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International audience ; Background: Malaria remains endemic in Comoros. In 2006, malaria was the leading cause of mortality, morbidity and consultation in hospitals. The Government of the Union of the Comoros is committed in the fight against malaria through the establishment of a National Strategic Plan in 2007 that was later updated for the period 2012-2016. The results of these efforts show that the disease is in a pre-elimination phase. Despite a clear decline of malaria several aspects of its epidemiology should be clarified including the identification of endemic areas.Methods: Monthly cases, as reported by the "Programme National de lutte Contre le paludisme" (PNLP) from 2010 to 2014, were geo-referenced in each island at the sanitary district level. The incidence of malaria by district was calculated using population data from the National Census. We completed the spatial database with data on environmental and social factors including meteorology, physical geography, land use (analyzed by remote sensing of SPOT 5 satellite images), population characteristics, and health care facilities. We performed statistical analyzes to show the relationships between the variables and the prevalence of malaria.Results: The mapping of malaria incidence between 2010 and 2014 shows its heterogeneity among the 17 sanitary districts. Five districts (Hambou, Centre, Fomboni, Mutsamudu and Pomoni) reveal a high endemicity. Also we have highlighted the spatial relationships between malaria incidences and environmental and socio-demographic variables.Conclusion: This work is the first spatial analysis of the epidemiology of malaria in Comoros. It contributes to a better understanding of the spatial dynamics of malaria to help the Ministry of Health to eradicate malaria by 2016.

International audience ; Background: Malaria remains endemic in Comoros. In 2006, malaria was the leading cause of mortality, morbidity and consultation in hospitals. The Government of the Union of the Comoros is committed in the fight against malaria through the establishment of a National Strategic Plan in 2007 that was later updated for the period 2012-2016. The results of these efforts show that the disease is in a pre-elimination phase. Despite a clear decline of malaria several aspects of its epidemiology should be clarified including the identification of endemic areas.Methods: Monthly cases, as reported by the "Programme National de lutte Contre le paludisme" (PNLP) from 2010 to 2014, were geo-referenced in each island at the sanitary district level. The incidence of malaria by district was calculated using population data from the National Census. We completed the spatial database with data on environmental and social factors including meteorology, physical geography, land use (analyzed by remote sensing of SPOT 5 satellite images), population characteristics, and health care facilities. We performed statistical analyzes to show the relationships between the variables and the prevalence of malaria.Results: The mapping of malaria incidence between 2010 and 2014 shows its heterogeneity among the 17 sanitary districts. Five districts (Hambou, Centre, Fomboni, Mutsamudu and Pomoni) reveal a high endemicity. Also we have highlighted the spatial relationships between malaria incidences and environmental and socio-demographic variables.Conclusion: This work is the first spatial analysis of the epidemiology of malaria in Comoros. It contributes to a better understanding of the spatial dynamics of malaria to help the Ministry of Health to eradicate malaria by 2016.

International audience ; Background: Malaria remains endemic in Comoros. In 2006, malaria was the leading cause of mortality, morbidity and consultation in hospitals. The Government of the Union of the Comoros is committed in the fight against malaria through the establishment of a National Strategic Plan in 2007 that was later updated for the period 2012-2016. The results of these efforts show that the disease is in a pre-elimination phase. Despite a clear decline of malaria several aspects of its epidemiology should be clarified including the identification of endemic areas.Methods: Monthly cases, as reported by the "Programme National de lutte Contre le paludisme" (PNLP) from 2010 to 2014, were geo-referenced in each island at the sanitary district level. The incidence of malaria by district was calculated using population data from the National Census. We completed the spatial database with data on environmental and social factors including meteorology, physical geography, land use (analyzed by remote sensing of SPOT 5 satellite images), population characteristics, and health care facilities. We performed statistical analyzes to show the relationships between the variables and the prevalence of malaria.Results: The mapping of malaria incidence between 2010 and 2014 shows its heterogeneity among the 17 sanitary districts. Five districts (Hambou, Centre, Fomboni, Mutsamudu and Pomoni) reveal a high endemicity. Also we have highlighted the spatial relationships between malaria incidences and environmental and socio-demographic variables.Conclusion: This work is the first spatial analysis of the epidemiology of malaria in Comoros. It contributes to a better understanding of the spatial dynamics of malaria to help the Ministry of Health to eradicate malaria by 2016.

Background:The approval of direct-acting antivirals for Interferon-free treatment revolutionized the therapy of chronic Hepatitis C infection. As of August 2014, two treatment regimens for genotype 1 infection received conditional approval in the European Union: Sofosbuvir and Ribavirin for 24 weeks and Sofosbuvir and Simeprevir with or without Ribavirin for 12 weeks. We aim to analyze the cost-effectiveness of both regimens in Germany. Methods: We set up a Markov model with a lifetime horizon to simulate immediate treatment success and long-term disease progression for treatment-naive patients. The model analyzes both short-term and long-term costs and benefits from the perspective of the German Statutory Health Insurance. We apply the efficiency frontier method, which was suggested by German Institute for Quality and Efficiency in Health Care for cost-effectiveness analysis in Germany. Results: The efficiency frontier is defined by dual therapy and first generation direct-acting antiviral Boceprevir, yielding a maximum of € 1,447.69 per additional percentage point of sustained virologic response gained. Even without rebates, Sofosbuvir/Simeprevir is very close with € 1,560.13 per additional percentage point. It is both more effective and less expensive than Sofosbuvir/Ribavirin. Conclusions: In addition to higher sustained virologic response rates, new direct-acting antivirals save long-term costs by preventing complications such as liver cirrhosis, hepatocellular carcinoma and ultimately liver transplants, thereby offsetting part of higher drug costs. Our findings are in line with the guidance published by German Society for Gastroenterology, Digestive and Metabolic Diseases, which recommends Sofosbuvir/Simeprevir for Interferon ineligible or intolerant patients.

Background: Physical illness is linked with an increased risk of suicide; however, evidence from China is limited. Aims: To assess the influence of physical illness on risk of suicide among rural residents of China, and to examine the differences in the characteristics of people completing suicide with physical illness from those without physical illness. Method: In all, 200 suicide cases and 200 control subjects, 1:1 pair-matched on sex and age, were included from 25 townships of three randomly selected counties in Shandong Province, China. One informant for each suicide or control subject was interviewed to collect data on the physical health condition and psychological and sociodemographic status. Results: The prevalence of physical illness in suicide cases (63.0%) was significantly higher than that in paired controls (41.0%; χ2 = 19.39, p < .001). Compared with suicide cases without physical illness, people who were physically ill and completed suicide were generally older, less educated, had lower family income, and reported a mental disorder less often. Physical illness denoted a significant risk factor for suicide with an associated odds ratio of 3.23 (95% CI: 1.85–5.62) after adjusted for important covariates. The elevated risk of suicide increased progressively with the number of comorbid illnesses. Cancer, stroke, and a group of illnesses comprising dementia, hemiplegia, and encephalatrophy had a particularly strong effect among the commonly reported diagnoses in this study population. Conclusion: Physical illness is an important risk factor for suicide in rural residents of China. Efforts for suicide prevention are needed and should be integrated with national strategies of health care in rural China.

The European Union (EU) Council Recommendation on rare diseases urged the member states to implement national and EU collaborative actions to improve the health care of rare disease patients. Following this recommendation, the European Commission launched a tender on newborn screening (NBS) to report on current practices of laboratory testing, form a network of experts and provide guidance on how to further implement NBS screening in a responsible way, the latter of which was provided in an Expert Opinion document. After consultation of experts from EU member states, (potential) candidate member states and European Free Trade Association countries, in a consensus meeting in June 2011, 70 expert opinions were finalized. They included the need to develop case definitions for all disorders screened for to facilitate assessment and international outcome studies. Decision whether a screening program should be performed can be based on screening criteria updated from the traditional Wilson and Jungner (1968) criteria, relating to disease, treatment, test and cost. The interest of the child should be central in the assessment of pros and cons. A European NBS body should assess evidence on (new) screening candidate disorders. For rare conditions, best level evidence should be used. The health system should ensure treatment to cases diagnosed by screening, controlled and revised by follow-up outcome studies. Screening methodology should aim to avoid unintended findings, such as mild forms and carrier status information, as much as possible. Activities to improve NBS in Europe, such as training and scientific evaluation, could benefit from collaboration at EU level and beyond.

On a per capita basis, Canadian drug costs are already the second highest in the world after the United States and are among the fastest rising in the Organization for Economic Co-Operation and Development. The Comprehensive Economic and Trade Agreement (CETA) between the European Union (EU) and Canada will further exacerbate the rise in costs by:. • Committing Canada to creating a new system of patent term restoration thereby delaying entry of generic medicines by up to two years;. • Locking in Canada's current term of data protection, and creating barriers for future governments wanting to reverse it;. • Implementing a new right of appeal under the patent linkage system that will create further delays for the entry of generics.CETA will only affect intellectual property rights in Canada-not the EU. This analysis estimates that CETA's provisions will increase Canadian drug costs by between 6.2% and 12.9% starting in 2023. The Canadian government committed to compensating provinces for the rise in costs for their public drug plans. Importantly, this means that people paying out-of-pocket for their drugs or receiving them through private insurance, will be charged twice: once through higher drug costs and once more through their federal taxes.As drug costs continue to grow, there are limited options available for provincial/territorial governments: restrict the choice of medicines in public drug plans; transfer costs to patients who typically are either elderly or sick; or take money from other places in the health system, and threaten the viability of Canada's single payer system. CETA will therefore negatively impact the ability of Canada to offer quality health care.

Mathematical models of cholera dynamics can not only help in identifying environmental drivers and processes that influence disease transmission, but may also represent valuable tools for the prediction of the epidemiological patterns in time and space as well as for the allocation of health care resources. Cholera outbreaks have been reported in the Democratic Republic of the Congo since the 1970s. They have been ravaging the shore of Lake Kivu in the east of the country repeatedly during the last decades. Here we employ a spatially explicit, inhomogeneous Markov chain model to describe cholera incidence in eight health zones on the shore of the lake. Remotely sensed data sets of chlorophyll a concentration in the lake, precipitation and indices of global climate anomalies are used as environmental drivers in addition to baseline seasonality. The effect of human mobility is also modelled mechanistically. We test several models on a multiyear data set of reported cholera cases. The best fourteen models, accounting for different environmental drivers, and selected using the Akaike information criterion, are formally compared via proper cross validation. Among these, the one accounting for seasonality, El Niño Southern Oscillation, precipitation and human mobility outperforms the others in cross validation. Some drivers (such as human mobility and rainfall) are retained only by a few models, possibly indicating that the mechanisms through which they influence cholera dynamics in the area will have to be investigated further. Key Points Markov chain model of cholera dynamics in the Lake Kivu area (DRC) Global climate anomalies are the main drivers, together with rainfall The influence of mobility and remotely sensed chlorophyll a were also tested

HIV/AIDS has emerged as a serious epidemic in Nepal, concentrated amongst the most-at-risk populations. Volun-tary Counseling and Testing (VCT) is a proven strategy for the prevention and management of HIV/AIDS especially in developing countries. Given that the utilization of VCT is low in Nepal, it is important to understand the barriers and challenges that Nepal is facing in the provision and utilization of these services. This study aimed to provide recommendations for policy makers to improve the utilization of VCT services in Nepal. A qualitative study of VCT health service providers and government officials was undertaken in 4 cities of Nepal. Sixteen interviews, three joint interviews and one focus group discussion were conducted, audio recorded and transcribed verbatim. Data were then analyzed using a thematic analysis framework and major themes were identified. Various barriers including socio-cultural issues, geography, the presence of stigma and discrimination faced by people with HIV/AIDS and a lack of knowledge and awareness were identified as important factors limiting the utilization of VCT services. Current gov-ernment efforts to improve VCT service provision, although promising, require ongoing development. Systemic barriers included the sustainability of the temporary NGO VCT services, lack of staff and training, inadequate moni-toring and evaluation and limited access to services for people living in rural areas. To increase the sustainability and utilization of VCT services, the Government can intervene in a number of areas including the integration of VCT services with existing primary health care services and addressing ongoing education and quality assurance.

SummaryThis study describes Finnish university students' knowledge and attitudes towards HIV and AIDS, homosexuality and sexual risk behaviour. Finnish-speaking students were randomly selected from all registered students at two universities in Finland (N=9715, n=950). The data were collected by using a modified version of the State University of New York at Buffalo School of Nursing AIDS Study Questionnaire on sexual risk behaviour developed by Held and Chng. The total response rate was 35% (n=333). The data were analysed using quantitative statistical methods. Normally distributed data were analysed by t-test and one-way ANOVA, with Bonferroni corrections. Non-normally distributed data were analysed using the Mann-Whitney U-test and Kruskal-Wallis test, followed by a post-hoc test. The majority of students were familiar with HIV and AIDS, including its mode of transmission. However, there were still some misconceptions concerning HIV and AIDS. The oldest students and women had a more positive attitude towards people living with HIV and AIDS (PLWHA). Of patients with HIV or AIDS, intravenous drug users were perceived most negatively. Male students had more homophobic attitudes. Students who reported that religion had an important role in their lives had significantly stricter attitudes towards sexual risk behaviour. Students' knowledge correlated positively with general attitudes towards HIV and AIDS. Knowledge about HIV and AIDS will lead to more positive attitudes towards HIV and AIDS as a disease, towards those infected as well as homosexual people. There is a need to focus on preventive health care and sexual health promotion by educating young people and changing their attitudes towards sexual risk behaviour.

Sub-optimal infant and young child feeding (IYCF) practices are likely a significant contributor to high undernutrition rates in Viet Nam. To date, however, there has been no comprehensive review of IYCF practices in Viet Nam. The objectives of this paper were to review: 1) patterns/trends in IYCF in Viet Nam; 2) the barriers and facilitators to IYCF practices; and 3) interventions and policies and their effectiveness. Methods used include reviewing and analyzing existing data, summarizing and organizing the evidence into broad themes based on a pre-defined conceptual framework. Findings show that the proportion of children ever breastfed is almost universal and the median duration of breastfeeding is 13-18 months. However, exclusive breastfeeding for the first six months is low (8-17%) and appears to be declining over time. Information on complementary feeding is limited, but two key challenges are: early introduction, and low nutrient quality of complementary foods. Facilitators of optimal IYCF were support from 1) government progressive policies, 2) non-profit organizations and 3) family members. Barriers to optimal IYCF included 1) the lack of enforcement of, and compliance with the code of marketing breast milk substitutes, 2) inadequate knowledge among health care providers; and 3) maternal poor knowledge. These findings indicate that the evidence base on complementary feeding is weak in Viet Nam and needs to be strengthened. The review also reinforces that program and policy actions to improve IYCF in Viet Nam must target multiple stakeholders at different levels: the family, the health system and the private sector. ; ISI; IFPRI3 ; PHND ; PR

The new Parliament will be asked at some point to make critical decisions about the BBC's future at a time when it is facing full‐frontal assaults from competitors who view the BBC as a major barrier to their own advancement. Whether it be newspaper groups seeking to monetise their online activities, commercial children's channels, terrestrial competitors or the owners of music radio stations, media conglomerates rail against the BBC's size and public funding with increasing regularity. Our aim is to remind our legislators of the vital contribution this institution makes to British life: from a journalism inscribed with values of fairness, integrity and impartiality—and valued throughout the world for its professional engagement with foreign affairs—to its creative commitment to British story‐telling, music, comedy, arts and children's programmes, the BBC's contribution to our democratic and cultural welfare is immense. It is a beacon for Britain, which provides social glue for its citizens at a time of fragmenting audiences and identities, within a uniquely non‐commercial space, accountable to both Parliament and its licence payers. It may distort the market, much as the National Health Service distorts the market for health care, but is held in high esteem by the British public and is admired throughout the world. This article explains why the BBC is a national treasure that underpins our creative economy as well as our cultural vitality, and argues that it must be protected from those who argue self‐interestedly for its diminution.

Abstract Background Infantile colic is a self-limiting condition that is distributed worldwide. It is often misdiagnosed as an organic disease for which an infant is admitted to the hospital. Many studies have described the aetiopathogenesis, pharmacologic and non-pharmacologic management of colic but none has evaluated self-medication for infants with colic. The aim of this study was therefore to determine the knowledge of Nigerian mothers about colic, their home-based management, extent of self-medication for the infants with colic and the types of medicines involved. Methods It is a prospective study conducted at the vaccination clinics of 20 primary health care centres, each from different Local Government Areas in Lagos, Nigeria. Eight hundred mothers that brought their infants for vaccination between April and September, 2006 were interviewed with open-and close-ended questionnaire. Results Six hundred and eighty three (85.4%) mothers claimed they had a good knowledge of colic. Incessant and excessive cry was the main clinical feature of colic identified by 430(62.9%) mothers. Three hundred and seventy eight (67.7%) infants were treated by self-medication, 157 (28.1%) sought medical intervention and 17 (3.1%) were treated at a traditional birth attendant home. Herbal medicines constituted 51.8% of the self-medicated medicines, of which 48 (26.2%) were "Ororo Ogiri". Nospamin ® (49.5%) and Gripe water ® (43.0%) were the two frequently prescribed and self-medicated medicines for infants with colic. Conclusion Nigerian mothers are deficient in their knowledge of colic. Self-medication was the most frequently used home-based intervention. Health education would appear necessary to improve parental management of this self-limiting condition.

Studies published from 1966 to 2006 describe how nurses' interpretations of clinical data vary widely, thus significant percentages of nurses' diagnoses may be of low accuracy. This is important because data interpretations, or diagnoses, serve as the basis for selection of interventions and the subsequent achievement of patient outcomes. Accuracy of nurses' diagnoses is defined as a rater's judgment of the match between a diagnostic statement and patient data. Low accuracy can lead to wasted time and energy, harm to patients, absence of positive outcomes, and patient and family dissatisfaction. The purpose of this article is to appeal to nurses in both practice and education to address the accuracy of nurses' diagnoses. This appeal is based on three factors: (a) research evidence indicates the need for greater consistency among nurses in making nurses diagnoses, (b) accuracy of nurses' diagnoses will always be an issue of concern because diagnosis in nursing is complex, and (c) with implementation of electronic health records, the degree of accuracy of nurses' diagnoses will have broad-based implications. In this article, the need for nurses to be accountable for addressing diagnostic accuracy is explained and strategies to improve accuracy related to the diagnostician, the diagnostic task, and the situational context are recommended. Some of these strategies include a greater focus on educational methods and content for development of nurses as diagnosticians, adoption of partnership models of nurse-patient relationships, an increase in opportunities for critical thinking and clinical decision making, selection of software with appropriate structures and content libraries, and a change in health care policies.

In Stockholm, Sweden, women are invited to a cost-free population-based cervical cancer screening programme (PCCSP) at regular intervals. Despite this, many women choose not to attend screening at all or to take opportunistic tests instead. This study explores how women who actively declined participation in the PCCSP reasoned about their choice. Qualitative telephone interviews and fax messages from women who actively declined participation in the PCCSP were analysed inductively. The manner in which women defined and conceptualized distinctions between, and the roles and responsibilities of, both private and public spheres were found to be central in explanations of decision making. Factors related to women's decisions not to participate in screening at all include a lack of confidence in the benefits of screening, previous negative health care and preventive experiences, a belief in one's own ability to discern health changes or a belief that one was not at risk for cervical cancer, as well as a number of unconventional standpoints on social and political issues. Women who chose not to participate in the organized PCCSP, but who did use private opportunistic screening, generally motivated this with direct or indirect criticism of the screening programme itself. Not only was the examination itself sensitive but also all facets of the PCCSP, from invitation letter on, were found to influence women's decisions. Using Jepson et al.'s ethical framework to peruse the evidence-base underlying women's 'informed decision-making' about CCS is suggested to be more constructive than discussing potential participants' knowledge versus lack of knowledge. Copyright © 2007 John Wiley & Sons, Ltd.