Development of a Context-Aware Publish/Subscribe Information System for Public Health Service Delivery

Publish/Subscribe is a messaging paradigm where senders (publishers) of messages are not programmed to send theirmessages to specific receivers (subscribers). Rather, published messages are characterized into classes, without knowledge ofwhat (if any) subscribers there may be. Subscribers express interest in one or more classes, and only receive messages thatare of interest, without knowledge of what (if any) publishers there are. This paradigm helps to solve the problem of dataredundancy, ensuring that only the required information gets to the end user. Public health is concerned more with improvingthe health of a population through prevention rather than healing individual patients. This is why the dissemination ofrelevant information on healthcare is a vital key to achieving the cardinal objective of Public Health.At present, most Public health information systems are largely dependent on the Internet. This however poses a seriouschallenge in developing nations where occurrence of major diseases are high and the cost of internet is also high as well. Inthis paper, a Context-Aware model for Public health Service delivery was developed and implemented via aPublish/Subscribe Information System. The implementation was done on the .NET Platform. The eGranary was incorporatedinto the model to eliminate the cost of Internet. A mobile Subscriber module was also developed to enable users with mobiledevices access the system.Keywords: Context, Context-Awareness, Publish/Subscribe, Service, Public Healt

Burden and risk factors for Pseudomonas aeruginosa community-acquired pneumonia:a Multinational Point Prevalence Study of Hospitalised Patients

Pseudornonas aeruginosa is a challenging bacterium to treat due to its intrinsic resistance to the antibiotics used most frequently in patients with community-acquired pneumonia (CAP). Data about the global burden and risk factors associated with P. aeruginosa-CAP are limited. We assessed the multinational burden and specific risk factors associated with P. aeruginosa-CAP. We enrolled 3193 patients in 54 countries with confirmed diagnosis of CAP who underwent microbiological testing at admission. Prevalence was calculated according to the identification of P. aeruginosa. Logistic regression analysis was used to identify risk factors for antibiotic-susceptible and antibiotic-resistant P. aeruginosa-CAP. The prevalence of P. aeruginosa and antibiotic-resistant P. aeruginosa-CAP was 4.2% and 2.0%, respectively. The rate of P. aeruginosa CAP in patients with prior infection/colonisation due to P. aeruginosa and at least one of the three independently associated chronic lung diseases (i.e. tracheostomy, bronchiectasis and/or very severe chronic obstructive pulmonary disease) was 67%. In contrast, the rate of P. aeruginosa-CAP was 2% in patients without prior P. aeruginosa infection/colonisation and none of the selected chronic lung diseases. The multinational prevalence of P. aeruginosa-CAP is low. The risk factors identified in this study may guide healthcare professionals in deciding empirical antibiotic coverage for CAP patients

Clinical standards for the diagnosis and management of asthma in low- and middle-income countries

BACKGROUND : The aim of these clinical standards is to aid the diagnosis and management of asthma in lowresource settings in low- and middle-income countries (LMICs). METHODS : A panel of 52 experts in the field of asthma in LMICs participated in a two-stage Delphi process to establish and reach a consensus on the clinical standards. RESULTS : Eighteen clinical standards were defined: Standard 1, Every individual with symptoms and signs compatible with asthma should undergo a clinical assessment; Standard 2, In individuals (>6 years) with a clinical assessment supportive of a diagnosis of asthma, a hand-held spirometry measurement should be used to confirm variable expiratory airflow limitation by demonstrating an acute response to a bronchodilator; Standard 3, Pre- and postbronchodilator spirometry should be performed in individuals (>6 years) to support diagnosis before treatment is commenced if there is diagnostic uncertainty; Standard 4, Individuals with an acute exacerbation of asthma and clinical signs of hypoxaemia or increased work of breathing should be given supplementary oxygen to maintain saturation at 94–98%; Standard 5, Inhaled short-acting beta-2 agonists (SABAs) should be used as an emergency reliever in individuals with asthma via an appropriate spacer device for metered-dose inhalers; Standard 6, Short-course oral corticosteroids should be administered in appropriate doses to individuals having moderate to severe acute asthma exacerbations (minimum 3–5 days); Standard 7, Individuals having a severe asthma exacerbation should receive emergency care, including oxygen therapy, systemic corticosteroids, inhaled bronchodilators (e.g., salbutamol with or without ipratropium bromide) and a single dose of intravenous magnesium sulphate should be considered; Standard 8, All individuals with asthma should receive education about asthma and a personalised action plan; Standard 9, Inhaled medications (excluding drypowder devices) should be administered via an appropriate spacer device in both adults and children. Children aged 0–3 years will require the spacer to be coupled to a face mask; Standard 10, Children aged <5 years with asthma should receive a SABA as-needed at step 1 and an inhaled corticosteroid (ICS) to cover periods of wheezing due to respiratory viral infections, and SABA as-needed and daily ICS from step 2 upwards; Standard 11, Children aged 6–11 years with asthma should receive an ICS taken whenever an inhaled SABA is used; Standard 12, All adolescents aged 12–18 years and adults with asthma should receive a combination inhaler (ICS and rapid onset of action long-acting beta-agonist [LABA] such as budesonide-formoterol), where available, to be used either as-needed (for mild asthma) or as both maintenance and reliever therapy, for moderate to severe asthma; Standard 13, Inhaled SABA alone for the management of patients aged >12 years is not recommended as it is associated with increased risk of morbidity and mortality. It should only be used where there is no access to ICS. The following standards (14–18) are for settings where there is no access to inhaled medicines. Standard 14, Patients without access to corticosteroids should be provided with a single short course of emergency oral prednisolone; Standard 15, Oral SABA for symptomatic relief should be used only if no inhaled SABA is available. Adjust to the individual’s lowest beneficial dose to minimise adverse effects; Standard 16, Oral leukotriene receptor antagonists (LTRA) can be used as a preventive medication and is preferable to the use of long-term oral systemic corticosteroids; Standard 17, In exceptional circumstances, when there is a high risk of mortality from exacerbations, low-dose oral prednisolone daily or on alternate days may be considered on a case-by-case basis; Standard 18. Oral theophylline should be restricted for use in situations where it is the only bronchodilator treatment option available. CONCLUS ION : These first consensus-based clinical standards for asthma management in LMICs are intended to help clinicians provide the most effective care for people in resource-limited settings.The Oskar-Helene-Heim Foundation (OHH; Berlin, Germany) and the Gunther Labes Foundation (Berlin, Germany).https://theunion.org/our-work/journals/ijtldam2024School of Health Systems and Public Health (SHSPH)SDG-03:Good heatlh and well-bein

Air Pollution Exposure Among Adult Chronic Airway Disease Patients in the Gambia: A Pilot Case-control Study

Background: Chronic Airway Diseases (CADs) are of public health importance in both the developed countries and Low-and-middle-income countries (LMICs). Air pollution has a role in the causation of CADs and the worsening of already established CADs. This study examines the extent to which adult CAD patients and age and sex-matched controls in The Gambia are exposed to fine particulate matter and carbon monoxide. Methodology: In a clinic-based pilot case-control study,50adult patients with diagnosis of asthma or COPD presenting at respiratory clinics in the Western Health region in The Gambia were consecutively recruited along with 50 age and sex-matched controls who presented for non-cardiorespiratory conditions. Baseline spirometry, clinical examination and chest x-ray were done alongside the questionnaire administration. Home and personal PM2.5, CO and Exhaled CO were subsequently measured. Results: The median (SD) age of cases was 51.5±26 years and controls 52.0±24.8 years. Most cases were urban dwellers, presented with wheeze, cough, shortness of breath and weight loss. Two-thirds (25/40) of the asthmatics had a poor asthma control test score, whilst 90% (9/10) of the COPD patients had CAT scores showing at least a medium impact on their lives. Three-quarters (21/50) of cases had ≥1exacerbation in the previous year. Passive smoking occurred in one-quarter of the cases. There is slightly more personal and home exposure to PM2.5 among controls (61.2μg/m3) than cases(51.8μg/m3). Controls had slightly more home CO exposure 71.2 μg/m3) compared to cases (65.2μg/m3). Cases have more personal CO exposure as the controls. Also, occupational dust exposure and exposure to burning refuse occurred among the cases. Conclusion: As compared with controls, Chronic airway disease patients in The Gambia, present with significantly advanced disease, are likely to have had at least one exacerbation in the last year, and are exposed to personal CO, second-hand smoke, occupational dust and burning refuse. There is need for concerted efforts among all stakeholders to reduce such exposure, thus preventing worsening of already established

Prevalence and risk factors for Enterobacteriaceae in patients hospitalized with community-acquired pneumonia

Background and objective Enterobacteriaceae (EB) spp. family is known to include potentially multidrug-resistant (MDR) microorganisms, and remains as an important cause of community-acquired pneumonia (CAP) associated with high mortality. The aim of this study was to determine the prevalence and specific risk factors associated with EB and MDR-EB in a cohort of hospitalized adults with CAP. Methods We performed a multinational, point-prevalence study of adult patients hospitalized with CAP. MDR-EB was defined when &gt;= 3 antimicrobial classes were identified as non-susceptible. Risk factors assessment was also performed for patients with EB and MDR-EB infection. Results Of the 3193 patients enrolled with CAP, 197 (6%) had a positive culture with EB. Fifty-one percent (n = 100) of EB were resistant to at least one antibiotic and 19% (n = 38) had MDR-EB. The most commonly EB identified were Klebsiella pneumoniae (n = 111, 56%) and Escherichia coli (n = 56, 28%). The risk factors that were independently associated with EB CAP were male gender, severe CAP, underweight (body mass index (BMI) &lt; 18.5) and prior extended-spectrum beta-lactamase (ESBL) infection. Additionally, prior ESBL infection, being underweight, cardiovascular diseases and hospitalization in the last 12 months were independently associated with MDR-EB CAP. Conclusion This study of adults hospitalized with CAP found a prevalence of EB of 6% and MDR-EB of 1.2%, respectively. The presence of specific risk factors, such as prior ESBL infection and being underweight, should raise the clinical suspicion for EB and MDR-EB in patients hospitalized with CAP