A Guide For Multicentre Trials in High-Burden Countries
Chikungunya virus (CHIKV) is a re-emerging mosquito borne alphavirus responsible
for the recent outbreak in the Americas. Immunologically naïve population in the Americas favors the spread of epidemics. Chikungunya fever is characterized by an abrupt febrile illness, polyarthralgia and maculopapul
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ar rash. In chikungunya fever, shock or severe hemorrhage is very rarely observed; the onset is more acute and the duration of fever is shorter than dengue disease. The pain is much more pronounced and localized to the joints and tendons in chikungunya fever, in comparison to dengue fever. There is no specific and effective antiviral therapy and vaccines are still in trails. The only effective preventive measures consist of individual protection against mosquito bites and vector control. Disease prevention is important due to the
economic burden it entails. Clinicians need to distinguish chikungunya fever between dengue fever and other diseases to give a successful treatment and prevent disease spreading.
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Contact tracing is a key component of the COVID-19 response, particularly as societies begin to lift non-pharmaceutical interventions. However, it is a time-consuming and resource-intensive effort that depends on a trained and motivated workforce. Emergent digital contact tracing and quarantine (
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DCTQ) tools offer the potential to complement and strengthen conventional contact tracing initiatives on an unprecedented scale. Despite their visibility throughout the pandemic
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Conducting simulations and drills is the most effective way to evaluate and test disaster preparedness plans; these exercises are used widely by organizations and institutions working in development and in disaster response. Drills and simulations are also excellent tools for training, and for asses
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sing decision making processes, teamwork, and coordination.
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The Model Disability Survey (MDS) is a general population survey that provides detailed and nuanced information about how people with and without disabilities conduct their lives and the difficulties they encounter, regardless of any underlying health condition or impairment.
Biodiversity and healthy natural ecosystems, including protected areas in and around cities, provide ecosystem benefits and services that support human health, including reducing flood risk, filtering air pollutants, and providing a reliable supply of clean drinking water. These services help to red
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uce the incidence of infectious diseases and respiratory disorders, and assist with adaptation to climate change. Access to nature offers many other direct health benefits, including opportunities for physical activity, reduction of developmental disorders and improved mental health.
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Background
Noncommunicable diseases are major contributors to morbidity and mortality worldwide. Modifying the risk factors for these conditions, such as physical inactivity, is thus essential. Addressing the context or circumstances in which physical activity occurs may promote physical activity a
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t a population level. We assessed the effects of infrastructure, policy or regulatory interventions for increasing physical activity.
Methods
We searched PubMed, Embase and clinicaltrials.gov to identify randomised controlled trials (RCTs), controlled before-after (CBAs) studies, and interrupted time series (ITS) studies assessing population-level infrastructure or policy and regulatory interventions to increase physical activity. We were interested in the effects of these interventions on physical activity, body weight and related measures, blood pressure, and CVD and type 2 diabetes morbidity and mortality, and on other secondary outcomes. Screening and data extraction was done in duplicate, with risk of bias was using an adapted Cochrane risk of bias tool. Due to high levels of heterogeneity, we synthesised the evidence based on effect direction.
Results
We included 33 studies, mostly conducted in high-income countries. Of these, 13 assessed infrastructure changes to green or other spaces to promote physical activity and 18 infrastructure changes to promote active transport. The effects of identified interventions on physical activity, body weight and blood pressure varied across studies (very low certainty evidence); thus, we remain very uncertain about the effects of these interventions. Two studies assessed the effects of policy and regulatory interventions; one provided free access to physical activity facilities and showed that it may have beneficial effects on physical activity (low certainty evidence). The other provided free bus travel for youth, with intervention effects varying across studies (very low certainty evidence).
Conclusions
Evidence from 33 studies assessing infrastructure, policy and regulatory interventions for increasing physical activity showed varying results. The certainty of the evidence was mostly very low, due to study designs included and inconsistent findings between studies. Despite this drawback, the evidence indicates that providing access to physical activity facilities may be beneficial; however this finding is based on only one study. Implementation of these interventions requires full consideration of contextual factors, especially in low resource settings.
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This publication, the third module of a resource manual to support the training of planners and practitioners in managing flash flood risk, deals with structural measures. It presents bioengineering techniques, physical measures for slope stabilisation and erosion control, and physical measures for
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river training. It also presents the concept of integrated flood management as a component of integrated water resource management. It emphasizes that structural measures are most effective and sustainable when implemented together with appropriate non-structural measures. The manual is aimed at junior to mid-level professionals with a civil engineering background working on flash flood risk management at the district level.
Flash floods are among the most destructive natural disasters in the Hindu Kush Himalayan region. Flash flood mitigation is generally addressed by community-based organisations, local non-governmental organisations, or district and local-level staff in government organisations. But these groups often lack adequate understanding of the processes causing flash floods and knowledge of flash flood risk management measures.
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Miscellaneous
Chapter J.2
Misceláneo
Capítulo J.2
Edición: Matías Irarrázaval & Andres Martin
Traductores: Fernanda Prieto-Tagle & Montserrat Pamias
The mhGAP community toolkit: field test version is an integral part of WHO's Mental Health Gap Action Programme (mhGAP), and aims at scaling up services for people with mental health conditions to achieve universal health coverage.
The toolkit provides guidance for programme managers on how to i
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dentify local mental health needs and tailor community services to match these needs. It offers practical information and necessary tools for community providers to promote mental health, prevent mental health conditions and expand access to mental health services.
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Cardiovascular disease, diabetes, chronic obstructive pulmonary disease, cancers, and other non-communicable diseases are among the leading causes of morbidity and mortality in low-income, middle-income, and high-income countries, and The Lancet Taskforce recently made the case for investing in non-
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communicable disease prevention. Now, in The Lancet Planetary Health, Benjamin Bowe and colleagues report that exposure to PM2·5 air pollution is indeed a risk factor for diabetes.
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