The burden of bladder outlet obstruction in men in rural Uganda
Notice bibliographique
Résumé
A patient with indwelling suprapubic catheter drainage due to late diagnosis of advanced BOO in Uganda. The realities of daily living in much of the developing world make maintenance of hygiene a challenge due to limited access to clean water and sanitation. Drugs available in a rural Ugandan medical clinic recommended for treatment of BOO. Investigators meet participants wanting to enroll in the Ugandan burden of disease survey. Men recruited at a rural community site. A participant recruited when attending a local medical clinic. Broadcasting information about the community-based survey via a radio talk show. Recruitment at remote rural sites involved extensive travel. A participant reporting his symptoms using the picture-based visual score (left), after completing the IPSS (right) by interview. Health education related to BOO was consistently sought during debriefing sessions for survey participants. Participants liked the visual symptom score and provided input on clarity of the pictures used. A considerable decrease in mortality from BOO has been achieved in the developed world through improvements in surgical and medical management. This decrease in mortality was reported as ‘A major unheralded health triumph’ in 1996, and the statement was made that high mortality rates in low-resource environments could be lowered by (i) education and (ii) ‘widespread availability’ of modern treatment.5 At the time, ‘modern treatment’ primarily meant surgery, but today international guidelines recommend drug therapy which can reduce morbidity in BOO by > 2-fold.6,7 Importantly, the drugs recommended are available and inexpensive in the developing world. However, educational barriers and limited knowledge that treatment is effective early in the disease restrict access to therapy, preventing meaningful impact on morbidity and mortality. We conducted the first community-based quantitative assessment of the burden of BOO in Africa as a first step in increasing awareness, facilitating early diagnosis and enabling patients to access effective but under-utilized medical therapy. The objective of this cross-sectional survey in rural Uganda was to compare the burden of disease due to LUTS in men > 50 years of age living in the community (N = 238) with a second cohort seeking treatment at a medical clinic (N = 177). We used two recruitment strategies: radio phone-in talk shows to promote clinic attendance, and community outreach travel to survey patients in rural areas. The WHO-endorsed International Prostate Symptom Score (IPSS), which quantifies symptoms and quality of life, was administered via interview.8 Usually the IPSS is self-administered, but literacy and language are barriers to completion this way. So with clinic participants we compared the IPSS to a newer visual score9 where pictures illustrating urinary tract symptoms allow quantification of four of the eight IPSS questions. Our data show that the frequency and negative impact of LUTS are high in the community, in keeping with WHO estimates, but that the burden of disease is greater than previously recognized, as by the time patients ultimately seek care their symptoms are severe due to advanced disease. Health education about BOO was welcomed at workshops to debrief participants. The visual symptom score was popular, showed validity and warrants further development. The people (identifiable) photographed have given their consent for their pictures to be used in the dissemination and publication of this research. This work was supported in part by a Stars in Global Health award from Grand Challenges Canada. Conflict of interest: All authors declare no conflict of interest. We acknowledge the contributions made by the participants in this community-based survey and the assistance provided by local clinic staff in the interview and data collection process, especially by Henry and Isaac.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,001 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,003 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».