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Current Impact, Future Prospects and Implications of Mobile Healthcare in India
Get PDFIndia has a diverse geographical landscape and predominately rural population. Telemedicine is identified as one of the technological pillars to support healthcare services in this region, but is associated with high cost and complex infrastructure, thus restricting its wider use. Mobile-based healthcare (m-Health) services may provide a practical, promising alternative approach to support healthcare facilities. India has a high mobile user base, both in cities and in rural regions. The appropriate identification of mobile data transmission technology for healthcare services is vital to optimally use the available technology. In this article, we review current telecommunication systemsin India, specifically the evolving consensus on the need for CDMA (Code Division Multiple Access - a wireless technology used by leading international and national operators. This technology is deployed in 800MHz band making it economically viable and far reaching with high quality of services) to continue its operations in India along with mobile healthcare services. We also discuss how healthcare services may be extended using m-Health technologies, given the availability of telecommunications and related services.
Cost-effectiveness Analysis of Denosumab in the Prevention of Skeletal-related Events in Patients with Prostate Cancer in Kazakhstan
Get PDFIntroduction. Bone mass loss (BML) is one of the adverse effects of oncological chemotherapy, especially in cases of hormonal types of cancer, such as a prostate cancer (PC). BML is strongly associated with skeletal-related events (SREs), therefore decreasing the quality of patient’s life. Denosumab shows an advantage over zoledronic acid (ZA) in delaying the first onset of SREs and subsequent SREs in adults with PC in several phase III clinical trials. Since generic ZA recently became available, the purpose of the present study was to assess the cost-effectiveness of denosumab vs. brand or generic ZA in the prevention of SREs in Kazakhstani patients with PC.Methods. A Markov model was constructed in Tree-Age Pro 2013 software program with 4-week model cycles to analyze the cost-effectiveness of the treatments from the perspective of Ministry of Health (MoH) over a 10-year PC cohort. Direct costs (in Kazakhstani monetary units “tenge” in 2014) included costs of drug, SRE (pathologic fracture, surgery to bone, radiation to bone, spinal cord compression), and adverse events treatment. All costs were discounted for 3% per year. Effectiveness was appraised based on the number of SREs. Health states were defined according to SRE occurrence, SRE history, and death. The model assumed that a maximum of 1 SRE could occur in each cycle. Transition probabilities were derived from the relevant phase III trials. Results were present in the incremental total cost per SRE avoided. One-way sensitivity analyses were performed to examine the robustness of the model.Results. Over the 10-year period, denosumab incurred 103,091 tenge higher costs than brand ZA, 677,133 tenge higher costs than generic ZA, and 0.58 fewer SREs per patient with PC. The estimated incremental total direct costs per SRE avoided with the use of denosumab were 177,743 tenge (instead of brand ZA) and 1,167,470 tenge (instead of generic ZA). Results were robust to one-way sensitivity analyses.Conclusions.With the assumption that brand and generic ZAs are equally effective in the prevention of SREs in PC patients, denosumab seems to be a cost-effective alternative for brand ZA (insignificant difference in costs – less than 5%) and a costly alternative for generic ZA from the perspective of MoH of Kazakhstan
Concurrent Brucellosis and Q Fever Infection: a Case Control Study in Bamyan Province, Afghanistan
Get PDFBackground: More than 500,000 people are affected by brucellosis each year while the incidence of Q fever is poorly recorded. Consistent outbreaks of brucellosis have been reported in Afghanistan, affecting social and economic life. This study aimed to determine the means of propagation of brucellosis and Q-fever and establish appropriate control measures for both.Methods and Materials: An outbreak of 1,317 cases of brucellosis and Q fever was investigated from May 2011 to the end of 2012 in Bamyan province of Afghanistan.A total of 100 cases were selected by random sampling with equal number of neighbor controls. Data were collected through structured questionnaire.Results: The average age was 30 years ±14 years. Of those sampled, 62% were female, 38% were male, and resided in three districts: Punjab, Yakawlang and Waras. Using multivariate analysis, being a housewife (OR=7.36), being within proximity of kitchens to barns (OR= 2.98), drinking un-boiled milk (OR= 5.26), butchering (OR= 3.53) and purchasing new animals in the last six months (OR= 3.53) were significantly associated with contraction of brucellosis and Q fever.Conclusion: Health educators should focus on families dealing with animals, especially on females. Pasturing, healthy milking, dunging, and slaughtering practices, along with use of safe dairy products should be the focus of preventive measures
Evaluation of communication between physicians and patients in Astana City Hospital ?1
Get PDFIntroduction: Communication between patients and health care providers is important for the effective functioning of health care systems. Miscommunication often stems from discrepancies in expectations of both healthcare professionals and patients due to cultural and historical influences. We investigated the degree to which health care providers (doctors and nurses) and patients in Kazakhstan believe that interaction between doctors and patients should be doctor- or patient-oriented.Material and methods: We conducted a cross-sectional study of 163 patients and 176 health care providers (71 doctors and 105 nurses) in a general hospital in Astana, Kazakhstan. The subjects completed a structured questionnaire containing the Patient-Practitioner Orientation Scale (PPOS), and scales assessing life and job satisfaction, effort-reward balance of healthcare professionals, and the patients’ perceptions of communication practices.Results: An overwhelming majority of doctors (81.7%), nurses (88.1%), and patients (92.3%) were doctor-oriented. Among health care providers, PPOS was not associated with age, sex, life and job satisfaction, or effort-reward imbalance. Among patients, PPOS was not associated with age, sex, or specialty of health care provider. However, higher PPOS among patients (indicating preference for patient-oriented interaction) was associated with higher satisfaction with communication with health care providers and, less strongly, with their life satisfaction.Conclusion: The main finding of this study is the very small proportion of doctors, nurses and patients who believe that interaction should be patient-oriented. These results highlight the necessity of improvement of communication among health care providers towards patient-oriented approach in order to decrease miscommunication with patients. The fact that most patients prefer doctor-oriented interaction may reflect historical stereotypes; educational/information interventions among patients may also be needed
Vitamin D Receptor Gene Polymorphisms in Susceptibility to Tuberculosis in the Kazakh Population in Almaty and Almaty Area
Get PDFIntroduction: Vitamin D receptor (VDR) plays an important role in activating the immune response against various infectious agents. It is known that the active metabolite of ligand receptor Vitamin D (1,25 – dihydroxyvitamin D) is encoded by VDR and helps mononuclear phagocytes to suppress the intracellular growth of M. tuberculosis. The VDR gene harbors approximately 200 polymorphisms, some of which are linked to differences in receptor Vitamin D uptake and therefore can be considered as candidate disease risk variants. The relation between VDR gene polymorphisms and susceptibility to TB has been studied in different populations. There is not a great deal of information regarding the association of these SNPs with TB risk in the Kazakh population. The four most commonly investigated VDR polymorphisms in association with different diseases, including susceptibility to tuberculosis, are located in exon 2 (rs2228570 or FokI), intron 8 (rs1544410 or BsmI and rs7975232 or ApaI), and exon 9 (rs731236 or TaqI). The aim of our study was to determine whether these four VDR gene single nucleotide polymorphisms were associated with TB and whether they were a risk for the development of TB in the Kazakh Population in Almaty city and Almaty area.Methods: This study was a hospital-based case-control analysis of 283 individuals (99 TB patients and 184 healthy controls). Genotyping was performed by Taqman SNP allelic discrimination using commercial TaqMan SNP Genotyping assays. Statistical analysis was conducted using SPSS Version 19.0 software.Results: Genotype frequencies for the Kazakh population are close to world (HapMap) data on Asian populations. FokI and ApaI polymorphisms genotypes tend to be associated with TB risk under the co-dominant model [OR=1.18; 95%CI: (0.68, 2.07), p=0.15] for FokI and [OR=1.33; 95%CI: (0.61, 2.91), p=0.6] for ApaI. No significant association between the disease and TaqI, BsmI genotypes was observed.Conclusions: In summary, we explored potential associations between SNPs in the VDR (FokI, ApaI) gene and susceptibility to tuberculosis in the Kazakh Population, which requires further detailed analysis with a larger sample size and greater geographic diversity including other regions of Kazakhstan
Influence of Probiotic Consortium on TH1 and TH2 Immune Response
Get PDFIntroduction: The main role of probiotics is to maintain homeostasis in the intestines and improve bowel protective function. The aim of the present study is to investigate immuno-modulatory effects of a probiotic consortium.Methods: Observations were carried out in vitro. The presence of IL-2, IL-4, IL-6, IL-8, IL-10, TNF-?, IFN-?, IgA, IgM, and IgE was studied using a solid-phase enzyme immunosorbent assay on the VECTOR-BEST sets (Russia).Results: Immunomodulatory properties of the probiotic consortium were studied, which consisted of the following strains: Streptococcus thermophilus, Lactococcus lactis, Lactobacillus plantarum, Lactobacillus fermentum, Lactobacillus acidophilus, Bifidobacterium longum, and Bifidobacterium bifidum. Elevated concentrations of INF? in control samples decreased 3.9 times (p < 0.05) after a saturation of blood with the probiotic consortium. Significant reduction of cytokine levels after the probiotic effects of the consortium was observed in IL-10 by 2.1 times (p < 0.05) and IgA by 1.87 times (p < 0.0005). There was a significant increase in the levels of IL-4, IgE, IL-6, and IL-8 by 1.3 (p < 0.005), 1.1 (p < 0.5), 18.0 (p < 0.005), and 6 (p < 0.05) times, respectively, in comparison with the control samples. IL-4 and INF? have different effects on the synthesis of IgE. Soluble low affinity receptors Fc?RII (CD23) in association with IL-4 facilitate a differentiation of the B-lymphocytes in IgE-synthesizing cells, while ?-INF inhibits this process. It is known that the intracellular expression of ?-INF and IL-4 is the most reliable marker for Th1 and Th2 immune responses, respectively. The conducted studies determined that the ratio of INF-?/IL-4 was 0.9 (control 4.8, P < 0.005) after the saturation of the blood cells with probiotic consortium. NF-?/IL4 ratio decreased by 5.3 times compared with a control value, which indicates a reduction in the functional activity of Th1 type lymphocytes in comparison with the function of Th2 cells.Conclusion: The application of the probiotic consortium results in the maintenance of homeostasis by the stimulation of immune function through the activation of humoral immunity. Moreover, the probiotic application changes the orientation of the immunological memory causing the cancellation of the recruitment of Th1 cells in the response
Antimutagenic Properties of Biologically Active Substances of Microalgae Associates
Get PDFIntroduction: There are an increasing number of different xenobiotics negatively influencing population health. Therefore, it is important to find effective protectors against mutagenic and toxic effects of environmental pollutants. Naturally occurring biologically active substances, the majority of which are antioxidants, are capable of functioning as modifiers of the induced mutation process. The application of various naturally occurring protectors will lower essential risks of congenital malformations, cancer, and hereditary diseases caused by mutational damages. Therefore, it is crucial to screen algal flora of Kazakhstan for the antimutagenic activity. This study involved the assessment of antimutagenic potential of biologically active polypeptide (BAP) produced in mixed microalgae cultures.Methods. 70 white outbred male rats (Rattus norvegicus) at 6 months of age were used for this study. The dosage of BAP produced by microalgae associates Anabaena flos-aquae x Anabaenopsis sp. comprised 100 mg/kg. Cadmium sulfate was used as a mutagen in a concentration of 1 mg/kg. Experiments on antimutagenic activity of BAP were carried out with the Mammalian Bone Marrow Chromosomal Aberration Test.Results. After acute and subacute exposure of BAP, the level of chromosomal structural abnormalities in rat bone marrow cells was the same as in control group. Therefore, BAP showed no mutagenic activity, whereas exposure to cadmium sulfate at used concentration induced chromosomal aberrations with a significantly higher frequency than the spontaneous mutation rate. The exposure combination of BAP with cadmium sulfate resulted in a two-fold decrease (? < 0.05) of mutagen-induced chromosomal aberrations. The range of induced chromosomal aberrations included alterations of all types both in control and experimental groups.Conclusion. Most of the genotoxic effects are mediated through oxidative stress. The repair of DNA damage is an enzymatic process, which depends on the cellular metabolic rate. It has previously been shown that many biologically active substances lead to reduction of DNA sensitivity to mutagenic damaging factors. Based on these facts and obtained results, it can be assumed that BAP from mixed microalgae cultures Anabaena flos-aquae ? Anabaenopsis sp. are capable of blocking free radical process reducing the likelihood of genome damage, as well as triggering the cellular repair system.
PTH Gene Polymorphism and Breast Cancer Risk in Kazakhstan
Get PDFIntroduction. Breast cancer is the most common type of cancer among women. In Kazakhstan, breast cancer holds first place among causes of women death caused by cancer in the 45-55 year age group . Many studies have shown that the risk of acquiring breast cancer may be related to the level of calcium in the blood serum. One of the important regulators of calcium metabolism in the body is the parathyroid hormone. Single nucleotide polymorphisms in the gene encoding the parathyroid hormone (PTH) are associated with breast cancer development risk, and may modify the associative interaction between the levels of calcium intake and breast cancer. Experimental studies have shown that PTH gene has a carcinogenic effect. At least three studies showed a weak positive correlation between the risk of acquiring breast cancer and primary hyperparathyroidism, a state with high levels of PTH and often high levels of calcium. The aim of this investigation was to evaluate potential association between PTH gene polymorphism and breast cancer risk among Kazakhstani women.Methods. Female breast cancer patients (n = 429) and matched control women (n = 373) were recruited into a case – control study,. Genomic DNA was extracted from peripheral venous blood of study participants using Wizard® Genomic DNA Purification Kit (Promega, USA). Detection of PTH gene polymorphism (rs1459015) was done by means of the TaqMan® SNP Genotyping Assay of real-time PCR. Statistical analysis was conducted using SPSS 19.0.Results. PTH gene alleles were in Hardy–Weinberg equilibrium (p > 0.05). Distribution was 59% CC, 35% CT, 6% TT in the group with breast cancer and 50% CC, 43% CT, 6% TT in the control group. Total difference (between the group with breast cancer and the control group) in allele frequencies for PTH polymorphism was not significant (p > 0.05). No association was found between rs1459015 TT and breast cancer risk (OR = 1.039; 95%, CI 0.740 - 1.297; p = 0.893).Conclusion. We found no association between PTHrs1459015 polymorphism and breast cancer in our present study. Further studies are required to confirm our results and clarify role of PTH gene genotypes on breast cancer risk
Molecular and Genetic Research in Tuberculosis Clinical Practice and Epidemiology
Get PDFIntroduction. Tuberculosis (TB) remains a global public health problem. In order for multi-drug resistant tuberculosis (MDR-TB) to be more effectively managed, there is a need for better tools for diagnosis, treatment, and prevention. The decline of TB incidence and mortality in Kazakhstan during last decade was accompanied with consistent growth of MDR-TB. This study aimed to investigate genotype characteristics of Mycobacterium tuberculosis (MT) isolated from TB patients from different regions of the country and its clinical and epidemiological significance.Methods. Over 500 clinical MT isolates from pulmonary TB patients between 2003-2008 were genotyped using spoligotyping, MIRU-VNTR, IS6110 RFLP, and hybridization on an oligonucleotide biochip “TB–biochip.”Results. Out of 250 isolates with interpretable results, 31 different spoligopatterns were detected. The Beijing genotype was the most predominant lineage detected (71.6%), characterized by heterogenicity on ETR A, B, C, D, and E markers, and 56.6% of them had an allelic profile 42435. The Beijing genotype and dominating variant strains have a high transmission rate, a high rate of primary MDR (associated with infiltrating lung TB and complications), and a high level resistance to rifampicin and izoniazid due to mutation of rpoB531TTG and katG315ACC. MIRU-VNTR–typing by 15 loci of 33 isolates from 13 family TB foci revealed that strains from supposed sources and contact persons completely coincide in only 5 foci in the genomic structure.Conclusion. There is a heterogeneous pool of genotypes that circulate in Kazakhstan, with the Beijing lineage being the most predominant. It appears that at the present stage of circulation , MT Beijing genotype has an endemic character. However, clonal spreading of epidemiologically and clinically significant MDR strains of this genotype is also a serious threat to the population. To increase TB control efficiency and prevent further transmission, it is necessary to compile a modern countrywide system of microbiological monitoring for the agent by use of a computer bank of spoligotyping and MIRU-VNTR-typing profiles of circulating strains