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Leishmaniasis continues to be a major health problem in 4 eco-epidemiological regions of the world: the Americas, East Africa, North Africa and West and SouthEast Asia. (1) This report on [...]

Objective To implement and evaluate a large-scale online cervical cancer screening programme in Hubei Province, China, supported by artificial intelligence and delivered by trained health workers. Methods The screening programme, which started in 2017, used four types of health worker: sampling health workers, slide preparation technicians, diagnostic health workers and cytopathologists. Sampling health workers took samples from the women on site; slide preparation technicians prepared slides for liquid-based cytology; diagnostic health workers identified negative samples and classified positive samples based on the Bethesda System after cytological assessment using online artificial intelligence; and cytopathologists reviewed positive samples and signed reports of the results online. The programme used fully automated scanners, online artificial intelligence, an online screening management platform, and mobile telephone devices to provide screening services. We evaluated the sustainability, performance and cost of the programme. Results From 2017 to 2021, 1 518 972 women in 16 cities in Hubei Province participated in the programme, of whom 1 474 788 (97.09%) had valid samples for the screening. Of the 86 648 women whose samples were positive, 30 486 required a biopsy but only 19 495 had one. The biopsy showed that 2785 women had precancerous lesions and 191 had invasive cancers. The cost of screening was 6.31 United States dollars (US$) per woman for the public payer: US$ 1.03 administrative costs and US$ 5.28 online screening costs. Conclusion Cervical cancer screening using artificial intelligence in Hubei Province provided a low-cost, accessible and effective service, which will contribute to achieving universal cervical cancer screening coverage in China. Objectif Deployer et evaluer un programme en ligne de grande envergure destine au depistage du cancer du col de l'uterus dans la province du Hubei, en Chine, reposant sur l'intelligence artificielle et mis en oeuvre par des agents de sante formes a cet effet. Methodes Le programme de depistage, qui a debute en 2017, s'appuyait sur quatre types d'agents de sante: des agents charges de prelever les echantillons, des techniciens charges de preparer les lames, des agents charges d'etablir le diagnostic et des cytopathologistes. Les premiers ont preleve des echantillons aupres des femmes sur place, les deuxiemes ont prepare les lames pour la cytologie en phase liquide, les troisiemes ont identifie les echantillons negatifs et classe les echantillons positifs selon le systeme de Bethesda apres analyse cytologique a l'aide d'une intelligence artificielle en ligne, tandis que les cytopathologistes ont examine les echantillons positifs et signe les rapports de resultats en ligne. Le programme etait constitue de scanners entierement automatises, d'une intelligence artificielle en ligne, d'une plateforme de gestion du depistage en ligne, ainsi que d'appareils de telephonie mobile pour les services de depistage. Nous avons evalue la viabilite, les performances et le cout d'un tel programme. Resultats Entre 2017 et 2021, 1 518 972 femmes residant dans 16 villes de la province du Hubei ont participe au programme, et 1 474 788 (97,09%) d'entre elles ont presente des echantillons valides pour le depistage. Sur les 86 648 femmes dont les echantillons se sont reveles positifs, 30 486 ont eu besoin d'une biopsie, mais seulement 19 495 en ont effectue une. La biopsie a montre que 2785 femmes presentaient des lesions precancereuses et que 191 etaient atteintes de cancers invasifs. Le cout du depistage s'elevait a 6,31 dollars americains (USD) par femme pour le payeur public: 1,03 USD pour les frais administratifs et 5,28 USD pour le depistage en ligne. Conclusion Le depistage du cancer du col de l'uterus assiste par intelligence artificielle dans la province du Hubei est un service abordable, accessible et efficace, qui contribuera a garantir une couverture universelle en la matiere dans le pays. Objetivo Implementar y evaluar un programa de deteccion del cancer del cuello uterino en linea a gran escala en la provincia de Hubei (China), con el apoyo de la inteligencia artificial y a cargo de trabajadores sanitarios formados. Metodos El programa de deteccion, que comenzo en 2017, utilizo cuatro tipos de trabajadores sanitarios: trabajadores sanitarios de muestreo, tecnicos de preparacion de portaobjetos, trabajadores sanitarios de diagnostico y citopatologos. Los trabajadores sanitarios de muestreo tomaban muestras de las mujeres in situ, los tecnicos de preparacion de portaobjetos preparaban los portaobjetos para la citologia mediante liquidos, los trabajadores sanitarios de diagnostico identificaban las muestras negativas y clasificaban las muestras positivas segun el Sistema Bethesda tras la evaluacion citologica mediante inteligencia artificial en linea, y los citopatologos revisaban las muestras positivas y firmaban los informes de los resultados en linea. El programa utilizo escaneres totalmente automatizados, inteligencia artificial en linea, una plataforma de gestion de la deteccion en linea y dispositivos de telefonia movil para proporcionar servicios de deteccion. Se evaluaron la sostenibilidad, el rendimiento y el coste del programa. Resultados Entre 2017 y 2021, 1 518 972 mujeres de 16 ciudades de la provincia de Hubei participaron en el programa, de las que 1 474 788 (97,09%) tenian muestras validas para la deteccion. De las 86 648 mujeres cuyas muestras dieron positivo, 30 486 necesitaron una biopsia, pero solo 19 495 se sometieron a ella. La biopsia mostro que 2785 mujeres tenian lesiones precancerosas y 191 canceres invasivos. El coste de la deteccion fue de 6,31 dolares estadounidenses (US$) por mujer para el organismo publico pagador: US$ 1,03 de costes administrativos y US$ 5,28 de costes de deteccion en linea. Conclusion La deteccion del cancer del cuello uterino mediante inteligencia artificial en la provincia de Hubei proporciono un servicio de bajo coste, accesible y eficaz, que contribuira a lograr la cobertura universal de deteccion del cancer del cuello uterino en China., Introduction Cervical cancer is a threat to women's health. According to data released by the International Agency for Research on Cancer, the cancer research agency of the World Health Organization [...]

Background: Health agencies recommend that homes of heat-vulnerable occupants (e.g., older adults) be maintained below 24-28[degrees]C to prevent heat-related mortality and morbidity. However, there is limited experimental evidence to support these recommendations. OBJECTIVE: To aid in the development of evidence-based guidance on safe indoor temperatures for temperate continental climates, we evaluated surrogate physiological outcomes linked with heat-related mortality and morbidity in older adults during simulated indoor overheating. Methods: Sixteen older adults [six women; median age: 72 y, interquartile range (IQR): 70-73 y; body mass index: 24.6 (IQR: 22.1-27.0) kg/[m.sup.2]] from the Ottawa, Ontario, Canada, region (warm summer continental climate) completed four randomized, 8-h exposures to conditions experienced indoors during hot weather in continental climates (e.g., Ontario, Canada; 64 participant exposures). Ambient conditions simulated an air-conditioned environment (22[degrees]C; control), proposed indoor temperature upper limits (26[degrees]C), and temperatures experienced in homes without air-conditioning (31[degrees]C and 36[degrees]C). Core temperature (rectal) was monitored as the primary outcome; based on previous recommendations, between-condition differences >0.3[degrees]C were considered clinically meaningful. Results: Compared with 22[degrees]C, core temperature was elevated to a meaningful extent in 31[degrees]C [+0.7[degrees]C; 95% confidence interval (CI): 0.5, 0.8] and 36[degrees]C (+0.9[degrees]C; 95% CI: 0.8, 1.1), but not 26[degrees]C (+0.2[degrees]C, 95% CI: 0.0, 0.3). Increasing ambient temperatures were also associated with elevated heart rate and reduced arterial blood pressure and heart rate variability at rest, as well as progressive impairments in cardiac and blood pressure responses to standing from supine. Discussion: Core temperature and cardiovascular strain were not appreciably altered following 8-h exposure to 26[degrees]C but increased progressively in conditions above this threshold. These data support proposals for the establishment of a 26[degrees]C indoor temperature upper limit for protecting vulnerable occupants residing in temperate continental climates from indoor overheating. https://doi.org/10.1289/EHP13159, Introduction In the summer of 2021, an unprecedented heat wave in the Pacific Northwest of North America broke national temperature records in Canada by 5[degrees]C and resulted in the deaths [...]

Objective To evaluate the evidence describing how the controlled temperature chain approach for vaccination could lead to improved equitable immunization coverage in low- and middle-income countries. Methods We created a theory of change construct from the Controlled temperature chain: strategic roadmap for priority vaccines 2017-2020, containing four domains: (i) uptake and demand for the approach; (ii) compliance and safe use of the approach; (iii) programmatic efficiency gains from the approach; and (iv) improved equitable immunization coverage. To verify and improve the theory of change, we applied a realist review method to analyse published descriptions of controlled temperature chain or closely related experiences. Findings We evaluated 34 articles, describing 22 unique controlled temperature chain or closely related experiences across four World Health Organization regions. We identified a strong demand for this approach among service delivery providers; however, generating an equal level of demand among policy-makers requires greater evidence on economic benefits and on vaccination coverage gains, and use case definitions. Consistent evidence supported safety of the approach when integrated into special vaccination programmes. Feasible training and supervision supported providers in complying with protocols. Time-savings were the main evidence for efficiency gains, while cost-saving data were minimal. Improved equitable coverage was reported where vaccine storage beyond the cold chain enabled access to hard-to-reach populations. No evidence indicated an inferior vaccine effectiveness nor increased adverse event rates for vaccines delivered under the approach. Conclusion Synthesized evidence broadly supported the initial theory of change. Addressing evidence gaps on economic benefits and coverage gains may increase future uptake. [phrase omitted] [phrase omitted] Objectif Evaluer les preuves exposant la manlere dont la chaine de temperature controlee pourrait constituer l'approche Ideale pour garantir une couverture vaccinale plus equitable dans les pays a revenu faible et intermediaire. Methodes Nous avons elabore un concept base sur la theorie du changement figurant dans Chaine de temperature controlee: feuille de route strategique pour les vaccins prioritaires 2017-2020, et portant sur quatre domaines: (i) demande et adhesion a l'approche; (ii) respect et securite d'utilisation de l'approche; (iii) avantages de l'approche au niveau de l'efficacite des programmes; et enfin, (iv) couverture vaccinale plus equitable. Afin de verifier et d'affiner la theorie du changement, nous avons employe une methode de synthese realiste destinee a analyser les descriptions publiees concernant la chaine de temperature controlee ou toute autre experience etroitement liee au sujet. Resultats Nous avons examine 34 articles decrivant 22 chaines de temperature controlee ou d'autres experiences similaires dans quatre regions de l'Organisation mondiale de la Sante. Nous avons identifie une forte demande pour cette approche chez les fournisseurs de services; cependant, pour declencher une demande identique chez les legislateurs, il faut plus d'arguments axes sur les retombees economiques et l'amelioration de la couverture vaccinale, ainsi que des definitions de cas d'utilisation. De nombreux elements probants ont confirme que l'approche etait sure lorsqu'elle est integree dans des programmes de vaccination speciaux. Assurer un niveau de formation et de supervision acceptable a permis aux fournisseurs de se conformer aux protocoles. Le gain de temps est le principal atout en termes d'efficacite, tandis que les donnees sur la reduction des couts sont limitees. Stocker les vaccins au-dela de la chaine du froid a rendu la couverture vaccinale plus equitable car les populations difficiles a atteindre ont ainsi pu y avoir acces. Rien n'a permis d'indiquer une diminution de l'efficacite des vaccins ou un taux d'effets indesirables plus eleve pour les vaccins fournis dans le cadre de cette approche. Conclusion La synthese des preuves a largement corrobore la theorie du changement. Apporter des arguments supplementaires pour demontrer ses bienfaits en matiere d'economie et de couverture vaccinale pourrait favoriser l'adhesion. [phrase omitted] Objetivo Evaluar las pruebas que describen como el enfoque de la cadena de temperatura controlada para la vacunacion podria suponer una mejora de la cobertura de inmunizacion equitativa en los paises de ingresos bajos y medios. Metodos Se creo un constructo de teoria del cambio a partir de la Cadena de temperatura controlada: hoja de ruta estrategica para las vacunas prioritarias 2017-2020, que contiene cuatro dominios: (i) adopcion y demanda del enfoque; (ii) cumplimiento y uso seguro del enfoque; (iii) beneficios del enfoque en terminos de eficacia del programa; y (iv) mejora de la cobertura de inmunizacion equitativa. Para verificar y mejorar la teoria del cambio, se aplico un metodo de revision realista para analizar las descripciones publicadas de la cadena de temperatura controlada o de experiencias muy relacionadas. Resultados Se evaluaron 34 articulos, que describian 22 experiencias especificas de cadena de temperatura controlada o muy relacionadas en cuatro regiones de la Organizacion Mundial de la Salud. Se identifico una fuerte demanda de este enfoque entre los prestadores de servicios; sin embargo, para generar un nivel igual de demanda entre los responsables de formular politicas se requieren mayores pruebas sobre los beneficios economicos y de la cobertura de vacunacion, asi como definiciones de casos de uso. Las pruebas consistentes apoyan la seguridad del enfoque cuando se integra en programas especiales de vacunacion. La formacion y la supervision factibles ayudaron a los prestadores a cumplir los protocolos. El ahorro de tiempo fue la principal prueba de los beneficios de eficiencia, mientras que los datos de ahorro de costes fueron minimos. Se informo de una mayor cobertura equitativa cuando el almacenamiento de vacunas mas alla de la cadena de frio permitio el acceso a poblaciones de dificil acceso. No hay pruebas que indiquen una menor eficacia de las vacunas ni un aumento de las tasas de efectos adversos de las vacunas suministradas mediante este enfoque. Conclusion La sintesis de las pruebas apoyaron ampliamente la teoria inicial del cambio. Resolver las deficiencias de las pruebas sobre los beneficios economicos y de cobertura podria aumentar su adopcion en el futuro., Introduction In many low- and middle-income countries, standard cold chain (2-8 [degrees]C) capacity for vaccine delivery is often restricted or unreliable, (1) leading to vaccine stock-outs, increasing equipment costs and [...]

This article examines institutional independence using the examples of the World Health Organization (WHO) and of the Public Health Emergencies of International Concern (PHEICs) in a theoretical and a practical approach. It highlights the two different sources of authority of the WHO Secretariat, based on conditional negotiated legitimacy and epistemologically derived legitimacy, and how this authority is threatened by an increase in state party influence beyond what is envisaged in the WHO's institutional setup. As a practical example, the article uses the PHEIC determinations, when the criteria as set out in the International Health Regulations (IHR) are not sufficient to explain the director-general's decision to determine a PHEIC. Instead, this article offers evidence of state party influence. This challenge to the WHO's legitimacy leads to a lack of institutional independence and, subsequently, to a declining basis for cooperation. Keywords institutional independence--global health governance--global health security--World Health Organization (WHO)--International Health Regulations (IHR)--Public Health Emergencies of International Concern (PHEICs), 1 Introduction In an age of unprecedented globalization, numerous key challenges emerge that put the current transnational system to the test. One example is the cross-border spread of infectious diseases [...]

Protein-energy malnutrition (PEM) remains a public health concern in most developing nations. In Africa, PEM can be attributed to monotonous diets based on cereals, roots, and tubers, with little or no protein of animal origin. Diversifying cropping systems to include protein dense pseudo-cereals such as Quinoa (Chenopodium quinoa Willd.) could help provide more protein in the diet of vulnerable populations. Quinoa is a crop with potential for biodiversification because it has a high nutritional value; however, it is underutilized in Africa, and information about the nutritional quality of the grain grown in contrasting environments is limited. Within the framework of FAO's commemoration of 2013 as the 'The International Year of the Quinoa' (IYQ), a Technical Cooperation Programme (TCP) project was developed with some African countries to assess the capacity of quinoa to adapt to different agro-ecological regions and the nutritional quality of the resulting grain. For this study, we evaluated the protein content and amino acid profile of three genotypes of quinoa that had been grown under diverse altitudes, soil, and climate conditions in Ethiopia, Kenya, Uganda, and Zambia. The mean protein content (g/100g) of Kancolla, Titicaca and BBR varieties grown in Africa ranged from 14.33 [+ or -]0.20 to 17.61 [+ or -]0.55, 14.23 [+ or -]0.25 to 16.65 [+ or -]0.55, and 13.13 [+ or -]0.2 to 16.23 [+ or -]0.49, respectively. On the other hand, the protein content (g/100g) of Kancolla, Titicaca, and BBR seeds grown in Peru was 13.80 [+ or -]0.10, 17.43 [+ or -]0.31, and 17.07 [+ or -]0.11, respectively. The Kancolla variety [grown in Ethiopia and Kenya] had a significantly higher protein content than that obtained from Peru [P < 0.001]. Regarding the profile of essential amino acids, Quinoa is essentially richer in methionine than most cereals. Levels of methionine were lower in the seeds grown in Africa compared to those from Peru [P < 0.001]. In terms of environmental influences, the protein content was relatively higher in quinoa seeds grown in high-altitude areas, where soils have a low pH and high nitrogen content. We conclude that Quinoa can be introduced to Africa, especially to high altitudes and warm regions where the soil has a low pH and high nitrogen content. The crop would be ideal for diversifying local diets. Key words: Africa, Agro-ecology, Chenopodium quinoa, protein, amino acid content, biodiversity, diets, INTRODUCTION Protein-energy malnutrition (PEM) remains a public health concern in most developing nations. A recent review concluded that, although the 'protein gap' waned during the 1970s, contemporary studies have challenged [...]

The 2015 European Society of Cardiology/European Respiratory Society guidelines for the diagnosis and treatment of pulmonary hypertension include a multidimensional risk assessment for patients with pulmonary arterial hypertension (PAH). However, prognostic validations of this risk assessment are limited, especially outside Europe. Here, we validated the risk assessment strategy in PAH patients in our institution in Japan. Eighty consecutive PAH patients who underwent right heart catheterization between November 2006 and December 2018 were analyzed. Patients were classified as low, intermediate, or high risk by using a simplified version of the risk assessment that included seven variables: World Health Organization functional class, 6-min walking distance, peak oxygen consumption, brain natriuretic peptide, right atrial pressure, mixed venous oxygen saturation, and cardiac index. The high-risk group showed significantly higher mortality than the low- or intermediate-risk group at baseline (P Key words: pulmonary arterial hypertension, ESC/ERS guidelines, risk assessment, mortality, Japan. Les lignes directrices des Societe europeenne de cardiologie/European Respiratory Society quant au diagnostic et au traitement de l'hypertension pulmonaire comprennent une evaluation multidimensionnelle du risque pour les patients atteints d'hypertension arterielle pulmonaire (HAP). Cependant les validations du pronostic pour cette evaluation du risque presentent des limites, en particulier en dehors de l'Europe. Nous avons ici valide la strategie devaluation du risque chez des patients atteints d'HAP dans notre etablissement au Japon. Nous avons etudie 80 patients atteints d'HAP consecutifs sur lesquels a ete realise un catheterisme du creur droit entre novembre 2006 et decembre 2018. Nous avons classe les patients selon des risques faible, intermediaire ou eleve a l'aide d'une version simplifiee de Revaluation du risque comprenant sept variables: classe fonctionnelle de l'Organisation mondiale de la sante, distance de marche pendant 6 min, consommation d'oxygene de pointe, peptide natriuretique cerebral, pression dans l'atrium droit, saturation veineuse mixte en oxygene et indice cardiaque. Le groupe expose a un risque eleve a presente un taux de mortalite nettement plus eleve que les groupes exposes a un risque faible ou intermediaire (P < 0,001 pour les deux comparaisons), et les taux de mortalite dans les groupes exposes a des risques intermediaire et faible etaient tous deux peu eleves (P = 0,989). Au suivi, les patients dont le risque auquel ils etaient exposes devenait faible ou demeurait a ce stade presentaient un meilleur taux de survie que les autres (P = 0,041). Nos donnees laissent entendre que cette evaluation du risque pourrait predire un risque de mortalite plus eleve, ainsi que le taux de survie a long terme chez des patients atteint d'HAP au Japon. [Traduit par la Redaction] Mots-cles: hypertension arterielle pulmonaire, lignes directrices des SEC/ERS, evaluation du risque, taux de mortalite, Japon., Introduction Although pulmonary arterial hypertension (PAH) is a progressive life-threatening disease, prognosis has improved with the development of PAH-specific therapy targeting the endothelin, nitric oxide, and prostacyclin pathways (Kondo et [...]

Introduction: In response to suboptimal adherence and retention, South Africa's National Department of Health developed and implemented National Adherence Guidelines for Chronic Diseases. We evaluated the effect of a package of adherence interventions beginning in January 2016 and report on the impact of Fast-Track Treatment Initiation Counselling (FTIC) on ART initiation, adherence and retention. Methods: We conducted a cluster-randomized mixed-methods evaluation in 4 provinces at 12 intervention sites which implemented FTIC and 12 control facilities providing standard of care. Follow-up was by passive surveillance using clinical records. We included data on subjects eligible for FTIC between 08 Jan 2016 and 07 December 2016. We adjusted for pre-intervention differences using difference-in-differences (DiD) analyses controlling for site-level clustering. Results: We enrolled 362 intervention and 368 control arm patients. Thirty-day ART initiation was 83% in the intervention and 82% in the control arm (RD 0.5%; 95% CI: -5.0% to 6.0%). After adjusting for baseline ART initiation differences and covariates using DiD we found a 6% increase in ART initiation associated with FTIC (RD 6.3%; 95% CI: -0.6% to 13.3%). We found a small decrease in viral suppression within 18 months (RD -2.8%; 95% CI: -9.8% to 4.2%) with no difference after adjustment (RD: -1.9%; 95% CI: -9.1% to 5.4%) or when considering only those with a viral load recorded (84% intervention vs. 86% control). We found reduced crude 6-month retention in intervention sites (RD -7.2%; 95% CI: -14.0% to -0.4%). However, differences attenuated by 12 months (RD: -3.6%; 95% CI: -11.1% to 3.9%). Qualitative data showed FTIC counselling was perceived as beneficial by patients and providers. Conclusions: We saw a short-term ART-initiation benefit to FTIC (particularly in districts where initiation prior to intervention was lower), with no reductions but also no improvement in longer-term retention and viral suppression. This may be due to lack of fidelity to implementation and delivery of those components that support retention and adherence. FTIC must continue to be implemented alongside other interventions to achieve the 90-90-90 cascade and fidelity to post-initiation counselling sessions must be monitored to determine impact on longer-term outcomes. Understanding the cost-benefit and role of FTIC may then be warranted. Keywords: adherence; ARV; counselling; differentiated care; South Africa; viral load, 1 | INTRODUCTION Extensive data from sub-Saharan Africa since large-scale antiretroviral therapy (ART) rollout began shows suboptimal retention in HIV care [1-6]. A particular point of concern is the period [...]

THIS PAPER REPORTS FINDINGS from a randomised investigation into the effect of teacher-designed, play-based learning experiences on preschool-aged children's knowledge connections between healthy eating and active play as wellbeing concepts, and sustainability. The investigation used a 'funds of knowledge' theoretical framework to situate young children's interests in digital media and popular culture, as a site for learning these knowledge connections. The findings suggest that the intervention group children created more wellbeing and sustainability knowledge connections than the waitlist control group children. Additionally, the intervention group children demonstrated an increase in vegetable serves and a decrease in unhealthy food servings post intervention (measured by parent report). The paper suggests that more attention should be paid to early childhood teachers' capacity for actively building children's knowledge about wellbeing and sustainability concepts through play-based learning, as opposed to top-down approaches towards obesity education and prevention alone., Introduction This paper reports the findings from a randomised trial investigating the effect of teacher-designed play-based learning experiences on four-year-old preschool children's knowledge connections about wellbeing and sustainability. It considers [...]

Author(s): Nathan Ford 1,*, Ingrid Eshun-Wilson 2, Wole Ameyan 1, Morkor Newman 1, Lara Vojnov 1, Meg Doherty 1, Elvin Geng 2 Summary points Improvements in HIV service delivery are [...]

Objective To develop and test a simple system for recording and reporting the diagnosis and treatment of latent tuberculosis infection and to compare the effects of passive and active tracing of child contacts on indicators of such infection. Methods We revised Burkina Faso's latent tuberculosis infection register and quarterly tuberculosis reporting form. Subsequently, coverage of the routine screening of contacts, who were younger than five years, for active tuberculosis and the corresponding percentages of such contacts who, if eligible, initiated preventive therapy were measured, nationwide, between 1 April 2016 and 31 March 2017. In 2016, we evaluated indicators of latent tuberculosis infection in the Hauts-Bassins region before and after community health workers had begun the active tracing of contacts who were younger than five years. Findings In Burkina Faso, during our study period, 3717 cases of pulmonary tuberculosis and 1166 corresponding contacts who were younger than five years were reported as the result of routine screening and passive contact tracing. The overall contact: index ratio was 0.31 and corresponding screening coverage was 82.0% (956/1166) and proportion of children starting on preventive treatment was 90.5% (852/941). Active tracing in Hauts-Bassins led to a substantially higher contact/index ratio (1.83) and screening coverage (99.3%; 145/146). Conclusion The newly established recording and reporting system proved feasible and user-friendly and allowed measurement of global indicators of latent tuberculosis infection. Compared with active tracing, passive tracing led to much lower estimates of the numbers of child contacts. Objectif Elaborer et testerun systeme simple pour enregistrer et declarer le diagnostic et le traitement des cas d'infection tuberculeuse latente et comparer les effets de la recherche passive et active des contacts enfants sur les indicateurs de cette infection. Methodes Nous avons passe en revue le registre des infections tuberculeuses latentes et le formulaire de rapport trimestriel des cas de tuberculose du Burkina Faso. Ensuite, nous avons mesure, dans tout le pays, entre le 1er avril 2016 et le 31 mars 2017, le taux de couverture du depistage systematique de la tuberculose active chez les contacts ages de moins de cinq ans et les pourcentages correspondants de contacts qui, s'ils remplissaient les conditions requises, avaient commence un traitement preventif. En 2016, nous avons evalue les indicateurs de l'infection tuberculeuse latente dans la region des Hauts-Bassins avant et apres que les agents de sante communautaires ont commence la recherche active des contacts ages de moins de cinq ans. Resultats Au Burkina Faso, au cours de la periode etudiee, 3717 cas de tuberculose pulmonaire et 1166 contacts correspondants ages de moins de cinq ans ont ete declares dans le cadre du depistage systematique et de la recherche passive des contacts. Le ratio total contacts/cas index etait de 0,31 et le taux de couverture du depistage correspondant s'elevait a 82,0% (956/1166), tandis que la proportion d'enfants ayant commence un traitement preventif etait de 90,5% (852/941). La recherche active dans les Hauts-Bassins a entraine une hausse sensible du ratio total contacts/cas index (1,83) et du taux de couverture du depistage (99,3%; 145/146). Conclusion Le nouveau systeme d'enregistrement et de declaration s'est avere utilisable et convivial et a permis de mesurer les indicateurs globaux de l'infection tuberculeuse latente. En comparaison avec la recherche active, la recherche passive a genere des estimations beaucoup plus faibles du nombre de contacts enfants. Objetivo Desarrollar y probar un sistema simple de registro y presentacion de informes sobre el diagnostico y el tratamiento de la infeccion tuberculosa latente y comparar los efectos del seguimiento pasivo y activo de los contactos infantiles con indicadores de dicha infeccion. Metodos Se reviso el registro de infeccion tuberculosa latente de Burkina Faso y el formulario trimestral de informacion sobre la tuberculosis. Posteriormente, se midio la cobertura de los examenes de deteccion rutinarios a los contactos, menores de cinco anos, para la tuberculosis activa y los porcentajes correspondientes de contactos que, de ser aptos, iniciaron la terapia preventiva a nivel nacional, entre el 1 de abril de 2016 y el 31 de marzo de 2017. En 2016, se evaluaron los indicadores de infeccion tuberculosa latente en la region de Hauts-Bassins antes y despues de que los trabajadores comunitarios de la salud empezaran el seguimiento activo de los contactos menores de cinco anos. Resultados En Burkina Faso, en nuestro periodo de estudio, se registraron 3717 casos de tuberculosis pulmonar y 1166 contactos correspondientes de menos de cinco anos como resultado de un examen rutinario y un seguimiento del contacto pasivo. La tasa global de indice de contacto fue del 0,31 y la cobertura de deteccion correspondiente fue del 82,0% (956/1166), ademas, la proporcion de ninos que iniciaron el tratamiento preventivo fue del 90,5% (852/941). El seguimiento activo en Hauts-Bassins dio lugar a una relacion de contacto/indice (1,83) y una cobertura de deteccion (99,3%; 145/146) sustancialmente mas altas. Conclusion El recien establecido sistema simple de registro y presentacion de informes resulto factible y facil de usar y permitio la medicion de indicadores globales de la infeccion tuberculosa latente. En comparacion con el seguimiento activo, el seguimiento pasivo dio lugar a estimaciones mucho mas bajas de la cantidad de contactos secundarios., Introduction The identification and treatment of individuals with latent Mycobacterium tuberculosis infection is an essential element of the World Health Organizations (WHO's) End TB Strategy. (1) Individuals with such infection, [...]

The 2014-2016 West Africa Ebola virus epidemic, unparalleled in spread for this disease, quickly overwhelmed the health systems of the 3 most affected countries (1). Ebola virus disease (EVD) can [...]

Problem Maternal and neonatal mortality remains high in low- and middle-income countries, with poor quality of intrapartum care as a barrier to further progress. Approach We developed and tested a method of measuring the quality of maternal and neonatal care that could be embedded in a larger national performance management initiative. The tool used direct observations and medical record reviews to score quality in nine domains of intra partum care. We piloted and evaluated the tool in visits to the 18 lead hospitals that have responsibility to promote and coordinate quality improvement efforts within a hospital cluster in Ethiopia. Between baseline and follow-up assessments, staff from a national quality collaborative alliance provided hospital-based training on labour and delivery services. Local setting Ethiopia has invested in hospital quality improvement for more than a decade and this tool was integrated into existing quality improvement mechanisms within lead hospitals, with the potential for scale-up to all government hospitals. Relevant changes Significant improvements in quality of intrapartum care were detected from baseline (June-July 2015) to follow-up (February-March 2016) in targeted hospitals. The overall mean quality score rose from 65.6 (standard deviation, SD: 10.5) to 91.2 (SD: 12.4) out of 110 items (P < 0.001). Lessons learnt The method was feasible, requiring a total of 3 days and two to three trained data collectors per hospital visit. It produced data that detected substantial changes made during 8 months of national hospital quality improvement efforts. With additional replication studies, this tool may be useful in other low- and middle-income countries. Qualite de ses hopitaux depuis plus de dix ans, et cet outil a ete integre aux mecanismes existants d'amelioration de la qualite de ces hopitaux principaux, avec la perspective de l'etendre eventuellement a tous les hopitaux gouvernementaux. Changements significatifs Des ameliorations considerables de la qualite des soins intrapartum ont ete constatees entre les donnees initiales (juin a juillet 2015) et les donnees de suivi (fevrier a mars 2016) dans les hopitaux cibles. Le score global moyen de la qualite est passe de 65,6 (ecart type, ET: 10,5) a 91,2 (ET: 12,4) pour les 110 elements evalues (P < 0,05). Lecons tirees La methode etait realisable, necessitant pour chaque visite troisjours et entre deux ettrois collecteurs de donnees experimentes. Elle a permis d'obtenir des donnees refletant les changements importants survenus en huit mois d'efforts d'amelioration de la qualite des hopitaux nationaux. Moyennant des etudes de reiteration complementaires, cet outil pourrait etre utile dans d'autres regions a revenu faible et intermediaire. Probleme La mortalite maternelle et la mortalite neonatale restent elevees dans les pays a revenu faible et intermediaire, oU la qualite insuffisante des soins pratiques pendant l'accouchement constitue un frein a la progression dans ce domaine. Approche Nous avons concu et teste une methode pour evaluer la qualite des soins dispenses aux meres et aux nouveau-nes, qui pourrait etre integree a une initiative nationale de gestion des performances de plus grande envergure. Grace a des observations directes et a l'examen des registres medicaux, notre outil a permis d'attribuer un score de qualite dans neuf domaines de soins intrapartum. Nous avons applique et teste notre outil dans le cadre de la visite des 18 hopitaux principaux ayant chacun la responsabilite de promouvoir et de coordonner les efforts d'amelioration de la qualite au sein d'un groupement d'hopitaux en Ethiopie. Entre les evaluations de depart et les evaluations ulterieures de suivi, le personnel d'une alliance nationale de collaboration pour la qualite a dispense des formations dans les hopitaux sur les services realises pendant le travail et l'accouchement. Environnement local L'Ethiopie investit dans l'amelioration de la integrado a los mecanismos existentes de mejora de la calidad en los hospitales mas importantes, con potencial para llegar a todos los hospitales publicos. Cambios importantes Se detectaron mejoras significativas en la calidad de la atencion durante el parto desde el principio (junio-julio de 2015) hasta el seguimiento (febrero-marzo de 2016) en los hospitales estudiados. La calidad media general obtuvo una puntuacion de 65,6 (desviacion estandar, DE: 10,5) a 91,2 (DE: 12,4) de 110 elementos (P < 0,05). Lecciones aprendidas El metodo fue viable, necesitando un total de tres dias y de dos a tres recopiladores de datos con formacion por visita hospitalaria. Se generaron datos que detectaron grandes cambios durante los ocho meses de trabajos de mejora de la calidad de los hospitales. Con otros estudios de reproduccion, esta herramienta podria resultar util en otros paises con ingresos bajos y medios. Situacion La mortalidad materna y neonatal sigue siendo alta en paises con ingresos bajos y medios, siendo la escasa calidad de atencion durante el parto un impedimento para hacer progresos. Enfoque Se desarrollo y probo un metodo de calculo de la calidad de la atencion materna y neonatal que podria aplicarse en una gran iniciativa nacional de gestion del rendimiento. La herramienta utilizo observaciones directas y revisiones de historiales medicos para puntuar la calidad en nueve dominios de atencion durante el parto. La herramienta se piloto y evaluo en visitas a los 18 hospitales mas importantes con responsabilidad para fomentar y coordinar esfuerzos de mejora de la calidad de un conglomerado de hospitales en Etiopia. Entre las primeras evaluacionesy las de seguimiento, el personal de una colaboracion nacional de calidad proporciono formacion hospitalaria sobre el parto. Marco regional Etiopia ha invertido en mejoras de la calidad de los hospitales durante mas de una decada y esta herramienta se ha, Introduction Maternal mortality remains high in most low-and middle-income countries, and poor quality of intrapartum care limits further progress. (1, 2) Pregnancy- or childbirth-related complications lead to more than 380 [...]

Background: Extensive exposure to per- and polyfluoroalkyl substances (PFAS) have been observed in many countries. Current deterministic frameworks for risk assessment lack the ability to predict the likelihood of effects and to assess uncertainty. When exposure exceeds tolerable intake levels, these shortcomings hamper risk management and communication. Objective: The integrated probabilistic risk assessment (IPRA) combines dose-response and exposure data to estimate the likelihood of adverse effects. We evaluated the usefulness of the IPRA for risk characterization related to decreased levels of total triiodothyronine ([T.sub.3]) in humans following a real case of high exposure to PFAS via drinking water. Methods: PFAS exposure was defined as serum levels from residents of a contaminated area in Ronneby, Sweden. Median levels were 270ng/mL [perfluorooctane sulfonic acid (PFOS)] and 229ng/mL [perfluorohexane sulfonic acid (PFHxS)] for individuals who resided in Ronneby 1 y before the exposure termination. This data was integrated with data from a subchronic toxicity study in monkeys exposed daily to PFOS. Benchmark dose modeling was employed to describe separate dose-effect relationship for males and females, and extrapolation factor distributions were used to estimate the corresponding human benchmark dose. The critical effect level was defined as a 10% decrease in total [T.sub.3]. Results: The median probability of critical exposure, following a combined exposure to PFOS and PFHxS, was estimated to be [2.1% (90% CI: 0.4%-13.1%)]. Gender-based analysis showed that this risk was almost entirely distributed among women, namely [3.9% (90% CI: 0.8%-21.6%)]. Discussion: The IPRA was compared with the traditional deterministic Margin of Exposure (MoE) approach. We conclude that probabilistic risk characterization represents an important step forward in the ability to adequately analyze group-specific health risks. Moreover, quantifying the sources of uncertainty is desirable, as it improves the awareness among stakeholders and will guide future efforts to improve accuracy. https://doi.org/10.1289/EHP6654, Introduction Per- and polyfluoroalkyl substances (PFAS) is a class of chemicals used in a multitude of applications (Buck et al. 2011; Lau 2015). Although they have useful technical properties, some [...]

Background The coverage of community-based maternal, neonatal, and child health (MNCH) services remains low, especially in hard-to-reach areas. We evaluated the effectiveness of a mobile-phone-and web-based application, Innovative Mobile-phone Technology for Community Health Operations (ImTeCHO), as a job aid to the government's Accredited Social Health Activists (ASHAs) and Primary Health Center (PHC) staff to improve coverage of MNCH services in rural tribal communities of Gujarat, India. Methods and findings This open cluster-randomized trial was conducted in 22 PHCs in six tribal blocks of Bharuch and Narmada districts in India. The ImTeCHO mobile-phone-and web-based application included various technology-based job aids to facilitate scheduling of home visits, screening for complications, counseling during home visits, and supportive supervision by PHC staff. Primary outcome indicators were a composite index calculated based on coverage of important MNCH services and coverage of at least two home visitations by ASHA within the first week of birth. Primary analysis was intention to treat (ITT). Generalized Estimating Equation (GEE) was used to account for clustering. Eleven PHCs each were randomly allocated to the intervention (280 ASHAs, population: 234,134) and control (281 ASHAs, population: 242,809) arms. The intervention was implemented from February, 2016 to January, 2017. At the end of the implementation, 6,493 mothers were surveyed. Most of the surveyed women were tribal (5,571, 85.8%), and reported having a government-issued certificate for living below poverty line (4,916, 75.7%). The coverage of at least two home visits within first week of birth was 32.4% in the intervention clusters compared to 22.9% in the control clusters (adjusted effect size 10.2 [95% CI: 6.4, 14.0], p < 0.001). Mean number of home visits within first week of birth was 1.11 and 0.80 for intervention and control clusters, respectively (adjusted effect size 0.34 [95% CI: 0.23, 0.45], p < 0.001). The composite coverage index was 43.0% in the intervention clusters compared to 38.5% (adjusted effect size 4.9 [95% CI: 0.2, 9.5], p = 0.03) in the control clusters. There were substantial improvements in coverage home visits by ASHAs during antenatal period (adjusted effect size 15.7 [95% CI: 11.0, 20.4], p < 0.001), postnatal period (adjusted effect size 6.4, [95% CI: 3.2, 9.6], p Conclusions In this study, we found that use of ImTeCHO mobile- and web-based application as a job aid by government ASHAs and PHC staff improved coverage and quality of MNCH services in hard-to-reach areas. Supportive supervision, change management, and timely resolution of technology-related issues were critical implementation considerations to ensure adherence to the intervention. Trial registration Study was registered at the Clinical Trial Registry of India (www.ctri.nic.in). Trial number: CTRI/2015/06/005847. The trial was registered (prospective) on 3 June, 2015. First enrollment was done on 26 August, 2015., Author(s): Dhiren Modi 1, Nishith Dholakia 2, Ravi Gopalan 3, Sethuraman Venkatraman 3, Kapilkumar Dave 1, Shobha Shah 1, Gayatri Desai 1, Shamim A. Qazi 4, Anju Sinha 5, Ravindra [...]

Byline: Hossein. Jabbari, Reza. Piri, Fariba. Bakhshian, Babak. Mohit, Mohammad. Naghavi-Behzad, Sahar. Mohammadi, Nasim. Mahmoudzadeh Context: Most of the patients suffering from cancer are diagnosed at late stages of cancer, [...]

Background WHO has promoted the concept of integrated preventive chemotherapy (PC) as the principal strategy for control and elimination of a group of debilitating parasitic infections listed among neglected tropical [...]