Diabetes mellitus (DM) appears to increase the risk for head and neck cancer (HNC).
JAMA Otolaryngology-Head & Neck Surgery
Kuo-Shu Tseng, Ph.D., of the Tainan University of Technology, Taiwan, and colleagues. Read more…
Xpert MTB/RIF, a recently implemented tuberculosis (TB) test, has the potential to control the TB epidemic in India, but only if the current, narrow, implementation strategy is replaced by a more ambitious one that is better funded, also includes the private sector, and better referral networks are developed between public and private sectors, according to new research published in this week’s PLOS Medicine. The study by David Dowdy, from Johns Hopkins University, United States, and colleagues is a mathematical model that suggests alternative strategies that include engagement with both the public and private sector may have a bigger population level impact on TB than the current implementation strategy of using Xpert for only those at risk of drug-resistance or HIV infection.
Xpert MTB/RIF is a new TB diagnostic that is more sensitive than other diagnostics in current widespread use and can detect resistance to certain antibiotics, but its cost is substantial, and the Indian health-care system is fragmented and heavily privatized with the majority of the population seeking private healthcare initially. Currently, due to resource constraints, the Indian Revised National Tuberculosis Control Programme is mainly implementing Xpert MTB/RIF as a rapid drug susceptibility test method among selected patients seeking care in the public sector.
The researchers explored the impact of six different rollout strategies on the incidence of tuberculosis (the number of new cases of tuberculosis in the population per year) by developing a mathematical model of tuberculosis transmission, care-seeking behavior, and diagnostic/treatment practices in India. A scenario that added access to Xpert MTB/RIF for 20% of all individuals with tuberculosis symptoms seeking diagnosis in the public sector and 20% of individuals seeking care from qualified private practitioners to the current national strategy was predicted to reduce the incidence of tuberculosis by 14.1% compared to the current national strategy which is only expected to reduce incidence by 0.2%. However, this scenario required more than 2,200 Xpert machines and reliable treatment referral. Notably, a scenario tested that encouraged informal providers to refer suspected tuberculosis cases to the public sector for diagnosis using currently available tests predicted a greater impact on the incidence of tuberculosis than Xpert scale-up within the public sector alone.
The authors acknowledge that their findings are subject to uncertainties in the assumptions made in their model but note, “Xpert [MTB/RIF] … could substantially reduce the burden of TB disease due to poor diagnosis in India; however, this impact depends not only on the accuracy of the test, but also on the behavior of both patients and providers, their level of access to new tools, and quality TB treatment following diagnosis.”
They conclude, “any Xpert [MTB/RIF] rollout strategy must also consider the complex health-care infrastructure into which the test is being rolled out. To achieve maximum impact of novel diagnostics, India should engage the private sector, improve quality of care across all sectors, and dramatically increase resources.”
Salje H, Andrews JR, Deo S, Satyanarayana S, Sun AY, et al. (2014) The Importance of Implementation Strategy in Scaling Up Xpert MTB/RIF for Diagnosis of Tuberculosis in the Indian Health-Care System: A Transmission Model. PLoS Med 11(7): e1001674. doi:10.1371/journal.pmed.1001674, http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001674
The project was funded by grants from the Bill & Melinda Gates Foundation (OPP1061487) and Canadian Institutes of Health Research (MOP 123291). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
MP serves as a consultant to the Bill & Melinda Gates Foundation (BMGF). MP is also a member of the Editorial Board of PLOS Medicine.
Johns Hopkins Bloomberg School of Public Health, United States
Massachusetts General Hospital, United States
Indian School of Business, India
McGill University, Canada
McGill University Health Centre, Canada
Johns Hopkins School of Medicine, United States
Johns Hopkins University, United States
David Dowdy, Johns Hopkins Bloomberg School of Public Health, United States, +1 (410) 614-0902, firstname.lastname@example.org
Nurse-led protocols are effective for managing outpatient care of chronic illnesses.
Annals of Internal Medicine
Chronic diseases cause a substantial burden to the U.S. health care system and account for about 75 percent of every health care dollar spent. There are well-established clinical practice guidelines for the outpatient management of chronic illnesses, but access to quality and appropriate care can be an issue, especially considering the nation’s shortage of primary care physicians. Some groups have suggested that quality care be delivered through a team-based approach, which the American College of Physicians calls the “patient-centered medical home”. One new model of the medical home may involve nurse-managed protocols for routine outpatient care of chronic diseases.
Researchers conducted a systematic review of published evidence to determine whether nurse-managed protocols are effective for outpatient management of adults with diabetes, hypertension, and hyperlipidemia, common chronic illnesses that require ongoing outpatient management. They found that a patient-centered medical home model using nurse-managed protocols helps to improve health outcomes for patients with moderately severe diabetes, hypertension, and hyperlipidemia, and that RNs can successfully titrate medications according to protocols for these conditions. Read more…
- Higher levels of stress, hostility and depressive symptoms are associated with significantly increased risk of stroke or transient ischemic attack (TIA) in middle-age and older adults.
- Significant increased risk was not observed for anger.
Higher levels of stress, hostility and depressive symptoms are associated with significantly increased risk of stroke or transient ischemic attack (TIA) in middle-age and older adults, according to new research in the American Heart Association journal Stroke.
A TIA is a stroke caused by a temporary blockage of blood flow to the brain. Read more…
On the link between periodontitis and atherosclerosis: how P. gingivalis causes chronic inflammation in blood vessels
Chronic oral infection with the periodontal disease pathogen, Porphyromonas gingivalis, not only causes local inflammation of the gums leading to tooth loss but also is associated with an increased risk of atherosclerosis. A study published on July 10th in PLOS Pathogens now reveals how the pathogen evades the immune system to induce inflammation beyond the oral cavity.
Like other gram-negative bacteria, P. gingivalis has an outer layer that consists of sugars and lipids. The mammalian immune system has evolved to recognize parts of this bacterial coating, which then triggers a multi-pronged immune reaction. As part of the “arms race” between pathogens and their hosts, several types of gram-negative bacteria, including P. gingivalis, employ strategies by which they alter their outer coats to avoid the host immune defense.
Caroline Attardo Genco, from Boston University School of Medicine, USA, in collaboration with Richard Darveau, at the University of Washington School of Dentistry, USA, and colleagues focused on the role of a specific lipid expressed on the outer surface of P. gingivalis, called lipid A, which is known to interact with a key regulator of the host’s immune system called TLR4. P. gingivalis can produce a number of different lipid A versions, and the researchers wanted to clarify how these modify the immune response and contribute to the ability of the pathogen to survive and cause inflammation—both locally, resulting in oral bone loss, and systemically, in distant blood vessels. Read more…