The state of integrated disease surveillance in seven countries: a synthesis report.

OBJECTIVES: Integrated disease surveillance (IDS) offers the potential for better use of surveillance data to guide responses to public health threats. However, the extent of IDS implementation worldwide is unknown. This study sought to understand how IDS is operationalized, identify implementation challenges and barriers, and identify opportunities for development. STUDY DESIGN: Synthesis of qualitative studies undertaken in seven countries. METHODS: Thirty-four focus group discussions and 48 key informant interviews were undertaken in Pakistan, Mozambique, Malawi, Uganda, Sweden, Canada, and England, with data collection led by the respective national public health institutes. Data were thematically analysed using a conceptual framework that covered governance, system and structure, core functions, finance and resourcing requirements. Emerging themes were then synthesised across countries for comparisons. RESULTS: None of the countries studied had fully integrated surveillance systems. Surveillance was often fragmented, and the conceptualization of integration varied. Barriers and facilitators identified included: 1) the need for clarity of purpose to guide integration activities; 2) challenges arising from unclear or shared ownership; 3) incompatibility of existing IT systems and surveillance infrastructure; 4) workforce and skills requirements; 5) legal environment to facilitate data sharing between agencies; and 6) resourcing to drive integration. In countries dependent on external funding, the focus on single diseases limited integration and created parallel systems. CONCLUSIONS: A plurality of surveillance systems exists globally with varying levels of maturity. While development of an international framework and standards are urgently needed to guide integration efforts, these must be tailored to country contexts and guided by their overarching purpose.

The influence of the COVID-19 pandemic on the psychological well-being of college students: a cross-sectional study.

OBJECTIVE: Even before the outbreak of the COVID-19 pandemic, concerns regarding college students' mental health were on the rise due to the increasing number of students afflicted with mental health issues. Exposure to numerous pandemic-related measures exacerbated existing issues with anxiety, depression, and stress. This study aimed to assess depression, anxiety, and stress levels among university students in the Aseer region in Saudi Arabia. SUBJECTS AND METHODS: Data were collected from eligible individuals using a web-based, self-administered DASS-21 questionnaire. This questionnaire consists of 21 questions with a rating scale of 0-3. Each of the psychological factors of depression, anxiety, and stress was categorized as normal, mild, moderate, severe, and extremely severe. Results were expressed using descriptive statistics as proportions, and the Mann-Whitney/Kruskal-Wallis' test was used to evaluate the presence of a significant difference between each of the socio-demographic factors of the respondents and the psychological outcomes. RESULTS: Respondents aged between 18-24 years reported higher rates of extremely severe depression than other age groups. Females had higher rates of depression, especially severe and extremely severe forms. Extremely severe anxiety had a relatively high prevalence across all age groups. Extremely severe stress was more common among respondents aged between 18-24 years, while respondents older than 34 years reported the highest prevalence of severe stress. The Mann-Whitney/Kruskal-Wallis' tests showed statistically significant differences between participants in the different groups. CONCLUSIONS: The COVID-19 pandemic had a high psychological impact on university students, which indicates that a psychological support program should be implemented to reduce this impact.

Detection and analysis of potential drug-drug interactions among patients admitted to the cardiac care unit in a tertiary care hospital.

OBJECTIVE: This study aimed to estimate how prevalent potential drug-drug interactions (pDDIs) were in patients with cardiovascular diseases who were hospitalized for more than 24 hours, and to determine the risk factors associated with these pDDIs. PATIENTS AND METHODS: A prospective observational study was conducted on patients admitted to the cardiac care unit in a tertiary care hospital. We included two hundred medical records of cardiovascular disease patients who were prescribed more than one drug. These medical records were analyzed for pDDIs using the Micromedex drug interaction checker database. Data were analyzed using Descriptive statistics. Chi-square test and the Pearson correlation coefficient were applied. RESULTS: PDDIs were prevalent in 95% of the analyzed medical records, with at least one detected pDDI per record. Within the 200 medical records, 430 potentially interacting drug pairs were identified, with the majority resulting in moderate and major interactions. Aspirin/clopidogrel (111), furosemide/aspirin (89), enoxaparin/clopidogrel (89) and Lisinopril/aspirin (60) were the most common interacting pairs. Whereas, aspirin, heparin, clopidogrel, furosemide, ranitidine and Lisinopril were the most frequently implicated drugs in DDIs. CONCLUSIONS: PDDIs were common among hospitalized cardiovascular patients. PDDIs were associated with age and number of drugs prescribed. The routine integration of an online drug interactions screening tool may improve the ability of pharmacists to identify cardiac patients at higher risk of potential drug interactions and conduct appropriate interventions thereafter.

Serum sonic hedgehog (SHH) and interleukin-(IL-6) as dual prognostic biomarkers in progressive metastatic breast cancer.

Serum from one hundred and ten breast cancer patients and thirty healthy female volunteers, were prospectively collected and evaluated for serum levels of Shh and IL-6 using human Shh and IL-6 specific enzyme-linked immunoassays. All patients were regularly monitored for event free survival (EFS) and overall survival (OS). Overall outcome analysis was based on serum Shh and IL-6 levels. In patients with progressive metastatic BC, both serum Shh and IL-6 concentrations were elevated in 44% (29 of 65) and 63% (41 of 65) of patients, respectively, at a statistically significant level [Shh (p = 0.0001) and IL-6 (p = 0.0001)] compared to the low levels in healthy volunteers. Serum levels tended to increase with metastatic progression and lymph node positivity. High serum Shh and IL-6 levels were associated with poor EFS and OS opposite to the negative or lower levels in serum Shh and IL-6. The elevated levels of both serum Shh and IL-6 were mainly observed in BC patients who had a significantly higher risk of early recurrence and bone metastasis, and associated with a worse survival for patients with progressive metastatic BC. Further studies are warranted for validating these biomarkers as prognostic tools in a larger patient cohort and in a longer follow-up study.

Experiences of parents of children with special needs at school entry: a mixed method approach.

BACKGROUND: The transition from pre-school to kindergarten can be complex for children who need special assistance due to mental or physical disabilities (children with 'special needs'). We used a convergent mixed method approach to explore parents' experiences with service provision as their children transitioned to school. METHODS: Parents (including one grandparent) of 37 children aged 4 to 6 years completed measures assessing their perceptions of and satisfaction with services. Semi-structured interviews were also conducted with 10 parents to understand their experience with services. RESULTS: Post transition, parents reported lower perceptions of services and decreased satisfaction than pre-transition. The following themes emerged from the qualitative data: qualities of services and service providers, communication and information transfer, parent advocacy, uncertainty about services, and contrasts and contradictions in satisfaction. The qualitative findings indicate that parents were both satisfied and concerned with aspects of the post-transition service provision. CONCLUSIONS: While the quantitative results suggested that parents' experience with services became less positive after their children entered school, the qualitative findings illustrated the variability in parents' experiences and components of service provision that require improvements to facilitate a successful school entry.

Primary health care use and health care accessibility among adolescents in the United Arab Emirates.

This study examined primary health care use and accessibility among adolescents living in the United Arab Emirates. In a cross-sectional study, we collected health care use, sociodemographic and residential data for a sample of 6363 adolescents. Logistic regression modelling was used to examine predictors of health care use. The most-consulted health professionals were dentists or orthodontists, family doctors and eye specialists. Local adolescents were more likely to attend public clinics/hospitals than private facilities, while the opposite was true for expatriates. In the previous 12 months 22.6% of the participants had not obtained the health care they needed and 19.5% had not had a routine health check-up. Common reasons for not obtaining care were busy schedules, dislike/fear of doctors and long waiting times. Predictors of not obtaining needed care included nationality and income, while those for having a routine check-up were mother's education and car ownership. Improvements to the health care sector may increase health care accessibility among adolescents.

Primary health care use and health care accessibility among adolescents in the United Arab Emirates

تناولت هذه الدراسة الاستفادة من الرعاية الصحية الأولية وإمكانية الحصول عليها بن المراهقن الذين يعيشون في الإمارات العربية المتحدة. فجمع الباحثان في دراسة مستعرضة - بيانات الاستفادة من الرعاية الصحية والبيانات الاجتماعية الديموغرافية والبيانات السكنية لعينة من 6363 مراهقاً. وتم استخدام نمذجة التحوُّف اللوجستي لدراسة منبئات الاستفادة من الرعاية الصحية. وكان معظم المهنين الصحين الذين تمت استشارتهم أطباء أسنان أو أطباء تقويم أسنان، وأطباء أسرة، ومتخصصن في أمراض العيون. فكان احتال حضور المراهقن المحلين إلى عيادات/مستشفيات عامة أكثر من حضورهم إلى مرافق خاصة، في حن كان العكس هو الصحيح بالنسبة للوافدين. وفي الأشهر ال 12 الأخرة لم يحصل 22.6 % من عموم المشاركين عى الرعاية الصحية التي احتاجوا إليها، ولم يُرَ ل 19.5 % منهم فحص طبي روتيني. وكانت الأسباب الشائعة لعدم الحصول عى الرعاية: ازدحام المواعيد، وكراهية الأطباء أو الخوف منهم، وطول أوقات الانتظار. وكان من منبئات عدم الحصول عى الرعاية اللازمة: الجنسية والدخل، في حن كانت منبئات تلقي فحص روتيني: ثقافة الأم وامتاك سيارة. إن إدخال تحسينات عى قطاع الرعاية الصحية قد يزيد من إمكانية الحصول عى الرعاية الصحية بن المراهقن.

This study examined primary health care use and accessibility among adolescents living in the United Arab Emirates. In a cross-sectional study, we collected health care use, sociodemographic and residential data for a sample of 6363 adolescents. Logistic regression modelling was used to examine predictors of health care use. The most-consulted health professionals were dentists or orthodontists, family doctors and eye specialists.Local adolescents were more likely to attend public clinics/hospitals than private facilities, while the oppositewas true for expatriates. In the previous 12 months 22.6% of the participants had not obtained the health care they needed and 19.5% had not had a routine health check-up. Common reasons for not obtaining care were busy schedules, dislike/fear of doctors and long waiting times. Predictors of not obtaining needed care included nationality and income, while those for having a routine check-up were mother’s education and car ownership.Improvements to the health care sector may increase health care accessibility among adolescents

La présente étude a examiné le recours aux soins de santé primaires et leur accessibilité chez des adolescents vivantaux Émirats arabes unis. Dans une étude transversale, nous avons recueilli des données sur le recours aux soins desanté, les lieux de résidence et des informations sociodémographiques dans un échantillon de 6363 adolescents. Unmodèle de régression logistique a été appliqué pour examiner les facteurs prédictifs du recours aux soins de santé.Les professionnels de santé les plus consultés étaient les dentistes ou les orthodontistes, les médecins de famille etles ophtalmologistes. Les adolescents locaux avaient davantage tendance à consulter les hôpitaux/établissementsde soins publics que les entités privées, contrairement aux expatriés. Au cours de 12 derniers mois, 22,6 % desparticipants dans l’ensemble avaient renoncé aux soins de santé dont ils avaient besoin et 19,5 % avaient renoncé àun bilan de santé systématique. Les raisons les plus fréquentes de non-recours aux soins étaient un emploi du tempschargé, une aversion/peur des médecins et la longueur des temps d’attente. Parmi les facteurs prédictifs de nonrecoursaux soins nécessaires, on peut citer la nationalité et le revenu, tandis que ceux favorisant le recours à un bilan de santé systématique étaient le niveau d’études de la mère et le fait de posséder une voiture. Des améliorations dans le secteur des soins de santé pourraient améliorer l’accès des soins de santé aux adolescents

Retention rate of Gabapentin in children with intractable epilepsies at 1 year.

Gabapentin (GAB) is a newer second-line antiepileptic drug (AED) used in children. This is a multi-centre retrospective observational study of the efficacy, tolerability and retention rate in 105 children, aged 0-17.5 years (mean 10.1) over a 14 year period. The median age of epilepsy onset was 2.5 years (range 0-14.6). 72% started GAB as at least the 3rd AED, with 43% having been withdrawn from at least 2 AEDs. 77% had focal and 52% symptomatic epilepsies. The maintenance doses for GAB ranged 6.0-87.3 mg/kg/day (mean 43.7). The study comprised 157 person-treatment years for GAB. GAB was well tolerated with 55% remaining on treatment beyond 1 year. No serious adverse events were reported whilst on GAB, but 39% reported possibly and probably related adverse events. Seizure improvement (<50% seizure frequency compared to baseline) at more than 12 months of treatment, was reported in 35% of patients starting GAB, including 6% who remained seizure free. The results demonstrated the efficacy and tolerability of GAB in children with difficult to treat epilepsies, and a good response to treatment beyond 12 months, in both focal and generalised epilepsies.

Calcium release from the endoplasmic reticulum of higher plants elicited by the NADP metabolite nicotinic acid adenine dinucleotide phosphate.

Higher plants share with animals a responsiveness to the Ca(2+) mobilizing agents inositol 1,4,5-trisphosphate (InsP(3)) and cyclic ADP-ribose (cADPR). In this study, by using a vesicular (45)Ca(2+) flux assay, we demonstrate that microsomal vesicles from red beet and cauliflower also respond to nicotinic acid adenine dinucleotide phosphate (NAADP), a Ca(2+)-releasing molecule recently described in marine invertebrates. NAADP potently mobilizes Ca(2+) with a K(1/2) = 96 nM from microsomes of nonvacuolar origin in red beet. Analysis of sucrose gradient-separated cauliflower microsomes revealed that the NAADP-sensitive Ca(2+) pool was derived from the endoplasmic reticulum. This exclusively nonvacuolar location of the NAADP-sensitive Ca(2+) pathway distinguishes it from the InsP(3)- and cADPR-gated pathways. Desensitization experiments revealed that homogenates derived from cauliflower tissue contained low levels of NAADP (125 pmol/mg) and were competent in NAADP synthesis when provided with the substrates NADP and nicotinic acid. NAADP-induced Ca(2+) release is insensitive to heparin and 8-NH(2)-cADPR, specific inhibitors of the InsP(3)- and cADPR-controlled mechanisms, respectively. However, NAADP-induced Ca(2+) release could be blocked by pretreatment with a subthreshold dose of NAADP, as previously observed in sea urchin eggs. Furthermore, the NAADP-gated Ca(2+) release pathway is independent of cytosolic free Ca(2+) and therefore incapable of operating Ca(2+)-induced Ca(2+) release. In contrast to the sea urchin system, the NAADP-gated Ca(2+) release pathway in plants is not blocked by L-type channel antagonists. The existence of multiple Ca(2+) mobilization pathways and Ca(2+) release sites might contribute to the generation of stimulus-specific Ca(2+) signals in plant cells.

Distinct localization and function of (1,4,5)IP(3) receptor subtypes and the (1,3,4,5)IP(4) receptor GAP1(IP4BP) in highly purified human platelet membranes.

Platelet activation is associated with an increase of cytosolic Ca(++) levels. The (1,4,5)IP(3) receptors [(1,4,5)IP(3)R] are known to mediate Ca(++) release from intracellular stores of many cell types. Currently there are at least 3 distinct subtypes of (1,4, 5)IP(3)R-type I, type II, and type III-with suggestions of distinct roles in Ca(++) elevation. Specific receptors for (1,3,4,5)IP(4) belonging to the GAP1 family have also been described though their involvement with Ca(++) regulation is controversial. In this study we report that platelets contain all 3 subtypes of (1,4,5)IP(3)R but in different amounts. Type I and type II receptors are predominant. In studies using highly purified platelet plasma (PM) and intracellular membranes (IM) we report a distinct localization of these receptors. The PM fractions were found to contain the type III (1,4,5)IP(3)R and GAP1(IP4BP) in contrast to IM, which contained type I (1,4,5)IP(3)R. The type II receptor exhibited a dual distribution. In studies examining the labeling of surface proteins with biotin in intact platelets only the type III (1,4,5)IP(3)R was significantly labeled. Immunogold studies of ultracryosections of human platelets showed significantly more labeling of the PM with the type III receptor antibodies than with type I receptor antibodies. Ca(++) flux studies were carried out with the PM to demonstrate in vitro function of inositol phosphate receptors. Ca(++) release activities were present with both (1,4,5)IP(3) and (1, 3,4,5)IP(4) (EC(50) = 1.3 and 0.8 micromol/L, respectively). Discrimination of the Ca(++)-releasing activities was demonstrated with cyclic adenosine monophosphate (cAMP)-dependent protein kinase (cAMP-PK) specifically inhibiting (1,4,5)IP(3) but not (1,3,4, 5)IP(4)-induced Ca(++) flux. In experiments with both PM and intact platelets, the (1,4,5)IP(3)Rs but not GAP1(IP4BP) were found to be substrates of cAMP-PK and cGMP-PK. Thus the Ca(++) flux property of (1,3,4,5)IP(4) is insensitive to cAMP-PK. These studies suggest distinct roles for the (1,4,5)IP(3)R subtypes in Ca(++) movements, with the type III receptor and GAP1(IP4BP) associated with cation entry in human platelets and the type I receptor involved with Ca(++) release from intracellular stores.

Functional characterization of PM6/13, a beta3-specific (GPIIIa/CD61) monoclonal antibody that shows preferential inhibition of fibrinogen binding over fibronectin binding to activated human platelets.

We report the characterization of a monoclonal antibody (MAb) PM6/13 which recognises glycoprotein IIIa (GPIIIa) on platelet membranes and in functional studies inhibits platelet aggregation induced by all agonists examined. In platelet-rich plasma, inhibition of aggregation induced by ADP or low concentrations of collagen was accompanied by inhibition of 5-hydroxytryptamine secretion. EC50 values were 10 and 9 microg/ml antibody against ADP and collagen induced responses respectively. In washed platelets treated with the cyclooxygenase inhibitor, indomethacin, PM6/13 inhibited platelet aggregation induced by thrombin (0.2 U/ml), collagen (10 microg/ml) and U46619 (3 microM) with EC50 = 4, 8 and 4 microg/ml respectively, without affecting [14C]5-hydroxytryptamine secretion or [3H]arachidonate release in appropriately labelled cells. Studies in Fura 2-labelled platelets revealed that elevation of intracellular calcium by ADP, thrombin or U46619 was unaffected by PM6/13 suggesting that the epitope recognised by the antibody did not influence Ca2+ regulation. In agreement with the results from the platelet aggregation studies, PM6/13 was found to potently inhibit binding of 125I-fibrinogen to ADP activated platelets. Binding of this ligand was also inhibited by two other MAbs tested, namely SZ-21 (also to GPIIIa) and PM6/248 (to the GPIIb-IIIa complex). However when tested against binding of 125I-fibronectin to thrombin stimulated platelets, PM6/13 was ineffective in contrast with SZ-21 and PM6/248, that were both potent inhibitors. This suggested that the epitopes recognised by PM6/13 and SZ-21 on GPIIIa were distinct. Studies employing proteolytic dissection of 125I-labelled GPIIIa by trypsin followed by immunoprecipitation with PM6/13 and analysis by SDS-PAGE, revealed the presence of four fragments at 70, 55, 30 and 28 kDa. PM6/13 did not recognize any protein bands on Western blots performed under reducing conditions. However Western blotting analysis with PM6/13 under non-reducing conditions revealed strong detection of the parent GPIIIa molecule, of trypsin treated samples revealed recognition of an 80 kDa fragment at 1 min, faint recognition of a 60 kDa fragment at 60 min and no recognition of any product at 18 h treatment. Under similar conditions, SZ-21 recognized fragments at 80, 75 and 55 kDa with the 55 kDa species persisting even after 18 h trypsin treatment. These studies confirm the epitopes recognised by PM6/13 and SZ-21 to be distinct and that PM6/13 represents a useful tool to differentiate the characteristics of fibrinogen and fibronectin binding to the GPIIb-IIIa complex on activated platelets.

Hospital dietetics and food service in developing countries: III. Bangladesh.

A survey of 11 hospitals in Bangladesh revealed that most heads of hospital food service had little or no training in nutrition and dietetics, hospital diets were usually inadequate, therapeutic diets were seldom used, and kitchen sanitation was poor. However, in three hospitals in which the heads of food service had some education in nutrition, conditions were markedly better. Even though the results of this survey suggest that major improvements are needed in hospital food service and dietetics in Bangladesh, extensive training programs are probably unrealistic because of the limited economic base of the country. Short-term inservice training programs could result in marked improvement in the quality of food service, sanitation, and the use of therapeutic diets.