The magnitude and correlates of geriatric depression using Geriatric Depression Scale (GDS-15) - a Bahrain perspective for the WHO 2017 campaign 'Depression - let's talk'.

AIMS:: Amid no current estimates or correlates of geriatric depression in Bahrain and support WHO campaign 2017 'Depression-let's talk', we aimed to assess the magnitude of geriatric depression and explore its association with socio-demographic and health characteristics among the Bahrainis. METHODS:: A cross-sectional survey was carried out among the geriatric Bahrainis attending the 12 community congregations of the ministry of labor and social development in Bahrain, as well as in the community, by a convenient sampling method using a validated, shorter, Arabic version of the Geriatric Depression Scale (GDS-15 items) which is a self-report instrument to screen for clinical depression. Univariate analysis followed by a multivariate ordinal logistic regression was employed to test the associations between socio-demographic and health characteristics for geriatric depression. RESULTS:: Of the 517 participants, 85% had the history of illness and polypharmacy. The prevalence of depression was 50.6% with a mean score of 5.23; mild, moderate, and severe depression was 30.8%, 12.4%, and 7.3%, respectively. Among the significant socio-demographic and health characteristics, the ordinal regression showed that lower depressive scores were observed for those currently married, educated, and who had not been hospitalized in the last year, with higher scores for financially dependent/income < BD 200(≈£377). CONCLUSION:: The high prevalence of geriatric depression using the screening tool of GDS-15 demands further diagnostic assessment by mental health professionals. Lower levels of education linked to low income or financial dependency, widowed or separated, and recent hospitalization were the factors associated with depression. We recommend targeted interventions of proactive screening and treatment options, cognitive behavioral therapy, and interpersonal therapy.

Vitamin D for the management of multiple sclerosis.

BACKGROUND: This review is an update of a previously published review, "Vitamin D for the management of multiple sclerosis" (published in the Cochrane Library; 2010, Issue 12). Multiple sclerosis (MS) is characterised by inflammation, demyelination, axonal or neuronal loss, and astrocytic gliosis in the central nervous system (CNS), which can result in varying levels of disability. Some studies have provided evidence showing an association of MS with low levels of vitamin D and benefit derived from its supplementation. OBJECTIVES: To evaluate the benefit and safety of vitamin D supplementation for reducing disease activity in people with MS. SEARCH METHODS: We searched the Cochrane Multiple Sclerosis and Rare Diseases of the CNS Specialized Register up to 2 October 2017 through contact with the Information Specialist with search terms relevant to this review. We included references identified from comprehensive electronic database searches and from handsearches of relevant journals and abstract books from conferences. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi-RCTs that compared vitamin D versus placebo, routine care, or low doses of vitamin D in patients with MS. Vitamin D was administered as monotherapy or in combination with calcium. Concomitant interventions were allowed if they were used equally in all trial intervention groups. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed the methodological quality of studies, while another review author sorted any disagreements. We expressed treatment effects as mean differences (MDs) for continuous outcomes (Expanded Disability Status Scale and number of magnetic resonance imaging (MRI) gadolinium-enhancing T1 lesions), as standardised MDs for health-related quality of life, as rate differences for annualised relapse rates, and as risk differences (RDs) for serious adverse events and minor adverse events, together with 95% confidence intervals (CIs). MAIN RESULTS: We identified 12 RCTs enrolling 933 participants with MS; 464 were randomised to the vitamin D group, and 469 to the comparator group. Eleven trials tested vitamin D3, and one trial tested vitamin D2. Vitamin D3 had no effect on the annualised relapse rate at 52 weeks' follow-up (rate difference -0.05, 95% CI -0.17 to 0.07; I² = 38%; five trials; 417 participants; very low-quality evidence according to the GRADE instrument); on the Expanded Disability Status Scale at 52 weeks' follow-up (MD -0.25, 95% CI -0.61 to 0.10; I² = 35%; five trials; 221 participants; very low-quality evidence according to GRADE); and on MRI gadolinium-enhancing T1 lesions at 52 weeks' follow-up (MD 0.02, 95% CI -0.45 to 0.48; I² = 12%; two trials; 256 participants; very low-quality evidence according to GRADE). Vitamin D3 did not increase the risk of serious adverse effects within a range of 26 to 52 weeks' follow-up (RD 0.01, 95% CI -0.03 to 0.04; I² = 35%; eight trials; 621 participants; low-quality evidence according to GRADE) or minor adverse effects within a range of 26 to 96 weeks' follow-up (RD 0.02, 95% CI -0.02 to 0.06; I² = 20%; eight trials; 701 participants; low-quality evidence according to GRADE). Three studies reported health-related quality of life (HRQOL) using different HRQOL scales. One study reported that vitamin D improved ratings on the psychological and social components of the HRQOL scale but had no effects on the physical components. The other two studies found no effect of vitamin D on HRQOL. Two studies reported fatigue using different scales. One study (158 participants) reported that vitamin D3 reduced fatigue compared with placebo at 26 weeks' follow-up. The other study (71 participants) found no effect on fatigue at 96 weeks' follow-up. Seven studies reported on cytokine levels, four on T-lymphocyte proliferation, and one on matrix metalloproteinase levels, with no consistent pattern of change in these immunological outcomes. The randomised trials included in this review provided no data on time to first treated relapse, number of participants requiring hospitalisation owing to progression of the disease, proportion of participants who remained relapse-free, cognitive function, or psychological symptoms. AUTHORS' CONCLUSIONS: To date, very low-quality evidence suggests no benefit of vitamin D for patient-important outcomes among people with MS. Vitamin D appears to have no effect on recurrence of relapse, worsening of disability measured by the Expanded Disability Status Scale (EDSS), and MRI lesions. Effects on health-related quality of life and fatigue are unclear. Vitamin D3 at the doses and treatment durations used in the included trials appears to be safe, although available data are limited. Seven ongoing studies will likely provide further evidence that can be included in a future update of this review.

Dietary habits and sedentary behaviors among health science university students in Bahrain.

OBJECTIVE: The aim of this study was to investigate the dietary patterns and sedentary behaviors among university students in Bahrain. MATERIALS AND METHODS: A cross-sectional study was carried out with students of the College of Health Sciences in Bahrain using a self-reported questionnaire. All the students enrolled in this college were included in this study (642 students; 90 males and 552 females). The mean age of the sample was 20.1±2.0 years. A pre-tested questionnaire was used to collect information on the students' breakfast intake, snacking, food frequency intake, and sedentary habits. RESULTS: More than 50% of the students did not consume breakfast on a daily basis. A statistically significant difference (p<0.003) was found between males (19%) and females (35%) in relation to the intake of an afternoon snack. There were no significant gender differences regarding frequency of food intake, except for carbonated beverages (p<0.001) and nuts (p<0.047) consumption. Females were more likely than males to spend time watching television, use the Internet, use a mobile phone and sleep; however, the only significant difference found was for Internet use (p<0.003). Being physically active on a daily basis was more prevalent among males (41.6%) than females (16%) (p<0.001). Females (42.9%) were more prone to sleep for less time (<7 h) than males (34.4%)(p<0.08). CONCLUSION: The findings indicated that a high percentage of health science students in Bahrain had unhealthy dietary habits and sedentary behaviors. Thus, an intervention program to promote healthy dietary patterns and lifestyle habits among university students is highly recommended.

Disaster response under One Health in the aftermath of Nepal earthquake, 2015.

Until now, an estimate quotes that 1100 healthcare facilities were damaged and over 100,000 livestock lost in the two earthquakes that occurred in April and May of 2015 in Nepal. Threats of infectious diseases, mostly zoonoses, could affect Nepal's economy, trade, and tourism, and reaching the targets of the United Nations Millennium Development Goals. Historically, outbreaks of infectious diseases, including zoonoses, were largely associated with the aftereffects of the earthquakes. It has been documented that zoonoses constitute 61% of all known infectious diseases. Therefore, the purpose of this communication was to examine the infectious disease outbreaks after earthquakes around the world and explore the risk assessment of the zoonoses threats reported in Nepal and highlight adopting One Health. Our summaries on reported zoonoses in Nepal have shown that parasitic zoonoses were predominant, but other infectious disease outbreaks can occur. The fragile public health infrastructure and inadequately trained public health personnel can accelerate the transmission of infections, mostly zoonoses, in the post impact phase of the earthquake in Nepal. Therefore, we believe that with the support of aid agencies, veterinarians and health professionals can team up to resolve the crisis under One Health.

Neuraminidase inhibitors for the treatment of influenza infection in people with cystic fibrosis.

BACKGROUND: Cystic fibrosis is the most common, life-threatening, recessively inherited disease of Caucasian populations. It is a multisystem disorder caused by a mutation in the gene encoding the cystic fibrosis transmembrane conductance regulator protein which is important in producing sweat, digestive juices and mucus.The impaired or absent function of this protein results in the production of viscous mucus within the lungs and an environment that is susceptible to chronic airway obstruction and pulmonary colonization by a range of pathogenic bacteria. Morbidity and mortality of cystic fibrosis is related to chronic pulmonary sepsis and its complications by these bacteria.Influenza can worsen the course of the disease in cystic fibrosis by increasing the risk of pneumonia and secondary respiratory complications. Antiviral agents form an important part of influenza management and include the neuraminidase inhibitors zanamivir and oseltamivir. These inhibitors can limit the infection and prevent the spread of the virus. OBJECTIVES: To assess the effects of neuraminidase inhibitors for the treatment of influenza infection in people with cystic fibrosis. SEARCH METHODS: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.Most recent search: 02 November 2015. SELECTION CRITERIA: Randomised controlled trials and quasi-randomised controlled trials comparing neuraminidase inhibitors with placebo or other antiviral drugs. DATA COLLECTION AND ANALYSIS: Two review authors had planned to independently screen studies, extract data and assess risk of bias using standard Cochrane methodologies. No studies were identified for inclusion. MAIN RESULTS: No relevant studies were retrieved after a comprehensive search of the literature. AUTHORS' CONCLUSIONS: We were unable to identify any randomised controlled studies or quasi-randomised controlled studies on the efficacy of neuraminidase inhibitors for the treatment of influenza infection in people with cystic fibrosis. The absence of high level evidence for the effectiveness of these interventions emphasises the need for well-designed, adequately powered, randomised controlled clinical studies.

Bradford Hill's criteria, emerging zoonoses, and One Health.

Zoonoses constitute more than 60% of infectious diseases and 75% of emerging infectious diseases. Inappropriate overemphasis of specialization of disciplines has ignored public health. Identifying the causes of disease and determining how exposures are related to outcomes in "emerging zoonoses" affecting multiple species are considered to be the hallmarks of public health research and practice that compels the adoption of "One Health". The interactions within and among populations of vertebrates in the causation and transmissions of emerging zoonotic diseases are inherently dynamic, interdependent, and systems based. Disease causality theories have moved from one or several agents causing disease in a single species, to one infectious agent causing disease in multiple species-emerging zoonoses. Identification of the causative pathogen components or structures, elucidating the mechanisms of species specificity, and understanding the natural conditions of emergence would facilitate better derivation of the causal mechanism. Good quality evidence on causation in emerging zoonoses affecting multiple species makes a strong recommendation under the One Health approach for disease prevention and control from diagnostic tests, treatment, antimicrobial resistance, preventive vaccines, and evidence informed health policies. In the tenets of One Health, alliances work best when the legitimate interests of the different partners combine to prevent and control emerging zoonoses.

Leveraging "big data" to enhance the effectiveness of "one health" in an era of health informatics.

Zoonoses constitute 61% of all known infectious diseases. The major obstacles to control zoonoses include insensitive systems and unreliable data. Intelligent handling of the cost effective big data can accomplish the goals of one health to detect disease trends, outbreaks, pathogens and causes of emergence in human and animals.

Neuraminidase inhibitors for the treatment of influenza infection in people with cystic fibrosis.

BACKGROUND: Cystic fibrosis is the most common, life-threatening, recessively inherited disease of Caucasian populations. It is a multisystem disorder caused by a mutation in the gene encoding the cystic fibrosis transmembrane conductance regulator protein which is important in producing sweat, digestive juices and mucus.The impaired or absent function of this protein results in the production of viscous mucus within the lungs and an environment that is susceptible to chronic airway obstruction and pulmonary colonization by a range of pathogenic bacteria. Morbidity and mortality of cystic fibrosis is related to chronic pulmonary sepsis and its complications by these bacteria.Influenza can worsen the course of the disease in cystic fibrosis by increasing the risk of pneumonia and secondary respiratory complications. Antiviral agents form an important part of influenza management and include the neuraminidase inhibitors zanamivir and oseltamivir. These inhibitors can limit the infection and prevent the spread of the virus. OBJECTIVES: To assess the effects of neuraminidase inhibitors for the treatment of influenza infection in people with cystic fibrosis. SEARCH METHODS: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.Most recent search: 08 July 2013. SELECTION CRITERIA: Randomised controlled trials and quasi-randomised controlled trials comparing neuraminidase inhibitors with placebo or other antiviral drugs. DATA COLLECTION AND ANALYSIS: Two review authors had planned to independently screen studies, extract data and assess risk of bias using standard Cochrane Collaboration methodologies. No studies were identified for inclusion. MAIN RESULTS: No relevant studies were retrieved after a comprehensive search of the literature. AUTHORS' CONCLUSIONS: We were unable to identify any randomised controlled trials or quasi-randomised controlled trials on the efficacy of neuraminidase inhibitors for the treatment of influenza infection in people with cystic fibrosis. The absence of high level evidence for the effectiveness of these interventions emphasises the need for well-designed, adequately powered, randomised controlled clinical trials.

Surveillance, response systems, and evidence updates on emerging zoonoses: the role of one health.

Globally, emerging zoonotic diseases are increasing. Existing surveillance systems for zoonoses have substantial gaps, especially in developing countries, and the systems in place in the developed world require improvements. Resources and updates on evidence-based practice (EBP) for zoonoses are sparser in the veterinary literature as compared to the medical literature. Evidence updates for emerging zoonoses are either absent or rudimentary in both human and veterinary medicine. A 'one-health' concept, including a global signaling surveillance system for emerging zoonoses, will be essential for correct diagnoses, interventions, and public health strategies. An open access EBP platform supported by builders of EBP resources is urgently needed to counter emerging zoonoses.

Prevention and treatment of biofilms by hybrid- and nanotechnologies.

Bacteria growing as adherent biofilms are difficult to treat and frequently develop resistance to antimicrobial agents. To counter biofilms, various approaches, including prevention of bacterial surface adherence, application of device applicators, and assimilation of antimicrobials in targeted drug delivery machinery, have been utilized. These methods are also combined to achieve synergistic bacterial killing. This review discusses various multimodal technologies, presents general concepts, and describes therapies relying on the principles of electrical energy, ultrasound, photodynamics, and targeted drug delivery for prevention and treatment of biofilms.

Emerging Infectious Diseases, Antimicrobial Resistance and Millennium Development Goals: Resolving the Challenges through One Health.

Most emerging infectious diseases are zoonoses, which could severely hamper reaching the targets of millennium development goals (MDG). Five out of the total eight MDG's are strongly associated with the Emerging Infectious Diseases (EIDs). Recent emergence and dissemination of drug-resistant pathogens has accelerated and prevent reaching the targets of MDG, with shrinking of therapeutic arsenal, mostly due to antimicrobial resistance (AMR). World Health Organization (WHO has identified AMR as 1 of the 3 greatest threats to global health. Until now, methicillin-resistant staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) have been observed in hospital-acquired infections. In India, within a span of three years, New Delhi metallo-ß-lactamase prevalence has risen from three percent in hospitals to twenty- fifty percent and is found to be colistin resistant as well. Routine use of antimicrobials in animal husbandry accounts for more than 50% in tonnage of all antimicrobial production to promote growth and prophylaxis. This has consequences to human health and environmental contamination with a profound impact on the environmental microbiome, resulting in resistance. Antibiotic development is now considered a global health crisis. The average time required to receive regulatory approval is 7.2 years. Moreover, the clinical approval success is only 16%. To overcome resistance in antimicrobials, intersectoral partnerships among medical, veterinary, and environmental disciplines, with specific epidemiological, diagnostic, and therapeutic approaches are needed. Joint efforts under "One Health", beyond individual professional boundaries are required to stop antimicrobial resistance against zoonoses (EID) and reach the MDG.

Evidence-based practice curriculum in allied health professions for teaching-research-practice nexus.

Allied healthcare workers are from diverse professions and the key skill required is providing evidence-based care but this concept has not permeated enough for using it skillfully in their professions. A well structured curriculum in allied health professions is needed to strengthen concerted teaching, research, and practice to empower their professionals and make considerable differences in the lives of people by adopting evidence-based practice. Information sources for allied health professionals have relied on advice of their supervisors and colleagues, personal experiences, authoritative theory and texts for practice. Because of "research-practice" gap, often the use of evidence is not reflected in an individual day to day professional practice. Although allied health professionals work in resource and evidence challenged settings, there are certain barriers and facilitators, which need to be addressed. To implement practice-related research findings and uptake of evidence requires two essential components, namely, practical component and knowledge component. Research bench marking and research metrics for quality assurance and standardization through evidence-based practice will promote academic status and credibility of allied health profession.

One health: perspectives on ethical issues and evidence from animal experiments.

Zoonoses constitute more than 60% of all known infectious diseases and 75% of emerging infectious diseases. Their impact is not monitored, prevented and treated in an integrated way. The efficacy of therapeutic interventions for zoonotic diseases is deemed to be comparable across species with scientifically valid results originating from a range of animal experiments. Ethical obligations limit the number of animals used in experiments as well as reduce repetition of studies. The evidence based on randomized controlled trails and systematic reviews for the effectiveness of health care interventions is often inconclusive. Subjecting human volunteers to risk in the absence of scientifically valid results from animal experiments is unethical. The One Health concept is a comparative, clinical approach directed towards zoonoses which present challenges to research workers and clinicians. Optimal health for all--One Health--should be underpinned by ethically conducted research in animals or humans and the results should be complementary to both.

One Health: perspectives on ethical issues and evidence from animal experiments

Zoonoses constitute more than 60% of all known infectious diseases and 75% of emerging infectious diseases. Their impact is not monitored, prevented and treated in an integrated way. The efficacy of therapeutic interventions for zoonotic diseases is deemed to be comparable across species with scientifically valid results originating from a range of animal experiments. Ethical obligations limit the number of animals used in experiments as well as reduce repetition of studies. The evidence based on randomized controlled trails and systematic reviews for the effectiveness of health care interventions is often inconclusive. Subjecting human volunteers to risk in the absence of scientifically valid results from animal experiments is unethical. The One Health concept is a comparative, clinical approach directed towards zoonoses which present challenges to research workers and clinicians. Optimal health for all-One Health-should be underpinned by ethically conducted research in animals or humans and the results should be complementary to both

Quality assessment of systematic reviews of health care interventions using AMSTAR.

Appraisal of the methodological quality of systematic reviews would reflect on their utility for the clinicians and policymakers. This study was done to assess the quality of systematic reviews published in five leading Indian medical journals using AMSTAR. 22 systematic reviews of healthcare interventions were identified. The scores ranged 0 to 10 (mean 3.77 and median 2.5), 9 reviews scored > 4/11. Most frequent yes and no scores were: publication status as an inclusion criterion (12 /22), respectively and duplicate study selection and data extraction (17 /22). Several suboptimal aspects of methodological quality were identified in the reviews evaluated.

One health national programme across species on zoonoses: a call to the developing world.

Zoonoses constitute 868 (61%) of all known infectious diseases, 75% of the infections considered 'emerging' are zoonoses. Developed nations have national programmes, adjoining "One Health" concept to combat zoonoses, whereas inadequacies exist in developing nations. As a case study, role of national programmes in India, a developing nation with a large human and animal population, was explored, as we did have acquaintance of it. Data from PubMed was extracted using keywords "Zoonoses AND Prevalence/Incidence AND India AND Human OR Animal" till 2009. Additionally, some individual disease keywords were used for extraction, which were missed by the above comprehensive search terms. On appraisal, the health sector in India has only a few national programme on zoonoses where as none exists in animal husbandry sector. In the struggle against zoonoses -a major constituent of emerging infections, a system approach based, one national programme is urgently required for the developing world.

Use of a systems approach and evidence-based One Health for zoonoses research.

The World Health Organization estimates that 25% of the 57 million annual deaths that occur globally are caused by microbes. A study reported 1415 species of infectious organisms are known to be pathogenic to humans. Zoonoses constitute 61% of all known infectious diseases, with humans serving as the primary reservoir for only 3% of them. Of the 175 infectious species considered to be emerging, 75% are zoonotic. Zoonotic diseases and their impact on human and animal health are not monitored, prevented, and treated in an integrated way, despite the fact that etiologies and treatments are similar across species. The efficacy and resistance of a drug in one species has a bearing on others, in the context of zoonoses. Further, an RCT involving many species is effective in a natural setting, is robust, and may require fewer human volunteers. One Health is based on a systems approach and a collaborative effort of multiple disciplines - working locally, nationally, and globally - to attain optimal health for people, animals, and the environment. Systematic reviews and meta-analyses have so far been independent and discipline oriented. Pooling of results for diagnostic test accuracies and treatment effects of drugs for zoonoses across species has to be done, since the results of preclinical trials emanate from laboratory animals. The Cochrane Collaboration is the platform of choice to initiate a new group on zoonoses to carry out systematic meta-analyses of diagnostic tests and drug efficacies without bias, thus underpinning the systems approach and One Health.