P056 Acute rheumatic fever: still a hot topic

Background Acute rheumatic fever (ARF) still a very common condition and constitutes a real public health problem in the developing countries including Algeria. The objective is to assess the epidemiological and clinical profile and the disease course of ARF in our region and estimate the incidence of cardiac complications. Method The authors report the results of a retrospective study of 52 cases of ARF in children, hospitalized and treated at the Sainte Therese Clinic of the CHU Annaba for a period of 6 years. The diagnosis was made according to Jones criteria. Information was obtained from hospital records. Results The disease mainly concerned the age group of 4–10 years (52%), the sex ratio was 0.86 (28 girls, and 24 boys). The maximum number of hospitalizations is observed during the rainfall period (October-March). 54% of patients had untreated angina. Clinically, fever was noted in 23 patients, polyarthritis in third of cases and a heart murmur in half of patients. Doppler-coupled echocardiography founded carditis in 73% of patients: Endocarditis was noted in all of these cases and the mitral insufficiency was the dominant anatomo-clinical form. The number of infra-clinical carditis was considerable (10/38 cases of carditis). Biologically, accelerated ESR (> 50 mm/H1) was observed in 65% of cases, high CRP level and hyper leucocytosis were noted in 38 and 31 patients, respectively. ASLOs were high in 85% of cases. The outcomes were favorable in the majority of cases. Nevertheless 5 relapses were recorded, including 3 complicated by severe carditis. Conclusion ARF still frequent in our region. Cardiac complications are always frequent and constitute a major factor of morbidity. Our results illustrate the absolute need for a rigorous application of the national prevention program, the main objective of which is to reduce the prevalence of rheumatic heart disease.

An appeal to our government for nationwide policies in the prevention of cardiovascular disease

The high prevalence and burden of cardiovascular diseases (CVD) is largely attributable to unhealthy lifestyle factors such as smoking, alcohol consumption, physical inactivity and unhealthy food habits. Prevention of CVD, through the promotion of healthy lifestyles, appears to be a Sisyphean task for healthcare professionals, as the root causes of an unhealthy lifestyle lie largely outside their scope. Since most lifestyle choices are habitual and a response to environmental cues, rather than rational and deliberate choices, nationwide policies targeting the context in which lifestyle behaviours occur may be highly effective in the prevention of CVD. In this point-of-view article, we emphasise the need for government policies beyond those mentioned in the National Prevention Agreement in the Netherlands to effectively reduce the CVD risk, and we address the commonly raised concerns regarding ‘paternalism’.

Static and Dynamic Prediction of Chronic Renal Disease Progression Using Longitudinal Clinical Data from Taiwan’s National Prevention Programs

Kidney diseases can cause severe morbidity, mortality, and health burden. Determining the risk factors associated with kidney damage and deterioration has become a priority for the prevention and treatment of kidney disease. This study followed 1042 chronic kidney disease (CKD) patients with Stage 3–5 kidney disease who were treated at a public veteran’s hospital through the national prevention program. A total of 12.5 years of records of clinical measurements were collected and analyzed using dynamic and static Cox hazard models to predict the progression to dialysis treatment. The results showed that the statistical significance of several variables in patients with Stage 3–5 CKD was attenuated while the dynamic model was being used. The estimated glomerular filtration rate (eGFR) and urine protein to creatinine ratio (PCR) had the powerful ability to predict the progression of CKD patients with Stage 3a and Stage 3b–5 kidney disease, whereas serum calcium was also predictive for the progression of Stages 3b–5 CKD. Because these two sub-stages of Stage 3 CKD are often associated with differences in routine measurements and the risk analysis of renal dialysis, future research can use this predictive model as a reference while similar prevention programs are implemented.

An assessment of human resource distribution for public eye health services in KwaZulu-Natal, South Africa

Background: The development of human resources for eye health (HReH), aimed at achieving a 25% reduction in visual impairment by the year 2020, was one of the VISION 2020 objectives.Aim: To assess HReH in the public sector of KwaZulu-Natal (KZN), and its effect on the accessibility of eye care in the province.Setting: All public eye facilities in KZN.Methods: A quantitative cross-sectional study using a close-ended questionnaire to assess distribution and outputs of HReH. At the end of the questionnaire, respondents gave general comments on their ability to provide services.Results: Human resource rates were 0.89 for ophthalmologists, 2.44 for cataract surgeons, 4.8 for optometrists and 4.7 for ophthalmic nurses per 1 million population. Most health facilities had some HReH working in them, albeit none had dispensing opticians. Regression analysis showed that 67.1% of variation in cataract surgery was because of the number of surgeons available. Cataract surgical rates were low with a waiting period of up to 18 months. In addition to the refractive error regression analysis of 33.7%, spectacle supply was low, with a backlog of up to 9 months in some facilities.Conclusion: Overall, HReH targets as per VISION 2020 and the National Prevention of Blindness have not been met in this region. Dispensing opticians are not employed in any of the province’s health districts. An increase in the eye health workforce is necessary to improve the eye health outcomes for people dependent on public eye facilities.

The importance of the management system of the diagnostic health professions and action strategies

The Italian national health system, in addition to being a world-class excellence, over the years has become increasingly competitive and dynamic, pushing those who coordinate and manage to have to work alongside staff figures and the most suitable tools to face the most pressing needs and contingencies strategic and operational. For this reason, the National Health Plan (PSN), the Regional Health Plan (PSR) and the National Prevention Plan (PNP) have been identified as the main planning tools, which are the basis of health planning at all levels, from that National to regional and local. The figure of the Head of the Health Professions and, specifically, that of the technical-diagnostic area, in the context of complex health systems such as Healthcare Companies and Hospitals, is indispensable within the strategic staff and as a necessary figure for the implementation of the programming and coordination of activities. Moreover, it is essential to deal with the fundamental issues regarding processes and work cycles by building, on these bases, the concept and importance of the choice of the management system according to advanced skills and thanks to the possession of a strong managerial culture.

Influence of Some Sociodemographic Factors on Causes of Death Among South African Youth

Youth mortality is a challenge in South Africa, where on a daily basis a number of deaths are reported and are related to youth. This study used the 2014 Statistics South Africa data to examine the influence of sociodemographic factors on causes of death among South African youth aged 15-34 years, using a logistic regression model. The results showed that there is a significant relationship between education and causes of death as well as other sociodemographic factors and that the youth mortality will likely reduce if more youth have higher levels of education. The results of this study could be used to improve national prevention campaigns to reduce death among young South Africans, especially adolescents.

A service evaluation of the dental and oral health of 5-year-old patients attending a specialised cleft centre

Introduction It is well recognised that cleft lip and/or palate carries an increased risk of developing dental caries. This article describes a service evaluation that was undertaken at the South Thames cleft service to analyse whether the five-year-old cohort of patients attending the clinic were following preventative advice as well as whether they were registered with a general dental practitioner and attending for regular recall. Methods A total of 96 patients were assessed. Data from a 24-month period were collected retrospectively using a data collection sheet. Results The vast majority (92%) of the patients included in this service evaluation were registered with a general dentist. Despite this, 40% had a decayed/missing/filled teeth score of >0, only 73% were having fluoride varnish applied regularly and 79% were using toothpaste containing the recommended fluoride content. More than half (57%) of the patients had developmental defects of enamel. Conclusions There needs to be increased emphasis on following national prevention guidelines given that this group of patients is known to be at a higher risk of dental caries. Parents and carers must be made aware of the requirement for shared care between general dental practitioners and secondary care.

Trends in Malaria Cases and Deaths: Assessing National Prevention and Control Progress in Burundi

Background: Malaria is associated with high morbidity and mortality especially in World’s tropical regions. In 2016, an estimated 216 million and 445,000 cases of malaria and deaths associated with malaria respectively were reported globally. Malaria is the first leading cause of outpatient visits, hospitalization and death in Burundi. We therefore examined the trend in malaria cases and deaths in Burundi. Methods: We extracted data from Burundi National Health Information System (BNHIS) and assessed trends in malaria cases and deaths from January 2015 to December 2017. A suspected case of malaria was defined as any person treated by anti-malarial drugs without testing while a confirmed case as any person with a positive microscopy or rapid diagnostic test for malaria parasite. We described malaria cases and deaths, and calculated malaria case incidence rate. Results: A total of22,225,699 malaria cases with 8,660 deaths (CFR 0.04%) was documented during the study period. Out of 22,225,699 cases, 45,291 cases (0.2%) were suspected malaria cases. The observed peak season of malaria infection in any of the studied year was in the raining season (March-June). All provinces of the country were affected. Kirundo and Cankuzo provinces the incidence of malaria cases increased from 10.1 cases per 1,000 persons in 2015 to 13.2 cases per 1,000 persons in 2017. The case fatality rate decreased from 0.06% in 2015 to 0.01% in 2017. Conclusions: An increasing trend in malaria prevalence was observed in Burundi but Kirundo and Cankuzo provinces were the most affected. However, the case fatality decreased within the studied period. Malaria intervention should be intensified/scaled up in the raining season and the most affected provinces.

Dutch Public health Foresight study 2018/20

The four-year Public Health Foresight Study (VTV) provides insight into the most important societal challenges for public health and health care in the Netherlands. The seventh edition of the Dutch Public Health Foresight study was published in 2018, with an update in 2020. In this update a business-as-usual or Trend Scenario was developed using 2018 as a base year. In the trend scenario demographic and epidemiological projections have been used to depict the future trends regarding ageing, health, disease, health behaviors, health expenditures and health inequalities. Next, these trends are used to identify the most important future challenges and opportunities for public health. In the 2020 update, special attentions is given to climate change and the local living environment and their impacts and interaction with public health outcomes. Trends in lifestyle-related lifestyle show both positive (smoking prevalence) and negative (overweight prevalence) future developments. Dementia will be the leading cause of mortality and disease burden in 2040 by far. Health care expenditures will double by 2040, with cancers showing the most rapid growth of all disease groups. The insights of this study are directly used as input for the National Health Policy Memorandum and for the National Prevention Accord.