Using telecare for diabetic patients: A mixed systematic review

ObjectiveNumerous telecare interventions and technologies are used in the management of type 2 diabetes mellitus. This systematic review examines the different telecare interventions implemented, the technologies used, as well as the outcomes. Such a synthesis serves to optimize telecare use for diabetic patients and inform decision makers on technology selection and the impacts that can be expected with telecare use.Materials and methodsFollowing a systematic, comprehensive search of databases, 2139 qualitative and quantitative studies were initially selected; after careful review and screening, 50 studies were coded and analyzed.ResultsA typology is proposed that identifies the nature of telecare interventions and technologies used as well as the outcomes associated with their use. Overall, telecare produces positive results with a variety of outcomes, such as improved health status, increased quality of care, decreased health service use or cost, increased satisfaction and increased patient knowledge.DiscussionWhile telecare is seen to have overall positive outcomes, some caveats have been identified. There is no “one size fits all” solution. Inexperience with technology combined with a mediocre user interface can create many problems that inhibit appropriate adoption of the technology. There is a growing presence of mobile technologies, which provide immediate feedback and can be integrated with social media.ConclusionThe results of this review can be used by healthcare professionals, organizations and patient support groups to tailor their policies with regard to the choice, planning, diffusion and monitoring of telecare interventions and the technologies implemented to care for patients with diabetes.     

Determinants of tuberculosis diagnosis delay in limited resources countries

BackgroundDelayed diagnoses of pulmonary tuberculosis contribute to the spread of the epidemic.MethodsThis study aims to identify risk factors associated with patient delay (from symptoms onset to the first visit), health system delay (from the first visit to the tuberculosis treatment initiation) and total delay (sum of the patient and the health system delay) in low income and high tuberculosis burden countries. A systematic literature review has been performed using the keywords: “tuberculosis”; “delay”, care seeking”; “health care seeking behavior”; “diagnosis” and “treatment”. Only quantitative studies showing delays for pulmonary tuberculosis adult cases were included in this review.ResultsLow income, gender, rural life, unemployment, ageing and misunderstanding the microbial cause of tuberculosis are associated with delayed diagnoses. Systemic factors including low health care coverage, patient expenditures and entry into the health system by consulting a traditional healer or a non-skilled professional delay the beginning of tuberculosis treatment.ConclusionDelays can be used as indicators to evaluate tuberculosis control programs. Active case finding in the households of contagious patients can help to diminish diagnostic delays in low-income countries with high endemicity.     

Efficacious,effective, and embedded interventions: Implementation research in infectious disease control

Background  

Research in infectious disease control is heavily skewed towards high end technology; development of new drugs, vaccines and clinical interventions. Oft ignored, is the evidence to inform the best strategies that ensure the embedding of interventions into health systems and amongst populations. In this paper we undertake an analysis of the challenge in the development of research for the sustainable implementation of disease control interventions.     

A Value Framework for the Assessment of Diagnostic Technologies: A Proposal Based on a Targeted Systematic Review and a Multistakeholder Deliberative Process in Latin America

Objectivesthere are very few value frameworks (VFs) to assess health technologies that are focused on diagnostic tests; they usually do not reflect a multistakeholder process; and they are all developed in high-income countries. Our project performed a targeted systematic review, with the objective of proposing an evidence-based, up-to-date VF informed by a multinational multistakeholder group working in the health technology assessment (HTA) space.Methods(1) A targeted systematic review, with the aim to identify existing VFs and their dimensions; and (2) generation a VF proposal through a mixed-methods, qualitative-quantitative approach.ResultsFrom 73 citations identified, 20 met our inclusion criteria and served to provide the initial list of dimensions for our VF. An initial list of criteria and subcriteria for a preliminary VF was proposed. After a full-day deliberative face-to-face meeting with 30 relevant stakeholders from seven Latin American countries and the United Kingdom, the final VF was defined, consisting of 15 criteria: five “essential or core,” six highly relevant, three moderately relevant, and one of low relevance. Barriers and facilitators of value assessment of diagnostic technologies were also discussed.ConclusionsWe propose a VF oriented to diagnostic technologies based on a targeted systematic review and a participatory process with key HTA stakeholders. It is the first to be produced in a lower and middle income setting but can also be potentially useful in other contexts aimed to assist decision-making processes with these particularly complex health technologies.     

Informing Balanced Investment in Services and Health Systems: A Case Study of Priority Setting for Tuberculosis Interventions in South Africa

ObjectivesHealth systems face nonfinancial constraints that can influence the opportunity cost of interventions. Empirical methods to explore their impact, however, are underdeveloped. We develop a conceptual framework for defining health system constraints and empirical estimation methods that rely on routine data. We then present an empirical approach for incorporating nonfinancial constraints in cost-effectiveness models of health benefit packages for the health sector.MethodsWe illustrate the application of this approach through a case study of defining a package of services for tuberculosis case-finding in South Africa. An economic model combining transmission model outputs with unit costs was developed to examine the cost-effectiveness of alternative screening and diagnostic algorithms. Constraints were operationalized as restrictions on achievable coverage based on: (1) financial resources; (2) human resources; and (3) policy constraints around diagnostics purchasing. Cost-effectiveness of the interventions was assessed under one “unconstrained” and several “constrained” scenarios. For the unconstrained scenario, incremental cost-effectiveness ratios were estimated with and without the costs of “relaxing” constraints.ResultsWe find substantial differences in incremental cost-effectiveness ratios across scenarios, leading to variations in the decision rules for prioritizing interventions. In constrained scenarios, the limiting factor for most interventions was not financial, but rather the availability of human resources.ConclusionsWe find that optimal prioritization among different tuberculosis control strategies in South Africa is influenced by whether and how constraints are taken into consideration. We thus demonstrate both the importance and feasibility of considering nonfinancial constraints in health sector resource allocation models.     

The Global Infectious Diseases Epidemic Information Monitoring System: Development and Usability Study of an Effective Tool for Travel Health Management in China

BackgroundObtaining comprehensive epidemic information for specific global infectious diseases is crucial to travel health. However, different infectious disease information websites may have different purposes, which may lead to misunderstanding by travelers and travel health staff when making accurate epidemic control and management decisions.ObjectiveThe objective of this study was to develop a Global Infectious Diseases Epidemic Information Monitoring System (GIDEIMS) in order to provide comprehensive and timely global epidemic information.MethodsDistributed web crawler and cloud agent acceleration technologies were used to automatically collect epidemic information about more than 200 infectious diseases from 26 established epidemic websites and Baidu News. Natural language processing and in-depth learning technologies have been utilized to intelligently process epidemic information collected in 28 languages. Currently, the GIDEIMS presents world epidemic information using a geographical map, including date, disease name, reported cases in different countries, and the epidemic situation in China. In order to make a practical assessment of the GIDEIMS, we compared infectious disease data collected from the GIDEIMS and other websites on July 16, 2019.ResultsCompared with the Global Incident Map and Outbreak News Today, the GIDEIMS provided more comprehensive information on human infectious diseases. The GIDEIMS is currently used in the Health Quarantine Department of Shenzhen Customs District (Shenzhen, China) and was recommended to the Health Quarantine Administrative Department of the General Administration of Customs (China) and travel health–related departments.ConclusionsThe GIDEIMS is one of the most intelligent tools that contributes to safeguarding the health of travelers, controlling infectious disease epidemics, and effectively managing public health in China.     

Leveraging Data and Digital Health Technologies to Assess and Impact Social Determinants of Health (SDoH): a State-of-the-Art Literature Review

ObjectiveIdentify how novel datasets and digital health technology, including both analytics-based and artificial intelligence (AI)-based tools, can be used to assess non-clinical, social determinants of health (SDoH) for population health improvement.MethodsA state-of-the-art literature review with systematic methods was performed on MEDLINE, Embase, and the Cochrane Library databases and the grey literature to identify recently published articles (2013-2018) for evidence-based qualitative synthesis. Following single review of titles and abstracts, two independent reviewers assessed eligibility of full-texts using predefined criteria and extracted data into predefined templates.ResultsThe search yielded 2,714 unique database records of which 65 met inclusion criteria. Most studies were conducted retrospectively in a United States community setting. Identity, behavioral, and economic factors were frequently identified social determinants, due to reliance on administrative data. Three main themes were identified: 1) improve access to data and technology with policy – advance the standardization and interoperability of data, and expand consumer access to digital health technologies; 2) leverage data aggregation – enrich SDoH insights using multiple data sources, and use analytics-based and AI-based methods to aggregate data; and 3) use analytics-based and AI-based methods to assess and address SDoH – retrieve SDoH in unstructured and structured data, and provide contextual care management sights and community-level interventions.ConclusionsIf multiple datasets and advanced analytical technologies can be effectively integrated, and consumers have access to and literacy of technology, more SDoH insights can be identified and targeted to improve public health. This study identified examples of AI-based use cases in public health informatics, and this literature is very limited.     

A review of health behaviour theories: how useful are these for developing interventions to promote long-term medication adherence for TB and HIV/AIDS?

Background  

Suboptimal treatment adherence remains a barrier to the control of many infectious diseases, including tuberculosis and HIV/AIDS, which contribute significantly to the global disease burden. However, few of the many interventions developed to address this issue explicitly draw on theories of health behaviour. Such theories could contribute to the design of more effective interventions to promote treatment adherence and to improving assessments of the transferability of these interventions across different health issues and settings.     

Emergency care for the elderly: A review of the application of health information technology

ObjectiveAs the need for emergency care for the elderly is increasing, applying creative solutions, such as using information technology is suggested to provide patients with more cost-effective health care services. The present study aimed to review the application of various types of health information technologies for the elderly in emergency care services.MethodsThis study was carried out in 2020. Studies related to the use of various health information technologies for the elderly in pre-hospital services and emergency departments were searched from January 2019 to end of September 2020 in the databases of PubMed, the Cochrane Library, Scopus, Web of Science, ProQuest, Ovid, and Google Scholar. Data were extracted and synthesized narratively.ResultsA total of 338 articles were collected and 21 articles were selected for further review. Six health information technologies used for the elderly in the emergency care services were emergency department information system (n = 2), clinical decision support system (n = 6), telemedicine technology (n = 7), electronic questionnaire (n = 1), electronic health records (n = 4) and personal health records (n = 1). The most common application was telemedicine technology.ConclusionAlthough a variety of health information technologies are used for caring the elderly in emergency care services, there are still valuable opportunities in this area to develop new technologies and new health policies are required to support better health care delivery.     

Assessment of knowledge and practice of health workers towards tuberculosis infection control and associated factors in public health facilities of Addis Ababa,Ethiopia: A cross-sectional study

Background

Tuberculosis is the leading causes of mortality among infectious diseases worldwide. The risk of transmission from patients to health workers is doubles that of the general population. The close contact to the infectious case before diagnosis is the major risk for tuberculosis infection. The aim of the study was to assess knowledge and practice of health professionals towards tuberculosis infection control and its associated factors in health facilities of Addis Ababa, Ethiopia.

Methods

A cross-sectional study was conducted from February 29 to April 15/2014 in selected health facilities in Addis Ababa. Five hundred ninety health workers were included in the study. The sample size was assigned to each health facility proportional to their number of health workers. Study subjects were selected from each stratum by simple random sampling technique. Interviewer administered structured questionnaire was used to collect information. Logistic regression was used to identify factors associated with knowledge and practice of health workers towards tuberculosis infection control.

Result

Five hundred eighty two participants with 98.6% response rate were involved in the study. Of these, 36.1% had poor knowledge and 51.7% unsatisfactory practice score towards tuberculosis infection control. Having more than six years working experience in health facility (AOR = 2.51; 95% CI: 1.5-4.1) and tuberculosis related training (AOR = 2.51 95% CI; 1.5, 4.1) were significantly associated with knowledge on tuberculosis infection control. Having experience in tuberculosis clinic (AOR =1.93; 95% CI: 1.12, 3.34) and tuberculosis related training (AOR = 1.48; 95% CI: 1.87, 2.51) were significantly associated with practice on tuberculosis infection control.

Conclusion

One third of health workers had relatively poor knowledge and nearly half of them had unsatisfactory practice on tuberculosis infection control. Tuberculosis training and work experiences in health facility are determinant factor to knowledge. Whereas tuberculosis related training and experience in tuberculosis clinic are predictor to practice. So, training of the health professionals, on job orientations of junior health workers, and farther study including private health workers are recommended.     

2012年北京市大兴区法定传染病监测情况

目的通过了解北京市大兴区2012年法定传染病发生情况及流行特征,为制定防制对策和措施提供科学依据。方法采用描述流行病学方法对大兴区2012年法定传染病疫情监测资料进行统计分析。结果大兴区2012年共报告法定传染病20种7 690例,报告发病率为544.12/10万,较2011年上升9%;死亡12例,死亡率0.85/10万,比2011年下降27.56%。报告发病数居前5位的病种依次为手足口病、其他感染性腹泻、肺结核、痢疾、猩红热。结论对重点疾病、重点地区和重点人群进行干预,可减少传染病的危害,保障人民群众身体健康。     

Valuing the Health States Associated with Chlamydia trachomatis Infections and Their Sequelae: A Systematic Review of Economic Evaluations and Primary Studies

ObjectivesEconomic evaluations of interventions to prevent and control sexually transmitted infections such as Chlamydia trachomatis are increasingly required to present their outcomes in terms of quality-adjusted life-years using preference-based measurements of relevant health states. The objectives of this study were to critically evaluate how published cost-effectiveness studies have conceptualized and valued health states associated with chlamydia and to examine the primary evidence available to inform health state utility values (HSUVs).MethodsA systematic review was conducted, with searches of six electronic databases up to December 2012. Data on study characteristics, methods, and main results were extracted by using a standard template.ResultsNineteen economic evaluations of relevant interventions were included. Individual studies considered different health states and assigned different values and durations. Eleven studies cited the same source for HSUVs. Only five primary studies valued relevant health states. The methods and viewpoints adopted varied, and different values for health states were generated.ConclusionsLimitations in the information available about HSUVs associated with chlamydia and its complications have implications for the robustness of economic evaluations in this area. None of the primary studies could be used without reservation to inform cost-effectiveness analyses in the United Kingdom. Future debate should consider appropriate methods for valuing health states for infectious diseases, because recommended approaches may not be suitable. Unless we adequately tackle the challenges associated with measuring and valuing health-related quality of life for patients with chlamydia and other infectious diseases, evaluating the cost-effectiveness of interventions in this area will remain problematic.     

Effectiveness of Contact Tracing for Viral Disease Mitigation and Suppression: Evidence-Based Review

BackgroundContact tracing in association with quarantine and isolation is an important public health tool to control outbreaks of infectious diseases. This strategy has been widely implemented during the current COVID-19 pandemic. The effectiveness of this nonpharmaceutical intervention is largely dependent on social interactions within the population and its combination with other interventions. Given the high transmissibility of SARS-CoV-2, short serial intervals, and asymptomatic transmission patterns, the effectiveness of contact tracing for this novel viral agent is largely unknown.ObjectiveThis study aims to identify and synthesize evidence regarding the effectiveness of contact tracing on infectious viral disease outcomes based on prior scientific literature.MethodsAn evidence-based review was conducted to identify studies from the PubMed database, including preprint medRxiv server content, related to the effectiveness of contact tracing in viral outbreaks. The search dates were from database inception to July 24, 2020. Outcomes of interest included measures of incidence, transmission, hospitalization, and mortality.ResultsOut of 159 unique records retrieved, 45 (28.3%) records were reviewed at the full-text level, and 24 (15.1%) records met all inclusion criteria. The studies included utilized mathematical modeling (n=14), observational (n=8), and systematic review (n=2) approaches. Only 2 studies considered digital contact tracing. Contact tracing was mostly evaluated in combination with other nonpharmaceutical interventions and/or pharmaceutical interventions. Although some degree of effectiveness in decreasing viral disease incidence, transmission, and resulting hospitalizations and mortality was observed, these results were highly dependent on epidemic severity (R0 value), number of contacts traced (including presymptomatic and asymptomatic cases), timeliness, duration, and compliance with combined interventions (eg, isolation, quarantine, and treatment). Contact tracing effectiveness was particularly limited by logistical challenges associated with increased outbreak size and speed of infection spread.ConclusionsTimely deployment of contact tracing strategically layered with other nonpharmaceutical interventions could be an effective public health tool for mitigating and suppressing infectious outbreaks by decreasing viral disease incidence, transmission, and resulting hospitalizations and mortality.     

2011-2016年全国6~22岁学生人群法定传染病监测数据分析

目的 分析2011-2016年全国6~22岁学生人群法定传染病发病特征,为法定传染病防控提供依据。方法 分析2011-2016年全国6~22岁学生人群法定传染病发病、死亡监测数据,对其发病主要特征进行阐述和分析。结果 2011-2016年全国6~22岁学生人群甲乙丙类传染病发病率整体呈下降趋势,从2012年最高发病率248.24/10万降至2016年158.57/10万。甲乙丙类传染病死亡率也呈下降趋势,从2011年最高死亡率0.12/10万降至2016年0.07/10万。甲乙类传染病年均发病率居前4位的病种为肺结核（16.24/10万）、猩红热（9.39/10万）、乙型肝炎（乙肝）（7.69/10万）及细菌性和阿米巴性痢疾（痢疾）（7.15/10万）。年均死亡率居前4位的病种为狂犬病（0.044 8/10万）、艾滋病（0.027 7/10万）、肺结核（0.008 0/10万）和流行性乙型脑炎（乙脑）（0.005 9/10万）。同期丙类传染病年均发病率居前4位的病种为流行性腮腺炎（75.81/10万）、手足口病（28.55/10万）、其他感染性腹泻病（22.41/10万）和流行性感冒（15.67/10万）。报告死亡的病种有手足口病（11例）、流行性感冒（9例）、流行性腮腺炎（1例）和风疹（1例）。大学生、高中生以艾滋病、乙肝、肺结核发病率较高,而小学生、初中生则以流行性腮腺炎、流行性感冒、手足口病发病率较高。结论 2011-2016年全国6~22岁学生人群法定传染病发病、死亡水平均有明显下降。学生人群面临传染病防控新的挑战,艾滋病成为大学生人群的流行传染病,肺结核在大学生、高中生人群的流行也不容忽视。     

The Effectiveness of Interactivity in Improving Mediating Variables,Behaviors and Outcomes of Web-Based Health Interventions: A Meta-Analytic Review

ABSTRACT

Despite the increasing amount of research investigating health interventions that applies to interactive computer technology, the effect sizes in Cohen’s d obtained across these studies range from ?0.32 to 1.74. The lack of systematic review of interactive health interventions leaves their overall effectiveness unknown. To address this, a meta-analysis of 67 studies examining the effects of web-based interactive health interventions was conducted. Results indicated that web-based interactive health interventions were effective in general, but the effects were moderated by health topic, theoretical framework, and design of treatment and control groups. The unique advantage of interactivity was small but significant when comparing to health interventions with comparable information in non-interactive version. Theoretical and practical implications of findings were discussed.     

The diagnosis of latent tuberculosis infection (LTBI): currently available tests,future developments,and perspectives to eliminate tuberculosis (TB)

Introduction:Despite great efforts, tuberculosis (TB) is still a major public health threat worldwide. For decades, TB control programs have focused almost exclusively on infectious TB active cases. However, it is evident that this strategy alone cannot achieve TB elimination. To achieve this objective a comprehensive strategy directed toward integrated latent tuberculosis infection (LTBI) management is needed. Recently it has been recognized that LTBI is not a stable condition but rather a spectrum of infections (e.g., intermittent, transient or progressive) which may lead to incipient, then subclinical, and finally active TB disease.Aim:Provide an overview of current available LTBI diagnostic test including updates, future developments and perspectives.Results:There is currently no test for the direct identification of live MT infection in humans. The diagnosis of LTBI is indirect and relies on the detection of an immune response against MT antigens, assuming that the immune response has developed after a contact with the biological agent. Tuberculin skin test (TST) and interferon gamma release assays (IGRAs) are the main diagnostic tools for LTBI, however, both present strengths and limitations. The most ancient diagnostic test (TST) can be associated with several technical errors, has limited positive predictive value, is being influenced by BCG vaccination and several conditions can reduce the skin reactivity. Notwithstanding these limitations, prompt identification of TST conversion, should orientate indications for preventive therapy of LTBI. IGRAs have superior specificity, are not affected by M. bovis, BCG vaccination and other environmental mycobacteria. However, they present some logistical and organisational constraints and are more expensive. Currently, the WHO guidelines recommend that either a TST or an IGRA can be used to detect LTBI in high-income and upper middle-income countries with estimated TB incidences less than 100 per 100,000 population. Two skin tests (C-TB and Diaskintest), using only two specific M. tuberculosis antigens (ESAT-6 and CFP-10) instead of the tuberculin solution, have recently been developed but, to date, none of these tests is available on the European market.Conclusion:Early identification and treatment of individuals with LTBI is an important priority for TB control in specific groups at risk within the population: this is of crucial meaning in recently infected cases both at the community level and in some occupational settings. Currently there is no gold standard test for LTBI: an improved understanding of the available tests is needed to develop better tools for diagnosing LTBI and predicting progression to clinical active disease.Key words: Tuberculosis, TB, latent tuberculosis infection, LTBI, diagnostic tests, elimination, occupational health, public health     

Coordination as a best practice from the polio eradication initiative: Experiences from five member states in the African region of the World Health Organization

BackgroundAs part of the efforts to eradicate polioviruses in the African Region, structures were put in place to ensure coordinated mobilization and deployment of resources within the framework of the global polio eradication initiative (PEI). The successes of these structures made them not only attractive to other public health interventions, but also caused them to be deployed to the response efforts of other diseases interventions, without any systematic documentation. This article documents the contributions of PEI coordination units to other public health interventions in the African Region of World Health OrganizationMethodsWe reviewed the contributions of PEI coordination units to other public health interventions in five countries in the African Region.ResultsThe analysis identified significant involvement of PEI coordination structures in the implementation of routine immunization programs in all the countries analyzed. Similarly, maternal and child health programs were planned, implemented, monitored and evaluation the Inter-Agency Coordination Committees of the PEI programs in the different countries. The hubs system used in PEI in Chad facilitated the efficient coordination of resources for immunization and other public health interventions in Chad. Similarly, in the Democratic Republic of Congo PEI led coordination activities benefited other public health programs like disease control and the national nutrition program, the national malaria control program, and the tuberculosis control program. In Nigeria, the polio Expert Review Committee effectively deployed the Emergency Operation Center for the implementation of prioritized strategies and activities of the National Polio Eradication Emergency Plan, and it was utilized in the response to Ebola Virus Disease outbreak in the country.ConclusionsThe PEI-led coordination systems are thus recognized as having made significant contribution to the coordination and delivery of other public health interventions in the African Region.     

结核分枝杆菌诊断方法的研究进展

传染性肺结核病是世界上最严重的传染病之一,也是影响全球的主要健康问题,对结核病的检测和控制受到各国政府的高度重视。缺少快速、灵敏和准确的诊断方法是无法有效控制结核病传播的一个重要原因。本文主要针对当前国际上出现的结核分枝杆菌检测新技术做简单的介绍,为检验人员在选择合适的检测方法和平台上提供一些建议,对研究者建立和开发快速、准确检测结核分枝杆菌,甚至是耐药结核分枝杆菌的技术研发上,提供新的研究思路。