Variability in interpretation of chest radiographs among Russian clinicians and implications for screening programmes: observational study.

OBJECTIVE: To determine variability in interpretation of chest radiographs among tuberculosis specialists, radiologists, and respiratory specialists. DESIGN: Observational study. SETTING: Tuberculosis and respiratory disease services, Samara region, Russian Federation. PARTICIPANTS: 101 clinicians involved in the diagnosis and management of pulmonary tuberculosis and respiratory diseases. MAIN OUTCOME MEASURES: Interobserver and intraobserver agreement on the interpretation of 50 digital chest radiographs, using a scale of poor to very good agreement (kappa coefficient: < or = 0.20 poor, 0.21-0.40 fair, 0.41-0.60 moderate, 0.61-0.80 good, and 0.81-1.00 very good). RESULTS: Agreement on the presence or absence of an abnormality was fair only (kappa = 0.380, 95% confidence interval 0.376 to 0.384), moderate for localisation of the abnormality (0.448, 0.444 to 0.452), and fair for a diagnosis of tuberculosis (0.387, 0.382 to 0.391). The highest levels of agreement were among radiologists. Level of experience (years of work in the specialty) influenced agreement on presence of abnormalities and cavities. Levels of intraobserver agreement were fair. CONCLUSIONS: Population screening for tuberculosis in Russia may be less than optimal owing to limited agreement on interpretation of chest radiographs, and may have implications for radiological screening programmes in other countries

HIGH PREVALENCE OF REACTIVE ARTHRITIS IN RUSSIA: OVERDIAGNOSIS OR REALITY?

Reactive arthritis (ReA) is one of the types of spondyloarthritis. According to the statistics reports by the Ministry of Health of Russia, the prevalence of ReA in 2013 was 42.8 per 100,000 adult population, 99, and 172.4 per 100,000 children aged 0–14 and 15–17 years, respectively. There is a wide scatter of ReA detection rates in both the federal districts and subjects of the Russian Federation, which may be associated with both the spread of sexually transmitted infections, asymptomatic trigger Chlamydia infection, and overdiagnosis of ReA

REACTIVE ARTHRITIS

At present, the problem of reactive arthritis (ReA) remains relevant in rheumatology. This is due to rather high prevalence of the disease primarily in Russia, which cannot but alarm. Analysis of epidemiological findings suggests a number of possible explanations for variability of ReA incidence rates in some regions of the Russian Federation and other countries. The lecture details the clinical presentations of the disease and analyzes the significance of different laboratory procedures aimed at detecting the pathogen of ReA. It presents Russian diagnostic criteria for ReA. It also sets forth basic approaches to ReA therapy with emphasis on the use of antimicrobial drugs. The efficiency and safety of drug immunomodulation (interferon inducers, polyoxidonium, immunofan, etc.) in treating urogenital Chlamydia infection in ReA patients are not confirmed by the data of randomized controlled trials. In this connection, it is impossible to give any recommendations for their use in urogenic ReA

Survival of Civilian and Prisoner Drug-Sensitive, Multi- and Extensive Drug- Resistant Tuberculosis Cohorts Prospectively Followed in Russia

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Идиопатическая узловатая эритема и беременность: описание случая

Erythema nodosum (EN) is a dermatosis of unclear etiology, which is characterized by vascular lesion of the skin; it shows itself as hard painful nodes occurring in the derma or subcutaneous fat on the shins and thighs. EN has been described in many chronic infectious processes with some features of its clinical course. In most cases, the disease is regarded as a nonspecific immunoinflammatory response to a wide spectrum of etiological factors, including that in gestation, which presents certain problems in curing the patient. The example given below supports the need for timely testing for infectious markers in pregnancy and, in case of evolving EN, for using not only nonsteroidal anti-inflammatory drugs, but also pathogenetic treatment.Узловатая (нодозная) эритема (УЭ) - дерматоз неясной этиологии, характеризующийся поражением сосудов кожи; проявляется возникновением в дерме или подкожной клетчатке на голенях и бедрах плотных болезненных узлов. УЭ была описана при многих хронических инфекционных процессах с некоторыми особенностями клинического течения. В большинстве случаев заболевание расценивается как неспецифический иммуновоспалительный ответ на широкий круг этиологических факторов, в том числе и при гестации, что вызывает определенные трудности курации пациента. Приводимый ниже пример подтверждает необходимость своевременного обследования на инфекционные маркеры при беременности и в случае развития УЭ применения не только нестероидных противовоспалительных препаратов, но и патогенетического лечения

Мелоксикам: перспективы примененияпри узловатой эритеме

Nonsteroidal anti-inflammatory drugs are widely used in rheumatology in the complex therapy of pain syndrome. The paper describes the pathophysiological mechanisms of development of acute and chronic pain. The action of cyclooxygenases (COX) (types 1 and 2) is detailed. The key role of COX-2 in the induction and transmission is shown. The stepwise course of meloxicam relieves pain syndrome in the shortest possible time. The presented case demonstrates the analgesic and anti-inflammatory effects of meloxicam (Movalis) in a female patient with erythema nodosum.Нестероидные противовоспалительные препараты широко используются в комплексной терапии болевого синдрома. Представлены патофизиологические механизмы развития острой и хронической боли. Подробно описаны функции циклооксигеназы (ЦОГ) 1-го и 2-го типа, показана ключевая роль ЦОГ 2 в индукции и трансмиссии боли. Ступенчатый курс терапии мелоксикамом позволяет в короткие сроки купировать болевой синдром. Представленное клиническое наблюдение демонстрирует выраженный анальгетический и противовоспалительный эффект мелоксикама (Мовалиса) у пациентки с узловатой эритемой

Ethics, politics and migration: Public debates on the free movement of Romanians and Bulgarians in the UK, 2006–2013

Public debates on immigration have become the subject of much concern, particularly in the UK. This article applies an ethical lens to assess changes in public debates over intra-EU migration in six UK national newspapers during 2006 and 2013. It finds an almost complete dominance of communitarian justifications, mainly based on welfare chauvinism, but a notable increase in security-related arguments and a decrease in economic nationalist ideas. Alternative cosmopolitan arguments about immigration go from rare to virtually absent. The discussion links these shifts to a failure of the UK centre-left to overcome historic difficulties in presenting a coherent narrative on immigration policy

Understanding informal payments in health care: motivation of health workers in Tanzania

<p>Abstract</p> <p>Background</p> <p>There is growing evidence that informal payments for health care are fairly common in many low- and middle-income countries. Informal payments are reported to have a negative consequence on equity and quality of care; it has been suggested, however, that they may contribute to health worker motivation and retention. Given the significance of motivation and retention issues in human resources for health, a better understanding of the relationships between the two phenomena is needed. This study attempts to assess whether and in what ways informal payments occur in Kibaha, Tanzania. Moreover, it aims to assess how informal earnings might help boost health worker motivation and retention.</p> <p>Methods</p> <p>Nine focus groups were conducted in three health facilities of different levels in the health system. In total, 64 health workers participated in the focus group discussions (81% female, 19% male) and where possible, focus groups were divided by cadre. All data were processed and analysed by means of the NVivo software package.</p> <p>Results</p> <p>The use of informal payments in the study area was confirmed by this study. Furthermore, a negative relationship between informal payments and job satisfaction and better motivation is suggested. Participants mentioned that they felt enslaved by patients as a result of being bribed and this resulted in loss of self-esteem. Furthermore, fear of detection was a main demotivating factor. These factors seem to counterbalance the positive effect of financial incentives. Moreover, informal payments were not found to be related to retention of health workers in the public health system. Other factors such as job security seemed to be more relevant for retention.</p> <p>Conclusion</p> <p>This study suggests that the practice of informal payments contributes to the general demotivation of health workers and negatively affects access to health care services and quality of the health system. Policy action is needed that not only provides better financial incentives for individuals but also tackles an environment in which corruption is endemic.</p

A Qualitative Assessment of Participation in a Rapid Scale-Up, Diagonally-Integrated MDG-Related Disease Prevention Campaign in Rural Kenya

Background: Many countries face severe scale-up barriers toward achievement of MDGs. We ascertained motivational and experiential dimensions of participation in a novel, rapid, ‘‘diagonal’ ’ Integrated Prevention Campaign (IPC) in rural Kenya that provided prevention goods and services to 47,000 people within one week, aimed at rapidly moving the region toward MDG achievement. Specifically, the IPC provided interventions and commodities targeting disease burden reduction in HIV/ AIDS, malaria, and water-borne illness. Methods: Qualitative in-depth interviews (IDI) were conducted with 34 people (18 living with HIV/AIDS and 16 not HIVinfected) randomly selected from IPC attendees consenting to participate. Interviews were examined for themes and patterns to elucidate participant experience and motivation with IPC. Findings: Participants report being primarily motivated to attend IPC to learn of their HIV status (through voluntary counseling and testing), and with receipt of prevention commodities (bednets, water filters, and condoms) providing further incentive. Participants reported that they were satisfied with the IPC experience and offered suggestions to improve future campaigns. Interpretation: Learning their HIV status motivated participants along with the incentive of a wider set of commodities that were rapidly deployed through IPC in this challenging region. The critical role of wanting to know their HIV status combine