in hope of providing guidance for chronic disease assessment in China.

Keywords

Challenges, Chronic diseases, Health risk assessment

Introduction

The mortality due to chronic diseases accounted for about 70% of the total deaths [1-3]. In 2012, deaths from chronic diseases accounted for 86.6% of the total deaths in China, higher than the global average over the same period [4]. Due to the slow onset and long incubation of the chronic disease, prevention and early intervention, which screen high-risk patients by studying the health risk factors, are recognized as effective ways to reduce the incidence. Health risk assessment, which aims to study the relationship of the risk factors with incidence and case fatality rate as well as the inherent laws, is a basic technology and the core for screening the patients with chronic disease.

The Status Quo in Chronic Disease Risk Assessment at Home and Abroad

In 1967, the National Institutes of Health of the United States established the Framingham risk model [5]. Risk factors for cardiovascular disease (CVD), including age, systolic blood pressure etc., were included in the model to predict the risk of coronary heart disease in the next 10 years of individual patients. Framingham model is a milestone in the history of chronic disease risk assessment, promoting the innovation of risk assessment technology. After a series of improvements [6-8], the prediction ability of the model has been further improved. Other common CVD assessment models include the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) [9]; QRISK risk score [10]; Reynolds Risk Score [11]; ischemic cardiovascular disease (ICVD) risk assessment in China [12]; and Chinese CMCS model [8].

Based on 2 large cohort studies, the Harvard Cancer Risk Index Working Group developed a risk assessment tool for cancers, which can be used to assess the risk of cancer in the population aged over 40 [13]. This method is simple, fast and widely accepted. In addition, Gail Model [14], as a comparatively accurate breast cancer assessment model, can assess the risk of breast cancer within 5 years or throughout the life of an individual patient, and is widely used in clinical practice [15]. In 2018, based on Framingham model, Southwest Hospital in Chongqing, China, developed a risk assessment model for asymptomatic cancer which integrates cancer statistics in 2015 and 2018 in China, and the data on chronic disease risk assessment and standardization project of preventive medicine. Currently the model is in clinical trial.

Over the past 50 years, remarkable progress has been made in the prevention of chronic disease by risk assessment: the mortality rate of chronic disease has been significantly reduced in many countries worldwide [16]. Since the 1980s, China has gradually built ICVD risk assessment and CMCS model [8,12], a lifetime risk assessment model for cardiovascular disease and stroke [17,18] and China-PAR model [19-21], which conformed with the national situation. However, most of the existing risk assessment models in China lack external validation, and thus the application of the models is limited [22]. As for early screening for cancer, many expert consensuses have been reached [23-25], but the risk assessment model based on multiple risk factors is still in the pilot stage.

The Challenges with Health Risk Assessment in China

  1. There is a lack of high-quality data. Large cohort studies are an important source of high-quality data; At present, there are China kadoorie biobank (CKB) and prospective follow-up studies on factors impacting development of cardiovascular disease and its mortality, but they are still in early phase.
  2. The standards for health data have not been unified. Basic data for health risk assessment may come from diversified sources, such as smart watches and wearable devices etc. However, the standards of health management data have not been developed to meet the real needs in China.
  3. The modeling method is not innovative enough. The main risk factors included were lifestyle-related and metabolic risk factors [26], such as smoking and BMI, while other factors, including the time sequence of chronic diseases [27], characteristics of disease evolution in population [28], environmental factors and social determinants, have not been considered [29]. In addition, support vector machine [22], classification and regression tree etc. are less frequently used.
  4. Promotion is limited. There is a lack of a sound health education system for chronic diseases, the public have limited knowledge about chronic diseases, their attitude towards chronic disease risk assessment is ambiguous, and the compliance is not high.

Competing Interests Statement

The authors declare that they have no conflicts of interest.

References

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  2. WHO (2018) World health statistics 2018: monitoring health for the SDGs. Geneva: World Health Organization.
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  15. He DD, Wu F, Wen XS, Tang H, Fang H (2016) Progress in Gail models for breast cancer risk assessment. Tumor 36: 1389-1394.
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  18. Wang Y, Liu J, Wang W, Wang M, Yue Qi, et al. (2016) Lifetime risk of stroke in young-aged and middle-aged Chinese population: the Chinese Multi-Provincial Cohort Study[J]. J Hypertens 34: 2434-2440. [crossref]
  19. Yang X, Li J, Hu D, Chen JC, Li Y, et al. (2016) Predicting the 10-year risks of atherosclerotic cardiovascular disease in Chinese population: the China-PARproject (prediction for ASCVD risk in China). Circulation 134: 1430-1440. [crossref]
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  21. Liu F, Li J, Chen J, Hu DH, Li Y, et al. (2018) Predicting lifetime risk for developing atherosclerotic cardiovascular disease in Chinese population: the China-PAR project. Sci Bull 63: 779-787.
  22. Li ZY, Shi TX, Huang XX, Shi JW, Huang JL, et al. (2020) Research status of chronic disease risk assessment at home and abroad and analysis of breakthrough in China. Chinese Health Resources 23: 49-54.
  23. Zhuan Liao, Tao Sun, Hao Wu, Yang F, Zou W B (2014) Consensus on screening and endoscopic diagnosis and treatment of early gastric cancer in China. Chinese Journal of Gastroenterology 7: 408-427.
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Cancer Donation: Integrating Homo emotionalis with Homo economicus

DOI: 10.31038/CST.2021632

Abstract

Data from a Mind Genomics cartography for Stand Up to Cancer, executed in 2008, were analyzed 13 years later to demonstrate the power of systematized and data based studies of communication. The Mind Genomics effort, executed in a 72-hour period, retained the value for creating a base of insights for donation behavior, as well as a searchable database for suggestions 13 years later. The value of systematic exploration was confirmed by a published report in 2010, suggesting that the 2008 study led to the most successful of the Standard Up To Cancer Simulcasts. Moving beyond the analysis of 2008, the paper demonstrates new ways to extract value from Mind Genomics data, through databasing, and through deeper, more up-to-date analyses of the study results.

Introduction

The files of corporations and individual researcher are filled with studies, many of which will never see the light of day. All too often the effort expended to answer a question is so focused that without the question and the contemporaneity of the problem to be solved, the research is simply a set of numbers, interesting when the study was run, but then quickly losing its relevance. In the words of a colleague at Tropicana (Division of Pepsi) in 1996: “I have warehouses of data, but it’s all irrelevant now, after the issue has been tackled.”

To a great extent, industrial-based research about consumers comprises the concerted effort to answer a minor question, such as ‘this idea, concept’ crate enough interest in the prospective buyer to get the customer to buy? Most of these efforts, whether dealing with products or communication, end up answering the question, but providing little additional value. The data, the report, the actual effort is all treated respectfully, with corporate guidelines issued about how to ‘close out a project,’ the appropriate paperwork to complete, and how to document what the study was about, in case someone from the corporation will need to consult the data at a later date. The process, for example, at the General Foods Corporation (Now Mondelez), was so detailed that a person had to be hired specifically to monitor the close-out process.

At the same time, however, many of the studies in industry have retained their value, far beyond the early years. Conversations with Michael Supran at the Campbell Soup Company in the 1990’s revealed that data studying the systematic variations of Prego Pasta Sauce, developed in 1982, was still being used 16 years later in 1998 to guide product development (Supran, personal communication, 1998). The same was true for other efforts as well in the food industry, up to at least 2006 (Judy Zauenbrecher, Welches’s, personal communication, 2006).

What seemed to emerge from these and other conversations was the fact that research done in a systematic manner to uncover rules about behavior often maintained value of years, even decades. What was of little value was the study so tightly focused that it yielded only a factoid rather than these rules. The realization led to the recognition that industrial, or better applied research, would do well to incorporate the effort to find rules. Indeed, in their 2007 book, Selling Blue Elephants authors [1] entitled the effort ‘Rule Development Experimentation.’ It was clear by 2007 that these studies, some twenty and thirty years old, would still yield value information to guide thinking, communication efforts, and product developments, decades later. In some respects, these rule-developing experiments were creating a sort of ‘scientific literature’ of a topic, albeit from the point of view of a corporation, and a specific application.

The reason for this introduction is to lay the groundwork for the additional information which can emerge from these studies, information that may be presented in a cursory manner to managers tasked with the job of creating the event. Yet, Mind Genomics provides an opportunity to develop a database of deeper knowledge and insight, both to create better telethons in the future, but also to understand the topic in far greater depth, an understanding which can become systemic. It is the further exploration of data, now about 13 years old, an exploration into the principles and patterns, which Mind Genomics provides as the foundation for the future.

The Stand Up To Cancer (SU2C) Project of 2008

In 2008, Stand Up To Cancer (SU2C) was just in its infancy. The vision was to fund scientists, accepting support from the ordinary citizen and business, as well as the entertainment community. The goal was to drive the solution to cancer by funding novel cancer research and promising cancer researchers [2].

The 2008 plan, the first, was to host a ‘Simulcast,’ broadcast simultaneously on the main networks. The objective was to raise awareness and to solicit donations to the charity [3]. At the time, the management of SU2C approached author Onufrey, with a request that he consider donating his time and efforts to helping SU2C discover the most impactful language. The request was made because of a family relationship of the author Onufrey with one of the key people of SU2C, and the opportunity for SU2C to avail itself of known expertise for optimizing their messages [4].

Figure 1 shows the introductory page to the report. The actual project itself was done; start to finish, in a period of 72 hours. The speed of the project was made possible by the underlying discipline and formatted output of the technology, Mind Genomics (at that time, and for that project having a different name ‘Addressable Minds’) As a consequence of the accelerated timetable, the project results were communicated in depth, and the television simulcast went on as planned. This was the positive outcome of the project, which raised the planned amount of money. At the same time, however, it was becoming increasingly clear that the project itself created a wealth of new, useful and indeed valuable information on the ‘mind of the donor.’ As happens so often, the project was filed away in summer 2008, to be resuscitated in 2021, at the time of this writing. The new objective was to extract the learning, not so much about the particular target (Stand Up To Cancer), but a base of knowledge for giving to a cancer-related cause. The disciplined experiment, the nature of the design, and the analyses provide a wealth of information about how people respond to these requests for donations.

fig 1

Figure 1: The introductory page to the project summary, showing the goals of the project, the timetable, and the tactics.

The process as described here followed the specifications of the Mind Genomics process [5-7]

The study proceeded very quickly. Author Onufrey worked with the SU2C team to create a set of 36 different messages. These messages are shown in Table 1. The rapid pace of the project (front to back in three days maximum) forced the creation of messages, followed by some polishing and then insertion into a matrix. Usually the groups comprise coherent questions and the series of such questions ‘tell a simple story.’ The virtually breakneck speed of message creation allowed for some polishing of the elements, improving the quality of the messages before the actual research. The messages required about four hours to develop, and two hours to polish. The field portion, with respondents, lasted a day and a half, and the report was finished the last night.

Table 1: The 36 elements for the study.

Group 1
A1 Because someone close to you has cancer
A2 Invest for life-changing results
A3 Every day, 1,500 people in America die from cancer
A4 Support research into ALL forms of cancer
A5 Every sixty seconds someone in America dies of cancer
A6 Your help provides support and programs for caregivers of cancer patients
Group 2
B1 Track and report progress… all who donate can see how their participation creates real change
B2 One in three women will get cancer in her lifetime
B3 Donating time, money and effort makes a difference
B4 You can make a difference
B5 Ensure the quality of life for those suffering from cancer
B6 Collecting the top experts in cancer research to work collaboratively
Group 3
C1 Volunteer!
C2 Accelerate the development of life saving cancer prevention, detection and treatment
C3 Just when science is on the verge of the breakthroughs that can end cancer, the will and the funding are disappearing from the national agenda
C4 Put together the best and the brightest minds in cancer research — those on the edge of accomplishment
C5 Every year, 2,300 children in America die of cancer
C6 We are close to scientific breakthroughs in the prevention, detection, treatment and reversal of cancer
Group 4
D1 A new movement to stop cancer once and for all
D2 There are 10.8 million cancer survivors in America
D3 Because everyone knows good health is important
D4 We can now target the genes and pathways that turn normal cells into cancerous ones
D5 Other organizations have made good progress in cancer research and programs… this program brings all the strengths together to reach the ultimate goal
D6 To provide support for finding a cure
Group 5
E1 Because… cancer is a major health issue that affects everyone
E2 Support the organization by purchasing items it sells or needs
E3 We conquered Polio and Smallpox… we CAN conquer Cancer
E4 Government funding for cancer research is declining… this fills the void
E5 We have the science, the technology, the tools… all we need is YOU
E6 One in two men will get cancer in his lifetime
Group 6
F1 Make sure that a strong interest in Fighting Cancer remains a priority
F2 Because you want to honor a loved one
F3 Push scientific breakthroughs to the finish
F4 We now understand the biology that drives cancer… we are on the brink of scientific breakthroughs
F5 Cancer is a war we can actually win
F6 Act before cancer takes another life away

The conventional research approach would have been either to test these elements one-at-a-time (so-called promise testing), or to test a limited number of combinations created by the researcher or by a marketing specialist with a ‘sensibility of what the listener needs to hear to drive donation.’ These methods are hallowed in the research community because they introduce the ‘voice of the consumer.’

The reality of most research is that no one knows which elements will perform very well. It is fairly easy to spot losing elements, especially after the promise testing study is completed. These ‘losing’ elements may be adequate in and of themselves, but they don’t do well because they may be trite, or ‘off strategy.’ After the performance of each element, or the entire concept, is published for everyone to see, the opinions will emerge as to why the elements failed, alongside new and better elements.

The messages were combined by an underlying experimental design, creating 48 unique vignettes (combinations of messages), 36 comprising four elements (two questions not contributing), and the remaining 12 comprising 3 elements (three questions not contributing). The Mind Genomics experiment was set up so that the respondent was shown a vignette and had to assign two ratings, one for Question 1 dealing with probability of donating, and the second for Question 2, dealing with the amount to be donated.

fig 2

Figure 2: Example of a 3-element vignette, and rating question #2 (amount that would be donated, based upon reading the vignette).

To the untrained eye, and in fact even to someone who knows how the vignettes were developed, the combinations seem to be combined in a way that one might call constrainedly haphazard [8] All vignettes had a limited number of elements, and each element ended up appearing an equal number of times. The vignettes were created by a specially constructed experimental design, which was rotated to create hundreds of isomorphic permutations—combinations which were identical in a mathematical sense, but whose combinations were different.

These custom created experimental designs are the workhorses of Mind Genomics. They ensure that the respondent is exposed to each element the same number of times (five) in 48 vignettes, absent the same number of times (43), and that the 36 elements are statistically independent of other. The underlying experimental design ensured that each respondent evaluated a unique combination of 48 vignettes [9], and that each set of 48 vignettes suffices to estimate the contribution of each of the 36 elements both to propensity to donate (question #1) and amount expected to donate (question #2)

  1. Probability of Donating – The first scale shows an anchored 1-9 scale, with the rating 1 anchored at ‘would not donate’ and the rating 9 anchored at ‘definitely would donate’. This is a Likert scale. It’s meaning is simple intuitively, but the scale must be anchored at both ends.
  2. Amount donated – The second scale comprises nine numbers, each number corresponding to an amount of money. This second scale is easy to use.

To make the analysis easier, we converted the first scale (probability) of donating to nine values, ranging from a probability of 0% (original rating of 1, definitely not donate) to a probability of 100% (original rating of 9, definitely will donate). The nine points were considered to be equally spaced, so that a rating of 5, for example, was considered to be a probability of 50%, a rating of 6 a probability of 62.5% etc.

The first analysis looks at the distribution of ratings. Even before we look at the linkage between the different messages and donations (probability, amount, respectively), we can ask a simpler question, namely what is the relation between the probability of donating and the amount donated?

Table 2 shows a two-way cross tabulation. The numbers in the body of the table are the percent of times that the specific pair appears in the data (specific probability of donating, and amount donated).

Table 2: Distribution of probability of donating and amount donated. The numbers in the body of the table are percentages of all the responses.

table 2

The far-right column in Table 2, labelled Total Probability, shows the distribution or probabilities of donating. Thus, 11.4% of the responses are ‘not donate,’ whether due to the respondents or to the messages. The source of the probability value is not clear. The most frequent response is ‘5’ (50% probability of donating), but that is only 17% of the responses. We can see that the percents not donating or donating (ratings 1-4) sum to 43% and the percents probably or definitely donating (ratings 6-9) total a bit over 40%,

The bottom row in Table 2, labelled Total Donating suggests, in contrast, that most donations are either 0 or less than 50$.

Is There a Discernible Relation between the Likelihood of Donating and Amount Donated?

Table 2 suggests that the relation between probability of donation and amount of donation exists, albeit in very rough and noisy form. Not surprisingly, there are more darkened cells towards the left side of the table, where the amount donated is lower, but there is not a correspondingly clearly shaded area when it comes to probability of donating.

We can create a less noisy data set by estimating the average donations and probability of donations for each of the 354 respondents. Figure 3 shows a plot of the averages, and suggests that with increasingly average likelihood of donating, there is a slight increase in the amount to be donated. The relation is noisy, however. It is clear, however, that when, on average the respondent is not interested in donating (low value of the abscissa), the respondent does not choose moderate to high amount of money to ‘not donate.’ This congruence of low donation probability and low/no donation amount, provides one indication of validity, in this case face validity. The pattern seems intuitively understandable.

fig 3

Figure 3: Relation between average rating of likely to donate and average amount to be donated. Each point is an average from 48 observations. There are 354 averages, one for each respondent.

Do Respondents Change Their Ratings as They Continue Rating Vignettes?

In the research community, and especially among applied research in a business setting, there is the ongoing dispute about the change in the criteria of judgment a respondent uses when judging a concept (vignette) or a product several times. Of course the concept or the product should be changed, but one can measure the effect of putting the concept or the product in the first position, the middle positions, or the last position. There is no end to the disputes about biases proposed by the purists who feel that every applied test of this type should be evaluated purely by itself, so-called pure monadic. There are others who feel that only with repeated experience does the respondent become able to validly rate the product. If the researcher relies only on the pure monadic, there is a great deal of extraneous variability, due to the proclivities and biases of the individual respondents.

The Mind Genomics approach attracts interest because the typical respondent evaluates as many as 24-48 vignettes, in short period of time, and without much consideration. The point of view espoused by a number of researcher is one of questioning the consistency of the data with repeated evaluations [10-14].

One of the analyses presented here looks at the change of the rating assigned by a respondent as the evaluations proceed from the first to the 48th. Independent of the specific elements in a vignette, can we demonstrate a systematic bias, viz. that the average rating of the probability of donating will increase with repeated rating, or the amount given will increase with repeat rating?

Figure 4 shows an order ‘effect, both in terms of probability (likelihood) of donating (left panel), and amount of money to be donated (right panel). The two plots were created simply by averaging the rated likelihood to donate by ‘test order,’ and amount to be donated, also by ‘test order.’ For both likelihood and probability to donate, and for amount to donate, we see the upward pattern, suggesting that as the evaluations move on, respondents feel more generous. Respondents may not realize that they are being more generous, and the degree of generosity is not marked, but there is a noticeable increase.

fig 4

Figure 4: Average probability of donating (question #1) and average amount to be donated (question #2) versus the test order. Later vignettes are uprated on both ratings.

The foregoing analysis shown in Figure 3 suggests that on average, individuals become increasingly generous in terms of both likelihood and probability of donating, and amount to be donated. Does this pattern hold for the average individual? The slopes of the curves in Figure 3 provide us the answer. What does this slope look like on an individual basis? The answer appears in Figure 4. Each point corresponds to a respondent. The slopes were computed separately for the data of each respondent. Figure 5 shows the two slopes on a scatterplot. Slopes near zero mean no change. High positive slopes mean a strong positive increase in the rating with repeated evaluation. Negative slopes mean a decrease in the rating with repeated evaluation.

We conclude from Figure 4 that repeating the evaluation 48 times with new combinations ends up increasing the stated likelihood to donate, and the amount to be donated. The strength of the effect (slope) varies by respondent to respondent. There is only one respondent who strongly decreases the amount donated and the probability of donation, as the respondent progresses. Most respondents fall into the right half, and the top half, suggesting either a modest increase in probability of donating (to the right on the abscissa), or a modest increase in the amount to be donated (upwards on the ordinate). There is no clear pattern, however. As the person moves through the 48 vignettes, evaluating each, the person might increase the rated probability of donating, increase the rated amount to be donated, increase both, or increase neither.

Relating the Elements to the Ratings

Most research works with numbers to identify patterns. The preliminary, viz., surface analysis of the data, shown in Table 2 and Figures 3-5 tell us a lot about the respondent, in terms of likelihood to donate, response to repeated messages, etc. Yet, the deepest information is yet to be obtained, information which can only emerge when the stimuli are ‘cognitively rich.’

fig 5

Figure 5: Distribution of changes in likelihood of donating (abscissa) and amount to be donated (ordinate), as shown by the slopes (versus test order). Numbers above 0 mean an increase in the likelihood or donating or the amount to be donated. Each point corresponds to one of the respondents.

Table 1 shows the 36 elements, with the underlying experimental design combining these elements into vignettes which communicate information about the efforts of SU2C. Table 2 shows us that respondents differentiate among these different vignettes. Beyond the effects of order, the underlying experimental design allows us to uncover the linkage between the specific element and the rating, either of probability to donate or amount to be donated.

The tool to be used is OLS (ordinary least-squares) regression analysis. OLS works regression with the underlying experimental design, deconstructing the rating assigned to the combination into the part-worth contributions of the elements. The experimental design was applied separately create the set of 48 vignettes for each respondent, allowing OLS regression to estimate, at either the level of the respondent or the level of the group, the part-worth contribution of each element.

We express the relation between the dependent variable and the independent variable by the simple equation: Dependent Variable = k0 +k1(A1) + k2(A2) … k36(F6)

The foregoing equation is easy to interpret. The equation for the dependent variables begins with an additive constant, k0, which is the estimated value of the dependent variable when there are no elements in the vignettes. This situation is purely hypothetical because the underlying experiment ensured that EACH vignette created would have a precise set of either three elements or four elements, respectively. The additive constant, k0, can thus be considered to be a baseline, the estimated value of the dependent variable without any other information.

  1. Probability of donating – the baseline likelihood to donate to SU2C in the absence of any elements.
  2. Estimated amount donate – the baseline amount that would be donated to SU2C, in the absence of any elements.
  3. Expected value – the ‘adjusted’ amount that would be donated, defined as the amount to be donated, multiplied by the probability of the donation, again in the absence of any elements.

The OLS regression requires preparation of the data so that all of the data are in the proper format. The 36 independent variables, on for each elements, are coded as ‘1’ when the element is present in the vignette, and coded ‘0’ when the element is absent from the vignette. For statistical validity, the OLS regression approach requires more observations (viz., vignettes) than there are independent variables. Each respondent was presented with 36 independent variables, viz. our 36 elements, taking on the value 0 (absent) or 1 (present), and contributed 48 such cases or observations to the data set. Even at the level of the individual respondent, therefore, the OLS regression will run, delivering the coefficients.

As a side note, the study used three dependent variables. Each value was ‘adjusted’ by the additional of a very small random number (<10-5), ensuring that there would be some slight variation in the dependent variable, and thus prevent a crash if the respondent assigned the same rating to each of the 48 vignette. This done not happen very often, but it is always better to add a bit of random variation to the dependent variable and prevent crashes.

We now move to the actual data itself, with the equations estimated using the data from the entire panel. Despite the apparent blooming buzzing confusion, a phrase that one might use to describe the person’s reaction to the vignettes, the results emerge quite clearly, or if not clearly, at least tell a story.

Table 3 shows two sets of three models—parameters for the equations. The first set is computed using all 36 elements, and estimating the additive constant, and the value of the individual coefficients. We can liken this first set of equations (columns A, B, and C) to a statue comprising two parts, a base, and then the statue part. The additive constant is the base, and the 36 elements are the parts of the statue. The height of the statue is estimated by adding together the magnitude of the additive constant and the coefficients of the particular, limited number of elements to be incorporated into a new vignette.

Table 3: The part-worth contribution of each of the elements to donations. The table shows the contributions when the model is estimated with an additive constant (baseline), and when the model is estimated without an additive constant (no baseline).

   

Additive Constant

No Additive Constant
    A B C D E

F

   

Probability Donate

Amount Donated Expected Value Probability Donate Amount Donated

Expected Value

 Additive constant (all elements absent)

41

$23 $17 NA NA

NA

B2 One in three women will get cancer in her lifetime

3

$6 $6 14 $12

$10

A3 Every day, 1,500 people in America die from cancer

5

$7 $5 16 $13

$10

B4 You can make a difference

4

$6 $5 15 $12

$10

B5 Ensure the quality of life for those suffering from cancer

4

$6 $5 15 $12

$9

A6 Your help provides support and programs for caregivers of cancer patients

5

$5 $4 17 $11

$8

B3 Donating time, money and effort makes a difference

3

$4 $4 14 $10

$8

D5 Other organizations have made good progress in cancer research and programs… this program brings all the strengths together to reach the ultimate goal

2

$4 $4 13 $10

$8

A1 Because someone close to you has cancer

3

$4 $3 14 $10

$7

A5 Every sixty seconds someone in America dies of cancer

3

$4 $3 14 $10

$8

B6 Collecting the top experts in cancer research to work collaboratively

3

$4 $3 14 $10

$8

C1 Volunteer!

2

$3 $3 13 $9

$7

C2 Accelerate the development of life saving cancer prevention, detection and treatment

3

$3 $3 13 $9

$7

C3 Just when science is on the verge of the breakthroughs that can end cancer, the will and the funding are disappearing from the national agenda

3

$3 $3 14 $9

$7

D3 Because everyone knows good health is important

2

$4 $3 13 $10

$8

F2 Because you want to honor a loved one

3

$3 $3 14 $10

$7

A2 Invest for life-changing results

4

$3 $2 15 $9

$7

B1 Track and report progress… all who donate can see how their participation creates real change

1

$2 $2 12 $8

$6

C4 Put together the best and the brightest minds in cancer research — those on the edge of accomplishment

2

$2 $2 13 $8

$6

C5 Every year, 2,300 children in America die of cancer

2

$2 $2 13 $8

$6

C6 We are close to scientific breakthroughs in the prevention, detection, treatment and reversal of cancer

1

$2 $2 12 $8

$6

D1 A new movement to stop cancer once and for all

2

$2 $2 12 $8

$6

D2 There are 10.8 million cancer survivors in America

2

$2 $2 12 $8

$7

D4 We can now target the genes and pathways that turn normal cells into cancerous ones

1

$3 $2 12 $9

$7

E1 Because… cancer is a major health issue that affects everyone

1

$3 $2 12 $8

$6

E6 One in two men will get cancer in his lifetime

2

$2 $2 12 $8

$6

F1 Make sure that a strong interest in Fighting Cancer remains a priority

1

$2 $2 12 $8

$6

A4 Support research into ALL forms of cancer

2

$2 $1 13 $8

$6

D6 To provide support for finding a cure

2

$1 $1 13 $8

$5

E2 Support the organization by purchasing items it sells or needs

1

$0 $1 11 $6

$5

E4 Government funding for cancer research is declining… this fills the void

1

$2 $1 11 $8

$6

E5 We have the science, the technology, the tools… all we need is YOU

1

$2 $1 11 $7

$6

F3 Push scientific breakthroughs to the finish

2

$2 $1 14 $8

$6

F4 We now understand the biology that drives cancer… we are on the brink of scientific breakthroughs

-1

$1 $1 10 $7

$5

F6 Act before cancer takes another life away

0

$1 $1 11 $7

$5

E3 We conquered Polio and Smallpox… we CAN conquer Cancer

0

$1 $0 10 $7

$5

F5 Cancer is a war we can actually win

-1

-$2 -$1 10 $5

$3

In contrast to the estimates of the coefficients in a model with an additive constant, we can choose to leave out the additive constant. Columns D, E, and F show the corresponding (and much larger) coefficients. Figure 6 shows, however, that there is little loss of relative information. The corresponding pairs of coefficients (viz., A & D, for probability of donating) are very highly related to each other, as are the other two corresponding pairs. Figure 6 shows the strong correlation.

fig 6

Figure 6: Scatterplots for each of the three dependent variables, showing the strong correlation between the 36 coefficients estimated with an additive constant (abscissa), and the 36 coefficients estimated but without an additive constant (ordinate).

Equations with the additive constant are estimated for those cases when there is a sense of a baseline ‘feeling,’ in the absence of elements. The judgments made based on the coefficients will be the same, because they line up so strongly in the same way.

Table 4 makes it easy for managers to understand what is working. We need only sort the table to find those elements which generate high probabilities of donating, and/or high amounts of donated money, and/or high expected value.

Table 4 shows us that the additive constant for probability of donating is a base of 41%. The two elements which drive donation most strongly, here operationally defined as an addition 5%, are A3 and A6. In turn the additive constant for amount to be donated ins 23$ in the absence of elements. One can get an addition 6-7 dollars, however by the correct choice of elements. Finally, when we look at the expected value, combining probability and amount, we end up with an additive constant of 17$. Looking across Table 4, the manager of the campaign would be advised to choose combination of A3 and B2.

Table 4: Strong performing elements for the three dependent variables, and the recommended combination.

table 4

The Allure of Mind-Sets

A continuing theme in Mind Genomics is the discovery of underlying groups of respondents, distinguished not so much by WHO they are, but by how they think. Marketers call these psychographic segments. The segments are typically created on the basis of variables such as age, gender, geography. These geo-demographic variables are relative blunt measures, because people who resemble each other in their geo-demographics often think in radically different ways. One need only visit a neighborhood food store to see the array of different flavors of the same food, sold to people of similar geo-demographic profiles.

A better way is to discover how people think about a topic. There are various approaches for identifying groups of people, who are demonstrated to think differently on a set of related topics such as lifestyle. The problem with these methods of dividing the population is that the methods come from the top down, showing differences in the way people think about large topics. How does one translate membership in a big lifestyle segment to the exact words one needs to use for a targeted campaign, with limited focus, and even more limited budget?

Mind Genomics works from the bottom-up, creating mind-sets or groups of people, based exclusively on the patterns of their reactions to the important stimuli, namely the messages. The key benefit provided by Mind Genomics is the ability to create an equation or model for each respondent, based upon the responses to the 48 vignettes. One can then cluster the 354 respondents based upon the pattern of the coefficients. The actual clustering method is left to the researcher.

Mind Genomics follows a simple process to discover mind-sets.

    1. Run three parallel analyses, one for each dependent variable; probability of donating, amount donated, expected value. The clustering analysis was thus done three times, once for each dependent variable.
    2. Choose the dependent variable (e.g., Probability of Donating). For the chosen dependent variable create the 354 individual level models, using OLS regression. For this specific study on messaging, the models were estimated without an additive constant. As Figure 6 shows, the same pattern of coefficients appears whether the researcher incorporates or does not incorporate the additive constant.
    3. Cluster the 354 respondents based upon the respondents’ patterns of coefficients, created using k-means clustering (Likas et. al., 2003). Individuals with similar patterns of 36 coefficients were put into the same cluster. The cluster will become the ‘mind-set’.
    4. Extract three clusters of mind-sets and assign each of the 354 respondent to the appropriate mind-set.
    5. Note that when we do the foregoing exercise three times, once for each dependent variable, the composition of the three mind-sets will change. That is, the composition of the three mind-sets or clusters, differs by the dependent variable.
    6. The foregoing steps have now created three new groupings for every dependent variable. These groups are the mind-sets. For every dependent variable, every one of the 354 respondents is assigned to exactly one of the three mind-sets.

Now, consider one dependent variable, e.g., probability of donating. Each respondent fits into only one of the three mind-sets. We analyze the data on a mind-set basis.

  1. Compute the average rating (or expected value) for each mind-set across all the respondents in the mind-set and all the 48 vignettes for each respondent. This average gives a sense of how the mine-set feels about the topic.
  2. Once again, run the equation for the dependent variable selected (viz., Probability of Donating, dependent variable 1). This time, estimate the equation using the additive model. Run the OLS regression analysis three times, once incorporating all the data from the respondents assigned to the mind-set for that dependent variable.
  3. Lay out the result and select only the strong-performing elements for each mind-set. The definition of ‘strong performing’ is a coefficient above a certain cutoff. The cutoff is operationally specified by the researcher.
  4. If an element fails to perform strongly for all three mind-sets, then eliminate the element. This action will eliminate most of the elements, allowing only the most promising elements. These are elements which do well for at least one mind-set. Tables 5shows the strong performing elements for each of the three mind-sets for a dependent variable.
  5. For purposes of selecting the correct messages for the proposed SU2C, Table 5 presents the relevant information from which to craft messages.
  6. For systematized understanding and data-basing in a ‘wiki of the mind,’ the original motivation for this reanalysis of the data 13 years later, Table 5 present the necessary information to better understand the mind of the donor, and to create a Mind Genomics of donation.

Table 5: Summary results for three mind-sets emerging for each dependent variable, and the strong performing elements for each mind-set. The recommended messages to use are shown in shaded cells.

table 5(1)

table 5(2)

table 5(3)

Discussion and Conclusions

At the time of writing Selling Blue Elephants (2006 for the 2007 publication deadline), the realization emerged that one could do studies for companies and other groups, studies which would answer the question, but studies which would have great residual value. It was in this spirit that many studies were run, studies which created these so-called rules. The question then was asked: Can these studies be reopened a significant time later, when the issue had been long answered, and in turn, can these studies ‘teach.’ If so, the opportunity was emerging to create studies whose value would be immediate AND long term. It is to that issue that we addressed this paper, with a case history about what was done, and what was learned 13 years later of a general nature.

By their very nature, Mind Genomics study provides valuable information years, even decades after they have been executed. The reason for the retained value is two-fold. First, the raw material, the elements, is cognitively rich. A database of the type shown in Tables 4 and 5 but comprising all 36 elements rather than just ‘strong performers’, becomes a valuable. The database can be searched, and new facts and insights can be discovered. One can imagine a world where there are millions or even hundreds of millions of these databases created each year, and available for search to broaden our understanding. The result is a Wikipedia of the Mind, produced at the level of local issues, at the level of granularity.

There is a second use, as well. That is as a database from which one can extract meta-patterns, such as average ratings of subgroups, or change in response patterns over time. This second use pales, of course, when compared to the first application above, the Wikipedia of the Mind at the level of granular, everyday experience. Yet, when we emerge from the euphoria of what could be, we realize that it is this less-exciting second use which corresponds to today’s archival sciences. Information, but without the systematized, cognitive richness so readily available from Mind Genomics.

The final question is very simple. Was the study effective? Here is a direct quote from 2010. Although one might not attribute the massive success of SU2C, the fact that those running the simulcast in 2008 knew ‘what to say’ should be taken into account as a factor in the success of SU2C, in its effort to change the perception of cancer, and to highlight the efforts being made to treat it, control it, and cure it.

Stand Up to Cancer

LOS ANGELES—A look at some of the statistics culled from the Stand Up to Cancer (SU2C) Sept. 10 broadcast may seem to indicate that the fundraising and cancer awareness effort fell somewhat short of its original milestones two years before: The 2010 show announced that $80 million had been pledged, whereas in 2008 the number was approximately $100 million. ….

The first show was seen on only ABC, CBS, and NBC, which for this year’s show were joined by many more collaborative network and cable partners including Fox, Bio, Current TV, Discovery Health, E!, G4, HBO, HBO Latino, MLB Network, mun2, Showtime, Smithsonian Channel, the Style Network, TV One, and VH1…..(Source… [11]).

References

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Psychological Problems of COVID-19 Sufferers

DOI: 10.31038/PSYJ.2021332

Abstract

COVID-19 has increased all over the world. It has brought a significant change around the world. Although the COVID-19 infected patients are mainly suffering from infection but there are other areas to concern about. The burden of mental health problems of pre and post-COVID-19 has become a major concern to address. Lockdown, quarantine, social distancing have already raised questions regarding mental health problems. This review demonstrates the psychological impacts of all of these on a healthy individual.

Keywords

COVID-19, Healthcare management, Psychological problems

Introduction

The continuous increasing rate of COVID-19 around the world has isolated the people from their normal life. There is still no hope of changing the situation immediately. Various safety initiatives are taken by the government of several countries. These include the lockdown, quarantine of people, maintaining social distances, wearing masks, etc. These are actually found effective to prevent the spread of viruses. But these initiatives have also raised questions regarding the mental health. The psychological impacts of these initiatives on healthy individuals are found very much negative. This is exactly how COVID-19 has caused a public health danger and it has become a global health challenge. Now the mental health problems of people tend to be higher than the death of COVID-19 infected people. We have seen it in the past also. Whenever, a infectious disease becomes epidemic or pandemic, it gives rise various psychological diseases, mental stress, fear, illness, anxiety, boredom [1,2]. We have seen how people’s mental health was hampered during the period of Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS). This review will provide necessary information on how the COVID-19 pandemic is causing a public health crisis inducing mental health problem [3].

The people who are getting infected by SARS-COV-2 are the biggest sufferers of COVID-19. The COVID-19 infected patient are not only undergoing physical damage in the body but also facing several mental problems in the post COVID-19 period. But this is actually not the end of the suffering scenario. The suffering is divided into pre and post-COVID-19 mental sufferings. This mental trauma is not only limited to the people infected by SARS-COV-2, it includes the healthcare professionals also. The people who are not yet infected by SARS-COV-2, also undergoing through a mental trauma. Staying in the house day after day during lockdown, making social distancing everywhere, using mask everywhere have distracted them from their normal life. Besides they are always in the fear of getting infected by SARS-COV-2 anytime. This is actually letting them down mentally. Because the fear largely accelerates the level of anxiety and stress that leads to the intensification of the symptoms of those with pre-existing psychiatric disorders [4-6]. The older people aged above 60 are in the highest risk position because of their more physically weak condition than any other age group [7]. They are undergoing through depression, anxiety, stress, emotional exhaustion very frequently. China recently conducted a study on the psychological/mental problems of COVID-19. The report stated that 53.8% of the participants among the general public were severely or moderately psychologically affected having depression, anxiety and stress [8]. The quarantine period is a very difficult period for the people to stay alone although it is effective to prevent the spread of viruses. But loneliness often takes place during this period. So the quarantine period has some bad psychological impacts on individuals which are confirmed by Lancet in a report. According to Lancet, long quarantine often induces post-traumatic stress symptoms, confusion, and anger. Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. This review was done using three electronic databases. Of 3166 papers found, 24 are included in this review [9]. The social distancing or social isolation is one of the hardest things to do for the people although it is effective to prevent the spread of virus. It often triggers loneliness that induces mental health problems due to arise of anxiety, depression, stress, fear, etc. [10]. Depression, anxiety, loneliness often induces the commitment of suicides [11,12]. Anxiety, insomnia, anger, boredom, loneliness of people are the results of the recent COVID-19 pandemic according to report of several studies [13]. A study, published in The Lancet Psychiatry journal, stated that one in 5 COVID-19 patients suffer from mental illness within 90 days after testing for COVID-19. This mental illness most likely includes anxiety, depression and insomnia. It also reported that having a pre-existing mental illness causes 65% more chance to be infected with COVID-19 than those without [14]. The healthcare professionals are not out of this COVID-19 induced mental problems. They are under tremendous mental pressure as the rate of COVID-19 patients is increasing day by day. They are unable to meet their family and friends for a long time. Several studies reported about the mental problems they are dealing with at the moment. The appearance psychiatric symptoms among the healthcare professionals are now clear according to the reports of some studies. A report in the Journal of Psychiatric Research stated that the healthcare professionals are in extreme working pressure that induces psychological distress. Anxiety, irritability, insomnia, fear and anguish are among them. The systemic review was made based on the PRISMA protocol [15]. Again, several studies confirmed the fact that the healthcare professionals are suffering from high rates of stress, anxiety as well as mental disorders [16,17].

Conclusion

The world is undergoing through a tough situation due to COVID-19 pandemic. Both physical and mental health of people are getting equally affected due to COVID-19. But the mental health issues are less focused. The COVID-19 pandemic has created this mental health challenge. This review Suggests the identification of the factors associated with COVID-19 induced mental health problems and making of specific and necessary guidelines to overcome this challenge.

References

  1. Reardon S (2015) Ebola’s mental-health wounds linger in Africa: Health-care workers struggle to help people who have been traumatized by the epidemic. Nature 519: 13-15. [crossref]
  2. Shin J, Park HY, Kim JL, Lee JJ, Lee H, et al. (2019) Psychiatric Morbidity of Survivors One Year after the Outbreak of Middle East Respiratory Syndrome in J Korean Neuropsychiatr Assoc 58: 245-251.
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  7. Kim, J (2020) Clinical Feature of Coronavirus Disease 2019 in Elderly. Korean J Clin Geri 21: 1-8.
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  9. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, et al. (2020) The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 395: 912-920. [crossref]
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Huge Retroperitoneal Mass: Ginecologic-Type Leiomyoma

DOI: 10.31038/CST.2021631

Abstract

Uterine leiomyomas are the most common gynecological tumors in women of reproductive age. However, there are cases of atypical localization, which could represent a diagnosis and treatment challenge. We describe the case of a 54-year-old female patient, with the finding of a large intra-abdominal mass, compatible with gynecological-type leiomyoma, located at the upper retroperitoneum, successfully diagnosed and treated with laparoscopic surgery.

Keywords

Retroperitoneal tumors, Ginecologic-type leiomyoma, Surgery, Laparoscopic surgery

Introduction

Uterine leiomyomas (also called myomata or fibroids) are the most common pelvic neoplasms in women [1,2]. They arise from the smooth muscle cells of the myometrium and extrauterine locations are extremely rare. Although they are histologically benign, in the presence of an atypical presentation, they could mimic malignant tumors at imaging and may become a diagnostic and treatment challenge that will require a multidisciplinary approach [3,4].

The case of a 54-year-old female patient, diagnosed with a large intra-abdominal mass, compatible with gynecological-type leiomyoma, located at the upper retroperitoneum, is presented.

Case Presentation

A 54-year-old female patient, with a history of hysterectomy for uterine fibroids, was diagnosed with an asymptomatic giant retroperitoneal mass, detected by ultrasound, as part of medical follow-up. In order to better assess this finding, a Magnetic Resonance Image (MRI) was carried out showing a left retroperitoneal lesion of 142 x 88 x 86 mm, of probable mesenchymal origin, causing displacement of the splenic vein, tail of the pancreas, kidney and spleen, with no clear dependence on any organ (Figure 1A and 1B).

fig 1

Figure 1: MRI (A: Axial and B: coronal views) showing an heterogeneous retroperitoneal mass of 142 x 88 x 86 mm.

The case was discussed on a multidisciplinary committee and based on the size and unknown origin of the lesion, she was considered a candidate for resection. The patient was placed in a lateral decubitus position and a laparoscopic approach was performed. Retroperitoneum was accessed by previously dissecting the sigmoid colon in a lateral to medial fashion. After identification of the mass, a complete resection was performed emphasising not to open the tumor´s capsule (Figure 2). The postoperative course was uneventful and the patient was discharged on the third postoperative day. Pathological analysis of the resected specimen revealed a nodular lesion constituted by a proliferation of elongated, fusiform cells of typical  muscle appearance without marked mitotic activity (<1 mitosis in 50 HPF) (Figure 3A). Hormonal receptors (Estrogen and Progesterone) showed intense and diffuse positivity (Figure 3B). These findings are consistent with gynecologic type retroperitoneal leiomyoma.

fig 2

Figure 2: Laparoscopic image showing retroperitoneal mass (black arrow), sigmoid colon (yellow asterisk), left kidney (green asterisk) (A, B and C). After complete dissection, the extraction was performed in a protective bag through a pfannenstiel incision (D).

fig 3

Figure 3: A: Gynecologic-type leiomyoma of retroperitoneum. Hematoxylin-Eosin (H-E) staining sections show intersecting fascicles of slender tapered smooth muscle cells arranged in a whorled pattern separated by well vascularized connective tissue. B: Gynecologic-type leiomyoma of retroperitoneum. Estrogen receptor protein (ER) nuclear staining shows irregular packets and fascicles of spindle cells.

Discussion

Leiomyomas represent the most common gynecologic and uterine neoplasms, diagnosed in up to 70% of women during their lifetime [5]. They originate primarily from smooth muscle cell proliferation in the myometrium and extrauterine locations are extremely rare [6]. Although they are histologically benign, extrauterine leiomyomas may mimic malignant tumors at imaging and may become a diagnostic challenge [6,7].

Analyzing the differential diagnoses to be taken into account when facing a retroperitoneal mass, a wide range of tumors can be found, both benign and malignant. Generally, they are divided into solid or cystic, based on the different imaging modalities [8]. In turn, each subgroup is subdivided into neoplastic and non-neoplastic [9,10]. The real incidence of each of these pathologies is unknown [11]. However, it has been shown that 80% of primary retroperitoneal neoplasms are malignant [12]; in fact the retroperitoneal space is the second most frequent location, followed by the lower extremities, where malignant mesenchymal tumors arise. Approximately, one third of retroperitoneal tumors are sarcomas [13]. The most frequent sarcomas are liposarcoma, malignant fibrous histiocytoma, and leiomyosarcoma [14,15]. Given that treatment options vary, it is useful to be able to noninvasively distinguish these masses, this is why preoperative imaging including MRI must be performed [16]. Nevertheless, is a fact, that most of the times it will not be possible to define the tumor`s nature [17]. Due to the lack of diagnostic accuracy, using currently available radiologic modalities, prompt surgical intervention will usually be indicated; more if we take into account that these tumors are usually asymptomatic and they may become huge masses before diagnose.

A laparoscopic approach is technically feasible and safe, and should be considered for this cases, given the well described advantages of this approach such as less postoperative pain, rapid recovery, and better cosmetic results [10,18]. However, the size and location could potentially be factors to hinder laparoscopic feasibility. If adequate safety margins cannot be ensured, and risk of opening the tumor´s capsule is present, an open procedure should be performed [19].

Conclusion

The relevance of the present case lies in the unusual presentation of a gynecologic type leiomioma as a retroperitoneal mass. As mentioned before, it must be taken into account in the differential diagnosis of retroperitoneal masses, especially when the patient has a history of leiomyoma.

Acknowledgments

The authors would like to thank the pathology department of the Hospital Italiano de Buenos Aires, for their services.

Conflicts of Interest

The authors declare not having any conflicts of interest.

Ethical Disclosures

Protection of Human and Animal Subjects

The authors declare that no experiments were performed on humans or animals for this study.

Confidentiality of Data

The authors declare that they have followed the protocols of their work center on the publication of patient data.

Right to Privacy and Informed Consent

The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.

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  10. Wee-Stekly WW, Mueller MD (2014) Retroperitoneal Tumors in the Pelvis: A Diagnostic Challenge in Gynecology. Frontiers in Surgery 1: 49.
  11. Scali EP, Chandler TM, Heffernan EJ, Coyle J, Harris AC, et al. (2015) Primary retroperitoneal masses: what is the differential diagnosis? Abdom Imaging 40: 1887-1903. [crossref]
  12. Neville A, Herts B (2004) CT Characteristics of Primary Retroperitoneal Neoplasms. Critical Reviews in Computed Tomography 45: 247-270. [crossref]
  13. Clark MA, Fisher C, Judson I, Meirion Thomas J (2005) Soft-Tissue Sarcomas in Adults. New England Journal of Medicine 353: 701-711.
  14. Francis IR (2005) Retroperitoneal sarcomas. Cancer Imaging 5: 89-94.
  15. Gupta AK, Cohan RH, Francis IR, Sondak VK, Korobkin M (2000) CT of Recurrent Retroperitoneal Sarcomas. American Journal of Roentgenology 174: 1025-1030. [crossref]
  16. Shah JD, Kirshenbaum M, Shah KD (2008) CT Characteristics of Primary Retroperitoneal Tumors And the Importance of Differentiation From Secondary Retroperitoneal Tumors. Contemporary Diagnostic Radiology 31: 1-5.
  17. Fasih N, Shanbhogue AKP, Macdonald DB, Fraser-Hill MA, Papadatos D, et al. (2008) Leiomyomas beyond the Uterus: Unusual Locations, Rare Manifestations. RadioGraphics 28: 1931-1948. [crossref]
  18. Tsivian M, Ami Sidi A, Tsivian A (2009) Laparoscopic Management of Retroperitoneal Masses: Our Experience and Literature Review. World Journal of Laparoscopic Surgery with DVD 1-5.
  19. Cadeddu MO, Mamazza J, Schlachta CM, Seshadri PA, Poulin EC (2001) Laparoscopic Excision of Retroperitoneal Tumors. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 11: 144-147. [crossref]

Analysis of the New Prescriptions Created in Our Organization during the First Twelve Months after the Declaration of the State of Alarm Due to SARS-CoV-2

DOI: 10.31038/JIPC.2021112

Commentary

One year after the declaration of the state of alarm due to SARS-CoV-2 in Spain (March 14, 2020) the authors wanted to know the impact that the changes implemented in the health system have had on the creation of new prescriptions in our organization (Integrated Health Organization (IHO) Bidasoa). Bidasoa IHO is a health organization belonging to Osakidetza, it serves more than 85,000 inhabitants and is composed of 3 health centers and a regional hospital.

This is the continuation of the analysis made of the first 3 months after the declaration of the state of alarm [1] and analyzes the new prescriptions made from March 14, 2020 to March 13, 2021 (one year since the declaration of the first state of alarm due to the pandemic in Spain) and compares them with those started between March 14, 2019 and March 13, 2020 (one year earlier). The prescriptions created by Primary Care physicians (family doctors, pediatricians, and doctors of Continuing Care Points and nursing homes), hospital outpatient clinics and outpatient consultations, and the hospital emergency services have been reviewed. All the data were obtained from the OAS (Oracle Analytics Server) tool, which records the electronic prescriptions [2].

In the Bidasoa IHO during this period 231,876 new prescriptions were created compared to 171,830 a year earlier, which represents a reduction of 25.9% (Table 1).

Table 1: Prescriptions initiated between March 14, 2020 and March 13, 2021 in Bidasoa IHO, compared to the same period of the previous year [2].

New prescriptions

2019/2020

2020/2021

Variation

Total

231.876

171.830

-25,9%

Acute

94.837

69.318

-26,9%

Chronic

137.039

102.512

-25,2%

On demand

168.076

117.909

-29,8%

Gender: Men

41.033

35.529

-13,4%

            Women

22.767

18.392

-19,2%

During the first twelve months after the declaration of the state of alarm, there have been substantial changes in the way of working in health care, including an increase in telephone consultations and a decrease in face-to-face consultations, or the successive automatic extensions of many of the chronic and on demand treatments. These facts are emerging as the most plausible reasons for the decrease in the new prescriptions initiated in this period.

The total number of medication containers dispensed in pharmacy offices between March 2020 and February 2021 compared to the same period of the previous year, has been reduced by 3% [3]. In other words that means that, in the same period in which there was a 25.9% reduction in the creation of new prescriptions, only 3% less medication was dispensed in pharmacies. This difference could be explained, among other reasons, by the successive automatic extensions of the treatments that have been carried out in the last year, which could mean that fewer treatment reviews have been carried out for chronic patients.

New prescriptions were analyzed by therapeutic groups and 3 groups stand out in terms of their reduction: in group R (respiratory) new prescriptions were reduced by 42.9%, in group M (musculoskeletal) by 35.4 % and in group J (anti-infectives for systemic use) by 34.6% (Figure 1).

fig 1

Figure 1: Start of prescriptions by therapeutic group March 14, 2020 to March 13, 2021 vs. same period of the previous year [2].

Likewise, some therapeutic subgroups have been reviewed and it is observed that in the vast majority of subgroups there is a reduction in the initiation of new prescriptions. The reduction is greater than 30% compared to the previous year in some subgroups such as: agents affecting bone structure and mineralization (M05) 41.9%, agents against obstructive airways conditions (R03) 39.4 %, systemic antibiotics (J01) 36.4%, opioids (N02A) 36.3%, NSAIDs (M01A) 35.9%, other analgesics and antipyretics (N02B) 31.6%, otologicals (S02) 31.1%, lipid modifiers (C10) 30.9% and calcium channel blockers (C08) 30%. On the contrary, an increase in the creation of new prescriptions was detected in the following subgroups: insulins (A10A) 52.9%, diuretics (C03) 1.4% and direct-acting anticoagulants (B01AE and B01AF) 10.5% (Table 2).

Table 2: Variation in the initiation of prescriptions in some therapeutic groups under the study period [2].

Therapeutic subgroup

2019

2020

Variation

A02. Antacids

8.664

6.931

-20,0%

A10A. Insulins

408

624

52,9%

A10B. Non-insulin antidiabetics

1.439

1.053

-26,8%

A11. Vitamins

2.105

1.611

-23,5%

B01. Antithrombotics

3.577

3.103

-13,2%

B01AE and B01AF. Direct-acting anticoagulants

218

241

10,5%

B03. Antianemics

3.370

2.752

-18,3%

C02. Antihypertensives

126

102

-19,0%

C03. Diuretics

1.776

1.801

1,4%

C07. Beta-blockers

885

799

-9,7%

C08. Calcium channel blockers

874

612

-30,0%

C09. Inhibitors of the renin-angiotensin system

3.490

2.573

-26,3%

C10. Lipid modifiers

1.631

1.127

-30,9%

J01. Systemic antibiotics

30.599

19.469

-36,4%

M01A. Nonsteroidal anti-inflammatory drugs

28.591

18.327

-35,9%

M05. Agents for bone structure and mineralization

363

211

-41,9%

N02A. Opioids

9.634

6.135

36,3%

N02B. Other analgesics and antipyretics

24.128

18.487

-23,4%

N02C. Anti-migraine

472

323

-31,6%

N03. Antiepileptics

2.547

2.329

-8,6%

N04. Antiparkinsonians

159

116

-27,0%

N05. Antipsychotics

13.840

13.319

-3,8%

N05B and N05C. Benzodiazepines

11.010

10.463

-5,0%

N06A. Antidepressants

4.879

4.529

-7,2%

R03. Agents for obstructive airway conditions respiratorias

7.600

4.595

-39,5%

R06A. Systemic antihistamines

6.380

4.535

-28,9%

S01. Ophthalmology

8.101

5.764

-28,8%

S02. Otologic

2.464

1.698

-31,1%

In some of the therapeutic subgroups, we found it interesting to go down to the level of active ingredients. In the NSAID group, there have been significant decreases in the initiation of new prescriptions in all the most prescribed active ingredients, highlighting ibuprofen (Table 3).

Table 3: Active ingredients of the group of NSAID with the highest number of starts of prescriptions in the study period[2].

Non-steroidal anti-inflammatory drugs

2019/20

2020/21

Variation

Celecoxib

632

538

-14,9%

Dexketoprofen

4.050

3.183

-21,4%

Diclofenac (including associations)

2.695

1.786

-33,7%

Etoricoxib

1.133

891

-21,4%

Ibuprofen (including ibuprofeno arginine)

15.102

8.341

-44,8%

Naproxen (including association with esomeprazole)

4.364

3.238

-25,8%

Systemic antibiotics have also suffered a significant decrease in the number of prescriptions created during the year that followed the declaration of the state of alarm, with several active ingredients with a reduction of around or more than 60% reduction compared to the previous year (amoxicillin, azithromycin, phenoxymethylpenicillin, levofloxacin or moxifloxacin). Cefuroxime and, to a lesser degree, fosfomycin, have increased the new prescriptions in this period (Table 4).

Table 4: Active ingredients of the group of systemic antibiotics with the highest number of prescription starts in the period under study [2].

Systemic antibiotics

2019/20

2020/21

Variation

Amoxicillin

7.905

3.154

-60,1%

Amoxicillin/clavulanate

7.558

5.074

-32,9%

Azithromycin

4.268

1.786

-58,1%

Cefuroxime

1.245

1.515

21,7%

Ciprofloxacin

1.519

1.392

-8,4%

Clarithromycin

355

221

-37,7%

Phenoxymethylpenicillin

165

56

-66,1%

Fosfomycin

3.831

3.873

1,1%

Levofloxacin

1.560

614

-60,6%

Moxifloxacin

235

88

-62,5%

The profile of new antibiotic prescriptions in pediatrics was also analyzed (Table 5). The reduction in new antibiotic prescriptions in pediatrics is even more pronounced than in the case of adults, and has remained so during these 12 months.

Table 5: Active ingredients of the group of systemic antibiotics with the highest number of prescription starts in the period under study [2].

Systemic antibiotics (pediatrics)

2019/20

2020/21

Variation

Amoxicillin

1.999

456

-77,2%

Amoxicillin/ clavulanate

714

431

-39,6%

Azithromycin

563

186

-67,0%

Total antibiotics

3.402

1.190

-65,0%

Finally, we wanted to check whether the significant decrease in new NSAID prescriptions could have shifted to other analgesics, such as paracetamol or metamizole. This was not the case in the periods analyzed previously and does not appear to be the case at present (Table 6).

Table 6: New prescriptions of non-NSAID analgesics in the study period [2].

N02B – Other analgesics and antipyretics

2019/20

2020/21

Variation

Metamizole

8.689

7.483

-13,9%

Paracetamol alone

15.388

10.983

-28,6%

Paracetamol with codeine

4.434

1.343

-69,7%

In summary, the creation of new prescriptions in the last year compared to the previous year has been reduced by 25.9%; however, the dispensing of drugs in pharmacy offices has only been reduced by 3%. This means that the medication consumed by the Bidasoa IHO population has been quantitatively similar to that of the previous year, probably due to the successive automatic extensions of medications that have been applied during this time.

References

  1. Mendizabal Olaizola A, Valverde Bilbao E (2020) Impacto de la pandemia SARS-CoV-2 en el inicio de las prescripciones. J Healthc Qual Res 402-403.
  2. Data obtained from Osakidetza’s OAS (Oracle Analytics Server) tool.
  3. Data obtained from Health Department’s OBIEE (Oracle Business Intelligence Enterprise Edition) tool.

How and Why Choirs May Promote Health and Wellbeing?

DOI: 10.31038/IJNM.2021223

 

Recent research confirm that longevity and a healthy life is strongly influenced by belonging to closely knit communities or groups, that can give you a sense of meaning and of mastering in collective activities like nature and culture experiences. Increasingly more emphasis has been put on nature and cultural activities for maintaining health and quality of life [1-3], and may be linked to the building of social capital in local communities [4]. Health promotion is carried out by and with people, which improves both the ability of individuals to take action, and the capacity of groups, organizations or communities to influence the determinants of health (WHO, 1997). “Settings for health” represent the organizational base of the infrastructure required for health promotion. New health challenges mean that new and diverse networks need to be created to achieve intersectoral collaboration. Such networks should provide mutual assistance within and between countries and facilitate exchange of information on which strategies are effective in which settings. Public health research and practice should focus not only on factors causing disease and injuries (pathogenesis), but also on factors promoting health (salutogenesis) in the perspective of health promotion and prevention in different settings. Creative arts initiatives can be an effective way of meeting the growing calls for a shift of emphasis in mental health services, enhancing the significance of relationships and social support in the context of the well-being agenda. An adequate grasp of mutuality and social relationships is also important in addressing recent policy initiatives around loneliness [5]. Choral singing contributes to people changing their self-perception or maintaining their identity despite life affecting challenges or changes in living conditions [6]. Choral singing practice can be seen from a salutogenetic perspective that is, as something which promotes health and strengthens the healthy aspects of an individual in states of ease or dis-ease [7]. Singing can also be beneficial for those in the wider community who are affected by non-communicable diseases such as cancer [8]. Vitality was improved in those with a cancer diagnosis, and anxiety was reduced in cares and the bereaved. To use resources and capacities in communities by strengthening empowerment of the individuals that suffer from mental disorders and diseases, mostly anxiety and depression would also underline the importance of giving priority to the topic Public Mental Health Promotion in the light of new epigenetic research [3].

Non-Pharmaceutical Interventions

Quite often people would rather be prescribed non-pharmaceutical interventions than medication The Lancet Commission on Culture and Health states that as it is increasingly recognized that wellbeing has both biological and social elements, health care providers can only improve outcomes if they accept the need to understand the sociocultural conditions that enable people to be healthy and make themselves healthier – that is, to feel well [9], and then possibly recommend non-pharmaceutical interventions. Seven years of research by the James Lind Alliance into the clinical research priorities of patients, carers, and clinicians indicated that 72% (103/126) of treatment priorities were non-pharmacological and that often people would rather be prescribed non-pharmaceutical interventions than medication [10]. Marmot has described social exclusion as “deprivation on stilts” [11] to accentuate how damaging it is for the individual and society. He advocates for any changes that could help tackle social exclusion, and it could be argued how choirs would be 2 fertile grounds for further research for a potential role in health promotion by facilitating a pathway to social inclusion. In response to this, ‘social prescribing’ is becoming more prevalent, whereby people presenting to primary care are linked with various sources of support within the local community, from gardening projects to table tennis clubs, and choirs can act as another potential non-pharmacological ‘tool’ [12]. Leisure time is increasingly important for emotional wellbeing, informal learning and identity formation among children and youth. Contemporary societies are characterized by increasing individualization, affecting identity formation, well-being and sense of coherence and belonging. The institutionalization of childhood and education/knowledge has increasingly compartmentalized children and young people into exclusive spheres set apart from the adult world, placing them in an age-segregated social order, at the cost of being included in an intergenerational social order [13]. Health benefits from musicking[1] [14] may reduce stress, anxiety, depression by building coping capabilities, resilience social inclusion and renewed strength [15].

Future Studies

Despite widespread anecdotal evidence that singing has a positive effect on health and wellbeing, and the burgeoning number of studies suggesting potential benefits in many diverse fields, recent systematic reviews have identified that the quality of evidence is sometimes poor. McNamara’s Cochrane review of the singing and COPD literature suggested that the quality of evidence is low to very low. This was thought to be due to the small size and the low number of randomized controlled trials [16]. Other methodological limitations have meant that outcome measures vary or there are no consistent changes in outcome measures. Randomised controlled trials of singing interventions suffered from attrition as people who wanted to sing were not allocated it, or the singing ‘intervention’ offered was too short, too finite, or simply not appealing. Clark and Harding’s [17] systematic review of the psychosocial outcomes of singing interventions concluded that more qualitative studies were needed. The results of the six studies that have been carried out since then are interesting, convergent, but (naturally) inconclusive. In order to explore such ecological functions of choral singing, participant observation is a good strategy in addition to the ethnographic interview. Through participant observation of the choral singing practice and events, we can investigate how choral singing is imbricated into their social networks and how it expands their social world.

[1] Musicking: To music is to take part, in any capacity, in a musical performance, whether by performing, by listening, by rehearsing or practicing, by providing material for performance (what is called composing) or by dancing. (Small, 1998:9). See also David Elliott’s definition of Musicing: all human action related to [music.]” [14].

Reference

  1. Hansen E, Sund E, Krokstad S (2015) Cultural activity participation and associations with self-perceived health, life-satisfaction and mental health: the Young HUNT Study, Norway. BMC Public Health
  2. Cuypers K, Krokstad S, Holmen TL, Margunn SK, Lars OB, et al. (2013) Patterns of receptive and creative cultural activities and their association with perceived health, anxiety, depression and satisfaction with life among adults: the HUNT study, Norway. J Epidemiol Community Health 66 : 698-703. [crossref]
  3. Tellnes G, Batt-Rawden KB, Christie WH (2018). Nature Culture Health Promotion as Community building. Journal “Herald of the International Academy of Science. #1. Russian Section” (HIAS.RS). Herald of the International Academy of Science. Russian Section”. vol. 1 (1).
  4. Campbell C, Gillies P (2001) Conceptualizing ‘social capital’ for health promotion in small local communities: a micro-qualitative study. Journal of Community & Applied Social Psychology. 11 : 329-346.
  5. Sturgeon S (2006) Promoting mental health as an essential aspect of health promotion. Health Promotion International 21 : 36-41. [crossref]
  6. Balsnes AH (2010) Choir research – a Norwegian perspective. In : Geisler U, Johansson K (eds.), Choir in Focus. Pg : 16 – 19, Bo Ejeby Publisher.
  7. Clift S, Jennifer N, Raisbeck M, Whitmore C, Morrison I (2010) Group singing, wellbeing and health: A systematic mapping of research evidence. UNESCO Observatory, Faculty of Architecture, Building and Planning, The Melbourne Refereed E-journal 2 .
  8. Batt-Rawden KB, Andersen S (2018) “Singing has empowered, enchanted and enthralled me” Choirs for Wellbeing?”. Health Promotion International 3.
  9. Napier D, et al (2011) Culture and Health Lancet Commission. The Lancet.
  10. Crowe S, Fenton M, Hall M, Cowan K, Chalmers I (2015) Patients’, clinicians’ and the research communities’ priorities for treatment research: there is an important mismatch. Research Involvement and Engagement 1.
  11. Marmot M (2015) The Health Gap: the Challenge of an Unequal World. Bloomsbury, London, UK.
  12. Ruud E (2013) Can music serve as a “cultural immunogen”? An explorative study. International journal of qualitative studies on health and well-being. 8 : 205-209. [crossref]
  13. Beynon C, Lang J (2018) The More We Get Together, The More We Learn: Focus on Intergenerational and Collaborative Learning Through Singing. Journal of Intergenerational Relationships 16 : 45-63.
  14. Small C (1998) Musicking. The Meanings of Performing and Listening. Weslyan Press. London.
  15. Batt-Rawden KB (2018) The fellowship of Health Musicking: A Model to Promote Health and Well-Being. Music and Public Health – A Nordic Perspective. Bonde LO, Theorell T (eds) Springer Verlag.
  16. Williams E, Dingle G, Clift S (2018) A systematic review of mental health and wellbeing outcomes of group singing for adults with a mental health condition. European Journal of Public Health 28 : 1035-1042. [crossref]
  17. Clark I, Harding K (2012) Psychosocial outcomes of active singing interventions for therapeutic purposes: A systematic review of the literature. Nordic Journal of Music Therapy 21 : 80-98.

Pediatric COVID-19

DOI: 10.31038/JPPR.2021423

 

Virus Description

Corona is a common viral disease that can be transmitted between humans and different types of animals, meaning it can be transmitted between different races and types of living organisms. It is characterized as having broad-spectrum disease symptoms that differ from one patient to another in their severity and type. In the last months of 2019, a storm of infection with the Corona virus appeared in the Chinese city of Wuhan, with symptoms that were almost different in severity and led to deaths in some infections. The virus was characterized by its rapid spread among people, which surprised researchers, doctors and people in that city and in China in general. Which challenged Chinese researchers and scientists to investigate the type and nature of the causative agent, so they were able to diagnose Corona virus (Cove 2).

Keywords

SARS cov2, Coronavirus, Children, COVID-19, Viral infection, Respiratory signs, Pfizer/BioNTech, Moderna and Johnson & Johnson vaccines

COVID 19 Susceptible Age of Children

In December 2019, a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) emerged in China and has spread globally, creating a pandemic. Information about the clinical characteristics of infected patients who require intensive care is limited. The 2019 novel coronavirus (SARS-CoV-2) has been responsible for more than 54000 000 infections and 1,200 000 deaths worldwide, but data regarding the epidemiologic characteristics and clinical features of infected children are limited [1,2]. The largest study so far, published in pediatrics J. included analysis of 2,143 children with COVID-19 documented from Jan. 16 to Feb. 8 in China. It found that symptoms of the disease were generally less severe in children and teens compared with adults. Specifically, 4.4 percent had no symptoms, 50.9 percent had mild disease and 38.8 percent had moderate symptoms. Of the children with symptoms, only 0.6 percent developed acute respiratory distress syndrome or multiple organ dysfunction. Of note, however, young children—particularly infants under one year of age—had a higher risk for significant illness. Ten percent of infants had severe disease, compared with 3 percent of teens over age 15.

How Likely are Children to Get Coronavirus Disease 2019 (COVID-19)?

Although all children can be infected with the virus that causes COVID-19, they are not as frequent as adults. Children rarely encounter serious illnesses from COVID-19. Although there have been many large-scale outbreaks around the world, few children have died. According to the US Centers for Disease Control and Prevention (CDC), between February 12 and April 2, of the nearly 150,000 COVID-19 cases in the United States, only 2500, or 1.7%, were children. This is similar to outbreaks in other countries such as China and Italy. The hospitalization rate of children is much lower than that of adults [3]. However, people of any age with certain underlying diseases (such as type 2 diabetes) have a higher risk of serious illnesses from COVID-19. In addition, children with congenital heart disease, genetic diseases, or diseases that affect the nervous system or metabolism are also at higher risk of serious illnesses from COVID-19. Discuss with them what happened and assure them that most situations are mild. Your child will get tips from you, so it’s also important to stay calm.

How Does COVID-19 have an Effect on Kids?

Children, together with very younger kids, can infected with COVID-19. Many of them don’t have any signs and symptoms. But those who do get the infection generally tend to show milder signs and symptoms which includes low to mild fever, exhaustion, and cough. Some kids have had marked fitness situations can be at expanded hazard for intense illness. A doubtlessly acute and perilous sequel can appear on kids. This case defined as multisystem inflammatory syndrome in children (MIS-C), it may result in life-threatening issues with the coronary heart and different organs with inside the frame. In this condition, exceptional frame parts, which includes the coronary heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs, can end up inflamed.

Symptoms of MIS-C can Include

  • Fever lasting more than a couple of days
  • Rash
  • Bloodshot eyes (redness of the white part of the eye)
  • Stomach ache
  • Vomiting and/or diarrhea
  • A large, swollen lymph node in the neck
  • Neck pain
  • Red, cracked lips
  • A tongue that is redder than usual and looks like a strawberry
  • Swollen hands and/or feet
  • Irritability and/or unusual sleepiness or weakness.

Why do Children React Differently to COVID-19?

The answer is unclear. Some experts suggest that children may not be severely affected by COVID-19 because there are other coronaviruses that spread in the community and cause illness, such as the common cold. Since children often catch colds, they may have antibodies to protect them against COVID-19. Children’s immune systems may also interact differently with adults’ immune systems. Some adults get sick because their immune system seems to overreact to the virus, causing more damage to their bodies. This may be unlikely to occur in children. Although rare, children under 1 year old (infants) have a higher risk of serious illness from COVID-19. This may be due to their immature immune system and small respiratory tract, which makes them more susceptible to respiratory problems caused by respiratory viral infections. Between late December and early February, more than 2,100 children with suspected or confirmed COVID-19 in China were studied, and the results showed that less than 11% of infants had serious or severe illnesses. In contrast, the prevalence of severe or severe illness is about 7% for children aged 1 to 5 years, 4% for children 6 to 10 years old, 4% for children 11 to 15 years old, and 3% for children 16 years and older. New born babies may be infected with the virus that causes COVID-19 when they come into contact with sick caregivers during or after delivery. The American Academy of Pediatrics recommends special care for new-borns born to women who have confirmed or suspected COVID-19. This may include temporarily separating the mother from the new born to reduce the risk of infecting the baby, monitoring the baby for signs of infection, and, if available, testing the new born for COVID-19 [4,5].

Do Children and Adults have Different Symptoms of COVID-19?

When you see some mild symptoms on your son or daughter and feel or suspect that these symptoms are similar to those of COVID 19, you should take quick steps to isolate your child in a special room where all the comforts and conditions of health are available and prevent contact with him from the rest of the family and tell his or her doctor or health care providers and following the procedures recommended by the World Health Organization. COVID-19 symptoms in children and adults experience similar symptoms of COVID-19, while children’s symptoms tend to be mild and cold. Most children will recover within one to two weeks. Their symptoms may include: fever Runny nose cough fatigue Muscle pain Vomiting diarrhoea. When children and adolescents get COVID-19, their symptoms seem to be milder than adults. Among the American population under 19, almost no one is hospitalized. Studies have shown that more than 90% of sick children have mild to moderate cold-like symptoms, including: fever Runny nose cough Vomiting diarrhoea. Some children and adolescents have been admitted to the hospital due to childhood multiple system inflammatory syndrome (MIS-C) or pediatric multiple system inflammatory syndrome (PMIS).

Coronavirus in Sick Children if Some Children have Other Diseases

They may be at higher risk of more serious diseases: asthma diabetes Blood disease Heart or liver disease Kidney disease requiring dialysis Weakened immune system. Doctors are still learning about it, but they think it is related to the new coronavirus. Symptoms include fever, abdominal pain, vomiting, diarrhea, skin rash, headache, and confusion. They are similar to toxic shock syndrome or Kawasaki disease, which causes inflammation of blood vessels in children. Serious problems are rare. If your child has any of the following symptoms, seek medical help immediately. Difficulty breathing Can’t let the liquid flow down Changes in skin tone, including blue lips or face Confused or trouble waking up Serious problems are rare. If your child has any of the following symptoms, seek medical help immediately: Difficulty breathing Can’t let the liquid flow down Confused or trouble waking up Blue lips or face.

When Will Youngsters be Capable of Get the COVID-19 Vaccine?

Pfizer/BioNTech and Moderna are already carrying out age de-escalation researches, wherein the vaccines are examined in different categories of children of descending age. Johnson & Johnson plans to do the same. Currently, the Pfizer/BioNTech COVID-19 vaccine is permitted to be used in teenagers sixteen years and older, but the Moderna and Johnson & Johnson vaccines are given a permission for the young in 18 years and older. In March 2021, Pfizer/BioNTech introduced promising effects for a Phase three trial trying out its vaccine in youngsters a while 12 to 15. Experiments were conducted on 2,260 voluntaries teenagers, half of whom were given mRNA vaccine and the rest were given Normal Saline or Placebo. The antibody reaction within side the vaccinated adolescent categories turned into even more potent than that during vaccinated sixteen- to 25-year-olds enrolled in an in advance study. In addition, a complete of 18 symptomatic instances of COVID-19 have been said at some point of the trial, all within the placebo group. Vaccine-associated signs and symptoms have been slight and akin to older corporations enrolled in in advance study. The effects have been introduced in a press release, now no longer in a peer-reviewed, posted study. Pfizer/BioNTech has submitted their facts to the FDA with a request to make bigger emergency use authorization to youngsters a while 12 to 15. The enterprise has additionally commenced trying out the vaccine in children more youthful than 12 years. Moderna is carrying out vaccines study — one in adolescents a while 12 to 17, the alternative in children among a while of 6 months and 12 years. The age de-escalation research is achieved to verify that the vaccines are secure and powerful for every age category. They additionally pick out the most reliable dose, which ought to be powerful, however with tolerable facet effects. The adult trail is a greater than the age de-escalation study in the children; in addition of recruiting many thousands of contributors, they may recruit between 2,000-3000 participants in every age category. Look like the adult studies, a few children in every study gets a placebo. The FDA will evaluation facts from the de-escalation trials to determine whether or not to authorize the vaccines for every age category.

References

  1. World Health Organization. Coronavirus disease 2019 (COVID-19): situation report — 50.
  2. Guan W, Ni Z, Hu Y, Wen-hua Liang, Chun-quan OU, et al. (2020) Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 382: 1708-1720.
  3. Bialek S, Boundy E, Bowen V, et al. (2020) CDC COVID-19 Response Team. Severe outcomes among patients with coronavirus disease 2019 (COVID-19)—United States, February 12–March 16, 2020. MMWR Morb Mortal Wkly Rep 69: 343-346.
  4. Ng Y, Li Z, Chua YX, et al. (2020) Evaluation of the effectiveness of surveillance and containment measures for the first 100 patients with COVID-19 in Singapore—January 2–February 29, 2020. MMWR Morb Mortal Wkly Rep 69: 307-311.
  5. The Novel Coronavirus Emergency Response Epidemiology Team (2020) The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19)—China. China CDC Weekly 2: 113-122.

The Importance of a Community Health Network: An Ethnoanthropological Approach, the Experience of Teaching Demoethnoanthropology of the Degree Course in Nursing at the University of Parma

DOI: 10.31038/IJNM.2021222

 

Although Italy has a long history of migration behind it, it seems unable to convey the long experience accumulated over 150 years on its territory. There seems to be a lack of a network of contacts and relationships with communities of different cultures and social distress in the area of health, where there is a virtuous experiment, even well functional, but not really structured in a network. The COVID-19 Pandemic has shown that the inherent weaknesses in the sphere of migration and social hardship, which have worsened in the absence of a community health network; cultural, linguistic, social barriers, of knowledge of services and institutions, have been widened due to the impossibility of travel and the lack of individual institutional references that could provide indications, information and guidance. The creation of a network of contacts for the teaching of Demoethnoanthropology of the Nursing Studies course at the University of Parma has shown how a culturally competent and correct anthropological approach can provide communities with a channel of orientation and adherence through pre-built direct contact.  The network of contacts built by the demo-ethnoanthropology course was born in the year 2013, when a discussion of involvement of the communities of different cultures of the territory is initiated, in a part of the training course of the course. The idea was to exploit university indications regarding the “Third Mission” by involving the cultural diversity of the area in an interaction between the university, students and communities both in the representative offices of the communities and in the university classrooms. The initiative, much appreciated by the representatives and members of the communities, involved a large part of those present in the territory of the city of Parma and the province. The first meetings brought in the classrooms representatives with an important university education, but also young university students and more. In 2015 we created that series of events known as “Cultural coffee” of the nursing study course, unique cultural encounters in Italy for this type of course held within a hospital dining area, therefore in a context outside the classrooms and open to the public in fact we added an element that was required by the Emilia Romagna region that is, bringing events with multicultural characteristics into common places among ordinary people. Over the years, public meetings and going with students to the associative centers of the communities, including the Islamic culture center of Parma, the Gurdwara Singh Saba associative headquarters, the Zoe pentecostal mission of Parma have increased institutional knowledge of the course and created a vast network of relationships. In order to build community involvement with an intention that is also inclusive, an institutional relationship more dedicated to health has also been initiated, since the same communities, aware of our dual role as teachers and nurses, have begun to ask us questions and requests in this regard. to health, to the approach to care, exposing basic care needs, effectively communicating the lack of an interconnection between community and health institution and seeing in our professional figure a simpler channel of approach.

It has happened that in several cases, single individuals have been advised and guided towards the healthcare receptivity of the hospital structure in particular towards complex operating units (cardiac surgery, cardiology, orthopedics, neurosurgery and others), through simple indications, or help in understanding and solution bureaucratic elements that are more difficult to understand. We have provided indications and advice with a correct approach towards the cultural dimension, taking into account the social, cultural context, of habits and customs, views and interpretation of health with respect to the culture of origin. We well know that care and health can be interpreted and seen not according to a standard, on the other hand health is not a static car in its being, but can be interpreted and welcomed on the basis of very diversified social and cultural rules, but which go and should be always considered competently to be correct. Our undergraduate training in anthropology has been for an advantage, both in building trust and networking relationships, as well as in the help and support of care and health and what at first appeared to be a great openness and trust. Towards us, it has also proved very valuable during the COVID-19 Pandemic the measure of trust was also increased by some particular institutional events, such as the meetings for the creation of the room of worship and silence that saw us present on 3 different occasions together with the representatives of the communities and the general managers of the two health companies of the territory, where we became spokesman and link between the two realities and in this regard I want to remember that the city of Parma alone has the presence of 31,000 people of foreign origin on a housing reality of 200,000 inhabitants, with as many as one hundred and 137 different nationalities , and more than 40 associations of different cultures. It is also true that a relationship of trust of a personal nature has been created, but the fact remains that we have presented ourselves to the communities also as institutions, university and hospital together. Was there even a time when we had some doubts about this, was this personal approach also correct? Could it be an advantage or could it become a double-edged sword, with the risk of creating expectations and even disappointments?

The answers came from a meeting with the former prefect of Parma, Dr. Giuseppe Forlani who removed all doubts, he already Central Director of Civil Services for Immigration and Asylum within the Department for Civil Liberties and immigration from the Ministry of the Interior, thus coming from a training similar to ours but with a very vast and particular background of experience in the field, advised us to continue on the path taken and gave us answers and advice, with an important indication or that the institutions must go to the communities and therefore we were doing this, that the personal relationship that has been created is above all an institutional relationship because in this way we entered the communities a personal form is fine too but it is the input context that unconsciously dictated the rules of the relationship. According to his vision, the extraordinary nature of the relationship of trust could be of great help and importance in the future and we are talking about the summer of 2019. created a moment of important meeting between institutions, the municipality, the prefecture, health authorities and the community itself. There was also a similar request arrived a few weeks later by the Ahmadiyya Muslim Jama’at Italia Association which asked us to help them organize an event of presentation and comparison between the religious, community, philosophical and secular diversity of the territory for thus building a relationship of trust and having a link with hospitals through our people. The event scheduled for March 26,2020 has been postponed due to the COVID-19 Pandemic. But what may appear as a building of relationships of trust, as the prefect had foreseen, in the Pandemic moment demonstrated all the potential of the network, of how the correct anthropological approach, respectful and culturally competent and prepared, had in fact filled a void dictated by an inexperience of the institutions. The communities have contacted us on many occasions, asking us to help them for particular situations, including indications on prevention systems and methods, such as, on our advice, the closure of the Sikh temple in Parma, the first cult institution in Italy to close the ‘access to the faithful, a week before the government decree which imposed an absolute ban on access to places of worship. But there are still many requests for the recovery of the bodies or to understand the procedures for managing them and personal effects. But again the participation in the construction of the dedicated site www.oltreemergenze.com in which we provided part of the communications in a different language and we placed ourselves as referents for some procedures. These are just a few examples of the work done.

What does all this prove? First of all, that cultural diversities are in fact largely outside the information context of care and health, that the absence of a system of interconnection between institutions and communities has created a vacuum, which has become a major problem in receiving information and providing actions. at a time when it was in the most complete lockdown. This demonstrated the need for territorial community healthcare, which not only approaches cultural diversity but also social discomfort, as demonstrated by Emergency NGO. The reality of the NGO of which i’m also a volunteer on the project in Milano, shows that in order not to leave anyone behind, there is a need for an institution that enters into community realities, that knows the cultures, that is culturally formed and prepared, that has a solid basis to be able to relate correctly with these. The structure as it is today, demonstrates that at the base there is a void, holes in the institutional mesh that puts in difficulty the realities of different cultures and beyond, that the simple approach with the brochure or flyer in the language is not enough. The construction of a network of relationships with a strong anthropological and intercultural characteristic in the small of a reality like Parma, with only two individuals myself and my colleague Murekabiri with the help of the communities and the network of built relationships, has shown that an intercultural service on the territory, which embraces cultural diversity and social discomfort, can guarantee people not only the possibility of real and correct information but above all equality in care and assistance, remembering that it is from the territory, from the fabric of this that you can improve access to care, adherence to it and also create a valid system of social inclusion. In a small way, this experience has shown that the method used, which in fact is the Canadian one, can be functional, and is required of us, even before the pandemic by the WHO 2020/2030 agenda and is moreover in the directives of the UN. Therefore, concluding if the network built with an anthropological and intercultural approach system has given good results even if in the small of our experience in a medium-sized city, the same system increased through culturally competent elements, organized at an institutional and service level, can achieve important local, regional and national results.