Evaluation of the National Tuberculosis Program and Tuberculosis Surveillance System, Jordan 2021.

Objectives: Evaluate and determine the gaps in the National Tuberculosis Program and Tuberculosis Surveillance System in Jordan. Methods: A concurrent embedded mixed quantitative/qualitative methods study was conducted to assess the National Tuberculosis Program and Tuberculosis Surveillance System in Jordan. A semi-structured questionnaire was developed based on the Updated CDC Guideline for Evaluating Public Health Surveillance System to collect necessary information from service providers and other stakeholders. Results: The National Tuberculosis Program and Tuberculosis Surveillance System encounter various gaps and challenges across several critical domains, including infrastructure, human resources, National Tuberculosis Program functions, surveillance system performance, coordination, case findings, and data collection and notification. Regrettably, not all of the Tuberculosis Surveillance System's objectives were successfully achieved in the past. Coordination of tuberculosis services has been repeatedly reported as inadequate. This deficiency manifests in the delay in diagnosing tuberculosis patients and, in some instances, misdiagnoses. The root cause is often traced back to insufficient knowledge of tuberculosis case definitions among healthcare providers at peripheral tuberculosis clinics. Additionally, a structured approach to active case finding is conspicuously absent. Furthermore, the tuberculosis management guidelines remain unfamiliar to many healthcare providers in tuberculosis centers, leaving them inadequately equipped to handle tuberculosis cases effectively. The utilization and analysis of the system's data are also far from optimal. A glaring concern is the delay in tuberculosis case notifications received from the stakeholders involved in the Tuberculosis Surveillance System. Conclusions: Our study showed different gaps in the National Tuberculosis Program and Tuberculosis Surveillance Systems across several areas. The structure of National Tuberculosis Program and the clinical expertise of human resources do not support tuberculosis elimination. An electronic data collection and notification system is essential to facilitate tuberculosis case detection, reporting, and follow-up. Decision-makers should push the tuberculosis epidemic on the national health agenda. Jordan should focus on allocating national and international resources for tuberculosis control programs.

Being Born in Winter-Spring and at Around the Time of an Influenza Pandemic Are Risk Factors for the Development of Schizophrenia: The Apna Study in Navarre, Spain.

BACKGROUND: We analyzed the relationship between the prevalence of schizophrenia and the season of birth and gestation during a period of an influenza pandemic. METHODS: Cross-sectional analysis of a prospective population-based cohort of 470,942 adults. We fitted multivariant logistic regression models to determine whether the season of birth and birth in an influenza-pandemic year (1957, 1968, 1977) was associated with schizophrenia. RESULTS: 2077 subjects had been diagnosed with schizophrenia. Logistic regression identified a significantly greater prevalence of schizophrenia in men than in women (OR = 1.516, CI 95% = 1.388-1.665); in those born in the winter or spring than in those born in the summer or autumn (OR = 1.112, CI 95% = 1.020-1.212); and in those born in a period of an influenza pandemic (OR = 1.335, CI 95% = 1.199-1.486). The increase in risk was also significant when each influenza pandemic year was analyzed separately. However, neither month of birth nor season of birth, when each of the four were studied individually, were associated with a statistically significant increase in that risk. CONCLUSIONS: The winter-spring period and the influenza pandemics are independent risk factors for developing schizophrenia. This study contradicts many previous studies and thus revitalizes a locked debate in understanding the neurodevelopmental hypothesis of this disorder.

Efectos del Programa "Ejercicio Dirigido-Paseos Saludables en Entornos Curativos Exteriores" en ancianos hospitalizados por trastornos depresivos / Effects of the Program Directed Exercise-Healthy Walks in Healing Outdoor Environments in elderly hospitalized for depressive disorders

Objetivo: Analizar los efectos de un programa integrado de "Ejercicio Dirigido-Paseos Saludables en Entornos Curativos Exteriores" (ED + PSECE) en el bienestar físico y psicosocial de pacientes con trastorno depresivo, mayores de 65 años, ingresados en la Unidad de Agudos de Hospitalización Psiquiátrica. Método: Estudio piloto experimental con un grupo intervención (GI, n = 32 sujetos) y un grupo control (GC, n = 32 sujetos). Las mediciones pre y postintervención se realizan con el índice de Barthel, el test de Guralnik Short Physical Performance Battery (SPPB), la escala de Hamilton, el Get Up and Go Test y la taxonomía NOC. Sesultados: Se encuentran mejoras significativas del GI en funcionalidad según Barthel (0,036) y en posición corporal según NOC (0,025), así como disminución de síntomas depresivos según Hamilton (0,001). Conclusión: La actividad física contribuye a la reducción de síntomas negativos de los trastornos depresivos y a la mejora de la funcionalidad para el desempeño de actividades básicas de una vida autónoma, siendo fundamental el rol desempeñado por el profesional de enfermería para la adherencia al programa de los pacientes ancianos hospitalizados en una unidad de salud mental (AU)

Objective: To analyze the effects of an integrated "Healthy ExerciseWalks in Outdoor Healing Environments" on the physical and psychosocial well-being of patients with depressive disorders over 65 years of age admitted to acute unit of Psychiatric hospitalization. Method: Experimental pilot study with an intervention group (N IG=32 subjects) and a control group (N CG=32 subjects). Preand post-intervention measurements were made with the Barthel index test, Guralnik Short Physical Performance Battery (SPPB), Hamilton scale, a Get Up and Go Test and the Taxonomy NOC. Results: Significant progress of the IG is in functionality as Barthel test (0.036) and in corporal position as NOC (0.025), as well as decrease of depressive symptoms according to Hamilton (0.001). Conclusion: Physical activity contributes to the reduction of negative symptoms of depressive disorders and to the improvement of functionality for the performance of basic activities of an autonomous life, the role played by the professional nurse for adherence to the program of elderly patients hospitalized in a mental health unit (AU)

Mortality trends for tuberculosis in European Union countries, 2000-2010 / Tendencias de la mortalidad por tuberculosis en los países de la Unión Europea, 2000-2010

BACKGROUND: The objective of this study was to update and analyze tuberculosis (TB) mortality data in the European Union between 2000 and 2010 separately for men and women and try to detect if there have been any changes in trends in each country and the association with the economic situation and inequalities. METHODS: Data were extracted for tuberculosis deaths in 2000-2010 for 29 European Union countries and for Switzerland, via the World Health Organization (WHO) European detailed mortality database (DMDB), using the Mortality tabulation list 1 (MTL1) codes for men and women separately for one age group (20-85+). We estimated age-standardised mortality rates, and analyzed data using the Joinpoint Regression Program for men and women separately in the European Union overall and by individual country for each year. RESULTS: Between 2000 and 2010, there were 68,771 recorded tuberculosis deaths in the European Union and the mortality rates were higher for men than women in the entire study zone. Overall, TB mortality rates declined linearly for both genders, but more in women than in men (from 5.43/100,000 in 2000 to 2.59/100,000 in 2010 in men and from 1.37/100,000 in 2000 to 0.51/100,000 in 2010 in women). There was decline in both genders for the entire study period, with a significant Estimated Annual Percentage Change (EAPC) of -8.1 for women and -7 for men when alpha < 0.05 and with a 95% confidence interval (CI). A higher tuberculosis mortality was associated with lower economic resources and greater inequalities. CONCLUSIONS: TB mortality rates in the European Union decreased overall in 2000-2010 for both genders. Men have higher TB mortality rates than women in all countries. Our findings were consistent with the downward TB mortality trend in many other countries worldwide

ANTECEDENTES: El objetivo de este estudio fue actualizar y analizar los datos sobre la mortalidad por tuberculosis (TB) en la Unión Europea entre 2000 y 2010, separadamente para varones y mujeres, así como tratar de detectar si se han producido cambios en las tendencias para cada país, al igual que la asociación con la situación económica y las desigualdades. MÉTODOS: Se extrajeron los datos sobre muertes por TB durante el periodo 2000-2010 para los 29 países de la Unión Europea y para Suiza, a través de la base de datos detallada europea sobre mortalidad (DMDB) de la Organización Mundial de la Salud (OMS), utilizando por separado los códigos para varones y mujeres de la lista de tabulación de la mortalidad 1 (MTL1) para un grupo de edad (20-85+). Calculamos los índices de mortalidad estandarizados por edad, y analizamos los datos utilizando el programa de regresión Joinpoint, separando varones y mujeres, en la Unión Europea en general, y por país individual para cada año. RESULTADOS: Entre 2000 y 2010, se produjeron 68.771 muertes por TB registradas en la Unión Europea, siendo los índices de mortalidad superiores en varones que en mujeres en el área total de estudio. En general, los índices de mortalidad por TB descendieron de forma lineal para ambos sexos, aunque más en mujeres que en varones (de 5,43/100.000 en 2000 a 2,59/100.000 en 2010 en varones, y de 1,37/100.000 en 2000 a 0,51/100.000 en 2010 en mujeres). Se produjo un descenso en ambos sexos durante el periodo total de estudio, con un cambio porcentual anual estimado (EAPC) de -8,1 para mujeres y de -7 para varones, siendo alfa < 0,05, y con un 95% de intervalo de confianza (IC). La mortalidad superior por TB se asoció a unos menores recursos económicos y a unas mayores desigualdades. CONCLUSIONES: Los índices de mortalidad por TB en la Unión Europea descendieron en general durante el periodo 2000-2010 para ambos sexos. Los varones reflejan unos índices superiores de mortalidad que las mujeres en todos los países. Nuestros hallazgos fueron consistentes con la tendencia a la baja de la mortalidad por TB en muchos otros países a nivel mundial

Mortality trends for tuberculosis in European Union countries, 2000-2010.

BACKGROUND: The objective of this study was to update and analyze tuberculosis (TB) mortality data in the European Union between 2000 and 2010 separately for men and women and try to detect if there have been any changes in trends in each country and the association with the economic situation and inequalities. METHODS: Data were extracted for tuberculosis deaths in 2000-2010 for 29 European Union countries and for Switzerland, via the World Health Organization (WHO) European detailed mortality database (DMDB), using the Mortality tabulation list 1 (MTL1) codes for men and women separately for one age group (20-85+). We estimated age-standardised mortality rates, and analyzed data using the Joinpoint Regression Program for men and women separately in the European Union overall and by individual country for each year. RESULTS: Between 2000 and 2010, there were 68,771 recorded tuberculosis deaths in the European Union and the mortality rates were higher for men than women in the entire study zone. Overall, TB mortality rates declined linearly for both genders, but more in women than in men (from 5.43/100,000 in 2000 to 2.59/100,000 in 2010 in men and from 1.37/100,000 in 2000 to 0.51/100,000 in 2010 in women). There was decline in both genders for the entire study period, with a significant Estimated Annual Percentage Change (EAPC) of -8.1 for women and -7 for men when alpha<0.05 and with a 95% confidence interval (CI). A higher tuberculosis mortality was associated with lower economic resources and greater inequalities. CONCLUSIONS: TB mortality rates in the European Union decreased overall in 2000-2010 for both genders. Men have higher TB mortality rates than women in all countries. Our findings were consistent with the downward TB mortality trend in many other countries worldwide.