Ethnic variations in ulcerative colitis: Experience of an international hospital in Thailand

AIM: To investigate the clinical characteristics, treatment, medication use, and treatment response in patients with ulcerative colitis(UC) across ethnic groups.METHODS: This study retrospectively analyzed medical records of all 268465 patients who visited the Bumrungrad International Digestive Disease Center during 2005-2010. The demographics, clinical characteristics, medication use, results of investigations, and medical and surgical management for patients with UC were evaluated. Evaluation included sigmoidoscopy and colonoscopy performed in compliance with the American Society of Gastrointestinal Endoscopy practice guidelines. Patient ethnicities were categorized into seven groups: Thai, Oriental, South Asian(SA), Middle Eastern(ME), Caucasian, African, and Hispanic. UC pathological severity was classified into inactive, mild, moderate, and severe. Associations between categorical variables were analyzed using the χ2 or Fischer's exact test. Associations between categorical and interval variables were analyzed usingStudent's t-test and/or analysis of covariance.RESULTS: UC was diagnosed in 371 of the 268465 patients: male 56.33%; ME 42%, Caucasian 23%, and Thai 19%. Annual incidence of UC was 82 cases per 100000 with wide ethnic variation, ranging from 29 to 206 cases per 100000 in Oriental and ME patients, respectively. Of the patients with UC, 16.71% had severe UC with highest incidence among the patients from ME(20.39%) and lowest among the Caucasian population(11.90%). ME had highest proportion of pancolitis(52.90%), followed by Caucasian(45.35%) and Asian(34.40%). Only 20.93% of Caucasian patients received steroid, compared with 26.40% and 27.10% of Asian and Middle Eastern, respectively(P = 0.732). Overall, 13.72% of UC patients did not respond to steroid therapy, with non-significantly higher proportions of non-responders among Asian and Middle Eastern patients(15.22% and 15.04%, respectively)(P = 0.781). On average, 5.93% underwent surgical management with ethnic variation, ranging from 0% in African to 18% in SA. Cancer was found in three(Thai, ME, and African) cases(0.82 institution-specific incidence).CONCLUSION: Incidence, symptom duration, pathological severity, clinical manifestations, medication use, treatment response, need for surgical consultation, and cancer incidence of patients with UC potentially vary by ethnicity.

Hepatitis B in healthcare workers: Transmission events and guidance for management

Hepatitis B virus(HBV) is the most efficiently transmissible of the bloodborne viruses that are important in healthcare settings. Healthcare workers(HCWs)are at risk for exposure to HBV from infected patients and, if infected, are similarly at risk of transmitting HBV to patients. Published cases of HBV transmission from HCW to patient are relatively rare, having decreased in frequency following the introduction of standard(universal) precautions, adoption of enhanced percutaneous injury precautions such as double-gloving in surgery, and routine HBV vaccination of HCWs. Here we review published cases of HCW-to-patient transmission of HBV, details of which have helped to guide the creation of formal guidelines for the management of HBV-infected HCWs. We also compare the published guidelines for the management of HBV-infected HCWs from various governing bodies, focusing on their differences with regard to vaccination requirements, viral load limits, frequency of monitoring, and restrictions on practice. Importantly, while there are differences among the recommendations from governing bodies, no guidelines uniformly restrict HBV-infected HCWs from performing invasive or exposure-prone procedures.

Case-finding for mental distress in primary health care: An evaluation of the performance of a five-item screening instrument

Background: There is an increased interest in developing better and more accurate methods to recognize and manage mental health problems in primary care settings. Abbreviated screening instruments for mental distress are useful tools for research and clinical practice. The present study seeks to investigate whether only a few questionnaire items from the Self-Reporting- Questionnaire-10 (SRQ-10) can be a robust method in the screening for Mental Distress in Primary Health care. Methods: We compared the screening accuracy of a short, five-item (SRQ-5) version of the SRQ-10 with that of the SRQ-20, General Health Questionnaire 12 (GHQ-12) using the DSM-IV axis as a gold standard and analyzed its performance in different diagnostic entities. We also assessed the correlation, sensitivity and specificity between the 4 instruments. All the instruments were administered to 400 primary health care attendees. Results: The estimated prevalence of mental distress was 13.6% in the study sample (Depression 11%, anxiety disorders 1.8%). The SRQ-5 was highly correlated to SRQ-10 (0.923, p < 0.001), SRQ-20 (0.764, p < 0.001) and only moderately correlated to GHQ-12 (0.417, p < 0.001). The SRQ-5 had high properties for identifying mental distress. The AUC for overall mental distress was 0.925 while that for depression and anxiety were 0.915 and 0.849 respectively. Conclusion: This validation showed that in moving from SRQ with 10 or 20 items to one with merely 5 items, we do not seem to lose the screening prowess of the instrument. The SRQ-5 represents a simplified and less time-consuming screening instrument with strong performance characteristics. We therefore recommend it for inclusion into existing patient assessment protocols, thus enhancing case finding at primary health care level.

Determinants of Health Care Seeking Behaviors in Puerperal Sepsis in Rural Sindh, Pakistan: A Qualitative Study

Background: Puerperal sepsis (PS) is one of the major causes of maternal death, contributing to 26,000 deaths per year in developing countries. Early recognition and treatment are essential to managing PS, but numerous social, cultural and technical barriers prevent or delay access to care and necessary medical attention. Through this qualitative study, we identified barriers to care seeking for puerperal sepsis among recently delivered women in Matiari, Pakistan. Methods: We conducted 20 in-depth interviews among recently delivered women with and without sepsis and their family members in September 2012. Key informant interviews were conducted with 14 healthcare providers and traditional birth attendants. The themes used for content analysis were knowledge of danger signs, factors affecting care seeking and local treatment practices for postpartum sepsis. Results: A total of 34 interviews were conducted. Recently delivered women, their family members and traditional birth attendants were unaware of the word PS or the local translated term for PS. However, they were familiar with most of the individual symptoms associated with PS. Healthcare providers were aware of the condition and the associated symptoms. The healthcare providers’ understanding of the seriousness of PS was directly proportional their age and clinical experience. The most common barriers to care seeking was the division of labor within the household, obtaining permission from the primary decision maker, access to transportation, lack of financial resources and support from family members. Conclusion: To improve maternal care seeking behaviors for PS, interventions focusing on increasing knowledge of PS, addressing gender inequality, implementing an affordable community transport service and enhancing TBA’s knowledge and skills to manage PS need to be implemented.

The Impact of HIV Spending on Health Outcomes in Thailand

Background: The Sustainable Development Goals commitment to Ending HIV/AIDS by 2030 requires sustained adequate investment. This study sought to examine the association between HIV/AIDS spending and outcomes in Thailand between 2008 and 2019. Methods: A quantitative secondary data analysis with time-series was conducted using a retrospective dataset of HIV spending and some selected outcomes including the number of people living with HIV (PLHIV), incidence and prevalence of HIV/AIDS, the prevention of mother-to-child transmission (PMTCT) and AIDS-related deaths. Data were obtained from a diverse set of sources. Descriptive statistics and univariate regression model were used to analyze HIV expenditure and outcomes. Results: HIV spending per PLHIV rose by two folds from $347 in 2008 to more than $600 in 2019, mostly financed by domestic sources. This increase of domestic resources per PLHIV was significantly associated with better HIV-related outcomes especially in the reduction of PLHIV and AIDS-related deaths through increased number of people receiving antiretroviral therapy (ART). However, the spending per PLHIV varied across the three public health insurance schemes. Comparison of HIV expenditure and health outcomes across upper-middle-income countries shows Thailand is not highly ranked in terms of spending efficiency despite having made good progress. Conclusion: Domestic financing for HIV programs is indispensable for achieving the goal of ending AIDS. Despite significant improvement in HIV-related outcomes, challenges remain in achieving the 90-90-90 goal. The redesigning of payment methods should be considered to increase the efficiency of HIV financing. Other factors related to strengthening the health system should not be overlooked.

Anemia and Its Associated Risk Factors at the Time of Antiretroviral Therapy Initiation in Public Health Facilities of Arba Minch Town, Southern Ethiopia

Background: Anemia is the most common hematologic abnormality in HIV patients and is associated with disease progression and decreased survival. This study aims to describe the prevalence and predictors of anemia in HIV positive patients at the time of ART initiation at public health facilities of Arba Minch town, Southern Ethiopia. Methods: A total of 411 adults (?15 years) HIV positive patients with complete information on hemoglobin levels and CD4 count and clinical characteristics registered from 2006 to 2013 were assessed for anemia prevalence and risk factors at the ART clinic of the Arba Minch hospital and health center. The measurements of Hemoglobin and CD4 + T cell count were performed using standard methodology at baseline of ART initiation. Results: A total of 411 HIV positive patients (195 males and 216 females) with a mean ± SD age of 33.9 ± 9.0 years were assessed. Hemoglobin levels were between 6.0 and 16.5 mg/dL. The overall prevalence of anemia at the time of ART initiation was 52.3%;with 28.1%, 22.9% and 1.3% mild, moderate and severe anemia respectively. The overall prevalence of anemia was 62.4% among males and 46.7% among females (P < 0.001). An increased risk of anemia was seen in males (adjusted OR = 2.78, 95% CI = 1.77 - 4.35);low CD4 cell counts (adjusted OR = 3.48, 95% CI = 2.09 - 5.79);and history of TB (adjusted OR = 2.89, 95% CI = 1.28 - 6.54). Conclusions: Anemia in HIV-positive patients was highly prevalent at the time of ART initiation. Male gender, low CD4 count and history of TB were associated with higher risk of baseline anemia.

A Brief Talk on How to Promote China Health and Quarantine at Points of Entry in the Framework of Global Health

Global health concerns about the health of the global population and the concepts of global health are gradually being accepted by all of the countries in the world.China health and quarantine at points of entry(POEs) is an integral part of global health,and its duty of prevention and control of the communicable diseases in POEs is consistent with the duty of global health to promote the health of global population.Under the principle of "prevention first",health and quarantine organ carries out the work of disease prevention and control and international travel health care,the reinforcement of core capacity at POEs,and focuses on human rights protection.All the same,there are some gaps with the requirements of global health,such as the inadequate of health promotion planning capacity,ethics awareness and legal protection.The future work of health and quarantine should change ideas on communicable diseases prevention at POEs,focus more on ethical consideration,and should optimize system architecture and human resources,strengthen cooperation,maintain core capacity at POEs,thus to build points of entry public health system with Chinese characteristics,meanwhile to apply the concepts of global health deeply into every aspects of health and quarantine at POEs.

Monocyte and macrophage function in respiratory viral infections

Pulmonary macrophages,such as tissue-resident alveolar and interstitial macrophages and recruited monocyte-derived macrophages,are the major macrophages present in the lungs during homeostasis and diseased conditions.While tissue-resident macrophages act as sentinels of the alveolar space and play an important role in maintaining homeostasis and immune regulation,recruited macrophages accumulate in the respiratory tract after acute viral infections.Despite sharing similar anatomical niches,these macrophages are distinct in terms of their origins,surface marker expression,and transcriptional profiles,which impart macrophages with distinguished characteristics in physi-ological and pathophysiological conditions.In this review,we summarize the current view on these macrophage populations,their shared functions,and what makes them distinct from each other in the context of homeostasis andrespiratoryviral infections.

Pregnancy stressors and postpartum symptoms of depression and anxiety:the moderating role of a cognitivebehavioural therapy(CBT)intervention

Background Little is known about the association between stressors(especially positive stressors)during pregnancy and postpartum depression and anxiety.Aims We investigated the association between positive and negative stress events during different stages of pregnancy and postpartum mental health outcomes among low-income pregnant women with symptoms of anxiety in Pakistan and evaluated whether an intervention based on cognitive behavioural therapy(CBT)had a regulatory effect.Methods Participants were 621 pregnant Pakistani women with mild anxiety.Using the Pregnancy Experience Scale-Brief Version,six scores were created to assess positive and negative stressors.We performed a multivariate linear regression to examine whether these six scores,measured both at baseline and in the third trimester,were associated with postpartum anxiety and depressive symptoms.The effect of the intervention on this relationship was examined by adding an interaction term to the regression model.Results Hassles frequency measured in the third trimester was positively associated with depression(B=0.22,95%confidence interval(Cl):0.09 to 0.36)and anxiety(B=0.19,95%Cl:0.08to 0.30).At the same timepoint,uplifts intensity was negatively associated with symptoms of depression(B=-0.82,95%Cl:1.46 to-0.18)and anxiety(B=-0.70,95%Cl:-1.25 to-0.15),whereas hassles intensity was positively related to symptoms of depression(B=1.02,95%Cl:0.36 to 1.67)and anxiety(B=0.90,95%Cl:0.34 to 1.47).The intensity ratio of hassles to uplifts reported in the third trimester was positively related to both depression(B=1.40,95%Cl:0.59 to 2.20)and anxiety(B=1.26,95%Cl:0.57 to 1.96).The intervention strengthened the overall positive effects of uplfts and the negative effects of hassles.Pregnancy experiences at baseline during early pregnancy to mid-pregnancy were not associated with mental health outcomes.Conclusions Stressors in the third trimester but not earlier in pregnancy were associated with postpartum symptoms of anxiety and depression.The CBT intervention modified the association between pregnancy stressors and postpartum mental health outcomes.Programmes that promote positive experiences and reduce negative experiences,especially in late pregnancy,may mitigate postpartum mental health consequences.

Prevalence and intensity of urinary schistosomiasis and soil-transmitted helminths among women of reproductive age in Mwaluphamba,Kwale

Objective:To assess the epidemiology of urinary schistosomiasis and soil-transmitted helminthiasis among women of reproductive age in Mwaluphamba,Kwale County,Kenya.Methods:A community-based cross-sectional study design was employed to randomly sample 422 women of reproductive age(15-<50 years)from four villages in Mwaluphamba location.Stool specimens were collected and examined using the Kato-Katz method,while filtration technique was used to analyze urine specimens.Participants’sociodemographic details were obtained using a standardized questionnaire.Results:Urinary schistosomiasis prevalence was at 4.7%(20/422,95%CI 2.8%-6.9%)while the prevalence of soil-transmitted helminthiasis infection was 4.5%(19/422,95%CI 2.6%-6.7%).The infection intensities of urinary schistosomiasis among the study participants ranged from 1 to 120 eggs/10 mL of urine with median egg count of 18.45 eggs/10 mL.The patients were diagnosed with light infection,of 56.16 egg/gram and 48.48 egg/gram for Trichuris trichiura and hookworms,respectively.Women without latrines had 15.7 times higher risk of having urinary schistosomiasis compared to those with a latrine.Similarly,use of surface water(aOR=1.0,95%CI 0.2-1.4,P=0.010)and crossing the river to go to a place(aOR=1.1,95%CI 0.3-1.6,P=0.009)were statistically significant risk factors for getting urinary schistosomiasis.In bivariable regression analysis,defecating around the water source(OR=4.3,95%CI 1.5-12.9)had a statistically significant association with the prevalence of soil-transmitted helminthiasis(P=0.008).Conclusions:This study has given an insight on the prevalence and intensity of urinary schistosomiasis and soil-transmitted helminthiasis in Mwaluphamba location that form a basis for strengthening the control and elimination programmes for these neglected tropical diseases.

Epidemiological and Subtype Characterization of Influenza Viruses Infection in Children in Shenzhen, China during Three Consecutive Seasons (January 2016-December 2018)

Background: Children with seasonal influenza infection cause a significant burden of disease each year in the pediatric clinic. Influenza A and B viruses are the major types responsible for illness. A better understanding of the periodicity facilitates the prevention and control of influenza in children. Objective: This study aims to analyze the epidemiological patterns and subtype characterization of influenza viruses among children in Shenzhen, China. Methods: Influenza samples were collected by nasopharyngeal swabs from influenza like illness patients in Shenzhen Children’s Hospital from January 2016 to December 2018. The positive cases and influenza subtypes were determined by gold labeled antigen detection and reverse transcriptase polymerase chain reaction. The influenza periodicity and age, subtype distribution as well as the association between climate parameters and different influenza subtypes were analyzed by SPSS 22.0. Results: The influenza positive rate during 2016-2018 was 21.0%, with a highest positive rate in the year 2018. The positive rate varied by month, season, and year describing a sequence of peaks presenting primarily in all year including spring, summer and winter. The characteristics of influenza peak were different in each year, with a spring peak in 2016 and a summer plus a winter-spring peaks in 2017 and 2018. In addition, influenza B exhibited a winter-spring seasonal pattern while influenza A displayed a more variable seasonality, highlighting influenza B rather than influenza A which had a negative association with climate parameters. Influenza-positive cases were older than influenza-negative cases (P P Conclusion: Influenza activity in children from Shenzhen typically displays both winter-spring and summer peaks. Influenza A epidemic occurred separately or co-circulated with influenza B, with a winter-spring pattern for influenza B and a much more variable seasonality for influenza A. Influenza B had a negative association with climate parameters. In addition, hospitalization with influenza often occurs in younger individuals infected with influenza A.

Unveiling the Threat: Case Reports of Extra-Pulmonary Tuberculosis among Sanctuary Chimpanzees

Primate sanctuaries across Africa play a pivotal role in the rescue and rehabilitation of confiscated and rescued wild primates, many of whom have had extensive contact with humans prior to their arrival and throughout the rehabilitation process, heightening the risk of disease transmission. While tuberculosis is not naturally occurring in free-living chimpanzees, it has been extensively observed in captive primates that have been in close proximity to humans or other captive primates infected with Mycobacterium tuberculosis. This case report delves into an outbreak of extra-pulmonary tuberculosis among juvenile chimpanzees within a sanctuary, detailing the associated diagnostic challenges and treatment approaches. The five cases had close contact with a caregiver infected with tuberculosis, subsequently transmitting the infection to other in-contact chimpanzees. Prolonged treatment, employing the human protocol of quadri-therapy (rifampicin, isoniazid, pyrazinamide, and ethambutol), followed by bi-therapy (rifampicin and isoniazid), resulted in complete resolution for all five cases. These cases underscore the critical importance of maintaining high levels of biosecurity, implementing effective quarantine measures, and adhering to strict hygiene practices when working with non-human primates.

Potentially traumatic events,coping strategies and associations with mental health and well-being measures among conflict-affected youth in Eastern Democratic Republic of Congo

Background:Youth in conflict and post-conflict settings are exposed to a variety of potentially-traumatic events that impact their mental health and well-being.The purposes of this study were to examine coping strategies among conflict-affected youth exposed to potentially-traumatic events and the relationship to psychological symptoms and well-being in the Democratic Republic of Congo(DRC).Methods:A total of 434 male and female youth(ages 10–15 years)completed data collection with a trained Congolese interviewer.The survey instrument included measures of exposure to potentially traumatic events,an adapted coping strategies checklist,and measures of psychosocial distress and well-being.Exploratory factor analyses was used to identify coping strategies and Hierarchical regression was used to assess how coping strategies were associated with psychological symptoms including internalizing and externalizing problems and well-being outcomes including prosocial behavior and self-esteem.Results:Exploratory Factor analysis suggested four coping strategies;problem-focused,emotion-focused,avoidance and faith-based strategies.Problem-focused coping strategies were associated with greater internalizing and externalizing problems and lower prosocial behavior in both boys and girls.However,when problem-focused strategies were used with emotion-focused coping strategies,the result was fewer internalizing problems in girls and fewer externalizing problems in boys and girls.Emotion-focused,avoidance and faith based strategies were associated with better self-esteem.Conclusion:These results suggest a complex relationship between coping strategies,psychological symptoms and well-being and contradict evidence that problem-focused strategies benefit mental health while emotion-focused strategies harm mental health,particularly in conflict and post-conflict settings.The results suggest coping flexibility,or use of multiple coping strategies may be particularly useful to improving mental health and well-being.The need for context specific understandings of coping strategies in conflict-affected populations is highlighted by the results of the study.

Aid effectiveness and programmatic effectiveness:a proposed framework for comparative evaluation of different aid interventions in a particular health system

Background:Against a backdrop of changing concepts of aid effectiveness,development effectiveness,health systems strengthening,and increasing emphasis on impact evaluation,this article proposes a theory-driven impact evaluation framework to gauge the effect of aid effectiveness principles on programmatic outcomes of different aid funded programs in the health sector of a particular country.Methods:The foundation and step-by-step process of implementing the framework are described.Results:With empirical evidence from the field,the steps involve analysis of context,program designs,implementation mechanisms,outcomes,synthesis,and interpretation of findings through the programs’underlying program theories and interactions with the state context and health system.Conclusions:The framework can be useful for comparatively evaluating different aid interventions both in fragile and non-fragile state contexts.

Optimizing data visualization for reproductive,maternal,newborn,child health,and nutrition(RMNCH&N)policymaking:data visualization preferences and interpretation capacity among decision-makers in Tanzania

Background:Reproductive,maternal,newborn,child health,and nutrition(RMNCH&N)data is an indispensable tool for program and policy decisions in low-and middle-income countries.However,being equipped with evidence doesn’t necessarily translate to program and policy changes.This study aimed to characterize data visualization interpretation capacity and preferences among RMNCH&N Tanzanian program implementers and policymakers(“decision-makers”)to design more effective approaches towards promoting evidence-based RMNCH&N decisions in Tanzania.Methods:We conducted 25 semi-structured interviews in Kiswahili with junior,mid-level,and senior RMNCH&N decision-makers working in Tanzanian government institutions.We used snowball sampling to recruit participants with different rank and roles in RMNCH&N decision-making.Using semi-structured interviews,we probed participants on their statistical skills and data use,and asked participants to identify key messages and rank prepared RMNCH&N visualizations.We used a grounded theory approach to organize themes and identify findings.Results:The findings suggest that data literacy and statistical skills among RMNCH&N decision-makers in Tanzania varies.Most participants demonstrated awareness of many critical factors that should influence a visualization choice—audience,key message,simplicity—but assessments of data interpretation and preferences suggest that there may be weak knowledge of basic statistics.A majority of decision-makers have not had any statistical training since attending university.There appeared to be some discomfort with interpreting and using visualizations that are not bar charts,pie charts,and maps.Conclusions:Decision-makers must be able to understand and interpret RMNCH&N data they receive to be empowered to act.Addressing inadequate data literacy and presentation skills among decision-makers is vital to bridging gaps between evidence and policymaking.It would be beneficial to host basic data literacy and visualization training for RMNCH&N decision-makers at all levels in Tanzania,and to expand skills on developing key messages from visualizations.

Experiences with a violence and mental health safety protocol for a randomized controlled trial to support youth living with HIV

Background:Safety protocols are an essential component of studies addressing violence and mental health but are rarely described in the published literature from Sub-Saharan Africa.We designed and implemented a safety protocol within Project YES!(Youth Engaging for Success),which enrolled 276 youth living with HIV(ages 15–24 years)in a randomized controlled trial of a peer-mentoring intervention across four HIV clinics in Ndola,Zambia.Methods:Youth who reported severe violence and/or suicidal thoughts on research surveys or during meetings with youth peer mentors(YPM)were referred to designated healthcare providers(HCP).We explored experiences with the safety protocol using:a)monitoring data of referrals,and b)in-depth interviews with youth(n=82),HCP(n=10),YPM(n=8),and staff(n=6).Descriptive statistics were generated and thematic analysis of coded transcripts and written memos performed.Results:Nearly half of youth enrolled(48%of females,41%of males)were referred to a HCP at least once.The first referral was most often for sexual violence(35%)and/or suicidal ideation/depression(29%).All referred youth aged 15–17 years and over 80%of referred youth aged 18+agreed to see a HCP.HCP referred 15%for additional services outside the clinic.Twenty-nine youth,all HCP,all YPM,and all staff interviewed discussed the safety protocol.Most youth felt“encouraged,”“helped,”“unburdened,”and“relieved”by their meetings with HCP;some expressed concerns about meeting with HCP.The safety protocol helped HCP recognize the need to integrate care for violence and mental health with medication adherence support.HCP,YPM,and study staff raised implementation challenges,including youth choosing not to open up to HCP,time and resource constraints,deficiencies in HCP training,and stigma and cultural norms inhibiting referrals outside the clinic for emotional trauma and mental health.Conclusions:Implementing a safety protocol within an HIV clinic-based research study is possible and beneficial for youth and HCP alike.Implementation challenges underscore that HCP in Zambia work in over-stretched healthcare systems.Innovative strategies must address deficiencies in training and resources within HIV clinics and gaps in coordination across services to meet the overwhelming need for violence and mental health services among youth living with HIV.

Strengthening the migrant-friendliness of Thai health services through interpretation and cultural mediation:a system analysis

Background:In addition to healthcare entitlements,‘migrant-friendly health services’in Thailand include interpretation and cultural mediation services which aim to reduce language and cultural barriers between health personnel and migrants.Although the Thai Government started implementing these services in 2003,challenges in providing them still remain.This study aims to analyse the health system functions which support the interpretation and cultural mediation services of migrant health worker(MHW)and migrant health volunteer(MHV)programmes in Thailand.Methods:In-depth interviews were conducted in two migrant-populated provinces using purposive and snowball sampling.A total of fifty key informants were recruited,including MHWs,MHVs,health professionals,non-governmental organisation(NGO)staff and policy stakeholders.Data were triangulated using information from policy documents.The deductive thematic analysis was classified into three main themes of evolving structure of MHW and MHV programmes,roles and responsibilities of MHWs and MHVs,and supporting systems.Results:The introduction of the MHW and MHV programmes was one of the most prominent steps taken to improve the migrant-friendliness of Thai health services.MHWs mainly served as interpreters in public facilities,while MHVs served as cultural mediators in migrant communities.Operational challenges in providing services included insufficient budgets for employment and training,diverse training curricula,and lack of legal provisions to sustain the MHW and MHV programmes.Conclusion:Interpretation and cultural mediation services are hugely beneficial in addressing the health needs of migrants.To ensure the sustainability of current service provision,clear policy regulation and standardised training courses should be in place,alongside adequate and sustainable financial support from central government,NGOs,employers and migrant workers themselves.Moreover,regular monitoring and evaluation of the quality of services are recommended.Finally,a lead agency should be mandated to collaborate with stakeholders in planning the overall structure and resource allocation for the programmes.

China’s engagement with development assistance for health in Africa

Background:As an emerging donor in health related development across the world,particularly towards Africa,the People’s Republic of China(PRC)has been increasing its influence within the field of global public health over the past few decades.Yet between the period of 2000 and 2013,little is known about the scope,scale and priority of China’s grant-making programs.Methods:Based on data sourced from the China Aid Database(version-1.2),descriptive analyses were applied to analyze the features of 531 health related projects that were undertaken between 2000 and 2013.Spearmen correlation was also performed to assess the relationship between China’s export and aid to recipient countries.Results:The total value of China’s grant-making programs in the health related sector between 2000 and 2013 was 5.67 billion USD,with 531 projects undertaken.During the five year period between 2004 and 2008,China had a contribution of 1.54 billion USD,which increased to 3.8 billion USD during the five year period between 2009 and 2013-an 146.26%increase.In terms of specific diseases,China is most concerned with building an African public health system through donations targeted towards general health(313 projects),combating Malaria(115 projects)and maternal,neonatal and child health(MNCH),(12 projects).When it comes to recipient countries,if counted in total value,Zimbabwe received the most financial assistance from China,totaling 1.08 billion USD and 19 projects,while Angola and Tanzania received more projects-30 and 29 projects respectively.In terms of the channeling of aid funding,most projects were targeted towards infrastructure,equipment and medicine(304 projects in total),followed by medical teams(189 projects).Moreover,there is a statistically significant relationship between aid to Africa and Chinese exports to Africa.Conclusion:During the past decade,Chinese aid projects played an important role in the African public health system through providing funding for infrastructure,equipment and medicine,training health professionals,as well as disease treatment.However,very limited attention was paid towards disease prevention,health promotion and awareness initiatives,and health education.Furthermore,serious questions were raised regarding the long-term financial sustainability and actual impact these projects have on health development.

The clinical impact of bacterial biofilms

Bacteria survive in nature by forming biofilms on surfaces and probably most, if not all, bacteria （and fungi） are capable of forming biofilms. A biofilm is a structured consortium of bacteria embedded in a self-produced polymer matrix consisting of polysaccharide, protein and extracellular DNA. Bacterial biofilms are resistant to antibiotics, disinfectant chemicals and to phagocytosis and other components of the innate and adaptive inflammatory defense system of the body. It is known, for example, that persistence of staphylococcal infections related to foreign bodies is due to biofilm formation. Likewise, chronic Pseudomonas aeruginosa lung infections in cystic fibrosis patients are caused by biofilm growing mucoid strains. Gradients of nutrients and oxygen exist from the top to the bottom of biofilms and the bacterial cells located in nutrient poor areas have decreased metabolic activity and increased doubling times. These more or less dormant cells are therefore responsible for some of the tolerance to antibiotics. Biofilm growth is associated with an increased level of mutations. Bacteria in biofilms communicate by means of molecules, which activates certain genes responsible for production of virulence factors and, to some extent, biofilm structure. This phenomenon is called quorum sensing and depends upon the concentration of the quorum sensing molecules in a certain niche, which depends on the number of the bacteria. Biofilms can be prevented by antibiotic prophylaxis or early aggressive antibiotic therapy and they can be treated by chronic suppressive antibiotic therapy. Promising strategies may include the use of compounds which can dissolve the biofilm matrix and quorum sensing inhibitors, which increases biofilm susceptibility to antibiotics and phagocytosis.

提高实效性临床试验报告的质量——《CONSORT声明》的扩展

近年来实效性临床试验受到更多重视,尤其在传统医学临床评价研究领域。为了提高实效性临床试验报告的质量,CONSORT声明组和医疗保健体系中的实效性随机对照临床试验(pragmatic randomized controlled trials in health care systems,PRACTIHC)小组对《CONSORT声明》进行了修改,以帮助读者评估试验质量和结果的可靠性。实效性试验报告指南,作为《CONSORT声明》的一个特殊扩展,能在报告、评价和应用实效性试验方面帮助编辑、系统评价者、试验设计者和决策者评估实效性试验报告中的信息,判定其结论是否适用,以及干预措施是否可行、可否被接受。2005年1月和2008年3月,在加拿大多伦多分别举行了为期两天的会议来探讨提高随机对照试验对卫生保健决策贡献的方法,焦点集中于实效性试验。2005年会,后扩展版草案修订清单发送至编写组成员,经过几次修订,编写组起草了一份摘要草案。在2008年讨论并修改了这一草案。这份草案发给CONSORT声明组以供修改并发表。这份声明的扩展版提出了对8个条目的补充。及时向国内读者和临床试验研究人员介绍该指南有重要的现实意义和学术价值。北京中医药大学循证医学中心刘建平教授等在短时间内翻译了该指南。本刊希望通过介绍中文版"提高实效性临床试验报告的质量——《CONSORT声明》的扩展"以提高国内实效性临床试验报告的质量,相信也有助于改进试验设计的方法学质量。