Geneva Health Forum 2012

What they say about the Geneva Health Forum

admin — Tue, 03 Apr 2012 13:41:56 +0000

	“GHF is a stimulating platform with ‘access’ as a key determinant for better health and well-being. The GHF inspires scientists and public health.” Marcel Tanner Professor & Director, Swiss Tropical & Public Health Institute
	“I expect that Geneva Health Forum 2012 will conclude with specific recommendations to national and international policy makers will promote safe cities and ensure healthy urbanization by accommodating non communicable diseases in upcoming global health agenda.” Sohana Samrin Chowdhury Associate Coordinator, Urban Health, Eminence, Bangladesh
	“Since its first edition, the driving force and keyword of the GHF has been “access to health care”, which remains by far the main challenge in global health. The rise of chronic diseases in developing countries adds a formidable dimension to the equation, and the frontliners on this subject should come up with innovative but tested concepts and strategies.” Bruno Gryseels Director of the Institute of Tropical Medicine, Antwerp, Belgium
	“I anticipate that Geneva Health Forum 2012 is an avenue to meet reputable experts and researchers. I have high expectations from this forum and strongly believe that a resounding and tremendous success would be recorded this year and beyond.” Ahmed Awaisu Qatar University
	“I see access to health as one of the fundamental needs of human beings. GHF provides a platform to look at ways in which this access can be provided to people, regardless of there physical location, and economic and social background.” Viola Krebs Executive Director of ICVolunteers.org
	“The GHF2012 will provide a great space to discuss the pros and cons of innovation projects and also to underline the crucial role of collaboration among colleagues in reaching dazzling results in innovation and chronic conditions.” Jordi Serrano Pons Innovator & Founder of UniversalDoctor.com
	“Geneva Health Forum is an important forum, because it brings together frontline workers and policy makers to find health solutions for chronic diseases that present an enormous personal and societal toll. IFPMA welcomes being part of this forum and the solutions.” Eduardo Pisani Director General of the IFPMA

Stopping Transfusion Transmitted Infections by Inactivating Pathogens in Donated Whole Blood

admin — Tue, 27 Mar 2012 18:57:28 +0000

http://youtu.be/4zxk65cniwg

Author(s):	Soraya Amar el Dusouqui
Affiliation(s):	¹Geneva University Hospitals
1st countries of focus:	Togo and Cameroon
Relevant to the conference theme:	Innovation in practice
Summary:	Our project aims to focus on pathogen inactivation (PI) in donated whole blood. We be-lieve it is possible in the future to be able to stop transcription and replication of RNA and DNA in contaminating cells of donated human whole blood units. Developing a simple method would enable to tackle the problem of major transfusion transmitted diseases. In a few steps, collection, leucoreduction, and inactivation, without the use of external en-ergy sources, we would obtain safer products when transfusing patients in countries using mainly whole blood for transfusion.
What hallenges does your project address and why is it of importance?:	37% of whole blood in transitional countries and 72% in developing countries is not sep-arated into blood components. PI means stopping the ability of these pathogens to repli-cate so as to make the organism inoffensive and inactive in the patient once transfused. If a donor is contaminated and his/her blood is used for blood transfusion then chronic infectious agents like HIV and of HCV and HBV can be transmitted to the patient. 42 countries worldwide are not able to screen all blood donations for one or more of the four transfusion-transmitted infections (HIV, hepatitis B, hepatitis C and syphilis) for which WHO recommends screening as being mandatory. In reality there are a lot of known agents causing transfusion-transmitted infections (TTI) including bacteria and parasites. We have increasingly become aware of the need to deal with emerging agents after the lessons learned during the West Nile Virus epidemic in the USA and Canada in the year 2002 or that of the Chicungunya virus in the Indian ocean, parts of Africa and Asia in 2005 and 2006. Today PI technologies are able to demonstrate therapeutic efficacy as well as safety based on photochemical treatment, using either UVA and psoralens or riboflavin and broadband UV, and are used daily in Europe. There is no feasible procedure for PI of RBCs (a separated component called red blood concentrates) or whole blood available yet. S-303 used together with glutathione has been developed by CERUS Corporation to inac-tivate pathogens in blood components containing red blood cells such as whole blood or separated RBCs. The inactivation has been demonstrated after a 3-hour incubation at room temperature by comparing organism titer before and after incubation demonstrating 4–6 log inactivation efficacy for many tested microorganisms. This approach also inhibits leukocyte proliferation, cytokine synthesis and antigen presentation. Clinical in vivo and in vitro safety and efficacy trials have been completed and results are promising. Our project is to use the same technology and concentration on whole blood units and demonstrate equivalent cellular viability, function and safety as in RBCs. The focus has not been on whole blood inactivation and we believe that it is the right approach. We have been able to convince our partners of the necessity not to wait years before adapting this promising technology on whole blood units but to perform research in parallel to rapidly find an adequate solution for countries with limited resources. Adapting this new technology will be faced with multiple challenges. Continuing in-vitro studies on whole blood to demonstrate equivalence and assure safety and efficacy. Obtain appropriate ethical reviews by our ethical committees as well as national health authorities. Establish acceptable product attributes and specifications in cooperation with whole blood users and in compliance with each countries national blood policy. Develop a device that would be well adapted to the needs of transfusion actors Demonstrate evidence to support the conduct of clinical trials that can only be performed in countries using whole blood transfusions. Secure budget and search for support and contribution of local resources. Training and conduction of clinical trials for local staff to guarantee high level ad-verse event management and documentation in cooperation with local haemovigi-lance services. Secure durability and post trial access to whole blood treated by S-303 and gluta-thion Creation of a bi-national data and safety management board
How have you addressed these challenges? Do you see a solution?:	One aspect of the technology is that inactivation is done without need of external energy sources. S-303 and glutathione function independently of availability of electrical energy. That explains why we approached CERUS Corporation. We aimed to convince them of the necessity not to wait years before adapting this promising technology on whole blood units but to perform research in parallel to research on RBCs. Finding an adequate solution for countries with limited resources has motivated CERUS Corporation’s interest in collaborating with us. They have kindly accepted to support our research project by transferring the technology to our research lab free of charge. We also aimed to convince our directors and research colleagues in the Geneva University Hospital to support our efforts. The clinical investigation unit – clinical research center of the University hospital of Geneva is currently examining the toxicological and safety criteria to access extend investigation needs of the S-303 technology when adapted to whole blood units. Criteria of our ethical committee and approval have to be reached and obtained We talked to Swiss Transfusion Swiss Red Cross to gain their support
How do you know whether you have made a difference?:	The project is arousing awareness that more efforts have to be done to support research in developed countries that are spending millions of dollars on pathogen inactivation today. Resource rich countries have reduced TTI by 1500 fold in the last 20 years so the gain is mainly in terms of facing emerging infectious agents but not in managing TTI. We have the moral obligation to act in the direction of adapting a rapidly budding tech-nology to the special needs of developing countries that transfuse whole blood most of the time and face a high TTI transmission risk. In a global vision the balance in terms of benefit and enhancement of transfusion safety tilts clearly towards countries with low resources facing the huge problem of TTI lacking adequate means to reduce them. We are convinced that our project will therefore make a major difference.
Have you or the project mobilized others and if so, who, why and how?:	Our project has gained a lot of interest very rapidly and we have been invited to present it in 2011 at the ICPIC in Geneva thanks to Professor Dr. PITTET and his team. We are in the phase of signing a memorandum of understanding between HUG (university Hospitals of Geneva), CERUS and Swiss Transfusion – Swiss Red Cross towards a close and extended collaboration. Transfusion Suisse CRS have accepted to support our project by helping in efforts to secure our budget as well as in facilitating contacts with national actors and health authorities. The department of Professor Dr. LOUTAN is willing to support in facilitating con-tacts with local health actors as well as in eventually supporting future clinical trial funding. We would like to thank him and his team for the opportunity to take part in the Geneva Health Forum of 2012. The clinical investigation unit – clinical research center of the University hospital of Geneva is currently examining the toxicological and safety criteria to determine extend investigation needs of the S-303 technology when adapted to whole blood units. Members from the EFS (French Transfusion Service) who have contacts with de-veloping African nations have expressed interest in supporting this project along with other researchers in the UK and United States.
When your donor funding runs out how will your idea continue to live?:	Developing a transfusion kit that uses this simple PI technology, without irradiation, in a closed system, needing no centrifugation no external energy and that could be transfused a few hours after collection allows us to look into the future and imagine that medical care workers in remote places would dispose of a transfusion unit that would be safe and easy to use. The product that will be developed will be delivered at production costs and the manufac-turer has assured us that they will make no profits in African countries with limited re-sources.

My Child Matters : Fighting against Childhood Cancer in Low and Middle-Income Countries

admin — Tue, 27 Mar 2012 18:43:51 +0000

Author(s):	Cary Adams¹, Catherine Boniface², Raul Ribeiro³
Affiliation(s):	¹Union for International Cancer Control (UICC),Switzerland, ²Fondation Sanofi Espoir, France, ³St. Jude Children’s Research Hospital, USA
1st countries of focus:	Honduras, Morocco, Paraguay, Philippines, Senegal, Thailand
Relevant to the conference theme:	Non-communicable chronic diseases
Summary:	The My Child Matters initiative was launched in 2005 when the Sanofi Espoir Foundation proposed to create an innovative partnership with the UICC (Union for International Cancer Control) for fighting against childhood cancer in low and mid-income countries where the paediatric oncology is still emerging. It has grown into one of the largest childhood cancer initiatives in terms of the number of countries involved. The programme enables local partners, hospitals and NGOs to benefit from financial support (€20,000 to €50,000 per project per year, following an annual evaluation of each project by the Steering Committee), advice from international paediatric oncology and public health experts, as well as the South/South pooling of project experiences. The Sanofi Espoir Foundation has contributed a total of € 4.400,000 towards the initiative since 2005.
What hallenges does your project address and why is it of importance?:	Cancer causes immense suffering and is is the leading cause of death worldwide. While cancer in children represents only a small proportion of all cancers, it is nevertheless testifies to the largest difference in survival rates between industrialized and developing or emerging countries. Childhood cancers are mostly curable, provided they are treated early on. More than 160,000 children face this disease each year, and about 90,000 die from it. In industrialized countries, around 80% of children with cancer can be cured. Yet, this figure falls to 20% or even 10% in the world’s poorest countries, where it is hard to have access to information, early diagnosis, care and treatment.
How have you addressed these challenges? Do you see a solution?:	My Child Matters is based on the concept that improvements to healthcare infrastructure, the training of qualified personnel, better public information and the involvement of local governments in more active public health policies are key drivers of improving childhood cancer survival in developing countries. The programme’s main objectives are to: generate actions on the ground that are as sustainable as possible, directly benefiting the country, including children and their families, and health professional partners raise greater awareness in civil society and among policy makers to help reduce the access-to-healthcare gap between developed countries and developing countries where paediatric oncology is still emerging. It also creates the opportunity to build momentum by bringing countries together around the same initiative against childhood cancer so that experiences and ideas can be actively shared. My Child Matters has already provided support to 43 hospitals and NGOs in 26 countries to reduce inequalities between developed and resource-constrained countries through grass-roots projects in these six years. Today, 21 projects across 17 countries continue to benefit from this initiative to improve every link in the health chain: better information, education and prevention, improved training for qualified personnel, helping to ensure earlier diagnoses, fostering better access to care and better pain management, developing palliative care and encouraging better understanding of the social aspects of this disease both for children and their families.
How do you know whether you have made a difference?:	Continued monitoring and planned annual reviews by the project’s mentors, experts and the steering committee with all local partners help to measure the programme’s impact on the community – the children, their families and health workers – and assess its leverage on the health policies of the countries concerned. Extremely promising results have been obtained on the three continents: For example: Latin America: In Honduras, in an effort to reduce the number of patients dropping out of treatment, the support provided has made it possible to position satellite clinics much closer to patients. This reduces both time spent travelling to the care centre, and work absenteeism among parents. Following the opening of six satellite clinics, dropout rates fell from 40% to 10% between 2005 and 2010. In Paraguay, where they face the same problem, a national network of professional support for childhood cancer has been formed (and declared of national interest) and a number of satellite clinics have been opened. Patient treatment dropouts have decreased from 20% to 0% in two years. The programme has expanded to include training projects by twinning with Spain and the United States, and a South/South pooling of expertise with Argentina and Bolivia. Africa: In Morocco, an interdisciplinary approach has been set up to fight pain in children, a still largely uncharted area. This integrated approach is based on awareness raising among children and parents, training for caregivers and appropriate treatment. Today, pain management has made significant progress and ‘anti-pain committees’ have been trained in several hospitals. This innovative experience has helped humanize care and will be shared with other countries. In Senegal, the rehabilitation of the paediatric oncology unit, the prevention of nosocomial infections, the treatment of febrile neutropenia and pain, the introduction of appropriate protocols and better training of health professionals have all led to greater government and civil society commitment to the project. This has led to an overall improvement in the survival rate for cancer, with the survival rate for kidney cancer (the most frequent childrens’ cancer in the unit) rising from 46.7% in 2005 to 71% in 2010. Asia: In the Philippines, the support provided has helped improve early diagnosis of acute leukaemia and retinoblastoma by boosting the training of primary care physicians and paediatricians. In 2010, the first and only centre for the diagnosis and treatment of childhood cancer was opened, and is now deemed a reference centre by the health authorities. In 2011, the first computerised database of childhood cancer will be compiled with the support of My Child Matters. In Thailand, advances have resulted in the recognition of the importance of palliative care and psychosocial support. The country will host a World Congress on palliative care for the first time in 2012.
Have you or the project mobilized others and if so, who, why and how?:	Nearly five years after the initiative ‘ My child matters’ was launched, it continues to show that we can all work together to create new types of partnerships to meet health challenges that do not receive sufficient attention, such as childhood cancers in developing countries. Estimating the size of the problem in the chosen countries, assessing the needs and resources, enhancing political commitment, initiating public education and advocacy activities, providing professional education including development of training materials, encouraging stakeholder participation, providing continued monitoring and evaluation, forming collaborative partnerships – by engaging multiple actors, interest groups and organizations made the success for many countries where grassroots foundations, other stakeholders, and ministry of health have been involved. Some projects have been considered as reference centers (the Phillipines, Paraguay, Senegal..) The partners of the project are: St Jude Children’s Research Hospital, USA; the International Confederation of Childhood Cancer Parent Organizations – ICCCPO; SIOP International Pediatric Oncology Society, The Netherlands; National Cancer Institute, USA; Childhood Cancer Foundation, USA; Groupe Franco-Africain d’Oncologie Pédiatrique, France; International Network for Cancer Treatment and Research, Belgium; Centre International de Recherche sur le Cancer, France.
When your donor funding runs out how will your idea continue to live?:	Focusing on the most impactful projects , determining gaps among the projects, evaluating barriers for success, project evaluation have been introduced as well as reinforcing healthcare capacity building and networking among the projects by sharing best practices and lessons learned in low- and mid-income countries. Leveraging MCM projects and more widely the cause of quality childhood cancer care in the participating countries for gaining sustainability has begun. In specific cases, support to scaling up the initiatives from local projects to regional or national plans will be provided, in particular if achievable goals by country can be agreed upon in order to get a better access to care for poor families and make quality childhood cancer care become a national health priority. An important role will be played by the UICC and its member organizations through strong advocacy actions.

The Mauritanian Model: An Effective Way to Improve Access to Mental Healthcare in Developing Countries

admin — Tue, 27 Mar 2012 17:19:54 +0000

Author(s):	Ahmed Ould Hamady¹, Daniel A Gérard², Osman Sall, Youssouf Ould Limame¹
Affiliation(s):	¹Ministry of Health, Mauritania, ²Chronic Diseases, Sanofi, France
1st country of focus:	Mauritania
Relevant to the conference theme:	Non-communicable chronic diseases
Summary (max 100 words):	Mauritania is a wide country of 1 million square kilometers mainly covered by desert, with 3 million inhabitants and only 3 psychiatrists. A pilot project designed to improve access to mental healthcare in the country was implemented in Nouadhibou city at the North West country border. In May 2009, 7 mental health clinics were opened in the city and surrounding areas. Thanks to the commitment of the medical staff and local NGOs, the treatment gap in schizophrenia was reduced by 38% in 2.5 years (from 93% to 58%) by running a strong awareness program and providing adapted, available, affordable medicines.
Background (max 200 words):	Four mental disorders are in the top ten leading causes of disability (depression, bipolar disorders, schizophrenia, alcohol abuse) and the prevalence of main mental disorders is similar in developed and developing countries. Mental disorders are one of the leading contributors to the Global Burden of Diseases in Low- and Lower-Middle-Income countries yet only scarce resources are devoted to them. A survey conducted in the general population of Nouakchott in 2003 indicated that 35% of the sample population had at least one mental disorder: anxiety: 20%, mood disorders: 19% and psychotic disorders: 2.4%. Available mental health care systems are not aligned with needs in Mauritania. Resources are mainly concentrated in the capital, Nouakchott: 3 outpatient psychiatric clinics, 1 Neuropsychiatric center and 1 psychiatric department in the Military Hospital and very few resources are accessible in the rest of the country. In addition the survey highlighted the overlap between madness and mental disorders in the perception of the population who mainly believes that psychiatric symptoms are from magic or religious origin. These data underline that improving mental health care in Mauritania requires a comprehensive process that combines: conducting awareness campaign; setting up services; getting funding; training healthcare professionals and making medicines accessible.
Objectives (max 100 words):	The aim of this pilot project was : (1) to test the feasibility of implementing one mental health clinic in each of the 13 Mauritanian provinces, working in a close network with the specialists from the Nouakchott neuropsychiatric center; (2) to assess the impact of the project on the access to mental health care (3) to learn from this experience for preparing an extension of the project to the rest of the country.
Methodology (max 400 words):	This project is an action research project focused on access to healthcare for psychotic patients. Intervention: inclusive approach bringing together: Advocacy towards decision makers (national, regional and local) so as to get their support for the implementation of the project; Training of health care professionals selected by the Head of the Regional Health Services; Regular supervision from specialists from the Nouakchott Neuropsychiatric center; Sustainable supply of quality affordable antipsychotics; Patients and families psycho-education sessions; Communities awareness initiatives on mental health issues; Collected data: Number of patients included in the program, sex, age and diagnosis according to CIM 10. In addition, specifically for psychotic patients: estimation of the number of people with schizophrenia in the area; number of patients treated at baseline; conformity of the diagnosis made by the “investigator” and the diagnosis made by the specialist; Clinical Global Improvement, number of hospitalizations, questionnaire of integration in family and community; Drug Attitude Inventory-10 questionnaire; Involvement Evaluation Questionnaire
Results (max 400 words):	An agreement was concluded between the Mauritania Ministry of Health represented by the Nouakchott Neuropsychiatric Center and Sanofi Access to Medicines in July 2008. Nouadhibou (100,000 population), at the north border of the country, in front of the Canary islands, was selected as pilot site because of its population exposure to many risk factors for mental disorders: life style changes (from nomad life to settlement), transit place for illegal migration and drug trafficking… The pilot program commenced in October 2008 with a meeting in the National Assembly and the endorsement of the national and local political and administrative decision makers. Between October 2008 and December 2010: 37 health professionals from both public and private sectors were trained; Outpatient mental health clinics were opened (since May 2009) in seven centers in the city (regional hospital, city hall dispensary, mine polyclinic, military infirmary, Moughataa dispensary) and in the surrounding areas (Boulenouar dispensary, Nouamghar dispensary). Information tools were specifically designed for awareness campaigns and are used by several NGOs: posters, flipcharts and booklets. More than 1000 people (patients, patient families, teachers, woman associations…) attended the different information meetings. About 1200 patients are followed up in the mental health clinics (mainly for psychosis, depressive disorders, anxiety disorders and epilepsy) In schizophrenia, with 342 new patients in 30 months, the treatment gap has decreased by 38% from 93% (May 2009) to 58.8% (December 2010). The detailed results of the impact assessment will be presented.
Conclusion (max 400 words):	This pilot program has a positive impact on the Nouadhibou population mental health. It indicates that access to care for patients with mental disorders can greatly be improved by a simple, assessable, replicable and scalable program. An agreement for the program extension to the whole country over 5 years through a partnership between the Mauritania Ministry of Health, the World Association for Social Psychiatry and Sanofi Access to Medicines was signed in June 2011. In addition to psychosis, the expanded program will also include other major mental disorders and epilepsy

The Connecting Nurses Initiative

admin — Tue, 27 Mar 2012 15:11:06 +0000

Author(s):	Sylvie Coumel¹
Affiliation(s):	¹Stakeholder & Advocacy Strategy, Sanofi corporate, France
1st country of focus:	NA
Additional countries of focus:	US, Canada, France, UK, Morocco
Relevant to the conference theme:	New roles and responsibilities of health personnel
Summary:	The Connecting Nurses program is an initiative for nurses supported by Sanofi and developed in collaboration with Nurses Federations. Its mission is to bring nurses together on-line and in the real world through the Care Challenge (http://www.care-challenge.com) platform launched in May 2011. This worldwide on line nursing recognition program’s ambition is to help turn caring ideas into reality: nurses from all countries are invited to showcase on line their creativity and their care solutions/practice innovations.
What challenges does your project address and why is it of importance?:	Nurses are at the fore front of patient care in a wide range of areas but their role is key in chronic disease management and patient education while their role will expand and become even more important in the future.
How have you addressed these challenges? Do you see a solution?:	Connecting Nurses will provide a web 2.0 collaborative platform for nurses from all around the world to share their ideas, advice and innovations. This network of shared knowledge and resources will equip nurses with the tools to advance their practices and inspire patients to become partners in their healthcare. Care Challenge (http://www.care-challenge.com) has been created to celebrate the immensely important role the nursing community plays in healthcare provision around the world, while addressing the challenges which arise within modern healthcare systems. Care Challenge is part of the Connecting Nurses international initiative. It comes in the form of a contest, accessible from a dedicated website where nurses can submit their ideas, vote for or engage conversation about other nurses’ ideas. Winners and awards There are two categories in the recognition program, “Helping Hand” and “Nurse in the Limelight.” Taking into account various criteria, including but not limited to, a web-based vote, a jury will choose ten winners from each category. Ten winners in the “Helping Hand” category will receive 3,000 Euros to support their innovative projects’ continued success, and ten winners in the “Nurse in the Limelight” category will be prominently featured on the Care Challenge website with a professionally produced video of their innovations. The program is focused on identifying nursing innovations related to: Education: Resources promoting patient self-management or raising community awareness of a disease Practice: Nursing services, procedures, techniques or tools promoting patient self-management of disease or new ways to support families and caregivers. Research: Studies of outcomes of innovative approaches to nursing, patient care, and patient education. The program will bring a range of other benefits to nurses such as improving recognition of the nursing community by giving them a stronger voice. Indeed, it will support dialogue within the nursing community by creating networking opportunities at a national and international level. Helping to share knowledge on nursing techniques will enhance education, research and practice as well as the care of patients. The Care Challenge unique nursing community enables members to share information and education with others in the field and nominate colleagues for an award in nursing excellence. This recognition program is open to licensed nurses anywhere in the world. There will be a total of 20 awards for the best ideas, which will support an incredible opportunity to develop the initiatives further and give them international recognition.
How do you know whether you have made a difference?:	Among the internet nurses landscape worldwide we have found no equivalent of Care Challenge as a unique repository of nursing innovation, allowing on line cross-continent share knowledge.
Have you or the project mobilized others and if so, who, why and how?:	The Connecting Nurses Initiative has been developed in partnership with Nurses Organizations: Care Challenge is part of the Connecting Nurses program, which was developed by Sanofi in partnership with the Nurse Practitioner Healthcare Foundation (NPHF), International Council of Nurses (ICN), the Secrétariat International Des Infirmières et Infirmiers de l’Espace Francophone (SIDIIEF), and the Association Française pour le Développement de l’Education Thérapeutique (AFDET).
When your donor funding runs out how will your ideas continue to live?	NA

Cardiovascular Risk in Type 2 Diabetic Immigrants in Spain: IDIME Study

admin — Thu, 16 Feb 2012 12:58:37 +0000

Author(s):	Francesc Xavier Cos Claramunt^{1, 2}, Josep Franch Nadal², Albert Goday Arno², Sara Artola Menendez²
Affiliation(s):	¹CAP sant Marti de Provençals en Institut Catala de la Salut, Barcelona, Spain, ²redGDPS (Spanish type 2 diabetes Primary Care Network)
1st country of focus:	Spain
Relevant to the conference theme:	Vulnerable groups
Summary (max 100 words):	To study the presence of cardiovascular risk factors and their treatment among the diabetic immigrant population in Spain.
Background (max 200 words):	To study the presence of cardiovascular risk factors and their treatment among the diabetic immigrant population in Spain.
Objectives (max 100 words):	To study the presence of cardiovascular risk factors and their treatment among the diabetic immigrant population in Spain.
Methodology (max 400 words):	National cross-sectional case-control study (diabetic immigrants versus native diabetic, a proportion of 2 to 1) including 877 patients with diabetes mellitus (307 native, 169 South-Americans, 126 Hindustani, 184 Maghribian and 89 from other countries). Sociodemographic, anthropometric and clinical variables of DM were analyzed. The existence of cardiovascular risk factors, their treatment and the presence of complications related to diabetes was studied. Descriptive and analytical statistics were utilised. Cardiovascular risk at 10 years was calculated with UKDPS risk engine.
Results (max 400 words):	Diabetic immigrants are younger than native diabetics (50.4 ±11.5 vs 62.7 ±13 years) with less diabetes evolution years (5.8 ±6.4 vs 10.5 ±8.3 years) (p<0.001). The sample population of smokers contributes to practically an non-existent percentage (0.2%). The diagnosis of hypertension is less prevalent among diabetic immigrants (40% vs 63.2%) (p<0.001). There is no statistical significance considering the prevalence of dyslipidemia between immigrants and natives (86.6 vs 86.5%), although the percentage is slightly higher among hindustani (92%), whom show higher values of triglycerides and use more fibrates (39.4%). Diabetic immigrants use less antiaggregation (21.1 vs 39.5%) (p<0.001). The calculated coronary risk is clearly lower in diabetic immigrants (9.9 vs 17.1%) as well as the risk of stroke (2.5 vs 8.7%) (p<0.001). The prevalence of all complications is fewer in diabetic immigrants, especially the macrovascular ones (7.7 vs 24.4%) (p<0.01).
Conclusion (max 400 words):	As a whole, diabetic immigrants manifest less cardiovascular risk than native diabetics, due to their younger age, lower disease evolution time and less prevalence of hypertension.

Assessing the Impact of Medical Nutrition Therapy in Pregnancy Complicated by Diabetes in a Maternity Centre: Ibadan, Nigeria

admin — Mon, 23 Jan 2012 08:57:07 +0000

Author(s):	Hamidu Oluyedun¹
Affiliation(s):	¹Oyo State Hospital Management Board Secretariat, Ibadan, Nigeria
1st country of focus:	Nigeria
Relevant to the conference theme:	Communicable chronic diseases
Summary (max 100 words):	The WHO regards diabetes as avicious silent killer diseases with its overall prevalence on the increase. This study aimed to reduce pregnancy mortality and faciliate better pregnancy outcomes. Two Hundred pregnant volunteers were chosen for the study which included the participation of various categories of Health Workers. The study revealed a correlation between Health, Social and Educational levels of participants and the awareness of the dangers posed by diabetics to pregnancy. Training and the provision of specific information to volunteers resulted in better pregnancy outcomes.
Background (max 200 words):	The WHO regards diabetes as one of the most vicious silent killer diseases with overall prevalence on the increase. It is forecasted to afflict at least 200million people by 2012. In 1998 1.05million diabetics were reported in Nigeria, and 5% – 10% of Nigerians were believed to be diabetic in 2010. Type 2 diabetes is more widespread than type 1 diabetes and the prevalence of type 2 prevalence is increasing rapidly. Diabetes leads not only to immediate health symptoms but also long term complications such as cardiovascular and kidney disease. The target levels for plasma glucose is >or = 6 but <7 mmol/l FPG and < 7.8mmol/l for PPG
Objectives (max 100 words):	To help pregnant women with diabetes learn how to make lifestyle choices which enable them to achieve optimum metabolic control and prevent diabetic complications. To achieve and sustain acceptable body weight and prevent, delay or treat, complications. In addition to integrate diet, activity and pharmacological therapy were also the objectives.
Methodology (max 400 words):	St. Peters Maternity Hospital, Aremo, Ibadan, a community based maternity centre, was chosen for this study. Volunteer pregnant women were selected for the study after consent forms were completed and the study was explained to the volunteers in languages they understood. In all, 200 pregnant women were involved in the study that spanned a 6 months period. Social History and Social Economic parameters were obtained from the pregnant women. The following diagnostics parameters were obtained from the recruits with the assistants of the Laboratory Scientists:- 1)Random blood glucose (RBG) – sample of blood taken at any time 2)Fasting blood glucose (FBG) – sample of blood obtained after a period of not eating or drinking for at least 8 hrs 3)Oral glucose tolerance test (OGTT) – a fasting blood glucose sample was initially taken, then a sweet drink is consumed and blood samples were then taken every 30mins for next 2hrs. The sample taken at 2hrs is the most important as it is linked to poor glycaemic control. Educational Intervention on nutrition were organised for the volunteers.
Results (max 400 words):	Type 2 Diabetics was common in 25% of the volunters. The perception of the pregnant women was related to their educational bacground. Thereofore training on nutritional modificatios and exposure to the benefits of adequate diets from indigenous foods is important. The results showed that 50% of the diabetes in the pregnant women was controlled while the remaining 50% needed additional anti diabetics drugs for management. The pregnancy outcomes were better when compared to the pregnancy outcomes of the precedding 3years when the training and interventions were not in place.
Conclusion (max 400 words):	The Millenium Development Goal 5 on Maternal Mortaltiy can be achieved with collaborative effort from all health workers. The result showed that good pregnancy outcomes are reliant on the collective efforts of all the health workers. The training should be increased and replicated in other health care facilities in the community.

Obesity and Under-Nutrition among Western Sahara Refugees: The Emerging Threat of Double Burden of Malnutrition in Emergencies

admin — Tue, 17 Jan 2012 10:01:13 +0000

Author(s):	C.S. Grijalva-Eternod^1,2, J.C.K. Wells³, M Cortina-Borja⁴, N. Salse-Ubach⁵,M. Tondeur² ,C. Dolan² ,C. Meziani⁶, C. Wilkinson⁷, P. Spiegel⁷, A.J. Seal^1,2
Affiliation(s):	¹Centre for International Health & Development, UCL Institute of Child Health, London, UK, ²Emergency Nutrition Network, Oxford, UK, ³MRC Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK, ⁴MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, UK, ⁵Independent Consultant, Barcelona, Spain, ⁶Tindouf Sub-Office, United Nations High Commissioner for Refugees, Tindouf, Algeria, ⁷Public Health and HIV Section, Division of Programme Support and Management, United Nations High Commissioner for Refugees, Geneva, Switzerland
1st country of focus:	Not applicable
Relevant to the conference theme:	Emergencies
Summary (max 100 words):	We assessed under-nutrition and overweight prevalence in Western Sahara women (15-49 years) and children (6-59 months) living in refugee camps for over 35 years. Both were found highly prevalent – the former among children, the latter among women. At the household level, more households presented cases of overweight than underweight. The number of households presenting both was high (19.9%). The results highlight the need to focus attention on non-communicable diseases within the humanitarian sector with special focus on refugees living a protracted emergency.
Background (max 200 words):	Vulnerable groups experiencing epidemiological transitions are known to suffer both under-nutrition and obesity. Yet, it is unknown whether this double burden affects food aid dependent refugees living in protracted emergencies.
Objectives (max 100 words):	We aimed at assessing the double burden of malnutrition among Western Sahara refugees living in a protracted emergency for over 35 years.
Methodology (max 400 words):	We implemented one stratified cluster nutrition survey in four Western Sahara refugee camps in Algeria. We sampled 2005 households collecting anthropometric indicators in 1608 children (6-59 months) and 1781 women (15-49 years). We estimated the prevalence of global acute malnutrition, stunting, underweight and overweight in children and the prevalence of underweight, overweight and central obesity in women. Households were first classified according to the presence of cases of each indicator. Households were later classified as underweight, overweight or double burden if they presented cases with under-nutrition or overweight, alone or in combination, or normal if no cases were found.
Results (max 400 words):	In children, prevalence of global acute malnutrition was 9.1%, stunting 29.1%, underweight 18.6% and overweight 2.4%.; whereas in women 5.1% were underweight, 53.7% were overweight or obese and 71.4% had central obesity. A larger proportion of households presented cases of central obesity (47.2%) or overweight (38.8%) in women compared to those presenting stunting (19.5%) or underweight (13.3%) in children, nonetheless the latter were high. Overall, overweight (43.6%) households were most commonly followed by underweight (20.5%) and double burden-affected (19.9%) households. Similar results were found if households were classified as primarily obese instead of overweight.
Conclusion (max 400 words):	Obesity and under-nutrition are highly prevalent and co-existing among Western Sahara refugees. The results highlight the need to focus attention on non-communicable diseases within the humanitarian sector. Results also raise the complex challenges of incorporating obesity prevention and treatment of associated co-morbidities into aid policies, without drawing resources away from providing essential life-saving interventions to tackle under-nutrition.

Prenatal Genetic Diagnosis of Sickle Cell Disease: Preliminary Experiences : Cameroon

admin — Tue, 17 Jan 2012 09:30:43 +0000

Author(s):	Ambroise Wonkam¹^,2, Cedrik Ngongang Tekendo¹, Huguette Zambo¹and Michael A. Morris³
Affiliation(s):	¹Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon, ²Division of Human Genetics, University of Cape Town, Cape Town, South Africa, ³Service of Genetic Medicine, Geneva University Hospitals, Geneva, Switzerland
1st country of focus:	Cameroon
Relevant to the conference theme:	Medicines and diagnostics
Summary (max 100 words):	The practice of prenatal genetic diagnosis of sickle cell disease is possible in Cameroon. To the best of our knowledge, the present study is the first report of PND experience in the Central African region.
Background (max 200 words):	The Republic of Cameroon is a sub-Saharan African country with a population of about 20 million. The health-care system of the country is organized into the public, orthodox private and traditional private sectors. There is no universal medical insurance coverage in Cameroon. With a carrier frequency of 8 to 34%, the country has developed a national control program for sickle cell anaemia (SCA). Nevertheless, prenatal genetic diagnosis (PND) has not yet been incorporated in this strategy. Despite a low acceptance (36.1%) of the termination of an affected pregnancy (TAP) for SCA by Cameroonian physicians, up to 95% of Cameroonian parents with an SCA-affected child would request PND and 65% would opt for TAP. PND for SCA was initiated in Cameroon in August 2007.
Objectives (max 100 words):	The main objective of the present study is to discuss the preliminary evaluation of the 36-month practice of prenatal genetic diagnosis of sickle cell anemia in Cameroon.
Methodology (max 400 words):	The study included all patients consulted regarding PND of SCA from August 2007 to January 2011. Fetal sampling was performed under ultrasound guidance by two obstetricians. Informed written consent was obtained from each patient. All the DNA samples of the parents and that of the fetus were extracted in Yaoundé, from peripheral blood and amniotic fluid, respectively, following instructions on the available commercial kits (Puregene blood kit®, Qiagen®, USA; and NucleoSpin® Blood QuickPure, Macherey-Nagel GmbH & Co ®, Germany). The molecular analyses for all the cases were done in the Service of Genetic Medicine of Geneva University Hospitals, Switzerland. Molecular analysis for the sickle cell mutation was carried out by PCR-restriction fragment length polymorphism (thermocycler from BIORAD®, USA; Dde I restriction enzyme from by GIBCO-BRL®, USA). In addition, any maternal contamination was also excluded. Maternal contamination was picked up on one occasion and the amniocentesis was repeated.
Results (max 400 words):	A total of 42 patients presented for PND of SCA. Most patients were university graduates of Christian faith. Amongst them, 93.9% had a family history of SCA, with either an SCA-affected child (59.5%; N = 25) or SCA-affected sibling (35.7%; N = 15). The possibility of having a child with SCA was not realized by 85.7% (N = 36) before marriage. Prior to the availability of PND in Cameroon, nine parents (21.4%) admitted to having voluntarily terminated at least one pregnancy for fear of having an SCA-affected child. The majority of patients (90.4%; N = 38) were counseled by the medical geneticist. Following counselling, two patients declined PND because of financial reasons; one for religious reasons and one had a spontaneous abortion prior to the scheduled date of amniocentesis. Thirty-eight patients underwent transabdominal amniocentesis, at an average gestational age of 16.3 weeks (range 13–23 weeks) with two procedure-related abortions. Late amniocentesis (above 21 weeks) was carried out on three patients (7.9 %). Three cases required repetition of amniocentesis; the reasons were maternal contamination (1/3) and failure of DNA extraction (2/3). Polymerase chain reaction-restriction fragment length polymorphism revealed ten fetuses affected with SCA (26.3%). Nine of these SCA-affected pregnancies (90%) were terminated. The only patient who declined termination of an SCA-affected pregnancy stated ethical reasons; the pregnancy was 24 weeks at the time of result delivery, because of late referral and transportation time of the DNA samples to Geneva.
Conclusion (max 400 words):	The practice of PND of SCA is possible in Cameroon. There is a need for open discussion of its ethical and legal challenges. The preliminary experience emphasizes the need for national and international collaborative efforts to overcome the lack of human, technical and financial resources.

Electronic Health Record as a Source of Information to Assess Quality of Healthcare for Hypertensives: Mexico

admin — Sun, 15 Jan 2012 14:36:02 +0000

Author(s):	Svetlana Doubova¹, Ricardo Pérez-Cuevas², Magdalena Suárez¹, Dennis Ross-Degnan³, Anita Wagner³
Affiliation(s):	¹Epidemiology and Health Services Research Unit, Mexican Institute of Social Security, Mexico, ²Ministry of Health, Mexico, ³Harvard University, United States
1st country of focus:	Mexico
Relevant to the conference theme:	Health information and technologies
Summary (max 100 words):	The objectives of this study were a) development of quality of care indicators (QCI) for hypertensives in Mexico; b) to determine the feasibility of constructing QCI using electronic health record data; and c) to evaluate the quality of care (QC) provided to hypertensives. Methods: The study had a mixed method approach which included 48,048 hypertensives. Results: 14 QCI emerged by using the available EHR (Electronic Health Record) data. The study demonstrated that it is feasible to evaluate QC for hypertensives using the EHR data yet substandard quality in processes and clinical outcomes was observed.
Background (max 200 words):	In low and middle-income countries (LMIC) the growing prevalence of hypertension and premature mortality from its complications is a public health problem. Blood pressure control in hypertensives reduces mortality and morbidity, however, more than half of them are untreated and only 23% -46% achieved recommended blood pressure levels. It has been reported that the higher QC for patients with hypertension is associated with better control of their blood pressure, highlighting the importance of measuring QC, in order to identify failures and implement improvement strategies. One of the tools to improve QC is the use of EHR; which is ‘a longitudinal collection of information about patient’s general characteristics, medical history, healthcare received and health outcomes. The use of EHR can improve the QC through its continuous monitoring, increased adherence to clinical guidelines, decreased medication errors, and other strategies. In order to facilitate and improve the QC, the EHR is widely deployed in developed countries but in LMIC the experiences are limited. Only a few LMIC countries like Argentina, Costa Rica and Peru introduced EHR for research in small-scale settings. Mexico introduced the EHR at institutional level in the Mexican Institute of Social Security (IMSS). The IMSS is responsible for the care of 47% of the Mexican population and has a network of 1,516 family medicine clinics (FMC). In the IMSS, hypertension and other cardiovascular diseases are among top causes of ambulatory and hospital care. Nevertheless little is know about the QC that patients with hypertension receive. Currently the EHR information is not available on a routine basis to measure QC for this population.
Objectives (max 100 words):	The objectives of this study were a) development of QCI in the Mexican Institute of Social Security (IMSS) health system; b) to determine the feasibility of constructing QCI using the IMSS EHR data; and c) to evaluate the QC provided to IMSS patients with hypertension.
Methodology (max 400 words):	Methods: The study had a mixed method approach consisting of: 1) Development of QCI for hypertensive patients using the RAND-UCLA method; 2) Extraction of routine EHR data and construction of predefined QCI; 3) Evaluation of quality of care for hypertensive patients who received healthcare at Family medicine clinics in 2009. Setting: 4 FMCs in Mexico City. Study Population: 48,048 patients with hypertension who received care in 2009.
Results (max 400 words):	Results: We developed 20 QCI, of which 14 were possible to construct using available EHR data. QCI comprised both process of care and health outcomes. Among 48,048 patients with hypertension, 64% were women, 66.7% were ≥60 years of age; 70% were overweight or obese (BMI ≥25.0 kg/m2); 30.9% had diabetes and 7.4% arteriosclerotic diseases. 51% of patients were prescribed one antihypertensive drug, 19.2% two, 4.3% received 3 or more antihypertensive drugs and 25.5% had no antihypertensive drugs prescriptions. The most frequently prescribed drugs were inhibitors of angiotensin converting enzyme (50%). The indicators of QC showed that during 2009, only in 15% of patients with newly diagnosed hypertension (in 2009) the diagnosis was based on the records of at least three blood pressure (BP) measurements with systolic ≥ 140 mmHg or diastolic ≥ 90 mmHg. Just 10% of them were ordered urinalysis, serum creatinine, fasting plasma glucose and total cholesterol. Regarding timely detection of complications: 39.8% of subsequent hypertensive patients without diabetes had fasting plasma glucose measurement at least once in the last 12 months; 37.8% of them had serum creatinine test; 43.2 had total cholesterol measurement and 10.0% were referred to the ophthalmologist. Regarding non-pharmacological and pharmacological treatment only 3.3% of obese hypertensive patients received nutritional counseling; 53% of patients with total cholesterol >= 240mg/dl or total cholesterol 200-239mg/dl and one or more of the following CV risk factors: smoking, diabetes or established atherosclerotic diseases were prescribed statins. 61.3% of patients with systolic BP ≥ 140 mmHg or diastolic ≥ 90 mmHg in the last 3 consultations and with 3 antihypertensive drugs were referred to the second level of care. Regarding health outcomes: 62.8% of hypertensive patients without diagnosis of diabetes and / or chronic kidney disease had blood pressure below 140/90 mmHg in the last 3 measurements; nevertheless 7.4% of hypertensive patients with type 2 diabetes or chronic kidney disease had blood pressure below 130/80 mmHg in the last 3 measurements. Furthermore, 1.5% of patients had a cardiovascular event (myocardial infarction, cerebral vascular event, arterial thrombosis) in the last year.
Conclusion (max 400 words):	The study demonstrated that it is feasible to evaluate QC for hypertensive patients using the IMSS EMR data. The results highlight the need to improve processes and clinical outcomes of guideline-based care for hypertensive patients in Mexico.