Strengthening international health co-operation in Africa through the regional economic communities

The Regional Economic Communities (RECs) are the pillars of the African Union (AU), and have been recognized by the AU as the key vehicles for economic integration and cooperation in Africa. The 2003 Session of the AU Conference of African Ministers of Health (CAMH) considered and adopted, inter alia, recommendations on a proposal to establish Health and Social Affairs Desks within the RECs. The 2003 Maputo Session of the Assembly of AU Heads of State and Government duly endorsed the Report of the Ministers and their recommendations. This paper represents an attempt to assess the extent to which the 2003 decision of CAMH has been implemented. It also argues that regional integration and cooperation should not be geared solely towards economic, trade or political purposes (but to the social sector as well), and proposes a set of criteria as useful starting points for determining which social (i.e. health) activities can be undertaken at the regional and sub-regional levels. Finally, it also proposes various programmatic options to be considered in strengthening the roles of the RECs in regional integration and cooperation in the social sector (in the context of NEPAD), as Health Desks are established within the RECs

Randomised short-term trial of high-span versus low-span APAP for treating sleep apnoea

PURPOSE: Auto-titrating continuous positive airway pressure (APAP) devices were developed to improve treatment efficacy and compliance in patients with obstructive sleep apnoea syndrome (OSAS). Since there are insufficient data on the optimal pressure range setting, we aimed to compare the adherence, efficacy and tolerability of treatment with high-span versus low-span APAP. METHODS: Seventy-six newly diagnosed OSAS patients fulfilling the treatment criteria were randomised to receive high-span (HS, range 4-15cmH2O, n?=?38) or low-span (LS, range 8-12cmH2O, n?=?38) APAP. Patients were assessed at 1 and 3 months. RESULTS: Median Epworth sleepiness scale (ESS) was 13 (IQR, 6-16) and median apnoea-hypopnoea index (AHI) was 35.9 (IQR, 27.6-56.3). There were no significant differences in baseline demographic and clinical characteristics between groups. Overall, no significant differences were found at the first month assessment. After 3 months of therapy, we found again no differences in residual AHI or ESS. However, the group HS proved less adherent than group LS, respectively, with median 87 % (IQR, 60.5-97.5) versus 94 % (IQR, 80.0-98.3) of the nights using =4 h (P?=?0.014) and mean (±SD) usage 5.7?±?1.6 versus 6.4?±?1.2 h/night (P?=?0.049). The group HS reported more frequently nasal congestion, excessive oronasal dryness and nocturnal awakenings of at least moderate intensity, the latter with statistical significance (P?=?0.005). CONCLUSIONS: Both pressure ranges appear to be equally effective to correct AHI and to improve symptoms. Though, patients with high-span APAP were less compliant to treatment, raising issues about the tolerability of wide pressure range settings of these devices.T Pinto has received financial support from Linde and Vitalaire (Healthcare Providers) for attending symposia and honoraria for speaking at symposia from Philips. After the conclusion of the study, JC Winck has started working in a global position for Linde. The remaining authors declare that they have no conflict of interest

Impact of distinct poxvirus infections on the specificities and functionalities of CD4+ T cell responses.

UNLABELLED: The factors that determine CD4+ T cell (TCD4+) specificities, functional capacity, and memory persistence in response to complex pathogens remain unclear. We explored these parameters in the C57BL/6 mouse through comparison of two highly related (\u3e92% homology) poxviruses: ectromelia virus (ECTV), a natural mouse pathogen, and vaccinia virus (VACV), a heterologous virus that nevertheless elicits potent immune responses. In addition to elucidating several previously unidentified major histocompatibility complex class II (MHC-II)-restricted epitopes, we observed many qualitative and quantitative differences between the TCD4+ repertoires, including responses not elicited by VACV despite complete sequence conservation. In addition, we observed functional heterogeneity between ECTV- and VACV-specific TCD4+ at both a global and individual epitope level, particularly greater expression of the cytolytic marker CD107a from TCD4+ following ECTV infection. Most striking were differences during the late memory phase where, in contrast to ECTV, VACV infection failed to elicit measurable epitope-specific TCD4+ as determined by intracellular cytokine staining. These findings illustrate the strong influence of epitope-extrinsic factors on TCD4+ responses and memory. IMPORTANCE: Much of our understanding concerning host-pathogen relationships in the context of poxvirus infections stems from studies of VACV in mice. However, VACV is not a natural mouse pathogen, and therefore, the relevance of results obtained using this model may be limited. Here, we explored the MHC class II-restricted TCD4+ repertoire induced by mousepox (ECTV) infection and the functional profile of the responding epitope-specific TCD4+, comparing these results to those induced by VACV infection under matched conditions. Despite a high degree of homology between the two viruses, we observed distinct specificity and functional profiles of TCD4+ responses at both acute and memory time points, with VACV-specific TCD4+ memory being notably compromised. These data offer insight into the impact of epitope-extrinsic factors on the resulting TCD4+ responses

Open Banking API Security: Anomalous Access Behaviour

Third-party providers pose a significant risk for financial institutions owing to the manner in which banks expose their API to the public. Such threats include inadequate authentication, malicious injections, unsecure key handling. Therefore, financial institutions must adopt a series of countermeasures to mitigate threats exposed by third-party providers, and anomaly detection is considered one such method. In this paper, we develop random forests and a linear kernel SVM to compare the accuracy of our models in predicting anomalous user access behaviour. A dataset that presents users' access behaviour as a numerical feature, including raw API call graphs, is utilised as a case study in this paper. Our novel approach of identifying a risk score and predicting it with a deep neural network showed a high degree of accuracy when the risk scores were developed as a multi-class classification proble

Detecting Open Banking API Security Threats Using Bayesian Attack Graphs

Particularly amid Covid-19, enterprises' digital transformation has rapidly accelerated, making cybersecurity an even bigger challenge. Financial institutions adopt FinTech technologies to advance their service and achieve an enhanced customer experience that creates a competitive edge in the market. FinTech products utilise open banking API services to allow communication between a financial institution and a FinTech provider. However, such an integration introduces significant security concerns. Therefore, financial firms must ensure that a robust API service to protect the bank's infrastructure and its customers' information. To address this concern, we propose a Framework for Open Banking API security that utilises STRIDE model to identify security threats in FinTech integration via Open Banking API and Bayesian Attack Graphs to automate predictions of the most exploitable attack paths

A multinational study of treatment failures in asthma management

EmSetting: Emergency rooms. Objective: To assess quality of care and its determinants for asthma patients before emergency room treatment. Design: Consecutive patients with acute severe asthma attending emergency rooms were questioned about the severity of their disease and treatment in the previous 4 weeks. Prescriptions of inhaled corticosteroids were recorded. Other outcomes included self-reported adherence to treatment and loss of work. Results: Thirteen centres in 11 countries recruited 1156 patients. Only 36% of patients with persistent asthma had been prescribed an adequate dose of inhaled corticosteroids. This percentage improved in those receiving regular care from the same doctor (OR 2.86, 95%CI 1.38-5.96), and was at least as good for the 10% of patients receiving 'private' health care (OR 3.08, 95%CI 1.69-5.62). Forty-four per cent of patients had health insurance covering some asthma medications. These patients were more likely to be receiving adequate inhaled corticosteroids (OR 1.74, 95%CI 1.17-2.58), and reported better adherence than those without insurance (OR 3.00, 95%CI 1.64-5.50). Of those on adequate inhaled corticosteroids, 18% had lost work in each of the 4 previous weeks compared with 59% among those more than one treatment step below the recommended dose.ergency rooms. Conclusions: Access to adequate treatment is critical for better management of asthma

Oral health knowledge and behavior among male health sciences college students in Kuwait

BACKGROUND: Health auxiliary personnel have an important role in oral health promotion when they graduate and start working in the health care system. This study aims to find out oral health knowledge and oral health behavior of male Health Sciences College students. METHODS: A questionnaire was distributed to all students at the male Health Sciences College in Kuwait (N = 153) during the academic year 2001/2002. The students filled the anonymous questionnaire in the class after the lecture. The response rate was 84% (n = 128). The questions consisted information on the general background, oral health behavior and oral health knowledge. RESULTS: Oral health knowledge seemed to be limited and very few background factors were associated with it. More than half of the students had visited a dentist during the previous 12 months, but only one third of students were brushing twice a day or more often. CONCLUSIONS: It may be concluded that the male Health Sciences College students seemed to have appropriate knowledge on some oral health topics, but limited knowledge on the others. Their toothbrushing practices are still far behind the international recommendation (twice a day) and also the knowledge, why it should be done so frequently also very limited

Seasonality in pulmonary tuberculosis among migrant workers entering Kuwait

<p>Abstract</p> <p>Background</p> <p>There is paucity of data on seasonal variation in pulmonary tuberculosis (TB) in developing countries contrary to recognized seasonality in the TB notification in western societies. This study examined the seasonal pattern in TB diagnosis among migrant workers from developing countries entering Kuwait.</p> <p>Methods</p> <p>Monthly aggregates of TB diagnosis results for consecutive migrants tested between January I, 1997 and December 31, 2006 were analyzed. We assessed the amplitude (<it>α</it>) of the sinusoidal oscillation and the time at which maximum (<it>θ</it>°) TB cases were detected using Edwards' test. The adequacy of the hypothesized sinusoidal curve was assessed by <it>χ</it>²goodness-of-fit test.</p> <p>Results</p> <p>During the 10 year study period, the proportion (per 100,000) of pulmonary TB cases among the migrants was 198 (4608/2328582), (95% confidence interval: 192 – 204). The adjusted mean monthly number of pulmonary TB cases was 384. Based on the observed seasonal pattern in the data, the maximum number of TB cases was expected during the last week of April (<it>θ</it>° = 112°; <it>P </it>< 0.001). The amplitude (± se) (<it>α </it>= 0.204 ± 0.04) of simple harmonic curve showed 20.4% difference from the mean to maximum TB cases. The peak to low ratio of adjusted number of TB cases was 1.51 (95% CI: 1.39 – 1.65). The <it>χ</it>²goodness-of-test revealed that there was no significant (<it>P </it>> 0.1) departure of observed frequencies from the fitted simple harmonic curve. Seasonal component explained 55% of the total variation in the proportions of TB cases (100,000) among the migrants.</p> <p>Conclusion</p> <p>This regularity of peak seasonality in TB case detection may prove useful to institute measures that warrant a better attendance of migrants. Public health authorities may consider re-allocation of resources in the period of peak seasonality to minimize the risk of <it>Mycobacterium tuberculosis </it>infection to close contacts in this and comparable settings in the region having similar influx of immigrants from high TB burden countries. Epidemiological surveillance for the TB risk in the migrants in subsequent years and required chemotherapy of detected cases may contribute in global efforts to control this public health menace.</p