An appraisal: How notifiable infectious diseases are reported by Hungarian family physicians

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From habits of attrition to modes of inclusion: enhancing the role of private practitioners in routine disease surveillance

Background: Private practitioners are the preferred first point of care in a majority of low and middle-income countries and in this position, best placed for the surveillance of diseases. However their contribution to routine surveillance data is marginal. This systematic review aims to explore evidence with regards to the role, contribution, and involvement of private practitioners in routine disease data notification. We examined the factors that determine the inclusion of, and the participation thereof of private practitioners in disease surveillance activities. Methods: Literature search was conducted using the PubMed, Web of Knowledge, WHOLIS, and WHO-IRIS databases to identify peer reviewed and gray full-text documents in English with no limits for year of publication or study design. Forty manuscripts were reviewed. Results: The current participation of private practitioners in disease surveillance efforts is appalling. The main barriers to their participation are inadequate knowledge leading to unsatisfactory attitudes and misperceptions that influence their practices. Complicated reporting mechanisms with unclear guidelines, along with unsatisfactory attitudes on behalf of the government and surveillance program managers also contribute to the underreporting of cases. Infrastructural barriers especially the availability of computers and skilled human resources are critical to improving private sector participation in routine disease surveillance. Conclusion: The issues identified are similar to those for underreporting within the Integrated infectious Disease Surveillance and Response systems (IDSR) which collects data mainly from public healthcare facilities. We recommend that surveillance program officers should provide periodic training, supportive supervision and offer regular feedback to the practitioners from both public as well as private sectors in order to improve case notification. Governments need to take leadership and foster collaborative partnerships between the public and private sectors and most importantly exercise regulatory authority where needed

Getting into the haart of matter: HIV protease inhibitors and onset of cardiovascular diseases

Background & Objectives: Cardiovascular diseases have been an emerging area of concern in the HIV population. The successful roll-out of highly active antiretroviral therapy (HAART) has extended life expectancy and enhanced the overall well-being of HIV-positive individuals (Reyskens et al., 2014). There are, however, augmented concerns regarding HAART-mediated metabolic derangements and its potential risk for cardiovascular diseases (CVD) in the long run. Methods: Systemic review of literature from 11 research articles from 2000 to 2014 was conducted through electronic medium by using JPMA, SAGE and Google search engines. Results: Despite successful antiviral therapy, numerous studies suggest a role of chronic inflammation, together with immune activation, that could lead to vascular dysfunction and atherothrombosis. It is now high time for physicians to prevent coronary heart disease in this high-risk population through the use of tools employed in the general population. Moreover, the lower median age at which acute coronary syndromes occur in HIV-infected patients should shift prevention to include patients 45 years of age (Boccara et al., 2013). Available cardiovascular risk scores in the general population usually fail to screen young patients at risk for myocardial infarction. Moreover, the novel vascular risk factors identified in HIV-related atherosclerosis, such as chronic inflammation are not taken into account in the available risk scores, leading to underestimation of cardiovascular risk in the HIV population. Conclusion: Thus while HIV Protease Inhibitors substantially improve life expectancy and quality of life in HIV-positive patients, however, greater clinical awareness regarding its benefit–harm paradigm, and the development and evaluation of novel co-treatment strategies should be explored. Healthcare professionals require new tools to assess this higher risk and studies to determine whether intensive primary prevention is warranted. Keywords: HAART, Primary Prevention, Cardiovascular Diseases, HIV Protease Inhibitor

Beyond biochemical medicine: analyzing the psychosocial and psychological correlates of patient post-breast cancer treatments

Background & Objectives: Lengacher, Bennett, Gonzalez, Gilvary, Cox, Cantor, Jacobsen, Yang, & Djeu, (2008) mentioned that cancer has affected 214,640 women in the United States and unfortunately 40,970 will die from this disease. Purpose: To scrutinize the effect of breast cancer on the patient and their family and correlate it with contemporary literature. Methods: Systemic review of literature from 11 research articles from 1999 to 2011 was conducted through electronic medium by using JPMA, SAGE and Google search engines. Results: The patient showed psychological symptoms such as depression, anxiety, chronic sorrow, feelings of sadness, anger, confusion, fatigue related to surgery, helplessness and hopelessness, this is also evident in a study where 85% of breast cancer population, showed similar symptoms (Kim et al., 2010). Compas & Luecken (2002) revealed that psychological distress and elevated negative emotions are allied with breast cancer. Kim et al. (2010), Armento & Hopko (2009) and Al-Azri et al. (2009) listed supportive psychotherapy, cognitive restructuring, relaxation training, problem-solving and social skills training as certain psychosocial interventions. It has been suggested by Lee at al. (2011) and Harding & Higginson (2003) that it is often imprecise that who the patient is. However, to place the caregivers’ view upfront brings about challenges in palliative settings. Conclusion: In order to alleviate emotional distress and to amplify coping mechanisms, sessions of problem solving therapy is empirically recommended to accommodate the needs. As oncology nurses it is further recommended to counsel women with breast cancer as it would persuade them to verbalize and reflect their feelings pertaining to their experiences. Keywords: psychological distress, Palliative therapies, Caregivers, Coping mechanism

Predicting the disability post stoke: applying NIHSS in tertiary health care settings

Background& Objectives: Numerous guidelines for the early management of patients with ischemic stroke outline the goals associated with early care encompassing interventions and facilitation of measures aimed at improving consequences post stroke (Adams et al., 2003).One such tool is the National Institutes of Health Stroke Scale (NIHSS) which is a well-validated, reliable scoring system for use specifically with assessing stroke patients (Lyden et al., 1999). Methods: Systemic review of literature from 28 research articles from 1994 to 2014 was conducted through electronic medium by using JPMA, SAGE and Google search engines. Results: Literature findings revealed that during a stroke patient\u27s hospitalization, the NIHSS can be applied to help identify clinical findings that might put the patient at risk for complications. Despite its evidence for validity and reliability, there has been reluctance to implement it within clinical settings. When compared to standard neurological assessments, some users believe that scale completion is too time consuming (Lai, Duncan, & Keighley, 1998). Other detractors perceive a lack of interrater reliability in scoring on certain questions, particularly the questions for ataxia and dysarthria assessment (Lyden, Lu, Levine, Brott, & Broderick, 2001). Others cite a hemispheric bias within the NIHSS, because 7 of the points are directly related to measurement of language (a left hemisphere function) and only 2 points are related to neglect (a right-hemisphere phenomenon). Hence, the NIHSS is believed to underestimate stroke severity in the right hemisphere (Woo et al., 1999). Conclusion: The NIHSS becomes easier and less time consuming to administer if it is made a standard part of nursing practice in order to communicate stroke severity (Criddle et al., 2003). Studies are required to compare its application in Pakistani Tertiary Health Care Settings and its impacts on reducing the disability among patients suffering from stroke. Keywords: NIHSS, Stroke, Neurology, Disabilit

The art and science of diabetes self-management education (DSME): a culture out of balance in Pakistan

Background & Objectives: Group-based diabetes self-management education (DSME) programmes have been shown to be effective. In spite of growing evidence of the value of DSME in reducing hospitalization costs, improvement in glucose, weight and medication adherence, DSME remains an underutilized insurance benefit and access to qualified diabetes educators is problematic (Tomky, et al., 2013). The purpose of this study is to summarize the accumulated state of knowledge in the area of diabetes patient education research and highlight important issues that research has left unanswered. Methods: An integrative literature review was conducted on the topic of diabetes patient education between the years 2000 and 2013. Keywords used in the computerized search were diabetes mellitus, patient education, health education, research, and behavior change. The databases searched were MEDLINE, CINAHL, HealthSTAR, EMBASE, and CHID-HE. A total of 25 papers were reviewed Results: Most studies lacked a theoretical framework and the majority of studies were conducted in an outpatient setting. HbA, was the most frequently employed outcome measure, with little, if any, description of the interventions. Since diabetes is a complex condition reaching pandemic proportions, which requires self-management of the chronic disease on a daily basis, the future of DSME faces challenges in the current fee for service environment. The National Standards for Diabetes self-management education and support and the American Association of Diabetes Educators Practice Guidelines offers new concepts for meeting the future demand of diabetes educators and education. Conclusion: With the emphasis on patient-centered care, patients and care providers can consider options based on DSME intervention features for its broad and specific impact on outcomes to potentially make programming more effective. Much has been learned in terms of the effectiveness of diabetes education on improving knowledge. Keywords: HAART, HIV Protease Inhibitors, Cardiovascular Diseases, Primary Preventio

New insights for healthcare professionals for detecting oral cancer: an epidemiological approach

Background & Objectives: Warnakulasuriya (2010) reported that oral cancer is the 6th most common cancer worldwide. Bhurgri (2005) stated an increase in the age standardized incidence rates (ASIR) per 100,000 in Pakistani males from 9.1 to 15.3 and in females from 9.3 to 12.3 in a period of 8 years from 1995-2002. Purpose: To explore the magnitude, causation and early detection of oral cancer and correlate it with contemporary literature. Methods: Systemic review of literature from 28 research articles from 1999 to 2013 was conducted through electronic medium by using JPMA, SAGE and Google search engines. Furthermore, data from AKUH was also collected. Results: In the Aga Khan University Hospital Karachi, Pakistan, since 2000 till date, 4,039 cases of oral cancers have been diagnosed. With 108 males and 37 females under 18 years of age, 26 males and 52 females at 35 years of age and 2,549 males and 857 females above 35 years of age. Literature supports that the possible risk factors include smoking tobacco, alcohol consumption, betel quid and areca nut chewing with or without tobacco, viruses, diet and deficiency states, and exposure to sunlight (Tanaka et al., 2011). In two studies conducted in Pakistan, and India and Srilanka, the relative risks for smoking were found to be 5.7 and 2.1 for men, and 12.9 and 11.5 for women, respectively (S. Carnelio et al., 2004). Conclusion: Screening should be an ongoing method and not a once-in-a-while project. Warnakulasuriya (2010) suggested that screening for recurrences or second primary tumors is pivotal in the foremost five years preceding treatment. Most recently, the World Health Assembly (WHA) passed a resolution on oral health for the first time in 25 years (Petersen, 2009). This accentuates the requirement for framing policies and strategies for oral health in the 21st century, along with the objective prevention and control of oral cancer. Keywords: Oral cancer, smoking, screening, Healthcare professional

Implementing a public-private mix model for tuberculosis treatment in urban Pakistan: lessons and experiences

Setting: Six towns of Karachi, Pakistan. Objectives: 1) To strengthen the capacity of general practitioners (GPs) in providing tuberculosis (TB) treatment through DOTS, and 2) to enhance collaboration between the public and private sectors in TB management and case reporting. Design: A quasi-experimental Study Design was adopted to ensure enrolment of TB Patients through trained GPs with the support of laboratory networks and to improve the case detection rate. Results: The following challenges were faced during implementation of the model in urban settings: no systematic list of GPs was available, the majority of the GPs were untrained health practitioners working in squatter settlements, where formally trained GPs are most needed, the motivation of GPs with high Patient loads is very low, and access to a laboratory is difficult. Of 35 Patients enrolled in the first quarter (third quarter 2009), 87% completed their treatment successfully. Conclusion: Public-private mix (PPM) DOTS is feasible in the cities of Pakistan. However, the cost, time and effort required to establish the programme is higher than in many other developing countries

Two-year duration of immunity of inactivated poliovirus vaccine: A follow-up study in Pakistan in 2020

This was a follow-up study conducted in 2020 assessing changes in levels of type 2 poliovirus-neutralizing antibodies two years post-immunization in children who received inactivated poliovirus vaccine (IPV) in Karachi, Pakistan. Unexpectedly, the findings revealed an increase in seroprevalence of type 2 antibodies from 73.1% to 81.6% one and two years after IPV, respectively. The increase in type 2 immunity could result from the intensive transmission of circulating vaccine-derived poliovirus type 2 (cVDPV2) in Karachi during the second year of IPV administration. This study suggests that the cVDPV2 outbreak detected in Pakistan infected large proportions of children in Karachi. Clinical Trial Registration NCT03286803