Improvement In Global Health Research Articles

BETTER ORAL HEALTH TO ALL

Despite vast improvement in global oral health, problems persist in many populations and communities particularly among the underprivileged in both and developed and developing countries. Dental caries and periodontal diseases have for years burdened the majority of populations with heavy treatment and financial needs. Dental caries is still a major oral health problem in most industrialized countries as it affects 60-90% of school-aged children and the vast majority of adults. According to the World Health Organization oral diseases are the fourth most expensive to treat. Their treatment costs exceed those of cancer, heart and coronary diseases, stroke and dementia in most industrialized countries. It has been estimated that the European Union countries used 79 billion euros for oral health care in 2012. Should the present trend continue the costs could exceed 93 billion euros in 2020. Oral and dental care, as known in the developed world, is not available to 90% of the global population. The millions living in poverty do not have access to emergency dental care or to preventive measures to help them in their own oral health. It has been estimated that 80% of dentists in the world are serving 20% of the global population. Given their prevalence worldwide oral diseases represent major public health problems causing pain, suffering and reduced quality of life. Generally, studies on dental caries and periodontal diseases have shown a decreasing trend of oral diseases in developed countries. On the other hand assessing the situation in developing countries is characterized by lack of continuous and reliable data despite the recommendations of WHO. To provide or even to plan dental services required to meet the needs, oral health need assessments and surveys are necessary both locally and nationally. The major oral diseases are today understood more clearly than ever as behavior-related diseases. They are preventable through individual’s own actions supported by the health professionals. Generally, health behaviors, either health-enhancing or health-detrimental, are mostly derived through norms, values and goals of the family. The family plays the primary role in the acquisition, modification and improvement of health behavior. However, maintaining let alone changing health related behavior is a vast challenge. Everyday life is full of health related risks known or unknown to the individuals. A health-related behavior is not a simple matter of freedom of choice rather than reflection of one’s lifestyle. Lifestyle with different risks being also determinants of different diseases should be understood as an expression of the cultural and social environment in which people live and work. This concept bears significant impact on oral health. The core group of modifiable risk factors for the chronic diseases often cluster in the same population groups and individuals. These factors include smoking, alcohol consumption, diet, hygiene and stress. Controlling one or a small number of risk factors have a major impact on a number of chronic diseases including oral diseases. The behavioral science experts are of opinion that only comprehensive and integrated common-risk-factor-based health promotion activities can enhance oral health and its equity as a part of general health. Are health professionals ready to assume their responsibility for promoting better oral health?

One Health proof of concept: Bringing a transdisciplinary approach to surveillance for zoonotic viruses at the human-wild animal interface

As the world continues to react and respond inefficiently to emerging infectious diseases, such as Middle Eastern Respiratory Syndrome and the Ebola and Zika viruses, a growing transdisciplinary community has called for a more proactive and holistic approach to prevention and preparedness – One Health. Such an approach presents important opportunities to reduce the impact of disease emergence events and also to mitigate future emergence through improved cross-sectoral coordination. In an attempt to provide proof of concept of the utility of the One Health approach, the US Agency for International Development’s PREDICT project consortium designed and implemented a targeted, risk-based surveillance strategy based not on humans as sentinels of disease but on detecting viruses early, at their source, where intervention strategies can be implemented before there is opportunity for spillover and spread in people or food animals. Here, we share One Health approaches used by consortium members to illustrate the potential for successful One Health outcomes that can be achieved through collaborative, transdisciplinary partnerships. PREDICT’s collaboration with partners around the world on strengthening local capacity to detect hundreds of viruses in wild animals, coupled with a series of cutting-edge virological and analytical activities, have significantly improved our baseline knowledge on the zoonotic pool of viruses and the risk of exposure to people. Further testament to the success of the project’s One Health approach and the work of its team of dedicated One Health professionals are the resulting 90 peer-reviewed, scientific publications in under 5 years that improve our understanding of zoonoses and the factors influencing their emergence. The findings are assisting in global health improvements, including surveillance science, diagnostic technologies, understanding of viral evolution, and ecological driver identification. Through its One Health leadership and multi-disciplinary partnerships, PREDICT has forged new networks of professionals from the human, animal, and environmental health sectors to promote global health, improving our understanding of viral disease spillover from wildlife and implementing strategies for preventing and controlling emerging disease threats.

Emerging Concepts and Technologies for the Discovery of Microorganisms Involved in Human Disease.

Established infectious agents continue to be a major cause of human morbidity and mortality worldwide. However, the causative agent remains unknown for a wide range of diseases; many of these are suspected to be attributable to yet undiscovered microorganisms. The advent of unbiased high-throughput sequencing and bioinformatics has enabled rapid identification and molecular characterization of known and novel infectious agents in human disease. An exciting era of microbe discovery, now under way, holds great promise for the improvement of global health via the development of antimicrobial therapies, vaccination strategies, targeted public health measures, and probiotic-based preventions and therapies. Here, we review the history of pathogen discovery, discuss improvements and clinical applications for the detection of microbially associated diseases, and explore the challenges and strategies for establishing causation in human disease.

Smartphone Application to Self-Monitor Daily Sickle Cell Disease Symptoms: A Qualitative Study of Users' Experience

Background: Despite the well-organized follow up of Sickle Cell Disease patients in Northern countries, the knowledge of this chronic disease mostly relies on data collected during hospital stays or visits. There is scare patients reported data and little is known about the daily impact of the disease, assessed by the patient him or herself. Sickle-O-Scope is the first mobile phone application allowing patients with SCD and their families' caregivers to self-monitor the disease symptoms on a daily basis. The mobile app is able to save the daily records and to restitute results on Excel charts, ready to be sent. This qualitative survey presents how patients with sickle cell disease or caregivers perceive the benefits from the use of this first mobile app and their suggestions for improvement of this appMethod: 8 French speaking patients (n=7) and a caregiver (n=1), living in France had been enrolled in a qualitative survey to assess their satisfaction. They had been asked to use the mobile app, during 30 days. They had been submitted to a phone administrated questionnaire. The questionnaire comprises the Hospital Anxiety and Depression Scale, questions based on their expectations of symptoms following hospital stays or visits, their global satisfaction, their detailed satisfaction and the perceived benefit for their disease management.Results: Results show that most of the participants have no sign of anxiety and depression. There is no significant before app/after app evolution of the anxiety and depression scores. Most of the participants are satisfied (75%) or very satisfied (25%) with this mobile app. All participants find the mobile app very easy to use and encounter no difficulty. The majority of participants (75%) find the mobile app useful for their follow up and think it could help them to have a better monitoring of their disease (62,5%). 75% of participants find it could facilitate the communication with their physician and 88% of them will be ready to use it on a daily basis if asked by the physician. All participants are ready to send data to their physicians and will recommend other patients or caregivers to use it. Only half of participants think that the monitoring of their symptoms could help them to avoid complications. Participants suggestions to improve the mobile app are: integrating a reminder of data collection, integrating an agenda of the hospital appointments, allowing a more precise pain localization, monitoring hemoglobin rate, indicating the name of used medicines.Conclusion: This limited survey indicates that an app could be of interest for the patient follow-up and monitoring. Following these initial results, a second improved version was published. Further studies on a larger scale are ongoing to see what impact this type/sort of application can have on global health improvement. DisclosuresAdjibi:ADDMEDICA: Consultancy. Meddeb:ADDMEDICA: Consultancy. Dauvergne:ADDMEDICA: Employment. Duguet:ADDMEDICA: Employment.

Pablo Perel: leading improvements in global cardiovascular health

Pablo Perel splits his working time between London, UK, and Geneva, Switzerland. He is director of the Centre for Global Non-Communicable Diseases (NCDs) at the London School of Hygiene & Tropical Medicine (LSHTM) and senior science advisor for the World Heart Federation.

UK must stop arms sales to Saudi Arabia in light of bombings of Yemeni health facilities, says charity.

The charity Medact has called on the UK international trade secretary, Liam Fox, to suspend arms sales to Saudi Arabia to prevent further bombing of healthcare facilities in the conflict in Yemen. Fox, who studied medicine in Glasgow and worked as a GP in Buckinghamshire before entering politics, is now responsible for licensing arms sales in his ministerial role. Campaigners from Medact, a charity for health professionals focused on global health improvement, and other doctors and health professionals have appealed to Fox as a doctor to think of the health of Yemeni people, the brutal attacks on clinicians, and his duty to “first do no harm.” They cited evidence that British arms were being used to …

Integration of Functional and Traditional Food in Emerging Markets: Regulatory and Substantive Aspects of Yerba Mate and Quinoa

Given the rising cost of healthcare, the increase in life expectancy and the wish for a better quality of life, the request for foods and beverages producing a beneficial effect on health has increased worldwide. “Functional food” is a new concept and may play a key role in diseases’ prevention and management. Although its meaning is currently under definition, its role in global health improvement is growing constantly. This article aims at giving a description of existing legislation on functional food in South America, identifying future directions for health and marketing policies. Furthermore, authors provide a literature revision on two products widely consumed in Latin American countries: Yerba Mate and Quinoa. Thanks to their beneficial health effects in terms of disease prevention and promotion of well-being, they may be considered as functional foods with a potential key role in health care.

Effects of a global health nursing program on Vietnamese and South Korean students

This study evaluated the improvement of global health nursing knowledge and attitude of participants in a program developed using a students’ needs assessment about global health nursing competency that was obtained in a previous study. The program comprised a lecture, group work, and field activities based on six global health nursing competence modules over a one-week period. Sixty individuals participated: thirty from South Korea and thirty from Vietnam. A pre-post survey was undertaken to measure knowledge change, and thematic content analysis was used to further understand attitude change. The overall score increased from 21.02 ± 3.36 before the program to 28.10 ± 6.56 after the program, showing a statistically significant difference ( p < .05). The change in the perception of knowledge on the healthcare system was high (from 1.53 ± 0.63 to 3.37 ± 4.23; p < .001), however a difference in perception of knowledge of the functions of the United Nations and World Health Organization was not significant after the program for Vietnam students ( p < .293). Ten sub-themes of thematic content were derived and regrouped into five themes, resulting in three domains: global health competence, global leadership competence, and cultural competence. The global health nursing program grew students’ knowledge and attitudes. Further studies on the long-term program effects are needed to generalize the global health nursing program.

Time to Invest in Sickle Cell Anemia as a Global Health Priority.

* Abbreviations: MDG — : Millennium Development Goal NBS — : newborn screening NCD — : noncommunicable disease POC — : point of care SCA — : sickle cell anemia SDG — : Sustainable Development Goal More than 500 children with sickle cell anemia (SCA) die every single day because of lack of access to early diagnosis and associated treatment, yet SCA remains an invisible global health problem. Over the last several decades, unprecedented improvements in the survival of children across the world have been accomplished through strategic collaboration among global health leaders and funding agencies by targeting specific preventable and treatable conditions associated with high early mortality.1 The Millennium Development Goal (MDG) program has been remarkable, and through MDG 4, the number of deaths in children <5 years of age has declined from 12.7 million in 1990 to nearly 6 million in 2015. Despite the historical and paradigm-shifting successes of the MDG program, much work remains to be done. Although the MDG era has resulted in many global health improvements, the progress has been somewhat uneven because global health funding has largely focused on a small number of infectious diseases, such as HIV/AIDS, tuberculosis, polio, and malaria.2 The successful efforts in these areas have demonstrated that focused and goal-oriented global health strategies can result in dramatic improvements from a baseline situation that may appear dire. As we transition from the MDGs to the Sustainable Development Goals (SDGs), we must learn from the successes of the MDG era while focusing on diversification of the global health agenda beyond just a few specific health conditions. With the transition to the SDGs, noncommunicable diseases (NCDs) have risen to the forefront of the global health agenda. In an effort to include children in the global NCD initiative, the American Academy of Pediatrics has become a leader in NCD Child, a global alliance focused on NCDs in children and adolescents. The NCD Child Initiative importantly recognizes the necessity of including children in the NCD discussion, but, as is … Address correspondence to Patrick T. McGann, MD, MS, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229. E-mail: patrick.mcgann{at}cchmc.org

Thermostabilization of inactivated polio vaccine in PLGA-based microspheres for pulsatile release

Vaccines are a critical clinical tool in preventing illness and death due to infectious diseases and are regularly administered to children and adults across the globe. In order to obtain full protection from many vaccines, an individual needs to receive multiple doses over the course of months. However, vaccine administration in developing countries is limited by the difficulty in consistently delivering a second or third dose, and some vaccines, including the inactivated polio vaccine (IPV), must be injected more than once for efficacy. In addition, IPV does not remain stable over time at elevated temperatures, such as those it would encounter over time in the body if it were to be injected as a single-administration vaccine. In this manuscript, we describe microspheres composed of poly(lactic-co-glycolic acid) (PLGA) that can encapsulate IPV along with stabilizing excipients and release immunogenic IPV over the course of several weeks. Additionally, pH-sensitive, cationic dopants such as Eudragit E polymer caused clinically relevant amounts of stable IPV release upon degradation of the PLGA matrix. Specifically, IPV was released in two separate bursts, mimicking the delivery of two boluses approximately one month apart. In one of our top formulations, 1.4, 1.1, and 1.2 doses of the IPV serotype 1, 2, and 3, respectively, were released within the first few days from 50mg of particles. During the delayed, second burst, 0.5, 0.8, and 0.6 doses of each serotype, respectively, were released; thus, 50mg of these particles released approximately two clinical doses spaced a month apart. Immunization of rats with the leading microsphere formulation showed more robust and long-lasting humoral immune response compared to a single bolus injection and was statistically non-inferior from two bolus injections spaced 1 month apart. By minimizing the number of administrations of a vaccine, such as IPV, this technology can serve as a tool to aid in the eradication of polio and other infectious diseases for the improvement of global health.

Does percutaneous tibial nerve stimulation improve global pelvic function in women with faecal incontinence?

Percutaneous tibial nerve stimulation (PTNS) is a minimally invasive treatment for faecal incontinence. Many patients with faecal incontinence have coexisting pelvic floor disorders such as urinary incontinence and vaginal symptoms. We utilized a pelvic floor assessment tool to analyse any effect of PTNS on global pelvic floor function. Patients with faecal incontinence attending our institution who had failed to respond sufficiently to biofeedback were offered a course of PTNS. Patients underwent pre- and post-stimulation assessment with a validated electronic Personal Assessment Questionnaire - Pelvic Floor (ePAQ-PF) for pelvic floor disorders. Scores were compared to assess the effect of treatment on global pelvic floor function. During the study period pre- and post-stimulation ePAQ-PF data were available for 60 patients (55% of all patients starting PTNS). In this cohort there was a significant improvement in bowel continence, bowel related quality of life, irritable bowel syndrome and bowel evacuation with a large effect size for continence and bowel related quality of life. There was also a significant improvement in non-bowel related symptoms, including urinary pain and stress incontinence, urinary related quality of life and bowel related sexual function. Sixty-five per cent of those who answered the question reported improvement in global health after stimulation. For patients presenting with faecal incontinence, PTNS appears to have a positive effect on bowel related function in approximately two-thirds of patients. However, for treatment responders, improvement appears to relate mainly to improvement in bowel related function rather than a global pelvic floor effect.

Thermostable Subunit Vaccines for Pulmonary Delivery: How Close Are We?

In the past century, vaccines have contributed to a significant improvement in global public health by preventing a number of infectious diseases. Despite this, the vaccine field is still facing challenges related to incomplete vaccine coverage and persistent difficult vaccine targets, such as influenza, tuberculosis, and Ebola, for which no good universal vaccines exist. At least two pharmaceutical improvements are expected to help filling this gap: i) The development of thermostable vaccine dosage forms, and ii) the full exploitation of the adjuvant technology for subunit vaccines to potentiate strong immune responses. This review highlights the status and recent advances in formulation and pulmonary delivery of thermostable human subunit vaccines. Such vaccines are very appealing from compliance, distribution and immunological point of view: Being non-invasive, inhalable vaccines are self-administrable, can be distributed independently of functioning freezers and refrigerators, and can be designed to induce mucosal and/or cell-mediated immunity, which is attractive for a number of diseases requiring stimulation of local mucosal immunity for protection. However, the design and delivery of thermostable dry powder-based vaccines represents a technological challenge: It calls for careful formulation and dosage form design, combined with cheap and efficient delivery devices, which must be engineered via a thorough understanding of the physiological barrier and the requirements for induction of mucosal immunity. Here, I review state of the art and perspectives in formulation design and processing methods for powder-based subunit vaccines intended for pulmonary administration, and present dry powder inhaler technologies suitable for translating these vaccines into clinical trials.

Monoclonal antibody therapy for Junin virus infection

Countermeasures against potential biothreat agents remain important to US Homeland Security, and many of these pharmaceuticals could have dual use in the improvement of global public health. Junin virus, the causative agent of Argentine hemorrhagic fever (AHF), is an arenavirus identified as a category A high-priority agent. There are no Food and Drug Administration (FDA) approved drugs available for preventing or treating AHF, and the current treatment option is limited to administration of immune plasma. Whereas immune plasma demonstrates the feasibility of passive immunotherapy, it is limited in quantity, variable in quality, and poses safety risks such as transmission of transfusion-borne diseases. In an effort to develop a monoclonal antibody (mAb)-based alternative to plasma, three previously described neutralizing murine mAbs were expressed as mouse-human chimeric antibodies and evaluated in the guinea pig model of AHF. These mAbs provided 100% protection against lethal challenge when administered 2 d after infection (dpi), and one of them (J199) was capable of providing 100% protection when treatment was initiated 6 dpi and 92% protection when initiated 7 dpi. The efficacy of J199 is superior to that previously described for all other evaluated drugs, and its high potency suggests that mAbs like J199 offer an economical alternative to immune plasma and an effective dual use (bioterrorism/public health) therapeutic.

Highlights of the 8th International Conference on Vaccines for Enteric Diseases: the Scottish Encounter To Defeat Diarrheal Diseases.

Infectious diarrhea is a leading cause of morbidity and of mortality; the burden of disease affects individuals of all ages but particularly young children, especially those living in poor regions where the disease is endemic. It is also a health concern for international travelers to these areas. Experts on vaccines and enteric infections and advocates for global health improvement gathered in Scotland from 8 to 10 July 2015 to discuss recent advances in the assessment and understanding of the burden of enteric diseases and progress in the development and implementation of strategies to prevent these infections. Highlights of the meeting included description of advances in molecular assays to estimate pathogen-specific prevalence, methods to model epidemiologic trends, novel approaches to generate broad-spectrum vaccines, new initiatives to evaluate vaccine performance where they are most needed, renewed interest in human challenge models, immunological readouts as predictors of vaccine efficacy, maternal immunization to prevent enteric infections, and the impact of maternal immunity on the vaccine take of infants. A follow-up scientific gathering to advance Shigella and enterotoxigenic Escherichia coli (ETEC) vaccine efforts will be held from 28 to 30 June 2016 in Washington, DC.

A brief history of primate research: Global health improvements and ethical challenges

Humans have benefitted from close relationships with animals for hundreds of thousands of years. However it has only been in relatively recent times that they have made use of the scientific investigation of animals; their anatomy, physiology and response to disease in attempts to alleviate human suffering. Scientists rapidly realized the value of primates as research models – their evolutionary proximity to humans making them better predictors, or models, of human biology. Systematic studies using primates began in the last century and massive demand for research subjects almost caused the extinction of some important wild populations. This resulted in initially ex situ and then latterly in situ breeding centers, purpose-breeding animals for biomedical research. Primate research typically follows that using less sentient animals (generally rodents) in which mechanism and proof of principle are established before examining effect and safety in primates. The quality of life of millions of people has rested on progress from primate research. The broader society has become more concerned with how we treat animals and use of animals in research has come under particular scrutiny. The actions of extremists have threatened not only the continued use of primates in research, but also the property, welfare, and occasionally, lives of those that have committed their careers to studying primates to aid humanity. This commentary examines the history of primate research and discusses key advances as well as important lessons learnt about the ethics surrounding the use of primates in research. KEY WORDS : Primate research; Biomedical research; Ethical challenges; Primate welfare; Translational research; Health benefits

Electrochemical magnetic microbeads-based biosensor for point-of-care serodiagnosis of infectious diseases

Access to appropriate diagnostic tools is an essential component in the evaluation and improvement of global health. Additionally, timely detection of infectious agents is critical in early diagnosis and treatment of infectious diseases. Conventional pathogen detection methods such as culturing, enzyme linked immunosorbent assay (ELISA) or polymerase chain reaction (PCR) require long assay times, and complex and expensive instruments making them not adaptable to point-of-care (PoC) needs at resource-constrained places and primary care settings. Therefore, there is an unmet need to develop portable, simple, rapid, and accurate methods for PoC detection of infections. Here, we present the development and validation of a portable, robust and inexpensive electrochemical magnetic microbeads-based biosensor (EMBIA) platform for PoC serodiagnosis of infectious diseases caused by different types of microorganisms (parasitic protozoa, bacteria and viruses). We demonstrate the potential use of the EMBIA platform for in situ diagnosis of human (Chagas disease and human brucellosis) and animal (bovine brucellosis and foot-and-mouth disease) infections clearly differentiating infected from non-infected individuals or animals. For Chagas disease, a more extensive validation of the test was performed showing that the EMBIA platform displayed an excellent diagnostic performance almost indistinguishable, in terms of specificity and sensitivity, from a fluorescent immunomagnetic assay and the conventional ELISA using the same combination of antigens. This platform technology could potentially be applicable to diagnose other infectious and non-infectious diseases as well as detection and/or quantification of biomarkers at the POC and primary care settings.

Quality of life in chronic myeloid leukaemia patients after haematopoietic cell transplantation pretreated with second-generation tyrosine kinase inhibitors.

Aim of the studyThe majority of patients with chronic myeloid leukaemia (CML) respond to tyrosine kinase inhibitors (TKI), while allogeneic haematopoietic cell transplantation (HCT) is indicated in selected clinical situations. HCT carries the risk of severe complications, while the toxicity profile of dasatinib and nilotinib may lead to adverse reactions affecting the quality of life (QoL). We present the results of observational analysis of CML patients who underwent HCT after exposure to second-generation TKI (TKI2), with respect to their quality of life assessed comparatively after transplantation.Material and methodsEligible subjects included 19 patients. The quality of life and global health assessment were performed with a questionnaire comparing the signs and symptoms present during the TKI2-therapy with those related to post-transplant complications, including psychosocial problems.Results and conclusionsMost patients had no/few problems with exhausting activities, no/few difficulties during long-distance walks, and do not/rarely rest in the daytime. Seventeen (89.5%) patients reported at least one symptom related to TKI2-therapy and most of them disappeared after HCT. Thirteen (68.4%) patients noted no serious complication after HCT. Most patients claimed to have a very good QoL and general health compared to the period prior to HCT. We found statistically significant improvement in global health (p = 0.016) and QoL (p = 0.043) after HCT.From the survivors perspective, HCT influence positively general health and QoL comparing to TKI2-therapy period. Further studies on larger group of patients will more precisely define the QoL level and possible predictors of changes in QoL, to assess which group of patients needs psychological support.

Quality of Life in Elderly Patients with Acute Myeloid Leukemia Undergoing Induction Chemotherapy

Aims: In elderly patients with acute myeloid leukemia (AML), complete remission (CR) rate following intensive chemotherapy is approximately 45%, considerably lower than in younger patients, with a shorter duration of remission and high treatment-related mortality (30-50%). Median survival is about 12 months. Intensive chemotherapy is indicated in a small proportion of "fit" elderly patients. In a phase III, prospective, randomized, open-label, multicenter trial designed to assess the efficacy of post-remission treatment with 5-Azacitidine versus best supportive care (BSC) in patients > 60 years of age with AML in CR after conventional induction ("3+7") and consolidation chemotherapy, quality of life (QoL) was assessed from diagnosis. We present interim results of changes of QoL.Methods: Patients with newly diagnosed AML with > 30% myeloid marrow blasts, either "de novo" or evolving from myelodysplastic syndrome without contraindications for intensive chemotherapy and with an ECOG performance status < 3 are included. Induction chemotherapy consists of two courses of "3+7": Daunorubicin 40 mg/m2 daily days 1-3 and cytarabine 100 mg/m2 daily continuous IV infusion days 1-7. Patients in CR receive consolidation (cytarabine 800 mg/m2 3 hour infusion bid days 1-3) and are randomized 1:1 to receive BSC or 5-Azacitidine maintenance therapy up to 4 years and six months until AML recurrence. QoL assessment was performed using the EORTC QLQ-C30 and the QOL-E v.3 questionaires.Results: QoL results assessed at 3 time points are reported: 1) baseline; 2) at hematological recovery immediately after the first "3+7" course; and 3) after consolidation at randomization. Ninety-nine patients (male/female 50/49) of median age 70 (IQR 65-74) years have been enrolled. At diagnosis, mean hemoglobin was 9.2 (SD ± 2.4) g/dL, leukocytes were 7.9 (2.3-29.6)/µL, platelet count was 54 (IQR 29-85) Gi/L and bone marrow blasts were 70 (IQR 50-85)%. Seventy-five patients had "de novo" AML. Twenty-three patients had comorbidities. Forty-three patients had an ECOG PS 1 and 28 had ECOG PS 2. Baseline median QOL-E scores were poor (≤60) in all dimensions, except for fatigue (76, IQR 52-85). EORTC QLQ-C30 confirmed that fatigue was not prevalent at diagnosis (median 33, IQR 22-56). Median baseline EORTC QLQ-C30 scores were good in all domains except for global health status (GHS, median 50, IQR 33-67). Gender, comorbidities, bone marrow blasts and secondary AML were not related to QoL. Baseline Hb levels correlated with QOL-E functional (r=0.0216, p=0.14), fatigue (r=0.256, p=0.002) and disease-specific (r=0.247, p=0.010) scores and with EORTC QLQ-C30 GHS (r=0.270, p=0.001), physical (r=0.304, p<0.0001), role (r=0.281, p=0.001), cognitive (r=0.262, p=0.003), social (r=0.229, p=0.010) functions and fatigue (r=-0.280, p=0.001), dyspnea (r=-0.287, p=0.001) and appetite loss (r=0.244, p=0.007). Age correlated with QOL-E disease specific scores (r=0.242, p=0.012). There were no changes in QOL-E scores following 1st "3+7". However, the EORTC QLQ-C30 detected deterioration in physical function from median 80, IQR 60-93, to 67, IQR 52-87 (p=0.008), in role function from median 83, IQR 67-100, to 67, IQR 33-83 (p=0.023) and in GHS from median 50, IQR 33-69, to 67, IQR 50-75 (p=0.002) and improvement in dyspnea (p=0.023). Forty patients obtained a CR. Interestingly, baseline role function was better (median 83, IQR 67-100) in cases obtaining a CR than in resistant patients (median 67, IQR 33-83, p=0.007). Patients obtaining CR experienced improvements after consolidation in median QOL-E physical scores from 56, IQR 41-72 to 63, IQR 50-84 (p=0.033), disease-specific domain scores from 59, IQR 48-67 to 74, IQR 67-85 (p=0.003) and treatment-outcome index scores from 55, IQR 32-77, to 79, IQR 41-86 (p=0.026). Median EORTC QLQ-C30 emotional function improved after consolidation therapy from 83, IQR 67-92, to 92, IQR 77-100 (p=0.015) as well as GHS from median 50, IQR 33-65 to 67, IQR 58-83 (p=0.002). Dyspnea and insomnia regressed while financial problems increased.Conclusions: Elderly patients with AML at diagnosis identified as fit for chemotherapy generally do not present fatigue, though health status is poor and is mainly correlated with Hb levels. Role function may predict response to induction chemotherapy. Patients obtaining CR perceive improvements in global health, including physical and emotional QoL and symptoms. DisclosuresOliva:Celgene: Other: Advisory Board, Speakers Bureau; Amgen: Consultancy; Novartis: Speakers Bureau.

Computer-Aided Drug Discovery Approaches against the Tropical Infectious Diseases Malaria, Tuberculosis, Trypanosomiasis, and Leishmaniasis.

Despite the tremendous improvement in overall global health heralded by the adoption of the Millennium Declaration in the year 2000, tropical infections remain a major health problem in the developing world. Recent estimates indicate that the major tropical infectious diseases, namely, malaria, tuberculosis, trypanosomiasis, and leishmaniasis, account for more than 2.2 million deaths and a loss of approximately 85 million disability-adjusted life years annually. The crucial role of chemotherapy in curtailing the deleterious health and economic impacts of these infections has invigorated the search for new drugs against tropical infectious diseases. The research efforts have involved increased application of computational technologies in mainstream drug discovery programs at the hit identification, hit-to-lead, and lead optimization stages. This review highlights various computer-aided drug discovery approaches that have been utilized in efforts to identify novel antimalarial, antitubercular, antitrypanosomal, and antileishmanial agents. The focus is largely on developments over the past 5 years (2010-2014).

Adolescent Suicide Rates Between 1990 and 2009: Analysis of Age Group 15–19 Years Worldwide

PurposeThe aim of the current analysis is to analyze suicide rates in adolescents aged 15–19 years in decades between 1990 and 2009 worldwide. MethodsSuicide data were obtained from the World Health Organization Mortality Database and population data from the World Bank Data set. In total, 81 countries or territories, having data at least for 5 years in 1990–1999 and in 2000–2009, were included in the analysis. Additional analysis for regional trends with 57 countries was performed. ResultsOver the decades considered, analysis showed a declining trend in the overall suicide rate for males from 10.30 to 9.51 per 100,000 (p = .076), and for females from 4.39 to 4.18 (p = .472). The average suicide rate showed a significant decline for both genders in Europe, dropping from 13.13 to 10.93 (p = .001) in males and from 3.88 to 3.34 in females (p = .038). There was a significant increase in South American countries for males, from 7.36 to 11.47 (p = .016), and a close to significant rise for females, from 5.59 to 7.98 (p = .053). Although other world regions did not show significant trends, there were several significant changes at country level. ConclusionsReasons behind the decrease in Western countries could potentially be related to the overall improvements in global health; the possible contribution of suicide prevention activities remains unclear. Increases in several South American countries might be related to economic recession and its impact on adolescents from diverse cultural backgrounds, and partly also to improvements in mortality registration.