Chronic respiratory disease surveys in adults in low- and middle-income countries: a systematic scoping review of methodological approaches and outcomes

Background Chronic respiratory diseases (CRDs) contribute significantly towards the global burden of disease, but the true prevalence and burden of these conditions in adults is unknown in the majority of low- and middle-income countries (LMICs). We aimed to identify strategies - in particular the definitions, study designs, sampling frames, instruments, and outcomes - used to conduct prevalence surveys for CRDs in LMICs. The findings will inform a future RESPIRE Four Country ChrOnic Respiratory Disease (4CCORD) study, which will estimate CRD prevalence, including disease burden, in adults in LMICs.Methods We conducted a scoping review to map prevalence surveys conducted in LMICs published between 1995 and 2018. We followed Arksey and O'Malley's six-step framework. The search was conducted in OVID Medline, EMBASE, ISI Web of Science, Global Health, WHO Global Index Medicus and included three domains: CRDs, prevalence and LMICs. After an initial title sift, eight trained reviewers undertook duplicate study selection and data extraction. We charted: country and populations, random sampling strategies, CRD definitions/phenotypes, survey procedure (questionnaires, spirometry, tests), outcomes and assessment of individual, societal and health service burden of disease.Results Of 36 872 citations, 281 articles were included: 132 from Asia (41 from China). Study designs were cross-sectional surveys (n = 260), cohort studies (n = 11) and secondary data analysis (n= 10). The number of respondents in these studies ranged from 50 to 512 891. Asthma was studied in 144 studies, chronic obstructive pulmonary disease (COPD) in 112. Most studies (100/144) based identification of asthma on symptom-based questionnaires. In contrast, COPD diagnosis was typically based on spirometry findings (94/112); 65 used fixed-ratio thresholds, 29 reported fixed-ratio and lower-limit-of-normal values. Only five articles used the term `phenotype'. Most studies used questionnaires derived from validated surveys, most commonly the European Community Respiratory Health Survey (n = 47). The burden/impact of CRD was reported in 33 articles (most commonly activity limitation).Conclusion Surveys remain the most practical approach for estimating prevalence of CRD but there is a need to identify the most predictive questions for diagnosing asthma and to standardise diagnostic criteria.Public Health and primary carePrevention, Population and Disease management (PrePoD

Dissipation rate study and pre-harvest intervals calculation of imidacloprid and oxamyl in exported Egyptian green beans and chili peppers after pestigation treatment

Two QuEChERS-based methods were developed and validated, using liquid chromatography–tandem mass spectrometric detection, in order to accurately determine residues of imidacloprid and oxamyl in green beans and chili peppers after treatment via irrigation system under field conditions in Egyptian farms. The validation included experiments for specificity, linearity, trueness, precision, matrix effect and limits of detection and quantification according to European Commission standards. The dissipation rates of both pesticides in green beans and chili peppers were studied and the pre-harvest intervals (PHIs) were calculated. The LOQ values of imidacloprid were 0.47 and 2.6 μg/kg in green beans and chili peppers, respectively, while for oxamyl the LOQs were 2.9 and 0.67 μg/kg, respectively. No PHI of imidacloprid is required, while for oxamyl it was found that still after 21 days, its residues’ concentration on both crops was significantly higher than the maximum residue limit. © 2017 Elsevier Lt

Liquid chromatography–tandem mass spectrometric methods for the determination of spinosad, thiacloprid and pyridalyl in spring onions and estimation of their pre-harvest interval values

Two liquid chromatography–tandem mass spectrometric methods were developed and validated to determine spinosyn A and D, thiacloprid and pyridalyl in spring onions cultivated under Egyptian field conditions. The degradation rates, the pre-harvest interval (PHI) values and the half-life values of the three pesticides were estimated. QuEChERS was used for sample preparation and the separation was performed on an X-Bridge C18 column with ACN-formic acid 0.1% as the mobile phase. Linear range, method detection limits (MDLs), precision, recovery and matrix effects were estimated. The multi-residue MDLs ranged from 0.02 μg/kg (spinosyn A & D) to 0.05 μg/kg for pyridalyl. All the investigated pesticides showed high degradation rates. For spinosad the half-life value was 1.2 days, for thiacloprid it reached 2.2 days and for pyridalyl 4.4 days. Furthermore, the calculated PHI values, according to the maximum residue levels set by the EU, were 0 days for spinosad, 9.8 days for thiacloprid and 39.4 days for pyridalyl. © 2016 Elsevier Lt

Development of Specific LC-ESI-MS/MS Methods to Determine Bifenthrin, Lufenuron, and Iprodione Residue Levels in Green Beans, Peas, and Chili Peppers Under Egyptian Field Conditions

The dissipation of bifenthrin, lufenuron, and iprodione was studied in green beans, peas, and chilli peppers under Egyptian field conditions. For this purpose, three specific and one multi-analyte liquid chromatography-electrospray ionization-tandem mass spectrometry methods were developed and validated according to SANCO guidelines for the determination of bifenthrin, iprodione, and lufenuron residues in the selected commodities. Sample preparation was carried out by the QuEChERs approach, and determination was performed in positive ionization mode for iprodione and bifenthrin and in negative mode for lufenuron. Optimization of the ionization parameters and the chromatographic conditions was performed for each method developed. All methods showed satisfactory performance criteria. Linear dynamic range, limits of detection (LOD) and quantification (LOQ), precision, recovery, and matrix effects were estimated, and the calculated LODs were in the micrograms-per-kilogram range, namely 0.14, 0.61, and 1.4 μg/kg for bifenthrin, lufenuron, and iprodione, respectively. Field trials were carried out in one of the biggest farms in Egypt (Blue Nile) that exports significant quantities of vegetables to the European Union (EU) countries. All the examined pesticides showed high degradation rates. The t 1/2 values for bifenthrin were 3.3, 2.1, and 9.6 days in green beans, peas, and chili peppers, respectively. For iprodione, they reached 2.4 and 14.4 days in green beans and peppers. Furthermore, the calculated pre-harvest interval (PHI) values, according to the maximum residue limits set by EU, were 0, 4, and 0 days for bifenthrin in green beans, peas, and peppers, respectively, and for iprodione, 2 days in green beans and 0 days in peppers. In case of lufenuron, no t 1/2 and PHI were estimated as no residues were found in all pea samples. © 2012 Springer Science+Business Media New York

Evidence for persisting with treatment with paracetamol in patients with mild to moderate osteoarthritis of the knees

Although paracetamol is recommended as first line pharmacological therapy for mild to moderate osteoarthritis (OA) of the knees, it is deemed to be not as efficacious as other pharmacological agents. One of the reasons could be due to poor adherence and persistence to therapy. This study examines the efficacy of the early response and the response after four weeks to paracetamol in mild to moderate OA of the knees in daily clinical practice. This is an open label study. Consecutive patients with mild to moderate OA of the knees were given 1.3 grams extended-release paracetamol three times per day for 4 weeks. Pain based on the Western Ontario and McMaster Universities (WOMAC) v3 VAS osteoathritis index was used as a measure of efficacy. Serial liver and renal profiles were done for safety monitoring. An early assessment of efficacy was done at week 1 and a later at the end of 4 weeks of therapy. The primary efficacy endpoint was a 30 reduction in global pain score at week 4 compared to baseline Analysis was done using the SPSS Version 18. Thirty patients entered the study. 73.3 were females. Mean age, BMI and duration of OA was 58.5years (SD +/- 6.9), 28.1 kg/m2 (SD +/- 6.4) 22.8 (SD +/- 32.2) months respectively. The mean VAS WOMAC at baseline for pain was 35.4mm (SD +/- 17.5). At the end of the first week of therapy, there was no difference in the WOMAC pain score compared to baseline. (95 CI -0.54-12.1, p=0.07). However by the end of 4 weeks there was a statistically significant 46.6 (95 CI 27.6-72.6, p<0.001) reduction in global pain compared to baseline. An absolute reduction of 16.5mm in global pain (95 CI 9.9-23.0, p<0.001) compared to baseline was also seen. No serious adverse events were encountered. Paracetamol used to treat OA of the knees is not efficacious in the first week of therapy. However persistence with therapy for a further three weeks results in significant reduction in pain. Therefore every effort should be made to ensure persistence with the recommended full four weeks of treatment. Chia Yook Chin, Rabia Khartoum, Mohazmi Mohamed, Nik Sherina Hanafi, Ng Chirk Jenn. Evidence for Persisting with Treatment with Paracetamol in Patients with Mild to Moderate Osteoarthritis of the Knees. Life Sci J 2012;9(3):1131-1137]. (ISSN: 1097-8135). http://www.lifesciencesite.com. 15

Healthcare in Asia: a perspective from primary care at the gateway to a continent

Malaysia has achieved reasonable health outcomes even though the country spends a modest amount of Gross Domestic Product on healthcare. However, the country is now experiencing a rising incidence of both infectious diseases and chronic lifestyle conditions that reflect growing wealth in a vibrant and successful economy. With an eye on an ageing population, reform of the health sector is a government priority. As in other many parts of the world, general practitioners are the first healthcare professional consulted by patients. The Malaysian health system is served by public and private care providers. The integration of the two sectors is a key target for reform. However, the future health of the nation will depend on leadership in the primary care sector. This leadership will need to be informed by research to integrate care providers, empower patients, bridge cultural gaps and ensure equitable access to scarce health resource

What influences patients&rsquo; acceptance of a blood pressure telemonitoring service in primary care? A qualitative study

Background: Telemonitoring of home blood pressure (BP) is found to have a positive effect on BP control. Delivering a BP telemonitoring service in primary care offers primary care physicians an innovative approach toward management of their patients with hypertension. However, little is known about patients’ acceptance of such service in routine clinical care. Objective: This study aimed to explore patients’ acceptance of a BP telemonitoring service delivered in primary care based on the technology acceptance model (TAM). Methods: A qualitative study design was used. Primary care patients with uncontrolled office BP who fulfilled the inclusion criteria were enrolled into a BP telemonitoring service offered between the period August 2012 and September 2012. This service was delivered at an urban primary care clinic in Kuala Lumpur, Malaysia. Twenty patients used the BP telemonitoring service. Of these, 17 patients consented to share their views and experiences through five in-depth interviews and two focus group discussions. An interview guide was developed based on the TAM. The interviews were audio-recorded and transcribed verbatim. Thematic analysis was used for analysis. Results: Patients found the BP telemonitoring service easy to use but struggled with the perceived usefulness of doing so. They expressed confusion in making sense of the monitored home BP readings. They often thought about the implications of these readings to their hypertension management and overall health. Patients wanted more feedback from their doctors and suggested improvement to the BP telemonitoring functionalities to improve interactions. Patients cited being involved in research as the main reason for their intention to use the service. They felt that patients with limited experience with the internet and information technology, who worked out of town, or who had an outdoor hobby would not be able to benefit from such a service. Conclusion: Patients found BP telemonitoring service in primary care easy to use but needed help to interpret the meanings of monitored BP readings. Implementations of BP telemonitoring service must tackle these issues to maximize the patients’ acceptance of a BP telemonitoring service

Are doctors assessing patients with hypertension appropriately at their initial presentation?

INTRODUCTION The aim of this study was to determine the extent to which primary care doctors assessed patients newly diagnosed with hypertension for the risk factors of cardiovascular disease (CVD) during the patients’ first clinic visit for hypertension. The study also aimed to examine the trend of assessment for CVD risk factors over a 15-year period. METHODS This retrospective study was conducted between January and May 2012. Data was extracted from the paper-based medical records of patients with hypertension using a 1:4 systematic random sampling method. Data collected included CVD risk factors and a history of target organ damage (TOD), which were identified during the patient’s first visit to the primary care doctor for hypertension, as well as the results of the physical examinations and investigations performed during the same visit. RESULTS A total of 1,060 medical records were reviewed. We found that assessment of CVD risk factors during the first clinic visit for hypertension was poor (5.4%–40.8%). Assessments for a history of TOD were found in only 5.8%–11.8% of the records, and documented physical examinations and investigations for the assessment of TOD and secondary hypertension ranged from 0.1%–63.3%. Over time, there was a decreasing trend in the percentage of documented physical examinations performed, but an increasing trend in the percentage of investigations ordered. CONCLUSION There was poor assessment of the patients’ CVD risk factors, secondary causes of hypertension and TOD at their first clinic visit for hypertension. The trends observed in the assessment suggest an over-reliance on investigations over clinical examinations

Epidemiological and evolutionary dynamics of influenza B viruses in Malaysia, 2012-2014

10.1371/journal.pone.0136254PLoS ONE108e013625

Performance of a taqman assay for improved detection and quantification of human rhinovirus viral load

10.1038/srep34855Scientific Reports63485