Financing for tuberculosis prevention, diagnosis and treatment services in the Western Pacific Region in 2005-2020.

Objective: This paper provides an overview of financing for tuberculosis (TB) prevention, diagnostic and treatment services in the World Health Organization (WHO) Western Pacific Region during 2005-2020. Methods: This analysis uses the WHO global TB finance database to describe TB funding during 2005-2020 in 18 low- and middle-income countries (LMICs) in the Western Pacific Region, with additional country-level data and analysis for seven priority countries: Cambodia, China, the Lao People's Democratic Republic, Mongolia, Papua New Guinea, the Philippines and Viet Nam. Results: Funding for the provision of TB prevention, diagnostic and treatment services in the 18 LMICs tripled fromUS$ 358 million in 2005 to US$ 1061 million in 2020, driven largely by increases in domestic funding, which rose from US$ 325 million to US$ 939 million over the same period. In the seven priority countries, TB investments also tripled, from US$ 340 million in 2005 to US$ 1020 million in 2020. China alone accounted for much of this growth, increasing its financing for TB programmes and services fivefold, from US$ 160 million to US$ 784 million. The latest country forecasts estimate that US$ 3.8 billion will be required to fight TB in the seven priority countries by 2025, which means that unless additional funding is mobilized, the funding gap will increase from US$ 326 million in 2020 to US$ 830 million by 2025. Discussion: Increases in domestic funding over the past 15 years reflect a firm political commitment to ending TB. However, current funding levels do not meet the required needs to finance the national TB strategic plans in the priority countries. An urgent step-up of public financing efforts is required to reduce the burden of TB in the Western Pacific Region.

Implant-supported canine retraction using different reactivation intervals of elastomeric chains: A CBCT-based split-mouth randomized controlled trial.

INTRODUCTION: Orthodontists attempt to maximize treatment efficiency regarding time, tooth position and adverse effects. A new approach, not yet explored, is the activation frequency. OBJECTIVE: The aim of this split-mouth randomized controlled trial was to evaluate the effect of reactivation intervals on the efficiency of tooth movement. METHODS: Thirty eight patients having a Class I malocclusion with bimaxillary dentoalveolar protrusion or severe crowding, Class II with mandibular deficiency or Class III, requiring first premolar extraction and canine retraction were recruited. Elastomeric chains producing 150g were replaced every two, four, six or eight weeks. There were 36, 37, 36, and 36 quadrants randomly allocated to these groups, respectively. The canine retraction rate was the primary outcome. Canine tipping, rotation, and root resorption and pain were the secondary outcomes. Only the outcome assessors were blinded to group assignment. RESULTS: The average total movement for the 6 months was 5.14, 5.31, 2.79 and 3.85 mm for the two-week, four-week, six-week and eight-week reactivation intervals, respectively. Root resorption was significantly higher in the two-week and four-week groups. No adverse events were observed. CONCLUSION: The canine retraction rate, tipping, rotation and pain were similar in 2, 4, 6 and 8-week activation intervals groups. Longer reactivation intervals show less root resorption. The trial protocol was not pre-registered. The study was self-funded.

Implant-supported canine retraction using different reactivation intervals of elastomeric chains: A CBCT-based split-mouth randomized controlled trial

ABSTRACT Introduction: Orthodontists attempt to maximize treatment efficiency regarding time, tooth position and adverse effects. A new approach, not yet explored, is the activation frequency. Objective: The aim of this split-mouth randomized controlled trial was to evaluate the effect of reactivation intervals on the efficiency of tooth movement. Methods: Thirty eight patients having a Class I malocclusion with bimaxillary dentoalveolar protrusion or severe crowding, Class II with mandibular deficiency or Class III, requiring first premolar extraction and canine retraction were recruited. Elastomeric chains producing 150g were replaced every two, four, six or eight weeks. There were 36, 37, 36, and 36 quadrants randomly allocated to these groups, respectively. The canine retraction rate was the primary outcome. Canine tipping, rotation, and root resorption and pain were the secondary outcomes. Only the outcome assessors were blinded to group assignment. Results: The average total movement for the 6 months was 5.14, 5.31, 2.79 and 3.85 mm for the two-week, four-week, six-week and eight-week reactivation intervals, respectively. Root resorption was significantly higher in the two-week and four-week groups. No adverse events were observed. Conclusion: The canine retraction rate, tipping, rotation and pain were similar in 2, 4, 6 and 8-week activation intervals groups. Longer reactivation intervals show less root resorption. The trial protocol was not pre-registered. The study was self-funded.

RESUMO Introdução: Os ortodontistas buscam otimizar a eficiência do tratamento quanto ao tempo de duração, à posição dos dentes e aos efeitos adversos. Um aspecto ainda não avaliado são os diferentes intervalos entre as ativações. Objetivo: O objetivo desse estudo controlado e randomizado de boca dividida foi avaliar a influência de diferentes intervalos de reativação na eficiência da movimentação dentária. Métodos: Foram recrutados 38 pacientes com má oclusão de Classe I com biprotrusão dentoalveolar ou apinhamento severo, Classe II com deficiência mandibular ou Classe III, que necessitavam de extração do primeiro pré-molar e retração do canino. As cadeias elastoméricas gerando 150 g foram substituídas a cada duas, quatro, seis ou oito semanas, constando 36, 37, 36 e 36 quadrantes alocados aleatoriamente nesses grupos, respectivamente. O desfecho primário foi a taxa de retração do canino. Os desfechos secundários foram a inclinação, a rotação e a reabsorção radicular do canino, e a dor. Somente os avaliadores dos resultados não tinham conhecimento da alocação nos grupos. Resultados: O movimento total médio para os seis meses foi de 5,14; 5,31; 2,79 e 3,85 mm para os intervalos de reativação de duas semanas, quatro semanas, seis semanas e oito semanas, respectivamente. A reabsorção radicular foi significativamente maior nos grupos de duas e quatro semanas. Não foram observados eventos adversos. Conclusão: A taxa de retração, a inclinação e a rotação do canino e a dor foram semelhantes nos grupos com intervalos de ativação de duas, quatro, seis e oito semanas. Intervalos de reativação mais longos mostram menos reabsorção radicular. O protocolo do estudo não foi pré-registrado. O estudo foi autofinanciado.

Depression, Nutrition, and Adherence to Antiretroviral Therapy in Men Who Have Sex With Men in Manila, Philippines.

Introduction: Depression is the most frequently observed psychiatric disorder among HIV patients. The effect of depression on adherence among men who have sex with men (MSM) HIV patients has not been well studied in the Philippines. Depression is commonly undiagnosed and consequently untreated, which leads to a negative influence on antiretroviral therapy (ART) adherence. Other risk factors such as HIV-related stigma, self-body image satisfaction, and nutritional status are recognized as potential barriers to access HIV prevention and treatment services issues and poor adherence. Methods: Hospital anxiety and depression scale (HADS) was used to screen depressive symptoms during scheduled clinic visits. ART adherence was self-reported using a visual analog scale questionnaire covering the last 30 days. Structured questionnaires were used for measuring risk factors and socio-demographic data. Anthropometry was conducted and body composition was assessed using bioelectrical impedance analysis. Results: One-hundred and ninety-three participants were recruited from the SHIP clinic between 7th March and 30th September 2018, of whom, 42 (21.8%) screened positive for depression (HADS score ≥ 8) and 24 (12.4%) were non-adherent to ART (<95% of medication taken as prescribed). The most common reported reason for non-adherence was simply forgotten (18 out of 42, 42.9%). Increasing depressive symptoms were associated with non-adherence [crude odds ratio (OR) = 1.13; 95% CI: 1.02-1.26]. Social family support (SFS) and body image (BI) scores were also associated with non-adherence, but were not statistically significant in multivariable models. Factors significantly associated with depressive symptoms (but not non-adherence) included the following: using intravenous drugs, being in a relationship, anxiety, self-esteem, and stigma scores. Conclusions: Increased depression symptoms, low social family support, and body image dissatisfaction may be interconnected risk factors for ART non-adherence among Filipino MSM HIV patients. Comprehensive mental health services beyond regular post-HIV testing counseling may increase adherence to ART and improve HIV treatment outcomes. Further prospective studies are needed to address the causal/reverse causal pathway between depression and non-adherence.

Comprehensive comparison of canine retraction using NiTi closed coil springs vs elastomeric chains.

OBJECTIVES: To compare canine retraction using NiTi closed coil springs vs elastomeric chains comprehensively in a split-mouth randomized controlled trial. MATERIALS AND METHODS: The canines in 64 quadrants were randomly retracted into the first premolar extraction spaces using NiTi closed coil springs or elastomeric chains, in the maxilla and mandible. The retraction force was 150 g. Cone beam computed tomography scans and study models were obtained before the start of canine retraction and 6 months later. The rate and total amount of canine retraction, canine rotation, tipping, and root resorption were evaluated. A visual analogue scale was used to evaluate patients' pain experience. RESULTS: The two methods were statistically similar for dental changes, rate of canine retraction, and root resorption. However, patients reported significantly more days of pain with the elastomeric chain compared to the NiTi closed coil springs. CONCLUSIONS: Within the constraints of the current study, using either NiTi closed coil springs or elastomeric chains as force delivery systems for canine retraction results in no significant difference in the rate of canine retraction, tipping, rotation, or root resorption. Pain experience during retraction using elastomeric chains is more significant yet needs further investigation.

Epidemiology of tuberculosis in the Western Pacific Region: Progress towards the 2020 milestones of the End TB Strategy.

Since 2015, the End TB Strategy and the Regional Framework for Action on Implementation of the End TB Strategy in the Western Pacific 2016-2020 have guided national tuberculosis (TB) responses in countries and areas of the Region. This paper provides an overview of the TB epidemiological situation in the Western Pacific Region and of progress towards the 2020 milestones of the Strategy. A descriptive analysis was conducted of TB surveillance and programme data reported to WHO and estimates of the TB burden generated by WHO for the period 2000-2018. An estimated 1.8 million people developed TB and 90 000 people died from it in the Region in 2018. Since 2015, the estimated TB incidence rate and the estimated number of TB deaths in the Region decreased by 3% and 10%, with annual reduction rates of 1.0% and 3.4%, respectively. With current efforts, the Region is unlikely to achieve the 2020 milestones and other targets of the Strategy. Major challenges include: (1) wide variation in the geographical distribution and rate of TB incidence among countries; (2) a substantial proportion (23%) of TB cases that remain unreached, undiagnosed or unreported; (3) insufficient coverage of drug susceptibility testing (51%) for bacteriologically confirmed cases and limited use of WHO-recommended rapid diagnostics (11 countries reported < 60% coverage); (4) suboptimal treatment outcomes of TB (60% of countries reported < 85% success), of TB/HIV co-infection (79%) and of multidrug- or rifampicin-resistant TB (59%); (5) limited coverage of TB preventive treatment among people living with HIV (39%) and child contacts (12%); and (6) substantial proportions (35-70%) of TB-affected families facing catastrophic costs. For the Region to stay on track to achieve the End TB Strategy targets, an accelerated multisectoral response to TB is required in every country.

Fixed orthodontic treatment has an insignificant effect on clinical attachment level.

Data sources Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, Web of Knowledge, Virtual Health Library, Google Scholar and ISRCTN registry databases.Study selection Randomised controlled trials (RCTs) and prospective or retrospective non-randomised clinical trials on periodontal healthy human patients receiving comprehensive fixed appliance treatment were considered.Data extraction and synthesis Two reviewers independently extracted data and assessed risk of bias using either the Cochrane tool for RCTs or the ROBINS-I (Risk Of Bias In Non-randomised Studies - of Interventions) tool for non-randomised studies. A Paule-Mandel random-effects meta-analyses was conducted for clinical attachment loss. Results Nine prospective non-randomised trials involving a total of 335 periodontally healthy patients were included. The patients' average age was 22.6 years (range 11.4 - 42.1 years). Seven of the nine studies were assessed as being at moderate risk of bias. Orthodontic treatment was associated with a mean clinical attachment loss of 0.11 mm (95 %CI: 0.12 mm gain to 0.34 mm loss; P = 0.338, I2 = 99.6%), which was neither statistically nor clinically significant.Conclusions The findings suggest that orthodontic treatment might have little or no clinically relevant detrimental effect on the clinical attachment levels of patients.

Comparison of transverse changes during maxillary expansion with 4-point bone-borne and tooth-borne maxillary expanders.

INTRODUCTION: The purposes of this study were to evaluate and compare the dentoskeletal changes concurrent with 4-point bone-borne and tooth-borne rapid maxillary expanders in growing children. METHODS: The study was conducted with 20 growing girls (ages, 12 ± 0.6 years) with posterior crossbite. They were divided into 2 equal groups; patients in one group were treated with a tooth-borne maxillary hyrax expander (TBME), and those in the other group received a bone-borne maxillary hyrax expander (BBME) anchored directly to the palatal bone. Changes were assessed using cone-beam computed tomography. Images were taken before and immediately after expansion. RESULTS: Superimpositions of the 3-dimensional palatal images showed significant increases in skeletal widths at the canine, first premolar, and first molar areas in both groups. The TBME group had greater nasal width expansion. Regarding the transverse dentolinear measurements, significant increases were seen in both groups, whereas the TBME group showed a greater increase than the BBME group. Significant increases in the dentoangular measurements were seen in the TBME group only and were significantly greater than in the BBME group at the first premolars. CONCLUSIONS: There were significant increases in facial and maxillary widths for the BBME group and in nasal width for the TBME group. Both expanders produced basal bone expansion at the level of the hard palate. The TBMEs produced more dental expansion, buccal rolling, and a greater increase in nasal width than did the BBMEs.

Quality of life and sexual activity during treatment of Bartholin's cyst or abscess with a Word catheter.

OBJECTIVES: Cysts and abscesses of the Bartholin glands are a common occurrence in gynecologic or general practice. Little is known about restrictions in patient's daily life and sexual activity during treatment of Bartholin's cysts in general and especially with the Word catheter. This study is to assess the Quality of Life and Sexual Activity during treatment of Bartholin cyst's and abscesses with the Word-catheter. STUDY DESIGN: Between March 2013 and May 2014 30 women were included in the study. Pain before treatment and during catheter insertion and removal was assed using a standardized VAS scale. Health-related quality of life was assessed with the Short-Form-12-Health-Survey. Fallowfield's Sexual Activity Questionnaire was administered to investigate sexual limitations. During treatment patient self-reported to a pain-diary (VAS 0-10). RESULTS: Pain levels decreased from a 3 [0-10] on day 1 to 0 [0-6] on day 6 with the median staying at 0 for the remaining treatment period. Discomfort and pain during sexual activity decreased significantly from initial presentation to end of treatment. The mental component summary score of the SF 12 increased significantly from 46.94±10.23 before treatment to 50.58±7.16 after treatment (p=0.016); the physical component summary score did not change significantly. CONCLUSIONS: The Word catheter is well tolerated for the treatment of Bartholin's cysts and abscesses with few and no serious side effects and little impingement of sexual health. A more relevant informed consent ahead of treatment, specifically with regard to pain in the first few days after catheter placement, might further increase acceptance of the catheter and adjust patient expectations.