Prioritizing Strategies for Building the Resilience of Public Health Systems to Disasters Across Multiple Communities and Countries

The COVID-19 pandemic highlighted the urgent need to strengthen public health systems.In response,the United Nations Disaster Risk Reduction(UNDRR) Public Health System Resilience Scorecard(Scorecard) was applied in workshops across multiple countries.The aim of our research was to explore the workshop findings to develop priority strategies for strengthening public health system resilience.We conducted a workshop from 14 to 16 March 2023,at the UNDRR Global Education and Training Institute in Incheon,Republic of Korea.A sequential modified Delphi method was utilized to develop a set of prioritized resilience strategies.These were drawn from 70 strategies identified from 13 distinct workshops in eight countries.After two surveys,23 strategies were finalized.Ten received ratings of "High" or Very High" from89% of participants.These related to the inclusion of public health risks in emergency plans,integrating multidisciplinary teams into public health,enabling local transport mechanisms,and improving the ability to manage an influx of patients.The Scorecard provides an adaptable framework to identify and prioritize strategies for strengthening public health system resilience.By leveraging this methodology,our study demonstrated how resilience strategies could inform disaster risk reduction funding,policies,and actions.

Role of H2 receptor blocker famotidine over the clinical recovery of COVID-19 patients: A randomized controlled trial

BACKGROUND Coronavirus disease 2019(COVID-19)is a global pandemic putting the population at a high risk of infection-related health hazards,mortality and a potential failure of proper medical therapies.Therefore,it is necessary to evaluate the potential use of the existing drugs that could be used as options for the medical management of COVID-19 patients.AIM To evaluate the role of the H_(2) receptor blocker“famotidine”in COVID-19 illness.METHODS This study was done on seriously ill COVID-19 patients admitted to the intensive care unit(ICU)from different institutes in Bangladesh.Patients were divided into famotidine treatment group“A”(famotidine 40 mg to 60 mg oral formulation every 8 h with other treatment as given),and control group“B”(treatment as given).National early warning score(NEWS)-2,and sequential organ failure assessment day-1 score was calculated to evaluate the outcome.Outcomes were evaluated by the time required for clinical improvement,characterized as duration required from enrollment to the achievement of NEWS-2 of≤2 maintained for 24 h;time to symptomatic recovery,defined as the duration in days(from randomization)required for the recovery of the COVID-19 symptoms;mortality rate;duration of ICU and hospital stay;total period of hospitalization;the rate of supplementary oxygen requirement;the computed tomography(CT)chest recovery(%),the time required for the viral clearance and“NEWS-2”on discharge.RESULTS A total of 208 patients were enrolled in this study with 104 patients in each group.The famotidine treatment group had comparatively better recovery of 75%and a low mortality of 25%than the control with a recovery of 70%and a mortality of 30%.Duration of clinical improvement(group A 9.53 d,group B 14.21 d);hospitalization period among the recovered patients(group A 13.04 d,group B 16.31 d),pulmonary improvement in chest CT(group A 21.7%,group B 13.2%),and the time for viral clearance(group A 20.7 d,group B 23.8 d)were found to be statistically significant P≤0.05.However,the Kaplan Meier survival test was not significant among the two study groups,P=0.989.CONCLUSION According to our study,treatment with famotidine achieved a better clinical outcome compared to the control group in severe COVID-19 illness,although no significant survival benefit was found.

Applications of nanomaterials in mosquito vector control:A review

The periodic outbreak of mosquito-borne diseases like dengue fever,zika fever,and yellow fever all over the world highlights the need for effective mosquito control methods targeting the biological system.Due to the lack of therapeutic measures,preventive treatments or vaccines against pathogens,insecticide resistance eventually lead the research focus towards novel technological applications in mosquito management.Nanomaterials with ovicidal,larvicidal,adulticidal,and repellent properties for controlling mosquito vectors are under research.A literature search was carried out for advancements in nanomaterials,insecticides,and mosquito control in PubMed/MEDLINE,Scopus,Google Scholar,ScienceDirect,and Web of Science.This paper aims to provide insights into various nanomaterials relevant to mosquito-borne diseases,in vivo and in vitro toxicity evaluation against mosquito species,mode of action,effect on non-target organisms,and ecological risks.Organic and inorganic materials that provide controlled release,target delivery,less dosage,prolonged efficacy,a reduction in the use of organic solvents and emulsifiers,and minimum pollution to the environment have already been explored.Indeed,further research on the ecological risk and economic feasibility of nanomaterials in mosquitocidal applications should be done prior to commercialization.

Breast cancer in India:Present scenario and the challenges ahead

Breast cancer is the commonest malignancy among women globally.From being fourth in the list of most common cancers in India during the 1990s,it has now become the first.In this review,we examine the available literature to understand the factors that contributed to the high burden of breast cancer in the country.We also provide the landscape of changes in the field of early diagnosis and the treatment modalities as well as the limitations of the Indian healthcare delivery systems(e.g.,delayed diagnosis,human resources and funding for treatment).This review also sheds light on the newer interventions and the future of breast cancer management keeping in mind the coronavirus disease 2019 imposed limitations.

Levels, Trends and Inter-Regional Variations in Transfusion Transmissible Infection Positivity among Blood Donors in India: Evidence from India’s National HIV Program

In India, transfusion transmissible infections (TTIs) are monitored for trends at the blood bank level, but limited efforts have been made to analyze data from a large number of blood banks and present it at the national, regional and state levels. The Computerized Management Information System (CMIS), National AIDS Control Organization’s (NACO) online data capturing system, systematically collects information on TTIs in a monthly aggregated format from blood banks across the country. This information is being captured in NACO’s annual reports, but a systematic scientific analysis and publication of the same have not been attempted so far. Hence, the objective of this study is to analyze and report TTIs among blood donors in India at three different levels—national, regional and state—from 497 consistent blood banks reporting through CMIS during 2008-2012. National level analysis shows an increasing trend in voluntary blood donation from 9.28 lakh to 19.02 lakh, and a decreasing trend in TTIs, with female donors constituting only 6% of the entire pool of donors. Of the five TTIs studied, in 2012 Hepatitis-B-surface Antigen (HBsAg) positivity was highest (0.9%), followed by Hepatitis C Virus (HCV) (0.45%), syphilis (0.23%), HIV (0.17%) and malaria (0.03%). Regional analysis indicated that voluntary donation was high in the Eastern and Western regions, with 11% of female donors in Eastern India in 2012. All the TTIs showed a declining trend, except HCV, which showed a rising trend in the Eastern and Southern regions. The level of positivity for all the five TTIs was higher than the national average in the Eastern region. Among the TTIs, HIV positivity among voluntary donors was below the national average, while in Mizoram both HBsAg and HCV of more than 1% seropositivity and VDRL of 1.7% in Arunachal Pradesh had been reported. Malaria has the lowest national positivity, with Nagaland reporting a high positivity of 0.4%. Although the national and regional trends in TTI positivity are declining, regional level variations in TTIs, especially in hepatitis, suggest the importance of advocating for pre-donation counseling and educating donors on self-exclusion.

Importance of Wolbachia-mediated biocontrol to reduce dengue in Bangladesh and other dengue-endemic developing countries

Mosquito-borne diseases,particularly dengue and chikungunya have become global threats,infecting millions of people worldwide,including developing countries of Southeast Asia and Latin America.Bangladesh,like many other developing countries,is experiencing frequent dengue outbreaks.This article,therefore,critically discussed the current status of dengue disease,vector control approaches,and the need for Wolbachia-mediated intervention in Bangladesh and other dengue-endemic developing countries.In this narrative review study,rel-evant literature was searched from major databases and search engines such as PubMed,BanglaJol,World Health Organization(WHO)/European Centre for Disease Prevention and Control(ECDC)and Google Scholar.Considering the selection criteria,our search strategies finally involved 55 related literature for further investigation.Findings showed that current vector control strategies could not render protection for an extended period,and the disease burden of arboviruses is increasing.The impoverished outbreak preparedness,urbanization,climate change,and less efficacy of existing control methods have made people susceptible to vector-borne diseases.Hence,Wolbachia,a naturally occurring endosymbiont of many mosquito species that can potentially limit virus transmission through several host genetic alterations,would be a potential alterna-tive for dengue prevention.We also critically discussed the challenges and prospects of Wolbachia-based den-gue control in developing countries.The evidence supporting the efficacy and safety of this intervention and its mechanism have also been elucidated.Empirical evidence suggests that this introgression method could be an eco-friendly and long-lasting dengue control method.This review would help the policymakers and health experts devise a scheme of Wolbachia-based dengue control that can control mosquito-borne diseases,partic-ularly dengue in Bangladesh and other developing countries.

Threats of Zika virus transmission for Asia and its Hindu-Kush Himalayan region

Asia and its Hindu Kush Himalayan(HKH)region is particularly vulnerable to environmental change,especially climate and land use changes further influenced by rapid population growth,high level of poverty and unsustainable development.Asia has been a hotspot of dengue fever and chikungunya mainly due to its dense human population,unplanned urbanization and poverty.In an urban cycle,dengue virus(DENV)and chikungunya virus(CHIKV)are transmitted by Aedes aegypti and Ae.albopictus mosquitoes which are also competent vectors of Zika virus(ZIKV).Over the last decade,DENV and CHIKV transmissions by Ae.aegypti have extended to the Himalayan countries of Bhutan and Nepal and ZIKV could follow in the footsteps of these viruses in the HKH region.The already established distribution of human-biting Aedes mosquito vectors and a naïve population with lack of immunity against ZIKV places the HKH region at a higher risk of ZIKV.Some of the countries in the HKH region have already reported ZIKV cases.We have documented an increasing threat of ZIKV in Asia and its HKH region because of the high abundance and wide distribution of human-biting mosquito vectors,climate change,poverty,report of indigenous cases in the region,increasing numbers of imported cases and a naïve population with lack of immunity against ZIKV.An outbreak anywhere is potentially a threat everywhere.Therefore,in order to ensure international health security,all efforts to prevent,detect,and respond to ZIKV ought to be intensified now in Asia and its HKH region.To prepare for possible ZIKV outbreaks,Asia and the HKH region can also learn from the success stories and strategies adopted by other regions and countries in preventing ZIKV and associated complications.The future control strategies for DENV,CHIKV and ZIKV should be considered in tandem with the threat to human well-being that is posed by other emerging and re-emerging vector-borne and zoonotic diseases,and by the continuing urgent need to strengthen public primary healthcare systems in the region.

印度结核病控制的现状与展望

背景:有关结核病控制的全球策略多数是在印度建立。但是,在印度每年估计有200万结核病人发生。 目的:本文报导了印度在修订后的国家结核病控制规划内,应用DOTS原则作为控制政策及其初步的结果。 设计:修订后的国家结核病控制规划于1993年开始设计和实施,资金来源于印度政府、邦政府、世界银行和双边支持的赞助商。常规的药品供应和后勤服务得到了保证。有呼吸道症状的人都能到卫生机构并转到显微镜检查中心进行诊断,病人分类根据WHO的大纲,病人治疗采用督导化疗,实施了系统的登记和队列报告。 结果:自1993年10月至1999年中,规划内治疗病人146012例,病人诊断的质量得到改善,涂阳病人与涂阴病人的比例为1:1。病人发现率在项目地区之间有不同程度的进步,与接受诊断检查的人群中涂阳病人百分比有关,提示疾病的不均衡性。新涂阳病人的治疗成功率达81％,新涂阴病人达82％,肺外结核病人达89％,复治病人的成功率为70％。 结论:在印度15个邦的20个区,大约80％的病人在国家规划中获得成功的治疗。治疗成功率比以前的规划提高一倍,死亡率得到下降,为原先的1/7。自1998年后期开始,新规划逐渐扩展,至今已覆盖1.3亿人口,在进一步扩展期间,保持实施质量是进一步的挑战。

新型冠状病毒疫情下护士压力应对资源的概况性综述

目的在应对新型冠状病毒疫情中护士的心理健康问题只是冰山一角。本研究旨在对新型冠状病毒疫情期间和疫情之后适用于护士的心理应对技术和资源进行综述,以维持医疗系统的复原力。方法文献检索范围包括2020年1月至2021年5月发表的文章,使用Endnote存储和管理。数据综合和审查遵循乔安娜·布里格斯研究所手册和PRISMA-ScR原则。排除多余、无关和不合格的研究,最终纳入13项研究(3613名护士)。结果这些文献中的绝大部分护士为女性且有孩子,主要在重症监护室、急诊室和发热门诊工作。担心家人或同事的安全,以及缺乏安全的工作环境,是发生心理问题的主要原因。另一方面,职业责任感、COVID-19相关培训、工作场所安全、团队精神以及一些放松活动,如深呼吸、读书、看电影和祈祷等,对护士应对压力有益。结论心理健康的护士在面对任何威胁生命的疫情暴发时更具能力和灵活性,即使传染性很强。研究发现,疫情期间的一些应对策略对护士有效,针对特定问题的干预可能效果更好。抗疫战场上的心理健康干预不应滞后,以确保其可行性和有效性,否则整个医疗卫生系统都将受到严重影响。

Pregnancy Outcomes in Smokeless Tobacco Users Cohort Study in a Tertiary Care Hospital

There is a dearth of literature regarding the pregnancy outcomes in antenatal women using smokeless tobacco products (STP). Objective: To compare maternal and neonatal pregnancy outcomes in antenatal women using smokeless tobacco products with those not using tobacco products. Method: Pregnant women attending antenatal clinic at Guru Teg Bahadur hospital, Delhi received brief information about smokeless tobacco products. Antenatal women using STP and matched controls, 92 in each group (total 184) were recruited for the study. After obtaining consent, the urinary cotinine level was measured in both groups at first contact. Antenatal, labour and postpartum events were recorded in both groups. Urinary cotinine levels were again measured at 6 months in the user group. Results: Average age of antenatal women under study was 24.8 yrs and 25.21 yrs in user and non-user groups respectively. More women in the user group were illiterate (P ? 20.39 μg/ml and 24.37 +/? 20.14 μg/ml respectively (p < 0.0001). Women using STPs for more than 5 yrs recorded higher urinary cotinine levels. There was no significant difference in urinary cotinine levels with the type of tobacco product consumed. Pregnancy outcomes of 39 women are known. There was no significant difference in antenatal, intra-natal and postpartum complications in the two groups. Neonatal weight difference was 20 gms.Conclusion: Smokeless tobacco products are the most common forms used by women in low and middle income countries. Larger studies are required to understand their effects on pregnancy outcomes.

印度结核病患者中的HIV感染率估算

使用全球的数据已经对印度结核病(TB)患者的人类免疫缺陷病毒(HIV)感染状况进行了间接估算。为了使用当地数据对HIV感染状况进行更加准确的估算,我们将县/区级产前门诊的HIV监测数据与结核病诊断中心的HIV监测数据联系起来,并将这一关联性应用到省级对孕妇人群的HIV感染状况估算中。我们估计,2007年196万新发结核病患者的HIV感染率为4.85%(95%可信区间为4.12～5.73)或HIV感染人数为95 240(95%可信区间为80 730～112 478)例。从使用这些当地数据所进行的估算中,国家结核病防治规划能够更好的制定TB/HIV双重感染防治联合行动,并监控在这一大规模人群中发现HIV感染者的结果。

应用痰抗酸杆菌涂片批量抽样对镜检中心进行评价

地点:进行痰抗酸菌镜检的指定镜检中心(DMC)和其他镜检中心(AMC),地区结核病中心(DTC)和参比实验室(RL)。目的:使用盲法 AFB 痰涂片对不知晓 AFB 镜检质控的结核病实验室高级督导员(STLS)和经过培训知晓质控的参比实验室(RL)的技术员进行结果评估,确定批量抽样痰涂片的可行性。方法:镜检中心(MC)的痰涂片送至地区结核病中心(DTC)和参比实验室;经过系统选择每个镜检中心每月送 20 个涂片;DMC 的 1547 张涂片和 AMC 的 726张涂片分别由DTC的STLS和RL的技术员进行检查,由第三者负责分析差别。结果:和 RL 的 1%相比,MC 实验室技术员和 DTC 的STLSs 之间的不符合率为 4.7%。STLSs 与 RL 实验室技术员各有 70 次和 2 次错误。结论:AFB 涂片的批量抽样在现场情况下是可行的。受过 AFB 涂片镜检质控培训的 RL 技术员对 MC 的评价比没有受过此训练的 STLSs 更有效。

2001—2002年印度喀拉拉邦坎纳区公立和私立医疗卫生机构合作开展结核病控制项目的成本及成本—效益分析

背景:对于公立和私立机构合作(PPM)诊断和治疗结核病的成本效益方面的了解尚不足。设计:从新的国家结核病防治规划(RNTCP)角度,评价印度坎纳地区私立机构实验室开展PPM项目的花费及成本-效益。我们估算了每聘用并维持一个服务提供者的花费,估算了在不同效率假设的情况下多发现1例病人的花费、以及多成功治疗1例病人的花费。有关这些干预措施的花费的数据来自于国家结核病控制规划的登记资料,治疗花费的估算基于国家结核病控制规划的病例管理方案。结果:本项目每年总的估算花费为8 712～11611美元,平均每聘用1个私立服务提供者的费用从22～54美元不等,私立机构多诊断1例肺结核病人的花费为14～18美元。多登记1个病人,最保守的估算需花费29～36美元。每成功治疗1例抗酸杆菌阳性的病人约花费47～51美元。提高报告率会改善成本效益。结论:与公立卫生机构的诊断费用相比,需要明确这项干预措施是否对不同实施级别的公共卫生系统在经济上具有吸引力;如需扩展PPM项目,需要明确补充资源的需求。