Tuberculosis in migrant populations. A systematic review of the qualitative literature.

BACKGROUND The re-emergence of tuberculosis (TB) in low-incidence countries and its disproportionate burden on immigrants is a public health concern posing specific social and ethical challenges. This review explores perceptions, knowledge, attitudes and treatment adherence behaviour relating to TB and their social implications as reported in the qualitative literature. METHODS Systematic review in four electronic databases. Findings from thirty selected studies extracted, tabulated, compared and synthesized. FINDINGS TB was attributed to many non-exclusive causes including air-born transmission of bacteria, genetics, malnutrition, excessive work, irresponsible lifestyles, casual contact with infected persons or objects; and exposure to low temperatures, dirt, stress and witchcraft. Perceived as curable but potentially lethal and highly contagious, there was confusion around a condition surrounded by fears. A range of economic, legislative, cultural, social and health system barriers could delay treatment seeking. Fears of deportation and having contacts traced could prevent individuals from seeking medical assistance. Once on treatment, family support and "the personal touch" of health providers emerged as key factors facilitating adherence. The concept of latent infection was difficult to comprehend and while TB screening was often seen as a socially responsible act, it could be perceived as discriminatory. Immigration and the infectiousness of TB mutually reinforced each another exacerbating stigma. This was further aggravated by indirect costs such as losing a job, being evicted by a landlord or not being able to attend school. CONCLUSIONS Understanding immigrants' views of TB and the obstacles that they face when accessing the health system and adhering to a treatment programme-taking into consideration their previous experiences at countries of origin as well as the social, economic and legislative context in which they live at host countries- has an important role and should be considered in the design, evaluation and adaptation of programmes.

Cost-effectiveness of an exercise intervention program in perimenopausal women: the Fitness League Against MENopause COst (FLAMENCO) randomized controlled trial.

BACKGROUND The high prevalence of women that do not reach the recommended level of physical activity is worrisome. A sedentary lifestyle has negative consequences on health status and increases health care costs. The main objective of this project is to assess the cost-effectiveness of a primary care-based exercise intervention in perimenopausal women. METHODS/DESIGN The present study is a Randomized Controlled Trial. A total of 150 eligible women will be recruited and randomly assigned to either a 16-week exercise intervention (3 sessions/week), or to usual care (control) group. The primary outcome measure is the incremental cost-effectiveness ratio. The secondary outcome measures are: i) socio-demographic and clinical information; ii) body composition; iii) dietary patterns; iv) glycaemic and lipid profile; v) physical fitness; vi) physical activity and sedentary behaviour; vii) sleep quality; viii) quality of life, mental health and positive health; ix) menopause symptoms. All outcomes will be assessed at baseline and post intervention. The data will be analysed on an intention-to-treat basis and per protocol. In addition, we will conduct a cost effectiveness analysis from a health system perspective. DISCUSSION The intervention designed is feasible and if it proves to be clinically and cost effective, it can be easily transferred to other similar contexts. Consequently, the findings of this project might help the Health Systems to identify strategies for primary prevention and health promotion as well as to reduce health care requirements and costs. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02358109 . Date of registration: 05/02/2015.

Allele variants in functional MicroRNA target sites of the neurotrophin-3 receptor gene (NTRK3) as susceptibility factors for anxiety disorders

Genetic and functional data indicate that variation in the expression of the neurotrophin-3 receptor gene (NTRK3) may have an impact on neuronal plasticity, suggesting a role for NTRK3 in the pathophysiology of anxiety disorders. MicroRNA (miRNA) posttranscriptional gene regulators act by base-pairing to specific sequence sites, usually at the 3'UTR of the target mRNA. Variants at these sites might result in gene expression changes contributing to disease susceptibility. We investigated genetic variation in two different isoforms of NTRK3 as candidate susceptibility factors for anxiety by resequencing their 3'UTRs in patients with panic disorder (PD), obsessive-compulsive disorder (OCD), and in controls. We have found the C allele of rs28521337, located in a functional target site for miR-485-3p in the truncated isoform of NTRK3, to be significantly associated with the hoarding phenotype of OCD. We have also identified two new rare variants in the 3'UTR of NTRK3, ss102661458 and ss102661460, each present only in one chromosome of a patient with PD. The ss102661458 variant is located in a functional target site for miR-765, and the ss102661460 in functional target sites for two miRNAs, miR-509 and miR-128, the latter being a brain-enriched miRNA involved in neuronal differentiation and synaptic processing. Interestingly, these two variants significantly alter the miRNA-mediated regulation of NTRK3, resulting in recovery of gene expression. These data implicate miRNAs as key posttranscriptional regulators of NTRK3 and provide a framework for allele-specific miRNA regulation of NTRK3 in anxiety disorders.

Development of Abutment Design Standards for Local Bridge Designs, Volume 1 of 3, Development of Design Methodology, August 2004

Several superstructure design methodologies have been developed for low volume road bridges by the Iowa State University Bridge Engineering Center. However, to date no standard abutment designs have been developed. Thus, there was a need to establish an easy to use design methodology in addition to generating generic abutment standards and other design aids for the more common substructure systems used in Iowa. The final report for this project consists of three volumes. The first volume (this volume) summarizes the research completed in this project. A survey of the Iowa County Engineers was conducted from which it was determined that while most counties use similar types of abutments, only 17 percent use some type of standard abutment designs or plans. A literature review revealed several possible alternative abutment systems for future use on low volume road bridges in addition to two separate substructure lateral load analysis methods. These consisted of a linear and a non-linear method. The linear analysis method was used for this project due to its relative simplicity and the relative accuracy of the maximum pile moment when compared to values obtained from the more complex non-linear analysis method. The resulting design methodology was developed for single span stub abutments supported on steel or timber piles with a bridge span length ranging from 20 to 90 ft and roadway widths of 24 and 30 ft. However, other roadway widths can be designed using the foundation design template provided. The backwall height is limited to a range of 6 to 12 ft, and the soil type is classified as cohesive or cohesionless. The design methodology was developed using the guidelines specified by the American Association of State Highway Transportation Officials Standard Specifications, the Iowa Department of Transportation Bridge Design Manual, and the National Design Specifications for Wood Construction. The second volume introduces and outlines the use of the various design aids developed for this project. Charts for determining dead and live gravity loads based on the roadway width, span length, and superstructure type are provided. A foundation design template was developed in which the engineer can check a substructure design by inputting basic bridge site information. Tables published by the Iowa Department of Transportation that provide values for estimating pile friction and end bearing for different combinations of soils and pile types are also included. Generic standard abutment plans were developed for which the engineer can provide necessary bridge site information in the spaces provided. These tools enable engineers to design and detail county bridge substructures more efficiently. The third volume provides two sets of calculations that demonstrate the application of the substructure design methodology developed in this project. These calculations also verify the accuracy of the foundation design template. The printouts from the foundation design template are provided at the end of each example. Also several tables provide various foundation details for a pre-cast double tee superstructure with different combinations of soil type, backwall height, and pile type.

Development of Abutment Design Standards for Local Bridge Designs, Volume 3 of 3, Verification of Design Methodology, August 2004

Several superstructure design methodologies have been developed for low volume road bridges by the Iowa State University Bridge Engineering Center. However, to date no standard abutment designs have been developed. Thus, there was a need to establish an easy to use design methodology in addition to generating generic abutment standards and other design aids for the more common substructure systems used in Iowa. The final report for this project consists of three volumes. The first volume summarizes the research completed in this project. A survey of the Iowa County Engineers was conducted from which it was determined that while most counties use similar types of abutments, only 17 percent use some type of standard abutment designs or plans. A literature review revealed several possible alternative abutment systems for future use on low volume road bridges in addition to two separate substructure lateral load analysis methods. These consisted of a linear and a non-linear method. The linear analysis method was used for this project due to its relative simplicity and the relative accuracy of the maximum pile moment when compared to values obtained from the more complex non-linear analysis method. The resulting design methodology was developed for single span stub abutments supported on steel or timber piles with a bridge span length ranging from 20 to 90 ft and roadway widths of 24 and 30 ft. However, other roadway widths can be designed using the foundation design template provided. The backwall height is limited to a range of 6 to 12 ft, and the soil type is classified as cohesive or cohesionless. The design methodology was developed using the guidelines specified by the American Association of State Highway Transportation Officials Standard Specifications, the Iowa Department of Transportation Bridge Design Manual, and the National Design Specifications for Wood Construction. The second volume introduces and outlines the use of the various design aids developed for this project. Charts for determining dead and live gravity loads based on the roadway width, span length, and superstructure type are provided. A foundation design template was developed in which the engineer can check a substructure design by inputting basic bridge site information. Tables published by the Iowa Department of Transportation that provide values for estimating pile friction and end bearing for different combinations of soils and pile types are also included. Generic standard abutment plans were developed for which the engineer can provide necessary bridge site information in the spaces provided. These tools enable engineers to design and detail county bridge substructures more efficiently. The third volume (this volume) provides two sets of calculations that demonstrate the application of the substructure design methodology developed in this project. These calculations also verify the accuracy of the foundation design template. The printouts from the foundation design template are provided at the end of each example. Also several tables provide various foundation details for a pre-cast double tee superstructure with different combinations of soil type, backwall height, and pile type.

Development of Abutment Design Standards for Local Bridge Designs, Volume 2 of 3, Design Manual, August 2004

Several superstructure design methodologies have been developed for low volume road bridges by the Iowa State University Bridge Engineering Center. However, to date no standard abutment designs have been developed. Thus, there was a need to establish an easy to use design methodology in addition to generating generic abutment standards and other design aids for the more common substructure systems used in Iowa. The final report for this project consists of three volumes. The first volume summarizes the research completed in this project. A survey of the Iowa County Engineers was conducted from which it was determined that while most counties use similar types of abutments, only 17 percent use some type of standard abutment designs or plans. A literature review revealed several possible alternative abutment systems for future use on low volume road bridges in addition to two separate substructure lateral load analysis methods. These consisted of a linear and a non-linear method. The linear analysis method was used for this project due to its relative simplicity and the relative accuracy of the maximum pile moment when compared to values obtained from the more complex non-linear analysis method. The resulting design methodology was developed for single span stub abutments supported on steel or timber piles with a bridge span length ranging from 20 to 90 ft and roadway widths of 24 and 30 ft. However, other roadway widths can be designed using the foundation design template provided. The backwall height is limited to a range of 6 to 12 ft, and the soil type is classified as cohesive or cohesionless. The design methodology was developed using the guidelines specified by the American Association of State Highway Transportation Officials Standard Specifications, the Iowa Department of Transportation Bridge Design Manual, and the National Design Specifications for Wood Construction. The second volume (this volume) introduces and outlines the use of the various design aids developed for this project. Charts for determining dead and live gravity loads based on the roadway width, span length, and superstructure type are provided. A foundation design template was developed in which the engineer can check a substructure design by inputting basic bridge site information. Tables published by the Iowa Department of Transportation that provide values for estimating pile friction and end bearing for different combinations of soils and pile types are also included. Generic standard abutment plans were developed for which the engineer can provide necessary bridge site information in the spaces provided. These tools enable engineers to design and detail county bridge substructures more efficiently. The third volume provides two sets of calculations that demonstrate the application of the substructure design methodology developed in this project. These calculations also verify the accuracy of the foundation design template. The printouts from the foundation design template are provided at the end of each example. Also several tables provide various foundation details for a pre-cast double tee superstructure with different combinations of soil type, backwall height, and pile type.

Impact of a telenursing service on satisfaction and health outcomes of children with inflammatory rheumatic diseases and their families: a crossover randomized trial study protocol.

BACKGROUND: Pediatric rheumatic diseases have a significant impact on children's quality of life and family functioning. Disease control and management of the symptoms are important to minimize disability and pain. Specialist clinical nurses play a key role in supporting medical teams, recognizing poor disease control and the need for treatment changes, providing a resource to patients on treatment options and access to additional support and advice, and identifying best practices to achieve optimal outcomes for patients and their families. This highlights the importance of investigating follow-up telenursing (TN) consultations with experienced, specialist clinical nurses in rheumatology to provide this support to children and their families. METHODS/DESIGN: This randomized crossover, experimental longitudinal study will compare the effects of standard care against a novel telenursing consultation on children's and family outcomes. It will examine children below 16 years old, recently diagnosed with inflammatory rheumatic diseases, who attend the pediatric rheumatology outpatient clinic of a tertiary referral hospital in western Switzerland, and one of their parents. The telenursing consultation, at least once a month, by a qualified, experienced, specialist nurse in pediatric rheumatology will consist of providing affective support, health information, and aid to decision-making. Cox's Interaction Model of Client Health Behavior serves as the theoretical framework for this study. The primary outcome measure is satisfaction and this will be assessed using mixed methods (quantitative and qualitative data). Secondary outcome measures include disease activity, quality of life, adherence to treatment, use of the telenursing service, and cost. We plan to enroll 56 children. DISCUSSION: The telenursing consultation is designed to support parents and children/adolescents during the course of the disease with regular follow-up. This project is novel because it is based on a theoretical standardized intervention, yet it allows for individualized care. We expect this trial to confirm the importance of support by a clinical specialist nurse in improving outcomes for children and adolescents with inflammatory rheumatisms. TRIAL REGISTRATION: ClinicalTrial.gov identifier: NCT01511341 (December 1st, 2012).

Genetic Loci Associated with C-reactive Protein Levels and Risk of Coronary Heart Disease.

CONTEXT: Plasma levels of C-reactive protein (CRP) are independently associated with risk of coronary heart disease, but whether CRP is causally associated with coronary heart disease or merely a marker of underlying atherosclerosis is uncertain. OBJECTIVE: To investigate association of genetic loci with CRP levels and risk of coronary heart disease. DESIGN, SETTING, AND PARTICIPANTS: We first carried out a genome-wide association (n = 17,967) and replication study (n = 13,615) to identify genetic loci associated with plasma CRP concentrations. Data collection took place between 1989 and 2008 and genotyping between 2003 and 2008. We carried out a mendelian randomization study of the most closely associated single-nucleotide polymorphism (SNP) in the CRP locus and published data on other CRP variants involving a total of 28,112 cases and 100,823 controls, to investigate the association of CRP variants with coronary heart disease. We compared our finding with that predicted from meta-analysis of observational studies of CRP levels and risk of coronary heart disease. For the other loci associated with CRP levels, we selected the most closely associated SNP for testing against coronary heart disease among 14,365 cases and 32,069 controls. MAIN OUTCOME MEASURE: Risk of coronary heart disease. RESULTS: Polymorphisms in 5 genetic loci were strongly associated with CRP levels (% difference per minor allele): SNP rs6700896 in LEPR (-14.8%; 95% confidence interval [CI], -17.6% to -12.0%; P = 6.2 x 10(-22)), rs4537545 in IL6R (-11.5%; 95% CI, -14.4% to -8.5%; P = 1.3 x 10(-12)), rs7553007 in the CRP locus (-20.7%; 95% CI, -23.4% to -17.9%; P = 1.3 x 10(-38)), rs1183910 in HNF1A (-13.8%; 95% CI, -16.6% to -10.9%; P = 1.9 x 10(-18)), and rs4420638 in APOE-CI-CII (-21.8%; 95% CI, -25.3% to -18.1%; P = 8.1 x 10(-26)). Association of SNP rs7553007 in the CRP locus with coronary heart disease gave an odds ratio (OR) of 0.98 (95% CI, 0.94 to 1.01) per 20% lower CRP level. Our mendelian randomization study of variants in the CRP locus showed no association with coronary heart disease: OR, 1.00; 95% CI, 0.97 to 1.02; per 20% lower CRP level, compared with OR, 0.94; 95% CI, 0.94 to 0.95; predicted from meta-analysis of the observational studies of CRP levels and coronary heart disease (z score, -3.45; P < .001). SNPs rs6700896 in LEPR (OR, 1.06; 95% CI, 1.02 to 1.09; per minor allele), rs4537545 in IL6R (OR, 0.94; 95% CI, 0.91 to 0.97), and rs4420638 in the APOE-CI-CII cluster (OR, 1.16; 95% CI, 1.12 to 1.21) were all associated with risk of coronary heart disease. CONCLUSION: The lack of concordance between the effect on coronary heart disease risk of CRP genotypes and CRP levels argues against a causal association of CRP with coronary heart disease.

B-1 Monthly Report of Medical Services Provided under Title XIX of the Social Security Act, February 2008

B-1 Medicaid Reports The monthly Medicaid series of eight reports provide summaries of Medicaid eligibles, recipients served, and total payments by county, category of service, and aid category. These reports may also be known as the B-1 Reports. These reports are each available as a PDF for printing or as a CSV file for data analysis. Report name Report number IAMM1800-R001 Medically Needy by County - No Spenddown and With Spenddown IAMM1800-R002 Total Medically Needy, All Other Medicaid, and Grand Total by County IAMM2200-R002 Monthly Expenditures by Category of Service IAMM2200-R003 Fiscal YTD Expenditures by Category of Service IAMM3800-R001 ICF & ICF-MR Vendor Payments by County IAMM4400-R001 Monthly Expenditures by Eligibility Program IAMM4400-R002 Monthly Expenditures by Category of Service by Program IAMM4600-R002 Elderly Waiver Summary by County

B-1 Monthly Report of Medical Services Provided under Title XIX of the Social Security Act, February 2007

B-1 Medicaid Reports -- The monthly Medicaid series of eight reports provide summaries of Medicaid eligibles, recipients served, and total payments by county, category of service, and aid category. These reports may also be known as the B-1 Reports. These reports are each available as a PDF for printing or as a CSV file for data analysis. Report Report name IAMM1800-R001--Medically Needy by County - No Spenddown and With Spenddown; IAMM1800-R002--Total Medically Needy, All Other Medicaid, and Grand Total by County; IAMM2200-R002--Monthly Expenditures by Category of Service; IAMM2200-R003--Fiscal YTD Expenditures by Category of Service; IAMM3800-R001--ICF & ICF-MR Vendor Payments by County; IAMM4400-R001--Monthly Expenditures by Eligibility Program; IAMM4400-R002--Monthly Expenditures by Category of Service by Program; IAMM4600-R002--Elderly Waiver Summary by County.

B-1 Monthly Report of Medical Services Provided under Title XIX of the Social Security Act, February 2006

B-1 Medicaid Reports -- The monthly Medicaid series of eight reports provide summaries of Medicaid eligibles, recipients served, and total payments by county, category of service, and aid category. These reports may also be known as the B-1 Reports. These reports are each available as a PDF for printing or as a CSV file for data analysis. Report Report name IAMM1800-R001--Medically Needy by County - No Spenddown and With Spenddown; IAMM1800-R002--Total Medically Needy, All Other Medicaid, and Grand Total by County; IAMM2200-R002--Monthly Expenditures by Category of Service; IAMM2200-R003--Fiscal YTD Expenditures by Category of Service; IAMM3800-R001--ICF & ICF-MR Vendor Payments by County; IAMM4400-R001--Monthly Expenditures by Eligibility Program; IAMM4400-R002--Monthly Expenditures by Category of Service by Program; IAMM4600-R002--Elderly Waiver Summary by County.

B-1 Monthly Report of Medical Services Provided under Title XIX of the Social Security Act, February 2005

B-1 Medicaid Reports -- The monthly Medicaid series of eight reports provide summaries of Medicaid eligibles, recipients served, and total payments by county, category of service, and aid category. These reports may also be known as the B-1 Reports. These reports are each available as a PDF for printing or as a CSV file for data analysis. Report Report name IAMM1800-R001--Medically Needy by County - No Spenddown and With Spenddown; IAMM1800-R002--Total Medically Needy, All Other Medicaid, and Grand Total by County; IAMM2200-R002--Monthly Expenditures by Category of Service; IAMM2200-R003--Fiscal YTD Expenditures by Category of Service; IAMM3800-R001--ICF & ICF-MR Vendor Payments by County; IAMM4400-R001--Monthly Expenditures by Eligibility Program; IAMM4400-R002--Monthly Expenditures by Category of Service by Program; IAMM4600-R002--Elderly Waiver Summary by County.

B-1 Monthly Report of Medical Services Provided under Title XIX of the Social Security Act, February 2009.

B-1 Medicaid Reports -- The monthly Medicaid series of eight reports provide summaries of Medicaid eligibles, recipients served, and total payments by county, category of service, and aid category. These reports may also be known as the B-1 Reports. These reports are each available as a PDF for printing or as a CSV file for data analysis. Report Report name IAMM1800-R001--Medically Needy by County - No Spenddown and With Spenddown; IAMM1800-R002--Total Medically Needy, All Other Medicaid, and Grand Total by County; IAMM2200-R002--Monthly Expenditures by Category of Service; IAMM2200-R003--Fiscal YTD Expenditures by Category of Service; IAMM3800-R001--ICF & ICF-MR Vendor Payments by County; IAMM4400-R001--Monthly Expenditures by Eligibility Program; IAMM4400-R002--Monthly Expenditures by Category of Service by Program; IAMM4600-R002--Elderly Waiver Summary by County.

B-1 Monthly Report of Medical Services Provided under Title XIX of the Social Security Act, February 2004

B-1 Medicaid Reports -- The monthly Medicaid series of eight reports provide summaries of Medicaid eligibles, recipients served, and total payments by county, category of service, and aid category. These reports may also be known as the B-1 Reports. These reports are each available as a PDF for printing or as a CSV file for data analysis. Report Report name IAMM1800-R001--Medically Needy by County - No Spenddown and With Spenddown; IAMM1800-R002--Total Medically Needy, All Other Medicaid, and Grand Total by County; IAMM2200-R002--Monthly Expenditures by Category of Service; IAMM2200-R003--Fiscal YTD Expenditures by Category of Service; IAMM3800-R001--ICF & ICF-MR Vendor Payments by County; IAMM4400-R001--Monthly Expenditures by Eligibility Program; IAMM4400-R002--Monthly Expenditures by Category of Service by Program; IAMM4600-R002--Elderly Waiver Summary by County.

B-1 Monthly Report of Medical Services Provided under Title XIX of the Social Security Act, February 2003

B-1 Medicaid Reports -- The monthly Medicaid series of eight reports provide summaries of Medicaid eligibles, recipients served, and total payments by county, category of service, and aid category. These reports may also be known as the B-1 Reports. These reports are each available as a PDF for printing or as a CSV file for data analysis. Report Report name IAMM1800-R001--Medically Needy by County - No Spenddown and With Spenddown; IAMM1800-R002--Total Medically Needy, All Other Medicaid, and Grand Total by County; IAMM2200-R002--Monthly Expenditures by Category of Service; IAMM2200-R003--Fiscal YTD Expenditures by Category of Service; IAMM3800-R001--ICF & ICF-MR Vendor Payments by County; IAMM4400-R001--Monthly Expenditures by Eligibility Program; IAMM4400-R002--Monthly Expenditures by Category of Service by Program; IAMM4600-R002--Elderly Waiver Summary by County.