Questions related to Disease Prevention
If I count the number of risk factors at baseline and then after how many days of lifestyle modification (e.g. Physical Excercise with gamification, smoking stopping aid, etc) what type of instrument should be used because I might get biased data, however, I can check the body fat percentage to validate.
How to ensure adherence to a lifestyle modification program, or in other words how to reduce attrition rates?
I want to do an RCT, not a pre-and post-survey. So in this case how can I blind my outcome assessor?
For a lifestyle modification intervention done in at the LMIC setting, I need a good quality evidence-based program. The mobile reminder doesn't seem to work in LMIC as stated in a systematic review.
Considering how well different states have dealt with the pandemic, there seem to be two clear success stories and a number of open cases.
China seems to have brought the cumulative number of infections to essentially a standstill. The number of daily new cases is pretty low, the total number of cases hovers around 82000, of which 77000 patients have recovered already. (The rest are mostly dead.) One of the attached pdf files gives the case number as a function of time, together with an exponential fit to the first ten data points and a fit to the solution of a three-parameter logistic equation, suggesting that saturation has been reached. (Of course the fitting function is too simplistic, but it gives a decent approximation.) The time axis is in days, day 1 is 01/02/2020, hence day 30 is March 1st, day 61 April 1st. The axis of ordinates is the cumulative number of infections (active plus inactive). Since a constant level has essentially been reached, I have not continued the fit to the current date.
Another country that has succeeded in obtaining control over the spread of the disease is South Korea. Here the data cannot be fitted by a logistic function, but a slightly modified curve, allowing for a linear increase instead of a final plateau, does the job nicely (with four parameters). I attach the result as well. The fit is up to date until yesterday and I would say it is predictive on time scales of a week or even a month. (That is, I don't need to make a new fit with the data of the next few days and the curve will still produce a decent approximation.)
The time scale between take-off and plateau or switch-over to linear behaviour is about 25 days in the case of China and 20 days in the case of South Korea.
In Europe, the disease started spreading later, and no country so far has succeeded in attaining a plateau or weakly (linearly) increasing number of cumulative cases. As an example, I give Germany. We are at about day 25 to 30 after take-off, and the curve is still rising. The exponential curve was obtained by fitting to the 22 initial data points only (omitting days 0 to 29, where the number of cases was below 100), the intermediate curve is a stretched exponential fitted to the first 28 data points (the rationale being that the lockdown measures might lead to a distribution of exponentials with different growth rates first, the average of which would behave as a stretched exponential). The logistic curve is not yet predictive. It gives almost correct predictions for a day or two, then starts to underestimate growth and a new fit leads to a higher plateau. In the case of Italy, we have predictiveness over a longer period and in the case of Spain, the plateau even decreased in height in one case. All of this is suggestive that the lockdown measures seem to work and we may have a plateau on a time scale of two months instead of one. The US is not faring any better than Europe, in fact their success in diminishing the exponential growth rate seems worse than that in countries such as Italy or Spain (which have been hit most heavily in Europe).
The question is what to do once the plateau has been reached? To keep the lockdown much longer than two or three months would be disastrous for the economy, and we are of course still far from herd immunity at the plateau.
First, it may be useful to consider by what strategies China and South Korea were more successful than Europe. Clearly, the numbers from China have to be taken with caution. They report about 3300 deaths, but I have read rumours that the actual numbers might rather be in the tens of thousands. Also their total number of once-infected persons may be way too small due to counting tricks. (It might well be 300000 rather than 82000.) Nevertheless, there seems to be agreement that they have essentially stopped the disease for now. We probably cannot copy their methods, as China is a dictatorship and they may use brutal measures for enforcing a lockdown. (You could probably be killed by the police, if you disobey the lockdown rules.)
With South Korea, the situation is different. While they did not manage to completely stop the case count, they could drastically reduce its growth rate. And we know how they did it. In principle, we could copy their approach; it does not go beyond the power of authority of a democracy. And it works without a complete lockdown.
In fact, on 19 March, I sent an e-mail to our chancelor (Angela Merkel), discussing how the South Korean approach works, in principle, and that in copying it, Germany should be able to keep its case count similarly low. South Korea had about 9000 cases then and has about 10000 now. Germany had about 15000 cases then and has more than 95000 now. South Korea's population is 51 million, Germany's 82 million, so if Germany had done as well as South Korea, they should have brought growth to a slow-down at 16000 or at most 20000...
Anyway, since I sent the e-mail to Ms. Merkel via an official e-mail address, it was certainly read by some official, who filters the (presumably) large number, and it may in fact never have been read by her. Which would be a pity as she is an intelligent woman and has a PhD in physics, so she would certainly have understood it. (Also the person deciding not to give it to her carries a great responsibility.)
Acting on it is of course a different matter, in particular when you get much advice by other experts, each one focused on a different thing. After all, being a physicist, she must have understood the dangers of nuclear power plants for a long time. But it took the emotional shaking by Fukushima for her to act on that knowledge. (And then she overreacted, resulting in the taxpayer having to reimburse electricity companies for lost gains due to early shutdown of power plants -- which might instead have helped reduce carbon dioxide emissions, if rather some carbon power plants had been shut down a few years earlier.)
In that context, it may be useful to point out that there exists a report addressing the German federal parliament, dated 13 January 2013, in which the government presents a risk analysis, among other things, of a pandemic by the virus "MODI-Sars", which is a fancy name for a virus of the Corona type, producing a modified SARS like disease. The risk analysis starts on page 55 and goes on through page 88 of the report. It comes to the conclusion that Germany will suffer 7.5 million casualties by the disease (assuming a relatively high lethality of 10%). Most assumptions on the disease are similar to the properties of COVID 19. Ideas about the availability of a vaccine are conservative, assuming it will take 3 years to produce. The report concludes that there will be 3 waves of the disease, each one about half a year long and each one overcharging the German health system. A new wave starts when lockdown measures from the old one are relieved. Also, the report assumes that immunity after recovery from the disease will be only for about a year, due to continuing mutations of the virus. All in all, the pandemic will take three years. Details about economic reverberations are murky, but I suppose the world economy cannot sustain three successive lockdowns of half a year each and some milder version of lockdown for the remaining one and a half years.
As far as I can tell, no measures have been taken on that report (that would have been communicated to the public). So Bill Gates is right. We were unprepared for the pandemic. (And that is true not only for Germany. Germany is in fact doing o.k. as far as lethality and availability of hospital capacity is concerned. The situations are worse in the rest of Europe and far worse in the US.)
Here is the basic idea on how to stop the disease without a full lockdown and with continuing economic activity. It is pretty simple and I will first discuss it in the form that was given in my e-mail. Since I have more precise figures in the meantime, I will then show that a somewhat more optimistic view is possible.
What was known to me then was that there was an incubation period between one and two weeks, before symptoms showed up, and so an infected person might infect others even before knowing they were ill. Also the quarantine for patients was two weeks, so one may assume that three to four weeks after infection you are either recovered or dead. I assumed that you become infectious yourself after one or two days and lose that a week or so before recovery. The basic reproduction number R0 (which is the average number of persons infected by one ill person) was supposed to be between 2 and 3. (For measles, that number is about 15!) If you infect two to three persons in three weeks time, you will infect fewer than one on average, if you are identified and put into quarantine within a third of your infectious period, i.e., within a week. So we must do what South Korea did: test extensively (and track the contacts of all positively tested individuals). If we catch everyone who is infected early enough, no other measures are necessary in order to keep the effective basic reproduction number below one, which is sufficient to stop spreading of the disease. With additional measures in place, such as a full or partial lockdown, we may succeed in doing so even when discovering the disease in everyone only within two weeks (on average) after infection. But of course we want to get away from lockdown, to get the economy going again.
The problem with this approach is, of course, the huge testing capacity you need. But South Korea did it, so it should not be impossible. What numbers are possible? Right now, it seems that about 300000 tests are done in Germany per week. But Germany is a highly industrialized country, with some of its industries having little to do now. With an appropriate effort, it should be possible to push that up to 500000 tests per day, even a million. (Testing the whole population once every three months.) If Germany can't do it, China certainly can (and sell the equipment to Germany for a good price...). And they even don't have a lockdown... Billions of Euros are being set aside to save our industries across the period of the lockdown. A few of these billions could be spent for tests (and part of them for breathing masks). At the moment, the importance of tests is emphasized in public speeches as a means to learn more about the disease. This is misinformation. They are much more important as a means to stop the spreading of the pandemic (which requires linking them with quarantine).
In fact, I have learned more accurate numbers about the disease in the meantime. There is a paper by the Robert Koch institute , in which they say that infectiosity is present for 10 days, starts around day 2.5 and symptoms are present for 9 days, starting at day 4.5. Duration of the disease is 17.5 days, if there are no complications, otherwise up to 28 days (intensive care starting around day 9.5, taking 10 days, resulting in death on average on day 19 for 50% of the patients in intensive care and recovery for the remaining 50% around day 24; - this may be different in other countries). Moreover, the basic reproduction number has been estimated to be between 2.24 and 3.58 in the Wuhan outbreak .
What is important for us is that the period of infectiosity is 9 days, of which only 2 days are before symptoms. It is therefore not actually necessary to test everyone before symptoms. If we catch and test everyone on the first day they have symptoms, that should alone be sufficient to reduce the effective basic reproduction number below one, because we are then on day 3 of 9 infectious days, when fewer than a third of the possible secondary infections have happened. So testing symptom-free persons might be reserved to high-risk or high-multiplicator groups (personnel of hospitals, teachers), and a million tests per day may actually be enough. Of course, the result of a test must be available the same day, within a few hours after testing. (Or else, the tested person must be kept in quarantine precautionarily until the test result is available.)
So the course of action for the near future, after -- hopefully -- getting below an effective basic reproduction number of 1 via lockdown, should be
1) to gradually reduce the lockdown, best only partially at the beginning, masks could be worn in public (once enough are available) which gives a small level of protection, but also contributes to lowering the effective basic reproduction number, and what matters is the overall statistical effect (not whether a particular individual has more or less protection -- older people should try to protect themselves more thoroughly than younger ones, being at a higher general risk)
2) making available fast testing with quick results to everyone having the slightest symptoms and putting those people immediately into quarantine on positive testing
3) testing the contacts of positively tested persons, if those have a smart phone on which the app is installed that registers all smart phones that satisfy certain closeness conditions with the carrier of the infected person (temporary measure, as anonymous as possible, expiring automatically, if not renewed be legislation regularly)
4) testing persons from critical professions (that might have multiplier function) on a regular basis even without any symptoms.
5) Production stops in any economic branch for the purpose of a partial lockdown should be limited to less than a month whenever possible, and not happen too often. The point is that losing certain production capabilities via failures of enterprises will also cost some lives in the end, although this may be less visible than direct losses via a disease.
This requires mass production of reliable testing equipment. The tests must be so standardized that qualified medical personnel (numbers of whom cannot be augmented fast) have to spend only very little time with each single test. (The swab could be made by the patients themselves in many cases -- except if they are helpless.)
What do people think about how to proceed? Are there additional or alternative measures that suggest themselves?
 an der Heiden M, Buchholz U: Modellierung von Szenarien der SARS-CoV-2-Epidemie 2020 in Deutschland | DOI 10.25646/6571.2
 Shi Zao et al., Preliminary estimation of the basic reproduction number of novel coronavirus (2019-nCoV) in China, from 2019 to 2020: A data-driven analysis in the early phase of the outbreak, Internat. J. Infect. Diseases 92 (2020) 214 - 217
I’m trying to compose a timeline that projects threats and problems that cause uncertainty to health over the next century.
I’m interested in all long-term health issues including drug resistance, global warming impacts, the impact of technology, biological warfare and terrorism etc.
The closer these events are, the better we can predict when and if they’ll make an impact, but I'm interested in the lot (and the fuzzy logic of when and how big).
I've asked a similar question recently and I got a single good answer - but surely there's more than just one forward thinking researcher out there!
1. Have you heard of any major risks to health over the next 100 years?
2. When are these risks expected and why then?
3. Any predictions on impact size?
4. Do you have any references? They don’t need to be academic, but academic Is better.
5. Any other thoughts?
6. Do you want to receive this data once I’ve compiled it?
We are in an environment where health-related news is shared unlimitedly in the media and social media. It is important to interpret health related information and news correctly. Health literacy is of great importance at this point.
Health literacy is of concern to everyone involved in health promotion and protection, disease prevention and early screening, health care and maintenance, and policy making. Health literacy skills are needed for dialogue and discussion, reading health information, interpreting charts, making decisions about participating in research studies, using medical tools for personal or familial health carecalculating timing or dosage of medicine, or voting on health or environmental issues.
What do you think about the outbreak of coronavirus? Will the outbreak stop in China soon? Will there be an effective vaccine soon? Does the international community succeed in controlling it? What are the negative effects of this disease on the international community? Please share your opinion.
We don't have any Reviewed sequence in Uniprot and no tertiary structure available for any of the protein of this Virus. How we can work on protein level?
In my recent study, I found that the health promoting behaviors of Iranian nurses were poor. Nurses usually have adequate knowledge about the health behaviors and the benefits of these behaviors in disease prevention. What do you think about the reason of this finding?
I would like to develop some medical assays for example for cancer prevention, or analysis of some markers for some disease which would be good for application in medicine in Georgia country. I did not find any database for such requests where medical doctors would say that it would be good to have assay for this and this things.
Does anyone know how to find information about requestable assays or analysis for some disease, or disease prevention or something useful in medicine?
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Effectiveness of mindfulness-based stress reduction program in treating and/or preventing form morbidity on coronary heart diseases
what we can interpret by accessing the blood albumin globulin, total protein and A/G ratio? the blood protein and it fraction can indicate the health status of an animal. but how? what are the related parameters that can be concluded by seeing these indices?
Calibration vs discrimination: which one more important in a prediction model? The answer may be it depends.
1) calibration (ie, agreement between observed and predicted risk) is more important in prognostic settings, because we would like to predict future risk of the target population, and the intercept (disease prevalence) is very important;
2) discrimination (ie, separating people with disease from without disease) is more important in diagnostic settings, because we want to diagnose the people as with/without disease using some test/factors under the predefined cutpoints. Good discrimination means that people with true disease will always have higher predicted risks than those people without disease. The intercept is not of interest.
Sometimes the model may be over-/under-estimate the risk (poor calibration), but it may still separate those with disease from without disease (good discrimination). Vice versa- the model may have good calibration, but cannot discriminate the cases from the control.
Any other relevant difference for these two metrics? Thanks in advance!!
Actually it had some debate/discussion about this (http://andrewgelman.com/2014/05/10/property-important-risk-prediction-model-discrimination-calibration/), but without firm agreement..
Usually in Suspected TB patients sputum smear x 3 times negative is considered as a tool to stop air borne precautions and my question is can GenXpert for TB/Rif R be used for this purpose in parallel in low endemic areas? for a quick withdrawal !
Based on recent literature I am under the impression that the genome-wide comparison of prehistoric and modern pathogen DNA is significant for the following reasons:
- Prehistoric human microbiomes can be screened for novel vaccine targets
- Reconstructed draft genomes may be used to identify close relatives of modern pathogens
- Reference genomes can provide clues that may aid in the timeous and appropriate management of contemporary disease threats
Is this correct? In which other ways can one express the contemporary significance of prehistoric pathogen research?
Has anyone any information about papers concerning pre-exposure (PrEP) prophylaxis given to people with risk for contracting other infections than HIV? There are many ethical issues concerning use of PrEP in populations at high risk to contract HIV so I am wondering whether that possibility has also been given in cases where people could be exposed to other infections. By that, I exclude vaccinations and consider only long term usage of drugs for the purpose of avoiding infections.
I am about to dig myself into & conduct a research on health marketing, more specifically health-consciousness & prevention in general. I would be more than happy to know which the top relevant papers in this field are. What is the best scale to measure health-consciousness & prevention in general?
I will do my research in Hungary. Should you be interested to collaborate to compare research findings in different countries/cultures, please let me know.
Thanks in advance.
I am currently looking for research on any clinical study of the direct correlation between oil extraction and specific diseases in Africa, such as cancer, asthma or other respiratory illnesses in Africa.
The essential logic is to decrease the time of exposure to cardiovascular risk factors with genetic insights providing strong justification for this approach. Lifetime exposure to lower concentrations of cholesterol specifically, plasma levels of low-density lipoprotein (LDL) cholesterol, is shown to be associated with larger reduction in the risk of coronary heart disease. The decrease in risk is related to the genetic variants of receptors that remove cholesterol from the circulation matched with individuals who do not carry such variants. For a known reduction in LDL cholesterol, there was much more impact on reduction in cardiovascular disease risk than that reached with pharmacotherapeutic modulation in late life. Several studies have shown that the adoption of a healthy life , the act of not smoking, weight control and perform regular physical activity , with the reduction of cholesterol levels can be more effective than drug therapy of known effectiveness. How best to link these two strategies and show people that the protection of their coronary health goes beyond the use of drugs ?
Some excerpts from the enclosed link:
"Lychee is a small fruit with a sweet smell and taste, which is available in the summer. It is a small fruit packed with healthy nutrients. It has rough skin outside while contains juicy flesh inside. It is used as medicine in China"
Why Lychee fruit is healthy?
- Lychee contains good amount of antioxidant Vitamin C, Vitamin B-complex and phytonutrient flavonoids.
- Lychee is a rich source of nutrient that is required for the production of blood. It provides manganese, magnesium, copper, iron and folate that are required for the formation of RBC.
- Lychee contains good amount of fiber and Vitamin B-complex which increase metabolism fat, protein and carbohydrate. Fiber rich foods has proved to suppress appetite and increase metabolism.
- Lychee contains high amount of antioxidants which is effective to prevent early ageing.
- Lychee contains high amount of antioxidant Vitamin C. Lychee also contains a good amount of potassium. Potassium is required to maintain sodium level. Also high potassium is required to maintain fluid level i.e. Balance electrolyte. Thus it helps to maintain high blood pressure and it reduces the risk of stroke and heart attack. Also it contains minerals like manganese, magnesium, iron, copper and folate that maintain blood pressure.
- Lychee is rich source antioxidants Vitamin C. Antioxidants are effective to protect from free radicals and oxidative stress. So it protects from degenerative disease and prevents arthritis.
- Lychee is also effective to protect from asthma.
- Lychee contains high amount of dietary fiber which proves best nutrient that promote cardiovascular health.
Your views are welcome! Thanks - Sundar
The scientists already know the DNA sequence of a HIV virus based on which they develop the primers called HIV primers. Now during the PCR they mix the DNA sample of the person with this HIV primer (along with enzyme and nucleotides), and if this sequence matches with the target (patient's) DNA there will be amplification which means that the person is infected. And if the sequence doesn't match then there will not be any amplification which means that the person is not infected. If this right what are the roles of PCR in detecting unknown diseases?
The SCORE tables for the year 2011 only based on total cholesterol (and other risk factors) despite recognizing the huge impact of the concentrations of HDL in cardiovascular risk estimation. Moreover, for a given concentration of total cholesterol, LDLc calculation (therapeutic target) can change greatly depending on the concentration of HDL in the time.
Ebola virus disease or Ebola haemorrhagic fever, is transmitted to people from wild animals and spreads in the human population through human-to-human transmission. Ebola was first discovered in 1976 near the Ebola River in the Democratic Republic of the Congo. Researchers believe that the Ebola virus is animal-borne and that bats are the most likely reservoir. Four of the five virus strains occur in an animal host native to Africa. Fruit bats of the Pteropodidae family are natural Ebola virus hosts.
Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals such as chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest. A 2013 study isolated antibodies from fruit bats in Bangladesh, against Ebola Zaire and Reston viruses, thus identifying potential virus hosts and signs of the filoviruses in Asia.
The current and most severely Ebola affected countries are Guinea, Sierra Leone and Liberia (see the attached Figures). There is no FDA-approved vaccine available for Ebola. The disease has a high risk of death, killing between 50% and 90% of those infected with the virus. A number of interventions would be required to prevent or control the disease.
Question: What are the possible measures that would prevent Ebola virus from spreading into new areas/countries? What measures your country is taking to prevent the disease?(Any weblinks or references relevant to Ebola prevention would be much appreciated)
The calculation of cardiovascular risk is a current need in the management of cardiovascular disease prevention day today but there are differences between them.
The advent of vaccines has considerable effect on the public health and disease prevention.
If we take two populations (patients and controls) and you dose trace elements in the blood or plasma or tissue .... etc..
A lower rate compared to controls may reveal that this trace element plays an important role for the prevention of this disease.
The American Medical Association has now joined other organizations in deeming obesity a disease (not just a condition or syndrome). There is hand-wringing about proliferation of pharmaceuticals, surgery, and other medical treatments. What about prevention, and specifically, primary prevention for children? Is there applicable evidence for other diseases to inform us of what to expect for prevention and public health efforts around childhood obesity?
Any explanations for calculating relative risk (RR) for incidence and odds ratio (OR) for the longitudinal prevalence of diarrhea in randomized controlled trials to evaluate the effectiveness of intervention?