RESUMEN
OBJECTIVE: To investigate the effect of using volunteer screeners in active tuberculosis case-finding in South Kivu, the Democratic Republic of the Congo, especially among groups at high risk of tuberculosis infection. METHODS: To identify and screen high-risk groups in remote communities, we trained volunteer screeners, mainly those who had themselves received treatment for tuberculosis or had a family history of the disease. A non-profit organization was created and screeners received training on the disease and its transmission at 3-day workshops. Screeners recorded the number of people screened, reporting a prolonged cough and who attended a clinic for testing, as well as test results. Data were evaluated every quarter during the 3-year period of the intervention (2014-2016). FINDINGS: Acceptability of the intervention was high. Volunteers screened 650 434 individuals in their communities, 73 418 of whom reported a prolonged cough; 50 368 subsequently attended a clinic for tuberculosis testing. Tuberculosis was diagnosed in 1 in 151 people screened, costing 0.29 United States dollars (US$) per person screened and US$ 44 per person diagnosed. Although members of high-risk groups with poorer access to health care represented only 5.1% (33 002/650 434) of those screened, they contributed 19.7% (845/4300) of tuberculosis diagnoses (1 diagnosis per 39 screened). The intervention resulted in an additional 4300 sputum-smear-positive pulmonary tuberculosis diagnoses, 42% (4 300/10 247) of the provincial total for that period. CONCLUSION: Patient-led active tuberculosis case-finding represents a valuable complement to traditional case-finding, and should be used to assist health systems in the elimination of tuberculosis.
Asunto(s)
Servicios de Salud Comunitaria/métodos , Tamizaje Masivo/organización & administración , Esputo/microbiología , Tuberculosis Pulmonar/diagnóstico , Voluntarios , Antituberculosos/uso terapéutico , República Democrática del Congo/epidemiología , Femenino , Humanos , Masculino , Áreas de Pobreza , Población Rural , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/epidemiología , Tuberculosis Pulmonar/prevención & controlRESUMEN
Some have suggested a protective effect of tuberculosis (TB) infection on allergic disease risk, but few studies have examined the association between the two. We therefore investigated whether TB disease and bacillus Calmette-Guérin (BCG) vaccination in early life protect against allergic disease. Information on allergic disease symptoms, past TB disease, and BCG vaccination as well as potential confounding factors was gathered by parental questionnaire from a randomly selected subset of 23,901 8- to 12-yr-old schoolchildren in 20 centers in both developed and developing countries. Children were also physically examined for flexural eczema and underwent skin prick testing. Pooled odds ratio (OR) estimates and corresponding 95% confidence intervals (CIs) across study centers were calculated, using random effects meta-analysis models. There were 245 (1.0%) reported cases of TB disease, and 66.3% (15,857) of all children received the BCG vaccine. Asthma, hay fever, and flexural eczema symptoms in the past year as well as flexural eczema on skin examination were all positively linked to a history of TB (adjusted pooled OR 'wheeze in the past year' = 2.27, 95% CI 1.52-3.41; adjusted pooled OR 'hay fever symptoms in the past year' = 2.23, 1.22-4.09; adjusted pooled OR 'flexural eczema symptoms in the past year' = 3.21, 2.01-5.12; adjusted pooled OR 'flexural eczema on skin examination' = 4.04, 1.71-9.56). Even higher risk estimates were seen for severe asthma and eczema symptoms [adjusted OR = 4.02 (2.17-7.47) and adjusted OR = 6.31 (2.19-18.17), respectively]. There was no significant association between past TB and skin prick test positivity (adjusted pooled OR = 1.32, 0.87-2.02). BCG vaccination during the first year of life was also not associated with any of the allergy outcomes. We found a uniform positive association between TB and all allergic disease outcomes, including eczema on skin examination. As this was a cross-sectional study, it is unclear whether this positive association is attributable to a causal relationship, and further longitudinal studies are required.
Asunto(s)
Asma/epidemiología , Vacuna BCG/administración & dosificación , Eccema/epidemiología , Rinitis Alérgica Estacional/epidemiología , Tuberculosis Pulmonar/prevención & control , Asma/etiología , Vacuna BCG/efectos adversos , Niño , Estudios Transversales , Países Desarrollados/estadística & datos numéricos , Países en Desarrollo/estadística & datos numéricos , Eccema/etiología , Femenino , Humanos , Masculino , Prevalencia , Rinitis Alérgica Estacional/etiología , Índice de Severidad de la Enfermedad , Pruebas Cutáneas , Encuestas y CuestionariosRESUMEN
Asthma is a global health problem affecting around 300 million individuals of all ages, ethnic groups and countries. It is estimated that around 250,000 people die prematurely each year as a result of asthma. Concepts of asthma severity and control are important in evaluating patients and their response to treatment, as well as for public health, registries, and research (clinical trials, epidemiologic, genetic, and mechanistic studies), but the terminology applied is not standardized, and terms are often used interchangeably. A common international approach is favored to define severe asthma, uncontrolled asthma, and when the 2 coincide, although adaptation may be required in accordance with local conditions. A World Health Organization meeting was convened April 5-6, 2009, to propose a uniform definition of severe asthma. An article was written by a group of experts and reviewed by the Global Alliance against Chronic Respiratory Diseases review group. Severe asthma is defined by the level of current clinical control and risks as "Uncontrolled asthma which can result in risk of frequent severe exacerbations (or death) and/or adverse reactions to medications and/or chronic morbidity (including impaired lung function or reduced lung growth in children)." Severe asthma includes 3 groups, each carrying different public health messages and challenges: (1) untreated severe asthma, (2) difficult-to-treat severe asthma, and (3) treatment-resistant severe asthma. The last group includes asthma for which control is not achieved despite the highest level of recommended treatment and asthma for which control can be maintained only with the highest level of recommended treatment.
Asunto(s)
Asma/clasificación , Ensayos Clínicos como Asunto , Humanos , Organización Mundial de la SaludRESUMEN
The International Study of Asthma and Allergies in Childhood (ISAAC) Phase One showed large worldwide variations in the prevalence of symptoms of asthma, rhinoconjunctivitis and eczema, up to 10 to 20 fold between countries. Ecological analyses were undertaken with ISAAC Phase One data to explore factors that may have contributed to these variations, and are summarised and reviewed here.In ISAAC Phase One the prevalence of symptoms in the past 12 months of asthma, rhinoconjunctivitis and eczema were estimated from studies in 463,801 children aged 13 - 14 years in 155 centres in 56 countries, and in 257,800 children aged 6-7 years in 91 centres in 38 countries. Ecological analyses were undertaken between symptom prevalence and the following: Gross National Product per capita (GNP), food intake, immunisation rates, tuberculosis notifications, climatic factors, tobacco consumption, pollen, antibiotic sales, paracetamol sales, and outdoor air pollution.Symptom prevalence of all three conditions was positively associated with GNP, trans fatty acids, paracetamol, and women smoking, and inversely associated with food of plant origin, pollen, immunisations, tuberculosis notifications, air pollution, and men smoking. The magnitude of these associations was small, but consistent in direction between conditions. There were mixed associations of climate and antibiotic sales with symptom prevalence.The potential causality of these associations warrant further investigation. Factors which prevent the development of these conditions, or where there is an absence of a positive correlation at a population level may be as important from the policy viewpoint as a focus on the positive risk factors. Interventions based on small associations may have the potential for a large public health benefit.
Asunto(s)
Asma/epidemiología , Conjuntivitis Alérgica/epidemiología , Eccema/epidemiología , Exposición a Riesgos Ambientales/estadística & datos numéricos , Enfermedades Ambientales/epidemiología , Modelos de Riesgos Proporcionales , Rinitis Alérgica Estacional/epidemiología , Distribución por Edad , Causalidad , Comorbilidad , Femenino , Humanos , Incidencia , Internacionalidad , Masculino , Medición de Riesgo/métodos , Factores de Riesgo , Distribución por SexoRESUMEN
Worldwide, more individuals have iron deficiency than any other health problem. Most of those affected are unaware of their lack of iron, in part because detection of iron deficiency has required a blood sample. Here we report a non-invasive method to optically measure an established indicator of iron status, red blood cell zinc protoporphyrin, in the microcirculation of the lower lip. An optical fibre probe is used to illuminate the lip and acquire fluorescence emission spectra in â¼1 min. Dual-wavelength excitation with spectral fitting is used to distinguish the faint zinc protoporphyrin fluorescence from the much greater tissue background fluorescence, providing immediate results. In 56 women, 35 of whom were iron-deficient, the sensitivity and specificity of optical non-invasive detection of iron deficiency were 97% and 90%, respectively. This fluorescence method potentially provides a rapid, easy to use means for point-of-care screening for iron deficiency in resource-limited settings lacking laboratory infrastructure.
Asunto(s)
Eritrocitos/química , Deficiencias de Hierro , Trastornos del Metabolismo del Hierro/diagnóstico , Labio/química , Mediciones Luminiscentes/métodos , Protoporfirinas/química , Eritrocitos/metabolismo , Femenino , Fluorescencia , Humanos , Hierro/química , Trastornos del Metabolismo del Hierro/metabolismo , Labio/metabolismo , Masculino , Protoporfirinas/metabolismo , Sensibilidad y EspecificidadRESUMEN
OBJECTIVES: Benin established a revolving drug fund (RDF) for essential asthma medicines in 2008. We evaluated the operation of the RDF and assessed whether there was interruption of supply of asthma medicine from 2008 to 2013. METHODS: We reviewed the process in establishing the RDF. We assessed cost and sale price of asthma medicines, expenditure of the RDF in procuring asthma medicines and other tools, revenue generated by sales of medicines to patients, and balance of capital as of 31 January 2013. We investigated whether there was interruption of supply of essential asthma medicines from 2008-2013. RESULTS: The total amount of grants initially injected into the RDF was 24,101. As of 31 January 2013, the capital of the RDF, including the deposit in the RDF bank account (8,114) and the value of inhalers in stock (12,172), was equivalent to 20,586, slightly less than the initial capital (24,101). The decrease of capital was mainly because a number of inhalers were expired or provided free-of-charge (6,091) and because part of the fund was used to procure other elements required for the management of asthma (4,338). Thanks to a RDF, Benin maintained an uninterrupted supply of essential asthma medicines in asthma pilot sites from 2008-2013. CONCLUSION: The Benin experience demonstrated that in countries where universal health coverage was not yet in place, establishment of a RDF may help maintain an uninterrupted supply of essential medicines.
Asunto(s)
Antituberculosos , Terapia por Observación Directa , Tuberculosis Pulmonar , Humanos , Antituberculosos/farmacología , Antituberculosos/uso terapéutico , Farmacorresistencia Microbiana , Mycobacterium tuberculosis/efectos de los fármacos , Rifampin/farmacología , Rifampin/uso terapéutico , Tuberculosis Pulmonar/tratamiento farmacológico , Revisiones Sistemáticas como AsuntoRESUMEN
This paper presents an automated real-time atrial fibrillation (AF) detection approach that relies on the observation of two characteristic irregularities of AF episodes in the electrocardiogram (ECG) signal. The results generated after the analysis of these irregularities are subsequently analyzed in real-time using a new fuzzy classifier. We have optimized this novel AF classification framework to require very limited processing, memory storage and energy resources, which makes it able to operate in real-time on a wearable wireless sensor platform. Moreover, our experimental results indicate that the proposed on-line approach shows a similar accuracy to state-of-the-art off-line AF detectors, achieving up to 96% sensitivity and 93% specificity. Finally, we present a detailed energy study of each component of the target wearable wireless sensor platform, while executing the automated AF detection approach in a real operating scenario, in order to evaluate the lifetime of the overall system. This study indicates that the lifetime of the platform is increased by using the proposed method to detect AF in real-time and diagnose the patient with respect to a streaming application that sends the raw signal to a central coordinator (e.g., smartphone or laptop) for its ulterior processing.
Asunto(s)
Fibrilación Atrial , Tecnología Inalámbrica , Técnicas Biosensibles/instrumentación , Electrocardiografía , HumanosRESUMEN
Wireless body sensor networks (WBSN) hold the promise to be a key enabling information and communications technology for next-generation patient-centric telecardiology or mobile cardiology solutions. Through enabling continuous remote cardiac monitoring, they have the potential to achieve improved personalization and quality of care, increased ability of prevention and early diagnosis, and enhanced patient autonomy, mobility, and safety. However, state-of-the-art WBSN-enabled ECG monitors still fall short of the required functionality, miniaturization, and energy efficiency. Among others, energy efficiency can be improved through embedded ECG compression, in order to reduce airtime over energy-hungry wireless links. In this paper, we quantify the potential of the emerging compressed sensing (CS) signal acquisition/compression paradigm for low-complexity energy-efficient ECG compression on the state-of-the-art Shimmer WBSN mote. Interestingly, our results show that CS represents a competitive alternative to state-of-the-art digital wavelet transform (DWT)-based ECG compression solutions in the context of WBSN-based ECG monitoring systems. More specifically, while expectedly exhibiting inferior compression performance than its DWT-based counterpart for a given reconstructed signal quality, its substantially lower complexity and CPU execution time enables it to ultimately outperform DWT-based ECG compression in terms of overall energy efficiency. CS-based ECG compression is accordingly shown to achieve a 37.1% extension in node lifetime relative to its DWT-based counterpart for "good" reconstruction quality.
Asunto(s)
Algoritmos , Electrocardiografía Ambulatoria/instrumentación , Procesamiento de Señales Asistido por Computador/instrumentación , Telemedicina/instrumentación , Tecnología Inalámbrica/instrumentación , Humanos , Análisis de OndículasRESUMEN
This work is devoted to the evaluation of multilead digital wavelet transform (DWT)-based electrocardiogram (ECG) wave delineation algorithms, which were optimized and ported to a commercial wearable sensor platform. More specifically, we investigate the use of root-mean squared (RMS)-based multilead followed by a single-lead online delineation algorithm, which is based on a state-of-the-art offline single-lead delineator. The algorithmic transformations and software optimizations necessary to enable embedded ECG delineation notwithstanding the limited processing and storage resources of the target platform are described, and the performance of the resulting implementations are analyzed in terms of delineation accuracy, execution time, and memory usage. Interestingly, RMS-based multilead delineation is shown to perform equivalently to the best single-lead delineation for the 2-lead QT database (QTDB), within a fraction of a sample duration of the Common Standards for Electrocardiography (CSE) committee tolerances. Finally, a comprehensive evaluation of the energy consumption entailed by the considered algorithms is proposed, which allows very relevant insights into the dominant energy-draining functionalities and which suggests suitable design guidelines for long-lasting wearable ECG monitoring systems.
Asunto(s)
Algoritmos , Diagnóstico por Computador/métodos , Electrocardiografía Ambulatoria/métodos , Electrocardiografía/métodos , Análisis de Ondículas , Tecnología Inalámbrica/instrumentación , Bases de Datos Factuales , Humanos , Sensibilidad y Especificidad , Procesamiento de Señales Asistido por ComputadorRESUMEN
Respiratory disease has never received priority in relation to its impact on health. Estimated DALYs lost in 2002 were 12% globally (similar for industrialized and developing countries). Chronic airflow limitation (due mainly to asthma and COPD) alone affects more than 100 million persons in the world and the majority of them live in developing countries. International guidelines for management of asthma (GINA) and COPD (GOLD) have been adopted and their cost-effectiveness demonstrated in industrialized countries. As resources are scarce in developing countries, adaptation of these guidelines using only essential drugs is required. It remains for governments to set priorities. To make these choices, a set of criteria have been proposed. It is vital that the results of scientific investigations are presented in these terms to facilitate their use by decision-makers. To respond to this emerging public health problem in developing countries, WHO has developed 2 initiatives: "Practical Approach to Lung Health (PAL)" and the Global Alliance Against Chronic Respiratory Diseases (GARD)", and the International Union Against Tuberculosis and Lung Diseases (The Union) has launched a new initiative to increase affordability of essential asthma drugs for patients in developing countries termed the "Asthma Drug Facility" (ADF), which could facilitate the care of patients living in these parts of the world.
Asunto(s)
Países en Desarrollo , Medicamentos Esenciales/uso terapéutico , Costos de la Atención en Salud , Accesibilidad a los Servicios de Salud , Enfermedades Pulmonares/tratamiento farmacológico , Fármacos del Sistema Respiratorio/uso terapéutico , Adolescente , Adulto , Asma/tratamiento farmacológico , Bronquiectasia/tratamiento farmacológico , Costo de Enfermedad , Medicamentos Esenciales/economía , Adhesión a Directriz , Política de Salud , Humanos , Cooperación Internacional , Enfermedades Pulmonares/economía , Enfermedades Pulmonares/epidemiología , Guías de Práctica Clínica como Asunto , Prevalencia , Desarrollo de Programa , Salud Pública , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Fármacos del Sistema Respiratorio/economía , Resultado del Tratamiento , Tuberculosis Pulmonar/tratamiento farmacológico , Organización Mundial de la SaludRESUMEN
BACKGROUND: Phase I of the International Study of Asthma and Allergies in Childhood (ISAAC) was designed to allow worldwide comparisons of the prevalence of asthma symptoms. In phase III the phase I survey was repeated in order to assess changes over time. METHODS: The phase I survey was repeated after an interval of 5-10 years in 106 centres in 56 countries in children aged 13-14 years (n = 304,679) and in 66 centres in 37 countries in children aged 6-7 years (n = 193,404). RESULTS: The mean symptom prevalence of current wheeze in the last 12 months changed slightly from 13.2% to 13.7% in the 13-14 year age group (mean increase of 0.06% per year) and from 11.1% to 11.6% in the 6-7 year age group (mean increase of 0.13% per year). There was also little change in the mean symptom prevalence of severe asthma or the symptom prevalence measured with the asthma video questionnaire. However, the time trends in asthma symptom prevalence showed different regional patterns. In Western Europe, current wheeze decreased by 0.07% per year in children aged 13-14 years but increased by 0.20% per year in children aged 6-7 years. The corresponding findings per year for the other regions in children aged 13-14 years and 6-7 years, respectively, were: Oceania (-0.39% and -0.21%); Latin America (+0.32% and +0.07%); Northern and Eastern Europe (+0.26% and +0.05%); Africa (+0.16% and +0.10%); North America (+0.12% and +0.32%); Eastern Mediterranean (-0.10% and +0.79%); Asia-Pacific (+0.07% and -0.06%); and the Indian subcontinent (+0.02% and +0.06%). There was a particularly marked reduction in current asthma symptom prevalence in English language countries (-0.51% and -0.09%). Similar patterns were observed for symptoms of severe asthma. However, the percentage of children reported to have had asthma at some time in their lives increased by 0.28% per year in the 13-14 year age group and by 0.18% per year in the 6-7 year age group. CONCLUSIONS: These findings indicate that international differences in asthma symptom prevalence have reduced, particularly in the 13-14 year age group, with decreases in prevalence in English speaking countries and Western Europe and increases in prevalence in regions where prevalence was previously low. Although there was little change in the overall prevalence of current wheeze, the percentage of children reported to have had asthma increased significantly, possibly reflecting greater awareness of this condition and/or changes in diagnostic practice. The increases in asthma symptom prevalence in Africa, Latin America and parts of Asia indicate that the global burden of asthma is continuing to rise, but the global prevalence differences are lessening.