National Prevention Program Research Articles

Budesonide-Formoterol as Needed for The Treatment of Mild Persistent Asthma

Objective: To summarize literature assessing the safety and efficacy of budesonide/formoterol, a low dose inhaled corticosteroid (ICS) and long-acting beta agonist (LABA) used as needed for the treatment of adult patients with mild persistent asthma requiring step 2 therapy compared to low dose inhaled corticosteroid (ICS) plus short-acting beta agonist (SABA) and SABA monotherapy. Data Sources: A literature search of PubMed (1966-October 2020), EMBASE (1973-October 2020) and clinicaltrials.gov was conducted using the following search terms: budesonide, formoterol, as needed, and mild asthma. Study selection and data extraction: Randomized, controlled trials with data describing as needed use of budesonide-formoterol in the treatment of mild, persistent asthma were included. Data synthesis: Current trials demonstrate a reduced risk of exacerbation and an improvement in symptom control in patients receiving budesonide/formoterol as needed when compared to as needed SABA alone. However, when compared to scheduled budesonide maintenance, patients receiving budesonide/formoterol as needed experienced worse symptom control and mixed exacerbation results. Relevance to patient care and clinical practice: This review evaluates the efficacy and safety of budesonide/formoterol as needed for patients with mild asthma. The Global Initiative for Asthma (GINA), a global strategy for asthma management and prevention adopted this change in 2019, and the most recent updated Expert Panel Report 4 of the National Asthma Education and Prevention Program (NAEPP) did not address this area. Conclusions: Based on this review of the literature, further study is needed to determine the place in therapy for budesonide/formoterol as needed in the treatment of mild persistent asthma. Low-dose ICS should remain the standard of therapy in patients with mild asthma requiring Step 2 therapy.

Pattern of acute poisonings in Azerbaijan

Background: Epidemiologic data on acute chemical poisonings in Azerbaijan Republic is very limited. The purpose of this study was to evaluate and analyze the rate and characteristics of acute chemical poisoning cases in Azerbaijan.
 Material and methods: This investigation was performed on the data of poisoned patients admitted to the Center of Clinical Toxicology (CCT) of the Ministry of Health of Azerbaijan in Baku city from 1st January 2014 to 31st December 2016.
 Result: There were 6347 admissions due to acute poisoning in CCT intensive care unit (3593 females and 2754 males). Pediatric admissions (<15 age group) were 18.2%. The most frequent reason of hospitalizations was drug poisonings (T36-T50) – 40.9%. The other frequent cases of hospitalizations were inhalation of carbon monoxide (T58) - 21.6%, corrosive substances (T54) – 15.2% and alcohol intoxication (T51) - 5.9%. Hospitalizations of patients with envenomation (T63) - 5.2%, pesticides poisonings (T60) – 4.9%. poisoning by organic solvents (T52) - 4.5% and poisoning by noxious plants and mushrooms (T62) – 1.2% were less frequent. The mortality rate of the overall cohort was 2.7%. Corrosive liquids (especially – concentrated acetic acid) poisonings were the most often fatal.
 Conclusion: This study provides essential information about characteristic of toxicoepidemiological situation in Azerbaijan and could help to develop national program of prevention of acute chemical poisonings.

The effects of structure, process and outcome incentives on primary care referrals to a national prevention programme.

Despite widespread use, evidence is sparse on whether financial incentives in healthcare should be linked to structure, process or outcome. We examine the impact of different incentive types on the quantity and effectiveness of referrals made by general practices to a new national prevention programme in England. We measured effectiveness by the number of referrals resulting in programme attendance. We surveyed local commissioners about their use of financial incentives and linked this information to numbers of programme referrals and attendances from 5170 general practices between April 2016 and March 2018. We used multivariate probit regressions to identify commissioner characteristics associated with the use of different incentive types and negative binomial regressions to estimate their effect on practice rates of referral and attendance. Financial incentives were offered by commissioners in the majority of areas (89%), with 38% using structure incentives, 69% using process incentives and 22% using outcome incentives. Compared to practices without financial incentives, neither structure nor process incentives were associated with statistically significant increases in referrals or attendances, but outcome incentives were associated with 84% more referrals and 93% more attendances. Outcome incentives were the only form of pay-for-performance to stimulate more participation in this national disease prevention programme.

Correlation of neuropsychological indicators of child development with speech: Empirical research underpinning the National Children’s Health Prevention Programme

Background/Aim. Psychophysiological disorders and speech pathology is one of the priority public health problems in the Republic of Serbia. A child?s growth and development proceed in a particular sequence and course, depending on individual physiological capacities, quality of neuromuscular structures, and stimuli, which can be significantly affected by the environment. The development of speech from birth to the adult age is a result of the interaction of neurocognitive factors that contribute to the gradual attainment of phonological presentation and motor control abilities. The aim of the study was to examine the connection between manipulative manual dexterity, oral praxis, and lateralization with the development and speech in children and their potential for the development of prevention programs. Methods. The sample included 60 children from Belgrade of both sexes, aged between 5.5 and 7 years. Of these, 30 made up the experimental group ? children with deviations in speech development (articulation disorders), and 30 made up the control group ? typically developing children from the general population. The instruments used were the Manipulative Manual Dexterity Test (Lafayette), Oral Praxis Test, and part of the Test for assessing lateralization (auditory, visual, and functional). Results. The hand grip development level was statistically significantly different between the experimental and the control group (?2 = 21.40, df = 3, p < 0.01). The presence of associated involuntary movements statistically significantly differed between the experimental and the control group examinees (?2 = 10.58, df = 1, p < 0.01). Oral praxis statistically significantly differed between the experimental and the control group (t = 2.01, p < 0.05). Visual laterality statistically significantly differed (?2 = 7.56, p < 0.05) between the observed groups. When all predictors were taken into account, significant contribution to the explanation of the existence of speech pathology (articulation disorders) was given by the variables: Visual lateralization [odd ratio (OR) = 0.38; 95% confidence interval (CI) = 0.179?0.832; p = 0.015] and the level of hand grip development (OR = 0.23; 95% CI = 0.082?0.699; p = 0.009). Conclusion. The hand grip development level and visual laterality are worse in children with speech (articulation) impairment and developmental deviations. These indicators of child development should be used as a guide in designing the national programs for developmental assessment and prevention in the child healthcare system.

Oral Health Behaviour of Nine-Year-Old Children and Their Parents in Sarajevo

The oral health situation in Bosnia and Herzegovina is among the worst in Europe. We investigated the oral health behaviour of primary schoolchildren and their parents in Sarajevo. This was an anonymous cross-sectional survey among third-grade schoolchildren and their parents’ oral health habits in Canton Sarajevo. Cluster random sampling yielded a representative sample from all the public schools in Canton Sarajevo in 2019. The survey targeted a total of 441 children and 365 parents. Two thirds (66.5%) of the children reported brushing their teeth twice daily, and almost half of them failed to use fluoride toothpaste daily. Girls brushed their teeth significantly more often than did the boys (74% vs. 58%, p = 0.004). Children living in residential areas of middle and high socioeconomic status (SES) reported better oral health habits than did those living in areas of low SES. Our study showed that Sarajevo children’s oral health habits were poor. One-third of the nine-year-olds failed to brush their teeth according to recommendations, and almost half of them failed to use fluoride toothpaste daily. Improving the children’s oral health in the future will urgently require national oral health promotion and prevention programmes.

Cost-effectiveness of the national dog rabies prevention and control program in Mexico, 1990-2015.

BackgroundRabies is a viral zoonosis that imposes a substantial disease and economic burden in many developing countries. Dogs are the primary source of rabies transmission; eliminating dog rabies reduces the risk of exposure in humans significantly. Through mass annual dog rabies vaccination campaigns, the national program of rabies control in Mexico progressively reduced rabies cases in dogs and humans since 1990. In 2019, the World Health Organization validated Mexico for eliminating rabies as a public health problem. Using a governmental perspective, we retrospectively assessed the economic costs, effectiveness, and cost-effectiveness of the national program of rabies control in Mexico, 1990–2015.MethodologyCombining various data sources, including administrative records, national statistics, and scientific literature, we retrospectively compared the current scenario of annual dog vaccination campaigns and post-exposure prophylaxis (PEP) with a counterfactual scenario without an annual dog vaccination campaign but including PEP. The counterfactual scenario was estimated using a mathematical model of dog rabies transmission (RabiesEcon). We performed a thorough sensitivity analysis of the main results.Principal findingsResults suggest that in 1990 through 2015, the national dog rabies vaccination program in Mexico prevented about 13,000 human rabies deaths, at an incremental cost (MXN 2015) of $4,700 million (USD 300 million). We estimated an average cost of $360,000 (USD 23,000) per human rabies death averted, $6,500 (USD 410) per additional year-of-life, and $3,000 (USD 190) per dog rabies death averted. Results were robust to several counterfactual scenarios, including high and low rabies transmission scenarios and various assumptions about potential costs without mass dog rabies vaccination campaigns.ConclusionsAnnual dog rabies vaccination campaigns have eliminated the transmission of dog-to-dog rabies and dog-mediated human rabies deaths in Mexico. According to World Health Organization standards, our results show that the national program of rabies control in Mexico has been highly cost-effective.

Update to asthma guidelines covers ICS, LAMAs, indoor allergy mitigation, more

In December 2020, the National Asthma Education and Prevention Program (NAEPP) Coordinating Committee released a focused update to its 2007 asthma guidelines. The update covers only select topics, such as intermittent use of inhaled corticosteroids (ICS), the role of long-acting muscarinic antagonists (LAMAs), indoor allergy mitigation, use of immunotherapy, bronchial thermoplasty, and fractional exhaled nitric oxide (FeNO) testing.

Sterility and Infection Prevention Standards for Anesthesiologists in LMICs: Preventing Infections and Antimicrobial Resistance

Surgical site infections (SSI) affect millions of individuals around the world, leading to a significant burden on perioperative morbidity and healthcare economy. Over the past decade low-income and middle-income countries (LMICs) have made substantial advancements on infection prevention strategies. However, the incidence of SSI is still increasing in many LMICs across all surgical specialties, denoting overlooked areas and ongoing challenges. This article aims to describe the role of anesthesiologists on current standards of infection prevention and sterility as well as ongoing developments in resource-limited settings, with a focus on LMICs. Recent estimates indicate a threefold increase in the incidence of SSI across LMICs over the past two decades, approaching two times the estimated SSI incidence of high-income countries. As a result, public health officials have promoted standard practices for infection prevention in the surgical arena by creating multidisciplinary teams and tailoring to the availability of equipment and resources. Anesthesiologists play a pivotal role for the implementation of infection prevention strategies such as antimicrobial prophylaxis, normothermia, intraoperative glucose control, and adequate handling of intravenous anesthetics. Unfortunately, the lack of cohesive practices and leadership structures, along with poor surveillance systems, are still common barriers. One potential method of overcoming these obstacles is investment in sustainable national infection prevention programs. Infection prevention standards should be tailored to local workflow and institutional resources. The successful implementation of programs in LMICs depends on sustainable national infection prevention programs which includes a well-trained team and an institutional climate of safety.

Status of rpoB gene mutation associated with rifampicin-resistant Mycobacterium tuberculosis isolated in a rural setting in Nepal.

Mycobacterium tuberculosis ranks among the top 10 causes of deaths in Nepal despite the country having a long history of national tuberculosis prevention programmes that have proved very successful in the control of tuberculosis. Several cases of active or latent tuberculosis are still missing despite that the number of infected individuals is increasing each year. Microscopy has its own limitations and factors like low bacterial load, quality of sample, quality of smear, experience of microscopist etc. influence the overall sensitivity of the test. The implementation of a molecular technique-based rapid, point-of-care testing system offers higher sensitivity in the early diagnosis of tuberculosis. Cepheid GeneXpert is the most commonly used molecular technology in Nepal. It is a cartridge-based semi-quantitative, nested real-time PCR-based diagnostic system. It detects mutations in the beta-subunit of RNA polymerase (rpoB) gene that lead to rifampicin resistance (RR) in M. tuberculosis complex. The present study aims to increase our understanding of the epidemiology of mutations in the rpoB gene in tuberculosis-positive patients by using the Xpert MTB/RIF assay in a rural setting in Pyuthan Hospital, Nepal. Sputum from 2733 patients was tested for the diagnosis of tuberculosis using the Cepheid GeneXpert system between July 2018 and January 2020 at Pyuthan Hospital. Two hundred and ninety-seven of these samples (10.86 %) were positive for M. tuberculosis , of which 3.3 % (10/297) were rifampicin-resistant. Among rifampicin-resistant tuberculosis (RR-TB) patients, 50.0 % (5/10) showed mutations located in codons 529–533 (probe E) of the rpoB gene, followed by others. The GeneXpert system can be a convenient, highly sensitive, rapid and accurate tool for the diagnosis of tuberculosis, also identifying RR-TB and at the same time determining the molecular epidemiology of rifampin resistance-associated mutations in rural and/or resource-limited laboratory settings.

Awareness Regarding Primary Eye Care Among Primary Healthcare Workers of Pakistan: a Way to Revitalize Health for All!

Purpose: To assess awareness regarding Primary Eye Care among (primary healthcare workers) PHCWs and also intended to identify its determinants.
 Study Design: Descriptive cross-sectional study.
 Place and Duration of Study: All primary healthcare facilities of Tehsil Kallar Syedan, from October 2019 to December 2019.
 Methods: The calculated sample size was 115. Data was collected from primary health care workers (PHCWs). Data was collected through a structured questionnaire with both open-ended and close-ended questions. Questions were made using simple language and were also translated in Urdu. Questionnaire was adapted from two articles and some questions were made after reading the components of National Programme for Prevention and Control of Blindness (Punjab, Pakistan).Chi-square test of independence was used for finding associations.
 Results: Fifty-four percent PHCWs had poor awareness regarding primary eye care. Majority of the PHCWs, N = 64 (55.7%) identified just the names of common eye diseases. Cataract was identified with correct treatment by 88% primary healthcare workers. Age, education, designation were significantly associated with awareness of PHCWs.
 Conclusion: The study concluded that more than half of PHCWs had low awareness regarding PEC. All of them mentioned that there was a need of improving and refreshing their knowledge related to primary eye care. This will definitely help to reduce pressure on secondary and tertiary healthcare workers.
 Key Words: Primary eye care, Primary healthcare workers, Primary healthcare facilities, Pakistan.

Suicide Prevention Across Countries and Continents: Lessons Learned

Suicide Prevention Across Countries and Continents: Lessons Learned

Rh disease prevention: the European Perspective

Background and ObjectivesIn Europe, postnatal and subsequently antenatal administration of anti‐RH1 (D) immunoglobulins (Ig) has reduced the number of maternal anti‐RH1 immunizations and the incidence of haemolytic disease of the foetus and newborn since the 1960s. Non‐invasive foetal RHD genotyping now enables antenatal prophylaxis to be targeted only to women carrying RHD‐positive foetus. We aimed at describing how Rh disease prevention is currently managed in different European countries.Materials and MethodsWe prepared an online survey on guidelines and biological tests performed for Rh disease prevention. The link was sent to 15 expert laboratories among Europe, selected by their publications in the field.ResultsExperts from thirteen countries responded. Guidelines on anti‐RH1 prophylaxis are similar regarding the major aspects of RH disease prevention, including indication and timing of anti‐RH1 Ig administration, as well as indication of foetal RHD genotyping. Different anti‐RH1 Ig preparations are used, and the dosing may differ depending on gestational age. Other controversial issues include (1) timing for foetal RHD genotyping, (2) indication of tests performed to quantitate feto‐maternal haemorrhage prior to anti‐RH1 Ig administration, (3) if there is a remaining indication for newborn RH1 phenotyping. Procedures for monitoring the prophylaxis efficiency and evaluating the national prevention programme also differ among countries.ConclusionDespite some differences among countries, the Rh disease prevention policies are very efficient in Europe, but HDFN cases due to maternal anti‐RH1 immunization have not completely disappeared. It therefore remains important to share best practices for continuous improvement in reducing anti‐RH1 alloimmunization.

Epidemiologic characteristics of orthopedic surgical site infections and under-reporting estimation of registries using capture-recapture analysis

BackgroundSurgical Site Infections (SSIs) are among the leading causes of the postoperative complications. This study aimed at investigating the epidemiologic characteristics of orthopedic SSIs and estimating the under-reporting of registries using the capture-recapture method.MethodsThis study, which was a registry-based, cross-sectional one, was conducted in six educational hospitals in Tehran during a one-year period, from March, 2017 to March, 2018. The data were collected from two hospital registries (National Nosocomial Infection Surveillance System (NNIS) and Health Information Management database (HIM)). First, all orthopedic SSIs registered in these sources were used to perform capture-recapture (N = 503). Second, 202 samples were randomly selected to assess patients` characteristics.ResultsTotally, 76.24% of SSIs were detected post-discharge. Staphylococcus aureus (11.38%) was the most frequently detected bacterium in orthopedic SSIs. The median time between the detection of a SSI and the discharge was 17 days. The results of a study done on 503 SSIs showed that the coverage of NNIS and HIM was 59.95 and 65.17%, respectively. After capture-recapture estimation, it was found that about 221 of orthopedic SSIs were not detected by two sources among six hospitals and the real number of SSIs were estimated to be 623 ± 36.58 (95% CI, 552–695) and under-reporting percentage was 63.32%.ConclusionTo recognize the trends of SSIs mortality and morbidity in national level, it is significant to have access to a registry with minimum underestimated data. Therefore, according to the weak coverage of NNIS and HIM among Iranian hospitals, a plan for promoting the national Infection Prevention and Control (IPC) programs and providing updated protocols is recommended.

Evaluating the impact of culturally specific patient-centric behavioral intervention package versus usual care for tobacco cessation among patients attending noncommunicable disease clinics in North India: A single-blind trial pilot study protocol.

BackgroundIn a low and middle-income country (LMIC) like India, non—communicable diseases (NCDs) contribute a major proportion (61.8%) of all causes of death. Out of this, 48% of cardiovascular diseases , 23% of Chronic Respiratory Diseases , and 10% of Cancer deaths are attributable to tobacco use. Tobacco use is a major risk factor for NCDs and thus, the tobacco cessation approach is a high priority intervention to combat complications and death among NCD patients. While several interventions are available for tobacco cessation, in resource constraint countries like India, the effectiveness of low-cost, culturally specific patient-centric tobacco cessation behavioral intervention holds a potential that needs to be evaluated. A newly developed evidence-based tobacco cessation intervention package will be compared with the existing/usual care provided under the National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) at NCD clinics.Methods and design2 arm, parallel-group randomized controlled trial.ParticipantsPatients aged ≥30 years suffering from NCD, currently using tobacco, and attending NCD clinics in 2 districts of Punjab, India.Sample sizeA total of 200 participants meeting the selection criteria will be recruited. They will be allocated either to the intervention arm or control (usual care) arm (100 each) using block randomization.InterventionFor the participants, there will be 4 face-to-face disease-specific cessation counseling sessions, disease-specific pamphlets, short text messages in vernacular language, that is, Punjabi. Follow-ups will be done at the third, sixth, ninth, and 12th months.Primary outcomeSeven-day abstinence, biochemically verified by plasma cotinine levels.Secondary outcomeQuit attempts, number of sticks/number of times of smokeless tobacco usage in a day, and stage of behavior change in tobacco users.DiscussionThis multicomponent culturally specific-patient-centric behavioral intervention package for tobacco cessation at NCD clinic settings focusing on the individual, family, and social environment could increase the outreach of cessation services using existing resources, thereby strengthening health systems and enhancing the quality of life of NCD patients.Trial registrationThe protocol for the study has been registered with the Clinical Trials Registry in India under the registration number CTRI/2018/01/011643.

Optimizing the impact of health and related programmes / policies to address the issue of Childhood Obesity in India----A narrative review.

Non-communicable diseases are already acknowledged as a double burden, and now childhood obesity is putting extra strain on our health system. The current paper aimed to analyze the ongoing health and related programmes/policies in India, and we discussed the existing opportunities in the programmes to address the issue of childhood obesity in India. We searched the “MEDLINE,” “PsycINFO,” “Scopus,” “Web of Science,” and “Google Scholar” databases using the following keywords: (“overweight”) and (“obesity”), (“childhood obesity”), (“nutritional programmes in India”), (“Health policies in India”), (“malnourished children in India”) in combination with each other and in truncated form. All the relevant articles and policy documents (MOHFW, INDIA) available in the public domain were included to support the argument for this narrative review. We found that we have programme gaps like guidelines issues by Food Safety Standards Authority of India to tackle childhood obesity and it has not been strictly implemented due to multiple reasons. School health programme has an opportunity to address the issue of childhood obesity, but at the ground level the outcomes are not very promising. The National Nutrition Mission have only focussed on undernutrition and anemia problem, ignoring the overweight/childhood obesity. Primary care physicians are key players in the treatment of childhood obesity, yet rates of obesity management in the primary care setting are low. National Programme for prevention & Control of Cancer, Diabetes, Cardiovascular Diseases & stroke is dealing with health promotion and prevention, early diagnosis, and management of all ages, except children. Diet provided in Integrated Child Development Scheme is calculated based on calories, not by the quality which is a concern to us. The breastfeeding promotion programme named Mothers Absolute Affection programme has not been implemented with letter and spirit. Other than health programmes, we assume that Ministry of Urban Planning, Foreign Direct Investment policy, Advertisement Council of India and many more sector/policy/programme are indirectly responsible for the increasing burden of childhood obesity in India. Lack of awareness and wrong perception also responsible for the development of childhood obesity. We have multiple National Health Programmes and Policies to address the childhood malnutrition, but are focussing the undernutrition component only, ignoring overnutrition problem in the children, which is emerging as quadruple burden to our health system. Appropriate actions and inclusion of suggestions provided in this study for the improvement of the programmes at the practical level needs to be considered by the policy makers to halt the ever-rising trend of childhood obesity and primary care physicians should play a leadership role.

Management of Asthma Exacerbations in the Emergency Department

Asthma exacerbations occur across a wide spectrum of chronic severity; they contribute to millions of emergency department (ED) visits in both children and adults every year. Management of asthma exacerbations is an important part of the continuum of asthma care. The best strategy for ED management of an asthma exacerbation is early recognition and intervention, continuous monitoring, appropriate disposition, and, once improved, multifaceted transitional care that optimizes subacute and chronic asthma management after ED discharge. This article concisely reviews ED evaluation, treatment, disposition, and postdischarge care for patients with asthma exacerbations, based on high-quality evidence (eg, systematic reviews from the Cochrane Collaboration) and current international guidelines (eg, the National Asthma Education and Prevention Program Expert Panel Report 3, Global Initiative for Asthma, and Australian guidelines). Special populations (young children, pregnant women, and the elderly) also are addressed. Despite advances in asthma science, there remain many important evidence gaps in managing ED patients with asthma exacerbation. This article summarizes several of these controversial areas and challenges that merit further investigation.

Treatment outcomes among tuberculosis patients in Jeddah, Saudi Arabia: Results of a community mobile outreach directly observed Treatment, Short-course (DOTS) project, compared to a standard facility-based DOTS: A randomized controlled trial

IntroductionTuberculosis (TB) remains a global public health threat affecting people in many developing countries, including the Kingdom of Saudi Arabia. Maintaining a long-term treatment regimen has always been the cornerstone of successful treatment outcomes among tuberculosis patients. In the Jeddah region, the National Tuberculosis Control and Prevention Program is now treating TB patients by means of a community mobile outreach team approach.The objective of this study was to compare the effectiveness of the community mobile outreach approach in improving treatment outcomes (success rate) among local tuberculosis patients with those being treated with a facility-based directly observed treatment, short-course (DOTS). Study designOur study consisted of a two-sample, parallel design [1:1], statistician -blind randomized control trial with 200 newly diagnosed, TB patients as subjects. Setting/participantsThe patients had all presented at the Madain Alfahd Primary Health Care Center, Jeddah. Between Nov 2017 and Nov 2018, a total of 221 TB patients were screened of whom 200 were randomly selected using randomly generated sequences. InterventionPatients in the intervention sample group were treated by means of mobile outreach teams with oral anti-TB treatment under the DOTS, and control group patients were given the traditional facility-based DOTS treatment according to the WHO recommendations and national guidelines. Main outcomeThe primary outcome was the level of overall treatment success rate. It was finally determined and compared in the two sample groups using chi-square analysis and relative risk assessment. ResultsIn the analysis stage, 97 patients were in the intervention group, while the control group consisted of 76. The overall response rate was 86.5% (173/200). We found that the percentage of overall treatment success rate among the patients served by the mobile outreach team was 97%, compared to 76% in the non-mobile team treated patients. The relative risk of treatment success rate among the intervention group was 1.27 (95% CI = 1.13–1.43) times greater than that amongst the control group. Log-rank test (log-rank statistics = 18.91; p < 0.001) identified a significant difference in the default rate after six months of treatment. ConclusionThis study has shown that a mobile outreach DOTS approach is an effective and acceptable strategy for treating TB patients. It also provides important data on the efficacy of using mobile outreach teams to improve TB treatment outcomes in Jeddah. Our results provide evidence and highlight the positive and significant impact of mobile outreach teams in mitigating TB recurrence rates and in improving TB treatment outcomes.Clinical Trial Registration: Clinicaltrials.gov: NCT03787914

HIV Testing and Receiving Test Results by the Female Sex Workers; Retrospective Study using Data from Sri Lanka National HIV Prevention Programme

<strong>Introduction: </strong>Improving HIV testing among Key Populations (populations at high risk) is the first step to achieve 90:90:90 treatment targets. Studying the time taken to HIV testing and subsequent clinic visits to uptake the test results provide important inputs for development of HIV prevention programmes. <strong> </strong> <strong>Objectives: </strong>This study aims to understand the pattern of HIV testing behavior of Female Sex Workers (FSWs) over the time and provide recommendations for development of HIV prevention programmes for FSWs <strong> </strong> <strong>Methods: </strong>HIV testing data of 5,667 FSWs registered with national HIV prevention programme in 10 Districts of Sri Lanka during 2016 and 2017 were analyzed using, survival data analysis techniques and extended Prentice, Williams &amp; Peterson (PWP) gap time model. <strong> </strong> <strong>Results: </strong>Time taken to acceptance of HIV test is more dependent on individual factors of FSWs whereas uptake of test result is less dependent on individual factors. Youth FSWs take more time to accept an HIV test. FSWs who are operating in Districts out of Colombo, use condoms, reported undergone HIV testing before join the programme, take more time for HIV testing and uptake test results. FSWs with high partner exchange rate (therefore at high risk) are less likely to complete both events and take more time for testing. Interaction between FSW typology and condom use was found with the use of PWP model. <strong> </strong> <strong>Conclusion: </strong>High risk FSWs are more reluctant for HIV testing and uptake of test results. Factors identified in the study as associated with time taken for both events can be taken into account in planning future HIV preventions programs among FSWs.

Cancer mortality trends after implementation of the national programme for dispensarization of certain groups of the adult population: a population-based study from arkhangelsk, north-western russia

Purpose of the study. To conduct a comparative analysis of the mortality from malignant neoplasms (MNs) detected during the implementation of the oncological component of National Prevention Programme named Dispensarization of certain groups of the adult population (DCGAP) according to the data of the Arkhangelsk Regional Cancer Registry (ARCR) for the period from 2006 to 2019. Materials and methods. Anonymous data about patients with malignant neoplasms of the colon, rectum, lung, breast, cervix, uterus, ovaries, prostate gland, kidney undergoing examination (screening) at the first stage of the DCGAP from 2006 to 2019 were extracted from the ARCR database. We compared the averaged crude and age-standardized (WHO world standard 2001) mortality rates in the periods before (2006–2012) and after the implementation of DCGAP (2013–2019) in the entire population, as well as in men and women and in age groups 15–59 years old for males and 15–55 years old for the female population ("mortality at working age") and 30–69 years old ("premature mortality"). A segmented analysis of the mortality rates was carried out. The interventional value of the DCGAP was positive in the case of a decrease in the linear trend in mortality between 2013 and 2017. Results. A total of 33,824 deaths were included in the analysis. 25106 (74.2%) patients died from iMN, the proportion of deaths from other causes varied from 14% for lung cancer to 83% for cervical and prostate cancer. The crude mortality rate after the introduction of DCGAP increased for all iMNs, except for cervical cancer, while age standardized rate only for cancers of the uterus and prostate. In lung cancer, there was a decrease in age-standardized mortality rates for men from 64.7 to 60.3 per 100,000 population and an increase from 5.1 to 6.5 per 100,000 for women. Mortality rates “at working age” were low for all iMNs except for cervical and breast cancers and did not differ between periods; “premature mortality” decreased only in lung cancer in men from 40.1 to 36.2 per 100,000 population, with other iMNs differences between periods were not revealed. Segmented analysis revealed no significant changes in mortality trends. Conclusion. There was no decrease in mortality among all nine iMNs in the period after the introduction of DCGAP, which is probably due to increased incidence and insufficient follow-up for later period. A comparative analysis of survival is required.

Tackle and ruck technical proficiency in rugby union and rugby league: A systematic scoping review

The aim of this review was to consolidate and synthesise rugby union (RU) and rugby league (RL) studies on tackle and RU studies on ruck technique for rugby stakeholders. Forty-nine studies were identified (20 in RL and 29 in RU). RL studies primarily focussed on identifying factors that impact tackling ability. Leaner, fitter players, with greater lower body strength, tended to have more proficient tackle technique. Experience and level of play were positively associated with tackling ability. These findings highlight the importance of developing tackle technique and physical qualities to allow players to progress to higher levels. Research in RU mostly focussed on identifying tackle and ruck techniques associated with performance measures and injury outcomes. Eleven tackle techniques and five ball-carrier techniques were associated with both performance measures and injury outcomes. These findings support national injury prevention programmes that advocate that safe contact technique is also effective technique. (152 words)