Quantifying the Cost of Shigella Diarrhea in the Enterics for Global Health (EFGH) Shigella Surveillance Study

Background

Comparative costs of public health interventions provide valuable data for decision making. However, the availability of comprehensive and context-specific costs is often limited. The Enterics for Global Health (EFGH) Shigella surveillance study-a facility-based diarrhea surveillance study across 7 countries-aims to generate evidence on health system and household costs associated with medically attended Shigella diarrhea in children.

Methods

EFGH working groups comprising representatives from each country (Bangladesh, Kenya, Malawi, Mali, Pakistan, Peru, and The Gambia) developed the study methods. Over a 24-month surveillance period, facility-based surveys will collect data on resource use for the medical treatment of an estimated 9800 children aged 6-35 months with diarrhea. Through these surveys, we will describe and quantify medical resources used in the treatment of diarrhea (eg, medication, supplies, and provider salaries), nonmedical resources (eg, travel costs to the facility), and the amount of caregiver time lost from work to care for their sick child. To assign costs to each identified resource, we will use a combination of caregiver interviews, national medical price lists, and databases from the World Health Organization and the International Labor Organization. Our primary outcome will be the estimated cost per inpatient and outpatient episode of medically attended Shigella diarrhea treatment across countries, levels of care, and illness severity. We will conduct sensitivity and scenario analysis to determine how unit costs vary across scenarios.

Conclusions

Results from this study will contribute to the existing body of literature on diarrhea costing and inform future policy decisions related to investments in preventive strategies for Shigella.

Where is the market? Assessing the role of dryer performance and marketability of solar-dried products in acceptance of solar dryers amongst smallholder farmers

Agricultural technological development is a crucial strategy for agricultural commercialization and socio-economic transformation in Africa. However, a key challenge to technology use in agriculture remains the limited farmer acceptance of unfamiliar technologies. This paper uses a sample of 245 okra farmers drawn from northern Uganda to assess the drivers of the farmer acceptance of solar drying technology. On the basis of drying performance, farmers perceive the solar dryer to perform better than the open sun-drying method. Structural equation modelling results show that the drying rate and perceived product quality are the main determinants of farmer perceptions on product marketability. Further, product marketability drives acceptance of solar dryers among farmers. We conclude that acceptance of solar dryers is dependent on: i) the drying rate, ii) favorable perceptions towards product quality, and iii) perceived marketability of the solar-dried product. We call for policy action on intensification of efforts that promote solar drying technology, including supporting local artisans to fabricate dryers, to enable increased value addition and consumption of nutritious foods.

Stakeholders' Perceptions of Agronomic Iodine Biofortification: A SWOT-AHP Analysis in Northern Uganda

Agronomic biofortification (i.e., the application of fertilizer to elevate micronutrient concentrations in staple crops) is a recent strategy recommended for controlling Iodine Deficiency Disorders (IDDs). However, its success inevitably depends on stakeholders’ appreciation and acceptance of it. By taking Northern Uganda as a case, this study aimed to capture and compare the perceptions of seven key stakeholder groups with respect to agronomic iodine biofortification. Therefore, we employed a SWOT (Strength, Weaknesses, Opportunities & Threats) analysis in combination with an Analytical Hierarchy Process (AHP). Findings show that stakeholders (n = 56) are generally positive about agronomic iodine biofortification in Uganda, as its strengths and opportunities outweighed weaknesses and threats. Cultural acceptance and effectiveness are considered the most important strengths while the high IDD prevalence rate and the availability of iodine deficient soils are key opportunities for further developing agronomic iodine biofortification. Environmental concerns about synthetic fertilizers as well as the time needed to supply iodine were considered crucial weaknesses. The limited use of fertilizer in Uganda was the main threat. While this study provides insight into important issues and priorities for iodine biofortification technology in Uganda, including differences in stakeholder views, the application of the SWOT-AHP method will guide future researchers and health planners conducting stakeholder analysis in similar domains.

Is the step-wise tiered approach for ERA of pharmaceuticals useful for the assessment of cancer therapeutic drugs present in marine environment?

Methotrexate (MTX) and tamoxifen (TMX) cancer therapeutic drugs have been detected within the aquatic environment. Nevertheless, MTX and TMX research is essentially bio-medically orientated, with few studies addressing the question of its toxicity in fresh water organisms, and none to its' effect in the marine environment. To the authors' knowledge, Environmental Risk Assessments (ERA) for pharmaceuticals has mainly been designed for freshwater and terrestrial environments (European Medicines Agency-EMEA guideline, 2006). Therefore, the purpose of this research was (1) to assess effect of MTX and TMX in marine organism using the EMEA guideline, (2) to develop an ERA methodology for marine environment, and (3) to evaluate the suitability of including a biomarker approach in Phase III. To reach these aims, a risk assessment of MTX and TMX was performed following EMEA guideline, including a 2-tier approach during Phase III, applying lysosomal membrane stability (LMS) as a screening biomarker in tier-1 and a battery of biochemical biomarkers in tier-2. Results from Phase II indicated that MTX was not toxic for bacteria, microalgae and sea urchin at the concentrations tested, thus no further assessment was required, while TMX indicated a possible risk. Therefore, Phase III was performed for only TMX. Ruditapes philippinarum were exposed during 14 days to TMX (0.1, 1, 10, 50 μg L(-1)). At the end of the experiment, clams exposed to environmental concentration indicated significant changes in LMS compared to the control (p<0.01); thus a second tier was applied. A significant induction of biomarkers (activity of Ethoxyresorufin O-deethylase [EROD], glutathione S-transferase [GST], glutathione peroxidase [GPX], and lipid peroxidation [LPO] levels) was observed in digestive gland tissues of clams compared with control (p<0.01). Finally, this study indicated that MTX was not toxic at an environmental concentration, whilst TMX was potentially toxic for marine biota. This study has shown the necessity to create specific guidelines in order to evaluate effects of pharmaceuticals in marine environment which includes sensitive endpoints. The inadequacy of current EMEA guideline to predict chemotherapy agents toxicity in Phase II was displayed whilst the usefulness of other tests were demonstrated. The 2-tier approach, applied in Phase III, appears to be suitable for an ERA of cancer therapeutic drugs in the marine environment.

Photogrammetry for environmental monitoring: the use of drones and hydrological models for detection of soil contaminated by copper

Campania Region of Southern Italy has a complex environmental situation, due to geogenic and anthropogenic soil pollution. Some of the pollutants such as copper are mobilized in the organic matter. It has been shown that wetlands provide physical as well as biogeochemical barriers against pollutants. Therefore, the objective of this study was to introduce and test an innovative approach able to predict copper accumulation points at plot scales, using a combination of aerial photos, taken by drones, micro-rill network modelling and wetland prediction indices usually used at catchment scales. Data were collected from an area measuring 4500 m(2) in Trentola Ducenta locality of Caserta Province of southern Italy. The photos processing with a fifth generation software for photogrammetry resulted in a high resolution Digital Elevation Model (DEM), used to study micro-rill processes. The DEM was also used to test the ability of Topographic Index (TI) and the Clima-Topographic Index (CTI) to predict copper sedimentation points at plot scale (0.1-10 ha) by comparing the map of the predicted and the actual copper distribution in the field. The DEM obtained with a resolution of 30 mm showed a high potential for the study of micro-rill processes and TI and CTI indices were able to predict zones of copper accumulation at a plot scale.

Indirect field technology for detecting areas object of illegal spills harmful to human health: application of drones, photogrammetry and hydrological models

The accumulation of heavy metals in agricultural soils is a serious environmental problem. The Campania region in southern Italy has higher levels of cancer risk, presumably due to the accumulation of geogenic and anthropogenic soil pollutants, some of which have been incorporated into organic matter. The aim of this study was to introduce and test an innovative, field-applicable methodology to detect heavy metal accumulation using drone-based photogrammetry and microrill network modelling, specifically to generate wetlands wetlands prediction indices normally applied at large catchment scales, such as a large geographic basin. The processing of aerial photos taken using a hexacopter equipped with fifth-generation software for photogrammetry allowed the generation of a digital elevation model (DEM) with a resolution as high as 30 mm. Not only this provided a high potential for the study of micro-rill processes, but it was also useful for testing and comparing the capability of the topographic index (TI) and the clima-topographic index (CTI) to predict heavy metal sedimentation points at scales from 0.1 to 10 ha. Our results indicate that the TI and CTI indices can be used to predict points of heavy metal accumulation for small field catchments.

Suicide in cancer patients in South East England from 1996 to 2005: a population-based study

BACKGROUND

Studies from around the world have shown that suicide risk is increased in cancer patients, but no previous detailed analysis has been carried out in England.

METHODS

We calculated standardised mortality ratios (SMRs) for suicide in 206,129 men and 211,443 women diagnosed with cancer in South East England between 1996 and 2005, relative to suicide rates in the general population.

RESULTS

We found a significantly increased risk of suicide in men (SMR 1.45, 95% confidence interval (CI) 1.20-1.73) and a moderately increased risk in women (SMR 1.19, 95% CI 0.88-1.57). In both sexes, relative risk of suicide was greatest in the first year after cancer diagnosis (SMR for men 2.42, 95% CI 1.84-3.13; SMR for women 1.44, 95% CI 0.82-2.33), and was also greater in individuals diagnosed with types of cancer with high fatality (SMR for men 2.67, 95% CI 1.71-3.97; SMR for women 2.17, 95% CI 0.80-4.73).

CONCLUSION

There is a critical period immediately after the diagnosis of cancer during which the excess risk of suicide is particularly high. Carers need to be aware of the importance of attending to both the physical and emotional needs of cancer patients and cancer survivors.

The future burden of cancer in England: incidence and numbers of new patients in 2020

We estimated the future cancer incidence rates and the future numbers of cancer cases in England up to 2020 using cancer registration data for 1974-2003, and the official population projections from ONS up to 2023. Data were analysed using an age-period-cohort model as developed for the Nordic countries. We predict that for all cancers combined there will be relatively little change in age-standardised incidence rates in 2020. The number of new cancer cases per year in England is, however, predicted to increase by 33%, from 224,000 in 2001 to 299,000 cases in 2020. This increase is mainly due to the anticipated effects of population growth and ageing; cancer patients in 2020 will be older than today's cancer population.

Sildenafil in management of persistent pulmonary hypertension of the newborn: report of two cases

Persistent pulmonary hypertension of the newborn (PPHN) was described in 1969 by Gersomy and co-workers as persistent foetal circulation. Supra - systemic pulmonary artery pressures result in right to left shunting of blood through the ductus arteriosus and/or foramen ovale. This results from failure of the normal adaptation to extra uterine life of the foetal heart/lung system. The incidence is estimated at about 0.1-0.2% of live born infants, majority being term or post term. There is no race or gender related predisposition. Management was always difficult before the advent of nitric oxide (and now sildenafil). We report two newborn infants born at The Mater Hospital with perinatal asphyxia resulting inpersistent pulmonary hypertension that were successfully managed with sildenafil.