Feasibility and effectiveness of a two-tiered intervention involving training and a new consultation model for patients with palliative care needs in primary care: A before-after study.

BACKGROUND: Evidence suggests that involving General Practitioners in the care of patients with palliative care needs may improve patient outcomes. AIM: To evaluate whether a two-tiered intervention involving training in palliative care and a new consultation model in primary care for patients with palliative care needs is feasible and could reduce patients' symptom burden. DESIGN: Before-after study including an internal pilot. SETTING/PARTICIPANTS: Nine general practitioners working in a health region in Portugal and 53 patients with palliative care needs from their patient lists were recruited. General Practitioners received training in palliative care and used a new primary palliative care consultation model, with medical consultations every 3 weeks for 12 weeks. The primary outcome was physical symptom burden, self-reported using the Integrated Palliative care Outcome Scale (IPOS) patient version (min.0-max.1000). Secondary outcomes included emotional symptoms (min.0-max.400) and communication/practical issues (min.0-max.300). RESULTS: Of the 35/53 patients completed the 12-week intervention (mean age 72.53 years, SD = 13.45; 54.7% female). All had advanced disease: one third had cancer (n = 13), one third had congestive heart failure (n = 12); others had chronic kidney disease and chronic obstructive pulmonary disease. After the 12 weeks of intervention, there was a reduction in physical symptom burden [mean difference from baseline of 71.42 (95%CI 37.01-105.85) with a medium-large effect size (0.71], and in emotional symptom burden [mean difference 42.86 (95%CI 16.14-69.58), with a medium effect size (0.55)]. No difference was found for communication/practical issues. CONCLUSIONS: Our intervention can be effective in reducing patients' physical and emotional symptoms. TRIAL REGISTRATION: ClinicalTrials.gov ID - NCT05244590. Registration: 14th February 2022.

Bidirectional screening and testing for TB and COVID-19 among outpatient department attendees: outcome of an initial intervention in Ghana.

BACKGROUND: Tuberculosis (TB) remains a major public health threat in Ghana. The impact of COVID-19 resulted in a 15% decline of TB case notification in 2020 compared to 2019. To mitigate the impact on TB services, the Ghana National Tuberculosis Programme (NTP) introduced the bidirectional screening and testing for TB and COVID-19 in 2021. OBJECTIVE: To evaluate the yield of bidirectional screening and testing for TB and COVID-19 among facility attendees in the Greater Accra region. METHOD: We used secondary data obtained from the initial implementation stage of the bidirectional testing for TB and COVID-19 among COVID-19 and/or TB presumed cases in five health facilities in the Greater Accra Region from January to March 2021. To mitigate the impact of COVID-19 on TB services and accelerate TB case detection, the NTP of Ghana introduced bidirectional screening and testing for TB and COVID-19 in Greater Accra Region before scaling up at national level. RESULTS: A total of 208 presumed TB or COVID-19 cases were identified: 113 were tested for COVID-19 only, and 94 were tested for both TB and COVID-19, 1 was tested for TB only. Among presumed cases tested for COVID-19, 9.7% (95% CI, 5.6-13.7%) were tested positive. Whilst among the total presumed tested for TB, 13.7% (95% CI, 6.8-20.6%) were confirmed to have TB. Among the total 94 presumed cases tested for both TB and COVID-19, 11.7% (95% CI, 5.2-18.2%) were confirmed to have TB and 13.8% (95% CI, 6.9-20.8%) participants were COVID-19 positive and one participant (1.1%) had both COVID-19 and TB. CONCLUSION: Bidirectional screening and testing for TB and COVID-19 shows significant potential for improving overall case detection for the two diseases. The bidirectional screening and testing could be applicable to address a similar respiratory epidemic in the future that might have a masking effect on the response to TB disease.

Morphological response accompanying size reduction of belemnites during an Early Jurassic hyperthermal event modulated by life history.

One of the most common responses of marine ectotherms to rapid warming is a reduction in body size, but the underlying reasons are unclear. Body size reductions have been documented alongside rapid warming events in the fossil record, such as across the Pliensbachian-Toarcian boundary (PToB) event (~ 183 Mya). As individuals grow, parallel changes in morphology can indicate details of their ecological response to environmental crises, such as changes in resource acquisition, which may anticipate future climate impacts. Here we show that the morphological growth of a marine predator belemnite species (extinct coleoid cephalopods) changed significantly over the PToB warming event. Increasing robustness at different ontogenetic stages likely results from indirect consequences of warming, like resource scarcity or hypercalcification, pointing toward varying ecological tolerances among species. The results of this study stress the importance of taking life history into account as well as phylogeny when studying impacts of environmental stressors on marine organisms.

Mechanisms and drivers of belemnite body-size dynamics across the Pliensbachian-Toarcian crisis.

Body-size reduction is considered an important response to current climate warming and has been observed during past biotic crises, including the Pliensbachian-Toarcian crisis, a second-order mass extinction. However, in fossil cephalopod studies, the mechanisms and their potential link with climate are rarely investigated and palaeobiological scales of organization are not usually differentiated. Here, we hypothesize that belemnites reduce their adult size across the Pliensbachian-Toarcian boundary warming event. Belemnite body-size dynamics across the Pliensbachian-Toarcian boundary in the Peniche section (Lusitanian Basin, Portugal) were analysed based on the newly collected field data. We disentangle the mechanisms and the environmental drivers of the size fluctuations observed from the individual to the assemblage scale. Despite the lack of a major taxonomic turnover, a 40% decrease in rostrum volume is observed across the Pliensbachian-Toarcian boundary, before the Toarcian Oceanic Anoxic Event where belemnites go locally extinct. The pattern is mainly driven by a reduction in adult size of the two dominant species, Pseudohastites longiformis and Passaloteuthis bisulcata. Belemnite-size distribution is best correlated with fluctuations in a palaeotemperature proxy (stable oxygen isotopes); however, potential indirect effects of volcanism and carbon cycle perturbations may also play a role. This highlights the complex interplay between environmental stressors (warming, deoxygenation, nutrient input) and biotic variables (productivity, competition, migration) associated with these hyperthermal events in driving belemnite body-size.

Evaluation of the tuberculosis surveillance system in the Ashaiman municipality, in Ghana.

INTRODUCTION: Tuberculosis (TB) was the leading cause of death from an infectious illness globally with an estimated 10.4 million new cases and 1.4 million deaths in 2015. In Ghana, from the 2013 TB prevalence survey conducted by the National Tuberculosis Control Programme, the incidence is estimated as 165 per 100,000 population and a mortality rate of 7.5 per 1,000 infected people. The Tuberculosis surveillance system is part of the general framework of the Integrated Disease Surveillance and Response. This evaluation was to assess whether the system is meeting its set objectives, assess its usefulness and describe its attributes. METHODS: The TB surveillance system of the Ashaiman municipality was evaluated using Centre for Disease Control and Prevention updated guidelines for evaluating public health surveillance systems 2006. Records review from 2014 to 2016 was done to assess objectives of the system and surveillance data source of 2016 was used to assess attributes. Interviews were conducted at the various levels using semi-structured questionnaire and data analysis done with Epi info 7 and Microsoft Excel to run frequencies and percentages. RESULTS: The surveillance system is well structured with standardized data collection tools. The system was found to be useful, though it just partially met its objectives. It was also found to be simple, flexible and fairly stable with average timeliness. It had low acceptability and is not geographically representative. It had low sensitivity of 45/100,000 and a low predictive value positive of 6.6%. CONCLUSION: The surveillance system was found to be useful but partially met its objectives. There is the need to improve the sensitivity, predictive value positive timeliness and acceptability.

Cicatrização de úlceras teciduais não infectadas tratadas com papaína / Tecidual ulcers cicatrization no infected by papaína

estudar os aspectos histológicos da cicatrização de lesões ulcerativas assépticas tratadas com soluções de papaína. MÉTODO: estudo experimental, utilizandos ratos Wistar (n=18), machos, adultos, que após procedimento cirúrgico, para a retirada de uma seção quadrada de pele da região cervical, foram distribuídos em dois grupos: Grupo I - Controle (n=9), sem tratamento; Grupo II ? Tratados (n=9), com tratamento com soluções de papaína de 10%, 6% e 4%, de acordo com as características morfológicas macroscópicas das lesões. A análise histológica das áreas lesadas, coradas com Hematoxilina-eosina e tricrômico de Masson, foi realizada com 7, 14 e 21 dias. RESULTADOS: a papaína auxiliou na modulação do processo inflamatório; formação e amadurecimento do tecido de granulação, e organização das fibras colágenas; acelerando a proliferação e organização da epiderme nas lesões ulcerativas em todos os dias estudados. CONCLUSÕES: estes dados reforçam e complementam pesquisas que relacionam os efeitos cicatrizantes da papaína sobre lesões ulcerativas principalmente por facilitar a organização do tecido de granulação e possivelmente por modular a resposta inflamatória

OBJECTIVES: study the histology of healing of ulcerative wound treated with papaine solutions METHODS: a square section of skin was surgically removed from the cervical region of adult-male Wistar rats (n=18), which were divided into two groups: Group I - Control (n=9), no treatment; and Group II ? Treated (n=9) with treatment with papaine solutions of 10, 6 and 4%, according to the macroscopic morphological characteristics of the lesions. A histological analysis was made of the lesions, stained with hematoxilin and eosin and with Masson?s trichrome, at 7, 14 and 21 days. RESULTS: the papaine aided in the modulation of the inflammatory process, in the formation and maturation of the granulation tissue and in the organization of the collagenous fibers; accelerating the proliferation and organization of the epidermis at the ulcerative lesions throughout