Vulnerable individuals with tuberculosis (TB) struggle to access and stay on treatment. While patient-related and social barriers to TB treatment adherence are well documented, less is known about how the organisation and delivery of TB care influences adherence behaviour. To examine the influence of TB service organisation and culture on patients’ experience of starting and staying on treatment in Riga, Latvia. An intervention package to support adherence to TB treatment amongst vulnerable patients in Riga, Latvia was piloted between August 2016 and March 2017. Qualitative observations (5), interviews with staff (20) and with TB patients (10) were conducted mid-way and at the end of the intervention to understand perceptions, processes, and experiences of TB care. The organisation of TB services is strongly influenced by a divide between medical and social aspects of TB care. Communication and care practices are geared towards addressing individual risk factors for non-adherence rather than the structural vulnerabilities that patients experience in accessing care. Support for vulnerable patients is limited because of standardised programmatic approaches, resource constraints and restricted job descriptions for non-medical staff. Providing support for vulnerable patients is challenged in this setting by the strict division between medical and social aspects of TB care, and the organisational focus on patient-related rather than systems-related barriers to access and adherence. Potential systems interventions include the introduction of multi-disciplinary approaches and teams in TB care, strengthening patient literacy at the point of treatment initiation, as well as stronger linkages with social care organisations.

Background: Tanzania remains among the countries with the highest burden of infectious diseases (notably HIV, Malaria and Tuberculosis) during pregnancy. In response, the country adopted World Health Organization’s (WHO) latest antenatal care (ANC) guidelines which recommend comprehensive services including diagnostic screening and treatment for pregnant women during antenatal. However, as Tanzania makes efforts to scale up these services under the existing health system resources, it is crucial to understand its capacity to deliver these services in an integrated fashion. Using the WHO’s service availability and readiness assessment(SARA) framework, this study assesses the capacity of the Tanzanian Health System to provide integrated Malaria, Tuberculosis and HIV services. Methods: Composite indicators of the five components of integration were constructed from primary datasets of the Tanzanian Service Provision Assessments (SPA) under the Demographic and Health Survey (DHS) programs. Chi-squared analysis was conducted to determine the associations of each of the defined components and background characteristics of facilities/health workers. A logistic regression model was further used to explore strength of relationships between availability of service readiness components and a pregnant women’s receipt of HIV, Malaria and TB services by reporting adjusted odds ratios. Results: Generally, capacity to integrate malaria services was significantly higher (72.3 95% CI 70.3–74.4 p = 0.02) compared to Tuberculosis (48.9 95% CI 48.4–50.7) and HIV (54.8 95% CI 53.1–56.9) services. Diagnostic capacity was generally higher than treatment commodities. Regarding the components of SARA integration, logistic regression found that the adjusted odds ratio of having all five components of integration and receiving integrated care was 1.9 (95% CI 0.8–2.7). Among these components, the strongest determinant (predictor) to pregnant women’s receipt of integrated care was having trained staff on site (AOR 2.6 95% CI 0.6–4.5). Conclusion: Toward a successful integration of these services under the new WHO guidelines in Tanzania, efforts should be channelled into strengthening infectious disease care especially HIV and TB. Channelling investments into training of health workers (the strongest determinant to integrated care) is likely to result in positive outcomes for the pregnant woman and unborn child.

Introduction. Human factor is the single cause of road traffic injuries in 57%, and together with other factors in more than 90% of all road traffic accidents. Human factor includes many aspects, where reaction time is very important. Material and methods. Thirty healthy drivers 28-40 y.o. with 50-500 km passed per week, having caused at least one road traffic accident in the last ten years were selected, provided they were not under the influence of alcohol and drugs during traffic accident. The same number of control were selected. Both cases and controls were tested to reaction time. Results. We found statistically significant difference between car drivers who caused car accidents and those who did not in both simple and choice reaction times. Discussion. Car drivers who caused road traffic accidents have longer reaction time (both simple and choice reaction time), but as the tasks were more complex, that difference was less visible. Since drivers involved in this study had introductory phase before measuring their reaction times, they faced with unpleasant sound when they made mistake, which forced them to be aware not to make a mistake in further tasks, so they showed longer reaction times. Conclusion. Measuring of reaction time seems to be important, and as we have showed they are different in drivers who have caused road traffic accidents and those who have do not.

Globally, an estimated 257 million people are living with chronic hepatitis B (HBV) infection and an estimated 71 million people with the chronic hepatitis C virus (HCV). The true public health dimensions and impact of hepatitis epidemics are poorly understood. Case definitions are fundamental parts of disease surveillance, representing sets of standardised criteria used to assess whether or not a person has a certain disease. The study evaluated the sensitivity and specificity of hepatitis B and hepatitis C case definitions, current at the time of data collection, recommended by the European Commission (EC) and the Centers for Disease Prevention and Control (CDC). The study involved 150 hospital referrals with suspected cases of hepatitis from a Serbian clinic during 2014/2015. Case definitions of hepatitis B and C were tested for their sensitivity, specificity, positive and negative predictive values. EC 2008 and the CDC 2012 case definitions for acute hepatitis B, and the CDC 2012 case definition for probable case of chronic hepatitis B have low sensitivity. Case definitions which rely on laboratory confirmation only have maximal sensitivity. EC case definitions showed maximal sensitivity and specificity for hepatitis C confirmed cases. The CDC case definition for chronic hepatitis C showed low sensitivity (36.8%) and low negative predictive value (65.6%) for probable cases and maximal sensitivity and specificity for confirmed cases. Hepatitis C case definitions requiring presence of clinical criteria have low sensitivity and high specificity, resulting from presence of infection and absence of any clinical manifestation, but have high positive and negative predictive values. Syndromic case definitions show low sensitivity and are of limited use. They highlight the importance of laboratory diagnostics (offering maximal sensitivity and specificity, and high positive and negative predictive values), as well as the need for universal case definitions, for confirmed cases only.