Evaluation of the 2016–2020 regional tuberculosis response framework,WHO Western Pacific Region

ObjectiveTo assess the implementation of the Regional framework for action on implementation of the End TB Strategy in the Western Pacific, 2016–2020 in countries and areas in the World Health Organization Western Pacific Region.MethodsWe used a mixed methods approach to assess the framework’s measurable and perceived impact. We conducted an analysis of national tuberculosis strategic plans, a cross-sectional survey of senior staff of tuberculosis programmes, key informant interviews and some country case studies.FindingsOf the 37 countries and areas of the Western Pacific Region, 14 had a national tuberculosis strategic plan, including all countries and areas with a high incidence of tuberculosis. Most senior tuberculosis programme staff who responded to the survey (16/23) found the regional framework useful when developing their national targets and grant applications. Programmatic challenges identified included financing, human resources, public–private mix, active case finding, and paediatric and drug-resistant tuberculosis. Most of the 17 key informants thought that the regional framework’s categorization of actions (for all settings, for specific settings and for pre-elimination settings) was useful, but that the added value of the regional framework over other relevant documents was not obvious because of overlap in content.ConclusionThe regional framework influenced national level tuberculosis control planning and implementation in a positive way. A future regional framework should provide a longer-term strategic horizon and specifically address emerging trends and persistent problems faced by countries or areas of the region.     

A prospective study of amylase-rich pleural effusions with special reference to amylase isoenzyme analysis.

By analysis of pleural effusions from 200 patients, 25 cases of amylase-rich effusions were identified, for an overall incidence of 13 percent. Four of the 25 patients (16 percent) had evidence of pancreatitis. These patients had higher mean ratios of pleural fluid to serum amylase levels (18 +/- 6.3 [SEM] vs 4.8 +/- 1.3) compared to patients with nonpancreatic diseases (p = 0.003); all four exhibited a predominant pancreatic isoenzyme profile. Of the 21 patients with nonpancreatic amylase-rich effusions, lung cancer was the most commonly associated condition (8 patients). In 14 of the 21 patients in whom an isoenzyme profile was obtained, salivary-type amylase was predominant. Amylase-rich pleural effusions occur frequently, and pleural fluid isoamylase determination is specific for pancreatitis-associated effusions. The finding of a pleural effusion rich in salivary isoamylase should prompt an evaluation for carcinoma (particularly of lung primary), but may also be seen in other pleural inflammatory conditions.     

The effectiveness of personal construct psychotherapy in clinical practice: A systematic review and meta-analysis

Abstract

This study updates a systematic review of the effectiveness of personal construct psychotherapy and refines a previous meta-analysis by focusing on studies conducted in clinical settings. Twenty-seven studies satisfied the criteria for the systematic review, including 20 in clinical settings. Meta-analysis of the latter provided strong evidence of an advantage of personal construct psychotherapy over a no-treatment control; this benefit was maintained at follow-up. Meta-analysis of studies with an active treatment control group provided no evidence of the superiority or inferiority of personal construct psychotherapy. The available research justifies the practice of personal construct psychotherapy with clients in clinical practice, but conclusions must be tempered by the small number of studies and their methodological shortcomings.     

An outbreak of Q fever associated with parturient cat exposure at an animal refuge and veterinary clinic in southeast Queensland

Objective: To determine the source of a Q fever outbreak in humans at an animal refuge and veterinary clinic in southeast Queensland from October to December 2016. Methods: Case interviews and a retrospective cohort study of animal refuge and veterinary clinic staff using a self‐administered questionnaire related to clinical history of Q fever, Q fever vaccination status and workplace activities during the exposure period. Results: Seven cases (six confirmed, one probable) were identified. Forty‐three questionnaires were completed (92% response rate). Workplace activities associated with the greatest risk of illness were the disposal of deceased cats or dogs (RR, 14.0; 95%CI, 1.9–104.1) and participating in euthanasia of cats or dogs (RR, 4.6; 95%CI, 1.3–16.9). Five feline birthing events occurred at the animal refuge from 25 September to 19 October 2016, each with subsequent euthanasia of the queen cat and litter. All cases had likely exposure to a specific queen cat and her litter that were euthanised the same day as the birthing event. Conclusions: A parturient cat was the most likely source of the outbreak. Implications for public health: Occupational groups and others with regular exposure to feline or canine parturient products should receive Q fever vaccine.     

Ultrasound biomicroscopic appearances of eyelid lesions at 50 MHz

PURPOSE: To correlate the ultrasound biomicroscopy (UBM) appearance of eyelid lesions with the results of histopathologic examination. METHODS: Fifty-two patients with eyelid lesions were evaluated using 50-MHz UBM, and the UBM scans were compared with the histopathologic findings. The obscuration of the normal lid sonographic layers and invasion into adjacent tissues were criteria suggesting malignancy. RESULTS: UBM characteristics of different eyelid lesions are presented. The sensitivity of UBM in detecting malignancy ranged from 78% to 86%, whereas the specificity ranged from 37% to 69%. CONCLUSION: This study of eyelid lesions shows that UBM can help differentiate between various benign and malignant lid lesions.     

Lymphocyte proliferation in mice congenitally deficient in T-cell receptor alpha beta + cells.

In mice and humans, T cells are characterized on the basis of T-cell receptor (TcR) expression and divided into the major TcR alpha beta + and minor TcR gamma delta + populations. TcR alpha beta + cells are considered to be the primary regulators of the immune response, whereas the function of TcR gamma delta + cells is unclear. Mice congenitally deficient in TcR alpha beta-expressing cells provide an ideal model for analyzing the independent in vivo function of TcR gamma delta + cells in the absence of TcR alpha beta + cells. Here we report that lymphoid organs in TcR alpha mutant mice undergo substantial enlargement after being challenged by environmental antigens. This organ expansion can be attributed in part to increases in the relative proportions and absolute numbers of TcR gamma delta + cells, but an expansion of the recently described TcR beta + alpha - population also has a role. The expansion of the TcR gamma delta + population is polyclonal, as evidenced by the usage of multiple gamma and delta variable chain segments. Furthermore, a substantial proportion of the cells appears to be activated and these activated cells express surface activation markers. The results clearly demonstrate that TcR gamma delta + cells proliferate independently in response to a broad spectrum of challenges. Moreover, since the expansion of the lymphoid tissues and the TcR gamma delta + cell population is excessive relative to that seen in wild-type animals, one role of TcR alpha beta + cells is directly or indirectly to limit the responses of the other lymphoid components.     

Ultrasound biomicroscopic characteristics of the anterior segment in primary congenital glaucoma

PURPOSE: To evaluate qualitatively and quantitatively ultrasound biomicroscopic (UBM) features of the anterior segment in eyes with primary congenital glaucoma. METHODS: UBM of 45 eyes of patients with primary congenital glaucoma (39 previously operated and 6 unoperated eyes) and 28 control eyes were included in this study. UBM parameters were correlated with ocular biometry. Iris thickness, ciliary body thickness, ciliary body-lens distance, posterior chamber depth, and anterior chamber angle were measured and compared with control eyes. Other features of the anterior segment were qualitatively evaluated. RESULTS: A thin, stretched-out ciliary body and abnormal tissue at the iridocorneal angle were features seen in 90% of UBM scans. Iris thickness and stretched zonules correlated with the axial length (r = -0.6 and 0.58, respectively; p = 0.04) but not with the mean corneal diameter. Abnormal insertion of the ciliary body to the posterior surface of the iris was noted in eight eyes (17%). CONCLUSIONS: The present study documents characteristic anterior segment dysplasia and ciliary body anomalies in patients with primary congenital glaucoma.     

Using stated preference discrete choice modelling to evaluate the introduction of varicella vaccination

Applications of stated preference discrete choice modelling (SPDCM) in health economics have been used to estimate consumer willingness to pay and to broaden the range of consequences considered in economic evaluation. This paper demonstrates how SPDCM can be used to predict participation rates, using the case of varicella (chickenpox) vaccination. Varicella vaccination may be cost effective compared to other public health programs, but this conclusion is sensitive to the proportion of the target population immunised. A choice experiment was conducted on a sample of Australian parents to predict uptake across a range of hypothetical programs. Immunisation rates would be increased by providing immunisation at no cost, by requiring it for school entry, by increasing immunisation rates in the community and decreasing the incidence of mild and severe side effects. There were two significant interactions; price modified the effect of both support from authorities and severe side effects. Country of birth was the only significant demographic characteristic. Depending on aspects of the immunisation program, the immunisation rates of children with Australian-born parents varied from 9% to 99% while for the children with parents born outside Australia they varied from 40% to 99%. This demonstrates how SPDCM can be used to understand the levels of attributes that will induce a change in the decision to immunise, the modification of the effect of one attribute by another, and subgroups in the population. Such insights can contribute to the optimal design and targeting of health programs.