Current and Contemporary Developments in Pulmonary Rehabilitation

Chronic obstructive pulmonary disease (COPD) is now recognized as a global health problem. It is most usually caused by smoking cigarettes, although it can also be caused by a variety of environmental toxins, noxious gases, fumes, and dust. Pulmonary rehabilitation (PR) is an effective intervention for patients with chronic obstructive pulmonary disease and is recommended by clinical guidelines. It is an important part of the treatment of chronic obstructive pulmonary disease and other chronic respiratory disorders. Pulmonary rehabilitation is a recent approach in respiratory medicine that is defined as an “individually customized and designed, interdisciplinary program of care” for patients with persistent respiratory failure. Patient selection and assessment, psychological support, self-management education, nutritional support, and exercise training (including inspiratory muscle training (IMT) are all important components of pulmonary rehabilitation

Work - Related Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease characterized by airflow obstruction and increasing breathlessness. COPD is increasing worldwide, both in developed and developing countries. The most important risk factor of developing COPD is cigarette smoking; however, occupational exposures such as vapors, gases, dusts and fumes present an important risk factor for the development of the disease, by itself and through interaction with other risk factors. The dusts from coal, stone quarries, wood, cereals and agricultural work, animal stables, textiles, and paper production that can arise in occupational environments have been regulated by the International Labor Organization and considered possible as contributors to COPD. A better understanding of these causes paves the way for effective interventions to reduce the future incidence of this unpleasant condition. Breathlessness and occupational exposures to vapors, gases, dusts and fumes were identified as the main modifiable factors associated with unemployment and poor work productivity in COPD patients

Assessment of barriers to the implementation of community-based data verification and immunization data discrepancies between health facilities and the community in Tach Gayint district, Northwest Ethiopia.

AbstractIntroduction: While community-based data verification (CBDV) is critical for effective implementation of immunization programs, limited evidence exists detailing its implementation at the local levels thereby threatening data quality which is used to guide decision making.Aim: To explore the barriers to proper implementation of CBDV and determine the level of immunization data discrepancy between the health facilities and community levels in Tach Gayint district of Northwest Ethiopia.Methods: A Mixed methods approach was used. Interviews with twenty-six key informants’ (health experts) in immunization data, and an additional a sample of 324 infants were recruited. All health centers in the district (6) and 2 health posts from each health center (12 in total) were selected using Simple Random Sampling. Key informant interviewees were purposely included from all health facilities. For quantitative data, samples of infants were proportionally allocated for each health facility as per their DPT/Pentavalent-1 vaccine report. Thematic analysis of the qualitative data and descriptive quantitative analysis were performed using statistical software open-code v-4.02 and STATA v14.1 respectively.Results: Only few health facilities implemented CBDV and consider it to be their routine task. Also, barriers to effective implementation of CBDV such as lack of prioritization, poor capacity among health staff, and conflicting job roles were identified. The highest immunization data discrepancy among community and health facilities was observed for the measles-one vaccine (35.4%), and the minimum was for DPT/Pentavalent-1 (25.6%).Conclusion: This study revealed a poor level of CBDV implementation and barriers to its effective implementation which include lack of prioritizing CBDV, limited capacity among health staff in performing CBDV, and conflicting job roles among health staff. There was a high level of immunization data discrepancy for measles-1 and DTP/Pentalent-3 vaccines. Based on our finding, we make the following recommendations: building skills among health workers to perform CBDV, enhancing availability and use of standard CBDV tools, ensuring monitoring, and control mechanism, and setting clear definition of roles regarding CBDV, as well as closing the gap in level of immunization data discrepancy could help foster effective implementation of CBDV. [Ethiop. J. Health Dev. 2021; 35(SI-3):09-15]Key words: Immunization, CBDV, Data discrepancy, Data qualit

Assessment of immunization data management practices, facilitators, and barriers to immunization data quality in the health facilities of Tach Gayint district, Northwest Ethiopia

AbstractIntroduction: Although data quality mainly depends upon the proper management of its primary sources, limited studies examined immunization data management practice in Ethiopia.Aim: To explore data management practices, facilitators, and barriers to immunization data quality among front-line immunization experts in the Tach Gayint district of Northwest Ethiopia.Methods: A mixed method study design was applied using document review and key-informant interviews. Quantitative data was collected through document review from 18 health facilities and 26 key-informant interviews, were conducted on experts of immunization for qualitative data. A STATA version 14.1 was used for quantitative data analysis. Qualitative data was transcribed verbatim and translated back into English. Data was coded, reduced, and searched for salient patterns. Thematic analysis was done using open-code version 4.02.Results: The Health Management Information System data recording tools were often lacking. The significant number (83.3%) of health facilities practiced immunization information display, while dissemination at the local level was low. The key informants mentioned that they were responsible for conducting regular Performance Monitoring Team (PMT) and Lots Quality Assurance Sampling (LQAS) as facilitators. Furthermore, a shortage of recording tools, limited supportive supervision, vertical reporting, impracticality of Lots of Quality Assurance Sampling (LQAS) at the health posts, poor implementation of Community Health Information System (CHIS), and mass vaccination were barriers identified to immunization data quality.Conclusion: We found that majority of health workers use locally developed tools instead of using the standard data recording and reporting tools. Regular Performance Monitoring Team meetings and Lots Quality Assurance Sampling assessment were found to be facilitators. Furthermore, limited supportive supervision, vertical reporting and poor implementation of Community Health Information System were barriers. Therefore, strengthening the use of standard recording and reporting tools, conducting regular supportive supervision, and implementing routine vaccination services are recommended to improve the data management practice. [Ethiop. J. Health Dev. 2021; 35(SI-3):28-38]Key words: Immunization, Data management practice, Data quality, Information us

Quantitative analysis of knowledge, attitude and practice of workers in chicken slaughter slabs toward food safety and hygiene in Ouagadougou, Burkina Faso

Introduction: In low- and middle-income countries, chicken serves as a cheap source of protein and an income source for many households. It is particularly important in the capital, Ouagadougou, Burkina Faso, where chicken is regularly consumed. However, hygiene standards are very low, posing a significant public health risk. Methods: To better understand the food safety situation, we conducted a cross-sectional survey of the hygienic practices of 155 randomly selected chicken slaughter outlets and carcass shops with a semi-structured questionnaire. Results and discussion: Of the outlets visited, 59% are not licensed, and 63% are not regularly inspected, operating in the dominant, largely unregulated informal sector. More than 80% of the chickens are sourced from village production systems, but around 6% of the birds die during transport. The monetary loss due to chicken death during transportation is around four million USD annually. Market hygiene is poor; 86% of the holding pens have no hard floor and are not washed regularly. Almost all (92%) chickens are slaughtered on bare earth floors; bleeding, plucking, and evisceration are done on a wooden table that is rarely washed. On average, the same scalding water is used for 33 birds, seven scalded at a time. Most respondents (49%) thought that plucking and evisceration were the major cause of contamination of carcasses with foodborne pathogens. Most operators only washed their hands and knives with tap water at the beginning of the slaughtering process. Some shops use refrigerators and freezers to store carcasses before selling. However, they store carcasses with other foods like fish, beef and vegetables, facilitating further cross-contamination. There were rats (26%), cats (39%) and dogs (30%) present at outlets, roaming for food, especially roadside outlets. Training schemes on hygienic food handling practices were favoured by outlets as an approach to improve matters; however, improvements in food safety will be limited without significant upgrades in infrastructure and facilities. Slaughter slabs need a standard house with stable energy, adequate airflow, clean water, toilets, detergents and freezers. Also, they need equipment like knives, tables and dishes made of high-quality, easy-to-clean materials

Multi-scale mosaics in top-down pest control by ants from natural coffee forests to plantations

While top-down control plays an important role in shaping both natural and agricultural food webs, we lack insights into how top-down control effects vary across spatial scales. We used a multi-scale survey of top-down control of coffee pests and diseases by arboreal ants to examine if colony location creates a small-scale mosaic in top-down control around trees and if the strength of that control varies between sites at the landscape scale. We investigated pest and disease levels on coffee shrubs at different distances from shade trees with and without a Crematogaster spp. ant colony in 59 sites along a coffee management intensity gradient in southwestern Ethiopia. Within sites, ants significantly suppressed herbivory and coffee leaf rust at distances less than 10 m from nesting trees. Top-down control varied between sites, with stronger top-down control of free-feeding herbivory near ant colonies at sites with lower management intensity and stronger top-down control of a skeletonizer at sites with higher canopy cover. We conclude that the strength of top-down control by ants is highly heterogeneous across spatial scales, as a consequence of the biology of the predator at the small scale and herbivore density or changes in herbivore-ant interactions at the landscape scale

Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019 : a systematic analysis from the Global Burden of Disease Study 2019

Background Ending the global tobacco epidemic is a defining challenge in global health. Timely and comprehensive estimates of the prevalence of smoking tobacco use and attributable disease burden are needed to guide tobacco control efforts nationally and globally. Methods We estimated the prevalence of smoking tobacco use and attributable disease burden for 204 countries and territories, by age and sex, from 1990 to 2019 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We modelled multiple smoking-related indicators from 3625 nationally representative surveys. We completed systematic reviews and did Bayesian meta-regressions for 36 causally linked health outcomes to estimate non-linear dose-response risk curves for current and former smokers. We used a direct estimation approach to estimate attributable burden, providing more comprehensive estimates of the health effects of smoking than previously available. Findings Globally in 2019, 1.14 billion (95% uncertainty interval 1.13-1.16) individuals were current smokers, who consumed 7.41 trillion (7.11-7.74) cigarette-equivalents of tobacco in 2019. Although prevalence of smoking had decreased significantly since 1990 among both males (27.5% [26. 5-28.5] reduction) and females (37.7% [35.4-39.9] reduction) aged 15 years and older, population growth has led to a significant increase in the total number of smokers from 0.99 billion (0.98-1.00) in 1990. Globally in 2019, smoking tobacco use accounted for 7.69 million (7.16-8.20) deaths and 200 million (185-214) disability-adjusted life-years, and was the leading risk factor for death among males (20.2% [19.3-21.1] of male deaths). 6.68 million [86.9%] of 7.69 million deaths attributable to smoking tobacco use were among current smokers. Interpretation In the absence of intervention, the annual toll of 7.69 million deaths and 200 million disability-adjusted life-years attributable to smoking will increase over the coming decades. Substantial progress in reducing the prevalence of smoking tobacco use has been observed in countries from all regions and at all stages of development, but a large implementation gap remains for tobacco control. Countries have a dear and urgent opportunity to pass strong, evidence-based policies to accelerate reductions in the prevalence of smoking and reap massive health benefits for their citizens. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

The relationship between climate, disease and coffee yield: optimizing management for smallholder farmers

Climate change and diseases are threatening global crop production. Agroforestry systems, which are characterized by complex multispecies interactions, are considered to provide nature-based solutions for climate change mitigation and pest and disease regulation. Understanding the role of the abiotic environment and species interactions in shaping diseases and yield in agroforestry systems would enable us to develop effective ecologically-informed pest and disease management under a changing climate, support sustainable agricultural practices, and maximize the benefits gained from agroforestry systems. To gain such a comprehensive understanding of what shapes pest and disease levels and yield in agroforestry systems, we need to investigate how the interactions between agroforestry system components, such as trees, crops and their associated organisms, vary in space and time, and how they are influenced by abiotic factors in terms of pests and diseases and yield.  In this thesis, my overarching goal was to understand how microclimate and management impact major coffee pests and diseases, their natural enemies, and coffee yield, as well as farmers’ perceptions of climate change and climate-mediated changes in disease dynamics and yield, with the aim of using these insights to optimize management decisions for smallholder farmers in southwestern Ethiopia. With this aim, I selected 58 sites along a gradient of management intensity, ranging from minimal management in the natural forest to moderate management in smallholder farms and intensive management in commercial plantations. As an approach, I combined observational and interview studies to examine i) the impact of shade tree species identity and canopy cover on coffee pests and diseases, ii) the effect of climate and management on coffee berry disease and yield, iii) the impact of climate on a host-hyperparasite interaction, and iv) farmers’ perceptions of climate change and climate-mediated changes in disease dynamics and yield.  I found that tree identity affected the incidence and severity of coffee diseases, whereas insect pests were strongly affected by canopy cover, but in a species-specific way (I).  Both climate and management affected coffee berry disease and yield. Importantly, the effect of climatic variables on disease and yield differed strongly between the developmental stages from flowering to ripening (II). In chapter (III), I found that the climatic niches of coffee leaf rust and its hyperparasite differed, with coffee leaf rust severity preferring high maximum temperatures, whereas the hyperparasite preferred cold nights. The interviews revealed that the majority of farmers perceived long-term changes in one or more aspects of the climate, and the majority of farmers perceived an increase in coffee leaf rust and a decrease in coffee berry disease. Climate data also supported farmers’ knowledge on climate-disease-yield relationships (IV).  Taken together, my thesis advances our understanding of the relationship between climate and management of coffee pests, diseases and yield, and this may contribute to the development of ecologically-informed pest and disease management strategies for coffee production and other agroforestry crops