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Sarno G, Stanisci I, Maio S, Williams S, Ming KE, Diaz SG, Ponte EV, Lan LTT, Soronbaev T, Behera D, Tagliaferro S, Baldacci S, Viegi G. Issue 2 - "Update on adverse respiratory effects of indoor air pollution". Part 2): Indoor air pollution and respiratory diseases: Perspectives from Italy and some other GARD countries. Pulmonology 2023:S2531-0437(23)00083-1. [PMID: 37211526 DOI: 10.1016/j.pulmoe.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 03/20/2023] [Indexed: 05/23/2023] Open
Abstract
OBJECTIVE to synthesize the Italian epidemiological contribution to knowledge on indoor pollution respiratory impact, and to analyze the perspective of some GARD countries on the health effects of indoor air pollution. RESULTS Italian epidemiological analytical studies confirmed a strong relationship between indoor air pollution and health in general population. Environmental tobacco smoke, biomass (wood/coal) fuel for cooking/heating and indoor allergens (house dust mites, cat and dog dander, mold/damp) are the most relevant indoor pollution sources and are related to respiratory and allergic symptoms/diseases in Italy and in other GARD countries such as Mexico, Brazil, Vietnam, India, Nepal and Kyrgyzstan. Community-based global health collaborations are working to improve prevention, diagnosis and care of respiratory diseases around the world, specially in low- and middle-income countries, through research and education. CONCLUSIONS in the last thirty years, the scientific evidence produced on respiratory health effects of indoor air pollution has been extensive, but the necessity to empower the synergies between scientific community and local administrations remains a challenge to address in order to implement effective interventions. Based on abundant evidence of indoor pollution health effect, WHO, scientific societies, patient organizations and other members of the health community should work together to pursue the GARD vision of "a world where all people breathe freely" and encourage policy makers to increase their engagement in advocacy for clean air.
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Affiliation(s)
- G Sarno
- CNR Institute of Clinical Physiology (IFC), Via Trieste, 41, 56126 Pisa, Italy
| | - I Stanisci
- CNR Institute of Clinical Physiology (IFC), Via Trieste, 41, 56126 Pisa, Italy
| | - S Maio
- CNR Institute of Clinical Physiology (IFC), Via Trieste, 41, 56126 Pisa, Italy
| | - S Williams
- International Primary Care Respiratory Group (IPCRG), 19 Armour Mews, Larbert FK5 4FF, Scotland, United Kingdom
| | - K E Ming
- International Primary Care Respiratory Group (IPCRG), 19 Armour Mews, Larbert FK5 4FF, Scotland, United Kingdom
| | - S G Diaz
- Universidad Autónoma de Nuevo León, Faculty of Medicine and University Hospital "Dr. José Eleuterio González", Regional Center of Allergy and Clinical Immunology, Av. Dr. José Eleuterio González 235, Mitras Centro, 64460 Monterrey, N.L., Mexico
| | - E V Ponte
- Faculdade de Medicina de Jundiaí - Department of Internal Medicine, R. Francisco Teles, 250, Vila Arens II, Jundiaí SP, 13202-550, Brazil
| | - L T T Lan
- University Medical Center, 217 Hong Bang, dist.5, Ho Chi Minh City 17000, Vietnam
| | - T Soronbaev
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Togolok Moldo str., Bishkek 720040, Kyrgyzstan
| | - D Behera
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases (NITRD), Sri Aurobindo Marg Near Qutub Minar, Mehrauli, New Delhi 110030, India
| | - S Tagliaferro
- CNR Institute of Clinical Physiology (IFC), Via Trieste, 41, 56126 Pisa, Italy
| | - S Baldacci
- CNR Institute of Clinical Physiology (IFC), Via Trieste, 41, 56126 Pisa, Italy
| | - G Viegi
- CNR Institute of Clinical Physiology (IFC), Via Trieste, 41, 56126 Pisa, Italy.
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Boudewijns EA, Trucchi M, van der Kleij RMJJ, Vermond D, Hoffman CM, Chavannes NH, van Schayck OCP, Kirenga B, Brakema EA. Facilitators and barriers to the implementation of improved solid fuel cookstoves and clean fuels in low-income and middle-income countries: an umbrella review. Lancet Planet Health 2022; 6:e601-e612. [PMID: 35716672 DOI: 10.1016/s2542-5196(22)00094-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 04/01/2022] [Accepted: 04/01/2022] [Indexed: 06/15/2023]
Abstract
2·6 billion people rely on solid fuels for cooking or heating. Accelerating access to cleaner solutions is crucial to reduce the negative effects of solid fuel use. Despite abundant evidence on how to implement these solutions, previous attempts have been disappointing. An overview of the evidence is missing and the translation of the evidence into practice is poor. We conducted an umbrella review using eight databases to: consolidate evidence on the factors that influence the implementation of improved solid fuel cookstoves and clean fuels in low-income and middle-income countries; weigh the level of confidence in existing evidence; and develop two practical implementation strategy tools. We identified 31 relevant reviews (13 systematic reviews and 18 narrative reviews) that covered over 479 primary studies. We found 15 implementation factors supported by the highest level of evidence. Regarding improved solid fuel cookstoves, these factors included: cost; knowledge and beliefs about the innovation; and compatibility. For clean fuels these factors included: cost; knowledge and beliefs about the innovation; and external policy and incentives. The factors were synthesised into the Cleaner Cookstove Implementation Tool and the Clean Fuel Implementation Tool. These tools can be used to optimise the implementation of cleaner cooking solutions, thereby improving health, environmental, climate, and gender equity outcomes.
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Affiliation(s)
- Esther A Boudewijns
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands.
| | - Maria Trucchi
- Leiden University College The Hague, Leiden University, The Hague, Netherlands
| | | | - Debbie Vermond
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Charlotte M Hoffman
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Onno C P van Schayck
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Bruce Kirenga
- Department of Medicine and Makerere Lung Institute, Makerere University, Kampala, Uganda
| | - Evelyn A Brakema
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
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Shen H, van der Kleij R, van der Boog PJM, Wang W, Song X, Li Z, Brakema E, Lou X, Chavannes N. Digital tools/eHealth to support CKD self-management: A qualitative study of perceptions, attitudes and needs of patients and health care professionals in China. Int J Med Inform 2022; 165:104811. [PMID: 35753175 DOI: 10.1016/j.ijmedinf.2022.104811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 05/05/2022] [Accepted: 06/05/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND A growing body of evidence supports the potential effectiveness of electronic health (eHealth) self-management interventions in improving disease self-management skills and health outcomes of patients suffering from chronic kidney disease (CKD). However, current research on CKD eHealth self-management interventions has almost exclusively focused on high-income, western countries. OBJECTIVE To inform the adaptation of a tailored eHealth self-management intervention for patients with CKD in China based on the Dutch Medical Dashboard (MD) intervention, we examined the perceptions, attitudes and needs of Chinese patients with CKD and health care professionals (HCPs) towards eHealth based (self-management) interventions in general and the Dutch MD intervention in specific. METHODS We conducted a basic interpretive, cross-sectional qualitative study comprising semi-structured interviews with 11 patients with CKD and 10 HCPs, and 2 focus group discussions with 9 patients with CKD. This study was conducted in the First Affiliated Hospital of Zhengzhou University in China. Data collection continued until data saturation was reached. All data were transcribed verbatim and analyzed using a framework approach. RESULTS Three themes emerged: (1) experience with eHealth in CKD (self-management), (2) needs for supporting CKD self-management with the use of eHealth, and (3) adaptation and implementation of the Dutch MD intervention in China. Both patients and HCPs had experience with and solely mentioned eHealth to 'inform, monitor and track' as potentially relevant interventions to support CKD self-management, not those to support 'interaction' and 'data utilization'. Factors reported to influence the implementation of CKD eHealth self-management interventions included information barriers (i.e. quality and consistency of the disease-related information obtained via eHealth), perceived trustworthiness and safety of eHealth sources, clinical compatibility and complexity of eHealth, time constraints and eHealth literacy. Moreover, patients and HCPs expressed that eHealth interventions should support CKD self-management by improving the access to reliable and relevant disease related knowledge and optimizing the timeliness and quality of patient and HCPs interactions. Finally, suggestions to adaptation and implementation of the Dutch MD intervention in China were mainly related to improving the intervention functionalities and content of MD such as addressing the complexity of the platform and compatibility with HCPs' workflows. CONCLUSIONS The identified perceptions, attitudes and needs towards eHealth self-management interventions in Chinese settings should be considered by researchers and intervention developers to adapt a tailored eHealth self-management intervention for patients with CKD in China. In more detail, future research needs to engage in co-creation processes with vulnerable groups during eHealth development and implementation, increase eHealth literacy and credibility of eHealth (information resource), ensure eHealth to be easy to use and well-integrated into HCPs' workflows.
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Affiliation(s)
- Hongxia Shen
- School of Nursing, Guangzhou Medical University, Guangzhou, China; Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China.
| | - Rianne van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands; Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Wenjiao Wang
- Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Xiaoyue Song
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Zhengyan Li
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Evelyn Brakema
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Xiaoping Lou
- Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Niels Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
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Anastasaki M, van Bree EM, Brakema EA, Tsiligianni I, Sifaki-Pistolla D, Chatzea VE, Crone MC, Karelis A, van der Kleij RMJJ, Poot CC, Reis R, Chavannes NH, Lionis C. Beliefs, Perceptions, and Behaviors Regarding Chronic Respiratory Diseases of Roma in Crete, Greece: A Qualitative FRESH AIR Study. Front Public Health 2022; 10:812700. [PMID: 35493388 PMCID: PMC9051233 DOI: 10.3389/fpubh.2022.812700] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/14/2022] [Indexed: 11/30/2022] Open
Abstract
Background The global burden of chronic respiratory diseases (CRDs) disproportionally affects Roma populations. Health interventions addressing CRD among Roma or other vulnerable groups often fail to be effective, as their implementation strategy misaligns with the local context. To design context-driven strategies, we studied CRD-related beliefs, perceptions, and behaviors among a Greek Roma population, focussing on asthma and COPD. Methods For this qualitative study in Crete, Greece, we used a Rapid Assessment Process. We conducted interviews and focus groups with purposively selected Roma community members (CMs), key informants (KIs) and healthcare professionals (HPs) serving the population. Data were triangulated using observations of households and clinical consultations. Key themes were identified using Thematic Content Analysis. The Health Belief Model, the Explanatory Model of Illness, and the Theory of Planned Behavior that are complementary is some aspects, guided our methodology with the several variables from them to be integrated to better understand CRD risk preventative behavior. Results We conducted six focus groups, seven interviews and 13 observations among 15 CMs, four KIs, and three HPs. Five themes emerged: (1) Poor CRD-awareness (smoking and household air pollution were perceived as harmful, but almost exclusively associated with acute rather than chronic symptoms); (2) Low perceived susceptibility to CRD (and CMs tended to ignore respiratory symptoms); (3) High risk exposure (smoking was common, and air pollution was perceived inevitable due to financial constraints); (4) Healthcare seeking (healthcare was sought only for persistent, severe symptoms, daily needs were a priority); (5) Perceived barriers/facilitators to care (health illiteracy, perceived discrimination and financial constraints were main barriers; established trust the main facilitator). Conclusion These five themes highlight that strategies to tackle CRD in the studied Roma setting require a multilevel approach: bridging awareness gaps at the population level, providing resources to enhance the adoption of healthy behaviors, and fighting discrimination at the societal level, whilst establishing trusted relationships at the local level. Similar methodologies to address local context may strengthen the implementation of effective interventions for similarly vulnerable and/or low-resource populations.
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Affiliation(s)
- Marilena Anastasaki
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
- *Correspondence: Marilena Anastasaki
| | - Egid M. van Bree
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Evelyn A. Brakema
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Ioanna Tsiligianni
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Dimitra Sifaki-Pistolla
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Vasiliki E. Chatzea
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Matty C. Crone
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Andreas Karelis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | | | - Charlotte C. Poot
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Ria Reis
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Niels H. Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
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Brakema EA, van der Kleij RMJJ, Poot CC, An PL, Anastasaki M, Crone MR, Hong LHTC, Kirenga B, Lionis C, Mademilov M, Numans ME, Oanh LTT, Tsiligianni I, Sooronbaev T, Walusimbi S, Williams S, Chavannes NH, Reis R. Mapping low-resource contexts to prepare for lung health interventions in four countries (FRESH AIR): a mixed-method study. THE LANCET GLOBAL HEALTH 2022; 10:e63-e76. [DOI: 10.1016/s2214-109x(21)00456-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/20/2021] [Accepted: 09/13/2021] [Indexed: 01/19/2023] Open
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Williams S, Tsiligianni I. IPCRG is committed to lower cost, lower environmental impact and improved social impact: the triple bottom line in global primary care. NPJ Prim Care Respir Med 2021; 31:44. [PMID: 34750388 PMCID: PMC8575986 DOI: 10.1038/s41533-021-00256-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Siân Williams
- International Primary Care Respiratory Group, London, UK.
| | - Ioanna Tsiligianni
- International Primary Care Respiratory Group, London, UK.,Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
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Tabyshova A, Estebesova B, Beishenbekova A, Sooronbaev T, Brakema EA, Chavannes NH, Postma MJ, van Boven JFM. Clinical Characteristics, Treatment Patterns and Economic Burden of COPD in Kyrgyzstan: A FRESH AIR Study. Int J Chron Obstruct Pulmon Dis 2021; 16:2833-2843. [PMID: 34703219 PMCID: PMC8523360 DOI: 10.2147/copd.s322778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/13/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND COPD prevalence and mortality in Kyrgyzstan are high. Data on clinical and economic impact of COPD in Kyrgyzstan are scarce. This study was part of the FRESH AIR research project that focused on prevention, diagnosis and treatment of chronic lung diseases in low-resource settings. AIM We aimed to evaluate the clinical characteristics, treatment patterns and economic burden of COPD in Kyrgyzstan. METHODS A representative sample of patients with a spirometry-confirmed diagnosis of COPD was included. All patients were registered in one of the five major hospitals in Kyrgyzstan. Patients were surveyed on COPD risk factors, health-care utilization and patient reported outcomes (CCQ, MRC). Associations with high symptom burden (MRC score ≥4) and cost were assessed using logistic regression analyses. RESULTS A total of 306 patients were included with mean age 62.1 (SD: 11.2), 61.4% being male, mean BMI 26.9 (SD: 5.2) and mean monthly income $85.1 (SD: 75.4). Biomass was used for heating and cooking by 71.2% and 52.0%. Current and ex-smokers accounted 14.1% and 32%. Mean FEV1 was 46% (SD: 12.8), 71.9% had COPD GOLD III-IV and most frequent co-morbidities were hypertension (25.2%), diabetes (5.6%) and heart diseases (4.6%). Mean CCQ score was 2.0 (SD: 0.9) and MRC score 3.7 (SD: 0.9). Yearly mean number of hospital days due to COPD was 10.1 (SD: 3.9). Total annual per-patient costs of reimbursed health-care utilization ($107) and co-payments ($224, ie, 22% of patients' annual income) were $331. We found that only GOLD IV and hypertension were significantly associated with high symptom burden. Exacerbations and hypertension were significantly associated with high cost. CONCLUSION The clinical and economic burden of COPD on patients and the government in Kyrgyzstan is considerable. Notably, almost half of interviewed patients were current or ex-smokers and biomass exposure was high.
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Affiliation(s)
- Aizhamal Tabyshova
- Pulmonology Department, National Center of Cardiology and Internal Medicine Named After M.M. Mirrakhimov, Bishkek, Kyrgyzstan
- Department of Health Sciences, Unit of Global Health, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bermet Estebesova
- Kyrgyz-Russian Slavic University (KRSU), Bishkek, Kyrgyzstan
- Primary Care Center of the Ministry of Internal Affairs, Bishkek, Kyrgyzstan
| | | | - Talant Sooronbaev
- Pulmonology Department, National Center of Cardiology and Internal Medicine Named After M.M. Mirrakhimov, Bishkek, Kyrgyzstan
| | - Evelyn A Brakema
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Maarten J Postma
- Department of Health Sciences, Unit of Global Health, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Economics, Econometrics & Finance, University of Groningen, Faculty of Economics & Business, Groningen, The Netherlands
- Department of Pharmacology & Therapy, Airlangga University, Surabaya, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Job F M van Boven
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
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Challenges in the Implementation of Chronic Obstructive Pulmonary Disease Guidelines in Low- and Middle-Income Countries: An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2021; 18:1269-1277. [PMID: 34328399 PMCID: PMC8513652 DOI: 10.1513/annalsats.202103-284st] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
There is a substantial burden of chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD), in low- and middle-income countries (LMICs). LMICs have particular challenges in delivering cost-effective prevention, diagnosis, and management of COPD. Optimal care can be supported by effective implementation of guidelines. This American Thoracic Society workshop considered challenges to implementation of COPD guidelines in LMICs. We make 10 specific recommendations: 1) relevant organizations should provide LMIC-specific COPD management guidance; 2) patient and professional organizations must persuade policy-makers of the importance of lung function testing programs in LMICs; 3) healthcare education and training should emphasize the early-life origins of COPD; 4) urgent action is required by governments to reduce airborne exposures, including exposures to tobacco smoke and indoor and outdoor air pollution; 5) guidance for COPD in LMICs should explicitly link across Essential Medicine Lists and the World Health Organization package of essential noncommunicable disease interventions for primary health care in low-resource settings and should consider availability, affordability, sustainability, and cost-effective use of medicines; 6) the pharmaceutical industry should work to make effective COPD and tobacco-dependence medicines globally accessible and affordable; 7) implementation of locally adapted, cost-effective pulmonary rehabilitation programs should be an international priority; 8) the World Health Organization Global Action Plan for the Prevention and Control of Noncommunicable Diseases should specify how improvements in respiratory health will be achieved; 9) research funders should increase the proportion of funding allocated to COPD in LMICs; and 10) the respiratory community should leverage the skills and enthusiasm of earlier-career clinicians and researchers to improve global respiratory health.
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The Global Alliance against Chronic Respiratory Diseases: journey so far and way ahead. Chin Med J (Engl) 2021; 133:1513-1515. [PMID: 32530880 PMCID: PMC7386342 DOI: 10.1097/cm9.0000000000000851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Shen H, van der Kleij RMJJ, van der Boog PJM, Wang W, Song X, Li Z, Lou X, Chavannes N. Patients' and healthcare professionals' beliefs, perceptions and needs towards chronic kidney disease self-management in China: a qualitative study. BMJ Open 2021; 11:e044059. [PMID: 33664078 PMCID: PMC7934774 DOI: 10.1136/bmjopen-2020-044059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES To support the adaptation and translation of an evidence-based chronic kidney disease (CKD) self-management intervention to the Chinese context, we examined the beliefs, perceptions and needs of Chinese patients with CKD and healthcare professionals (HCPs) towards CKD self-management. DESIGN A basic interpretive, cross-sectional qualitative study comprising semistructured interviews and observations. SETTING One major tertiary referral hospital in Henan province, China. PARTICIPANTS 11 adults with a diagnosis of CKD with CKD stages G1-G5 and 10 HCPs who worked in the Department of Nephrology. RESULTS Four themes emerged: (1) CKD illness perceptions, (2) understanding of and motivation towards CKD self-management, (3) current CKD practice and (4) barriers, (anticipated) facilitators and needs towards CKD self-management. Most patients and HCPs solely mentioned medical management of CKD, and self-management was largely unknown or misinterpreted as adherence to medical treatment. Also, the majority of patients only mentioned performing disease-specific acts of control and not, for instance, behaviour for coping with emotional problems. A paternalistic patient-HCP relationship was often present. Finally, the barriers, facilitators and needs towards CKD self-management were frequently related to knowledge and environmental context and resources. CONCLUSIONS The limited understanding of CKD self-management, as observed, underlines the need for educational efforts on the use and benefits of self-management before intervention implementation. Also, specific characteristics and needs within the Chinese context need to guide the development or tailoring of CKD self-management interventions. Emphasis should be placed on role management and emotional coping skills, while self-management components should be tailored by addressing the existing paternalistic patient-HCP relationship. The use of electronic health innovations can be an essential facilitator for implementation.
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Affiliation(s)
- Hongxia Shen
- Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Rianne M J J van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Wenjiao Wang
- Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Xiaoyue Song
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Zhengyan Li
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoping Lou
- Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Niels Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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Kjærgaard J, Nissen TN, Isaeva E, Quynh NN, Reventlow S, Lund S, Sooronbaev T, Le An P, Østergaard MS, Stout J, Poulsen A. No time for change? Impact of contextual factors on the effect of training primary care healthcare workers in Kyrgyzstan and Vietnam on how to manage asthma in children - A FRESH AIR implementation study. BMC Health Serv Res 2020; 20:1137. [PMID: 33302935 PMCID: PMC7730734 DOI: 10.1186/s12913-020-05984-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 11/30/2020] [Indexed: 01/02/2023] Open
Abstract
Background Training is a common and cost-effective way of trying to improve quality of care in low- and middle-income countries but studies of contextual factors for the successful translation of increased knowledge into clinical change are lacking, especially in primary care. The purpose of this study was to assess the impact of contextual factors on the effect of training rural healthcare workers in Kyrgyzstan and Vietnam on their knowledge and clinical performance in managing pediatric patients with respiratory symptoms. Methods Primary care health workers in Kyrgyzstan and Vietnam underwent a one-day training session on asthma in children under five. The effect of training was measured on knowledge and clinical performance using a validated questionnaire, and by direct clinical observations. Results Eighty-one healthcare workers participated in the training. Their knowledge increased by 1.1 Cohen’s d (CI: 0.7 to 1.4) in Kyrgyzstan where baseline performance was lower and 1.5 Cohen’s d (CI: 0.5 to 2.5) in Vietnam. Consultations were performed by different types of health care workers in Kyrgyzstan and there was a 79.1% (CI 73.9 to 84.3%) increase in consultations where at least one core symptom of respiratory illness was asked. Only medical doctors participated in Vietnam, where the increase was 25.0% (CI 15.1 to 34.9%). Clinical examination improved significantly after training in Kyrgyzstan. In Vietnam, the number of actions performed generally declined. The most pronounced difference in contextual factors was consultation time, which was median 15 min in Kyrgyzstan and 2 min in Vietnam. Discussion and conclusion The effects on knowledge of training primary care health workers in lower middle-income countries in diagnosis and management of asthma in children under five only translated into changes in clinical performance where consultation time allowed for changes to clinical practice, emphasizing the importance of considering contextual factors in order to succeed in behavioral change after training.
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Affiliation(s)
- Jesper Kjærgaard
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Juliane Marie Center, Copenhagen University Hospital "Rigshospitalet", Copenhagen, Denmark. .,The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Thomas Nørrelykke Nissen
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Juliane Marie Center, Copenhagen University Hospital "Rigshospitalet", Copenhagen, Denmark
| | - Elvira Isaeva
- National Center of Maternity and Childhood Care, Bishkek, Kyrgyzstan
| | - Nguyen Nhat Quynh
- Center for Training in Family Medicine, University of Medicine and Pharmacy, Ho Chi Minh city, Vietnam
| | - Susanne Reventlow
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Stine Lund
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Juliane Marie Center, Copenhagen University Hospital "Rigshospitalet", Copenhagen, Denmark
| | - Talant Sooronbaev
- Respiratory, Critical Care and Sleep Medicine Department, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Pham Le An
- Center for Training in Family Medicine, University of Medicine and Pharmacy, Ho Chi Minh city, Vietnam
| | - Marianne Stubbe Østergaard
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jim Stout
- Seattle Children's Hospital, Washington University, Seattle, USA
| | - Anja Poulsen
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Juliane Marie Center, Copenhagen University Hospital "Rigshospitalet", Copenhagen, Denmark
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Boudewijns EA, Vermond D, van der Kleij RMJJ, Chavannes NH, van Schayck OCP, Kirenga B, Brakema EA. Factors critical to implementation success of cleaner cooking interventions in low-income and middle-income countries: protocol for an umbrella review. BMJ Open 2020; 10:e041821. [PMID: 33293323 PMCID: PMC7722821 DOI: 10.1136/bmjopen-2020-041821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Over a third of the world's population relies on solid fuels as their primary energy source. These fuels have damaging effects on health, air quality and forest resources. Interventions to promote access to cleaner solid fuel cookstoves and clean fuels have existed for decades. However, the adoption by local communities has largely failed, which led to a waste of resources and suboptimal outcomes. Therefore, the objective of this umbrella review is to identify factors that determine implementation success for cleaner cooking interventions in low-resource settings and weigh their level of confidence in the evidence. METHODS AND ANALYSIS We identified systematic and narrative reviews examining factors that influence the acquisition, initial adoption or sustained use of cleaner solid fuel cookstoves and clean fuels at any scale by a literature search in PubMed, Embase, Global Health Database, Cochrane, PsycINFO, Emcare, Web of Science and CINAHL, without date or language restrictions. The search was conducted on 23 October 2017 and updated on 10 July 2019. Reviews based on qualitative, quantitative or mixed-methods studies were included and will be appraised using the Meta Quality Appraisal Tool combined with the Assessment of Multiple Systematic Reviews. Data will be extracted and factors affecting implementation will be coded using the Consolidated Framework for Implementation Research. The Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research tool will be used to determine the level of confidence in the coded factors. Two researchers will independently conduct these steps. ETHICS AND DISSEMINATION This umbrella review does not require the approval of an ethical review board. Study results will be published in an international peer-reviewed journal. The outcomes will be converted into two practical tools: one for cleaner solid fuel cookstoves and one for clean fuels. These tools can guide the development of evidence-based implementation strategies for cleaner cooking interventions in low-income and middle-income countries to improve implementation success. These tools should be pilot-tested and promoted among regional and global initiatives. PROSPERO REGISTRATION NUMBER CRD42018088687.
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Affiliation(s)
- Esther A Boudewijns
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Debbie Vermond
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Onno C P van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Bruce Kirenga
- Department of Medicine and Makerere Lung Institute, Makerere University, Kampala, Uganda
| | - Evelyn A Brakema
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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Implementing a context-driven awareness programme addressing household air pollution and tobacco: a FRESH AIR study. NPJ Prim Care Respir Med 2020; 30:42. [PMID: 33024125 PMCID: PMC7538921 DOI: 10.1038/s41533-020-00201-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/25/2020] [Indexed: 12/18/2022] Open
Abstract
Most patients with chronic respiratory disease live in low-resource settings, where evidence is scarcest. In Kyrgyzstan and Vietnam, we studied the implementation of a Ugandan programme empowering communities to take action against biomass and tobacco smoke. Together with local stakeholders, we co-created a train-the-trainer implementation design and integrated the programme into existing local health infrastructures. Feasibility and acceptability, evaluated by the modified Conceptual Framework for Implementation Fidelity, were high: we reached ~15,000 Kyrgyz and ~10,000 Vietnamese citizens within budget (~€11,000/country). The right engaged stakeholders, high compatibility with local contexts and flexibility facilitated programme success. Scores on lung health awareness questionnaires increased significantly to an excellent level among all target groups. Behaviour change was moderately successful in Vietnam and highly successful in Kyrgyzstan. We conclude that contextualising the awareness programme to diverse low-resource settings can be feasible, acceptable and effective, and increase its sustainability. This paper provides guidance to translate lung health interventions to new contexts globally.
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Anastasaki M, Trigoni M, Pantouvaki A, Trouli M, Mavrogianni M, Chavannes N, Pooler J, van Kampen S, Jones R, Lionis C, Tsiligianni I. Establishing a pulmonary rehabilitation programme in primary care in Greece: A FRESH AIR implementation study. Chron Respir Dis 2020; 16:1479973119882939. [PMID: 31742441 PMCID: PMC6864042 DOI: 10.1177/1479973119882939] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pulmonary rehabilitation (PR) is an evidence-based, low-cost, non-medical treatment approach for patients with chronic respiratory diseases. This study aimed to start and assess the feasibility, acceptability and impact of a PR programme on health and quality of life of respiratory patients, for the first time in primary care in Crete, Greece and, particularly, in a low-resource rural setting. This was an implementation study with before-after outcome evaluation and qualitative interviews with patients and stakeholders. In a rural primary healthcare centre, patients with chronic obstructive pulmonary disease (COPD) and/or asthma were recruited. The implementation strategy included adaptation of a PR programme previously developed in United Kingdom and Uganda and training of clinical staff in programme delivery. The intervention comprised of 6 weeks of exercise and education sessions, supervised by physiotherapists, nurse and general practitioner. Patient outcomes (Clinical COPD Questionnaire (CCQ), COPD Assessment Test (CAT), St. George's Respiratory Questionnaire (SGRQ), Patient Health Questionnaire-9 (PHQ-9), Incremental Shuttle Walking Test (ISWT)) were analysed descriptively. Qualitative outcomes (feasibility, acceptability) were analysed using thematic content analysis. With minor adaptations to the original programme, 40 patients initiated (24 with COPD and 16 with asthma) and 31 completed PR (19 with COPD and 12 with asthma). Clinically important improvements in all outcomes were documented (mean differences (95% CIs) for CCQ: -0.53 (-0.81, -0.24), CAT: -5.93 (-8.27, -3.60), SGRQ: -23.00 (-29.42, -16.58), PHQ-9: -1.10 (-2.32, 0.12), ISWT: 87.39 (59.37, 115.40)). The direct PR benefits and the necessity of implementing similar initiatives in remote areas were highlighted. This study provided evidence about the multiple impacts of a PR programme, indicating that it could be both feasible and acceptable in low-resource, primary care settings.
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Affiliation(s)
- Marilena Anastasaki
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Maria Trigoni
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Anna Pantouvaki
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Marianna Trouli
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Maria Mavrogianni
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Niels Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Jillian Pooler
- Population Studies and Clinical Trials, Faculty of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | - Sanne van Kampen
- Population Studies and Clinical Trials, Faculty of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | - Rupert Jones
- Population Studies and Clinical Trials, Faculty of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Ioanna Tsiligianni
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
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Brakema EA, Vermond D, Pinnock H, Lionis C, Kirenga B, An PL, Sooronbaev T, Chavannes NH, van der Kleij MJJR. Implementing lung health interventions in low- and middle-income countries: a FRESH AIR systematic review and meta-synthesis. Eur Respir J 2020; 56:13993003.00127-2020. [PMID: 32341109 PMCID: PMC7409813 DOI: 10.1183/13993003.00127-2020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/29/2020] [Indexed: 01/17/2023]
Abstract
The vast majority of patients with chronic respiratory disease live in low- and middle-income countries (LMICs). Paradoxically, relevant interventions often fail to be effective particularly in these settings, as LMICs lack solid evidence on how to implement interventions successfully. Therefore, we aimed to identify factors critical to the implementation of lung health interventions in LMICs, and weigh their level of evidence. This systematic review followed Cochrane methodology and Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) reporting standards. We searched eight databases without date or language restrictions in July 2019, and included all relevant original, peer-reviewed articles. Two researchers independently selected articles, critically appraised them (using Critical Appraisal Skills Programme (CASP)/Meta Quality Appraisal Tool (MetaQAT)), extracted data, coded factors (following the Consolidated Framework for Implementation Research (CFIR)), and assigned levels of confidence in the factors (via Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual)). We meta-synthesised levels of evidence of the factors based on their frequency and the assigned level of confidence (PROSPERO:CRD42018088687). We included 37 articles out of 9111 screened. Studies were performed across the globe in a broad range of settings. Factors identified with a high level of evidence were: 1) “Understanding needs of local users”; 2) ensuring “Compatibility” of interventions with local contexts (cultures, infrastructures); 3) identifying influential stakeholders and applying “Engagement” strategies; 4) ensuring adequate “Access to knowledge and information”; and 5) addressing “Resource availability”. All implementation factors and their level of evidence were synthesised in an implementation tool. To conclude, this study identified implementation factors for lung health interventions in LMICs, weighed their level of evidence, and integrated the results into an implementation tool for practice. Policymakers, non-governmental organisations, practitioners, and researchers may use this FRESH AIR (Free Respiratory Evaluation and Smoke-exposure reduction by primary Health cAre Integrated gRoups) Implementation tool to develop evidence-based implementation strategies for related interventions. This could increase interventions’ implementation success, thereby optimising the use of already-scarce resources and improving health outcomes. This systematic review and meta-synthesis shows why implementation of lung health interventions often fails in low- and middle-income countries, and it provides critical factors to prevent failure with their level of evidencehttps://bit.ly/2UYJOSa
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Affiliation(s)
- Evelyn A Brakema
- Dept of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Debbie Vermond
- Dept of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Hilary Pinnock
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Bruce Kirenga
- Dept of Medicine and Makerere Lung Institute, Makerere University, Kampala, Uganda
| | - Pham Le An
- Center of Training Family Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Talant Sooronbaev
- Pulmonary Dept, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Niels H Chavannes
- Dept of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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Brakema EA, Tabyshova A, van der Kleij RMJJ, Sooronbaev T, Lionis C, Anastasaki M, An PL, Nguyen LT, Kirenga B, Walusimbi S, Postma MJ, Chavannes NH, van Boven JFM. The socioeconomic burden of chronic lung disease in low-resource settings across the globe - an observational FRESH AIR study. Respir Res 2019; 20:291. [PMID: 31864411 PMCID: PMC6925865 DOI: 10.1186/s12931-019-1255-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/05/2019] [Indexed: 01/01/2023] Open
Abstract
Background Low-resource settings are disproportionally burdened by chronic lung disease due to early childhood disadvantages and indoor/outdoor air pollution. However, data on the socioeconomic impact of respiratory diseases in these settings are largely lacking. Therefore, we aimed to estimate the chronic lung disease-related socioeconomic burden in diverse low-resource settings across the globe. To inform governmental and health policy, we focused on work productivity and activity impairment and its modifiable clinical and environmental risk factors. Methods We performed a cross-sectional, observational FRESH AIR study in Uganda, Vietnam, Kyrgyzstan, and Greece. We assessed the chronic lung disease-related socioeconomic burden using validated questionnaires among spirometry-diagnosed COPD and/or asthma patients (total N = 1040). Predictors for a higher burden were studied using multivariable linear regression models including demographics (e.g. age, gender), health parameters (breathlessness, comorbidities), and risk factors for chronic lung disease (smoking, solid fuel use). We applied identical models per country, which we subsequently meta-analyzed. Results Employed patients reported a median [IQR] overall work impairment due to chronic lung disease of 30% [1.8–51.7] and decreased productivity (presenteeism) of 20.0% [0.0–40.0]. Remarkably, work time missed (absenteeism) was 0.0% [0.0–16.7]. The total population reported 40.0% [20.0–60.0] impairment in daily activities. Breathlessness severity (MRC-scale) (B = 8.92, 95%CI = 7.47–10.36), smoking (B = 5.97, 95%CI = 1.73–10.22), and solid fuel use (B = 3.94, 95%CI = 0.56–7.31) were potentially modifiable risk factors for impairment. Conclusions In low-resource settings, chronic lung disease-related absenteeism is relatively low compared to the substantial presenteeism and activity impairment. Possibly, given the lack of social security systems, relatively few people take days off work at the expense of decreased productivity. Breathlessness (MRC-score), smoking, and solid fuel use are potentially modifiable predictors for higher impairment. Results warrant increased awareness, preventive actions and clinical management of lung diseases in low-resource settings from health policymakers and healthcare workers.
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Affiliation(s)
- Evelyn A Brakema
- Department of Public Health and Primary Care, Leiden University Medical Center, Postzone V0-P, Postbus 9600, 2300 RC, Leiden, The Netherlands.
| | - Aizhamal Tabyshova
- Pulmonary Department, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan.,Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rianne M J J van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Center, Postzone V0-P, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Talant Sooronbaev
- Pulmonary Department, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Marilena Anastasaki
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Pham Le An
- University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | | | - Bruce Kirenga
- Department of Medicine and Makerere Lung Institute, Makerere University, Kampala, Uganda
| | - Simon Walusimbi
- Department of Medicine and Makerere Lung Institute, Makerere University, Kampala, Uganda
| | - Maarten J Postma
- Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Postzone V0-P, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Job F M van Boven
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
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Poot CC, van der Kleij RM, Brakema EA, Vermond D, Williams S, Cragg L, van den Broek JM, Chavannes NH. From research to evidence-informed decision making: a systematic approach. J Public Health (Oxf) 2019. [PMID: 29538728 PMCID: PMC5896638 DOI: 10.1093/pubmed/fdx153] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Knowledge creation forms an integral part of the knowledge-to-action framework aimed at bridging the gap between research and evidence-informed decision making. Although principles of science communication, data visualisation and user-centred design largely impact the effectiveness of communication, their role in knowledge creation is still limited. Hence, this article aims to provide researchers a systematic approach on how knowledge creation can be put into practice. Methods A systematic two-phased approach towards knowledge creation was formulated and executed. First, during a preparation phase the purpose and audience of the knowledge were defined. Subsequently, a developmental phase facilitated how the content is 'said' (language) and communicated (channel). This developmental phase proceeded via two pathways: a translational cycle and design cycle, during which core translational and design components were incorporated. The entire approach was demonstrated by a case study. Results The case study demonstrated how the phases in this systematic approach can be operationalised. It furthermore illustrated how created knowledge can be delivered. Conclusion The proposed approach offers researchers a systematic, practical and easy-to-implement tool to facilitate effective knowledge creation towards decision-makers in healthcare. Through the integration of core components of knowledge creation evidence-informed decision making will ultimately be optimized.
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Affiliation(s)
- Charlotte C Poot
- Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, Postbus 9600 zone V-0-P, 2300 RC Leiden, The Netherlands
| | - Rianne M van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, Postbus 9600 zone V-0-P, 2300 RC Leiden, The Netherlands
| | - Evelyn A Brakema
- Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, Postbus 9600 zone V-0-P, 2300 RC Leiden, The Netherlands
| | - Debbie Vermond
- Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, Postbus 9600 zone V-0-P, 2300 RC Leiden, The Netherlands
| | - Siân Williams
- International Primary Care Respiratory Group, IPCRG, PO Box 11961, Westhill AB32 9AE, UK
| | - Liza Cragg
- International Primary Care Respiratory Group, IPCRG, PO Box 11961, Westhill AB32 9AE, UK
| | - Jos M van den Broek
- Department Science Communication & Society, Leiden University, PO Box 9505, 2300 RA Leiden, The Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, Postbus 9600 zone V-0-P, 2300 RC Leiden, The Netherlands
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Kjærgaard J, Anastasaki M, Stubbe Østergaard M, Isaeva E, Akylbekov A, Nguyen NQ, Reventlow S, Lionis C, Sooronbaev T, Pham LA, Nantanda R, Stout JW, Poulsen A. Diagnosis and treatment of acute respiratory illness in children under five in primary care in low-, middle-, and high-income countries: A descriptive FRESH AIR study. PLoS One 2019; 14:e0221389. [PMID: 31693667 PMCID: PMC6834279 DOI: 10.1371/journal.pone.0221389] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 08/07/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Respiratory disease and, specifically, pneumonia, is the major cause of mortality and morbidity in young children. Diagnosis of both pneumonia and asthma in primary care rests principally on clinical signs, history taking, and bronchodilator responsiveness. This study aimed to describe clinical practices in diverse global primary care settings concerning differential diagnosis of respiratory disease in young children, especially between pneumonia and asthma. METHODS Health professionals in Greece, Kyrgyzstan, Vietnam, and Uganda were observed during consultations with children aged 2-59 months, presenting with cough and/or difficult breathing. Data were analyzed descriptively and included consultation duration, practices, diagnoses and availability/use of medications and equipment. The study is part of the European Horizon 2020 FRESH AIR project. RESULTS In total, 771 consultations by 127 health professionals at 74 facilities in the four countries were observed. Consultations were shorter in Vietnam and Uganda (3 to 4 minutes) compared to Greece and Kyrgyzstan (15 to 20 minutes). History taking was most comprehensive in Greece. Clinical examination was more comprehensive in Vietnam and Kyrgyzstan and less in Uganda. Viral upper respiratory tract infections were the most common diagnoses (41.7% to 67%). Pneumonia was diagnosed frequently in Uganda (16.3% of children), and rarely in other countries (0.8% to 2.9%). Asthma diagnosis was rare (0% to 2.8%). Antibiotics were prescribed frequently in all countries (32% to 69%). Short acting β-agonist trials were seldom available and used during consultations in Kyrgyzstan (0%) and Uganda (1.8%), and often in Greece (38.9%) and Vietnam (12.6%). CONCLUSIONS Duration and comprehensiveness of clinical consultations observed in this study seemed insufficient to guide respiratory diagnosis in young children. Appropriate treatment options may further not be available in certain studied settings. Actions aiming at educating and raising professional awareness, along with developing easy-to-use tools to support diagnosis and a general strengthening of health systems are important goals.
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Affiliation(s)
- Jesper Kjærgaard
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital “Rigshospitalet”, Copenhagen, Denmark
- * E-mail:
| | - Marilena Anastasaki
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Marianne Stubbe Østergaard
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, Copenhagen University, Copenhagen, Denmark
| | - Elvira Isaeva
- National Center of Maternity and Childhood Care, Bishkek, Kyrgyzstan
| | - Azamat Akylbekov
- National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Nhat Quynh Nguyen
- Family Medicine Department, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Susanne Reventlow
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, Copenhagen University, Copenhagen, Denmark
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Talant Sooronbaev
- Kyrgyz Thoracic Society, Respiratory, Critical Care and Sleep Medicine Department, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Le An Pham
- Vietnamese Association Family Medicine, Center for training Family Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Rebecca Nantanda
- Department of Paediatrics, Mulago Hospital and Makere University, Kampala, Uganda
| | - James W. Stout
- University of Washington, Seattle, Washington, United States of America
| | - Anja Poulsen
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital “Rigshospitalet”, Copenhagen, Denmark
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Vardavas CI, Kyriakos CN, Fernández E, Bamidis P, Siddiqi K, Chavannes NH, van der Kleij R, Parker G, Radu-Loghin C, Ward B, Berkouk K. H2020 funding for respiratory research: scaling up for the prevention and treatment of lung diseases. Eur Respir J 2019; 54:54/3/1901417. [DOI: 10.1183/13993003.01417-2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 07/28/2019] [Indexed: 02/02/2023]
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Adapting Very Brief Advice (VBA) on smoking for use in low-resource settings: experience from the FRESH AIR project. J Smok Cessat 2019. [DOI: 10.1017/jsc.2019.4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AbstractIntroductionVery Brief Advice (VBA) on smoking is an evidence-based intervention and a recommended clinical practice for all healthcare professionals in the UK.AimsWe report on experience from the FRESH AIR project in adapting the VBA model and training in three low-resource settings: Greece, Vietnam and Kyrgyzstan.MethodsUsing a participatory research process, UK experts and local stakeholders conducted an environmental scan and needs assessment to examine the VBA intervention model, training materials and recommend adaptations to the local context. Two VBA training sessions were piloted in each country to inform adaptation. A final training tool kit was developed in the local language.ResultsIn each country, the VBA on smoking intervention model remained primarily intact. The lack of a formal smoking cessation system to refer motivated clients in two countries required adaptation of the ACT component of the model. A range of local adaptations to the training resources were made in all three countries to ensure cultural appropriateness as well as enhance key messages including expanding training on nicotine addiction, second-hand smoke and pharmacotherapy.ConclusionsImplementation of VBA requires sensitive, collaborative, local and cultural adaptation if it is to be achieved successfully.Trial registrationTrial ID# NTR5759Critical appraisal toolsThe Standards for Reporting Implementation Studies (StaRI) statement: https://www.equator-network.org/reporting-guidelines/stari-statement/
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Effects and acceptability of implementing improved cookstoves and heaters to reduce household air pollution: a FRESH AIR study. NPJ Prim Care Respir Med 2019; 29:32. [PMID: 31417087 PMCID: PMC6695425 DOI: 10.1038/s41533-019-0144-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 07/10/2019] [Indexed: 12/27/2022] Open
Abstract
The objective was to evaluate the effectiveness and acceptability of locally tailored implementation of improved cookstoves/heaters in low- and middle-income countries. This interventional implementation study among 649 adults and children living in rural communities in Uganda, Vietnam and Kyrgyzstan, was performed after situational analyses and awareness programmes. Outcomes included household air pollution (PM2.5 and CO), self-reported respiratory symptoms (with CCQ and MRC-breathlessness scale), chest infections, school absence and intervention acceptability. Measurements were conducted at baseline, 2 and 6–12 months after implementing improved cookstoves/heaters. Mean PM2.5 values decrease by 31% (to 95.1 µg/m3) in Uganda (95%CI 71.5–126.6), by 32% (to 31.1 µg/m3) in Vietnam (95%CI 24.5–39.5) and by 65% (to 32.4 µg/m3) in Kyrgyzstan (95%CI 25.7–40.8), but all remain above the WHO guidelines. CO-levels remain below the WHO guidelines. After intervention, symptoms and infections diminish significantly in Uganda and Kyrgyzstan, and to a smaller extent in Vietnam. Quantitative assessment indicates high acceptance of the new cookstoves/heaters. In conclusion, locally tailored implementation of improved cookstoves/heaters is acceptable and has considerable effects on respiratory symptoms and indoor pollution, yet mean PM2.5 levels remain above WHO recommendations.
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22
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Nantanda R, Buteme S, van Kampen S, Cartwright L, Pooler J, Barton A, Callaghan L, Mirembe J, Ndeezi G, Tumwine JK, Kirenga B, Jones R. Feasibility and acceptability of a midwife-led health education strategy to reduce exposure to biomass smoke among pregnant women in Uganda, A FRESH AIR project. Glob Public Health 2019; 14:1770-1783. [PMID: 31345124 DOI: 10.1080/17441692.2019.1642931] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Biomass smoke exposure is a threat to child and maternal health in many resource-limited countries and is associated with poor pregnancy outcomes and serious lung diseases in the offspring. We aimed to assess the feasibility, acceptability and impact of a midwife-led education programme on biomass risks and prevention for women attending maternity clinics in Uganda. Education materials were co-developed through an iterative process by midwives and other stakeholders. The materials were serially tested and approved by the Ministry of Health and used by midwives and village health teams (VHTs). The district health team, 12 midwives and 40 VHTs were sensitised on biomass smoke. Two hundred and forty-four women were educated about biomass smoke by midwives; pre- and post-session questionnaires showed major improvements in knowledge of biomass smoke risks. Qualitative interviews with women three months after the sessions showed that they made behavioural changes such as avoiding smoke while cooking, using dry wood, solar power for lighting and improved ventilation. The major barrier to behavioural changes was poverty, but some improvements cost no money. The programme delivered by midwives was feasible and acceptable; implementing this programme has the potential to reduce exposure to smoke with major benefits to mother, foetus, and children throughout their lives.
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Affiliation(s)
- Rebecca Nantanda
- Makerere University Lung Institute, Makerere University College of Health Sciences , Kampala , Uganda.,Department of Paediatrics and Child Health, Makerere University College of Health Sciences , Kampala , Uganda
| | - Shamim Buteme
- Makerere University Lung Institute, Makerere University College of Health Sciences , Kampala , Uganda
| | - Sanne van Kampen
- Clinical Trials and Population Studies, University of Plymouth , Plymouth , England
| | - Lucy Cartwright
- Clinical Trials and Population Studies, University of Plymouth , Plymouth , England
| | - Jill Pooler
- Clinical Trials and Population Studies, University of Plymouth , Plymouth , England
| | - Andy Barton
- Clinical Trials and Population Studies, University of Plymouth , Plymouth , England
| | - Lynne Callaghan
- Clinical Trials and Population Studies, University of Plymouth , Plymouth , England
| | - Jean Mirembe
- Directorate of Health Services , Jinja District , Uganda
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences , Kampala , Uganda
| | - James K Tumwine
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences , Kampala , Uganda
| | - Bruce Kirenga
- Makerere University Lung Institute, Makerere University College of Health Sciences , Kampala , Uganda.,Department of Internal Medicine, Makerere University College of Health Sciences , Kampala , Uganda
| | - Rupert Jones
- Clinical Trials and Population Studies, University of Plymouth , Plymouth , England
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23
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Halpin DMG, Celli BR, Criner GJ, Frith P, López Varela MV, Salvi S, Vogelmeier CF, Chen R, Mortimer K, Montes de Oca M, Aisanov Z, Obaseki D, Decker R, Agusti A. It is time for the world to take COPD seriously: a statement from the GOLD board of directors. Eur Respir J 2019; 54:54/1/1900914. [PMID: 31273036 DOI: 10.1183/13993003.00914-2019] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 05/22/2019] [Indexed: 11/05/2022]
Affiliation(s)
- David M G Halpin
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Gerard J Criner
- Dept of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Peter Frith
- Flinders University College of Medicine and Public Health, Adelaide, Australia
| | - M Victorina López Varela
- Cátedra de Neumología, Facultad de Medicina, Universidad de la República Hospital Maciel, Montevideo, Uruguay
| | | | - Claus F Vogelmeier
- Dept of Medicine, Pulmonary and Critical Care Medicine, University Medical Centre Giessen and Marburg, Philipps-Universität Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Ronchang Chen
- Guangzhou Institute of Respiratory Disease, State Key Lab of Respiratory Disease and National Clinical Research Center for Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | | - Maria Montes de Oca
- Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela
| | - Zaurbek Aisanov
- Dept of Pulmonology, N.I. Pirogov Russian State National Research Medical University, Healthcare Ministry of Russia, Moscow, Russia
| | - Daniel Obaseki
- Dept of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Rebecca Decker
- Program Director, Global Initiative for Chronic Obstructive Lung Disease
| | - Alvar Agusti
- Institut Respiratori, Hospital Clínic, IDIBAPS Universitat de Barcelona, CIBER Enfermedades Respiratorias, Barcelona, Spain
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24
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Brakema EA, Tabyshova A, Kasteleyn MJ, Molendijk E, van der Kleij RMJJ, van Boven JFM, Emilov B, Akmatalieva M, Mademilov M, Numans ME, Williams S, Sooronbaev T, Chavannes NH. High COPD prevalence at high altitude: does household air pollution play a role? Eur Respir J 2019; 53:1801193. [PMID: 30464013 PMCID: PMC6428658 DOI: 10.1183/13993003.01193-2018] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/02/2018] [Indexed: 01/09/2023]
Abstract
Studies comparing chronic obstructive pulmonary disease (COPD) prevalence across altitudes report conflicting results. However, household air pollution (HAP), a major COPD risk factor, was mostly not accounted for in previous analyses and never objectively measured. We aimed to compare the prevalence of COPD and its risk factors between low-resource highlands and lowlands, with a particular focus on objectively measured HAP.We conducted a population-based, observational study in a highland (∼2050 m above sea level) and a lowland (∼750 m above sea level) setting in rural Kyrgyzstan. We performed spirometry in randomly selected households, measured indoor particulate matter with an aerodynamic diameter <2.5 µm (PM2.5) and administered a questionnaire on other COPD risk factors. Descriptive statistics and multivariable logistic regressions were used for analyses.We included 392 participants: 199 highlanders and 193 lowlanders. COPD was more prevalent among highlanders (36.7% versus 10.4%; p<0.001). Their average PM2.5 exposure was also higher (290.0 versus 72.0 µg·m-3; p<0.001). In addition to high PM2.5 exposure (OR 3.174, 95% CI 1.061-9.493), the altitude setting (OR 3.406, 95% CI 1.483-7.825), pack-years of smoking (OR 1.037, 95% CI 1.005-1.070) and age (OR 1.058, 95% CI 1.037-1.079) also contributed to a higher COPD prevalence among highlanders.COPD prevalence and HAP were highest in the highlands, and were independently associated. Preventive interventions seem warranted in these low-resource, highland settings. With this study being one of the first spirometry-based prevalence studies in Central Asia, generalisability needs to be assessed.
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Affiliation(s)
- Evelyn A Brakema
- Dept of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Aizhamal Tabyshova
- Pulmonary Dept, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
- Dept of General Practice and Elderly Care Medicine, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marise J Kasteleyn
- Dept of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Eveline Molendijk
- Dept of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Job F M van Boven
- Dept of General Practice and Elderly Care Medicine, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Berik Emilov
- Pulmonary Dept, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Meerim Akmatalieva
- Pulmonary Dept, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Maamed Mademilov
- Pulmonary Dept, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Mattijs E Numans
- Dept of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Sian Williams
- International Primary Care Respiratory Group (IPCRG), London, UK
| | - Talant Sooronbaev
- Pulmonary Dept, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Niels H Chavannes
- Dept of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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25
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Østergaard MS, Kjærgaard J, Kristensen MM, Reventlow S, Poulsen A, Isaeva E, Akylbekov A, Sooronbaev T. Recurrent lower respiratory illnesses among young children in rural Kyrgyzstan: overuse of antibiotics and possible under-diagnosis of asthma. A qualitative FRESH AIR study. NPJ Prim Care Respir Med 2018; 28:13. [PMID: 29636473 PMCID: PMC5893612 DOI: 10.1038/s41533-018-0081-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 02/26/2018] [Accepted: 03/13/2018] [Indexed: 12/21/2022] Open
Abstract
Lower respiratory tract illnesses (LRT-illnesses) in children under 5 years (U5s) are a leading cause of morbidity, hospitalisations and mortality worldwide, particularly in low-income countries. It is pertinent to understand possible inconsistent management. This study explored perceptions and practices among caregivers and health professionals on recurrent LRT-illnesses in U5s. Semi-structured interviews with 13 caregivers to U5s with recurrent LRT-illnesses and with 22 primary care health professional interviews in two rural provinces in Kyrgyzstan were triangulated. Data were thematically analysed. The majority (8/13) of caregivers described their young children as having recurrent coughing, noisy breathing and respiratory distress of whom several had responded positively to acute salbutamol and/or had been repeatedly hospitalised for LRT-illness. Family stress and financial burdens were significant. The health professionals classified young children with recurrent LRT-illnesses primarily with pneumonia and/or a multitude of bronchitis diagnoses. Broad-spectrum antibiotics and supportive medicine were used repeatedly, prescribed by health professionals or purchased un-prescribed by the caregivers at the pharmacy. The health professionals had never applied the asthma diagnosis to U5s nor had they prescribed inhaled steroids, and none of the interviewed caregivers’ U5s were diagnosed with asthma. Health professionals and caregivers shared a common concern for the children’s recurrent respiratory illnesses developing into a severe chronic pulmonary condition, including asthma. In conclusion, the study identified an inconsistent management of LRT-illnesses in U5s, with exorbitant use of antibiotics and an apparently systemic under-diagnosis of asthma/wheeze. When the diagnosis asthma is not used, the illness is not considered as a long-term condition, requiring preventer/controller medication.
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Affiliation(s)
- Marianne Stubbe Østergaard
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Jesper Kjærgaard
- The Global Health Unit, Department of Paediatrics and Adolescent Medicine, Danish National Hospital "Rigshospitalet", Copenhagen, Denmark
| | | | - Susanne Reventlow
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anja Poulsen
- The Global Health Unit, Department of Paediatrics and Adolescent Medicine, Danish National Hospital "Rigshospitalet", Copenhagen, Denmark
| | - Elvira Isaeva
- National Center of Maternity and Childhood Care, Bishkek, Kyrgyzstan
| | - Azamat Akylbekov
- National Center of Cardiology and Internal Medicine named after Academician M. Mirrakhimov, Bishkek, Kyrgyzstan
| | - Talant Sooronbaev
- National Center of Cardiology and Internal Medicine named after Academician M. Mirrakhimov, Bishkek, Kyrgyzstan
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26
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Pinnock H, Sheikh A. Standards for reporting implementation studies (StaRI): enhancing reporting to improve care. NPJ Prim Care Respir Med 2017; 27:42. [PMID: 28652602 PMCID: PMC5484688 DOI: 10.1038/s41533-017-0045-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 05/20/2017] [Accepted: 05/31/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
- Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, EH* 9AG, UK.
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, EH* 9AG, UK
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