Theoretical Assessment of Environmental Factors and Untreated Infectious Individuals in the Transmission Dynamics of Buruli ulcer

Buruli ulcer is the third most common mycobacterial disease worldwide, posing a significant public health burden, especially in impoverished regions of West and Central Africa, such as Benin. The management of Buruli ulcer (BU) in Africa is often hindered by limited resources, delays in treatment, and inadequate medical facilities. Additionally, a portion of the population does not seek hospital care, which facilitates the continued presence of the pathogen in the environment. This paper aims to investigate the role of environmental factors in the transmission of Buruli ulcer. We develop a mathematical model to describe the dynamics of Buruli ulcer transmission, incorporating the presence of the bacterium in the environment. Theoretical results are presented to demonstrate that the model is well-posed. We compute the equilibria, including the disease-free equilibrium and the endemic equilibrium, and study their stability. To achieve this, we derive a threshold parameter called the basic reproduction number ℛ0, which determines whether the disease will persist in a human population. If ℛ0is less than one, the disease will eventually die out;if ℛ0is greater than one, the disease will persist. Sensitivity analysis is performed to understand the impact of various parameters on the dynamics of Buruli ulcer transmission and to identify the parameters that influence the basic reproduction number ℛ0. Finally, numerical simulations are conducted to validate the theoretical results obtained from the mathematical analysis.

Evolution of Mother-to-Child HIV-1 Transmission Rate in Mali from 2009 to 2018

Despite enormous efforts to achieve the goal of eliminating mother-to-child transmission of HIV-1, it remains a major challenge for many countries in sub-Saharan Africa, particularly Mali. Our objective is to assess changes in the rate of mother-to-child transmission of HIV-1. We conducted a cross-sectional study between January 1, 2009 to December 31, 2018 (10 years) of early diagnosis activity in newborns and children born to HIV-1-positive mothers at the National Institute for Public Health (INSP). The samples came from health and referral centers in mali. All samples were received at the Laboratory of Molecular Biology at the INSP. Proviral DNA extraction was performed from a blood spot sample with a Roche DNA kit, Cobas AmpliPrep/Cobas TaqMan HIV-1 qualitative Test, V2.0 (Roche Molecular System, Inc, USA) following the company procedures. Molecular diagnosis was performed using the same kits using an algorithm of three identical PCRs. The Epi Info version 7 software was used for data analysis with a significance threshold of 5%. A total of 10,714 samples of infants and children born to HIV-positive mothers were analyzed by PCR. Ninety-six percent of mothers were on ARV prophylaxis (AZT 3TC NVP and AZT NVP) and 60% of newborns received the same ARV prophylaxis. Of these children, 956 tested positive with an overall transmission rate of 8.92%, varying between 7.27% in 2009 and 08.01% in 2018. This rate was relatively low among children receiving prophylaxis at 2.04% and remained high for children who received breastfeeding at 5.62%. However, the transmission rate remains low for those who have benefited from mixed and artificial breastfeeding at 1.58% and 1.27% respectively. A significant proportion of children remained infected by their mothers during pregnancy, childbirth or breastfeeding. This study shows the importance of early diagnosis of HIV in children using molecular technology.

Global and Regional Surface Nitrogen Balances in Intensive Agricultural Production Systems for the Period 1970-2030

Global nitrogen (N) budgets for intensive agricultural systems were compiled for a 0.5 by 0.5 degree resolution. These budgets include N inputs (N fertilizer, animal manure, biological N fixation and atmospheric N deposition) and outputs (N removal from the field in harvested crops and grass and grass consumption by grazing animals, ammonia volatilization,denitrification and leaching). Data for the historical years 1970 and 1995 and a projection for 2030 were used to study changes in the recovery of N and the different loss terms for intensive agricultural systems. The results indicate that the overall system N recovery and fertilizer use efficiency slowly increased in the industrialized countries between 1970 and 1995, the values for developing countries have decreased in the same period. For the coming three decades our results indicate a rapid increase in both the industrialized and developing countries. High values of ＞ 80% for fertilizer use efficiency may be related to surface N balance deficits, implying a depletion of soil N and loss of soil fertility. The projected intensification in most developing countries will cause a gradual shift from deficits to surpluses in the coming decades.The projected fast growth of crop and livestock production, and intensification and associated increase in fertilizer inputs will cause a major increase in the surface N balance surplus in the coming three decades. This implies increasing losses of N compounds to air (ammonia, nitrous oxide and nitric oxide), and groundwater and surface water (nitrate).

Surface N Balances in Agricultural Crop Production Systems in China for the Period 1980-2015

Surface nitrogen （N） balances for China＇s crop production systems was estimated using statistical data collected from 1980 to 2004 at the national and provincial scale and from 1994 to 1999 at the county level. There was a surplus N balance throughout these periods, but the surplus was nearly stable in recent years. Projections using nonseasonal Box-Jenkins model or exponential models show that the N surplus for the total cultivated land in China was likely to increase from 142.8 kg ha^-1 in 2004 to 168.6 kg ha 1 in 2015. The N balance surplus in the more developed southeastern provinces was the largest, and was slightly less in the central region, which caused the nitrate pollution in the ground water. The N surplus was much less in the western and northern provinces because of lower synthetic fertilizer inputs. The region with high N risk includes Beijing Municipality and Jiangsu, Zhejiang, Fujian, Guangdong, Hubei, and Shandong provinces for 2002-2004. The projections suggested that 15 provinces （or municipalities） in the middle and southeastern part of China except Jiangxi and Shanxi provinces would become the high-risk region by 2015. The level of economic development, transportation, and labor force condition had an important effect on the N balance surplus at the county level, but the last two factors showed remarkable impact at the provincial level. To decrease the nonpoint pollution （Npp） risk from crop production, the authors suggested to reduce the target level for national grain self-sufficiency to 90%-95% and change the regional structure of grain production by moving some of the future grain production from the high Npp risk areas of eastern China to parts of the central and western provinces where the Npp risk was much less.

Spatial patterns of health clinic in Malaysia

Background: This manuscript aimed to map the spatial distributions of health clinics for public and private sectors in Malaysia. It would assist the stakeholders and responsible authorities in the planning for health service delivery. Methods: Data related to health clinic were gathered from stakeholders. The location of health facilities was geo-coded using a Global Positioning System (GPS) handheld. The average nearest neighbour was used to identify whether health clinics were spatially clustered or dispersed. Hot spot analysis was used to assess high density of health clinics to population ratio and average distance of health clinics distribution. A Geographically Weighted Regression (GWR) was used to analyse the requirement of health clinic in a sub-district based on population density and number of health clinics with significant level

Fenofibrate for the prevention of progression of non-proliferative diabetic retinopathy:review,consensus recommendations and guidance for clinical practice

The prevalence of diabetic retinopathy(DR),and associated morbidity is high in the Asia-Pacific region.Emerging evidence suggests a potential role for fenofibrate in the prevention of progression of DR,especially in patients with cardiovascular risk,and pre-existing mild-to-moderate DR.Fenofibrate has also been found to reduce maculopathy,and the need for laser treatment in these patients.Considering these benefits of fenofibrate,a group of experts from the fields of endocrinology and ophthalmology convened in May 2017,to discuss on the the mechanism of action,and clinical efficacy of fenofibrate in DR.The findings from key clinical studies on fenofibrate in DR were reviewed by the experts,and consensus statements were derived to define the role of fenofibrate in the prevention and treatment of DR.The statements were rated based on the GRADE criteria.An algorithm was also developed for the screening and treatment of DR in patients with type 2 diabetes(T2D),and the place of fenofibrate was defined in the algorithm.The expert recommendations,and the algorithm provided in this review will serve as a guide to the clinicians to reconsider the adjunctive use of fenofibrate for preventing the progression of DR in selected T2D patients.

Missed Opportunities for Prevention of Mother-to-Child Transmission of HIV (PMTCT) in Ibadan, Southwest Nigeria

Background: Nigeria has the largest paediatric HIV-infected population in the world. Missed opportunities for prevention of mother-to-child transmission of HIV (PMTCT) compromise efforts at eliminating new pediatric HIV infections. Methods: Six hundred children, aged < 15 years, presenting to the pediatric units of the University College Hospital (UCH), Ibadan Southwest Nigeria between June to December 2007 were studied. The demographics, HIV status and socioeconomic status of mothers and their children were studied. A 4-step hierarchy was used to assess the missed opportunities for PMTCT. Step 1: utilization of a health facility for antenatal care and delivery;Step 2: maternal HIV status determination during pregnancy;Step 3: provision of antiretroviral medication to HIV-infected mother and baby;and Step 4: avoidance of mixed feeding in HIV-exposed children. The rates of missed opportunities for PMTCT services at different steps in the PMTCT cascade, perinatal transmission rates, and associated factors were reported. Results: There were 599 mothers and 600 children (one set of twins), 60 (10%) were HIV infected and 56 (93.3%) of these were adjudged perinatally infected. Of 78 HIV-infected women, 7 (9.0%) accessed all interventions in the PMTCT cascade and 71 (91.0%) had missed opportunities for PMTCT. Missed opportunities for PMTCT occurred 42.9% in cascade Step 1, 64.2% in Step 2, 52.6% in step 3 and 73.7% in Step 4. All mother-baby pairs who accessed complete PMTCT interventions received care at a teaching hospital. Among infants with perinatal HIV infection, 53 (94.6%) were born to mothers who had missed opportunities for PMTCT. Most women with missed opportunities attended antenatal care outside the teaching hospital setting and belonged to low socioeconomic status. Conclusion: It is imperative to expand PMTCT access to women who receive antenatal care outside the teaching hospitals and to those of low socioeconomic status.

Socio-Demographic and Behavioral Factors for Serious Injury among Adolescents in Malaysia

This study was to determine the prevalence and socio-demographic associated factors for serious injury among adolescents in Malaysia. The study used data from the Malaysian Global School-based Health Survey which was conducted in 2012. Logistic regression analysis was used to establish associations. Of the 25,507 respondents, 34.9% (42.1% males and 27.8% females) reported having been in a serious injury. Compared to participants who were not bullied, those who reported being bullied were more likely to have sustained serious injury (aOR = 2.2;95% CI [1.95 - 2.48]). Adolescents who were involved in physical fighting were 57.5% (aOR = 2.75;95% CI [2.53 - 2.99]) and more likely to have sustained serious injury compared to those who were not involved in the fighting. Meanwhile, adolescents who used substances were 52.3% (aOR = 1.68 [1.52 - 1.85]) and more likely to have sustained serious injury compared to those who did not use substances. Serious injury is frequent among adolescents in Malaysia. Based on studies by Harel, suggestion where reduction of substance use and bullying may be assessed if they have an impact in reducing serious injury among adolescents. Furthermore, educational programmes that focus on the underlying causes and determinants of injury provide an effective and efficient method of injury prevention.

Health Facilities Affected by Flood Simulation to a District in Malaysia

Objective: The Ministry of Health Malaysia is developing a GIS database of health facilities in the country with the main aim to assist in the planning and development of the services, and in allocation of resources. Methodology: Apart from coordinates of the facilities, other digital information such as states and districts boundaries, main road networks and river were obtained from MacGDI, a centre responsible to manage geospatial data infrastructure in Malaysia. In assisting the Ministry of Health in its planning, one of the analyses that were conducted was a flood simulation analysis in a district in a coastal area of Peninsular Malaysia. This was done following a possibility that a tropical storm “Sonamu” would happen in that area. The objective was to identify health facilities that would be affected if a flood were to happen in the district and finally to assist the Ministry of Health in their emergency plan. Data on contour was obtain from a relevant government agency and was also mapped digitally. Results: The results were showing that with one metre depth of flood, more than half of the facilities would be affected and about two third of the facilities would be affected if the flood level rises to 2.5 metres. Conclusion: Application of GIS is very useful for the health sector in planning of facing an environmental related disaster.

Perilipin2 inhibits the replication of hepatitis B virus deoxyribonucleic acid by regulating autophagy under high-fat conditions

BACKGROUND Chronic hepatitis B virus(HBV)infection is often associated with increased lipid deposition in hepatocytes.However,when combined with non-alcoholic fatty liver disease or hyperlipidemia,it tends to have a lower HBV deoxyribonucleic acid(DNA)load.The relationship between lipid metabolism and HBV DNA replication and its underlying mechanisms are not well understood.AIM To investigate the relationship between lipid metabolism and HBV DNA replication and its underlying mechanisms.METHODS 1603 HBsAg-seropositive patients were included in the study.We first explored the relationship between patients'lipid levels,hepatic steatosis,and HBV DNA load.Also,we constructed an HBV infection combined with a hepatic steatosis cell model in vitro by fatty acid stimulation of HepG2.2.15 cells to validate the effect of lipid metabolism on HBV DNA replication in vitro.By knocking down and overexpressing Plin2,we observed whether Plin2 regulates autophagy and HBV replication.By inhibiting both Plin2 and cellular autophagy under high lipid stimulation,we examined whether the Plin2-autophagy pathway regulates HBV replication.RESULTS The results revealed that serum triglyceride levels,high-density lipoprotein levels,and hepatic steatosis ratio were significantly lower in the HBV-DNA high load group.Logistic regression analysis indicated that hepatic steatosis and serum triglyceride levels were negatively correlated with HBV-DNA load.Stratified analysis by HBeAg showed significant negative correlations between HBV-DNA load and hepatic steatosis ratio in both HBeAgpositive and HBeAg-negative groups.An in vitro cell model was developed by stimulating HepG2.2.15 cells with palmitic acid and oleic acid to study the relationship between HBV-DNA load and lipid metabolism.The results of the in vitro experiments suggested that fatty acid treatment increased lipid droplet deposition and decreased the expression of cell supernatant HBsAg,HBeAg,and HBV DNA load.Western blot and polymerase chain reaction analysis showed that fatty acid stimulation significantly induced Plin2 protein expression and inhibited the expression of hepatocyte autophagy proteins.Inhibition of Plin2 protein expression under fatty acid stimulation reversed the reduction in HBsAg and HBeAg expression and HBV DNA load induced by fatty acid stimulation and the inhibition of cellular autophagy.Knocking down Plin2 and blocking autophagy with 3-methyladenine(3-MA)inhibited HBV DNA replication.CONCLUSION In conclusion,lipid metabolism is a significant factor affecting HBV load in patients with HBV infection.The in vitro experiments established that fatty acid stimulation inhibits HBV replication via the Plin2-autophagy pathway.

Role of Ki-67 as a prognostic factor in gastrointestinal stromal tumors

AIM:To investigate primarily the prognostic value of Ki-67,as well as other parameters,in gastrointestinal stromal tumors(GISTs).METHODS:Ki-67,c-KIT,platelet-derived growth factor receptor-alpha(PDGFRα),smooth muscle actin(SMA),CD34,S100 were stained for immunohistochemistry which was performed on formalin-fixed,paraffinembeded sections on representative block from each case.Proliferation index counted by Ki-67 antibody was calculated as a number of positive nuclear reaction over 100 cells.Immunoreactivity for c-KIT and PDGFRα was evaluated semiquantitatively(weak,intermediate,strong) and for c-KIT type of reactivity was analyzed(cytoplasmic,membrane and "dot-like" staining).Immunoreactivity for SMA,CD34 and S100 were was evaluated as positive or negative antigen expression.Pathologic parameters investigated in this study included tumor size,cell type(pure spindle,pured epitheloid mixed spindle and epitheloid),mitotic count,hemorrhage,necrosis,mucosal ulceration.Clinical data included age,gender,primary tumor location and spread of disease.χ 2 test and Student's t-test were used for comparisons of baseline characteristics.The Cox's proportional hazard model was used for univariable and multivariable analyses.Survival rates were calculated by Kaplan-Meier method and statistical significance was determined by the log-rank test.RESULTS:According to the stage of disease,there were 36 patients with localized disease,29 patients with initially localized disease but with its recurrence in the period of follow up,and finally,35 patients had metastatic disease from the very beginning of disease.Tumor originated most commonly in the stomach(41%),small intestine was the second most common location(36%).The mean size of primary tumors was 6.5 cm.The mean duration of follow-up was 60 mo.Multiple parameters were analyzed for their effect on overall survival,but no one reached statistical significance(P = 0.06).Analysis of time to progression/relapse in initially localized disease(univariate analysis),tumor size,mitotic count,Ki-67 and type of d-KIT distribution(cytoplasmic vs membrane/"dot-like") showed statistically significant correlation.In multivariate analysis in the group of patients with localized disease,there were only 2 parameters that have impact on relapse,Ki-67 and SMA(P < 0.0001 and P < 0.034,respectively).Furthermore,Ki-67 was analyzed in localized diseasevs localized with recurrence and metastatic disease.It was shown that there is a strict difference between these 2 groups of patients(median value was 2.5 for localized disease vs 10.0 for recurrent/metastatic disease,P < 0.0001).It was also shown that the cut-off value which is still statistically significant in terms of relapse on the level of 6%.The curves for survival on that cut-off level are significantly different(P < 0.04,Cox F).CONCLUSION:Ki-67 presents a significant prognostic factor for GIST recurrence which could be of great importance in evaluating malignant potential of disease.

Fatty acids of erythrocyte membrane in acute pancreatitis patients

AIM:To evaluate changes in the fatty acid composition of erythrocyte membrane phospholipids during severe and mild acute pancreatitis(AP)of alcoholic and nonalcoholic etiology.METHODS:All consecutive patients with a diagnosis of AP and onset of the disease within the last 72 h admitted to the Hospital of Lithuanian University of Health Sciences between June and December 2007 were included.According to the Acute Physiology and ChronicHealth Evaluation(APACHEⅡ)scale,the patients were subdivided into the mild(APACHEⅡscore<7,n=22)and severe(APACHEⅡscore≥7,n=17)AP groups.Healthy individuals(n=26)were enrolled as controls.Blood samples were collected from patients on admission to the hospital.Fatty acids(FAs)were extracted from erythrocyte phospholipids and expressed as percentages of the total FAs present in the chromatogram.The concentrations of superoxide dismutase and glutathione peroxidase were measured in erythrocytes.RESULTS:We found an increase in the percentages of saturated and monounsaturated FAs,a decrease in the percentages of total polyunsaturated FAs(PUFAs)and n-3 PUFAs in erythrocyte membrane phospholipids of AP patients compared with healthy controls.Palmitic(C16:0),palmitoleic(C16:1n7cis),arachidonic(C20:4n6),docosahexaenoic(DHA,C22:6n3),and docosapentaenoic(DPA,C22:5n3)acids were the major contributing factors.A decrease in the peroxidation and unsaturation indexes in AP patients as well as the severe and mild AP groups as compared with controls was observed.The concentrations of antioxidant enzymes in the mild AP group were lower than in the control group.In severe AP of nonalcoholic etiology,the percentages of arachidic(C20:0)and arachidonic(C20:4n6)acids were decreased as compared with the control group.The patients with mild AP of nonalcoholic etiology had the increased percentages of total saturated FAs and gama linoleic acid(C18:3n6)and the decreased percentages of elaidic(C18:1n9t),eicosapentaenoic acid(EPA,C20:5n3),DPA(C22:5n3),DHA(C22:6n3)as well as total and n-3 PUFAs in erythrocyte membrane phospholipids.CONCLUSION:The composition of FAs in erythrocyte membranes is altered during AP.These changes are likely to be associated with alcohol consumption,inflammatory processes,and oxidative stress.

Lipocalin 2 stimulates bone fibroblast growth factor 23 production in chronic kidney disease

Bone-produced fibroblast growth factor 23(FGF23)increases in response to inflammation and iron deficiency and contributes to cardiovascular mortality in chronic kidney disease(CKD).Neutrophil gelatinase-associated lipocalin(NGAL or lipocalin 2;LCN2 the murine homolog)is a pro-inflammatory and iron-shuttling molecule that is secreted in response to kidney injury and may promote CKD progression.We investigated bone FGF23 regulation by circulating LCN2.At 23 weeks,Col4a3KO mice showed impaired kidney function,increased levels of kidney and serum LCN2,increased bone and serum FGF23,anemia,and left ventricular hypertrophy(LVH).Deletion of Lcn2 in CKD mice did not improve kidney function or anemia but prevented the development of LVH and improved survival in association with marked reductions in serum FGF23.Lcn2 deletion specifically prevented FGF23 elevations in response to inflammation,but not iron deficiency or phosphate,and administration of LCN2 increased serum FGF23 in healthy and CKD mice by stimulating Fgf23 transcription via activation of cAMP-mediated signaling in bone cells.These results show that kidney-produced LCN2 is an important mediator of increased FGF23 production by bone in response to inflammation and in CKD.LCN2 inhibition might represent a potential therapeutic approach to lower FGF23 and improve outcomes in CKD.

Misdiagnosis of tuberculosis and the clinical relevance of nontuberculous mycobacteria in Zambia

Objective:To determine the accuracy of TB diagnosis of TB in Zambia in the era of increasing HIV prevalence.Methods:Sputum of the clinically diagnosed TB cases was additionally subjected to liquid culture and molecular identification.This study distinguished between TB cases confirmed by positive Mycobacterium tuberculosis(M.tuberculosis) cultures and mycobacterial disease caused by non-tuberculous mycobacteria(NTM).Results:Only 49% of the 173 presumptively diagnosed TB cases was M.tuberculosis cultured,while in 13% (22) cases,a combination of M.tuberculosis and NTM was found.In 18% of the patients only NTM were cultured.In 28% ,no mycobacteria was cultivable.HIV positive status was correlated with the isolation of NTM(P【0.05).Conclusions:The diagnosis of tuberculosis based on symptoms, sputum smear and/or chest X-ray leads to significant numbers of false-positive TB cases in Zambia,most likely due to the increased prevalence of HIV.The role of NTM in tuberculosislike disease also seems relevant to the false diagnosis of TB in Zambia.

Etiologies of tropical acute febrile illness in West Pahang, Malaysia: A prospective observational study

Objective: To determine the etiologies of tropical acute febrile illness(TAFI) in West Pahang, Malaysia and to investigate morbidity and mortality factors in relation to TAFI. Methods: A multicenter prospective cohort study was conducted between January and June 2016 in six district hospitals throughout the western part of Pahang State in Peninsular Malaysia. A total of 336 patients answered a standardized questionnaire and blood samples were collected for laboratory confirmation of infectious etiology. Descriptive analysis and logistic regression were performed to identify factors associated with TAFI. Results: A total of 336 patients were included. The patients were mainly Malays(70.2%), males(61.3%), aged(44.6±17.4) years, with more than half(58.9%) presenting with gastrointestinal symptoms. The majority were diagnosed with dengue(35.7%) while malaria(4.5%) was the least frequent. The in-hospital mortality due to TAFI was 9.2%. Patients with meliodosis had five times higher mortality [Adjusted OR: 5.002, 95% CI:(1.233, 20.286)]. Patients with comorbidities such as cardiovascular symptoms(P<0.001) and renal replacement therapy initiation(P<0.001) were significantly associated with in-hospital mortality in all TAFI. Conclusions: The etiology of TAFI in the western Pahang includes dengue, leptospirosis, malaria and melioidosis, which carry the highest risk of in-hospital mortality. The presence of cardiovascular symptoms may be used to assess the disease severity in TAFI, but more studies are needed in the future.

荷兰不同来源耐多药结核病例中二线耐药情况

背景:荷兰。目的:调查不同地理来源的耐多药结核病人耐二线药情况及其相关因素。方法:对荷兰1993年1月至2007年10月间耐多药结核病人分离菌株的实验室数据进行回顾性研究。结果:发现的153例耐多药结核病人中,18例(12%)为荷兰本国人。对其中的131例进行二线药物敏感性实验,有28例(21%)为耐二线药,且大部分为单一耐药(24/28(86%));9例耐丙硫异烟胺(PTH),6例耐对氨基水杨酸,4例耐阿米卡星(ASK),4例耐环丙沙星,1例耐环丝氨酸)。有4例耐多药结核病人耐多种二线药;2例为广泛耐药的牛型结核分枝杆菌。在所有耐多药结核病人中,来自欧洲和中亚者二线耐药较普遍,且涉及的药物也较广泛。来自非洲和美洲者主要耐PTH,而来自东南亚者主要耐AMK。结论:在荷兰,耐多药结核病人中二线耐药情况并不普遍。大部分二线耐药发生在移民当中,来源于不同的地域,病人耐药情况也不同。

MUTAGENIC PROPERTIES OF OXIDATION MIXTURES OF SOME COMMERCIAL HAIR DIE PREPARATIONS

Ten oxidative-type hair die preparations available on theSlovenian market were tested for their mutagenic activity inSalmonella typhimurium TA 98.All the preparations containedphenylenediamine as basic colour preparation component.Tosimulate normal conditions of use hair die preparations wereoxidised with hydrogen peroxide based developer.

越南国家结核病防治规划中的管理培训效果评估

背景:越南国家结核病防治规划(NTP)目的:展示美国疾病预防控制中心可持续管理发展项目(SMDP)是如何通过组织实施管理培训计划而在越南NTP中进行能力建设,并评价其对NTP国内培训规划的影响(NTP的国内培训规划是针对个人和团队管理实施,以及省级结核病防治规划的实施)。设计:对参与该项目的8个省级结核病防治机构进行案例研究,包括交叉案例和内容分析。结果:学员们和学员返回原单位后组织自学的团队对所学概念理解深入,特别是在循证决策、发现问题和解决问题、以及团队协同工作提高效果方面。有关在日常工作中如何运用这些概念的问题,学员给列举了许多例子。参与该项目的团队均超过、达到或非常接近其预期目标,包括提搞了DOTS的实施质量。改善工作过程已成为其实践的常规内容,且常常应用到其他地区。有几个团队表示,他们在发现问题和寻找解决方法方面更加主动。其他团队责表示,团队合作的增强提高了NTP工作人员的责任心。结论:包含实践内容的管理培训能够提升NTP的管理和实施效果。

Body size, physical activity, and exposure to television in preschoolers

Objective: To investigate relationships between preschool-aged children’s body size and physiccal activity, exposure to television (TV), and parental body size. Design and subjects: Cross-sectional study of 80 children (age: 2 - 5 y, 29% overweight or obese), 73 mothers (37% overweight or obese), and 22 fathers (72% overweight or obese), residing in Auckland, New Zealand, between October 2006 and July 2007. Measurements: Body size was determined using waist circumference and body mass index (BMI). Child exposure to TV was assessed by questionnaire (number of household TV sets, presence of TV in the child’s bedroom, mean TV/ movie watching hours on weekdays and weekend days), and physical activity by 7 days of accelerometry. Results: Compared with children of normal weight/underweight mothers (classified by BMI status), the age-adjusted odds of a child being overweight/obese if their mother was over-weight/obese/otherwise was 2.46 (95% CI 1.11, 5.48, P = 0.03). No other associates of child body size were identified. Conclusion: Contributors to overweight and obesity in preschool aged children are complex and likely to exist in multiple facets of young children’s lives. More detailed measurement of TV watching and other sedentary behaviours is needed. An ecological approach to identifying risk factors for increased body size in preschoolers is required.

Prevalence of the Respiratory Allergies among Adult Population in the City of Skopje in Relation to Climatic Change and Change in Pollen Micro Flora

Introduction: Climate change may have an impact of prevalence and severity of respiratory allergies causing changes in the concentrations, distribution, dispersion patterns, and allergenic potential of aeroallergens in the environment. Objective: To assess the prevalence of atopy, sensitization to common pollen allergens, and respiratory allergies (allergic rhinitis and asthma) among adult population in the city of Skopje in relation to changes in pollen distributions caused by climate change and particularly maximum temperature, in the period 1996-2010. Methods: Aeropalinological measurements in the city of Skopje were performed by volumetric method in the period 1996-2009. Serial cross-sectional studies on the prevalence of atopy, sensitization to common pollen allergens, allergic rhinitis and asthma in adults by standardized methodology were conducted in defined critical periods (1996, 2003, 2007/2008 and 2009/2010). Evaluation of examined subjects included completion of a questionnaire, skin prick tests (SPT) to common inhalant allergens, and lung function tests. Results: Data from aeropalinological measurements showed differences in the pollen concentrations, as well as in the duration of pollen season for some pollen types. The prevalence of atopics was similar in all critical periods, and the prevalence of sensitization to common pollen allergens was slightly higher in the last study than in the study performed in 1996. We registered increase in the prevalence of allergic rhinitis in the examined period (11.5% in 1996 to 17.4% in 2009/2010) followed by increase in the prevalence of rhinitics sensitized to common pollen allergens. The prevalence of allergic asthma was significantly higher in the study conducted in 2009/2010 than in the study conducted in 1996 (5.1% vs. 2.1%, P = 0.037) followed by slightly higher prevalence of asthmatics sensitized to common pollen allergens in the same period. Conclusions: Registered changes in the prevalence of sensitization to common pollen allergens, as well as in the prevalence of subjects with respiratory allergies sensitized to these allergens, even statistically non-significant, indicate the need of further monitoring and investigation in order to assess the association between climate change with change in pollen micro flora and related allergic disorders.