Status of universal drug-susceptibility testing among sputum smear-positive tuberculosis patients diagnosed at a tertiary care centre

Background & objectives: This study was aimed at estimating the proportion among sputum smear-positive tuberculosis (TB) patients diagnosed at a tertiary care centre in India, who did not undergo universal drug-susceptibility testing (UDST), assessing the sociodemographic and morbidity-related factors associated with it, ascertaining the reasons for not getting tested and estimating the proportion with any drug resistance (DR). Methods: TB Notification Register and TB Laboratory Register, maintained in Designated Microscopy Centre and Intermediate Research Laboratory, respectively were used to obtain the patient details and information regarding UDST and DR-TB status. Under UDST, the TB patients had undergone rapid molecular tests to check for any DR. TB patients who dropped out of this strategy (those who did not submit a sputum sample for DR testing even after being instructed) were telephonically contacted and asked regarding reasons for not getting themselves tested. Results: Of the 215 patients, 74 [34.4%, 95% confidence interval (CI): 28.1-41.2] did not undergo UDST. Of these 74 participants, 60 per cent reported the reason that they were not informed regarding the drug-susceptibility test. Among the 141 patients who underwent UDST, six (4.3%, 95% CI: 1.58-9.03) had DR. Non-UDST patients were significantly more in percentage among TB patients who were aged <30 years (adjusted prevalence ratio 2.36; 95% CI: 1.19-4.68) compared to >60 years. Interpretation & conclusions: The present findings point towards a need to sensitize healthcare workers and TB patients to improve UDST.

Relevance of Project Evaluation and Review Technique (PERT) for Procurement of Equipments in a Government Medical College and Hospital in North-East India

Introduction: Continuous procurement of various equipments in the hospitals is essential to keep up with global progress of healthcare services. In public sectors, procurement process largely depends on budget sanctions and also by a number of formal procedures and rules which leads to delayed procurement. With this prevalent scenario, the present study was carried out to evaluate the procurement of two major equipments in an apex tertiary care institute using Project Evaluation and Review Technique (PERT). Objective: This study was done to evaluate the procurement of two major equipments using PERT in a tertiary care institute. Method: This study was conducted using Operational Research technique in an apex tertiary care institute i.e., medical college and hospital, in one of the North Eastern states of India. All the procurements related to equipments in that teaching hospital initiated in the financial year 2021 were listed. Out of them, two procurement files were selected by simple random sampling; procurement of Operating Table and Bio Safety cabinet Level – III. Project Evaluation and Review Technique (PERT) was applied to calculate the possible reduction in time in the whole procurement process. Results: The present study showed that procurement of Operating table took 185 days where minimum 8 days could have been saved and procurement of Bio-Safety cabinet Level-III was completed by 702 days where minimum 196 days could have been saved. Conclusion: Application of PERT in this procurement evaluation process can play significant role by calculating critical path and predicting the possible delay.

Replacement of core team members on embedded implementation research teams: experiences from Latin America and the Caribbean / Sustitución de los miembros principales de los equipos de investigación integrada en materia de ejecución: experiencias en América Latina y el Caribe / Substituição de membros essenciais de equipes de pesquisa de implementação incorporada: experiências da América Latina e do Caribe

ABSTRACT Objective. To understand how replacement of decision-makers (DMs) serving as principal investigators (PI) or co-PIs on research teams may affect the feasibility and value of embedded implementation research (EIR) used to improve health policies, programs, and services in Latin America and the Caribbean. Methods. This was a descriptive qualitative study based on 39 semistructured interviews with 13 embedded research teams selected by financing agencies to explore team composition, interaction among members, and research results. Interviews were conducted at three points during the study period from September 2018 to November 2019; data were analyzed from 2020 to 2021. Results. Research teams were found to be operating in one of three situations: (i) permanent core team (no change) with either active DM or inactive DM participation; (ii) replacement of DM-PI or co-PI that did not affect EIR research; and (iii) replacement of DM-PI that affected EIR. Conclusions. To ensure EIR continuity and stability, research teams should include high-level DMs together with more technical staff performing essential implementation activities. This structure could improve collaboration among professional researchers and ensure greater embeddedness of EIR to strengthen the health system.

RESUMEN Objetivo. Comprender de qué manera la sustitución de los responsables de tomar decisiones (RTD) que se desempeñan como investigadores principales (IP) o coinvestigadores principales (coIP) en los equipos de investigación puede incidir en la viabilidad y el valor de la investigación integrada en materia de ejecución (IIME) utilizada con el objetivo de mejorar las políticas, los programas y los servicios de salud en América Latina y el Caribe. Métodos. Este estudio cualitativo descriptivo se basó en 39 entrevistas semiestructuradas realizadas a 13 equipos de investigación integrada seleccionados por organismos de financiación con el objetivo de estudiar la composición de los equipos, la interacción entre sus miembros y los resultados de la investigación. Las entrevistas se realizaron en tres ocasiones durante el período de estudio, que se extendió de septiembre del 2018 a noviembre del 2019; los datos se analizaron entre el 2020 y el 2021. Resultados. Se encontró que los equipos de investigación se desempeñaban en una de las siguientes tres situaciones: a) un equipo central permanente (sin cambios), sea con participación activa del RTD o sin participación activa del mismo; b) sustitución del RTD-IP o coIP, sin consecuencias para la IIME; y c) sustitución del RTD-IP, con consecuencias para la IIME. Conclusiones. Para asegurar la continuidad y estabilidad de la IIME, los equipos de investigación deberían incluir RTD de alto nivel junto con más personal técnico que lleve a cabo actividades esenciales en materia de ejecución. Esta estructura podría mejorar la colaboración entre los investigadores profesionales y asegurar una mayor integración de la IIME con la finalidad de fortalecer el sistema de salud.

RESUMO Objetivo. Entender como a substituição de decisores atuando como investigadores principais ou co-investigadores em equipes de pesquisa pode afetar a viabilidade e o valor da pesquisa de implementação incorporada (EIR, na sigla em inglês), método usado para aprimorar as políticas, programas e serviços de saúde na América Latina e no Caribe. Métodos. Estudo qualitativo e descritivo, baseado em 39 entrevistas semiestruturadas com 13 equipes de pesquisa incorporadas, selecionadas por agências de fomento, para explorar a composição das equipes, a interação entre os membros e os resultados das pesquisas. As entrevistas foram realizadas em três momentos durante o período de estudo, de setembro de 2018 a novembro de 2019. Os dados foram analisados de 2020 a 2021. Resultados. Verificou-se que as equipes de pesquisa se encontravam em uma das seguintes três situações: (i) equipe essencial permanente (sem alteração), com participação ativa ou inativa do decisor; (ii) substituição do decisor (investigador principal ou co-investigador) não afetou a pesquisa EIR; e (iii) substituição do decisor (investigador principal ou co-investigador) afetou a pesquisa EIR. Conclusões. Para garantir a continuidade e estabilidade de pesquisas de EIR, as equipes de pesquisa devem incluir decisores de alto nível, juntamente com pessoal de perfil mais técnico, para realizar atividades essenciais de implementação. Tal estrutura poderia melhorar a colaboração entre pesquisadores profissionais e garantir uma incorporação ainda maior da EIR para fortalecer o sistema de saúde.

Colistin resistance in Escherichia coli and Klebsiella pneumoniae in humans and backyard animals in Ecuador / Resistencia a la colistina de las bacterias Escherichia coli y Klebsiella pneumoniae en humanos y animales de granja en Ecuador / Resistência à colistina em Escherichia coli e Klebsiella pneumoniae em humanos e animais de quintal no Equador

ABSTRACT Objective. Colistin is an antibiotic of last resort for treating serious Gram-negative bacterial infections. However, the misuse of colistin, especially as an animal growth promoter, has contributed to increasing antimicrobial resistance, mediated mainly through plasmid transfer of the mcr-1 gene. This study assessed the prevalence of phenotypic and molecular colistin resistance in Escherichia coli and Klebsiella pneumoniae in Ecuador in healthy humans and their chickens and pigs. Methods. Fecal samples were collected from humans and their chickens and pigs in two rural coastal and Amazon regions between April and August 2020. Gram-negative bacteria were isolated and identified using conventional techniques. Phenotypic resistance was determined using the broth microdilution technique, and the mcr-1 gene was detected using conventional polymerase chain reaction. Results. A total of 438 fecal samples were obtained from 137 humans, 147 pigs and 154 chickens. The prevalence of E. coli isolates was 86.3% (378/438) and K. pneumoniae, 37.4% (164/438). Overall, the mcr-1 gene was found in 90% (340/378) of E. coli isolates, with higher prevalences found in isolates from coastal regions (96.5%, 191/198), humans (95.6%, 111/116) and chickens (91.8%, 123/134); for K. pneumoniae, the gene was found in 19.5% (32/164) of isolates, with equal distribution between regions and hosts. Only four isolates, two E. coli and two K. pneumoniae, showed phenotypic resistance: mcr-1 was present in both E. coli strains but absent in the K. pneumoniae strains. Conclusions. Despite a low prevalence of phenotypic resistance to colistin, the high prevalence of the mcr-1 gene in E. coli is of concern. Ecuador's ban on using colistin in animal husbandry must be enforced, and continual monitoring of the situation should be implemented.

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RESUMO Objetivo. A colistina é um antibiótico de último recurso para o tratamento de infecções graves por bactérias Gram-negativas. Entretanto, o uso indevido da colistina, principalmente como promotor de crescimento animal, tem contribuído para o aumento da resistência a antimicrobianos, principalmente por transferência horizontal do gene mcr-1 mediada por plasmídeos. Este estudo avaliou a prevalência de resistência fenotípica e molecular à colistina em Escherichia coli e Klebsiella pneumoniae no Equador em humanos hígidos e em galinhas e porcos por eles criados. Métodos. Entre abril e agosto de 2020, foram coletadas amostras de fezes de habitantes de duas regiões litorâneas e amazônicas do Equador e de galinhas e porcos por eles criados. Bactérias Gram-negativas foram isoladas e identificadas por meio de técnicas convencionais. A resistência fenotípica foi determinada pela técnica de microdiluição em caldo, e o gene mcr-1 foi detectado por reação em cadeia da polimerase convencional. Resultados. Foram obtidas 438 amostras fecais de 137 humanos, 147 suínos e 154 galinhas. A prevalência de isolados de E. coli foi de 86,3% (378/438), e de K. pneumoniae, 37,4% (164/438). Em geral, o gene mcr-1 foi encontrado em 90% (340/378) dos isolados de E. coli, com maiores prevalências encontradas em isolados de regiões litorâneas (96,5%, 191/198), humanos (95,6%, 111/116) e galinhas (91,8%, 123/134); para K. pneumoniae, o gene foi encontrado em 19,5% (32/164) dos isolados, com igual distribuição entre regiões e hospedeiros. Somente quatro isolados, dois de E. coli e dois de K. pneumoniae, demonstraram resistência fenotípica: o gene mcr-1 estava presente em ambas as cepas de E. coli, mas ausente nas de K. pneumoniae. Conclusões. Apesar da baixa prevalência de resistência fenotípica à colistina, a alta prevalência do gene mcr-1 em E. coli é preocupante. É preciso fiscalizar a proibição ao uso agropecuário de colistina no Equador e implementar o monitoramento contínuo da situação.

Logistical transportation routes optimization for Brazilian soybean: an application of the origin-destination matrix / Otimização das rotas logísticas de transporte da soja brasileira: uma aplicação da matriz origem-destino

ABSTRACT: The last Brazilian agricultural frontier known as MATOPIBA, an acronym for the states of Maranhão, Tocantins, Piaui and Bahia, is a region that has stood out in the scenario of modern large-scale agriculture intensive in capital and technology. However, barriers related to the transportation system, especially regarding the high logistics costs, have been negatively impacting this sector. To optimize the performance of this chain, a model for minimizing transportation costs was developed, using linear programming with an origin-destination matrix. The purpose of this paper was to evaluate whether the use of the North-South Railroad has potential as a new alternative intermodal route for soybean export from the MATOPIBA region, in order to minimize the transportation costs and promote the viability of new ports located in the northeast region of the country. This configuration can also contribute to reduce the overload of Santos Port (SP). Two scenarios were proposed based on the 2016/17 harvest of soybeanwhere the first scenario (A) consisted only of road routes, while the second (B), in addition to these routes, incorporated road-rail and road-water way intermodal routes. As a result, total transportation cost was reduced by 30% in scenario B and about half of all cargo was shipped by the new intermodal road-rail route to the Itaqui Port in the Northeast region. This configuration promotes a more sustainable logistics chain for soy, with more rational use of transport modes and decentralization of investments to other regions.

RESUMO: A última fronteira agrícola brasileira conhecida como MATOPIBA, acrônimo de Maranhão, Tocantins, Piauí e Bahia, é uma região que vem se destacando no cenário da agricultura moderna de grande escala e intensiva em capital e tecnologia. No entanto, entraves relacionados ao sistema de transporte, principalmente com relação aos altos custos logísticos, vêm impactando negativamente esse setor. Para otimizar o desempenho dessa cadeia foi desenvolvido um modelo de minimização dos custos de transporte, operacionalizado por programação linear sob a forma de uma matriz origem-destino. A proposta deste trabalho é avaliar se a utilização da Ferrovia Norte-Sul apresenta potencial como nova rota intermodal alternativa para a exportação da soja da região do MATOPIBA, afim de minimizar o custo com transporte e promover a viabilidade de novos portos localizados na região Nordeste do país. Esta configuração também pode contribuir para reduzir a sobrecarga do Porto de Santos (SP). Dois cenários foram propostos com base na safra 2016/17, onde o primeiro cenário (A) foi composto apenas por rotas rodoviárias, enquanto o segundo (B), além dessas rotas foram incorporadas as rotas intermodais rodoferroviária e rodohidroviária. Como resultado, o custo total de transporte teve uma redução de 30% no cenário B, e cerca da metade de toda a carga foi escoada pela nova rota intermodal rodoferroviária com destino ao Porto de Itaqui na região Nordeste. Esta configuração promove uma logística de distribuição mais sustentável para a soja, com uso mais racional dos modais de transporte e a descentralização dos investimentos para outras regiões.

Avaliação do desempenho do uso da tecnologia da informação na saúde: revisão sistemática da literatura sobre o tema / Performance assessment of the use of information technology in health management: a systematic review of the literature on the topic

Resumo A Tecnologia da Informação (TI) tornou-se fundamental na prestação de serviços de cuidado à saúde, abrangendo a pluralidade dos aspectos que envolvem a área. Isso faz com que a TI possa oferecer significativa contribuição ao desempenho das organizações de saúde. Há uma lacuna do conhecimento sobre como realizar e implementar melhorias nessas tecnologias, que como um dos motivos, cita-se a carência de estudos com o tema de Avaliação de Desempenho de Tecnologia da Informação na saúde. O objetivo deste trabalho é contribuir na disseminação do conhecimento sobre o assunto, através da realização de uma revisão sistemática com o emprego do "Knowledge Development Process - Constructivist (Proknow-C)". Através da análise de métricas de produção, observou-se de que forma os estudos integrantes do Portfólio Bibliográfico da pesquisa representam a área do conhecimento investigada, e a partir de uma análise sistemática do conteúdo dessas publicações foi possível indicar as lacunas do conhecimento ainda existentes na área. Como limitação do estudo destaca-se a característica construtivista do "Proknow-C" e, nas sugestões para futuras pesquisas, recomenda-se o preenchimento das lacunas de conhecimento observadas, oriundas da análise realizada.

Abstract Information Technology (IT) has become fundamental in the provision of healthcare services, encompassing the entire gamut of aspects involved in the area. For this reason, IT can make a significant contribution to the performance of health organizations. There is a knowledge gap about how to introduce and implement improvements in these technologies, one of the reasons cited being the lack of studies on the topic of Evaluation of the Performance of Information Technology in health. The objective of this work is to contribute to the dissemination of knowledge on the subject, by conducting a systematic review using Proknow-C (Knowledge Development Process-Constructivist). By means of the analysis of production metrics, it was seen how the studies comprised in the Bibliographical Portfolio of research represent the area of knowledge investigated. Based on a systematic analysis of the content of these publications, it was possible to ascertain the knowledge gaps still existing in the area. As a limitation of the study, the constructivist nature of Proknow-C is the main issue and, in the suggestions for future research, it is recommended that, based on the analysis performed, the knowledge gaps identified be filled.

Indicadores operacionais do controle da tuberculose no município de belém-pará / Indicadores operativos del control de la tuberculosis en el municipio de belém-pará / Operational indicators of tuberculosis control in the municipality of belém-pará

RESUMO Objetivo: descrever os indicadores operacionais do controle da tuberculose no município de Belém no período 2013-2017. Método: estudo quantitativo, descritivo, cujos dados foram oriundos do Sistema de Informação de Agravos de Notificação do município de Belém, obtidos junto à Secretaria Municipal de Saúde em junho de 2019 e dizem respeito aos indicadores operacionais do Programa Nacional de Controle da Tuberculose. A análise se deu por meio de estatística descritiva. Resultados: identificou-se fragilidades no controle da doença no município de Belém. Todos os indicadores, sejam os referentes ao diagnóstico precoce, tratamento e desfecho, mostraram baixa capacidade para o controle da doença no município. Conclusão: o não cumprimento das metas previstas implica na manutenção da doença na comunidade e favorecimento de casos de resistência às drogas, aumentando custos e sofrimento humano. Os resultados possibilitam reflexão acerca da necessidade do monitoramento das ações de controle.

RESUMEN: Objetivo: describir los indicadores operativos del control de la tuberculosis en el municipio de Belém durante el período 2013-2017. Método: estudio cuantitativo y descriptivo, cuyos datos fueron extraídos del Sistema de Información de Enfermedades de Notificación Obligatoria del municipio de Belém, obtenidos con la intervención de la Secretaría Municipal de Salud en junio de 2019, relacionados con los indicadores operativos del Programa Nacional de Control de la Tuberculosis. El análisis se realizó por medio de estadística descriptiva. Resultados: se identificaron debilidades en el control de la enfermedad en el municipio de Belém. Todos los indicadores, ya sea referidos al diagnóstico precoz, tratamiento o resultado, presentaron escasa capacidad para controlar la enfermedad en el municipio. Conclusión: la falta de cumplimiento de las metas previstas implica la permanencia de la enfermedad en la comunidad, el favorecimiento de los casos de resistencia a los fármacos, con el consiguiente aumento de costos y sufrimiento humano. Los resultados permiten reflexionar acerca de la necesidad de monitorear las acciones de control.

ABSTRACT Objective: to describe the operational indicators of tuberculosis control in the municipality of Belém in the 2013-2017 period. Method: a quantitative and descriptive study, whose data came from the Notifiable Diseases Information System in the municipality of Belém, obtained together with the Municipal Health Secretariat in June 2019 and relating to the operational indicators of the National Program for Tuberculosis Control. The analysis was performed using descriptive statistics. Results: weaknesses in the control of the disease were identified in the municipality of Belém. All the indicators, whether referring to early diagnosis, treatment or outcome, showed low capacity for disease control in the municipality. Conclusion: failure to meet the targets set implies maintaining the disease in the community and favoring cases of drug resistance, increasing costs, and human suffering. The results make it possible to reflect on the need to monitor the control actions.

Barriers of Treatment-Supporters for DOTS under RNTCP in District Shahdol, India: A Mix-Method Study

Background: One of the challenges of Revised National Tuberculosis Control Programme (RNTCP) has been that it has not been able to impart adequate knowledge, satisfactory attitude and desirable practices among treatment-supporters of rural and tribal communities. Present study was planned to explore the knowledge, attitude, practice and perceived barriers related to Directly Observed treatment (DOT) provision among the treatment-supporters of Shahdol district, Madhya Pradesh in 2018. Methods: Mixed–methods study design of triangulation type was used among 30 community- based treatment-supporters of DOT from Sohagpur tahsil of district Shahdol of Madhya Pradesh, India. The cross-sectional quantitative component assessed the knowledge, attitude and practices and three focus-group discussions were used to explore the perceived barriers related to DOT provision. Results: ‘Adequate knowledge’ related to DOT provision was found in 37% of treatment- supporters, while 40% had “satisfactory attitude” and 60 % had “satisfactory practice” related to DOT. The focus-group discussions revealed, ineffective training, lack of supportive supervision, insecure monetary incentive, distant Public Health Institution/Designated Microscopic Center, language barrier and patient related stigma to TB disease as main perceive challenges related to DOT. Conclusion: Study revealed inadequate knowledge and unsatisfactory attitude and practice related to DOT provision among treatment-supporters. Effective training, making services accessible to patient, making RNTCP form in Hindi language and strengthening of honorarium disbursement mechanism are urgently required.

Research on supervision strategy of physical examination institutions after abolishing administrative approval / 中华劳动卫生职业病杂志

Objective@#To follow the principle of adapting to the constantly updated laws and regulations of the state, put forward the supervision strategy of occupational health inspection institutions under the new situation, and standardize the practice of inspection institutions.@*Methods@#The work of supervision and inspection was carried out in the provincial occupational health inspection institutions for five consecutive years.@*Result@#Occupational health inspection institutions generally have non-standard work of occupational health inspection, deviations in understanding the relevant laws, regulations, policies and standards of occupational diseases, incomplete coverage of the assessment forms used in previous supervision and inspection, and insufficient refinement of the scores, only considering the basic conditions for occupational health inspection, but not from the level of quality management and discipline construction. As a result, some occupational health inspection institutions have backward instruments and equipment, poor ability and low level of practitioners, and inaccurate results of occupational health inspection, which bring hidden dangers to the health of employers and workers.@*Conclusion@#According to the results of supervision and inspection of occupational health inspection institutions in the province, the common problems are summarized and analyzed, and the supervision strategies of occupational health inspection institutions under the new situation are put forward in accordance with the principle of adapting to the constantly updated laws and regulations of the state.

Protocolo de Atendimento Psicológico em um Serviço de Reprodução Humana Assistida do Sistema Único de Saúde - SUS / Psychological Assistance Protocol in a Human Reproductive Service of Brazilian Unified Health System

Resumo: Este trabalho apresenta uma solução otimizada para atender casais submetidos a tratamentos de infertilidade em um serviço público. O objetivo foi a construção de um protocolo de atendimento psicológico. A metodologia foi baseada em técnicas da pesquisa operacional, sendo o protocolo elaborado em cinco etapas: 1) construção do fluxograma de atendimento; 2) elaboração do instrumento de entrevista semiestruturada; 3) aplicação de instrumentos de avaliação; 4) criação do grupo de apoio aos casais; 5) estabelecimento da rotina de atuação da psicologia. Como resultado, apresenta-se o protocolo criado. A criação desse protocolo busca contribuir para a necessária sistematização da entrevista psicológica, melhorando a qualidade da assistência integral a esses casais.

Abstract This paper presents an improved solution for the care of couples undergoing infertility treatments in a public service. The purpose of the study was to develop a psychological treatment protocol. The methodology used was based on techniques of operations research and protocol elaborated of five steps: 1) construction of service flowchart; 2) preparation of semi-structured interview tool; 3) application of assessment tools; 4) creation of a support group for couples;; 5) establishment of psychological intervention routine. As a result the elaborated protocol is presented. The creation of this protocol aims to contribute to the necessary systematization, improving the quality of comprehensive care to these couples.

Operational research principles for a routine service process for monitoring the human immunodeficiency virus/acquired immunodeficiency syndrome treatment cascade: data from a cohort in Brazil

Abstract INTRODUCTION: Bottlenecks still exist during human immunodeficiency virus care that may delay the achievement of better outcomes. METHODS: We established a monitoring system to trace patients throughout the human immunodeficiency virus/acquired immunodeficiency syndrome care process in Juiz de Fora, Brazil, to identify potential bottlenecks. RESULTS: Among 250 patients, 17.6% abandoned follow-up. Our monitoring system tracked 86.4% of patients through the medication logistics control system and 2.3% through the mortality information system. Two percent of patients were not located by our monitoring system. CONCLUSIONS: A pathway care process contributes to a better understanding of the barriers to the treatment cascade.

Tuberculosis contact tracing among children and adolescent referred to children's hospital in Rio de Janeiro, Brazil

Objective: To describe the investigation of latent tuberculosis infection and indication for isoniazid preventive therapy in children and adolescents evaluated at the children's hospital. Methods: This retrospective study examines all latent tuberculosis infection subjects with indication for isoniazid preventive therapy attended during 2002-2009 at the pulmonology outpatient clinic from children's hospital in Rio de Janeiro, Brazil. The subjects were classified into three groups by origin: (G1) primary and secondary health units; (G2) children's hospital-pulmonology outpatient clinic; and (G3) children's hospital-specialty outpatient clinics. The association between the variables examined and G1 was analyzed using uni- variate analysis. Results: Of the 286 latent tuberculosis infection cases included 169 (59.1%) were from G1, 56 (19.6%) from G2, and 61 (21.3%) from G3. Latent tuberculosis infection diagnosis without isoniazid preventive therapy prescription was present in 142 (49.6%) cases before arrival at the pulmonology outpatient clinic: 135 (95.1%) from G1, three (2.1%) from G2, and four (2.8%) from G3. Variables associated with G1 were presence of isoniazid preventive therapy criteria before attending the pulmonology outpatient clinic (OR: 62.3; 26.6-146.2), negative HIV infection status (OR: 9.44; 1.16-76.3); contact with pulmonary tuberculosis (OR: 5.57; 1.99-15.5), and residing in Rio de Janeiro city (OR: 1.89; 1.04-3.44). Conclusion: Strategies that increase latent tuberculosis infection identification and isoniazid preventive therapy prescription in primary and secondary health units are urgently needed. .

Mapping an HIV Treatment Program to Identify Barriers to Linkage in HIV Care in Resource Limited Settings.

Aims: To develop a practical method to evaluate and address failures to linkage to care for HIV treatment so as to achieve better access to antiretroviral therapy in resource limited settings. Study Design: A mixed methods analysis to identify and quantify failure to linkage to care involving intensive program mapping, retrospective quantification of retention data, and statistical analysis. Place and Duration of Study: AIC Kijabe Hospital, Kijabe Kenya. Data were collected from January 1 to December 31, 2011. Data collection and analysis was conducted in February 2012. Methodology: First a series of successive interviews of all levels of care providers was used to create a program map and identify linkage points. Following this, data registries were identified and cases at each linkage point were quantified. Simple statistical analysis of retention data were then completed and trends analyzed by Kaplan-Meier survival analysis. Results: Less than 20% of eligible cases testing positive for HIV were enrolled in the treatment program. Most cases enrolled received CD4 testing (78.9%). Most eligible enrolled patients were initiated on ART (82.2%). Patients referred from VCT (voluntary testing) were more likely to be enrolled, receive CD4 testing, and be initiated on therapy. Cases enrolled in the program within 7 days of HIV diagnosis had improved time to initiation of therapy (43 days vs 79 days, p<.001). Cases who received a CD4 test within seven days of diagnosis also had improved time to initiation of therapy (47 vs 77 days, p=.01). Conclusion: This method proved effective to identify, prioritize, and problem solve to improve linkages to care in our setting. Further evaluation should include prospective studies to identify facilitators to linkage and test interventions.

Morbidity Control of Schistosomiasis by Mass Drug Administration: How Can We Do It Best and What Will It Take to Move on to Elimination?

The World Health Organization (WHO) has, for some time, encouraged countries endemic for schistosomiasis to control morbidity from this disease through mass drug administration (MDA) of the well-tolerated drug, praziquantel (PZQ). With the London Declaration in January 2012 and the promise by Merck Serono to eventually donate 250 million PZQ tablets per year, most endemic countries in sub-Saharan Africa have now developed national plans to do MDA for schistosomiasis morbidity control. More recently, based on two World Health Assembly (WHA) resolutions (WHA 54.19 & WHA 65.21) on schistosomiasis, countries are further encouraged to eliminate schistosomiasis, where feasible. The fight against schistosomiasis is therefore in a critical period of tremendous opportunities and equal challenges. How do we do the most effective job of MDA? What tools do we need to do this job better? How will we know when to move from morbidity control to elimination? What combinations of interventions, beyond MDA, are needed to eliminate transmission? The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) has its Secretariat at the University of Georgia and with programs in more than 26 institutions in 19 countries it is trying to answer these very practical questions through multiple large field-based studies and the evaluation or development of better diagnostics for schistosomiasis. This presentation will summarize the current status of morbidity control and elimination programs and the operational research by SCORE that we hope will provide much-needed answers for national program managers so they can most effectively pursue these critical public health programs.

Morbidity control of schistosomiasis by mass drug administration: How can we do it best and what will it take to move on to elimination?

The World Health Organization (WHO) has, for some time, encouraged countries endemic for schistosomiasis to control morbidity from this disease through mass drug administration (MDA) of the well-tolerated drug, praziquantel (PZQ).With the London Declaration in January 2012 and the promise by Merck Serono to eventually donate 250 million PZQ tablets per year, most endemic countries in sub-Saharan Africa have now developed national plans to do MDA for schistosomiasis morbidity control. More recently, based on two World Health Assembly (WHA) resolutions (WHA 54.19 & WHA 65.21) on schistosomiasis, countries are further encouraged to eliminate schistosomiasis, where feasible. The fight against schistosomiasis is therefore in a critical period of tremendous opportunities and equal challenges. How do we do the most effective job of MDA? What tools do we need to do this job better?How will we know when to move from morbidity control to elimination? What combinations of interventions, beyond MDA, are needed to eliminate transmission? The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) has its Secretariat at the University of Georgia and with programs in more than 24 institutions in 17 countries it is trying to answer these very practical questions through multiple large field-based studies and the evaluation or development of better diagnostics for schistosomiasis. This presentation will summarize the current status of morbidity control and elimination programs and the operational research by SCORE that we hope will provide much-needed answers for national program managers so they can most effectively pursue these critical public health programs.

Proportion of Hospitalization at a Respiratory Centre Under RNTCP.

Objective: To determine proportion of patients requiring hospitalization under RNCTP. Methodology:All area-patients registered for treatment under RNTCP at LRS Institute, New Delhi through 16 DOTS centre during the reference period (1st April 2006 to 31st Dec 2006) were listed and those patients requiring hospitalization (upto 31st Dec 2007) at LRS Institute were identified and interviewed by a single investigator using semi-structured proforma with certain inclusion and exclusion criteria’s. The data was entered into master sheet and analysis carried out using software statistical package by computing proportion (%) and chi-square test. Results: It was observed that there were 2,345 patients registered for treatment under RNTCP during the reference period, out of which, 4.22% (99) required hospitalization. The males outnumbered females in absolute numbers, however, gender related hospitalization was similar, 4.08% for males to 4.47% for females (p=0.647). Maximum case load (75.75%) was seen in economically productive age group (15-49 years). The proportion of hospitalization amongst 1- 14, 15-49, 50-60 and 61 years & above age group was 2.36%, 4.10%, 5.11% and 8.60% respectively (p=0.08); category II (7.61%) patient admissions was twice than category I (3.65%) patients (p<0.001). The proportion of hospitalization was 2.37% and 5.4% amongst patients with negative and positive sputum status respectively. Conclusion: The study was undertaken at a respiratory tertiary care centre in a metro city and within the study constraints it highlights disease severity, late presentation and minimum need for TB beds under prevailing socio-economic circumstances in the country.

¿DISENSO ENTRE PARES REVISORES? NO SE PREOCUPE, QUE A FIN DE CUENTAS EL EDITOR SIEMPRE TIENE LA ÚLTIMA PALABRA / DISSENT BETWEEN PEER REVIEWERS? DON'T WORRY, ULTIMATELY THE EDITOR HAS THE LAST WORD

Todos hemos sometido algún artículo científico a revisión con la idea de que sea publicado en cierta revista. Frecuentemente, los autores experimentan muchas barreras para alcanzar el éxito (lograr la publicación) cuando someten artículos a revisión. Estas barreras dependen de la escritura del artículo en sí mismo, de los sesgos de los pares revisores, de la forma en que se escribe la carta de presentación (cover letter), y de la manera en la cual se implementa una estrategia para abordar y responder a las observaciones (erradas o no) que emiten los pares revisores y el editor de la revista. El propósito de este artículo vivencial es el de brindar consejos útiles a autores que investigan en el área de la ingeniería clínica, sobre cómo publicar artículos que aborden temas en el área de la salud en revistas de alto impacto en el área del operations research & management sciences.

All of us have at some point submitted a scientific paper for review with the idea of being published in a given journal. Often, the authors experience many barriers to success (achieving publication) when they submit articles for publication. These barriers depend on the quality of the writing itself, on the biases of the peer reviewers, the way you write your cover letter, and the way in which you address and respond to the observations (erroneous or not) emitted by peer reviewers and the editor of the journal. The purpose of this paper is to provide useful pieces of advice on how to publish articles that tackle issues in the health area in high impact journals in the area of Operations Research & Management Sciences.

Health research strengthening and operational research needs for improving child survival in India.

Health research can be utilized to improve the policies, interventions and outputs of the health systems, and ultimately the health of individuals and population. This requires systematic evaluation of evidence and its integration into national policies and programs after suitable adoption at the local level. It has been noted that there has been limited focus upon strengthening health research in India, due to weak research systems or institutional mechanisms, lack of trained human resources and enabling environment, absence of well defined priorities, perceived low quality of research, and inadequate funding. Though various vertical and integrated health programs for improving child survival in the country have been introduced, the decline in child mortality has been excessively slow. Operational research, a sub theme of health research, which uses systematic research techniques to provide evidence to the policymakers and program managers, can be used to assess programmatic issues and improve their effectiveness. This article analyzes the current situation of health research in India, describes briefly the process of operational research, and summarizes the areas of programmatic concern and priority topics for future research in five key fields of child health (Newborn health, Immunization, Malnutrition, Disease prevention and control, health systems strengthening). Finally, it outlines the immediate need of strengthening health research system in the country for improving child survival through increased funding, development of institutional mechanisms, building pool of talented researchers and provision of an enabling environment, to facilitate health and operational research in a scientifically credible manner and to ensure wider dissemination of results.

Discussing the present mistakes about teaching of operational research of hygienic management / 中华医学教育探索杂志

This paperd probed four mistakes about teaching of Operational Research of Hygienic Management from different angles such as nature of courses,content of courses,academic goal and multimedia.By teaching example analysis,it put forward corresponding measures and suggestions on how to avoid these mistakes.