Treatment Of Communicable Diseases Research Articles

Factors influencing utilization of communicable disease prevention and treatment education among the floating population: a cross-sectional study in China

BackgroundIn China, communicable diseases (CD) have a negative impact on public health and economic stability. The influx of migrants, who make up a substantial portion of China’s population and continue to rapidly expand, has seriously hampered CD prevention and control, needing special care. This study aimed to identify key factors influencing the utilization of CD prevention and treatment education (CDPTE) among the floating population. We are confident that the findings will highlight obstacles facing CDPTE among the migrants, and guide future development prevention, treatment of CD, and health education services.MethodsA sample of migrants aged 15 years and above in 32 provincial units nationwide in 2018 was recruited by stratified multi-stage proportional to population size sampling (PPS). A structured questionnaire survey was conducted via face-to-face interviews. Subsequently, the Anderson health service utilization model was used as the theoretical framework and SPSS 26.0 statistical software was applied to analyze the data. The statistical description of the current situation of CDPTE acceptance and the chi-square test were used to compare the differences in CDPTE acceptance by different characteristics. Multivariate logistic regression was used to analyze key factors affecting the use of CDPTE among migrants.ResultsA total of 40.1% of the recruited participants reported receiving education on CD prevention and treatment, primarily delivered through traditional transmission media. Multilevel logistic regression results revealed that male migrants, aged 30–49 years, unmarried, with higher educational attainment, an average monthly household income of CNY 7,500-9,999 (or US$1,176-1,568), working more than 40 h per week, flowing into the Central and Western regions, migrated in the province, self-rated health, contracted family doctors and those with health records were more likely to receive CDPTE (p < 0.05).ConclusionOur findings revealed unsatisfactory acceptance of education on CD prevention and treatment among migrants, implying that health education should be strengthened further. Publicity of relevant policies and works should be strengthened and specific interventions should be developed for key regions as well as vulnerable groups to enhance CDPTE. More financial support should also be provided to improve the quality of health education.

Microbes of Empire

Microbes of Empire Priscilla Wald (bio) Click for larger view View full resolution Anti-Asian hate crimes rose dramatically during the pandemic. This poster appeared in the New York subway in February 2021. Credit: STAR MAX file photo via AP. [End Page 706] In memory of Amy Kaplan We are living in a moment in which the natural world and the social world are manifesting dramatic chaos, beset with reminders of the precarity of human existence in the form of pandemics, climate catastrophes, and seemingly endless examples of structural racism. In the ancient world, plague spoke in the language of the gods: it was the natural—which is to say divine—world's way of manifesting a rupture in the social order. The ancients' understanding of the connection between these worlds has been severed over time, but perhaps the contemporary moment can return us to that sacred insight. Since the onset of the COVID-19 pandemic, the world has witnessed a proliferation of devastating climate disasters in the form of record-setting temperatures, especially heat waves, and accompanying droughts, fires, hurricanes, cyclones, tornados, monsoons, and landslides. Glaciers are melting, and air and water are becoming increasingly unhealthy to breathe or drink. Social tensions are escalating worldwide. The pandemic is at once a symptom and an accelerant, putting on display the inequities in the United States and abroad that find expression in discrepancies in morbidity and mortality rates from COVID-19 and other health disparities and from state violence at "home" and abroad, the embodiment of the racism of US imperialism that Amy Kaplan documents in The Anarchy of Empire in the Making of U.S. Culture. If, as Kaplan suggests, the incorporation of colonial (or postcolonial) territories and populations posed a threat to the ostensible coherence of the national (American) body politic, the conventional story that circulates in science, the media, and popular fiction and film about the bodily threat of microbes materializes the threat to American bodies.1 COVID-19 is certainly not the first, but it is the most recent and perhaps most widespread of what epidemiologists and other medical professionals have dubbed "emerging infections." In the 1980s, the identification of a catastrophic communicable disease that had similarly circled the globe—AIDS—drew the [End Page 707] attention of medical science and epidemiology to what appeared to be a new phenomenon: the emergence of catastrophic communicable diseases that humanity had not previously encountered. In 1989, the epidemiologist Stephen S. Morse organized a meeting of medical professionals to discuss what they labeled "Emerging Viruses: The Evolution of Viruses and Viral Diseases." The eradication of naturally occurring smallpox and other dramatic developments in the identification and treatment of communicable diseases in the 1960s and 1970s had imparted an air of sanguinity to the medical community. The increasing control over communicable disease was hailed as an emblem of progress: human conquest over nature. AIDS and other emerging infections challenged that story. In the analysis that surfaced at the 1989 conference, the new viruses emerged as evidence of the unforeseen and disastrous consequences of that progress: the technological and other advances that contributed to increasing globalization and development practices, including improved transportation that moved people and goods more rapidly around the globe and the settlement of a growing population in previously sparsely inhabited or uninhabited areas around the world. Emerging infections, that is, were material expressions of the dangerous expansiveness and uncontrolled forces of what Kaplan—following W. E. B. Du Bois—called the "anarchy of empire." The message of the conference was clear: the world could not rely on scientific medicine alone to contain this new threat; humans had to change the way we inhabit the planet. As Morse explained in a postconference publication, the deadly outbreaks were the result of "ecological or demographic changes including deforestation, dam building, changes in agricultural products or in land use, and major demographic changes such as population migrations," and humans were the "major engineers of biological traffic."2 The biologist Rachel Carson had issued an analogous warning in her chilling 1962 account of how the "fanatic zeal" to dominate the nonhuman world—"the crusade to create a chemically sterile, insect-free world"—had turned...

Program Planning to Develop Infrastructure for Cancer Care in Liberia.

Liberia's health infrastructure was completely devastated after 14 years of back-to-back civil war. Postconflict rebuilding of the country's health workforce and infrastructure has become a priority. Initially, the focus was on the diagnosis and treatment of communicable diseases that caused multigenerational family losses. With the increasing burden of noncommunicable diseases, however, the country has turned its attention to addressing diabetes, cancer, and cardiovascular and respiratory diseases, with the development of the noncommunicable disease unit under the Ministry of Health. Recovering from another setback caused by the Ebola virus outbreak in 2014, the country assembled a diverse group of stakeholders to form Liberia's first National Cancer Committee. To structure a program that would address the increasing burden of cervical and breast cancers, the major cause of mortality among reproductive-aged women in Liberia, input from the International Atomic Energy Agency was critical. This article describes the preplanning activities for developing infrastructure to support cancer care in Liberia that occurred between 2013 and 2020 and is still ongoing. This case study is intended to serve as a planning guide for countries with limited resources as they work toward the goal of eliminating cervical cancer and developing infrastructure to address their country's burden of all cancers.

Social determinants of the disproportionately higher rates of COVID-19 infection among African Caribbean and Black (ACB) population: A systematic review protocol.

The challenges of identifying and eliminating racial disparities regarding the exposure, transmission, prevention, and treatment of communicable diseases within the healthcare system have been a mounting concern since the COVID-19 pandemic began. The African, Caribbean, and Black (ACB) populations in Canada represent a fast-expanding and underprivileged community, which have been previously found to have higher susceptibility to communicable diseases and lower sensitivity to intervention measures. Currently, there is insufficient evidence to adequately identify racial patterns in the prevalence and healthcare utilization among the ACB population within the context of the ongoing pandemic. Our proposed study will explore the association between the social determinants of health (SDH) and COVID-19 health outcomes in ACB populations in high-income countries (UK, US, Australia, Canada). We will explore the current evidence through a systematic review of COVID-19 pandemic literature covering the period between December 2019 and October 2020. The objectives include investigating the effect of SDH on the ACB populations’ risk to COVID-19 health outcomes, including COVID-19 infection incidence, severity of disease, hospitalization, mortality and barriers to the treatment and management of COVID-19 for Black people in Canada. In addition, this project aims to investigate the effect of COVID-19 on ACB communities in Ontario by examining the challenges that front-line healthcare workers and administrators have during this pandemic as it pertains to service provisions to ACB communities. A systematic review of original and review studies will be conducted based on the publications on eleven databases (MEDLINE, Web of Science, Cochrane Library, CINAHL, NHS EDD, Global Health, PsychInfo, PubMed, Scopus, Proquest, and Taylor and Francis Online Journals) Primary outcomes will include the rate of COVID-19 infection. The systematic review will include a meta-analysis of available quantitative data, as well as a narrative synthesis of qualitative studies. This systematic review will be among the first to report racial disparities in COVID-19 infection among the ACB population in Canada. Through synthesizing population data regarding the risk factors on various levels, the findings from this systematic review will provide recommendations for future research and evidence for clinical practitioners and social workers. Overall, a better understanding of the nature and consequences of racial disparities during the pandemic will provide policy directions for effective interventions and resilience-building in the post-pandemic era. Significance for public health Since the outbreak of the recent COVID-19 pandemic, there has been a growing concern regarding the challenges in identifying and eliminating racial disparities in exposure to transmission of communicable diseases and access to preventive and curative healthcare services. This is particularly the case for the countries that experience high numbers of immigrants, including Canada, where the racial inequality remains a major public health concern. Existing research suggests that the African, Caribbean, and Black (ACB) population in Canada represent a fast-expanding and underprivileged community previously found to have higher susceptibility to communicable diseases and lower sensitivity to intervention measures. However, currently there is no systematic research on the social determinants that underlie the disproportionately higher prevalence of COVID-19 among the ACB population. The findings of our systematic review will contribute to evidence-based policy making targeted at addressing the COVID-19 related vulnerabilities among ACB population and thereby ensuring more effective containment of the pandemic.

Ayurvedic management for COVID-19 – A review

As the corona pandemic has emerged, researchers around the globe are working on finding specific treatment for it. But till date, no conclusive specific treatment has been found, and we are following the protocols with symptomatic management. Ayurveda is an ancient science of healing, with highly sophisticated literature about diseases, their pathogenesis, clinical features, and management. The evaluation of different modalities for treating COVID-19 pandemic patients is the foremost aim of the study. For review, we used the knowledge of the ancient classics and past literature regarding human treatment guidelines mentioned in Ayurveda classics, for prevention and treatment of communicable diseases, to provide appropriate direction in the prevention of COVID-19. The thorough review has been done, of literature, Samhitas(Ayurveda Classics), and research articles which were published between January and June 2020 by PubMed, Google Scholar, WHO, Ministry of AYUSH. The opinions of experts have also been referred to. As individuals with lower immunity have a higher risk of COVID-19, so the herbal Rasayana(Rejuvenating) drug, which has proven immunomodulatory activity, is also included in the given study. The Review for Ayurveda formulations, which might help in preventing the progression of COVID-19, has also been made. The Indian herbs are widely utilized in the preparation of Ayurvedic medicines or formulations or in the form of drinks to manage various respiratory disorders such as cough, cold, and flu. Hence, these drugs are formulated by using active parts of the plants, which are used for preventing and treating the COVID-19. These formulations are immunity modulators and they prevent the spread of the virus, by intruding at a different stage of virus multiplication in the infected person.

Utilization of Essential Service Package by rural community

Background: Government has implemented Essential Service Package (ESP) under Health, Nutrition and Population Sector Program (HNPSP) to reach and maintain the highest attainable level of health care to the people of Bangladesh.&#x0D; Objective: To assess the utilization of Essential Service Package by rural community.&#x0D; Methodology: A descriptive, cross-sectional study was carried out during January 2011 to June 2011 on 160 respondents of age 18 years and above.Sample was selected purposively from Nababganj Upazila under Dhaka district. After taking informed consent data were collected by face to face interview using structured questionnaire. Data analysis was done by SPSS version 16.&#x0D; Results: The study revealed that highest number (71.9%) of respondents attended Upazila health Complex (UHC) to utilize ESP services. Among the respondents female (85.6%) were more than male. The lower class (19.4%) and middle class population (46.9%) utilized significantly more than upper class (8.7%).The most of the respondents had primary level of education (31.9%). Utilization of Expanded Programme on Immunization (EPI) (82.9%), Antenatal care (ANC) (16.2%), Family planning (FP) (11.2%), treatment of communicable diseases (40%) and limited curative care (12.5%) were found. Regarding Behavioural change communication (BCC) (41.3%) said that they got health education from the UHC and 58.9% response was negative.&#x0D; Conclusion: The overall utilization of ESP services is good. To utilize the ESP from the existing UHC facilities for the rural community population is needed to be strengthening for achieving the health goals.&#x0D; Northern International Medical College Journal Vol.10 (2) Jan 2019: 377-380

Evaluation of antibacterial activity of different solvent extracts of medicinal plant: Cleome viscosa Linn.

Aim: The aim of the study deals with evaluation of antibacterial activity of the medicinal plant Cleome viscosa Linn. traditionally used in the treatment of communicable diseases. Materials and Methods: The plant was taxonomically identified and dried whole plant of C. viscosa Linn. was defatted with n-hexane (60–80°C) in a Soxhlet apparatus. The defatted powder material thus obtained was further extracted successively with chloroform, ethyl acetate, ethanol, and water to afford corresponding fractions. Standard strains of Escherichia coli, Salmonella typhi, Pseudomonas aeruginosa, Bacillus subtilis, and Staphylococcus aureus purchased from the Institute of Microbial Technology, Chandigarh, India. Antibacterial activities of the extracts were determined by the microbroth dilution assay. Results and Discussion: Plant extracts showed good bactericidal activity. Among the plant extracts, water and ethanol extract showed potent antibacterial activity against all the five bacteria, especially against Gram-negative bacteria E. coli, S. typhi, and P. aeruginosa followed by ethanol extract, whereas chloroform extract showed minimal bactericidal activity. Conclusion: The findings provide support for the use of these plants in traditional medicine for the treatment of infectious disease and are thus potential sources of drugs that would need to be subjected to further studies.

Physicians Call for Administration to Rescind ‘Public Charge’ Proposal

Back to table of contents Previous article Next article Government NewsFull AccessPhysicians Call for Administration to Rescind ‘Public Charge’ ProposalLinda M. RichmondLinda M. RichmondSearch for more papers by this authorPublished Online:26 Oct 2018https://doi.org/10.1176/appi.pn.2018.11a20AbstractAPA joined a physicians’ coalition in opposing a proposal DHS rule that would discourage noncitizens from using critical safety-net public services, such as Medicaid or CHIP, for fear of being deported.Acoalition of frontline physicians, including APA, is urging the Trump administration to rescind a proposed rule to deem more immigrants who use Medicaid or other social safety net services “a public charge” and bar them from entering the United States or obtaining a green card.iStock/Anna BryukhanovaThe Department of Homeland Security’s (DHS) proposed rule would alter the long-held standards used to determine whether a person is likely to become dependent on the government for subsistence, known as “a public charge,” to newly include use of most noncash public benefits. Current rules penalize immigrants who receive cash welfare payments, but the proposal seeks to add use of other benefits such as Medicaid, public housing or Section 8 benefits, and food stamps. DHS is also “considering” adding the use of the Children’s Health Insurance Program (CHIP).Immigration has dramatically increased over time (14 percent of the U.S. population were foreign born in 2015, compared with 5 percent in 1950), but the foreign-born population uses public benefits at virtually the same rate as native-born Americans: about 3 percent of noncitizens use public benefits versus 3 percent of U.S. citizens. Many see the proposal as the administration’s latest salvo against immigration, since its policy of separating families at the border and efforts to obtain funding for a border wall have failed.The concern is that immigrants will forgo critical health care, such as immunizations or treatment of communicable diseases, or other needed services to avoid being removed from the country.“The regulation upends decades of settled policy with regard to public charge and would make it much more likely that lawfully present immigrants could be denied green cards or U.S. visas, or even be deported, merely on the basis of seeking needed health services for them and their family, including those for which they are eligible,” the physician coalition wrote in a statement. In addition to APA, the coalition includes the American Academy of Family Physicians, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and American College of Physicians, representing more than 400,00 of America’s frontline physicians.“Rather than face that threat, many of the patients served by our members almost certainly will avoid needed care from their trusted providers, jeopardizing their own health and that of their communities,” stated the coalition.If finalized, the change would impact individuals who are applying for a green card to enter the United States as well as temporary visa holders seeking an extension or modification. The rule could extend beyond its intended recipients to affect existing green card holders or to family members of immigrants.When federal welfare was reformed in the 1990s, even classes of immigrants and refugees not touched by changing policies abandoned their benefits in significant numbers out of concerns that it could jeopardize their citizenship status—or that of a loved one—because of a lack of understanding of who was targeted or which programs were affected, explained Michelle Mittelstadt, a spokesperson at Migration Policy Institute.The DHS proposal would make current and past receipt of most public benefits “a heavily weighed negative factor” and would make nonimmigrants receiving such benefits “generally ineligible for change of status and extension of stay,” according to a DHS statement. Individuals needing disaster relief or emergency medical assistance would remain exempt from the rule, as would individuals seeking asylum or refugees.“The proposed regulation not only threatens our patients’ health, but as this deferred care leads to more complex medical and public health challenges, it will also significantly increase costs to the health care system and U.S. taxpayers,” the physician coalition wrote.Comments on the proposed rule must be posted by December 10 at www.regulations.gov. ■ The coalition’s statement can be accessed here. The proposed rule is available here. ISSUES NewArchived

Top 10 most used drugs in the Kingdom of Saudi Arabia 2010–2015

Medications usage has become a significant part of contemporary life. Many studies indicate that there is an excessive use and a considerable waste of medicines. This descriptive study aims at identifying the most used medicines in Saudi Arabia from 2010 to 2015 according to the statistics of specialized companies in the field. Comparison of the most commonly used drugs with those in the United States aims at clarifying similarities and differences. The results showed that the use of antibiotics and analgesics still accounted for the bulk, followed by proton pump inhibitors and anti-diabetics respectively, then anti-hyperlipidemic agents and erectile dysfunction treatments. The causes of this overuse vary according to the studies concerned between the self-medications and the over-prescription of the medication and the failure of the diagnostic and treatment procedures (malpractice). The recommendations are the strict application of prescribed and non–prescribed dispensing systems and the further establishment and application of national guides in the diagnosis and treatment of communicable diseases. The repetition of such studies is useful in reviewing health policies and regulations related to health practice in general and pharmacological policies in particular.

INFLUENCE OF PRIMARY HEALTH CARE DELIVERY SERVICES ON THE HEALTH STATUS OF RURAL DWELLERS IN ABIA STATE, NIGERIA

The study examined the influence of primary Health Care delivery services on the health status of rural dwellers in Abia State Nigeria. A sample size of 120 respondents selected via multi-stage random sampling technique was used. in selecting .Primary data generated using structured questionnaire and Focus Group Discussion were analyzed using descriptive statistics such as frequency counts, percentages, means, pooled means, and KAP analysis respectively. Result showed a mean age of 25 years, 58.3% were male, and 75% were married. About 61.0% had secondary education, 58.3% were farmers/traders, and earned mean monthly income of N48, 250.00 and had a mean household size of 4 persons respectively. Majority (50.0%) owed water system toilets, and 58.3% sourced their drinking water from boreholes, 75.0% fed 32 meals/day and 83.3% were not registered with NHIS. Result further showed high (X = 3.03) level of awareness on seven out of eight PHC delivery service packages in the study area. There was also high level of utilization on immunization (X= 3.00) and moderate level of utilization on treatment for malaria, prevention/ treatment of communicable diseases, family planning/ HIV and AIDS, maternal / child health care, public health education and environmental health education respectively. The KAP analysis showed the Knowledge, Attitude, and Practice Levels of the respondents towards these PHC activities and interventions influenced their health status positively in the study area. The study concluded that PHC delivery services influenced the health status of the rural dwellers positively. It recommends that the Ministries of Health at the three tier levels of government should provide the needed support for enhancing and sustaining the PHC as well as encouraging participation among the rural dwellers mostly in the study area. Article visualizations:

Mandating vaccination with unknown indirect effects

Social interactions make communicable disease a core concern of public health policy. A prevalent problem is scarcity of empirical evidence informative about how interventions affect illness. Randomized trials, which have been important to evaluation of treatments for noninfectious diseases, are less informative about treatment of communicable diseases because they do not fully reveal the indirect preventive (herd immunity) effect of vaccination on persons who are not vaccinated or are unsuccessfully vaccinated. This paper studies the decision problem faced by a health planner who observes the illness rate that occurs when persons make decentralized vaccination choices and who contemplates whether to mandate vaccination. The planner's objective is to minimize the social cost of illness and vaccination. Uncertainty about the magnitude of the indirect effect of vaccination implies uncertainty about the illness rate that a mandate would yield. I first study a simple representative‐agent setting and derive conditions under which the planner can determine whether mandating vaccination is optimal. When optimal policy is indeterminate, I juxtapose several criteria for decision making—expected utility, minimax, and minimax‐regret—and compare the policies they generate. I then extend the analysis to a more general setting in which members of the population may have heterogenous attributes.I have benefitted from the opportunity to present this work in seminars at the Booth School of Business, University of Chicago, the Department of Economics, University of California at Santa Barbara, and the Schaeffer Center for Health Policy and Economics, University of Southern California. I have also benefitted from the comments of an anonymous reviewer and associate editor.

Are Anganwadi Teachers the Ultimate Health Guides for Under-Five

Today's children are tomorrow's hope, who can constitute a stronger nation. Growing children in their tender age are at increased risk of becoming sick especially children of under-five year. Communicable diseases are one of the leading cause of death among Under-five children. It's transmitted through direct contact with infectious pathogens include some viruses, bacteria, fungi, protozoa, multicellular parasites and aberrant proteins known as prions. Transmission of pathogens can occur in various ways including physical contact, contaminated food, body fluids, objects, airborne inhalation and through vector organisms. In this era under five children's are suffering and dying each year due to the communicable diseases like malaria, diarrhoea, and scabies etc. Anganwadi teachers are influential people in the community who are able to disseminate the knowledge to children's as well as to the care givers. An ganwadi teachers can educate the mother regarding the upliftment of the health of their children, and thereby they can minimize the health problems among children. A study was conducted among 300 primary care givers regarding knowledge, attitude and practices regarding communicable diseases in Kampala district revealed that 40% of anganwadi teachers are not having adequate knowledge regarding treatment of communicable diseases. It is therefore desirable that these teachers have the knowledge prevent and manage communicable diseases among their children in any eventuality. Hence investigator felt to develop a planned teaching programme among primary caregivers here anganwadi teachers to improve their knowledge. In this study the pre-test majority (63%) samples had moderate knowledge level, (10%) samples had inadequate knowledge on prevention of selected communicable diseases among under five children. There is a significant increase in knowledge of anganwadi teachers after the introduction of planned teaching programme. During the post-test all (100%) anganwadi teachers gained adequate knowledge level of knowledge. The mean post-test knowledge score (22.7±1.70) was higher than the mean pre-test knowledge score (14.66±4.47).The 't' test (t29=2.05 p<0.005) was computed to compare the significant difference between the mean pre-test and posttest knowledge score. The calculated 't' value indicate that there is significant gain in knowledge score. The study concluded that planned teaching programme is effective in increasing the knowledge of anganwadi teachers regarding prevention of selected communicable diseases among under five children.

Factors Contributing to Delay in Seeking Treatment among Pulmonary Tuberculosis Patients in Suneka Sub-County, Kenya

Tuberculosis is a major global public health problem and a leading cause of morbidity and mortality in Kenya. TB control has remained a major challenge for the TB control programme especially in this HIV/AIDS era and the emergence of multi-drug resistant TB (MDR-TB). Early identification of cases and commencement of effective chemotherapy is an effective method to control the spread of TB. Reliance on passive case finding means that patients play a key role in reducing delay to diagnosis and treatment. Patient delay (duration from onset of symptoms to first contact with a health care provider at a public health facility) is a major challenge to TB control and is dependent on several factors. The purpose of this study was to determine the duration from onset of symptoms to seeking appropriate TB treatment among pulmonary TB (PTB) patients and investigate the factors associated with patient delay in Suneka sub-County, Kisii County, Kenya. A cross-sectional survey, using a semi-structured questionnaire, was carried out at five public health facilities in the sub-County. Data entry, management and analysis were done using SPSS Version 15. The mean patient delay and associations between length of patient delay and the various independent variables was determined. Multiple logistic regression was performed to determine the factors independently associated with patient delay. The mean patient delay was 54 days and 65.4% of the study subjects had delayed for more than 30 days. Delay in seeking appropriate TB treatment among PTB patients in Suneka sub-County was associated with poor perception of services in public health facilities (OR=4.91; CI=1.6-15.3; P=0.0061), visiting a private clinic (OR=4.24; CI=1.5-11.6; P=0.0052) and stigma (OR=2.46; CI=1.9-12.2; P=0.0178). Most PTB patients in Suneka sub-County delay in presenting at public health facilities after the onset of major TB symptoms and the main factors responsible for this delay include having a poor perception of the quality of services offered in public health facilities, prior attendance at a private clinic and stigma associated with the disease. Delay was not found to be associated with the patient socio-demographic characteristics, knowledge of TB, distance or transport cost to the nearest public health facility. Since TB services are integrated in the general health care system, the findings highlight the need by the Ministry of Health (MOH) to improve service delivery at public health facilities and thereby encourage patients to seek early diagnosis and treatment of communicable diseases or reduce patient delays. Educational campaigns should go beyond providing general information about TB to emphasize embracing a positive attitude of transmission reduction through early treatment.

Ageing world: Health care challenges

The world population reached 7 billion in 2012, which is 6 billion more than in 1800. This remarkable population growth is the result of several factors like advances in the medical, technological and public health systems resulting in the control and treatment of communicable diseases, the control of pandemics, the end of large-scale wars, improvements in living conditions and the revolutions in the field of agriculture. Because of all these factors, there has been a considerable improvement in the life expectancy of human beings. There is also an alarming reduction in fertility rates. The combination of declining fertility rate and augmented life expectancies has led to a change in the demographics of the population with the strata of older individuals growing faster than the younger individuals. The aging of populations is poised to become the next global public health challenge. Advances in medicine and socioeconomic development have substantially reduced mortality and morbidity rates due to infectious conditions and, to some extent, non-communicable diseases. These demographic and epidemiological changes, coupled with rapid urbanization, modernization, globalization, and accompanying changes in risk factors and lifestyles, have increased the prominence of chronic non-infective conditions. Health systems need to find effective strategies to extend health care and to respond to the needs of older adults. This review highlights the pathophysiology of aging, biological and physiological changes, impact of aging on health, epidemiological transitions, multi-morbidity in elderly and challenges for health care system.

Analysis of clinical research literature about treated plague by using traditional Chinese medicine

Objective To analyze the problems of treating plague by TCM and find out the characteristics of clinical research of contemporary plague by the analysis of clinical research literature on the treatment of plague by TCM. Methods Differential treatment methods of one kind of plague in the literature as the main source of the data and the information that the pathogenesis-symptom-location of disease-nature of disease-prescriptions-drugs were taken to build the data base of the syndrome differentiation and treatment of certain kind of plague. Results Analyzed with literatures,the characteristics of plague clinical research showed: Different pathogenesis characteristics and evolution of plague were caused by diff① erent evils. ②Contemporary plague was named by western disease name. A new model which disease differentiation combined with syndrome differentiation has been formed. ③The diversification of administration promoted the treatment of emergent communicable disease with Chinese medicine. Conclusion The plague research lacked such research literature which could both reflect individualized diagnosis and embody the clinical rules. Traditional Chinese medicine theory could be researched and enriched by finding out the pathogenesis characteristics and evolution rule of the new plague and thus guide the clinical practice. It was effective to control and treat mergent communicable disease with TCM. Key words: Traditional Chinese Medicine; Plague; Clinical literature research

A Nurse Contracts Tuberculosis on the Job, 1944 – 45

In our post-HIV/AIDS era, health care professionals know well the risks of infection and the need to practice universal precautions with all patients. Awareness of the dangers of infection grew in the late nineteenth century, although it had long been clear that caring for the sick entailed the risk of becoming ill. Moreover, prior to the development of antibiotics, nurses and others ministering to the sick contracted fatal and/or debilitating illnesses that had few or no effective treatments. Historians know little of these experiences. Constance Mally (pseudonym), a nurse working in the Sydenham Hospital, Baltimore, Maryland, in the 1940s was one such professional: she contracted tuberculosis when caring for patients. Letters about one part of Mally's experiences in the History of Medicine Division of the National Library of Medicine allow historians to explore a small part of the risks facing nurses working with patients suffering from contagious illnesses. They can also provide an important teaching tool to help students explore the complicated and complex historical dimensions of one particular experience. Health Department ran Sydenham Hospital for the isolation and treatment of communicable diseases. From 1909 until it closed in 1949-in large part because of the widespread use of antibiotics-the hospital had an average daily population of sixty patients, many of them children, with scarlet fever, smallpox, poliomyelitis, diphtheria, pneumonia, whooping cough, meningitis, syphilis, measles, chickenpox, and other contagious diseases. Patients stayed for weeks and sometimes months, nursed back to health with rest, a careful diet, and any available medical treatments. Hospital policy called for chest X-rays of new employees, and when Mally arrived at the hospital in September 1942 her lungs were clear. As the following letters reveal, within a few months she likely contracted tuberculosis from caring for a patient with fulminating infection and a tracheotomy tube. The patient died. A few years later, X-rays revealed a cavity in Mally's lung. Sent to a sanatorium in 1944, she underwent several operations and seemed to improve. Parts of Mally's experience are revealed in a set of letters exchanged between the hospital's medical director, the director of the city's Bureau of Tuberculosis, and the superintendent of the Maryland Tuberculosis Sanatoria. The letters do not make clear whether Mally fully recovered, left the sanatorium, and resumed her nursing career, although they suggest that such stren uous work after discharge would have been hazardous. They do reveal, however, how the hospital negotiated Mally's sick pay. Then, as now, hospitals kept a careful watch over their expenditures, balancing their need to support the workers who put their lives on the line with the interests of those paying the bills, in this case the taxpayers of Baltimore, who, through their elected officials, kept a tight rein over the budget. These letters also offer a window into other themes and issues in health care when analyzed within a broader context. Readers of these letters as well as those teaching history might want to use them to consider what has changed in hospitals, patient care, and medicine since the 1940s-and what has stayed the same. Here we would need more about the institution, about the work of nurses caring for contagious patients, and about the medical treatment of specific illnesses. Materials are available. The records of the Sydenham Hospital itself, including the correspondence regarding Mally, are located in the History of Medicine Division of the National Library of Medicine (for an online finding aid, see http://www.nlm.nih.gov/hmd/manuscripts/ead/sydenham.html). A brief history of the Sydenham hospital can be found in Baltimore's Sydenham Service for Hospital Care of Communicable Diseases 1909-1924-1949, Baltimore Health News, July 1949, 147-57; and an analysis of tuberculosis nursing can be found in Barbara Bates, Bargaining for Life: A Social History of Tuberculosis, 1876-1938 (Philadelphia: University of Pennsylvania Press, 1992). …

An approach to the management of leukemia in the developing world

Management of leukemia is expensive. In the developing world where there are significant resource constraints, how does the physician manage leukemia? Government health budgets need to put their money into areas where a small investment is likely to benefit a large proportion of its people and these would include immunization, sanitation, family planning and treatment of communicable diseases and the cost of expensive treatments would have to be borne by the patient and family. However, in many of the emerging economies in the developing world, society is three-tiered in terms of resources with a small proportion being able to afford the best treatment, the middle class with the ability to meet a significant proportion of the healthcare costs on their own and the poor who depend wholly on what the Government health budget can afford. Providing an accurate diagnosis is possible even with limited resources and this must be made available to all. Sometimes a precise diagnosis even at the molecular level is more important in the developing world so that resources are not wasted on inappropriate treatments. Choosing a protocol for management based on resources available for the individual patient would appear ethically unacceptable, but is probably the only solution when wealth is unevenly distributed in society. This paper illustrates an approach to the management of leukemia in the developing world that has evolved with experience over two decades in a tertiary referral hospital in India.

Health Care for Women Inmates

Rapidly increasing numbers of women incarcerated in the United States have created an overwhelming need for appropriate health services for these inmates despite limited resources. This article outlines the key health care issues associated with women inmates. We begin by examining the challenges posed by this population of inmates. Additionally, we investigate the provision of health care to these women and then evaluate the perceptions of that care from the perspective of the women and their care providers. We conclude with a discussion of policy-relevant considerations and suggest that realism should be the underlying premise of any health-related policy for women inmates. Specifically, we suggest that education and the treatment of communicable diseases become the most targeted health-related goals for women inmates, as it is inevitable that most of these women will eventually be released.

Legislating a Public Health Nightmare: The Anti-Immigrant Provisions of the 'Contract with America' Congress

The Personal Responsibility and Work Opportunity Reconciliation Act and the Illegal Immigration Reform and Immigrant Responsibility Act, two major products of the Contract With America Congress, have restricted federal funding for immigrant health care to an unprecedented extent. Legally present immigrants are eligible for few government-sponsored services, and undocumented immigrants have even less access to care. The consequences of this public health blunder are difficult to measure because the restrictions on health care access created by the 1996 laws limit investigators' contact with the immigrants who are the targets of the legislation. Public health research demonstrates that denial of care to new and undocumented immigrants has predictable adverse health consequences for all U.S. residents. This article reviews the statutory modifications affecting immigrants' health care access since 1996, their effect on prevention and treatment of communicable disease, prenatal care, and children's health care, recent litigation arising from the 1996 legislation, and the options available for avoiding the threat these restrictions pose to the public's health.

Hospital treatment of infectious diseases. Analysis of patients treated in an infectious disease clinic in a Swedish teaching hospital.

During a 12-month non-epidemic study period 1605 patients were hospitalised for 16 087 days. Pulmonary and respiratory tract infection was the dominating disease category responsible for 21% of all admissions and 25% of the total number of bed-days. Demographic analysis showed that all age groups were represented. However, a relative predominance of elderly patients was noted. While the age group greater than or equal to 70 yr comprises 11% of the general Swedish population, such patients accounted for 29% of all admissions and 41% of the total number of bed-days. A positive correlation was demonstrated between patient age and duration of hospital stay. The median duration of stay increased from 3.9 days in young individuals to 17.5 days in senior patients. Prolonged hospitalisation defined by a hospital stay exceeding 30 days was demonstrated in 99 patients; 71 patients (72%) were greater than or equal to 60 yr. 51 patients (3%) died during the hospital stay. In a defined population of local residents the overall annual admission rate was 609 per 100 000 inhabitants. Age-related annual admission rates in patients with pneumonia increased from 50 admissions per 100 000 inhabitants in the adult population to a peak value of 1493 in patients aged 90 yr or over. During the study period on average 26 hospital beds per 100 000 individuals were committed to treatment of communicable disease. The high frequency of emergency admissions and the short stay in hospital indicate that the beds were used mainly for acute short-term medical care.