Thalassemia in Malaysia.

Malaysia is a multi-ethnic nation, comprising of Malays and other indigenous groups (67.4%), Chinese (24.6%), Indians (7.3%) and others (0.7%). Thalassemia, which includes α- and ß-thalassemia (α- and ß-thal), is one of the most common genetic disease in Malaysia. Between 4.5 and 5.0% of the Malaysian population were reported to be carriers of this disease and 3.0-40.0% were Hb E (c.79G>A) carriers. In 2013, the Malaysian Thalassaemia Registry reported a total of 5712 registered thalassemia patients, of which 1847 had Hb E/ß-thal and 2329 had ß-thal major (ß-TM). Out of the total number of registered thalassemia patients, Malays comprise 62.0%, Chinese 13.0% and Kadazan-Dusun 13.0%. There were eight common deletions and mutations of the α-thal gene, including three double gene deletions, two single gene deletions, and three nondeletional mutations. The five types of ß-thal mutations generally found in the Malay ethnic group were codon 19 (A>G) (or Hb Malay (HBB: c.59A>G), IVS-I-1 (G>T) (HBB: c0.92+1G>T), IVS-I-5 (G>C) (HBB: 92+5 G>C), and polyadenylated signal (polyA) (AATAAA>AATAGA) (HBB: c.*112A>G). The structural variant, Hb E, accounted for 76.0% of the ß-thal mutations. Malaysia was positioned among the top countries in terms of having the best healthcare in the world in 2019 and this includes free access to three iron chelation agents for the treatment of thalassemia. The Malaysian National Programme for Thalassemia Prevention and Control was launched in 2004 and consisted of mass public education campaigns, public awareness and health education, Malaysian Thalassaemia Registry, population screening, laboratory diagnosis and comprehensive patient management.

Development and early outcomes of the national training initiative for transanal total mesorectal excision in the UK.

AIM: Transanal total mesorectal excision (TaTME) has attracted substantial interest amongst colorectal surgeons but its technical challenges may underlie the early reports of visceral injuries and oncological concerns. The aim of this study was to report on the feasibility, development and the outcome of the national pilot training initiative for TaTME-UK. METHODS: TaTME-UK was successfully launched in September 2017 in partnership with the healthcare industry and endorsed by the Association of Coloproctology of Great Britain and Ireland. This multi-modal training curriculum consisted of three phases: (i) set-up; (ii) selection of pilot sites; and (iii) formal proctorship programme. Bespoke Global Assessment Scoring (GAS) forms were designed and completed by both trainees and mentors. Data were collected on patient demographics, tumour characteristics and perioperative clinical and histological outcomes. RESULTS: Twenty-four proctored cases were performed by 10 colorectal surgeons from five selected pilot sites. Median operative time was 331 ± 90 (195-610) min which was reduced to 283 ± 62 (195-340) min in the final case. Independent performance (GAS score of 5) was achieved for most operative steps by case 5. There was one conversion (4.2%), but no visceral injuries. Pathological data confirmed no bowel perforation and intact quality of the mesorectal TME specimens with clear distal margin in all cases and circumferential margins in 23/24 cases (96%). CONCLUSION: This exploratory study demonstrates acceptable early outcomes in a small cohort suggesting that a competency-based multi-modal training programme for TaTME can be feasible and safe to implement at a national level.

Development of palliative care services in Turkey.

INTRODUCTION: Palliative care (PC) is a holistic philosophy of care that can only be obtained through the awareness of public and healthcare professionals, PC training and good integration into the health system. Depending on health system structures, there are differences in PC models and organisations in various countries. This study is designed to evaluate the current status of PC services in Turkey, which is strongly supported by national health policies. METHODS: The data were collected through official correspondence with the Ministry of Health, Provincial Directorate of Health and hospital authorities. Numbers of patients who received inpatient PC, the number of hospital beds, diagnosis of disease, duration of hospitalisation, the first three symptoms as the cause of hospitalisation, opioid use, place of discharge and mortality rates were evaluated. RESULTS: A total of 48,953 patients received inpatient PC support in 199 PC centres with 2,429 beds over a 26-month period. The most frequent diagnosis for hospitalisation was cancer (35%), and the most common symptom was pain (25%). Opioids were used in 26.7% of patients. CONCLUSION: Steps should be taken for PC training and providing continuity through organisations outside the hospital and home care.

Some considerable issues concerning malaria elimination in India.

Malaria elimination is a health priority of India for the national development and to meet UN sustainable development goals. In this article, an attempt has been made to highlight some of the key issues that need attention and consideration. These include addressing the gaps in malaria burden and adopting District Health Information System (DHIS) for real time data gathering, transfer and analysis for rapid response. The article highlights threat to malaria elimination from human migration, asymptomatic malaria, P. malariae as a neglected species, need for updating vector information and devising strategies to control relay vector species especially in the high burden states of India. Additionally, scale-up of vector control interventions, integrated vector management and enhancement of vector control capacity and capability have been emphasized. It is suggested that process, performance and progress indicators for malaria elimination may be clearly spelt out and disseminated. What are the data needs for malaria elimination certification, must be well-understood? Lessons learnt by the countries that have eliminated malaria recently shall be of great value to malaria elimination efforts in India.

Use of Salivary MicroRNAs for Diagnosis of Solid Cancers.

BACKGROUND: A modern approach to identify biomarkers of solid cancers in tissues and body fluids is based on microRNA (miRNA) expression profiling. miRNAs are a group of approximately 3.000 short noncoding RNAs containing 18-25 nucleotides that regulate gene expression at the post-transcriptional (mRNA) level. The abilities of miRNAs to inhibit the translation or induce degradation of oncogenes and tumor suppressors indicate that they are involved in carcinogenesis. There is increasing evidence that miRNAs regulate apoptosis, cell proliferation, differentiation, and invasion. miRNA expression profiles are therefore often analyzed for molecular diagnostics of solid cancers, similar to analyses based on mRNA profiling. It is important that miRNAs are highly stable and present at high levels in body fluids, including saliva, for analytic usage. miRNAs in saliva have been successfully tested as potential diagnostic biomarkers of many solid cancers. The main advantage of these miRNAs is that saliva samples can be collected non-invasively. AIM: This review aims to summarize current knowledge of circulating miRNAs in solid cancers, with a focus on the use of miRNAs in saliva for oncology diagnostics. Key words: microRNA - saliva - diagnosis - cancer The results of this research have been acquired within CEITEC 2020 (LQ1601) project with fi nancial contribution made by the Ministry of Education, Youths and Sports of the Czech Republic within special support paid from the National Programme for Sustainability II funds. The authors declare they have no potential confl icts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 8. 3. 2018 Accepted: 15. 5. 2018.

Lessons learned from conceptualising and operationalising the National Adolescent Health Programme or Rashtriya Kishor Swasthya Karyakram's Learning Districts Initiative in six districts of India.

In 2018, WHO with the support of the Ministry of Health and Family Welfare, India and partner organisations launched a Learning Districts Initiative to strengthen the district-level application of the National Adolescent Health Programme and to draw out lessons. An assessment of this initiative from 2019 to 2023 using qualitative and quantitative programme monitoring data from interviews, discussions, observations and data from multiple secondary sources explored the evolution of the concept, the process of securing government agreement, operationalising the initiative and the feasibility, acceptability, effectiveness and the potential of sustainability and replicability within the government health system. As part of the process, WHO developed the concept with partners to address the challenges identified in a Rapid Programme Review requested by the Ministry. The Ministry concurred with the proposed participatory problem identification and problem-solving approach. A review-based process guided the implementation. Local non-government organisations supported District Health Management Units to strengthen planning, implementation and monitoring. An expert in adolescent health provided technical oversight. Three years later in 2022, adolescent health is on district agendas, staff capacity has been built, and clinic and community-based activities are carried out in a structured manner. The Initiative is feasible as it leverages local expertise. Its core interventions are acceptable to government officials. While there are improvements in inputs, processes and outputs, these need to be independently validated. Challenges such as unfilled vacancies, problems in supply procurement, inability of staff to discuss sensitive issues, weak intersectoral convergence and low engagement of adolescents in programme management remain to be addressed. Nevertheless, the overall experience augurs well for the future of the programme.

Indian National Association for Study of the Liver (INASL) Guidance Paper on Nomenclature, Diagnosis and Treatment of Nonalcoholic Fatty Liver Disease (NAFLD).

Nonalcoholic fatty liver disease (NAFLD) is a major cause of chronic liver disease globally and in India. The already high burden of NAFLD in India is expected to further increase in the future in parallel with the ongoing epidemics of obesity and type 2 diabetes mellitus. Given the high prevalence of NAFLD in the community, it is crucial to identify those at risk of progressive liver disease to streamline referral and guide proper management. Existing guidelines on NAFLD by various international societies fail to capture the entire landscape of NAFLD in India and are often difficult to incorporate in clinical practice due to fundamental differences in sociocultural aspects and health infrastructure available in India. A lot of progress has been made in the field of NAFLD in the 7 years since the initial position paper by the Indian National Association for the Study of Liver on NAFLD in 2015. Further, the ongoing debate on the nomenclature of NAFLD is creating undue confusion among clinical practitioners. The ensuing comprehensive review provides consensus-based, guidance statements on the nomenclature, diagnosis, and treatment of NAFLD that are practically implementable in the Indian setting.

Folic acid fortification of flour to prevent neural tube defects in Europe - A position statement by the European Board and college of obstetrics and gynaecology (EBCOG).

Neural tube defects are disabling birth defects developing during the very early stages of conception. Children born with spina bifida face significant physical, psychological and social consequences. They may have bowel and urinary dysfunction, and no lower limb muscle control, resulting in lifelong wheelchair use. There is robust evidence that periconceptual folic acid supplementation prevents neural tube defects, when compared with no intervention. However, approximately 40% pregnancies in Europe are unplanned, and women may therefore not be taking prophylactic folic acid at the time of conception. There is evidence that low dose folic acid consumption via flour fortification provides further benefits in prevention of neural tube defects.

Antibiotic usage at a clinical paediatric hospital before and after the implementation of actions related to the hospital antibiotic policy.

OBJECTIVES: The aim of this study was to determine the impact of undertaken interventions related to the hospital antibiotic policy (antibiotic stewardship programme (ASP)): participation in a point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals (PPS ECDC), and Polish national programme to protect antibiotics (NPOA) on the modification of the amount and profile of antibacterial drug use at the Public Paediatric Teaching Clinical Hospital in Warsaw. METHODS: A retrospective analysis of antimicrobials (with daily defined doses (DDD) assignment) usage expressed in DDD and DDD/100 bed days (BD) in the period 2013-2017 (5 years) on 14 hospital wards at the Public Paediatric Teaching Clinical Hospital in Warsaw before and after the implementation of ASP-related actions was conducted. RESULTS: A total of 188 405.78 DDD were used and 553 485 paediatric BD were recorded in the wards selected for the present study in the period mentioned above. Wards with pre-authorisation duty for third-line antibiotics (group 1 of wards) used less DDD/100 BD (from 28.81 to 31.12 DDD/100 BD) than wards without such a duty (from 54.72 to 76.06 DDD/100 BD). We observed a temporary decrease of 6.37% in DDD/100 BD in group 1 of wards and a stable 9% to 21% decrease in DDD/100 BD tendency in group 2 of wards (wards without pre-authorisation duty: oncology, haematology and intensive care unit) compared with average values of DDD/100 BD in the period before ASP-related actions (2013-2014). Changes in drug utilisation (DU90%) profile were also observed, both positive and negative. CONCLUSIONS: More frequent actions related to ASP, such as annual PPS ECDC participation and regular personnel education on the principles of antibiotic therapy, should improve and make antimicrobial treatment more rational.

Stereotactic Body Radiotherapy - Current Indications.

BACKGROUND: Stereotactic body radiotherapy (SBRT) is used to treat localized tumor lesions and consists of applying high doses of radiation to a small number of fractions using specially equipped linear accelerators, modern immobilization devices, and imaging methods, which are considered special, advanced techniques in modern day radiotherapy. SBRT is a very well tolerated, non-invasive, short-term treatment that does not require hospitalization or any complicated preparation. Compared to standard radiotherapy techniques, SBRT allows, due to its precision, significantly higher doses to be applied to the target with less damage to surrounding healthy tissues. If dose constraints are not exceeded, the risk of damage to tissues and organs around the irradiated volume is reduced to minimum. The principle of SBRT is the application of ablative doses of radiation that cause necrosis of the irradiated tissue. PURPOSE: The aim of this review is to provide a basic overview of SBRT indications, radiation doses used, and potential side effects. It is not intended to be a detailed description of treatment itself (such as discussion of patient fixation systems, management of respiratory movements, or image guided strategies of treatment). This review also discusses rarer indications for SBRT, such as pancreatic carcinoma or hepatocellular carcinoma. CONCLUSION: Advances in image navigation, radiation planning, and dose application have enabled successful introduction of SBRT as a treatment regimen for many primary tumors and oligometastatic disease. If surgery is not possible or the patient refuses surgery, it is always reasonable to consider SBRT. SBRT has curative potential for the treatment of primary lung or prostate tumors. High-dose irradiation of oligometastases of various primary tumors can lead to long-term survival without disease symptoms, delay administration of toxic systemic therapies, and improve the quality of life of oncological patients. Key words radiotherapy - stereotactic body radiotherapy - review - ablative radiotherapy - lung cancer - prostate cancer - oligometastatic disease This work was supported in part by the Ministry of Health, Czech Republic - Conceptual Development of Research Organization (MMCI 00209805). The results of this research have been acquired within CEITEC 2020 (LQ1601) project with the financial contribution made by the Minis-try of Education, Youths and Sports of the Czech Republic within special support paid from the National Programme for Sustainability II funds. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 30. 10. 2018 Accepted: 4. 11. 2018.

Impact of indian public health standards for rural health care facilities on national programme for control of deafness in India: The results of a cohort study.

INTRODUCTION: In National Programme for Prevention and Control of Deafness (NPPCD), the management of ear diseases of rural India is now guided by Revised Indian Public Health Standards (IPHS) for Rural Health Facilities for providing quality ear care. However, despite the IPHS existence, coverage and quality ear care is questionable. Moreover, this issue has not yet been studied till now in the Indian context. The objective of the study was to assess the role of Private Medical College Training Center (Rural Health Training Centre [RHTC]) in augmenting quality of ear care services in NPPCD at district level by adopting IPHS Standards. MATERIALS AND METHODS: A combined retrospective and prospective cohort study was done at RHTC of a Medical College in West Uttar Pradesh from January 1, 2013, to December 31, 2017, by retrospective approach of selecting all ear patients (n = 3840) and prospective way of assessing the impact of IPHS for ear care. The semi-structured Pro forma was used in exploring the coverage and quality of ear care. The data were analyzed by Epi Info version 7.2. RESULTS: Out of total 4817 ear, nose, and throat (ENT) patients, the majority of ear patients (n = 3840) were initially dissatisfied with coverage and quality of ear services provided by ENT specialists at RHTC. However, when IPHS exposure was given from July 1, 2015 to December 31, 2017, not only majority of patients were satisfied (n = 3110, 81%) but also ear curative treatment was significantly higher (n = 2120, 68.1% vs. n = 130, 17.8%, odds ratio = 9.8, RR = 1.5, P < 0.00001). CONCLUSIONS: Adherence to IPHS in NPPCD is essential for delivering better ear care by RHTC through primary health-care approach.

Evaluation of the 5th National Program on Maternal, Child and reproductive Health / Монголын Анагаах Ухаан

Background@#As a result of the previous programmes implemented by the Government of Mongolia, maternal mortality and under-five mortality rates had declined fourfold from 1990 levels to 2015 The Millennium Development Goals (50.0), shifting from a country with a high maternal mortality rate to a country with a moderate maternal mortality rate [6, 7, 8, 9]. However, as maternal and child mortality have not been steadily declining, regional disparities in care have not been eliminated, unmet needs for family planning have increased, contraception use has reduced, abortions and repeat abortions have not decreased. The quality of antenatal care is low; the continuing challenges have led to the development and implementation of the 5^th National Programme. As the programme was finished in 2016-2020, assessing its impact on Mongolia is significant. @*Objective@#Evaluating the objectives of the National on Maternal, Child and Reproductive Health Programme, the implementation of planned activities, whether the intended results have been achieved according to the criteria was to determine future needs and the main areas of focus. @*Materials and Methods@#Quantitative and qualitative methods were used to analyse the information required for the assessment. The activities of the programme implementation plan were evaluated in the form of activities implemented in 2016-2020 and time spent on implementation, which implemented, who was involved, the budget spent, the type and the number of beneficiaries, and the reasons for nonimplementation. @*Results@#A total of 28 indicators of the National Program was 76.8 percent. In 2016, by the time the programme was launched, the under-five mortality rate was 20.8 per 1000 live births. However, the goal to reach 15 in 2021 was achieved to reach 12.7 by successfully implementing the programme. The program aimed to reduce the maternal mortality rate from 48.6 per 100000 live births to 25 per 100000 live births in 2021, but has not yet been achieved, reaching 30.2 in 2020 and 43 in the first five months of 2021. Initially, the program implementation plan included cooperation with more than 600 organisations, such as 9 ministries, 14 government organizations, 21 provinces, health centers, and maternity hospitals. However, an excessive number of organizations and an unnecessary amount of planned work made it impossible to identify the beneficiaries in addition to the Government of Mongolia, donors such as UNFPA, UNICEF, and WHO made a significant contribution to the implementation of the programme by providing financial and technical assistance. As of 2017-2021, no funds had been found to implement the National Programme on how much has been spent on information, publicity, and advocacy measures. According to the interviews with the programme implementers, a lack of leadership, lack of proper planning, turnover in the civil servants, and the ongoing pandemic had resulted in the lack of a transparent annual implementation plan, the insufficient time and resources for next year’s planning and implementation of the planned work, and the lack of budget resources. @*Conclusion@#As the total of 28 indicators of the National Programme was 76.8 percent, it has been evaluated as having achieved specific results.

Prof Lalit Prakash Agarwal (1922-2004)-The Planner of the First-Ever National Blindness Control Program of the World.

Prof Lalit Prakash Agarwal drafted the National Programme for Prevention of Visual Impairment and Control of Blindness (now called National Programme for Control of Blindness) in India in 1976, first of its kind in the world. With his vision well ahead of his time, he brought the concept of super-specialty in Indian ophthalmology. He founded Dr. Rajendra Prasad Centre for Ophthalmic Sciences, the apex governmental ophthalmological center of India. His contributions to modern Indian Ophthalmology were so profound that we may not be mistaken by calling him "the father of modern Indian Ophthalmology."

Report on the creation of a diabetes register and retinopathy screening outcomes in the Mid-West of Ireland.

BACKGROUND: With concerns that blind registration in Ireland due to diabetic retinopathy is continuing to rise, a structured retinopathy screening service is in the process of being rolled out nationally. AIMS: To report on the validation process for creating a register of diabetics in the Mid-West of Ireland, and findings following retinopathy screening of a representative sample. METHODS: National primary care databases were employed in generating provisional lists of diabetic patients in the Health Service Executive (HSE) Mid-West area. Subsequent engagement with the corresponding general practices over a three year period between 2010 and 2013 facilitated the validation of these lists. A summary of the retinopathy screening outcomes of 1,434 patients and pre-existing screening patterns is reported. RESULTS: The number of patients on the Mid-West diabetes register to date is 11,126. Of the 1,434 patients screened, 288 (20.1 %) had background retinopathy, while 117 (8.2 %) had sight-threatening retinopathy. Seventeen (19.8 %) of the 86 patients identified with maculopathy required treatment with intravitreal injections. Of the 610 patients questioned about previous screening events, 389 (63.8 %) said they had undergone an ocular examination within the previous 12 months. CONCLUSIONS: The HSE Mid-West has over 11,000 patients on its database ready to be screened by the national programme, with the treatment of maculopathy expected to have the largest impact on resources. Although the majority of patients are already undergoing screening in the community in an ad hoc fashion, the rates of sight-threatening retinopathy encountered highlight the timeliness of the full implementation of the national programme.

Changes in geriatric rehabilitation: a national programme to improve quality of care. The Synergy and Innovation in Geriatric Rehabilitation study.

OBJECTIVE: To describe changes in the health service delivery process experienced by professionals, patients and informal caregivers during implementation of a national programme to improve quality of care of geriatric rehabilitation by improving integration of health service delivery processes. STUDY SETTING: Sixteen skilled nursing facilities. STUDY DESIGN: Prospective study, comparing three consecutive cohorts. DATA COLLECTION: Professionals (elderly care physicians, physiotherapists and nursing staff) rated four domains of health service delivery at admission and at discharge of 1075 patients. In addition, these patients [median age 79 (Interquartile range 71-85) years, 63% females] and their informal caregivers rated their experiences on these domains 4 weeks after discharge. PRINCIPAL FINDINGS: During the three consecutive cohorts, professionals reported improvement on the domain team cooperation, including assessment for intensive treatment and information transfer among professionals. Fewer improvements were reported within the domains alignment with patients' needs, care coordination and care quality. Between the cohorts, according to patients (n = 521) and informal caregivers (n = 319) there were no changes in the four domains of health service delivery. CONCLUSION: This national programme resulted in small improvements in team cooperation as reported by the professionals. No effects were found on patients' and informal caregivers' perceptions of health service delivery.

Effect of mobile reminders on screening yield during opportunistic screening for type 2 diabetes mellitus in a primary health care setting: A randomized trial.

Objective. We wanted to study whether mobile reminders increased follow-up for definitive tests resulting in higher screening yield during opportunistic screening for diabetes. Methods. This was a facility-based parallel randomized controlled trial during routine outpatient department hours in a primary health care setting in Puducherry, India (2014). We offered random blood glucose testing to non-pregnant non-diabetes adults with age >30 years (667 total, 390 consented); eligible outpatients (random blood glucose ≥ 6.1 mmol/l, n = 268) were requested to follow-up for definitive tests (fasting and postprandial blood glucose). Eligible outpatients either received (intervention arm, n = 133) or did not receive mobile reminder (control arm, n = 135) to follow-up for definitive tests. We measured capillary blood glucose using a glucometer to make epidemiological diagnosis of diabetes. The trial was registered with Clinical Trial Registry of India (CTRI/2014/10/005138). Results. 85.7% of outpatients in intervention arm returned for definitive test when compared to 53.3% in control arm [Relative Risk = 1.61, (0.95 Confidence Interval - 1.35, 1.91)]. Screening yield in intervention and control arm was 18.6% and 10.2% respectively. Etiologic fraction was 45.2% and number needed to screen was 11.9. Conclusion. In countries like India, which is emerging as the diabetes capital of the world, considering the wide prevalent use of mobile phones, and real life resource limited settings in which this study was carried out, mobile reminders during opportunistic screening in primary health care setting improve screening yield of diabetes.

Swedish strategies for health and safety in agriculture: a coordinated multiagency approach.

BACKGROUND: Occupational injuries are a major problem in agriculture world-wide. OBJECTIVE: Sweden is developing a national approach to scoordinate different stakeholders with the common goal of reducing injuries in the agricultural sector. METHOD: The Swedish strategy involves important factors, such as: 1) Collaboration between all stakeholders involved in health and safety in agriculture, 2) A national programme on injury prevention, 3) Coordination of actions and 4) Knowledge, attitude and behaviour in focus. PARTICIPANTS: This approach is being coordinated through the Swedish Committee on Working Environment (LAMK), a network acting to achieve a good, healthy and safe working environment in Swedish agriculture. The Committee consists of representatives of authorities, institutions, companies, research and education institutions and organisations working in the green sector. RESULTS: The Swedish model will be evaluated as a whole concept on its effect on the frequency of injuries in the agricultural industry in the beginning of 2014. Promising results has been shown in evaluations of minor parts. CONCLUSIONS: This coordinated approach has been applied in others countries (United States and New Zealand) as well and seems like an efficient way of using limited resources to achieve higher impact on a specific problems such as occupational injuries in agriculture.

Grupo de cessação de tabagismo na atenção primária à saúde: experiência de uma unidade de saúde de Porto Alegre/RS / Smoking cessation group in primary health care: experience at a health unit in Porto Alegre, RS

Objetivo: avaliar a frequência e tempo de cessação de tabaco em usuários que realizaram o Grupo de Cessação de Tabagismo em uma Unidade de Saúde de Porto Alegre/RS. Métodos: um estudo transversal, quantitativo, analítico, por meio da aplicação de um questionário com ex-participantes dos Grupos de Cessação de Tabagismo, realizados entre 2011-2014 da Unidade de Saúde SESC, Porto Alegre/RS. A entrevista foi composta por duas partes: a primeira com dados pessoais e socioeconômicos (sexo, idade, idade no momento do grupo, quantas pessoas moram na mesma casa, a renda total da casa), e a segunda sobre a cessação do tabagismo (se parou de fumar com o grupo, se voltou a fumar, se participou dos 4 encontros do grupo, pontos positivos e negativos do grupo). Resultados: trinta e oito pacientes foram entrevistados, 52,6% deles pararam de fumar com a ajuda do Grupo de Cessação, destes 50% seguem sem fumar e 100% deles participaram dos 4 encontros preconizados pelo INCA, essencial na cessação (p=0,001). Dos demais que não pararam de fumar (47,4%), apenas 33,3% participaram dos 4 encontros, 60,5% da amostra total usaram algum tipo de medicamento e a diferença entre o índice de Fagerström entre o grupo que parou de fumar e o que não parou não foi significativo. Dos pontos positivos do Grupo, a troca de experiências entre os membros foi o mais relevante, enquanto, no tocante ao ponto negativo, a curta duração do grupo e a falta de um grupo de manutenção tiveram destaque. Conclusões: o Grupo de Cessação de Tabagismo da Unidade SESC, na forma como está estruturado tem auxiliado os pacientes na cessação, uma vez que mais da metade dos participantes pararam de fumar. A participação nos 4 encontros do Grupo mostrou ser mais eficaz que o uso dos medicamentos. Algumas modificações podem ser feitas, para que cada vez mais os usuários consigam alcançar o objetivo esperado, sendo o Grupo de Manutenção uma estratégia possível, para aumentar o tempo de cessação, auxiliando na recaída.

Objective: evaluate the frequency and duration of tobacco cessation among users who took part in the Smoking Cessation Group at a Health Unit in Porto Alegre, RS. Methods: a cross-sectional, quantitative, analytical study that administered a questionnaire to past participants of Smoking Cessation Groups conducted between 2011-2014 at the SESC Health Unit, Porto Alegre, RS. The interview was composed of two parts: the first with personal and socioeconomic data (gender, age, age at the time of the group, number of people living in the same household, the total income of the household), and the second on smoking cessation (did they stop smoking with the group, did they go back to smoking, did they participate in the four meetings of the group, positive and negative points about the group). Results: thirty-eight patients were interviewed, 52.6% of them stopped smoking with the help of the cessation group, of these 50% continue not smoking and 100% of them participated in the four meetings recommended by the Brazilian National Cancer Institute (INCA), essential in cessation (p=0.001). Among the others who did not quit smoking (47.4%), only 33.3% participated in the four meetings. Among the total sample, 60.5% used some type of medication, and the difference in the Fagerström index between the group that stopped smoking and the group that did not stop was not significant. Among the positive points about the group, the exchange of experiences among members was the most relevant, while among the negatives the short duration of the group and the lack of a maintenance group stood out. Conclusions: we conclude that the Smoking Cessation Group of the SESC unit, in the way it is structured, has helped patients with cessation, since more than half of the participants stopped smoking. Participation in the 4 group meetings has proved more effective than the use of drugs. Some modifications can be made so that more and more users could reach the expected goal, with the Maintenance Group being a possible strategy to increase the duration of abstinence, helping against relapse.

Training and burn care in rural India.

Burn care is a huge challenge in India, having the highest female mortality globally due to flame burns. Burns can happen anywhere, but are more common in the rural region, affecting the poor. Most common cause is flame burns, the culprit being kerosene and flammable flowing garments worn by the women. The infrastructure of healthcare network is good but there is a severe resource crunch. In order to bring a positive change, there will have to be more trained personnel willing to work in the rural areas. Strategies for prevention and training of burn team are discussed along with suggestions on making the career package attractive and satisfying. This will positively translate into improved outcomes in the burns managed in the rural region and quick transfer to appropriate facility for those requiring specialised attention.