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Hintergrund: Mehr als eine Milliarde Menschen leiden an chronischen Atemwegserkrankungen wie Asthma, COPD, Rhinitis und Rhinosinusitis. Diese verursachen enorme Belastungen und gelten als schwerwiegende nicht übertragbare Erkrankungen. Viele Patienten sind noch unbehandelt und die Kosten der Untätigkeit sind nicht akzeptabel. Am 23. März 2018 fand in Vilnius eine Konferenz unter der Schirmherrschaft des Gesundheitsministeriums und verschiedener wissenschaftlicher Fachgesellschaften statt, auf der multisektorale Versorgungswege vorgeschlagen wurden, die angeleitetes Selbstmanagement, mHealth und Luftverschmutzung bei der Versorgung bestimmter chronischer Atemwegserkrankungen (Rhinitis, chronische Rhinosinusitis, Asthma und COPD) einschließen. Das Treffen schloss mit der Erklärung von Vilnius, die von den Teilnehmern des EU-Gipfels zu chronischen Atemwegserkrankungen unter der Federführung von Euforea entwickelt wurde. Schlussfolgerung: Die Erklärung von Vilnius ist ein wichtiger Schritt im Kampf gegen die weltweite Luftverschmutzung und ihre Auswirkungen für Patienten mit chronischen Atemwegserkrankungen und sie spielt im Hinblick auf die EU-Gesundheitsstrategie eine wichtige Rolle, da sie einen Zusatznutzen zu dem bereits vorhandenen Wissen über die öffentliche Gesundheit liefert.

The Nature Step to Respiratory Health was the overarching theme of the 12th General Meeting of the Global Alliance against Chronic Respiratory Diseases (GARD) in Helsinki, August 2018. New approaches are needed to improve respiratory health and reduce premature mortality of chronic diseases by 30% till 2030 (UN Sustainable Development Goals, SDGs). Planetary health is defined as the health of human civilization and the state of the natural systems on which it depends. Planetary health and human health are interconnected, and both need to be considered by individuals and governments while addressing several SDGs. Background: The Nature Step to Respiratory Health was the overarching theme of the 12th General Meeting of the Global Alliance against Chronic Respiratory Diseases (GARD) in Helsinki, August 2018. New approaches are needed to improve respiratory health and reduce premature mortality of chronic diseases by 30% till 2030 (UN Sustainable Development Goals, SDGs). Planetary health is defned as the health of human civilization and the state of the natural systems on which it depends. Planetary health and human health are interconnected, and both need to be consid‑ ered by individuals and governments while addressing several SDGs. Results: The concept of the Nature Step has evolved from innovative research indicating, how changed lifestyle in urban surroundings reduces contact with biodiverse environments, impoverishes microbiota, afects immune regulation and increases risk of NCDs. The Nature Step calls for strengthening connections to nature. Physical activity in natural environments should be promoted, use of fresh vegetables, fruits and water increased, and consumption of sugary drinks, tobacco and alcohol restricted. Nature relatedness should be part of everyday life and especially emphasized in the care of children and the elderly. Taking “nature” to modern cities in a controlled way is possible but a challenge for urban planning, nature conservation, housing, trafc arrangements, energy production, and impor‑ tantly for supplying and distributing food. Actions against the well-known respiratory risk factors, air pollution and smoking, should be taken simultaneously. Conclusions: In Finland and elsewhere in Europe, successful programmes have been implemented to reduce the burden of respiratory disorders and other NCDs. Unhealthy behaviour can be changed by well-coordinated actions involving all stakeholders. The growing public health concern caused by NCDs in urban surroundings cannot be solved by health care alone; a multidisciplinary approach is mandatory

In all societies, the burden and cost of allergic and chronic respiratory diseases are increasing rapidly. Most economies are struggling to deliver modern health care effectively. There is a need to support the transformation of the health care system into integrated care with organizational health literacy. MASK (Mobile Airways Sentinel NetworK) (1), a new development of the ARIA (Allergic Rhinitis and its Impact on Asthma) initiative (2), and POLLAR (Impact of Air POLLution on Asthma and Rhinitis, EIT Health) (3), in collaboration with professional and patient organizations in the field of allergy and airway diseases, are proposing real-life ICPs—centred around the patient with rhinitis and using mHealth monitoring of environmental exposure. An expert meeting took place at the Pasteur Institute in Paris, December 3, 2018. The aim was to discuss nextgeneration care pathways following an ongoing political agenda (4,5): (I) patient participation, health literacy and self-care through technology-assisted “patient activation”; (II) implementation of care pathways by pharmacists and (III) Next-generation guidelines assessing the recommendations of GRADE guidelines in rhinitis and asthma using real-world evidence (RWE) assessed by mobile technology. The present document reviews the workshop report and follows on from Part 1.

Background: Asthma patients in high-income countries (HIC) and low- and middle-income countries (LMIC) need uninterrupted supplies of affordable, quality-assured essential medicines. The World Health Organization (WHO) NonCommunicable Disease (NCD) Global Action Plan sets an 80% target for availability of essential NCD medicines. Access is likely to improve if medicines are on national Essential Medicines Lists (EML) and provided free/subsidised. Methods: Principal investigators of the Global Asthma Network were sent a questionnaire in 2014-5 about the inclusion of essential asthma medicines in their countries9 EML and national reimbursement list (NRL). Results: 111 of 120 countries sent data. Of 91 (82%) countries with an EML, 72 (79%) included 1 or more inhaled corticosteroids (ICS) and 79 (87%) included salbutamol. Inclusion of WHO-recommended dosages: of HIC with EML, 16 (70%) had beclometasone 50µg and 17 (74%) 100µg; of LMIC with EML, 38 (56%) had beclometasone 50µg and 31 (46%) 100µg. Of 80 (72%) countries with an NRL, 64 (80%) included 1 or more ICS; 32 (94%) of the HIC and 32 (70%) of the LMIC. There were 29 (85%) HIC but only 23 (50%) LMIC that had 50µg beclometasone; 28 (82%) HIC but only 20 (43%) LMIC had 100µg beclometasone. 69 (86%) had salbutamol; 32 (94%) of HIC and 37 (80%) of LMIC. Patients in HIC with NRL are best served (91% HIC had ICS and salbutamol). Patients in the 24 (34%) LMIC with no NRL as well as those in LMIC with an NRL but no ICS are likely to have very poor access to these ICS. Conclusion: Many LMIC do not have essential asthma medicines on their EML or NRL. A mechanism for accessing affordable, quality-assured medicines is needed; also technical guidance and advocacy for policy change.

The prevalence of diabetes mellitus is increasing at a dramatic rate, and countries in Asia, particularly India and China, will bear the brunt of this epidemic. Persons with diabetes have a significantly increased risk of active tuberculosis (TB), which is two to three times higher than in persons without diabetes. In this article, we argue that the epidemiological interactions and the effects on clinical presentation and treatment resulting from the interaction between diabetes and TB are similar to those observed for human immunodeficiency virus (HIV) and TB. The lessons learned from approaches to reduce the dual burden of HIV and TB, and especially the modes of screening for the two diseases, can be adapted and applied to the screening, diagnosis, treatment and prevention of diabetes and TB. The new World Health Organization (WHO) and The Union Collaborative Framework for care and control of TB and diabetes has many similarities to the WHO Policy on Collaborative Activities to reduce the dual burden of TB and HIV, and aims to guide policy makers and implementers on how to move forward and combat this looming dual epidemic. The response to the growing HIV-associated TB epidemic in the 1980s and 1990s was slow and uncoordinated, despite clearly articulated warnings about the scale of the forthcoming problem. We must not make the same mistake with diabetes and TB. The Framework provides a template for action, and it is now up to donors, policy makers and implementers to apply the recommendations in the field and to 'learn by doing'.

The steadily growing epidemic of diabetes mellitus poses a threat for global tuberculosis (TB) control. Previous studies have identified an important association between diabetes mellitus and TB. However, these studies have limitations: very few were carried out in low-income countries, with none in Africa, raising uncertainty about the strength of the diabetes mellitus-TB association in these settings, and many critical questions remain unanswered. An expert meeting was held in November 2009 to discuss where there was sufficient evidence to make firm recommendations about joint management of both diseases, to address research gaps and to develop a research agenda. Ten key research questions were identified, of which 4 were selected as high priority: (i) whether, when and how to screen for TB in patients with diabetes mellitus and vice versa; (ii) the impact of diabetes mellitus and non-diabetes mellitus hyperglycaemia on TB treatment outcomes and deaths, and the development of strategies to improve outcomes; (iii) implementation and evaluation of the tuberculosis 'DOTS' model for diabetes mellitus management; and (iv) the development and evaluation of better point-of-care diagnostic and monitoring tests, including measurements of blood glucose and glycated haemoglobin A(1c) (HbA(1c)) for patients with diabetes mellitus. Implementation of this research agenda will benefit the control of both diseases.

The International Union Against Tuberculosis and Lung Disease (The Union) is the oldest international non-governmental organization involved in the fight against tuberculosis. This review documents the history and structure of The Union up to 2009, and describes the achievements that have taken place in the field of tuberculosis and lung health. The progress made in tackling the major killer (pneumonia) of children less than 5 years of age, the barrier to affordable essential asthma medicines, the complex issue of tobacco control, the move into the realm of HIV and AIDS, and new ideas and activities around the increasingly important domain of operational research are described and discussed. Finally, as with many institutions that have seen a rapid phase of growth, expansion and decentralisation to regional offices around the world, the review highlights the internal strategic initiative that aims to fine-tune the organisational structure, clarify lines of authority, create more efficient business, human resource and financial systems and revise, where necessary, The Union's guiding mission, vision and values for the future.

The development of the DOTS Expansion Plan has been a milestone in tuberculosis (TB) control at the global and national levels. Key challenges that remain are overcoming the weakness of a strategy built on case management, sustaining commitment, competing priorities, the threat of HIV, maintaining high quality of care and preventing drug resistance, building human resource capacity, improving diagnosis and fostering operations research. The ability to address these challenges will determine the success or failure of the Global Plan to Stop TB, 2006-2015.

Asthma is a worldwide public health problem affecting about 300 million people. The majority of persons living with asthma are in the developing world where there is limited access to essential drugs. The financial burden for persons living with asthma and their families, as well as for healthcare systems and governments, is very high. Inadequate treatment and the high cost of medications leads to disability, absenteeism and poverty. Despite the existence of effective asthma medications and international guidelines, and progress made in the implementation of such guidelines over the last decade, the high cost of essential asthma medications remains a major obstacle for patient access to treatment in developing countries. The International Union Against Tuberculosis and Lung Disease has evaluated this problem and created an Asthma Drug Facility (ADF) so that countries can purchase affordable, good quality essential drugs for asthma. The ADF uses pooled procurement along with other purchasing and supply strategies to obtain the lowest possible prices. Accompanied by the implementation of standardized asthma management, the increased affordability of drugs provided by the ADF should bring rapid and significant health and cost benefits for patients, their communities and governments.

The International Union Against Tuberculosis and Lung Disease (The Union) held its 40th World Conference on Lung Health in Cancun, Mexico, between 3 and 7 December 2009. It was attended by over 2000 delegates from 104 countries around the world. The conference featured four stimulating plenary sessions and an extensive selection of scientific symposia. A total of 1125 abstracts were also presented from five broad categories: clinical trials and TB basic science, clinical research for treatment and care, epidemiology, education, advocacy and social issues, and policy and program implementation. In addition, the conference was preceded by a series of well-attended postgraduate courses and workshops.

The UN High-Level Meeting on Non-Communicable Diseases (NCDs) in September, 2011, is an unprecedented opportunity to create a sustained global movement against premature death and preventable morbidity and disability from NCDs, mainly heart disease, stroke, cancer, diabetes, and chronic respiratory disease. The increasing global crisis in NCDs is a barrier to development goals including poverty reduction, health equity, economic stability, and human security. The Lancet NCD Action Group and the NCD Alliance propose five overarching priority actions for the response to the crisis--leadership, prevention, treatment, international cooperation, and monitoring and accountability--and the delivery of five priority interventions--tobacco control, salt reduction, improved diets and physical activity, reduction in hazardous alcohol intake, and essential drugs and technologies. The priority interventions were chosen for their health effects, cost-effectiveness, low costs of implementation, and political and financial feasibility. The most urgent and immediate priority is tobacco control. We propose as a goal for 2040, a world essentially free from tobacco where less than 5% of people use tobacco. Implementation of the priority interventions, at an estimated global commitment of about US$9 billion per year, will bring enormous benefits to social and economic development and to the health sector. If widely adopted, these interventions will achieve the global goal of reducing NCD death rates by 2% per year, averting tens of millions of premature deaths in this decade.

OBJECTIVES To assess completeness and determinants of reporting to the AIDS registry of the Swiss Federal Office of Public Health. DESIGN AND METHODS Death certificates indicative of AIDS or HIV for deaths occurring between December 1987 and June 1990 were reviewed and compared with reports to the AIDS registry. RESULTS The completeness of the AIDS registry was 68%. However, almost all cases have now been ascertained, because more than 90% of unreported AIDS cases are detected when death certificates are reviewed. Thus, the ongoing review of death certificates adds to the total case ascertainment. The most important determinant of reporting was the reporting source: specialized AIDS clinics reported 85% of their cases, while all other sources reported only 48%. CONCLUSION The investigation of the heterogeneity of reporting is important. It can wrongly suggest regional and national differences in the epidemic and lead to a decrease in completeness of reporting over time without actual changes in reporting behavior.

Setting: Private practitioners including chest physicians are often an important obstacle to having a successful National Tuberculosis Programme (NTP) in low- and middle-income countries. This complicated situation has been present in most of the Latin American countries for many years. Objective: To design an intervention model to obtain collaboration and integration of specialist physicians in the actions of the NTP. Design: In 1998, the IUATLD designed a special interactive model of training courses, to be held in an important number of Latin American countries. This intensive (25 h in 3 days) course was named ‘Importance of the role of chest physicians and their integration in NTP strategies’. At the end of each course, the participants were invited to sign a series of agreements concerning controversial topics that had blocked collaboration in the past. Results: This course, adapted to the situation of the different countries, has been held 17 times in 9 different countries. So far, nearly 600 specialist physicians have been trained with this special model, and all of them have signed important agreements on future collaboration. Conclusion: There has been an important improvement in integrating these specialist physicians into the actions of the NTPs. This intervention has contributed to a substantial improvement of tuberculosis control in the last 4 years in Latin America.

Recent systematic reviews show that diabetes mellitus (DM) increases the risk and odds of developing tuberculosis (TB), especially in young people and in developing countries with a high background incidence of TB. There are no data showing that TB increases the risk of DM. The large dual burden of disease may make management of both conditions more difficult. High-quality implementation research is needed to assess the value and ways of screening for DM in patients with TB and vice versa, and to set up standardised systems of monitoring and evaluation based on the directly observed treatment, short-course (DOTS) model used for TB control.

Objective. —To assess the risk of hepatitis A in international travelers and to recommend preventive measures. Data Sources. — Index Medicus , 1974 through 1983; MEDLINE, 1984 through 1993; and unpublished data of the Centers for Disease Control and Prevention. Study Selection. —Review of all retrospective and cohort studies on hepatitis A and other vaccine-preventable diseases in travelers, of seroepidemiologic surveys of hepatitis A virus (HAV) antibodies in travelers, of data on the various hepatitis A vaccines, of economic analyses, and of recommendations of recognized organizations. Data Extraction. —Independent analysis by multiple observers. Data Synthesis. —The incidence rate for unprotected travelers, including those staying in luxury hotels, is estimated to be three per 1000 travelers per month of stay in a developing country. Persons eating and drinking under poor hygienic conditions have a rate of 20/1000 per month. This makes hepatitis A the most frequent infection in travelers that may be prevented by immunization. In many industrialized countries persons born after 1945 have an HAV antibody seroprevalence (immunity) of less than 20%. New inactivated HAV vaccines induce protective antibodies in more than 95% of recipients and offer protection estimated to last for 10 years or more, whereas protection by immune globulin lasts only 3 to 5 months. Conclusions. —Hepatitis A vaccine, or immune globulin where HAV vaccine is not available, is recommended for all nonimmune travelers visiting developing countries. Prescreening for antibodies to HAV in travelers living in countries with low prevalence is usually not necessary in persons born after 1945. ( JAMA . 1994;272:885-889)

Die Ubertragungswege des HIV, welche in der Bevolkerung eine Rolle spielen, sind heute bekannt. Neben der sexuellen Ubertragung, der Infektion durch Austausch von Injektionsnadeln bei Drogenabhangigen, den akzidentellen Blutkontakten wird vor allem auch die Ubertragung von der schwangeren Mutter auf ihr Kind beobachtet. Die Anzahl Neuinfektionen ist abhangig von der Anzahl Infizierter, der Ausbreitungsgeschwindigkeit und dem Ausbreitungspotential. Die Ausbreitungsgeschwindigkeit kann unter Drogenabhangigen sehr gross werden, konnen sich doch mehrere Abhangige durch Spritzentausch gleichzeitig infizieren. In der Gesamtbevolkerung besitzt die sexuelle Ubertragung das grosste Ausbreitungspotential. Die Aids-Pravention in der Schweiz beinhaltet Ziele, welche einerseits Neuinfektionen verhindern und andererseits Solidaritat aufbauen sollen. Mit der STOP-AIDS Kampagne wurde in der Schweiz eine gute Breitenwirkung erreicht. Es gilt nun in Zukunft vermehrt Tiefenwirkungen bei bestimmten Zielgruppen weiter zu fordern, sowie vermehrt individuelle Beratungen anzubieten.

The Global Asthma Network (GAN), established in 2012, followed the International Study of Asthma and Allergies in Childhood (ISAAC). ISAAC Phase One involved over 700 000 adolescents and children from 156 centres in 56 countries; it found marked worldwide variation in symptom prevalence of asthma, rhinitis and eczema that was not explained by the current understanding of these diseases; ISAAC Phase Three involved over 1 187 496 adolescents and children (237 centres in 98 countries). It found that asthma symptom prevalence was increasing in many locations especially in low- and middle-income countries where severity was also high, and identified several environmental factors that required further investigation.GAN Phase I, described in this article, builds on the ISAAC findings by collecting further information on asthma, rhinitis and eczema prevalence, severity, diagnoses, asthma emergency room visits, hospital admissions, management and use of asthma essential medicines. The subjects will be the same age groups as ISAAC, and their parents. In this first global monitoring of asthma in children and adults since 2003, further evidence will be obtained to understand asthma, management practices and risk factors, leading to further recognition that asthma is an important non-communicable disease and to reduce its global burden.

Open-access journal publications aim to ensure that new knowledge is widely disseminated and made freely accessible in a timely manner so that it can be used to improve people's health, particularly those in low- and middle-income countries. In this paper, we briefly explain the differences between closed- and open-access journals, including the evolving idea of the 'open-access spectrum'. We highlight the potential benefits of supporting open access for operational research, and discuss the conundrum and ways forward as regards who pays for open access.Les articles de journaux en accès libre visent à assurer la dissémination large de nouvelles connaissances et de rendre leur accès libre de façon à pouvoir être utilisées rapidement pour améliorer la santé des populations, surtout dans les pays à revenu faible ou moyen. Dans cet article, nous expliquons briêvement les différences entre les publications à accès limité et à accès libre, notamment l'idée en gestation de « spectre d'accès libre ». Nous soulignons les bénéfices potentiels du soutien à l'accès libre pour la recherche opérationnelle et ensuite discutons la question de qui paye pour cet accès et la recherche de solutions.El propósito de las publicaciones en las revistas de acceso libre es lograr una amplia difusión de los nuevos conocimientos mediante el acceso libre y oportuno, de manera que los avances se puedan aplicar a fin de mejorar la salud de las personas, sobre todo en los países de bajos y medianos ingresos. En el presente artículo se explican brevemente las diferencias entre las revistas de acceso libre y acceso restringido y se analiza además la idea evolutiva del ‘espectro del acceso libre’. Se destacan las ventajas que puede ofrecer el respaldo al libre acceso a la investigación operativa y se analiza luego el dilema y las opciones que pueden permitir progresar con respecto a la fuente de financiamiento del libre acceso.

Objectives Benin established a revolving drug fund (RDF) for essential asthma medicines in 2008. We evaluated the operation of the RDF and assessed whether there was interruption of supply of asthma medicine from 2008 to 2013. Methods We reviewed the process in establishing the RDF. We assessed cost and sale price of asthma medicines, expenditure of the RDF in procuring asthma medicines and other tools, revenue generated by sales of medicines to patients, and balance of capital as of 31 January 2013. We investigated whether there was interruption of supply of essential asthma medicines from 2008–2013. Results The total amount of grants initially injected into the RDF was 24,101€. As of 31 January 2013, the capital of the RDF, including the deposit in the RDF bank account (8,114€) and the value of inhalers in stock (12,172€), was equivalent to 20,586€, slightly less than the initial capital (24,101€). The decrease of capital was mainly because a number of inhalers were expired or provided free-of-charge (6,091€) and because part of the fund was used to procure other elements required for the management of asthma (4,338€). Thanks to a RDF, Benin maintained an uninterrupted supply of essential asthma medicines in asthma pilot sites from 2008–2013. Conclusion The Benin experience demonstrated that in countries where universal health coverage was not yet in place, establishment of a RDF may help maintain an uninterrupted supply of essential medicines.