Correction to: Vilnius Declaration on chronic respiratory diseases: multisectoral care pathways embedding guided self-management, mHealth and air pollution in chronic respiratory diseases

An amendment to this paper has been published and can be accessed via the original article.

Vilnius Declaration on chronic respiratory diseases: multisectoral care pathways embedding guided self-management, mHealth and air pollution in chronic respiratory diseases

Background

Over 1 billion people suffer from chronic respiratory diseases such as asthma, COPD, rhinitis and rhinosinusitis. They cause an enormous burden and are considered as major non-communicable diseases. Many patients are still uncontrolled and the cost of inaction is unacceptable. A meeting was held in Vilnius, Lithuania (March 23, 2018) under the patronage of the Ministry of Health and several scientific societies to propose multisectoral care pathways embedding guided self-management, mHealth and air pollution in selected chronic respiratory diseases (rhinitis, chronic rhinosinusitis, asthma and COPD). The meeting resulted in the Vilnius Declaration that was developed by the participants of the EU Summit on chronic respiratory diseases under the leadership of Euforea.

Conclusion

The Vilnius Declaration represents an important step for the fight against air pollution in chronic respiratory diseases globally and has a clear strategic relevance with regard to the EU Health Strategy as it will bring added value to the existing public health knowledge.

Open access for operational research publications from low- and middle-income countries: who pays?

Open-access journal publications aim to ensure that new knowledge is widely disseminated and made freely accessible in a timely manner so that it can be used to improve people's health, particularly those in low- and middle-income countries. In this paper, we briefly explain the differences between closed- and open-access journals, including the evolving idea of the 'open-access spectrum'. We highlight the potential benefits of supporting open access for operational research, and discuss the conundrum and ways forward as regards who pays for open access.

The looming epidemic of diabetes-associated tuberculosis: learning lessons from HIV-associated tuberculosis

The prevalence of diabetes mellitus is increasing at a dramatic rate, and countries in Asia, particularly India and China, will bear the brunt of this epidemic. Persons with diabetes have a significantly increased risk of active tuberculosis (TB), which is two to three times higher than in persons without diabetes. In this article, we argue that the epidemiological interactions and the effects on clinical presentation and treatment resulting from the interaction between diabetes and TB are similar to those observed for human immunodeficiency virus (HIV) and TB. The lessons learned from approaches to reduce the dual burden of HIV and TB, and especially the modes of screening for the two diseases, can be adapted and applied to the screening, diagnosis, treatment and prevention of diabetes and TB. The new World Health Organization (WHO) and The Union Collaborative Framework for care and control of TB and diabetes has many similarities to the WHO Policy on Collaborative Activities to reduce the dual burden of TB and HIV, and aims to guide policy makers and implementers on how to move forward and combat this looming dual epidemic. The response to the growing HIV-associated TB epidemic in the 1980s and 1990s was slow and uncoordinated, despite clearly articulated warnings about the scale of the forthcoming problem. We must not make the same mistake with diabetes and TB. The Framework provides a template for action, and it is now up to donors, policy makers and implementers to apply the recommendations in the field and to 'learn by doing'.

Health systems that serve: what's the bottom line?

SETTING

Health services in low- and middle-income countries.

BACKGROUND

The Global Plan to Stop TB, 2006-2015.

OBJECTIVE

Using a framework for evaluation of public health systems, to evaluate evidence that tuberculosis (TB) services contribute to strengthening the health systems.

DESIGN

Critical evaluation of published material.

RESULTS

The Global Plan to Stop TB 2006-2015 identifies strengthening the health systems as one of its components. Published material illustrates substantial improvement of quality of TB services over the past decade. However, even where these services have achieved a high level of quality, there is little evidence to indicate that other health services in the same locations show similar quality.

CONCLUSION

Policies, strategies and actions to strengthen health systems through TB services will require specific plans and priorities to achieve their objectives; this will not occur as a natural effect of improving TB services.

Access to inhaled corticosteroids is key to improving quality of care for asthma in developing countries

Asthma is a worldwide public health problem affecting about 300 million people. The majority of persons living with asthma are in the developing world where there is limited access to essential drugs. The financial burden for persons living with asthma and their families, as well as for healthcare systems and governments, is very high. Inadequate treatment and the high cost of medications leads to disability, absenteeism and poverty. Despite the existence of effective asthma medications and international guidelines, and progress made in the implementation of such guidelines over the last decade, the high cost of essential asthma medications remains a major obstacle for patient access to treatment in developing countries. The International Union Against Tuberculosis and Lung Disease has evaluated this problem and created an Asthma Drug Facility (ADF) so that countries can purchase affordable, good quality essential drugs for asthma. The ADF uses pooled procurement along with other purchasing and supply strategies to obtain the lowest possible prices. Accompanied by the implementation of standardized asthma management, the increased affordability of drugs provided by the ADF should bring rapid and significant health and cost benefits for patients, their communities and governments.

Impact of a model training course for private and public specialist physicians in El Salvador

BACKGROUND

Private and non-private specialist practitioners are often considered an obstacle to the performance of the National Tuberculosis Control Programme (NTP).

OBJECTIVE

To evaluate the impact of an intensive refresher course directed at specialist physicians in El Salvador, a questionnaire was sent to all course participants on their basic knowledge of tuberculosis (TB) control.

RESULTS

Of 64 participants, 55 were assessed (86%); 33 were chest physicians and 22 belonged to other related specialities. The evaluation showed a considerable improvement in both groups in their ability to suspect the disease, in their tendency to avoid hospitalising patients and instead refer them to out-patient clinics, and in their adherence to the recommendations of the NTP manual (diagnostic procedures, treatment guidelines, case notification and cohort studies). Improvements were more noticeable, in all the parameters evaluated, among the non-chest physicians.

CONCLUSION

The intervention model succeeded in improving the collaboration of private and non-private specialist practitioners with the NTP.

Towards elimination of tuberculosis in a low income country: the experience of Cuba, 1962-97

BACKGROUND

This study describes the epidemiological trends of tuberculosis in Cuba and the performance of the tuberculosis control programme. The circumstances that caused an increase in the incidence of new cases of tuberculosis between 1991 and 1994 had been analysed and were corrected in 1995-7.

METHODS

A descriptive study of the incidence rates of new cases of tuberculosis notified from 1962 to 1997 was made, with special emphasis on the total change between 1965 and 1991 and the increase thereafter.

RESULTS

The case notification rate of 14.7 per 100 000 in 1994 was almost three times the rate found in 1991 (4.8 per 100 000) and reversed the mean annual decrease of 5% observed since 1965. This increase was almost twofold in the rate of smear positive new cases (4.4 per 100 000 in 1991 and 8.3 in 1994). From 1971 onwards the programme had achieved a cure rate of 90% throughout the country with only 2% absconding by applying directly observed treatment. The main factors associated with the increasing trends were: (1) a probable underdetection of cases for the 1988-92 period that generated contagious sources in the community; (2) improved case finding from 1993 onwards and the introduction of an expanded case definition in 1994; (3) a considerable increase in the diagnostic delay from initial medical consultation to beginning of antituberculosis treatment (56.9 days in 1993); and (4) operational changes in the tuberculosis control programme due to the economic crisis in Cuba. In 1995, 1996 and 1997 it has been possible to reverse this trend, achieving rates of 14.1, 13.5, and 12.2 per 100 000, respectively (7. 6, 7.6, and 6.9 for smear positive cases) as a result of effective intervention correcting the problems identified. Reducing the diagnostic delay attributable to shortcomings in the health care system and the study of contacts were of particular importance for re-establishing the tuberculosis programme as a priority.

CONCLUSIONS

Cuba represents a good example of how it is possible to fight against tuberculosis effectively, even in a low income country, by applying control strategies advocated by the World Health Organisation and the International Union Against Tuberculosis and Lung Disease and by giving adequate support to the programme through political commitment.

[Epidemiologic trends in tuberculosis]

More than 90% of all tuberculosis cases occur in developing countries. Incidence rates estimated by WHO vary from 23 per 100,000 in industrialized countries to 191 per 100,000 in Africa and 237 per 100,000 in South East Asia. the downward trend observed in most industrialized counties in the 1970's and 1980's caused a neglect that nearly made tuberculosis a forgotten disease among the medical profession and policy makers. Ths neglect has led to a catastrophe in certain large cities in the United States. The resurgence of tuberculosis can not be attributed to the HIV/AIDS epidemic alone but also to the dismantling of health care structures responsible for tuberculosis control in certain countries.

[HIV infection: survey among practicing physicians in Bern]

With increasing numbers of HIV-infected patients, practitioners will play a crucial role in the prevention of HIV infection and in the care of infected persons. To assess the need for accurate education programs we investigated by questionnaire the current practice, attitudes and knowledge of 1057 practitioners (general, internists, surgeons, dermatologists, gynecologists), on care, prevention and treatment of HIV infection and HIV-related problems in the Canton of Berne (population 1 million), Switzerland. 65% of the practitioners provided completely evaluable responses. More than 90% had already prescribed HIV tests by the end of 1989. A majority rejected routinely performed tests (e.g. for all pregnant women, for all patients before surgery). Only about 50% considered a patient's informed consent mandatory before each test. Primary prevention by sexual history-taking was only rarely done in current practice. All recommendations from the Swiss "Stop Aids" campaign were supported, and even experimental measures such as allowing i.v. drug use in street corner agencies or controlled distribution of heroin were supported by the majority. Mandatory testing of risk groups was favored by about 50% but almost nobody wanted to establish name records of persons with risk behaviour. By the end of 1989 about one third of practitioners regularly cared for HIV-infected persons. Most practitioners would prefer to care independently for asymptomatic HIV-infected persons, but would favor a specialist support when caring for symptomatic patients. Lack of medical skills and knowledge was the main reason for their reluctance in caring for patients. Skilled and experienced practitioners were more prone to care for additional patients and were more active in prevention. Knowledge about HIV transmission, HIV-related complications and treatment was good among general practitioners and internists. However, there was some confusion about the indications for active vaccination in Aids patients. The readiness of Bern practitioners to care for HIV-infected persons is already large and could be increased by improving their medical knowledge. However, it is unlikely that more medical information alone will improve their prevention activities. It appears that education programs aimed at improving the prevention activities of practitioners are best designed and performed by their skilled and experienced colleagues.

[Medical examination of asylum seekers at entry]

It was the purpose of this analysis to summarize the salient findings made with the initial medical examination of asylum seekers in Switzerland. The evaluation covered the period from 1984 to 1987. The epidemiologic impact of diseases discovered by this screening and the logistic problems encountered with the decentralization of the program have required a modification and a reassessment of the necessary measures. As a consequence, indiscriminate stool examinations for bacteria and parasites have been abandoned. These examinations had required a considerable investment which is not considered to be justified by the limited epidemiologic significance of these intestinal pathogens. More emphasis is being placed on improved tuberculosis control measures, by providing concise guidelines for screening, prevention, and treatment. A simplified procedure for hepatitis B screening is to be maintained for the time being, conditional upon special emphasis on children, adolescents and adults of reproductive age groups. Hepatitis B vaccination of seronegative persons is a part of the standard basic immunization program. The core of the screening program and the delivery of initial preventive measures is to be carried out in the federal registration and transit centers for asylum seekers.

[Epidemiology of tuberculosis in Switzerland]

Mortality for tuberculosis declined from an average of 7.5% per year in 1952 to 1.7 in 1988, tuberculosis incidence declined by 5 to 6% per year since 1945 to 17.4% in 1988, and the annual risk of infection declined by 11.4% per year since 1945 to 10.9 per 100,000 inhabitants respectively. The crude prevalence of tuberculous infection in the Swiss population is estimated to be 22.3% for the year 1990. The age-specific prevalence of infection is mirrored in age-specific morbidity. Among Swiss citizens, tuberculosis has become a disease of the elderly and is on the brink of elimination. In contrast, tuberculosis among foreigners (40% of cases in 1988) occurs mainly among the young who experience a more than 10-fold elevated risk compared to their Swiss age peers. These data suggest that case-finding and contact investigations are the major intervention tools against tuberculosis in the Swiss population. The increased tuberculosis risk among foreigners and the young age of these patients suggest that identification of those at high risk and their preventive treatment will have to be pursued actively.

[Epidemiology of legionnaires' disease in Switzerland in 1988]

Both sporadic cases and outbreaks of legionnaire's disease have been reported. To date, no outbreaks have occurred but several case reports have been published in Switzerland. The newly organized surveillance system of notifiable diseases, introduced in 1987, makes it possible for the first time to analyze reported sporadic cases more precisely. In 1988, the laboratories reported a total of 32 cases with cultural or serologic proof of legionellosis. In 75% of cases patients were aged over 40 years, 78% occurred among males. The majority of them were known to be smokers. In 9 cases an underlying predisposing condition was known: hairy cell leukemia (3 cases), immune hemolytic anemia (1), type 2 diabetes (2), chronic lung disease (1), heart failure (1). The case fatality was 9%. A possible source of exposure, such as air-conditioned rooms or evaporative condensers, was reported in 4 cases.