It is unclear whether an improved agricultural pattern could relieve this issue and enhance agricultural sustainability in an arid irrigation area. A field experiment using a well-designed agricultural practice was carried out in northwest China; reduced tillage, coupled with wheat straw residue retention measures, was integrated with a strip intercropping pattern. We determined the crop productivity, water use, economic benefits, and carbon emissions (CEs). The wheat-maize intercropping coupled with straw covering , boosted grain yield by 27–38% and 153–160% more than the conventional monoculture of maize and wheat, respectively, and it also increased by 9.9–11.9% over the conventional intercropping treatment. Similarly, this pattern also improved the water use efficiency by 15.4–22.4% in comparison with the conventional monoculture of maize by 45.7–48.3% in comparison with the conventional monoculture of wheat and by 14.7–15.9% in comparison with the conventional intercropping treatment. Meanwhile, NTSI treatment caused 7.4–13.7% and 37.0–47.7% greater solar energy use efficiency than the conventional monoculture of maize and wheat, respectively. Furthermore, the NTSI treatment had a higher net return (NR) by 54–71% and 281–338% and a higher benefit per cubic meter of water (BPW) by 35–51% and 119–147% more than the conventional monoculture of maize and wheat, respectively. Similarly, it increased the NR and BPW by 8–14% and 14–16% in comparison with the conventional intercropping treatment, respectively. An additional feature of the NTSI treatment is that it reduced CEs by 13.4–23.8% and 7.3–17.5% while improving CE efficiency by 62.6–66.9% and 23.2–33.2% more than the conventional monoculture maize and intercropping treatments, respectively. We can draw a conclusion that intercropping maize and wheat, with a straw covering soil surface, can be used to enhance crop production and NRs while effectively lowering CO2 emissions in arid oasis irrigation region.Intercropping is considered a promising system for boosting crop productivity. However, intercropping usually requires higher inputs of resources that emit more CO A key question is whether we can design an improved farming system that effectively addresses these above issues and, thus, achieve sustainable agriculture in highly populated, natural resource-limited areas.The gap between food demand and grain production has become larger in recent years because of the continuously increasing demand from a growing population . Arable Intercropping is a systematic approach that makes full use of nutrient and water resources, achieves agricultural biodiversity, and increases yield significantly in comparison with crop monocultures . IntercrWith these issues in mind, we established an innovative farming system, with two key agronomic measures: (i) crop intensification via strip intercropping and (ii) crop residue management approaches combined with reduced tillage in a wheat-maize intercropping system to increase crop productivity and reduce CEs. The resultant crop yields, water use, solar energy use efficiency (SUE), economic benefits, and CEs of wheat/maize intercropping patterns to various straw returning options were determined in an arid oasis region. We formulated the following hypotheses: (i) intercropping wheat and maize could improve crop productivity when compared with monocultures of either crop under conventional tillage and (ii) reduced tillage and changes to the way straw residue is handled could improve crop productivity of intercrops while reducing CEs.The experiment was carried out at the Agricultural Research Station  of Gansu Agricultural University from 2010 to 2012. The research station is located in the eastern part of Hexi Corridor of northwestern China, with the sunshine duration above 2940 h, and accumulated temperature above 10°C greater than 2985°C, in each year. Temperature conditions were suitable for intercropping patterns. The annual mean precipitation of the crop growing season is below 160 mm, but the potential soil water evaporation is greater than 2400 mm. The low water availability limits the potential of cropping extension based on conventional tillage. Thus, plastic mulching and the return of crop straw to the field were applied to crop production to improve water utilization. Water shortage and a gradual shrink in arable land in that area result in a conflict between crop water requirements and food demands. Therefore, an innovative planting pattern for the intercropping system has been introduced to the Hexi Corridor of China. Maize and wheat are the two main grain crops in this region; they are planted in monoculture and intercropping systems. The soil at the experimental site is classified as a desert soil, a kind of desert land filled with calcareous particles. During the two study years, the precipitation during the wheat growing season (March–July) was 65.8 and 40.5 mm and the precipitation during the maize growing season (April–September) was 179.1 mm and 128.5 mm, in 2011 and 2012, respectively.A preparatory experiment was conducted in 2010 to create suitable straw management approaches and to provide a field basis for the implementation of various treatments in 2011 and 2012. In the testing years, three kinds of straw retention patterns were implemented, including plastic mulch applied to maize strips before sowing, forming an advanced pattern with crop straw and plastic mulching . The wheat-maize intercropping was tested in three crop-straw retention systems, and conventional tillage treatment without straw residue was applied to monoculture wheat, maize, and wheat-maize intercropping patterns. Thus, there were six treatments with three replicates constituting a total of 18 plots in a randomized, complete block design. Moreover, to improve the intercropping advantage, four straw management approaches were examined: (i) no-tillage with 25–30 cm lengths of straw standing in the plot during the wheat harvesting of the previous summer (NTSSI); (ii) no-tillage with 25–30 cm lengths of straw covering the soil surface during the wheat harvesting of the previous summer (NTSI); (iii) tillage with 25–30 cm lengths of straw incorporated into the soil through deep tillage after wheat harvesting of the previous summer (TSI); and (iv) conventional treatment without straw residue (CTI), such as deep tillage (30 cm depth) with wheat straw removed from the field.Figure 1). The different tillage and stubble retention practices were applied to the wheat strips in various wheat-maize intercropping systems only, and all the maize strips were tilled. Since the main objective is to discover intercrop response to various straw retention options, no single crop was subjected to conservation practices but only for conventional tillage  to form conventional monoculture maize treatments , and monoculture wheat  were included in this study. Conventional tillage without straw retention was used as the control where the soil (30 cm) was plowed the previous fall for weed control; then, an 80 cm wide rotavator was operated at a depth of 30 cm at pre-seeding for seedbed preparation. In late fall of each year, wheat strips were managed to form the different tillage and straw residue options, and maize strips were deeply plowed and raked. In the following spring, the soil was firstly fertilized, harrowed, smoothed, and compacted in the maize-preceded strips; then, a wheat crop was planted in the maize-preceded strips with a strip rotary tillage wheat seeder. At the same time, a plastic film was mulched on the wheat straw surface in the wheat-preceded strips, and maize was planted on the wheat-preceded strips with a manual duckbill punch roller dibbler. For the plastic film mulching on maize strips under the straw standing, a stone roller was applied to compact and crush the standing straw. Then, the surface was mulched with a 90 cm wide plastic film, and its two edges were covered with soil.The four crop-straw modes were applied to the wheat/maize intercropping patterns . In the wheat-maize intercropping, the maize strips from the previous year were planted with wheat in the current year and vice versa, thus, forming an “intra-field strip rotation.” This was implemented to avoid potential weaknesses or problems that might occur with continuous cultivation and to balance soil nutrients that were required by the two different crops in the alternate years.Yong-liang 4) was planted on 20 March and 19 March and was harvested on 22 July and 18 July in 2011 and 2012, respectively. Maize (cv. Ji-xiang 1) was planted on 17 April and 20 April and was harvested on 28 September and 2 October, in the two testing years, respectively. The plot size was 48 m2 (4.8 m × 10 m). Intercropped wheat was planted in six rows of 80 cm strip width (12 cm row space), and intercropped maize was alternately planted in two rows of 80 cm strip width (40 cm interrow). Planting density was 675 plants m-2 (375 kg ha-1) for monoculture wheat and 8.25 plants m-2 for maize; in the same occupied area, the intercrops’ density was consistent with that of monocultures. Urea and diammonium phosphate were broadcast and then incorporated into the soil for seeding. The N rates applied to maize and wheat were 450 kg ha-1 and 225 kg ha-1, respectively, and P rates were 225 kg ha-1 and 150 kg ha-1 in the monoculture maize and wheat, respectively. In the same occupied area, each intercrop received N and P rates consistent with those of monocultures. All N and P were used as base fertilizers for wheat, but for maize crops, 30% of N was applied as base fertilizer, 60% was applied for jointing, and the remaining 10% was applied during the grain-filling stage. Owing to low precipitation at the testing regions, supplemental irrigation was applied using flood irrigation with a hydrant pipe system, and a flow meter was installed at the inlet end to measure and record the amount of irrigation in each plot. All treatments received 120 mm of irrigation water (IW) during late fall, and then, the required irrigation quotas were applied to each cropping pattern during the growing season (Table 1).Field wheat  were used in the evaluation of the land use advantage provided by intercropping , which wintw and Yintm are the yields of intercropped wheat and maize, and Ymonow and Ymonom are the yields of corresponding monoculture wheat and maize. An LER greater than 1.0 indicates more efficient land use and vice versa.where Y-1) divided by evapotranspiration  during the entire growing period.Water use efficiency was calculated using grain yield  was obtained by multiplying the gravimetric water content by the soil bulk densities of 1.38, 1.40, 1.45, 1.51, 1.50, and 1.48 g cm-3 for the six soil depths. The bulk density was determined using undisturbed soil cores via cutting ring at sowing. The volumetric water content was converted into soil water storage  using the depth of the soil as follows:Soil water content (%) was measured using the oven-drying method. Soil water content in the 0–120 cm soil depth of each crop was measured at an interval of 20 days during the entire growing season. Therefore, it was measured at two points for both wheat and maize strips in the intercropping system, where the soil water content from 0 to 30 cm soil depth was measured in 10 cm increments and from 30 to 120 cm soil depth in 30 cm increments. The soil water content was determined in wheat and maize strips in the intercropping plot and between the two central rows in the monoculture plots. The average value of the two strips was used for the intercropping treatments. Soil water content was also measured prior to and after each irrigation. The volumetric water content (cmv is the volumetric water content at a specific soil layer (cm3 cm-3), and h is the soil depth increment (cm).where θ-1) divided by the total IW (mm) and is expressed as follows  was defined as the ratio of the total energy production based on the grain and biomass yield of crops to the total solar radiation per unit area during the entire crop growing period, and the equation was expressed as follows:-1 for the grain of wheat and maize and 14.6 MJ kg-1 for the biomass of wheat and maize) (where ‘’h’ is the heat production rate (16.3 MJ kgd maize) , ‘m’ is The total output value (TOV) was calculated using the following equation:-1; the prices of grain and straw for maize was 1.8 and 0.2 ¥ kg-1, respectively. The price expressed in USD was based on the exchange rate of 634.8 ¥ for every 100 USD in 2011 and 632.5 ¥ for every 100 USD in 2012.where P and Y denote the prices and yields for crops, the subscripts are ‘ws’ for wheat straw, ‘wg’ for wheat grain, ‘ms’ for maize straw, and ‘mg’ for maize grain, for each cropping pattern, respectively. In the two testing years, the prices of grain and straw for wheat was 2.4 and 0.6 ¥ kgThe net return (NR) is defined as the difference in the TOV and the total cost, and the equation is as follows:-3; the prices of urea, diammonium phosphate, and plastic film were 1.65 ¥, 3.5 ¥, and 13 ¥ kg-1; the prices of wheat and maize seeds were 6 ¥ and 26 ¥ kg-1, respectively. The cost of seedbed preparation  was 450 ¥ ha-1. The cost of cultivated land after wheat harvest was 750 ¥ ha-1. Wheat was harvested, threshed, and transported by hand, and the cost was 4500 ¥ ha-1; maize was harvested, threshed and transported by machine, and the cost was 1500 ¥ ha-1.where TOV is the total output value and TC is the total variable cost, which includes labor and machine costs as well as the costs of planting materials, fertilizer, plastic film, and irrigation in this experiment. However, the labor cost is treated as a constant in this study, because an almost equal amount of time was spent on each treatment. The number of hours spent clearing, weeding, and applying fertilizer were assumed to be equal in all treatments. During the two study years, the price of irrigation was 0.3 ¥ mThe benefit per cubic meter (BPW) of water was determined by dividing the NR by the total ET and is expressed as follows:S) was measured using a CFX-2 system  connected to a proprietary respiration chamber. The chamber was pushed gently into the hole to a depth of 3 cm in the center of each crop of monocultures and intercropped wheat and maize strips. For monocultures, the measuring value of each crop was used for a plot. For intercropping, the measuring values were taken for each crop strip, and the average value of the two strips were used for a plot (Soil respiration (Rr a plot . During r a plot .-1) was calculated using the following equation (Carbon emission (kg haequation :2 m-2 hr-1), ‘i + 1’ and ‘i’ are the current and the last measuring date, respectively, and ‘t’ is days after the sowing stage. The numbers 10 and 24 are the conversion factors of the numerical unit of CE from g CO2 m-2 hr-1 to kg ha-1.where Rs is soil respiration  was calculated using the following equation:-1), respectively.where GY and CE are grain yield (kg ha-1) and CEs . Two-way analysis of variance (ANOVA) followed by Duncan’s multiple-range test was performed to determine the treatment effects (straw retention approaches) and year × treatment interactions for most of the variables assessed.Figure 2). Wheat/maize intercropping patterns increased GY by 16–38% and 130–160%, respectively, compared with conventional monoculture maize and wheat. In particular, NTSI treatment boosted GY by 27 and 38% in 2011 and 2012, compared with CTM treatment; more noticeably, NTSI treatment boosted GY by 153 and 160% compared with CTW treatment, respectively.There was a significant effect of year × treatment interaction on crop yield, and straw retention approaches individually had a significant effect on GY of intercropping systems in each year . Wheat straw residue retention applied to intercropped treatments produced significantly higher GYs than the CTI treatment . In particular NTSI boosted GY by 9.9% in 2011 and by 11.9% in 2012 compared with CTI treatment.Total GYs represent the sum of the intercropped maize and wheat in the strip intercropping patterns . On average, the GYs of maize under NTSSI, NTSI, and TSI treatments were 7.0, 13.8, and 4.6% higher than those of the CTI treatment. Meanwhile, intercropped maize yields accounted for 65.7–70.8% of the total GYs, indicating that maize crop is the major contributor in wheat-maize intercropping patterns.Straw retention significantly increased the maize GY but had little or no effect on wheat GY in wheat-maize intercropping patterns . The result indicated that this cropping system used less land but produced more grain than the corresponding monocultures. The NTSSI, NTSI, and TSI treatments significantly improved the LER of wheat/maize intercropping from 8.5% to 9.2%, 9.0% to 10.1%, and 4.5% to 5.9% in comparison with conventional tillage treatment, respectively.Using the LER to indirectly assess the level of intercropping advantage to increase yield over monoculture, we found that the LERs of the wheat/maize intercropping (averaging to 1.63 in 2011 and 1.67 in 2012) was greater than 1.0 (Table 2). Wheat-maize intercropping patterns had greater total ET than monoculture maize and wheat during the entire growing period. Among the four intercropping treatments, NTSI treatment reduced total ET by 3.7–4.5% compared to CTI treatment. This suggests that the wheat straw covering measure applied to intercropping pattern is one of the most fundamental farming practices for saving water during agricultural production.The year × treatment interaction was significant for ET and ET modulus coefficient of various treatments most likely due to the complex weather conditions (Table 2). Similarly, the ET modulus coefficient was reduced by 44.8–54.9% and 48.8–58.7%, respectively. Among the four intercropping treatments, NTSSI and NTSI had lower ET and ET modulus coefficient, compared with CTI treatment, and reduced ET by 8.3–13.7% and 11.1–21.6%, respectively. Similarly, these two treatments reduced the ET modulus coefficient by 6.0–11.1% and 6.9–17.8%, respectively.From the wheat sowing stage to the maize jointing stage (responding to wheat booting stage), NTSSI and NTSI treatments reduced ET by 7.5–20.0% and 9.2–28.3% compared with CTW treatment, respectively (Table 2). Similarly, these two treatments decreased the ET modulus coefficient by 46.1–49.6% and 46.3–48.5%, respectively. Compared with CTM treatment, ET was increased by 8.3–12.1% under NTSSI treatment, by 6.1–12.6% under NTSI treatment, by 4.3–10.0% under TSI treatment, and by 6.7% to 14.4% under CTI treatment. However, the ET modulus coefficient was reduced by 6.6–12.8% and 4.2–13.6% under TSI and CTI treatments, respectively. After wheat harvest and from the maize silking stage to the early filling stage, NTSSI and NTSI treatments lowered ET by 11.2–18.4% and 24.9–27.1% compared with CTM treatment, respectively. Similarly, these two treatments decreased the ET modulus coefficient by 23.9–29.6% and 34.7–36.3%, respectively. Among the four intercropping treatments, the ET of NTSSI and NTSI treatments were reduced by 16.2–18.6% and 22.9–33.3%; similarly, ET modulus coefficient were reduced by 13.7–16.6% and 20.0–30.1% compared with CTI treatment, respectively. Additionally, compared with TSI treatment, NTSSI and NTSI treatments reduced ET by 14.0–16.0% and 20.8–31.1% and reduced ET modulus coefficient by 12.6–15.5% and 18.9–29.2%, respectively.From the maize jointing stage to the silking stage (responding to the wheat booting stage to the harvesting stage), NTSSI and NTSI treatments reduced ET by 4.3–10.6% and 6.3–8.7% compared with CTW treatment, respectively (Table 2). Compared with CTM treatment, NTSSI and NTSI treatments increased ET by 23.6–24.0% and 27.0–27.5% and increased the ET modulus coefficient by 6.0–6.9% and 10.7–12.3%, respectively. Across the four intercropping treatments, NTSSI and NTSI treatments increased ET by 3.0–5.5% and 5.7–8.5%, compared with CTI treatment; similarly, these two treatments also increased the ET modulus coefficient by 5.4–8.6% and 10.7–12.5%, respectively. Additionally, NTSSI and NTSI treatments increased ET by 3.9–4.7% and 6.7–7.7% and increased the ET modulus coefficient by 5.3–5.6% and 9.3–10.6% compared with TSI treatment, respectively.However, from the maize early filling stage to the harvesting stage, the intercropping pattern had a greater ET and ET modulus coefficient than conventional monoculture maize . The wheat/maize intercropping with wheat straw retention significantly improved WUE in comparison with the conventional monoculture systems. The straw residue retention that was applied to intercropping patterns improved WUE by 8.6–22.4% and 34.6–48.3% compared with conventional monoculture maize and wheat treatments, respectively. In particular, NTSI treatment had greater WUE than the CTM treatment by 15.4% in 2011 and 22.4% in 2012. More dramatically, NTSI treatment had greater WUE than the CTW treatment by 45.7% in 2011 and 48.3% in 2012. Across the four intercropping treatments, NTSI had greater WUE than CTI by 14.7% in 2011 and 15.9% in 2012.The year × treatment interaction was significant for WUE. However, the trend of the treatment effects was similar across the three study years . Wheat-maize intercropping, coupled with wheat straw residue retention, significantly improved WP by 3.4–16.4% and by 21.1–30.2% in comparison with the conventional monoculture maize and wheat treatments, respectively. In particular, the NTSI treatment increased WP by 7.3% in 2011 and 16.4% in 2012 compared with the CTM treatment, by 26.6% in 2011 and 30.2% in 2012 compared with the CTW treatment, and by 9.9% in 2011 and 12.0% in 2012 compared with the CTI treatment.Similarly, there was a significant effect of year × treatment interaction on WP, but the trend of the treatment effects was similar across the three study years . Wheat-maize strip intercropping had energy yields of 120.4–131.0% and 25.8–26.7% more than those of conventional monoculture wheat and maize, respectively. The NTSSI, NTSI, TSI and CTI treatments boosted energy yields by 123.3–134.1%, 123.1–134.0%, 116.2–125.9%, and 118.9–129.6% in comparison with CTW treatment and by 27.6–28.3%, 27.6–28.2%, 23.1–24.3%, and 25.1–25.9% in comparison with CTM treatment, in the two study years, respectively. However, there was no significant difference in energy yields among the four intercropping treatments.There was no significant effect of year × treatment interaction on energy yields, but straw retention approaches had a significant effect on energy yields in each year . Wheat-maize strip intercropping had SUEs of 35.3–45.6% and 6.1–12.2%  more than those of conventional monoculture of wheat and maize, respectively. Importantly, NTSSI and NTSI treatments increased SUE by 37.1–47.6% and 37.0–37.7% in comparison with CTW treatment and by 7.5–13.7% and 7.4–13.7% in comparison with CTM treatment, in the two study years, respectively. However, there was no significant difference in SUEs among the four intercropping treatments.Similarly, there was no significant effect of year × treatment interaction on SUE, but straw retention approaches had a significant effect on SUE in each year (Table 3). The wheat-maize intercropping system obtained a comparatively higher TOV, averaging to 6,121 USD ha-1 annually, which was 26% higher  than CTM and 131% higher  than CTW. The NTSI treatment was the most productive pattern and increased the TOV by 28%  in 2011 and 34%  in 2012 compared with the CTM treatment. Similarly, and more noticeably, NTSI treatment increased the TOV by 133%  in 2011 and by 146%  in 2012 compared with the CTW treatment. Moreover, the NTSI treatment had higher TOVs, which were 6% higher (325 USD ha-1) in 2011 and 8% higher (495 USD ha-1) in 2012 than the CTI treatment.There was a significant effect of year × treatment interaction on output value (Table 3). The wheat-maize intercropping pattern obtained a comparatively higher NR, averaging to 4,249 USD ha-1 annually, which was 53% (4249 vs. 2774 USD ha-1) and 286% (4249 vs. 1102 USD ha-1) greater than those of CTM and CTW treatments, respectively. The NTSI treatment increased the NR by 54% (4216 vs. 2739 USD ha-1) in 2011 and by 71% (4800 vs. 2811 USD ha-1) in 2012 compared with the CTM treatment. Similarly, NTSI treatment increased the NR by 281% (4216 vs. 1107 USD ha-1) in 2011 and by 338% (4800 vs. 1097 USD ha-1) in 2012 compared with the CTW treatment. Moreover, the NTSI treatment increased the NR by 8% (4216 vs. 3889 USD ha-1) in 2011 and by 14% (4800 vs. 4303 USD ha-1) in 2012 in comparison with the CTI treatment.Similarly, a significant year × treatment interaction affected NR, and straw retention significantly improved NR for intercropping treatments . However, the trend of the treatment effects was similar across the three study years. A higher BPW was observed in wheat-maize intercropping systems, which were 32% greater than that of CTM and 116% greater than that of CTW. The NTSI treatment was the best treatment in this regard and increased BPW by 35% in 2011 and by 51% in 2012 in comparison with CTM treatment. Similarly, BPW under the NTSI treatment was increased by 119 and 147% in 2011 and 2012, respectively, in comparison with the CTW treatment and by 14 and 16%, respectively, in comparison with the CTI treatment. Wheat straw covering in intercrops is one of the most effective strategies to increase crop productivity, improve NR, and increase BPW in developing a sustainable agricultural system.There was a significant effect of year × treatment interaction on BPW . Wheat and maize intercropping patterns emitted comparatively lower CO2 than conventional monoculture maize by 12.8 and 10.8% in 2011 and 2012. In addition, the NTSI treatment significantly reduced CEs by 23.8% in 2011 and 13.4% in 2012, compared with CTM treatment.There was a significant effect of year × treatment interaction on CE during the growing season . However, NTSSI treatment had no consistent effect on CEs. In terms of CEs in each strip of the intercropping systems, maize strips emitted 22.9–59.7% more carbon than the wheat strips, showing that maize strips were the major contributors of CEs in the entire intercropping pattern.Across the intercropping treatments, NTSI and TSI treatments reduced COFigure 8). Wheat-maize intercropping patterns produced a mean CEE value of 6.5 kg kg-1, which was 39.9% greater than that of monoculture maize without straw residue . Among the four strip intercropping treatments, NTSI had the highest CEE and improved CEE by 66.9% in 2011 and by 62.6% in 2012 compared with CTM treatment. Similarly, CEE was improved by 30.2% in 2011 and by 5.4% in 2012 compared with CTW treatment and was improved by 33.2% in 2011 and by 23.2% in 2012 compared with CTI treatment. In general, reduced tillage with straw covering was the optimal option for crop straw management approaches to promote CEE of the wheat-maize strip intercropping.There was a significant year × treatment interaction affected the CEE during the growing season, and straw retention individually had a significant effect on the CEE in each year  tillage . Therefo tillage . In termIntercropping has many advantages in terms of better use of environmental resources . EfficieProducers are most interested in economic benefits, and an increase in the TOV is the basis for obtaining the highest economic benefit. Strip intercropping has played a very crucial role in solving the problem of insecure grain supplies and in increasing the income of farmers in China . MoreoveCropping intensification through wheat and maize strip intercropping can significantly boost GYs, improve water utilization, and increase economic return while effectively reducing CEs. This leads to higher WUE and CEE in comparison with conventional monoculture of wheat and maize. Among the approaches evaluated in this study, straw covering the soil surface integrated into strip intercropping  was the most effective pattern in boosting crop productivity. The NTSI treatment increased NR by 54–71% and 281–338% and increased the BPW by 35–51% and 119–147%, in comparison with the conventional monoculture of maize and wheat, respectively. Similarly, the NTSI pattern increased NR and BPW by 8–14% and 14–16% in comparison with the conventional intercropping treatment. Meanwhile, NTSI treatment reduced CEs by 13.4–23.8% and 7.3–17.5%, while improving the CEE by 62.6–66.9% and 23.2–33.2%, compared with the conventional monoculture of maize. We conclude that the reduced tillage-based straw coverage strategy integrated into the intercropping pattern can be used to effectively enhance environmental and economic benefits in arid irrigation areas .QC and WY conceived and designed the experiment. WY, QC, and FF performed the statistical analyses. WY, YG, FH, ZF, CZ, and AY were involved in field data collection. All authors contributed to writing the paper.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Healthy controls had a higher average number of decayed teeth . In female subjects a significant lower relative amount of teeth with apical periodontitis was found among CHD patients (3.4% ± 0.9%) as compared to healthy controls (5.6% ± 1.9%) (p = 0.053). Regarding periodontal health, patients with CHD had lower rate of sulcus bleeding  and less alveolar bone loss than heart healthy individuals . On the contrary, CHD patients presented with higher amount of plaque in comparison to healthy controls . Based on the current results, it can be concluded that adults with CHD have better oral health than heart healthy individuals.Oral bacteria and odontogenic oral infections are responsible for a high portion of cases with infective endocarditis. Hence, oral health in patients with congenital heart disease (CHD) gains particular importance. This case-control study compared the oral health status in 112 adults with CHD and 168 healthy control subjects. In addition, the patient group was stratified according to the complexity of the heart defect and the recommendation for antibiotic prophylaxis during invasive dental procedures. Considering caries experience, a significantly lower mean DMFT (decayed missing filled teeth) score (7.91 ± 6.63 vs. 13.6 ± 8.15;  The diagnosis of congenital heart disease (CHD) encompasses various anatomical abnormalities of the heart and the great arteries . Modern It is commonly accepted that the development of infective endocarditis requires bacteremia with microorganisms that can successfully adhere to the endocardial surfaces . The oraApart from the use of systemic antibiotics, the prophylaxis of transient bacteremia due to professional dental care and routine daily activities is directed towards the prevention and treatment of the oral disease itself. Despite the elevated risk of manifestation of infective endocarditis, there exists some evidence that young patients with CHD show increasing amounts of dental deposits, i.e., plaque, more plaque induced gingival inflammation, lower compliance with dental maintenance care, and poorer routine oral hygiene measures during childhood and adolescence ,11. In aThe patients were consecutively recruited among the out- and inpatients with CHD attending the German Heart Center Munich in July and August 2017. Individuals who were eligible for inclusion into the study cohort had to be aged 18 years or older and had a diagnosis of CHD. Each patient was assigned to one of three subgroups of CHD, according to their severity using the Bethesda criteria . ControlAll study subjects received a standardized dental examination using mirror and probe as described previously . MissingRadiographic examination was performed in CHD-patients and control subjects using panoramic X-ray and apical radiographs as made during regular dental care. Due to ethical reasons appropriate X-rays were available only when radiographic examination was medically indicated. Radiographic findings regarding the periodontal status of study subjects was determined as the maximum amount of alveolar bone loss, indicated as a percentage of the root length, using the radiographic apex apically and a line 1 mm apical from the dento-enamel junction as crestal reference. Complementary evidence regarding carious defects, specifically approximal caries, was documented. In addition, radiographic signs, i.e., radiolucent areas indicating apical periodontitis, and previous root canal treatment was recorded for each patient.p values < 0.05 were considered significant. All test procedures were two-tailed and performed using the SPSS Software Program .Sample size calculation was performed under the assumption of an effect size d = 0.51 based on the mean DMFT scores for cases and controls as found in the age group 8–12 years for permanent teeth by Ali et al.  using thp < 0.0001), whereas the male to female ratio was not different (p = 0.432)  with CHD, among which the complexity of the CHD was classified as simple in 16 patients (14.3%), moderate in 44 patients (39.3%), and as severe in 52 patients (46.4%). The mean age in the patient group was 34.4 (±12.6) years. A total of 168 patients  with a mean age of 43.1 (±18.9) years were enrolled into the control group. The age was significantly different between groups (= 0.432) . Conside= 0.432) .p < 0.0001). In line, also the average number of decayed teeth was higher among healthy control individuals (1.76 ± 2.61) than for patients with CHD (0.33 ± 0.76) (p < 0.0001) (p < 0.0001), indicating a strong effect size (effect size f: 0.53) (Patients with CHD presented with a mean DMFT score of 7.91 (±6.63) compared to 13.6 (±8.15) in the control group ( 0.0001) . Logistif: 0.53) . Followip = 0.89). Moreover, 3.4% (±0.7%) of teeth presented with a diagnosis of apical periodontitis in patients with heart defects and 4.8% (±2.1%) of the teeth in healthy individuals (p = 0.129) (p = 0.053). Discerning the patients with CHD according to the recommendation for antibiotic prophylaxis, a higher average number of teeth with periapical periodontitis was found among patients who needed antibiotic prophylaxis than patients without recommendation, although not reaching significance.Radiographic evaluation revealed that a mean of 8.8% (±5.8%) teeth received previous root canal treatment among patients with CHD as compared to 8.6% (±4.7%) teeth in healthy controls (= 0.129) . After sp = 0.001) (p < 0.0001), as represented by the Quigley and Hein index score. Considering regression analysis, patients with CHD presented with a considerably higher chance for the manifestation of plaque  (p < 0.0001) (p = 0.155).The mean sulcus bleeding index (SBI) which reflects the tendency for gingival bleeding, was 0.32 (±0.65) for patients with CHD and 0.70 (±0.60) for healthy controls (= 0.001) . The man 0.0001) . The com 0.0001) . ConsistThe individual susceptibility for the manifestation of infective endocarditis is strongly influenced by the presence and severity of oral diseases ,18. The Despite the overall lower caries experience among individuals with CHD, the subgroup of patients needing antibiotic prophylaxis prior to invasive dental procedures, however, showed significantly elevated DMFT scores as previously reported , compareProgressing caries finally reaches the pulp chamber and causes necrosis of the pulp tissue, ultimately resulting in bacterial infection and inflammation of the periapical tissue. Root canal treatment is the commonly accepted therapeutic approach to address both entities. Despite no clear evidence, teeth showing periapical disease have been suggested to cause transient bacteremia in remote sites of the organism ,24. Here2 [The total soft tissue surface area of periodontal pockets amounts to almost 44 cm2  and has 2 . The sur2 . Based o2 ,11.It is commonly accepted that the manifestation and progression of periodontitis and caries is essentially bound to the presence of plaque . IntriguThe current data reveal distinct differences of oral health between individuals with CHD and heart healthy controls. When drawing conclusions, at least two specific aspects of the study design have to be taken into account. Most important, healthy control subjects were recruited in a tertiary dental hospital center, probably leading to selection bias. This problem was addressed by the random selection of controls among patients attending the hospital for dental treatment by undergraduate students. These patients typically present with common dental problems and appear as a representative sample of the general population. Moreover, since the oral examination was performed at two different hospital centers, clinical data were not collected by the same person in each patient, potentially resulting in a certain degree of interexaminer variability.Taken together, the findings of this study show a considerably lower experience of caries and periodontitis among adults with CHD. Subgroup analysis however revealed significantly higher DMFT scores and more radiographic bone loss in subjects with an indication for antibiotic prophylaxis prior to invasive dental treatment, who are exposed to a particularly elevated risk of infective endocarditis.


For the success of an immunotherapy regimen, adherence is a major success factor. The goal of our study was to identify the factors that positively and negatively influence patient compliance, and to create strategies to improve it. Four questionnaires were designed for different patient groups: A – after immunotherapy; B – during immunotherapy; C – before immunotherapy; D – no experience with immunotherapy. From March to October 2008, 790 questionnaires were collected. For the first group, questionnaire A was answered by 272 patients. Of these, 15.8% had dropped out of immunotherapy. Women had higher dropout rates than men (16.8% vs. 12.3%). The following aspects of immunotherapy were viewed by the patients as negative: time consuming (69.5%), adverse reactions (62.5%), insufficient patient information (53.7%), no change in use of symptomatic medication (33.8%) and no change in symptoms (60.7%). Despite the mentioned drawbacks, 74% of all patients would still recommend allergen immunotherapy. Questionnaire B was completed by 281 patients. In this group, 8.7% had already considered dropping out. The following unfavourable aspects were identified: time consuming (66.2%), adverse reactions (61.9%), insufficient patient information (54.8%), no change in symptoms (51.2%) and use of symptomatic medication (47.0%). Despite this, up to 95.4% of all patients would recommend immunotherapy. Questionnaire C was filled-out by 55 patients. The following reasons were rated by the patients as “important” or “very important” for the decision to start hyposensitization: long-lasting symptom alleviation (100%), few adverse reactions (98.2%), comprehensive patient information (96.3%), easy integration into daily routine (89.1%), re-assessment of therapy by doctor (83.3%) and reduced need for symptomatic medication (81.8%). Questionnaire D was filled in by 182 participants. 89% had already heard the term hyposensitization before. Their general knowledge regarding this therapy was average . Long-lasting symptom alleviation (99.5%), comprehensive patient information (97.8%), easy integration into daily routine (96.1%), reduced symptomatic medication use (92.6%) and re-assessment by doctor (88.8%) were considered “very important” or “important” characters in the desired immunotherapy regime. Adherence to the hyposensitization schedule is essential for its success. The treating doctor should aim at choosing the right therapy and working out an individualized patient treatment plan. Equally important is providing information to the patient throughout the duration of the treatment. The doctor should assist the patient to create an optimized time schedule to help make the therapy less time-consuming.  Adherence means that all therapeutic aims set by the patient and the physician are strictly followed . The terAccording to the current state of knowledge, the reasons for bad adherence are manifold. Physician-related factors like for example a bad bond of trust between the patient and the physician are as important as the age, gender, and economic background of the patient. Also, therapy-related factors like side effects and complicated therapeutic schemes influence therapy adherence. Furthermore, disease-specific factors that influence adherence have been identified , with diThe German Allergy and Asthma Association (Deutscher Allergie- und Asthmabund (DAAB)) in association with the Department of Medicine Statistics, Informatics and Epidemiology of the University Hospital Cologne is aiming at investigating positive and negative influencing factors for therapy adherence in hyposensitization. Following the presentation of the survey, we would like to present possible strategies for adherence improvement. The different treatment concepts for hyposensitization, subcutaneous immunotherapy (SCIT) , 7, 8 anFour questionnaires for various groups of patients were designed: Questionnaire A: Allergy patients who completed hyposensitization therapy. Questionnaire B: Allergy patients undergoing immunotherapy. Questionnaire C: Allergy patients shortly before initiation of therapy. Questionnaire D: Allergy patients without experience with hyposensitization. The questionnaires were arranged in four sections. knowledge of and reasons for deciding on hyposensitization. Among other things, they were asked to rate the following needs and wishes for therapy: comprehensive information on therapy, few side effects, enduring reduction of symptoms, effectiveness evaluation by the physician, reduction of drug use, and easy integration into everyday life. The following five questions were designed to test the patient’s knowledge of hyposensitization: Part 1 of the questionnaires assessed the patient’s “Hyposensitization accustoms the patient to the allergen”; “hyposensitization makes the patient more sensitive to the allergen”; “side effects always occur”; “hyposensitization prevents allergic bronchial asthma”; “new allergies will develop.” The patients had to answer these questions with “I agree” or “I do not agree”. allergy history of the participants was assessed. In the second part, the data on the therapy itself were investigated. In addition, the patient’s experience with symptomatic therapy options was inquired. In the third part, The form of hyposensitization, the (scheduled) treatment duration, and the profile of side effects was investigated. The disadvantages of hyposensitization were evaluated based on the following statements: “I did not feel sufficiently informed about the therapy”; “The therapy was too time consuming”; “The therapy was difficult to integrate into everyday life”; “Side effects were frequent”; “My symptoms have not improved so far”; “I do not take less drugs so far”; “Friends and relatives have advised against the therapy.” The information provided by the physician and the patient’s satisfaction with the therapy were to be evaluated using a school grade scale. demographic data. The last paragraph of the questionnaires covered The questionnaires were distributed via “AllergieMobil” (a mobile information center)  of the D272 patients completed Questionnaire A. 140 (69.7%) were female and 61 (30.3%) male. The mean age was 45.7 ± 14.6 years, range 6 – 85 years. SLIT was carried out in 16 patients and SCIT was carried out in 225 patients. 31 patients did not indicate the form of therapy. 15.8% of patients indicated having discontinued therapy. The discontinuation rate was higher in women (16.8%) than in men (12.3%). 74.0% of all patients would recommend hyposensitization to their friends and family. Details on general satisfaction with the therapy are presented in Various aspects of hyposensitization were rated as disadvantageous by patients . 53.7% felt insufficiently informed by their physician. This feeling can be demonstrated by the answers to the five questions on facts about hyposensitization. Not even half of the participants (47.1%) could answer all five questions correctly. 69.5% felt that the therapy was too time consuming. Particularly for the SCIT subgroup was this a decisive factor. 72.0% of all patients perceived the time factor as a disadvantage and 42.7% said they had difficulties integrating the treatment into everyday life. On the other hand, of the patients receiving SLIT only 37.5% saw the time factor as disadvantageous and only 25% indicated the integration into everyday life to be difficult. In 45.6% friends and relatives advised against hyposensitization. 60.7% of patients could not detect symptom reduction and drug use was not reduced in 33.8%. 62.5% of patients experienced side effects during the therapy. In the subgroup of participants who discontinued therapy, the percentage of patients experiencing side effects was particularly high (90.0%). In the subgroup of SCIT patients, 69.1% reported side effects, mainly local reactions (83.6%), but also circulatory complaints (20.4%), rash (17.8%), or respiratory problems (14.5%). In contrast, only 25.1% of SLIT patients indicated having suffered from side effects. 281 patients (126 (45.5%) male and 151 (54.5%) female) completed Questionnaire B during their hyposensitization therapy. Their mean age was 36.7 ± 15.4 years (range 2 – 72 years). SLIT was carried out in 29 patients and SCIT was carried out in 238 patients. 14 patients did not indicate which form of therapy they used. At the time of the survey, 8.7% of all patients had already thought about an early discontinuation of therapy. 95.4% of all patients would recommend hyposensitization to their friends and family. In contrast to patients with previous therapy, patients with current hyposensitization tended to be very satisfied with the treatment . Nevertheless, they also named some drawbacks. 54.8% felt they were insufficiently informed about the treatment. Despite the fact that many patients had been treated with hyposensitization for several years, only 58.4% of participants were able to answer all of the five above-mentioned test questions correctly. 66.2% felt that the therapy was too time consuming. 51.2% of patients had not experienced any symptom improvement by the time of the survey and drug use had not been reduced in 47.0% of patients. 63.9% of SCIT patients and 48.1% of SLIT patients suffered from side effects. At the beginning of SCIT these side effects were predominantly local reactions (97.3%), but also sneezing (12.2%), rash (8.2%), circulatory complaints (5.4%), or respiratory problems (4.8%). 55 allergy patients completed Questionnaire C before the onset of therapy. 30 were female (55.6%) and 24 were male (44.4%). The mean age was 30 ± 14.8 years (range 3 – 69 years). They indicated an enduring reduction of symptoms (100%), few side effects (98.2%), comprehensive information about therapy (96.3%), easy integration into everyday life (89.1%), effectiveness evaluation by their physician (83.3%), and reduction of drug use  to be “important” or “very important” reasons for the therapy . Before The patients had been previously treated as follows: medication as needed (69.1%), allergen avoidance (41.8%), perennial drug treatment (18.2%) and alternative medicine (9.1%). The average satisfaction with these methods was 3.0 . 182 participants (135 (75.4) female, 44 (24.6%) male) completed Questionnaire D. The mean age was 42.7 ± 16.4 years (range 4 – 81 years). Although this questionnaire was filled in by allergy patients without previous contact with hyposensitization, 89.0% “had already heard about hyposensitization.” The patients rated their own knowledge of hyposensitization therapy with an average grade of 3.2. This could also be demonstrated by the five test questions: only 44% could answer all of them correctly. The patients’ hopes in regard to therapy were similar to those in Questionnaire C. Enduring reduction of symptoms (99.5%), comprehensive information on therapy (97.8%), few side effects (96.7%), easy integration into everyday life (96.1%), reduction of drug use (92.6%) and effectiveness evaluation by their physician (83.3%) were considered to be “very important” or “important” . The patients had been previously treated as follows: medication as needed (63.2%), allergen avoidance (44.0%), perennial drug treatment (24.7%) and alternative medicine (21.4%). The average satisfaction with these methods was 3.0 . Successful hyposensitization requires active cooperation by the patient and particular commitment by the physician. The therapy drop-out rate in this survey was 15.8% which is relatively low compared to other studies . NeverthBefore the start of immunotherapy, the physician should inform the patient comprehensively and the most adequate form of hyposensitization (SCIT/SLIT) should be decided on together with the patient. This includes a detailed job-related and time-related patient history, and the patient should be asked about his/her expectations for treatment. The patient should be informed about the fact that concomitant symptomatic medication will be necessary in the beginning and that side effects are frequent. It is useful to base the individual treatment plan on the guideline for specific immunotherapy (hyposensitization) in IgE-mediated allergic diseases . StandarThe physician needs to try to fulfill the patient’s needs and wishes also during the course of hyposensitization. The patient expects monitoring and information on the therapy beyond the legal requirements. The fact that at all stages only half of the patients had exact knowledge about the effects of immunotherapy shows that patients have to be much better informed. Today, a patient will not be satisfied with an “injection in passing.” Treatment success can for example be objectively assessed by nasal or conjunctival provocation testing providing the patient with a better understanding of current progress. The treatment aspects that the patients perceive as negative, above all the component “time”, can for instance be improved by special times for hyposensitization, special consultation hours for working people, and also by effective appointment making. Paying attention to these factors should help the physician to select appropriate patients for immunotherapy, to improve their adherence, and to reduce the still high therapy drop-out rate .


Little is known on the characteristics of patients diagnosed with idiopathic pulmonary fibrosis (IPF) in Spain. We aimed to characterize the demographic and clinical profile of IPF patients included in the IPF National Registry of the Spanish Respiratory Society (SEPAR).This is a prospective, observational, multicentre and nationwide study that involved 608 IPF patients included in the SEPAR IPF Registry up to June 27th, 2017, and who received any treatment for their disease. IPF patients were predominantly males, ex-smokers, and aged in their 70s, similar to other registries.Upon inclusion, mean ± SD predicted forced vital capacity was 77.6% ± 19.4, diffusing capacity for carbon monoxide was 48.5% ± 17.7, and the 6-min walk distance was 423.5 m ± 110.4. The diagnosis was mainly established on results from the high-resolution computed tomography in the proper clinical context (55.0% of patients), while 21.2% of patients required invasive procedures  for definitive diagnosis. Anti-fibrotic treatment was prescribed in 69.4% of cases, 51.5% pirfenidone and 17.9% nintedanib, overall with a good safety profile.The SEPAR IPF Registry should help to further characterize current characteristics and future trends of IPF patients in Spain and compare/pool them with other registries and cohorts. LCO), radiological findings , a pattern or greater extent of fibrosis, and the development of acute exacerbations or comorbidities, especially pulmonary hypertension and emphysema [Sociedad Española de Neumología y Cirugía Torácica’, SEPAR) started in 2012 a National IPF Registry aimed to know the clinical characteristics of IPF patients, procedures for diagnosis, and the evolution of patients in Spain. The primary objective of the present study was to characterize the demographic and clinical profile of IPF patients included in the SEPAR IPF National Registry, regardless of any received treatment.Idiopathic pulmonary fibrosis (IPF) is a fatal, chronic fibrosing interstitial pneumonia, of unknown aetiology, which affects primarily adults older than 50 –3. Althomphysema –10. The mphysema , 12. Antmphysema , 14. To mphysema –17. Sevemphysema –24. The This prospective, observational, multicentre and nationwide study involved patients with IPF who were included in the SEPAR IPF National Registry and received any treatment for their disease. A total of 28 public hospitals, widely distributed through Spain, participated in the study by including patients in the Registry. Patients were eligible if confirmed diagnosis of IPF. The diagnosis of IPF was based on criteria from international clinical guidelines . Those cLCO at diagnosis, anti-fibrotic treatment (yes/no), proton-pump inhibitors (yes/no), reported comorbidities such as pulmonary emphysema (yes/no) or pulmonary hypertension (yes/no), and smoking habits. The patient comorbidities were reported by each participant and the Charlson comorbidity index was calculated after including the data in the Registry. All statistical procedures were performed by using SAS 9.4 software.All pulmonologists from SEPAR were invited to participate in this IPF Registry. They collected the information during routine visits, and uploaded data to the SEPAR website, up to June 27th 2017 . The firFrom 713 patients included in the SEPAR IPF National Registry, 105 were finally excluded , and ex-smokers (63.7%). Demographic and clinical characteristics of patients are shown in Table Patients were predominantly male (80.8%), with a mean age of 70.2 years (SD 9.2), a mean body mass index of 28.2 kg/mThe Charlson comorbidity index was 3.5 (SD 1.7). Diabetes mellitus with no target organ damage (15.8% of patients), chronic respiratory disease (15.6%), arterial hypertension (14%), gastroesophageal reflux (12.8%), pulmonary emphysema (12.1%), and coronary artery disease (8.6%) were the most frequent comorbidities.LCO was 48.5% of predicted (SD 17.7), mean TLC was 72.5% of predicted (SD 16.5), and the 6-min walk distance (6MWD) was 423.5 m , 62.8% non-productive cough, and 29.4% digital clubbing. The mean FVC was 77.6% of predicted (SD 19.4), mean DThe high-resolution computed tomography (HRCT) was the most frequent procedure performed at diagnosis (99.2% of patients), followed by pulmonary function tests 98.3%), autoimmune serology (91.8%), chest radiography (81.7%), and the 6-min walking test (71.2%). The confident radiological UIP pattern was found in 65.4% of cases , nintedanib (n = 11), or oral corticosteroids (n = 1). Recommended non-pharmacological treatment such as rehabilitation and lung transplant were performed in 10.1 and 3.1%, respectively.Patients were receiving pirfenidone (51.5%) or nintedanib (17.9%) as disease-modifying therapies for IPF at inclusion in the Registry. Main concurrent treatments were: proton-pump inhibitors (68.9%), oxygen therapy (21.5%), or oral corticosteroids (17.8%). From 30.6% of cases not anti-fibrotic treatment: 8.5% were > 85 years, 43.5% presented an FVC > 80%. Of those treated patients, 24.7% experienced at least one adverse event, such as gastrointestinal discomfort (14.0% of patients), anorexia/weight loss (5.9%), alteration of liver enzymes (3.3%), and photosensitivity (2.6%). The adverse event (AE) was the reason for discontinuing the treatment in 27 patients : pirfenidone (p = 0.092) . A patient had 39.1% lower risk of death per 10 units of DLCO (%) increased.A total of 108 patients (17.8%) died during the follow-up, 88 male (81.48%) and 20 females (18.51%) , with a mean age of 68.2 years (SD 9.2), and ex-smokers  after 12 months of treatment . The mean 6MWT distance was similar after 12 months of treatment  than at baseline .Patients receiving pirfenidone showed a stable lung function in FVC  and Dn = 10, discontinuing the treatment n = 9) were as follows: clinical worsening of disease (3.5%), AEs (2.2%) and requiring concomitant medications (1.3%).Of patients receiving pirfenidone, 23.4% experienced at least one adverse event (Table Eight patients receiving pirfenidone (3.5%) died during the first 12-month period of treatment. A total of 55 patients (23.8%) died during the follow-up. 87.3% were male and 12.7% female  increased. The impact of DLCO on survival has already been described in previous studies [LCO together with FVC (the Gender Age Physiology score) and with forced expiratory volume in 1 s  for predicting mortality [We aimed to describe pirfenidone in clinical practice because it was the first anti-fibrotic available in Spain (more than 2 years before nintedanib). In our Registry, up to 313 patients (51.5%) received treatment with pirfenidone. Despite the proven effectiveness of pirfenidone , when re studies , 48. In ortality , 50.Main limitations of our study were intrinsically related to the retrospective nature of data collection in the first participants in the Registry (those diagnosed before 2011). Presumably, no available data would improve the knowledge in management of IPF in clinical practice. For example, we only collected information of treatments at the time of inclusion. There is thus a lack of information regarding when they actually received the treatment or whether or not the patient received a new treatment during the follow-up. Another limitation derived from the heterogeneity of patients  and some uncertainty associated with the diagnostic process, i.e. integrating information from different healthcare professionals, such as clinicians, thoracic radiologists, and pathologists; with varying degrees of experience; and different sites  . FurtherDemographic characteristics of patients from the SEPAR IPF National Registry are in accordance with other national registries. In agreement with international guidelines, the diagnosis is mainly based on HRCT in the proper clinical context. A low percentage of patients require invasive procedures for the definitive diagnosis. The treatment with pirfenidone is generally safe and well tolerated, and most cases do not present disease progression after 12 months. Additional studies, including more patients and centres to the Registry, are required to corroborate these results. This SEPAR IPF Registry should help to further characterize current characteristics and future trends of IPF patients in Spain, and compare/pool them with other registries and cohorts.


Hypertension (HTN) is major public health challenge. Data on HTN prevalence and associated risk factors is necessary to better control it. This study aimed at estimating the prevalence of HTN and associated anthropometric and lifestyle predictors in Kombolcha and suburbs, northeast Ethiopia.kebeles (villages) formed the target population. Of these kebeles, 5(3 urban and 2 suburban) were selected randomly. Households (HHs) within the selected kebeles and individuals within HHs were similarly recruited in December 2016–May 2017. Anthropometric and blood pressure measurements were done. World Health Organization (WHO) STEPWISE TOOL was used to capture socio-demographic, physical activity, dietary habit, and nutritional status data.The study followed a community-based cross-sectional sampling design. Adult (≥18) residents of Kombolcha and suburbs in 11 p < 0.0001), obesity  and overweightness , ‘substantially high risk’  waist circumference , light occupational physical activity , walking or riding a bicycle for lower than 5 days/week  and lack of sport activity , smoking , khat , alcohol , HH size of two  and ≥ 3 ; and HTN in family history  were significant predictors of HTN in the binary logistic regression analysis; none of these were so in the multivariable model.Totally 318 adults participated in the study. However, only 312 (169(54.2%) males and 143(45.8%) females) were with complete information for statistical analysis. The lowest age was 18 years, the highest 65 and the mean 38.29 ± 10.88. The prevalence of HTN was 30.8% (96/312) : 25.9–36.1%), 16.4% male and 14.4% female. While 45 and older age (odds ratio (OR) 7.385, 95% CI 3.563–15.306, Although there was a high prevalence of HTN in the study area, its independent significant predictors were not identified. The World Health Organization (WHO) defines hypertension (HTN), also known as high or raised blood pressure (BP), as ‘a condition in which the blood vessels have persistently raised pressure’ . HTN is Lifestyle changes related to urbanization and income rise are fueling a sharp rise in chronic non-communicable diseases, including HTN, which are now becoming the leading cause of death in many low- and middle-income countries where the problem was little appreciated before. This is a double burden on acquired immunodeficiency syndrome (AIDS), tuberculosis (TB), malaria, diarrheal diseases, trachoma, etc. in these countries. In 2010, 31.5% of hypertensive cases occurred in these countries showing 7.7% age-standardized prevalence increase since 2000 . This saNevertheless, there is variability in the prevalence of HTN in low-income countries. Among the Latin American population, it is 35.0%, and 20.0–30.0% in Chinese and Indian populations , 8. In tBecause of differences in the rate of urbanization and resulting lifestyle changes among other factors are possible reasons for this variability in HTN prevalence among different populations. The main challenge in the management of HTN is a lack of awareness calling for scaling up of awareness efforts, studies of risk factors, and understanding of the impact of lifestyle changes in a contextual manner. The influence of dietary pattern, nutritional status, and lifestyle factors, as well as environmental parameters on BP is documented by various reports –13. HTN South African countries such as the Republic of South Africa and Namibia have the highest levels of HTN globally. A recent study in the Republic of South Africa recorded HTN prevalence of 43.0% and the study concluded that only 1 in 4 adults had normal BP . This saIn West Africa, analysis of data derived from the 2014 Ghana Demographic and Health Survey found an overall prevalence of HTN history among Ghanaian men was 5.7% . Higher In the Middle East, the prevalence of HTN is similarly alarming. For instance, the prevalence of HTN in Oman was about 40.0% and old age, male gender, smoking, impaired glucose tolerance and body mass index (BMI) were incriminated as important covariates of HTN . The aut2, larger WC, working in sedentary occupation, having diabetes mellitus, having proteinuria, and increased serum creatinine , and lifestyle factors [diet, physical activity, alcohol, etc.) are little addressed in Kombolcha which is among rapidly emerging industrial zones in the northeast of the country. With increasing urbanization, lifestyle and dietary habits are also being changed and regular monitoring of these changes in relation to the threat of HTN is necessary. It is anticipated that the outcome of the study will help health policymakers and administrators develop comprehensive and appropriate community-based health promotion strategies to encourage healthy lifestyles among its population, detect cases early enough, and choose appropriate intervention programmes.kebeles or villages (6 urban and 5 suburban) having an area of 124.5km2 . Based on the 2014 Ethiopian Central Statistical Agency population projection [The study area was Kombolcha town which is situated at 11°5′N 39°44′E latitude and 11.083°N 39.733°E longitude in northeast Ethiopia with an elevation between 1842 and 1915 m above sea level. Kombolcha is 375 km to the north of Addis Ababa. It is bordered by K’alu District in the east and south, Dessie Zuria District in the west and southwest, Tehulederie District in the north and Dessie City in the northwest. According to the Kombolcha Meteorological Agency, Kombolcha town is characterized by an average annual rainfall of 1030 mm and temperature 20.1 °C. The town is subdivided into 11 small units named ojection , the towkebeles (urban 6 suburban 5), 5 and 2 suburban ) were randomly selected (lottery method) first by clustering urban and suburban kebeles and taking into account the population size of each. Study households (HHs) were selected randomly from the selected kebeles and finally, individual adults were in turn randomly picked up from the selected HHs. Pregnant women, people with diabetes, age <18 years, those who lived in the study area for <6 months, seriously ill, or homeless were excluded from the study. The study period was from December 2016 to May 2017.A multistage sampling strategy was used to select study participants. Therefore, all adult residents of the study area formed the target population. Out of the total 11 The sample size was calculated using open EPITools epidemiological calculator  using sit 95% CI  was takeAnthropometric measurements were obtained from the participants wearing light clothing and no footwear. Bodyweight was measured to the nearest 0.1 kg using United Nations Children’s Fund (UNICEF) Seca digital weighing scale and height to the nearest 0.1 cm in a standing position using seca Germany a portable stadiometer. A constant tension tape was used to measure WC to the nearest 0.1 cm putting the tape at the level of the midpoint between the inferior margin of the last rib and the iliac crest in the mid-axillaries line directly over the skin or over light clothing. Waist and hip circumferences were measured with a flexible steel metric tape at the nearest 0.5 cm.BP was measured using aneroid sphygmomanometer  on the right hand at sitting position taking three measurements with intervals of 3 min between consecutive measurements. In addition, participants were asked whether they were taking any medications for the treatment of HTN. Average systolic BP (SBP) and diastolic BP (DBP) were determined from the second and third measurements.Catha edulis) chewing, salt use) and dietary habit. The 24-hour dietary recall and dietary record methods [A pretested structured questionnaire was used to collect data on socio-demographics, level of exercise , lifestyle factors  Analysis Guide and Guidelines for Measuring Household and Individual Dietary Diversity .The English questionnaire was translated into Amharic (participant language) for fieldwork and back to English for checking language consistency. Data was collected by the house-to-house visit. BP measurements were done by local health professionals. A digital weighing scale was used to reduce frequent calibration. The collected information was reviewed on a daily basis and errors returned to the data collectors for correction.p-value of less than 0.05 was considered statistically significant.Data was entered and statistical analysis performed using IBM SPSS Statistics 24 . Data analysis was performed by the Chi-squared test to determine the association of anthropometric measurements and BP with gender. Further, binary and multivariable logistic regression models were used to test the association between HTN and the independent variables . Odds ratios (OR) were calculated with 95% CI. A p ≤ 0.1. All significant variables in the binary test entered in the model and explanatory variables were sequentially removed when the exit cutoff is satisfied. Age, sex and sedentary lifestyle were kept in all multivariable models, irrespective of statistical significance, to control for any confounding effects.The multivariable model was constructed by forwarding the stepwise logistic regression analysis. The cutoff for retention of a variable in the model was set at HTN is defined clinically as SBP 140 mmHg or greater or DBP 90 mmHg or greater averaged over two or more readings on two or more visits following an initial screening [creening .Pre-hypertension: BP readings with a systolic pressure 120-139 mmHg or a diastolic pressure 80-89 mmHg [-89 mmHg .HTN: Readings equal to or greater than 140/90 mmHg [/90 mmHg .BMI (kg/m2): 18.5: underweight; 18.5–25: normal weight; 25–30: overweight; > 30: obese [0: obese .Abdominal obesity: It is an accelerated and excessive accumulation of fat around the abdomen and stomach that may lead to health impairment [pairment .WC: High risk ≥94 cm in men and 80 cm in women; substantially high risk > 102 cm in men and > 88 cm in women [in women .WHR: Substantially high ≥ 0.90 cm in men and ≥ 0.85 cm in women [in women .WHtR: Values for both sexes: low risk 0.40–0.499, high risk 0.50–0.59 and substantially high risk ≥ 0.60 [k ≥ 0.60 .A total of 318 respondents participated in this study with a response rate of 100%. But, only 312  had complete data for statistical analysis. The rest six had some missing variables and thus were excluded. Regarding socio-demographic characteristics, the male-to-female ratio was 1.18 with 54.2% males and 45.8% females. The age of the study population ranges from 18 to 65 years and the mean 38.29 ± 10.88. Hundred forty respondents (44.9%) were 31–45 years old. Hundred thirty-six (43.6%) were merchants followed by 134(42.9%) civil servants and the rest 42(13.5%) farmers. Hundred ninety-one (61.2%) participants were married. While 202(64.7%) participants were grade 8 or 10 complete those having qualification of certificate and above were 110(35.3%). Twenty-eight (8.9%) participants were living alone, 210(67.3%) living in HH size of two and the rest 74(23.7%) were from HH size of three and above. Hundred eighty-four (58.9%) participants had a history of HTN and other related diseases among their family members.All the major types of food groups are available in the local market year-round. When asked, 99.0% of the participants reported that they had consumed cereals, pulses, condiments, and 96.2% had used sugars and fast foods. Oil/fats; milk and milk products; meat, fish and poultry; and fruits were consumed by 43.3, 38.1, 33.7, and 26.0% of the respondents respectively. The mean DDS was 6.5 ± 1.9. Overall, 169(54.2%) had low DDS and the rest 143(45.8%) had high.2, with a mean of 25.7 ± 2.4 kg/m2. The mean BMI of the male respondents was 23.5 ± 3.3 kg/m2 whereas that of the females was 24.1 ± 4.4 kg/m2  had ≥ 25.0 kg/m2. Hundred thirty-nine (44.6%) participants were overweight and only 30(9.6%) obese. In addition, slightly higher proportions of females than males were overweight (46.2% versus 43.2%), and a higher proportion of females were obese . Categorized by sex, abdominal obesity occurred among 32.2% females and 24.8% males.The BMI of the respondents ranged from 18.21 to 36.94 kg/mvigorous-intensity type followed by 95(30.4%) moderate and 183(58.7%) light at least for 20 min continuously per week. Two-hundred twelve (67.9%) respondents reported no sport, 76(24.3%) do a moderate-intensity type and the rest 24(7.7%) practice vigorous-intensity sport. Similarly, 32(10.3%) and 280(89.7%) participants walk or ride a bicycle for 1–4 and 5–7 days (for 20 min each day) per week, respectively. The durations of sedentary activity on a typical day were > 120, 60–120 and < 60 min for 253(81.1%), 51(16.3%) and 8(2.6%) participants respectively (Table Only 34(10.9%) of the participants reported that their occupational physical activity was of the khat (Catha edulis) continuously for extended hours daily and 97(31.1%) responded negatively. Two-hundred twenty-eight (73.1%) participants were no-users of alcoholic drinks and 84(26.9%) answered in the affirmative. Three-hundred (96.2%) individuals use salt in their diet and only 12(3.8%) avoid.While 61(19.6%) participants reported that they smoke cigarettes regularly during the study period and prior, 251(80.4%) did not ever smoke. Similarly, 215(68.9%) chew substantially increased risk, 87(27.8%) increased risk and 133(42.6%) at low risk for HTN as per the WHO categorization. Based on WHR, 172(55.1%) of the individuals were under increased risk for developing cardiovascular diseases. Risk classification with WHtR showed that 165(52.8%) and 81(25.9%) participants had high risk and substantially increased risk, respectively.While 139(44.5%) participants were overweight, the prevalence of obesity was 9.6% (30/312). Concerning the WC, 92(29.4%) were in the category of The mean SBP of the study population was 129.6 ± 13.7 mmHg and that of DBP was 83.9 ± 8.2 mmHg. A total of 96(30.7%) individuals were hypertensive at 95% CI. Analysis of BP by age showed that the mean BP (both systolic and diastolic) was highest in the age group ≥45 years and the prevalence of HTN generally increased with age. HTN prevalence in males was 30.2% (51/169) and among females 31.5% (45/143) with no statistically significant difference (Table p < 0.0001), obesity  and overweightness , substantially high risk  WC , light occupational physical activity , walking or riding a bicycle for lower than 5 days/week  and lack of sport activity , smoking , khat chewing , alcohol drinking , HH size of two  and ≥ 3 , and HTN in family history  were significant predictors of HTN in the binary logistic regression analysis (Table Age of 45 and older (OR) 7.385, 95% CI 3.563–15.306, The prevalence of HTN in the present study is 30.8% which is comparable to previous similar community-based studies in Ethiopia. Reports from Addis Ababa  and GondOn the other hand, the prevalence of HTN in this study was higher than what was obtained from Bahir Dar 25.1%) in northwest Ethiopia .1% in no. ReportsThe 30.2 and 31.5% proportion of hypertensive male and female participants, respectively, is comparable with other studies like Tesfaye et al. 2009  who repoIn this study, the prevalence of overweight was 44.6% out of which 52.5% male and 47.5% female and overall obesity 9.6% . This finding shows a considerably high prevalence of overweight and obesity among adults in Kombolcha. Two thousand eleven Ethiopian Demographic and Health Survey [khat chewing) demonstrating that most of the adult population has a sedentary lifestyle, out of this 36.4% were hypertensive. These can be explained by modernization which is characterized by the increasing use of motorized transport and more sedentary lifestyles.Most participants (81.1%) practiced sedentary lifestyle  sample size for different categories of some variables might have impacted the statistical analysis of the multivariable model. Further, the study involves only anthropometric and BP measurements without biochemical tests due to cost, time and other related constraints. The women and even some males might not self-report their alcohol-drinking and smoking habits which are socially undesirable behaviors within the community.The data demonstrated an alarming rate of increasing weight, raised BP, widespread physical inactivity and sedentary behavior among adults although these factors were not independently significantly associated with HTN probably for inherent sampling problems. The findings emphasize the need for adopting a health policy to further assess the magnitude of HTN which typically does not cause symptoms, and devise control strategies in the study area.


Vital signs are often used in triage, but some may be difficult to assess in low-resource settings. A patient's ability to walk is a simple and rapid sign that requires no equipment or expertise. This study aimed to determine the predictive performance for death of an inability to walk among hospitalized Malawian adults and to compare its predictive value with the vital signs-based National Early Warning Score (NEWS). It is a prospective cohort study of adult in-patients on selected days in two hospitals in Malawi. Patients were asked to walk five steps with close observation and their vital signs were assessed. Sensitivities, specificities, and predictive values for in-patient death of an inability to walk were calculated and an inability to walk was compared with NEWS. Four-hundred and forty-three of the 1094 participants (40.5%) were unable to walk independently. In this group, 70 (15.8 %) died in-hospital compared to 16 (2.5%) among those who could walk: OR 7.4 (95% CI 4.3-13.0 p<0.001). Inability to walk had a sensitivity for death of 81.4%, specificity of 63.0%, positive predictive value (PPV) of 15.8%, and negative predictive value (NPV) of 97.5%. NEWS>6 had sensitivity 70.9%, specificity 70.6%, PPV 17.1%, and NPV 96.6%. An inability to walk had a fair concordance with NEWS>6 (kappa 0.21). Inability to walk predicted mortality as well as NEWS among hospitalized adults in Malawi. Patients who were able to walk had a low risk of death. Walking ability could be considered an additional vital sign and may be useful for triage. Simple physiological signs are often used in hospitals as markers of illness severity , 2. In eMany of the scoring systems use compound scores requiring a calculation of an overall score based on several components. This may be too time-consuming for efficient use in settings of low human resources, and time-pressured staff often miscalculate the scores leading to misclassification of patients , 9. MoreAn ideal physiological sign of risk in a low-resource setting would be one that is simple and quick to assess, does not require equipment or special training for staff, and had a good performance for dividing patients into risk groups. A patient's ability to walk has been proposed as such a sign , 16 and A prospective cohort study of adult in-patients recruited on single selected days with a primary outcome of in-hospital mortality.The study was conducted in Queen Elizabeth Central Hospital (QECH) and Chiradzulu District Hospital (CDH). QECH is a national referral hospital located in Blantyre in the south of Malawi with a 1000-bed capacity, including 4 adult intensive care beds, serving an immediate catchment population of 1 million people. CDH is a district hospital with a catchment population of 250,000 and a 300-bed capacity (no intensive care). These two hospitals were chosen to provide settings of different resources, personnel, and epidemiology.All in-patients aged 18 and above in QECH and CDH on the selected days—twice in QECH in January 2017 and May 2018 and three times in CDH in November 2017, February 2018 and July 2018—were included. Exclusion criteria were refusal to participate, healthy prenatal pregnant women, women in active labour, and patients with a psychiatric disorder as the primary reason for admission.A clinical evaluation of every patient was conducted by study nurses following training and using standardized methods and equipment. Patients were asked to stand up and walk five steps. Under close observation by a study nurse, each patient was coded as walking independently, walking with assistance, unable to walk, or refused to walk. Blood pressure was measured using Omron M2 digital blood pressure machines, oxygen saturations and heart rates were measured using Lifebox pulse oximeters, and axillary temperatures were taken using Ishnee IN 101A digital thermometers. Demographic and clinical information were extracted from the patients' files. Outcomes were collected by the ward clerks and the research team with a primary end-point of in-hospital mortality, censored at 30 days.Ethical clearance was granted by the University of Malawi College of Medicine Research and Ethics Committee (COMREC P.08/16/2007).For the primary analyses, the patients' ability to walk was recategorised into two groups: those not able to walk independently  and those able to walk independently. NEWS was scored between 0 and 20 according to the established system based on vital sign derangements . A critiOf the 1135 eligible adults in the hospital on the study days, data on walking status or hospital outcomes were not collected for 41 (3.6%) and 1094 patients were included in the study from medicine, surgery, obstetrics and gynaecology, ophthalmology, and orthopaedics . The parAmong the participants, 443 (40.5%) were unable to walk independently . Seventy of them died (15.8%) compared to 16 (2.5%) among those who could walk: OR 7.4 (95% CI 4.3-13.0 p<0.001). As a predictor of in-hospital mortality, inability to walk independently had a sensitivity of 81.4%, specificity of 63.0%, positive predictive value (PPV) of 15.8%, and negative predictive value (NPV) of 97.5%. In the sensitivity analysis, one hundred and thirteen were not able to walk independently due to a physical impairment and were classified as able to walk independently. As a predictor of in hospital mortality, an inability to walk that was not due to physical impairment (355 patients) had an OR 11.1 (CI 6.3-19.4 p<0.001) a sensitivity of 81.4%, and a specificity of 71.7% with a PPV of 19.7 % and an NPV of 97.8%.Of the 357 patients with NEWS>6, 61 (17.1%) died in-hospital, compared to 25 (3.4%) of those with NEWS≤6: OR 7.2 (CI 3.6-9.5 p<0.001). For predicting in-hospital mortality, NEWS>6 had a sensitivity of 70.9% and specificity of 70.6% with a PPV of 17.1% and an NPV of 96.6%. The AUROC for NEWS was 0.76 see .Of the 930 patients with NEWS>3, 82 (8.8%) died in-hospital, compared to 2.4% of those with NEWS ≤3: OR 3.9 (CI 1.4-10.7 p=0.009). As a predictor of in hospital mortality, NEWS>3 had a sensitivity of 95.3% and specificity of 16.0% with a PPV of 8.8% and an NPV of 97.6%.An inability to walk had a fair concordance with NEWS>6: kappa 0.21, 95% CI (0.16 - 0.27), and a poor concordance with NEWS>3: kappa 0.06, 95% CI (0.03 - 0.10).and”  and “or”  approaches. Among the 199 patients who were unable to walk and had NEWS>6, 53 (26.6%) died compared to 33 (3.7%) of those who were not positive for both pathological signs: OR 9.5 (CI 5.9-15.2 p<0.001). The sensitivity for in-hospital death of this “and” compound variable was 61.6% and specificity 85.5% with a PPV of 26.6% and an NPV of 96.3%.Combining inability to walk with NEWS was done using “ or had NEWS>6, 78 (13.0%) died compared to 8 (1.6%) of the 493 who had neither pathological sign: OR 9.0 (CI 4.3-19.0 p<0.001). The sensitivity for in-hospital death of this “or” compound variable was 90.7% and specificity 48.1% with a PPV of 13.0% and an NPV of 98.4%.Among the 601 patients who were unable to walkWe have found that an inability to walk was associated with death among hospitalized adults in Malawi. Inability to walk had as good a predictive performance as the compound vital signs-based NEWS score.An inability to walk may be a marker of generalised deranged physiology and illness severity, or a reduced physiological reserve for coping with subsequent stresses and may include subtle signals not fully reflected by traditional vital signs or NEWS . Our finOur finding that may be of most clinical utility is inability to walk has high negative predictive value – 97.5%. Only 2.5% of patients who were able to walk independently subsequently died in-hospital. The ease of assessing ability to walk and the low NPV could be used clinically for quickly “ruling-out” patients in need of urgent attention—a concept similar to the “walking wounded” in military situations, where injured soldiers who can still walk are triaged as a low-risk group to wait for medical assistance .Concordance of an inability to walk with a high NEWS was low, implying that an inability to walk identified a different group of high-risk patients to those identified by NEWS and a potential for combining triage signs. Indeed, when combining inability to walk with NEWS, three risk groups could be identified: one-in-four (26.6%) of those with both pathological signs died in-hospital, one-in-seven (13.0%) of those with either an inability to walk or NEWS>6 died, and fewer than one-in-sixty (1.6%) of those who could both walk and NEWS<6 died in-hospital. When inability to walk was added to NEWS>6 using an “and” approach , the sensitivity for death dropped from 70.9% to 61.6% and specificity increased from 70.6% to 85.5%. When inability to walk was combined to NEWS>6 using an “or” approach , the sensitivity increased from 70.9% to 90.7% and specificity decreased from 70.6% to 48.1%.Strength of our study is its use of a simple, pragmatic, and low-cost triage tool that does not require any equipment or expertise and would be possible in all resource levels. Our prospective study is unique in its focus on inpatients rather than patients at arrival to hospital—in-hospital triage and stratification of patients into risk groups is gathering interest, and this study is the first to look at such a simple triage criterion among an unselected patient population in a low-resource setting. While the methodology of collecting data from all hospital patients on selected days has such strengths, it also has limitations in that it does not capture the fluctuating nature of the conditions of patients or the effects of received therapies. Other limitations are that it was conducted in only two centres and data collection was done on only a few days.Our study suggests that assessing individual patients' ability to walk may be a quick and easy tool for the stratification of patients into high- and low-risk groups. In settings where regular checks of vital signs are difficult or impossible, an ability to walk may have the potential to be a pragmatic alternative and could be part of essential emergency and critical care services . In settInability to walk predicted mortality as well as NEWS among hospitalized adults in Malawi. Patients who were able to walk had a low risk of in-hospital death. Walking ability could be considered an additional vital sign and may be useful for triage.


To refine estimates of how many persons in the United States are candidates for treatment of latent tuberculosis, we removed from analysis persons who self-reported prior treatment on the National Health and Nutrition Examination Survey 2011–2012. We estimate that 12.6 million persons could benefit from treatment to prevent active tuberculosis. Mycobacterium tuberculosis infections acquired years earlier  incidence is at historic lows, the average annual rate of decline has slowed to 2% . We ascertained prevalence estimates of self-reported prior treatment among persons >6 years of age who had a positive result for TB infection for a test conducted by NHANES. We assessed treatment history among subgroups with IGRA positivity, TST positivity, TST or IGRA positivity, or dual TST and IGRA positivity. For comparison, we also assessed treatment history among persons with dual TST and IGRA negativity. We stratified subgroups by birthplace. We calculated population prevalence estimates and corresponding 95% CIs by using SAS software (https://www.sas.com), which accounted for the complex survey design, the 2-year examination weights, and population denominators from the 2011 American Community Survey data.We defined a positive test result for TB infection as a positive result for an IGRA administered by NHANES according to manufacturer’s standards (https://www.cdc.gov/nchs/nhanes).All NHANES participants or their proxies provided informed consent, and the Research Ethics Review Board of the National Center for Health Statistics reviewed all procedures and protocols. All data used for this analysis are publicly available  participants, 1.8 (95% CI 1.1–2.3) million of the 14.1 (95% CI 11.9–16.4) million persons in the civilian, noninstitutionalized US population with a positive IGRA blood test result for TB infection. This finding suggests that as of 2011–2012, 12.6 (95% CI 10.5–14.7) million persons could still benefit from LTBI treatment after further evaluation . Stratification by birthplace did not reveal substantial differences for prevalence of prior treatment for TB disease or LTBI; 11.3% (95% CI 5.5%–17.1%) of persons born in the 50 US states or the District of Columbia (US-born) and 13.0% (95% CI 9.5%–16.5%) of non–US-born persons with a positive IGRA result reported having received prior treatment . ExcludiWhen also considering TST results in the definition of a positive test result for TB infection, the prevalence of self-reported prior TB treatment among persons with TB infection ranged from 11.9% to 16.4%, with overlapping CIs . Among sAmong persons with dual negative results for the TST and IGRA, the prevalence of prior TB treatment was 0.6% (95% CI 0.3%–0.9%). Prevalence was higher among non–US-born (2.5% [95% CI 1.2%–3.7%]) than among US-born (0.3% [95% CI 0.1%–0.6%]) persons.An estimated 12.6 (95% CI 10.5–14.7) million persons living in the United States with evidence of TB infection by IGRA result reported no prior TB treatment. This number excludes ≈12% of persons in previously reported estimates of the number of persons with LTBI in the United States ; consecutive NHANES cycles of at least 4 or 6 years would provide more precise estimates  and that the result would have remained positive at the time of the NHANES examination. Conversely, the <1% prevalence of prior treatment history among those with negative TST and IGRA results suggests that some test results became negative after treatment or that some uninfected participants inaccurately recalled having taken medication for active TB disease or LTBI.The higher prevalence of self-reported prior treatment among persons with a positive test result for Regardless of which diagnostic test for TB infection was considered, consistently ≈12% of those with positive results during the NHANES 2011–2012 self-reported prior TB treatment. In conclusion, we estimate that the other 88%  could benefit from interventions to expand screening and treatment for LTBI.


We assessed the efficacy of the home-based Otago Exercise Program (OEP) as a secondary falls prevention strategy in seniors referred to a falls prevention clinic after an index fall. We conducted a 12-month randomized controlled trial of 344 adults, aged 70 years and older, with = or > 1 fall resulting in medical attention in the prior 12 months. Participants were randomized to OEP or standard of care (CON). The OEP is a home-based strength and balance training program delivered by a physical therapist. All participants received AGS Guideline Care for falls prevention from a geriatrician. Differences in falls rate was tested with a negative binomial regression model. The rate of falls was lower in the OEP group vs the CON group . The estimated incidence rate of falls per person-year was 1.4 (95% CI 0.1 to 2.0) in the OEP group and 2.1 (95% CI 0.1 to 3.2) in the CON group, with an absolute incidence rate difference of 0.74 (95% CI 0.04 to 1.78) falls per person-year. DSST performance also increased in the OEP group by a mean change of 1.1 points (95% CI 0.02 to 2.1) vs the CON group. Improved DSST was associated with fewer falls . These findings support the use of the OEP for secondary falls prevention.