Availability and readiness of primary healthcare facilities for the management of non-communicable diseases in different districts of Punjab, Pakistan.

Introduction: Non-communicable diseases (NCDs) and their effects are rising quickly. NCDs such as cardiovascular illnesses, diabetes, cancer, and chronic lung diseases cause 60% of global deaths; of which, 80% occur in developing countries. In established health systems, primary healthcare handles most of the NCD care. Methodology: This is a mixed-method study conducted to analyze the health service availability and readiness toward NCDs using the SARA tool. It included 25 basic health units (BHUs) of Punjab, which were selected through random sampling. Quantitative data were collected using the SARA tools, while qualitative data were collected through in-depth interviews with healthcare providers working at the BHUs. Results: There was a problem of load shedding of both electricity and water in 52% of the BHUs, which leads to the poor availability of healthcare services. Only eight (32%) out of 25 BHUs provide the diagnosis or management of NCDs. The service availability was the highest for diabetes mellitus (72%), followed by cardiovascular disease (52%) and then chronic respiratory disease (40%). No services were available for cancer at the BHU level. Conclusion: This study raises issues and questions about the primary healthcare system in Punjab in two areas: first, the overall performance system, and second, the readiness of basic healthcare institutions to treat NCDs. The data show that there are many persisting primary healthcare (PHC) deficiencies. The study found a major training and resource deficit (guidelines and promotional materials). Therefore, it is important to include NCD prevention and control training in district training activities. NCDs are underrecognized in primary healthcare (PHC).

Extracellular Vesicles Inhibit the Response of Pancreatic Ductal Adenocarcinoma Cells to Gemcitabine and TRAIL Treatment.

Pancreatic ductal adenocarcinoma remains an aggressive cancer with a low 5-year survival rate. Although gemcitabine has been a standard treatment for advanced pancreatic cancer, patients often develop resistance to this therapeutic. We have previously shown that treating pancreatic cancer cells in vitro with a combination of gemcitabine and the cytokine TRAIL significantly reduced both cell viability and survival. The data presented here demonstrate that this response to treatment is inhibited when cells are incubated with a conditioned medium derived from untreated cells. We show that this inhibition is specifically mediated by extracellular vesicles present in the conditioned medium, as seen by a significant decrease in apoptosis. Additionally, we further demonstrate that this effect can be reversed in the presence of GW4869, an inhibitor of exosome biogenesis and release. These results show that pancreatic cancer cell-derived extracellular vesicles can confer resistance to treatment with gemcitabine and TRAIL. The implications of these findings suggest that removal of EVs during treatment can improve the response of cells to gemcitabine and TRAIL treatment in vitro.

Monitoring responses of vegetation phenology and productivity to extreme climatic conditions using remote sensing across different sub-regions of China.

Drought is a major natural disaster that significantly impacts the susceptibility and flexibility of the ecosystem by changing vegetation phenology and productivity. This study aimed to investigate the impact of extreme climatic variation on vegetation phenology and productivity over the four sub-regions of China from 2000 to 2017. Daily rain gauge precipitation and air temperature datasets were used to estimate the trends, and to compute the standardized precipitation-evapotranspiration index (SPEI). Remote sensing-based Enhanced Vegetation Index (EVI) data from a moderate resolution imaging spectroradiometer (MODIS) was used to characterize vegetation phenology. The results revealed that (1) air temperature had significant increasing trends (P < 0.05) in all sub-regions. Precipitation showed a non-significant increasing trend in Northwest China (NWC) and insignificant decreasing trends in North China (NC), Qinghai Tibet area (QTA), and South China (SC). (2) Integrated enhanced vegetation index (iEVI) and SPEI variations depicted that 2011 and 2016 were the extremely driest and wettest years during 2000-2017. (3) Rapid changes were observed in the vegetation phenology and productivity between 2011 and 2016. In 2011, changes in the vegetation phenology with the length of the growing season (ΔLGS) = was - 14 ± 36 days. In 2016, the overall net effect changed at the onset and end of the growing season with ΔLGS of 34 ± 71 days. The change in iEVI per SPEI increased rapidly with a changing rate of 0.16 from arid (NWC, and QTA) to semi-arid (NWC, QTA and NC) and declined with a rate of - 0.04 from semi-humid (QTA, NC, and SC) to humid (SC) region. A higher association was observed between iEVI and SPEI as compared to iEVI and precipitation. Our finding exposed that north China is more sensitive to climatic variation.

Performance and relationship of four different agricultural drought indices for drought monitoring in China's mainland using remote sensing data.

Increasing frequency and intensity of extreme drought events have harmed the environment, ecosystem, and agricultural productivity. However, the characteristics of agricultural drought in China have not been well understood. The remote sensing (RS) based gridded monthly precipitation, soil moisture, land surface temperature (LST), and normalized difference vegetation index (NDVI) datasets over 1982-2018 were utilized to derive standardized precipitation index (SPI), standardized soil moisture index (SSI), multivariate standardized drought index (MSDI), and vegetation health index (VHI). The variation patterns and trends of SPI, SSI, and MSDI at the 1-, 3-, and 6-month timescales against monthly VHI anomaly were compared to identify the best agricultural drought index in China. The drought variations in the four sub-regions (northwest, north, Qinghai-Tibet area, and south area) were also investigated. The results showed that: (1) Temporal patterns of VHI anomaly were similar to relative soil moisture and slightly different from precipitation. The spatial patterns of MSDI matched with VHI the best than SPI and SSI. (2) All three indices showed positive correlations with VHI at the three timescales. The highest correlation coefficients (r) between MSDI and VHI ranged from 0.25 to 0.67, 0.22 to 0.78, 0.23 to 0.69, and 0.19 to 0.74 in northwest China, north China, Qinghai-Tibet Plateau, and south China, respectively. (3) The connections between monthly VHI and the three drought indices were weaker at the 1-month timescale (0.16 < r < 0.25) than the 3-month (0.39 < r < 0.78) and 6-month (0.26 < r < 0.68) timescales. (4) The VHI significantly increased in most of China except north China. Overall, MSDI showed better performance for monitoring agricultural drought in China's mainland.

Brief culturally adapted CBT (CaCBT) for depression: a randomized controlled trial from Pakistan.

OBJECTIVES: To determine the efficacy of brief Culturally adapted CBT (CaCBT) for depression when added to Treatment As usual (TAU)-delivered by trained therapists using a manual compared with alone TAU. METHODS: This was an assessor-blinded, randomised controlled clinical trial. Particpants with a diagnosis of depression, attending psychiatry departments of three teaching hospitals in Lahore, Pakistan, were included in the study. We screened a total of 280 patients and randomly allocated 137 of them to CaCBT plus Treatment As Usual (TAU) [Treatment group] or to TAU alone [Control group]. Assessments were completed at baseline, at 3 months and at 9 months after baseline. Reduction in depression score (Hospital Anxiety and Depression-Depression Subscale) at 3 months was primary outcome measure. The secondary outcome measures included anxiety scores (Hospital Anxiety and Depression-Anxiety Subscale), somatic symptoms (Bradford Somatic Inventory), disability (Brief Disability Questionnaire) and satisfaction with the treatment. FINDINGS: A total of 69 participants were randomised to Treatment group and 68 to Control group. Participants in Treatment group showed statistically significant improvement in depression (p=0.000), anxiety (p=0.000), somatic symptoms (p=0.005) and disability (p=0.000). This effect was sustained at 9 months after baseline (Except for disability). Participants in Treatment group also reported higher satisfaction with treatment compared with those in Control group. CONCLUSION: Brief CaCBT can be effective in improving depressive symptoms, when compared with treatment as usual. This is the first report of a trial of Culturally adapted CBT from South Asia and further studies are needed to generalise these findings.