Barriers to Treatment Adherence for Female Tuberculosis (TB) Patients during the COVID-19 Pandemic: Qualitative Evidence from Front-line TB interventions in Bengaluru City, India

Background: Available evidence shows that India’s ongoing COVID?19 pandemic response has adversely affected the national tuberculosis elimination program. Objectives: The study attempted to understand the barriers to successful treatment adherence for female tuberculosis (TB) patients due to disruptions caused by the pandemic. Methods: The study draws on qualitative in?depth interviews conducted with patients and TB health visitors from Bengaluru city before and during the pandemic period using a grounded theory approach. Results: While TB has the potential to push female patients who worked in informal arrangements to joblessness and poverty, the pandemic situation has exacerbated these vulnerabilities. The pandemic situation slowed down or suspended vital frontline interventions such as active case finding, distribution of medicine, follow?up of sputum examination, monitoring of medicine intake, and patient support measures. Conclusion: The pandemic?induced barriers to treatment adherence for the vulnerable TB patients can lead to adverse treatment outcomes including disease relapse and drug resistance. It is hence suggested that there is an urgent need for recasting the frontline TB interventions in India in the context of the pandemic in order to achieve the goal of TB elimination.

The impact of public health interventions in a developing nation: an overview

Introduction: Around 80% of factors that determine population health sit outside the control of health services. It is essential we influence these factors in addition to those within the remit of health services in order to improve and protect the health of population in a developing country. Public health functions encompass working across the domains that constitute population health systems with various partners. The objective of this article is to give an overview of public health interventions that can improve the health of the population of a developing nation. Method: A descriptive study, based on a review of the literature of key public health frameworks and interventions that are likely to have significant impacts on population health. Some selected public health interventions and case studies are highlighted to illustrate the importance of priority areas in developing countries. Results: Various public health frameworks recognise the importance of wider determinants of health (socio-economic factors), effective healthcare, healthy behaviours, working with communities as critical to securing population health. Another framework adopts a life-course model of intervention starting from public health interventions during preconception period and childhood, adolescence, working life and older age. For many developing countries, the author identified some examples of priority areas for interventions such as stopping and preventing wars; improving child health, including free school meals; achieving universal healthcare through integrated primary health care; addressing commercial determinants of health; embracing new technologies; and measuring and monitoring population health. Conclusion: In order to improve the health of a population in a developing country, attention needs to go beyond health services to influence the wider determinants of health, health behaviours and adopting the World Health Organisation's roadmap on essential public health functions.

Programa Bolsa Família e saneamento: uma revisão sistemática dos efeitos na diarreia e na desnutrição / Bolsa Família Program and environmental health: a systematic review of the effects on diarrhea and malnutrition

Resumo O Programa Bolsa Família e intervenções em saneamento são políticas públicas que podem ter efeito combinado positivo no enfrentamento das iniquidades em saúde. O Programa Bolsa Família busca propiciar melhoria das condições de saúde, diminuição da insegurança alimentar e aumento da renda familiar. Intervenções em saneamento objetivam garantir a saúde pública e a proteção do meio ambiente. O estudo objetivou revisar a literatura, procurando indícios de interações entre estas duas intervenções, influenciando nos desfechos morbidade e mortalidade por diarreia e desnutrição em menores de cinco anos. Foi realizada busca nas bases LILACS, SciELO e PubMed e a metodologia dos artigos foi avaliada por meio de escores da escala de Downs & Black adaptada. Foram identificados 1.658 artigos, dos quais quatro apresentaram todos os critérios para inclusão no estudo. Os estudos selecionados mostraram evidências do efeito positivo do Programa Bolsa Família e de intervenções em saneamento relacionados aos desfechos de interesse, quando analisados de forma independente um do outro. No entanto, nenhum artigo apresentou resultados que pudessem esclarecer o efeito conjunto destas políticas públicas em um modelo de interação, revelando lacuna na literatura nestas doenças particularmente atribuíveis à pobreza.

Abstract The Bolsa Família Programme and environmental health interventions are public policies that can have a combined positive effect on health inequities. The Bolsa Família Programme is designed to improve health conditions, reduce food insecurity and increase family incomes. Environmental health interventions aim to ensure public health and environmental protection. This study reviewed the literature for possible interactions between these two types of intervention that influence morbidity and mortality outcomes due to diarrhoea and malnutrition in the under-fives. A total of 1,658 articles were identified in the LILACS, SciELO and PubMed databases. The studies' methodologies were evaluated by scores on an adapted Downs & Black scale and four met all the study inclusion criteria. The findings showed evidence of the positive independent effects of the Bolsa Família Programme and of environmental health interventions in reducing illness and death from diarrhoea and malnutrition in the study age group. However, none of the articles offered results that might elucidate a joint effect of these public policies on an interaction model, revealing a gap in the literature on these diseases attributable particularly to poverty.

Vocal Training for Patients Post Vocal Cord Polyp Surgery Based on ICF and ICHI / 中国康复理论与实践

Objective:To explore the effect of vocal training based on International Classification of Functioning, Disability and Health (ICF) and International Classification of Health Interventions (ICHI) on vocal function after vocal cord polyps. Methods:A framework of rehabilitation was developed with joint use of ICF and ICHI. From January, 2017 to December, 2018, 30 patients with vocal cord polyps and vocal dysfunction post operation were sampled. They accepted the therapy for a month, and assessed with Grade, Roughness, Breathiness, Asthenia and Strain scale (GRBAS), and measured acoustic parameters before and after operation, and after training, respectively. Results:The scores of GRBAS decreased after training, compared with those both before and after operation (F > 6.214, P < 0.05), as well as the acoustic parameters of fundamental frequency, fundamental frequency perturbation, normalized noise energy and amplitude perturbation (F > 9.655, P < 0.05). Conclusion:Vocal training based on ICF and ICHI is effective on vocal function after operation for vocal cord polyps.

China′s strategy and experience in preventing and controlling the local spreading and epidemic of COVID-19 / 上海预防医学

After implementing a series of prevention and control strategies of Corona Virus Disease 19(COVID-19), China′s local epidemic situation has been basically blocked.While China has achieved a periodic success, global pandemic situation is still serious.Together with the timeline of China′s epidemic prevention and control this study reviewed the main strategies and measures in response to COVID-19 epidemic from Dec.2019 to Mar.23, 2020, and summarized China′s prevention and control plans and experiences.We hope all countries could fully understand the importance of non-pharmaceutical public health interventions, make positive and effective adjustments to the measures and strategies of prevention and control based on their own national conditions.

Zinc Supplementation for Promoting Growth in Children Under 5 years of age in Low- and Middle-income Countries: A Systematic Review

Objective: To study the effect of zinc supplementation in children under 5 years of age from low- and middle-income countries (LMICs) onanthropometry and prevalence of malnutrition.Design: Systematic review of randomized controlled trials and cluster randomized trials.Setting: Low- and middle-income countries.Participants: 63 trials with zinc supplementation, incorporating data on 27372 children. Trials conducted exclusively in specificallydiseased participants and in children with severe acute malnutrition were excluded.Intervention: Zinc supplementation, provided either as medicinal supplementation or through food fortification.Outcome Measures: (i) Anthropometry: weight, height, weight-for-height, mid-arm circumference, head circumference; (ii) Prevalenceof malnutrition.Results: There was no evidence of effect on height-for-age Z score at the end of supplementation period (25 trials; 9165 participants;MD= 0.00 Z; 95% CI -0.07, 0.07; P=0.98; moderate quality evidence) with significant heterogeneity (I² = 57%; P<0.001) related to doseand duration of zinc between trials. There was little or no effect on change in height-for-age Z score (13 trials; 8852 participants; MD= 0.11Z; 95% CI -0.00, 0.21; P=0.05), but the heterogeneity was considerable (I²=94%; P<0.001). There was no evidence of effect on length(6303 participants; MD= 1.18 cm; 95% CI -0.63, 2.99 cm, P=0.20; moderate quality evidence; considerable heterogeneity, I²=99%) but alittle positive effect on change in length (19 trials; 10783 participants; MD= 0.43 cm; 95% CI 0.16, 0.70, P=0.002; moderate qualityevidence; considerable heterogeneity, I²=93%). There was no evidence of effect on weight-for-age Z score or change in weight-for-age Zscore but a little positive effect on weight (19 trials; 8851 study participants; MD= 0.23 kg; 95% CI 0.03, 0.42; P=0.02; considerableheterogeneity, I²=91%) and change in weight (kg) (23 trials; 10143 study participants; MD= 0.11 kg; 95% CI 0.05, 0.17, P<0.001,substantial heterogeneity, I²=80%). There was no evidence of effect on weight-for-height Z score, and mid upper arm circumference at theend of supplementation period, but there was a little positive effect on change in mid-arm circumference from baseline (8 trials; 1724participants; MD = 0.09 cm; 95% CI 0.01, 0.16; P=0.03; no heterogeneity, I²=0%). Head circumference in zinc supplemented group wasmarginally higher compared to control (2966 study participants; MD= 0.39 cm; 95% CI 0.03, 0.75; P=0.03; substantial heterogeneity,I²=67%). There was no evidence of benefit in stunting (10 trials; 11838 study participants; RR= 1.0; 95% CI 0.95, 1.06; P=0.89; moderatequality evidence; no significant heterogeneity, I²=11%), wasting (7 trials; 8988 study participants; RR= 0.94; 95% CI 0.82, 1.06; P=0.31;moderate quality evidence; no significant heterogeneity, I²=13%) or underweight (7 trials; 8677 study participants; RR= 1.08; 95% CI 0.96,1.21; P=0.19; moderate quality evidence; substantial heterogeneity, I²=73%).Conclusion: Available evidence suggests that zinc supplementation probably leads to little or no improvement in anthropometric indicesand malnutrition (stunting, underweight and wasting) in children under five years of age in LMICs. Advocating zinc supplementation as apublic health measure to improve growth, therefore, appears unjustified in these settings with scarce resources.

Universal health care: What are the reform areas relevant to PAFP?

@#A good health system is supposed to improve the health of the population by providing effective health services equitably. Thus, the Universal Health Care (UHC) Act was designed to adopt a health care system that provides all Filipinos access to quality and cost-effective promotive, preventive, curative, rehabilitative and palliative health services without causing financial hardship especially the poor sector. There are four major elements in the UHC where family physicians can play a major role. The first is the population to be covered where there is now a shift of coverage from membership by premium payments to citizenship. The next is the health interventions to be included. This benefit package should be the one affordable to the whole society with priority to the worst-off sector. The next is the network of health professionals who will provide the health services. The network must be adequately distributed to provide service coverage for the whole population including the geographically isolated and disadvantaged areas. The last is the financing, where the delivery of health services must provide financial protection for the poor. To translate this into a realizable health sector reform agenda at the national and local level, there is a need for context-specific technical analyses and consultations from various sectors especially the private sector.

Caracterización de la interconsulta médico-psicológica en un hospital pediátrico de alta complejidad / Characterization of the medical-psychological consultation at a tertiary pediatric hospital

Durante los meses de febrero a mayo de 2014 se caracterizaron las interconsultas de pacientes del área de internación que no eran atendidos por equipos interdisciplinarios y por los que se consultaba por primera vez, realizadas por los becarios del Servicio de Salud Mental (SSM). Se analizaron los datos ociobiodemográficos de los pacientes, las categorías de los pedidos y los diagnósticos e intervenciones por parte del servicio de salud mental. También se analizó la coincidencia de los diagnósticos realizados por los pediatras solicitantes con los realizados por los especialistas. La muestra total quedó constituida por 62 pacientes, 53% de sexo masculino, 70% proveniente del conurbano. Los pediatras consideraron que el 94% de las consultas debían realizarse en el día. El pedido más frecuente fue el requerimiento de atención por síntomas psicopatológicos en el niño (45%), seguidos por el malestar en el niño inherente a la situación de enfermar (21%). De los síntomas psicopatológicos, los conversivos fueron los más frecuentes. En el 8% de los casos el especialista consideró luego de la evaluación que la interconsulta no era pertinente. En el 41% de los casos existió total coincidencia en el diagnóstico realizado por el pediatra y por el especialista. Los especialistas diagnosticaron 6% menos síntomas psicopatológicos que los pediatras en los niños, y 5% más en los padres. La intervención más utilizada fue la psicoterapéutica (90%). Solo requirieron farmacoterapia el 10% de los pacientes. El 86% de las consultas requirieron seguimiento durante la internación y el 26%, continuar de manera ambulatoria tras el alta (AU)

Between February and May 2014 consultations from the inpatient area for children who were not managed by multidisciplinary teams and who were consulted for the first time were evaluated by fellows from the Department of Mental Health. Sociodemographic data of the patients, consultation categories, diagnoses, and interventions by the Mental Health team were analyzed. Coincidence between the diagnosis made by the pediatricians who requested the consultation and that made by the specialists was also assessed. The total sample consisted of 62 patients; 53% were male and 70% came from Greater Buenos Aires. The pediatricians considered that 94% of the children needed consultation on the same day. The most common request for consultation was because of psychopathological symptoms in the child (45%), followed by disease-related discomfort in the child (21%). Conversion symptoms were the most common psychopathological symptoms observed. In 8% of the cases, after evaluation the specialist did not consider the consultation necessary. In 41% of the cases the diagnosis of the specialist coincided with that of the pediatrician. Specialists diagnosed 6% less psychopathological symptoms in children and 5% more in parents compared to pediatricians. The most commonly used intervention was psychotherapy (90%). Only 10% of the patients required pharmacotherapy. Overall, 86% of the consultations required follow-up during hospital stay and in 26% of the patients, follow-up in an outpatient setting was necessary (AU)

Applying principles of health system strengthening to eye care.

Understanding Health systems have now become the priority focus of researchers and policy makers, who have progressively moved away from a project-centred perspectives. The new tendency is to facilitate a convergence between health system developers and disease-specific programme managers in terms of both thinking and action, and to reconcile both approaches: one focusing on integrated health systems and improving the health status of the population and the other aiming at improving access to health care. Eye care interventions particularly in developing countries have generally been vertically implemented (e.g. trachoma, cataract surgeries) often with parallel organizational structures or specialised disease specific services. With the emergence of health system strengthening in health strategies and in the service delivery of interventions there is a need to clarify and examine inputs in terms governance, financing and management. This present paper aims to clarify key concepts in health system strengthening and describe the various components of the framework as applied in eye care interventions.

Chronic disease in the Caribbean: strategies to respond to the public health challenge in the region. What can we learn from Jamaica's experience? / Enfermedades crónicas en el Caribe: estrategias para responder a los retos de la salud pública en la región. ¿Qué podemos aprender de la experiencia de Jamaica?

With the advent of the epidemiological transition, chronic non-communicable diseases (CNCDs) have emerged as the leading cause of death globally. In this paper, we present an overview of the burden of CNCDs in the Caribbean region and use Jamaica as a case-study to review the impact of policy initiatives and interventions implemented in response to the CNCD epidemic. The findings show that while Jamaica has implemented several policy initiatives aimed at stemming the tide of the CNCD epidemic, a comparison of data from two national health and lifestyle surveys conducted in Jamaica in 2000/01 and 2007/08 revealed that there was an increase in the prevalence of intermediate CNCD risk factors such as hypertension and obesity. We therefore present recommended strategies which we believe will enhance the current CNCD response and thus reduce, or at least stem, the current epidemic of CNCDs.

Con el advenimiento de la transición epidemiológica, las enfermedades no comunicables crónicas (ENCCs) han emergido como la causa principal de muerte a nivel mundial. En este trabajo, se presenta un panorama general de la carga que las ENCCs representa para la región caribeña. Asimismo, se utiliza Jamaica como estudio de caso para examinar el impacto de las iniciativas en materia de políticas así como las intervenciones, implementadas en respuesta a la epidemia de ENCC. Los hallazgos muestran que si bien Jamaica ha implementado varias iniciativas en cuanto a políticas, dirigidas a detener la marea de la epidemia de ENCC, una comparación de datos de dos encuestas nacionales sobre salud y estilo de vida realizadas en Jamaica en 2000/01 y 2007/08 revelaron que hubo un aumento de la prevalencia de los factores de riesgo intermedios de las ENCC, tales como la hipertensión y la obesidad. Por lo tanto, se presentan estrategias recomendadas, las cuales pueden - a nuestro juicio - mejorar la respuesta actual a las ENCC, y por ende reducir - o al menos frenar - la actual epidemia de ENCCs.

Epidemiology to public health intervention for preventing cardiovascular diseases: The role of translational research.

Despite significant progress in medical research, cardiovascular diseases (CVDs) continue to be the largest contributors of morbidity and mortality both in developed and developing countries. The status of public health interventions related to CVDs prevention was reviewed to identify actions that are required to bridge the existing gap between the evidence and the policy. We used a framework comprising two steps - “bench to bedside” and from “bedside to community” to evaluate translational research. Available literature was reviewed to document the current status of CVD prevention and control at national level in India. Case studies of risk factor surveillance, tobacco control and blood pressure measurement were used to understand different aspects of translational research. National level initiatives in non-communicable diseases surveillance, prevention and control are a recent phenomena in India. The delay in translation of research to policy has occurred primarily at the second level, i.e., from ‘bedside to community’. The possible reasons for this were: inappropriate perception of the problem by policy makers and programme managers, lack of global public health guidelines and tools, and inadequate nationally relevant research related to operationalization and cost of public health interventions. Public health fraternity, both nationally and internationally, needs to establish institutional mechanisms to strengthen human resource capacity to initiate and monitor the process of translational research in India. Larger public interest demands that focus should shift to overcoming the barriers at community level translation. Only this will ensure that the extraordinary scientific advances of this century are rapidly translated for the benefit of more than one billion Indians.

Intervenciones de enfermería en la salud en el trabajo / Nursing activities in occupational health care

Resumen

El campo de la salud ocupacional o salud en el trabajo es complejo y requiere la atención de diferentes disciplinas que coadyuven al cumplimiento de su misión. En esta área como en otras, la enfermería cumple la noble función bajo la perspectiva fundamental de la prevención y la promoción de la salud antes que el enfoque meramente curativo y por ello, su aporte es trascendental. En el presente escrito se describe la historia de la enfermería en el campo de la salud ocupacional, su enfoque y su importancia, asimismo, se señalan nueve intervenciones básicas de la enfermería en esta área y las funciones correspondientes a cada una. Se comentan las perspectivas futuras de desarrollo de la enfermería en el tema y los potenciales retos.

Summary

The occupational health field is complex and requires the involvement of different disciplines which must support its efforts so as to get their goals. In this area as others, the nursing profession carries out its functioning under the main focus of the health prevention and health promotion more than only from a cure approach, so its contribution is highly significant. In the present paper we described the history of occupational health nursing, its focus and importance as well as the nine basic interventions of nursing in occupational health considering the specific responsibilities and tasks in each intervention. The future perspectives and challenges of occupational health nursing are discussed.

Treinamentos em epidemiologia realizados em instituições conveniadas com o centro nacional de epidemiologia (cenepi): congruências e discrepâncias com indicadores

Resumo: A avaliação de intervenções na {1rea de saúde pública brasileira é uma prática que vem se consolidan­do nesses últimos anos. Diferentes modelos de avalia­ção têm sido utilizados para este fim. O presente estudo destina-se a verificar o grau de atingimento de parâmetros ou referenciais de treina­mento cm Epidemiologia estabelecidos pelo Centro Na­cional de Epidemiologia do Ministério da Saúde (CENEPI) por dez instituições de ensino superior con­veniadas por aquele Centro. Para esse propósito, foi escolhido o modelo de Stake, o qual focaliza-se em congruências e discrepâncias verificadas na prática das dez instituições conveniadas, bem assim na prática dos serviços de saúde envolvidos, em relação aos parâ­metros acima referidos. Os referenciais de treinamento em Epidemiolo­gia são oito: (a) planejamento conjunto do treinamento, (b)diagnóstico de recursos humanos em Epidemiolo­gia, (c) avaliação continuada dos convênios, (d)sclcção dos candidatos, (e) liberação dos candidatos/modulari­zação dos cursos, (f) instalação de núcleos de Epidemio­logia, (g)assessoramento de equipes após treinamento e (h)disseminação de bibliografia de treinamento. Questionários respondidos pelo CENEPT, insti­tuições de ensino superior e senriços de saúde mostra­ram que predomina a congruência entre os três grupos de órgãos com relação aos oito parâmetros ou referen­ciais do CENEPJ. Entretanto, ressaltam proporções ele­vadas de discrepâncias, bem assim de concordâncias quanto ao não atingimento dos referenciais tanto pelas instituições de ensino superior como por servi­ços de saúde.

Abstract: Public health authorities have made an increasingly regular practice to submit interventions in their services to evaluation. Numerous evaluation models have been employed to this end. The present study seeks to verify the extent to which training parameters or referents in Epidemiology established by the Epidemiology National Center (CENEPI) of the Brazilian Ministry of Health were attained by ten university level institutions contracted by the referred Center and also the local public health services. Consonant with this purpose. Stake's evaluation model was chosen. This model focuses on congruencies and discrepancies occurring in the training practices of the ten institutions regarding CENEPI's training parameters. The parameters set up by CENEPI for training in Epidemiology are eight, namely: (a) joint planning of training, (b) diagnostic of available personnel in epidemiology, (c) continned evaluation of the contracts, (d) screening of candidates € candidate discharge from service/training flexibilization, (f) establishment of state epidemiology centers, (g) support to local epidemiology groups after training, and (h) dissemination of training bibliography. Questionnaires responded by the three groups of institutions involved in the evaluation - CENEP university level institutions and local public health services - showed a predominance of congruencies among the three groups of institutions regarding the eight parameters of training in epidemiology. However, discrepancies as well as agreement concerning failure to attain CENEPI's parameters on the part of university level institutions and local public health services were noticeable.