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Background: Mozambique is one of the countries in Africa that is continuously at risk of cholera outbreaks due to poor sanitation, hygiene, and limited access to potable water in some districts. The Mozambique Cholera Prevention and Surveillance (MOCA) project was implemented in Cuamba District, Niassa Province to prevent and control cholera outbreaks through a preemptive cholera vaccination, strengthened surveillance system for cholera and diarrheal diseases, and better understanding of cholera-related healthcare seeking behavior of local populations, which may further guide the national cholera control and prevention strategies. This article presents the surveillance component of the MOCA project. Methodology/Principal findings: A prospective healthcare facility (HCF)-based surveillance of cholera and diarrheal disease was conducted in six HCFs in the District of Cuamba from March 2019 to December 2020. A systematic surveillance procedure has been put in place with capacity building in selected sentinel HCFs and a basic microbiology laboratory established on-site. Patients presenting with suspected cholera or other diarrheal symptoms were eligible for enrollment. Clinical data and rectal swab samples were collected for laboratory confirmation of Vibrio Cholerae and other pathogens. A total of 419 eligible patients from six HCFs were enrolled. The median age was 19.8 years with a similar age distribution between sentinel sites. The majority were patients who exhibited diarrhea symptoms not suspected of cholera (88.8%; n = 410). Among those, 59.2% (210/397) were female and 59.9% (235/392) were 15 years and above. There were 2 cholera cases, coming outside of the catchment area. The incidence of diarrheal diseases ranged from 40–103 per 100,000 population. No Vibrio cholerae was isolated among surveillance catchment population and Escherichia coli spp. (82/277; 29.6%) was the most common pathogen isolated. Conclusion/Significance: Efforts were made to strengthen the systematic surveillance of suspected cholera with standardised patient screening, enrolment, and diagnostics. The first basic microbiology laboratory in Niassa Province established in Cuamba District under the MOCA project needs to be integrated into the national network of laboratories for sustainability. No reports of laboratory confirmed cholera cases from the surveillance catchment area may be highly related to the pre-emptive oral cholera vaccine (OCV) mass vaccination campaign conducted in 2018 and the use of drugs by local populations prior to visiting the sentinel HCFs. Continued systematic cholera surveillance is needed to closely monitor the cholera endemicity and epidemics, and further evaluate the long-term impact of this vaccination. High incidence of diarrheal illnesses needs to be addressed with improved water, sanitation, and hygiene (WaSH) conditions in Cuamba District. Efforts integrated with the prioritization of prevention measures are fundamental for the control of cholera in the country. Author summary: Mozambique faces an ongoing risk of cholera outbreaks, due to factors such as poor sanitation and limited access to clean and potable water. To address this challenge, the Mozambique Cholera Prevention and Surveillance (MOCA) project was launched in one of the high-risk areas, Cuamba District, Niassa Province, in 2018. This initiative was an integral part of Mozambique's efforts to develop a comprehensive National Cholera Plan, aiming to bolster cholera and diarrheal disease surveillance and inform national prevention strategies. Under the MOCA project, we conducted a preemptive oral cholera vaccine (OCV) mass vaccination campaign in 2018 and implemented a healthcare facility-based surveillance for cholera and diarrheal diseases in six healthcare facilities in Cuamba District. A systematic cholera surveillance system was put in place in the study sentinel sites with standardised patient screening, enrolment, and diagnostic procedures. The first basic microbiology laboratory in Niassa province was established in Cuamba District in 2018 with funding and technical support made available under this MOCA project. A significant portion of patients in our surveillance system exhibited diarrheal symptoms unrelated to cholera, with a notable representation of females and individuals aged 15 years and older during the surveillance period in 2019–2020. No suspected cholera patients enrolled was laboratory-confirmed with Vibrio cholerae, which may be highly related to the cholera vaccination campaign performed in 2018 and the local populations' tendency on the use of drugs before seeking healthcare at the HCFs. Continued surveillance is recommended to track cholera endemicity and outbreaks and also to assess the long-term impact of OCV vaccination in Cuamba District. Better infrastructure and practice of WaSH is needed to reduce the high incidence of diarrheal illnesses in the local populations. Sustainable technical and financial support is needed in the rural remote areas of Cuamba District for the continued systematic cholera and infectious disease surveillance system, including laboratory confirmation. Integrating these efforts with preventive measures is crucial for effective cholera control in Mozambique. [ABSTRACT FROM AUTHOR]

Objectives: We investigate the clinical utility of the lactate/albumin (L/A) ratio as an early prognostic marker of ICU mortality in a large cohort of unselected critically ill patients.Methods: A retrospective single-center study using data from the Multiparameter Intelligent Monitoring Intensive Care III (MIMIC-III) database collected between 2001 and 2012. We screened adult patients (age ≥ 15) with measured lactate and albumin on the first day of ICU stay to evaluate the prognostic performance of the lactate and lactate/albumin (L/A) ratio for ICU mortality prediction.Results: The overall ICU mortality in the 6414 eligible ICU patients was 16.4%. L/A showed a receiver-operating characteristics area under the curve (ROC-AUC) value of 0.69 (95% CI: 0.67, 0.70) to predict ICU mortality, higher than lactate 0.67 (95%CI: 0.65, 0.69). Regardless of the lactate level, L/A yielded better ROC-AUC compared to the lactate level [normal lactate (<2.0 mmol/L): 0.63 vs 0.60; intermediate lactate (2.0 mmol/L ≤ lactate <4.0 mmol/L): 0.58 vs 0.56; high lactate (≥4.0 mmol/L): 0.67 vs 0.66]. L/A was a better prognostic marker for ICU mortality in patients with decreased lactate elimination [hepatic dysfunction: 0.72 vs 0.70; renal dysfunction 0.70 vs 0.68]. The L/A ratio ROC-AUC was better in patients with sepsis (0.68 vs 0.66) and those who developed severe sepsis or septic shock (0.68 vs 0.66).Conclusions: The performance of L/A and lactate were equivalent in predicting ICU mortality and can be used as early prognostic markers for ICU patients with different initial lactate level and the presence of hepatic or renal dysfunction. [ABSTRACT FROM AUTHOR]

Background: Well-validated risk prediction models help to identify individuals at high risk of diseases and suggest preventive measures. A recent systematic review reported lack of validated prediction models for low back pain (LBP). We aimed to develop prediction models to estimate the 8-year risk of developing LBP and its recurrence. Methods: A population based prospective cohort study using data from 435,968 participants in the National Health Insurance Service-National Sample Cohort enrolled from 2002 to 2010. We used Cox proportional hazards models. Results: During median follow-up period of 8.4 years, there were 143,396 (32.9%) first onset LBP cases. The prediction model of first onset consisted of age, sex, income grade, alcohol consumption, physical exercise, body mass index (BMI), total cholesterol, blood pressure, and medical history of diseases. The model of 5-year recurrence risk was comprised of age, sex, income grade, BMI, length of prescription, and medical history of diseases. The Harrell's C-statistic was 0.812 (95% confidence interval [CI], 0.804-0.820) and 0.916 (95% CI, 0.907-0.924) in validation cohorts of LBP onset and recurrence models, respectively. Age, disc degeneration, and sex conferred the highest risk points for onset, whereas age, spondylolisthesis, and disc degeneration conferred the highest risk for recurrence. Conclusions: LBP risk prediction models and simplified risk scores have been developed and validated using data from general medical practice. This study also offers an opportunity for external validation and updating of the models by incorporating other risk predictors in other settings, especially in this era of precision medicine. [ABSTRACT FROM AUTHOR]

Purpose: Well-validated risk prediction models help to stratify individuals on the basis of their disease risks and to guide health care professionals in decision-making. The incidence of nephrolithiasis has been increasing in Korea. Racial differences in the distribution of and risk for nephrolithiasis have been reported in Asia but no population-specific nephrolithiasis models have been developed. We aimed to develop a simplified nephrolithiasis prediction model for the Korean population by using data from general medical practice. Materials and Methods: This was a prospective, population-based cohort study in Korea. A total of 497,701 participants from the National Health Insurance Service-National Sample Cohort (NHIS-NSC) were enrolled from 2002 to 2010. A Cox proportional hazards model was used. Results: During a median follow-up time of 8.5 years (range, 2.0-8.9 years) and among 497,701 participants, there were 15,783 cases (3.2%) of nephrolithiasis. The parsimonious model included age, sex, income grade, alcohol consumption, body mass index, total cholesterol, fasting blood glucose, and medical history of diseases. The Harrell's C-statistic was 0.806 (95% confidence interval [CI], 0.790-0.821) and 0.805 (95% CI, 0.782-0.827) in the derivation and validation cohorts, respectively. Conclusions: The results of the present study imply that nephrolithiasis risk can be predicted by use of data from general medical practice and based on predictors that clinicians and individuals from the general population are likely to know. This model comprises modifiable risk factors and can be used to identify those at higher risk who can modify their lifestyle to lower their risk for nephrolithiasis. This study also offers an opportunity for external validation or updating of the model through the incorporation of other risk predictors in other settings. [ABSTRACT FROM AUTHOR]

Abstract: We investigated the relationship between characteristics of coffee shade systems and coffee pest infestation by the black coffee twig borer Xylosandrus compactus Eichhoff. The pest deprives Uganda of $40 millions annually, yet its control remains inadequate. The present study considered three rainfall zones in Central Uganda and 50 coffee plots that were randomly selected from each rainfall zone. Data were collected on X. compactus infestation and key shade indicators: canopy cover, tree‐species densities, diameter at breast height (DBH) and ratio of coffee to banana. Cluster analysis revealed two coffee shade systems: a matured shade tree (MST) system and a young poly‐culture (YPC) system. Xylosandrus compactus infestations were significantly less in the MST system than in the YPC system and significantly less in the low rainfall zone than in the high rainfall zone. An increase in the density of Carica papaya and Albizia chinensis significantly reduced and increased X. compactus infestation, respectively. A higher average DBH of individual trees and a higher density of trees that exude sap significantly lowered X. compactus infestation. Suppressing X. compactus infestation requires bigger trees, a high density of sap‐exuding trees and no Albizia chinensis. Further research should aim to investigate X. compactus flight activity and microclimate influencing X. compactus population dynamics. [ABSTRACT FROM AUTHOR]

Many smallholder farm systems in Uganda produce coffee as an important cash crop. Yet coffee yields are poor. To increase farmers’ production, a range of agronomic practices have been recommended by national and international agencies. Yet the adoption potential of recommendations differs between farm systems. To understand the differences in adoption potential of recommended coffee management practices in Uganda, we provide a typology of farm systems with coffee, assess the diversity between the farm types, and evaluate the current use of existing management recommendations for each farm type. Through factor analysis and cluster analysis of farms producing coffee, we identified five farm types: large coffee farms, farms with off-farm activities, coffee-dependent farms, diversified farms, and banana–coffee farms. The farm types were based on differences in size, and on the relative contributions of coffee, banana and off-farm labour to total household income. They also differ in the availability of the resources labour, land and cash, in coffee production and revenue, and in current use of most recommended practices. Qualitative analysis indicates that farm types have different constraints and opportunities to adopt recommendations. Our results highlight that an analysis of different farm systems with coffee production, a degree of definition beyond the ‘smallholder coffee farmer’ as a homogenous entity, is important in order to understand the scope for success or failure of recommended practices. [ABSTRACT FROM PUBLISHER]