Tuberculosis comorbidity with communicable and non-communicable diseases: integrating health services and control efforts.

Recent data for the global burden of disease reflect major demographic and lifestyle changes, leading to a rise in non-communicable diseases. Most countries with high levels of tuberculosis face a large comorbidity burden from both non-communicable and communicable diseases. Traditional disease-specific approaches typically fail to recognise common features and potential synergies in integration of care, management, and control of non-communicable and communicable diseases. In resource-limited countries, the need to tackle a broader range of overlapping comorbid diseases is growing. Tuberculosis and HIV/AIDS persist as global emergencies. The lethal interaction between tuberculosis and HIV coinfection in adults, children, and pregnant women in sub-Saharan Africa exemplifies the need for well integrated approaches to disease management and control. Furthermore, links between diabetes mellitus, smoking, alcoholism, chronic lung diseases, cancer, immunosuppressive treatment, malnutrition, and tuberculosis are well recognised. Here, we focus on interactions, synergies, and challenges of integration of tuberculosis care with management strategies for non-communicable and communicable diseases without eroding the functionality of existing national programmes for tuberculosis. The need for sustained and increased funding for these initiatives is greater than ever and requires increased political and funder commitment.

Development and assessment of criteria to select projects for funding in the EU health programme.

BACKGROUND: Projects are the main financing mechanism within the EU community action programme for public health. This article reports the process of establishing and validating evaluation criteria for projects submitted for funding within this programme, to ensure that projects selected for funding conform with quality standards. METHODS: An evaluation checklist was developed, drawing on project management and health promotion literature, to Score 3 aspects of project quality: policy and contextual relevance (five criteria, scores 0-8), technical quality (five criteria, scored 0-6) and management quality (six criteria, scored 0-5). Teams of three people made consensus ratings with the checklist on each of 215 eligible applications submitted in response to Calls for Proposals in 2007 and 151 submitted in 2008. Construct validity, internal consistency and predictive validity were assessed on the grouped consensus ratings using psychometric test statistical methods. RESULTS: Principal component analyses on both the 2007 and 2008 data gave a three component solution, which largely coincides with the dimensions of contextual relevance, technical quality and management quality. Reliability analyses show high Cronbach α's (>0.86) for each of the three scales. Discriminant analyses indicate that all three of the dimensions contributed to the decision to fund a project. Over the 2 years, innovation, content specification, EU added value and geographical coverage contributing most consistently to the success of an application. CONCLUSION: The study shows the successful development and validation of criteria to evaluate EU health project grant proposals.

Fitness cost of chromosomal drug resistance-conferring mutations.

To study the cost of chromosomal drug resistance mutations to bacteria, we investigated the fitness cost of mutations that confer resistance to different classes of antibiotics affecting bacterial protein synthesis (aminocyclitols, 2-deoxystreptamines, macrolides). We used a model system based on an in vitro competition assay with defined Mycobacterium smegmatis laboratory mutants; selected mutations were introduced by genetic techniques to address the possibility that compensatory mutations ameliorate the resistance cost. We found that the chromosomal drug resistance mutations studied often had only a small fitness cost; compensatory mutations were not involved in low-cost or no-cost resistance mutations. When drug resistance mutations found in clinical isolates were considered, selection of those mutations that have little or no fitness cost in the in vitro competition assay seems to occur. These results argue against expectations that link decreased levels of antibiotic consumption with the decline in the level of resistance.