Novel study design to assess the utility of the copd assessment test in a primary care setting

The quality of a consultation provided by a physician can have a profound impact on the quality of care and patient engagement in treatment decisions. When the COPD Assessment Test (CAT) was developed, one of its aims was to aid the communication between physician and patient about the impact of COPD. We developed a novel study design to assess this in a primary care consultation. Primary care physicians across five countries in Europe conducted videoed consultations with six standardised COPD patients (played by trained actors) which had patient-specific issues that the physician needed to identify through questioning. Half the physicians saw the patients with the completed CAT, and half without. Independent assessors scored the physicians on their ability to identify and address the patient-specific issues, review standard COPD aspects, their understanding of the case and their overall performance. This novel study design presented many challenges which needed to be addressed to achieve an acceptable level of robustness to assess the utility of the CAT. This paper discusses these challenges and the measures adopted to eliminate or minimise their impact on the study results

Measuring client satisfaction and the quality of family planning services: A comparative analysis of public and private health facilities in Tanzania, Kenya and Ghana

Public and private family planning providers face different incentive structures, which may affect overall quality and ultimately the acceptability of family planning for their intended clients. This analysis seeks to quantify differences in the quality of family planning (FP) services at public and private providers in three representative sub-Saharan African countries (Tanzania, Kenya and Ghana), to assess how these quality differentials impact upon FP clients' satisfaction, and to suggest how quality improvements can improve contraceptive continuation rates.\ud Indices of technical, structural and process measures of quality are constructed from Service Provision Assessments (SPAs) conducted in Tanzania (2006), Kenya (2004) and Ghana (2002) using direct observation of facility attributes and client-provider interactions. Marginal effects from multivariate regressions controlling for client characteristics and the multi-stage cluster sample design assess the relative importance of different measures of structural and process quality at public and private facilities on client satisfaction. Private health facilities appear to be of higher (interpersonal) process quality than public facilities but not necessarily higher technical quality in the three countries, though these differentials are considerably larger at lower level facilities (clinics, health centers, dispensaries) than at hospitals. Family planning client satisfaction, however, appears considerably higher at private facilities - both hospitals and clinics - most likely attributable to both process and structural factors such as shorter waiting times and fewer stockouts of methods and supplies. Because the public sector represents the major source of family planning services in developing countries, governments and Ministries of Health should continue to implement and to encourage incentives, perhaps performance-based, to improve quality at public sector health facilities, as well as to strengthen regulatory and monitoring structures to ensure quality at both public and private facilities. In the meantime, private providers appear to be fulfilling an important gap in the provision of FP services in these countries

Herbal supplements in the print media: communicating benefits and risks

Background The rise in use of food supplements based on botanical ingredients (herbal supplements) is depicted as part of a trend empowering consumers to manage their day-to-day health needs, which presupposes access to clear and accurate information to make effective choices. Evidence regarding herbal supplement efficacy is extremely variable so recent regulations eliminating unsubstantiated claims about potential effects leave producers able to provide very little information about their products. Medical practitioners are rarely educated about herbal supplements and most users learn about them via word-of-mouth, allowing dangerous misconceptions to thrive, chief among them the assumption that natural products are inherently safe. Print media is prolific among the information channels still able to freely discuss herbal supplements. Method This study thematically analyses how 76 newspaper/magazine articles from the UK, Romania and Italy portray the potential risks and benefits of herbal supplements. Results Most articles referenced both risks and benefits and were factually accurate but often lacked context and impartiality. More telling was how the risks and benefits were framed in service of a chosen narrative, the paucity of authoritative information allowing journalists leeway to recontextualise herbal supplements in ways that serviced the goals and values of their specific publications and readerships. Conclusion Providing sufficient information to empower consumers should not be the responsibility of print media, instead an accessible source of objective information is required.</p

Synthesis and Characterization of Orange Peel Modified Hydrogels as Efficient Adsorbents for Methylene Blue (MB)

In recent years, due to the developments in the textile industry, water contaminated with synthetic dyes such as methylene blue (MB) has become an environmental threat based on the possible impacts in terms of chemical and biochemical demand, which leads to disturbance in aquatic plants photosynthesis, besides their possible toxicity and carcinogenicity for humans. In this work, an adsorbent hydrogel is prepared via free radical polymerization comprising acrylic acid (PAA) as a monomer and orange peel (OP) as a natural modifier rich in OH and COOH present in its cellulose and pectin content. The resulting hydrogels were optimized in terms of the content of OP and the number of cross-linkers and characterized morphologically using Scanning electron microscopy. Furthermore, BET analysis was used to follow the variation in the porosity and in terms of the surface area of the modified hydrogel. The adsorption behavior was found to follow pseudo-second-order as a kinetic model, and Langmuir, Freundlich, and Temkin isotherm models. The combination of OP and PAA has sharply enhanced the adsorption percent of the hydrogel to reach 84% at the first 10 min of incubation with an adsorption capacity of more than 1.93 gm/gm. Due to its low value of pHPZc, the desorption of MB was efficiently performed at pH 2 using HCl, and the desorbed OP-PAA were found to be reusable up to ten times without a decrease in their efficiency. Accordingly, OP-PAA hydrogel represents a promising efficient, cost-effective, and environmentally friendly adsorbent for MB as a model cationic dye that can be applied for the treatment of contaminated waters

The prevalence of osteoarthritis in rural Egypt: a WHO-ILAR COPCORD study

Objective: Osteoarthritis (OA) is the commonest form of arthritis affecting every population and ethnic group. The prevalence of OA and its types however varies in different studies according to the population studied, the denominator age of the population and the criteria used to define OA, whether clinical or radiological or both. This study was carried out to investigate the prevalence of OA and its types in a rural area of Egypt as part of a large study examining the prevalence of rheumatic diseases in Egypt. Methods: The study was conducted in Makosa village of Al-Minia governorate in Southern Egypt in 4 phases. Of the whole adult population (15 years and above) comprising 5208 individuals, 88 (1.7%) declined to participate in the study and 5120 subjects (98.7%, 2562 female and 2558 male) were screened by a preliminary WHO-ILAR-COPCORD questionnaire inquiring about joint and bone pain, swelling, stiffness or tenderness in the last 7 days. Those who answered positively were administered a more detailed questionnaire and invited for examination and laboratory and radiological investigations as required. A rheumatologist administered the 2 questionnaires face-to-face and carried out examinations to ensure reliability and validity of data collection. Consequently, OA cases were diagnosed according to validated criteria (1986 clinical ACR criteria for OA of the knee, 1986 ACR criteria for OA of the hand and 1991 ACR criteria for OA of the hip). Results: OA was the commonest rheumatic disease in the population, with OA cases constituting more than half of patients with rheumatic diseases, whether female (53.2%), male (50.8%) or total (52.4%). Osteoarthritis was diagnosed in 434 individuals, with a prevalence of 8.5% in the total adult population (95% CI: 7.7–9.1%). The prevalence of OA was significantly higher in females (10.9%) than males (6.1%) (p < 0.001). Local OA was the commonest type of OA diagnosed (6.3%), while the prevalence of primary generalized OA (nodal and non-nodal) was 1.5%, and secondary OA was found in 0.6% of the population. Regardless of type, the knee was afflicted in the majority of cases, with knee OA diagnosed in 8.1% of the population, while the prevalence of hand OA was 1.5%. Hip OA was rare, being diagnosed in only 3 cases (0.06%). Conclusion: OA is the commonest rheumatic disease in Egypt, with a prevalence of 8.5%. The disease is more common in females than males and predominantly affects the knees, while hip OA is extremely rare

Toxicity and Repellency Efficacy of Benzyl Alcohol and Benzyl Benzoate as Eco-Friendly Choices to Control the Red Flour Beetle <i>Tribolium castaneum</i> (Herbst. 1797)

Tribolium castaneum is a damaging pest of stored grains, causing significant losses and secreting lethal quinones, which render the grains unfit for human consumption. Chemical insecticides are the most commonly used approach for control; however, they create insecticide resistance and affect the health of humans, animals, and the environment. As a result, it is critical to find an environmentally friendly pest-management strategy. In this study, two naturally occurring chemicals, benzyl alcohol (BA) and benzoyl benzoate (BB), were investigated for insecticidal activity against T. castaneum using different assays (impregnated-paper, contact toxicity, fumigant, and repellency assays). The results showed that BA had a significant insecticidal effect, with the LC50 achieved at a lower concentration in the direct-contact toxicity test (1.77%) than in the impregnated-paper assay (2.63%). BB showed significant effects in the direct-contact toxicity test, with an LC50 of 3.114%, and a lower toxicity in the impregnated-paper assay, with an LC50 of 11.75%. Furthermore, BA exhibited significant fumigant toxicity against T. castaneum, with an LC50 of 6.72 µL/L, whereas BB exhibited modest fumigant toxicity, with an LC50 of 464 µL/L. Additionally, at different concentrations (0.18, 0.09, 0.045, and 0.0225 µL/cm2), BA and BB both showed a notable and potent repelling effect. BA and BB significantly inhibited acetylcholinesterase, reduced glutathione (GSH), and increased malondialdehyde (MDA) in treated T. castaneum. This is the first report of BA insecticidal activity against the red flour beetle. Also, the outcomes of various assays demonstrated that the application of BA induces a potent bio-insecticidal effect. BA may be a promising eco-friendly alternative to control T. castaneum due to its safety and authorization by the EFSA (European Food Safety Authority)

Detection of pyrrolizidine alkaloids in German licensed herbal medicinal teas

BACKGROUND: Because of the hepatotoxic, mutagenic, and cancerogenic effects of pyrrolizidine alkaloids (PAs) the German Federal Institute for Risk Assessment (BfR) recommends not to exceed a daily PA intake of 0.007 µg/kg body weight (0.42 µg/60 kg adult). In a recent study conducted by the BfR, up to 5647 µg PA/kg dried herbal material were detected in tea products marketed as food. PURPOSE: The present study aimed at elucidating whether medicinal teas licensed or registered as medicinal products contain PAs as well. STUDY DESIGN: One hundred sixty-nine different commercially available medicinal teas, i.e. 19 nettle (Urtica dioica L.), 12 fennel (Foeniculum vulgare Mill.), 14 chamomile (Matricaria recutita L.), 11 melissa (Melissa officinalis L.) and 4 peppermint (Mentha piperita L.) teas as well as 109 tea mixtures were analyzed for the presence of 23 commercially available PAs. METHOD: LC/MS was used for the determination of the PAs RESULTS: In general, the total PA contents ranging 0-5668 µg/kg. Thirty percent of the tested single-ingredient tea products and 56.9% of the tested medicinal tea mixtures were found to contain PA concentrations above the limit of quantification (LOQ) of 10 µg/kg. In 11 medicinal teas PA contents >300 µg/kg dry herb were determined thus exceeding the recommended limit for PA intake by BfR. In addition three products of the investigated tea mixtures revealed extremely high PA contents of 4227, 5137, and 5668 µg/kg. Generally, single-ingredient tea products contained much less or even no detectable amounts of PAs when compared to the tea mixtures. PAs in the range between 13 and 1080 µg/kg were also detected in five analyzed aqueous herbal infusions of the medicinal tea mixture products with the highest PA content. Two out of the five investigated herbal infusions exceeded the recommended BfR limit for PA intake. CONCLUSION: This study demonstrates clearly that also medicinal teas licensed as medicinal products may partly contain high amounts of PAs exceeding current recommendations. For that reason manufacturers are advised to carry out more rigorous quality control tests devoted to the detection of PAs. This is very important to minimize PAs in medicinal teas accounting for possible additional exposure of the consumer to PAs from other food sources (e.g. honey)