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Ferguson L, Emoto S, Gruskin S. Laws governing access to sexual health services and information: contents, protections, and restrictions. Sex Reprod Health Matters 2024; 32:2336770. [PMID: 38647261 PMCID: PMC11036897 DOI: 10.1080/26410397.2024.2336770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Access to sexual health services and information is critical to achieving the highest attainable standard of sexual health, and enabling legal environments are key to advancing progress in this area. In determining overall alignment with human rights standards to respect, protect, and fulfil sexual health-related rights without discrimination, there are many aspects of laws, including their specificity and content, which impact which sexual health services and information are availed, which are restricted, and for whom. To understand the nature of existing legal provisions surrounding access to sexual health services and information, we analysed the content of 40 laws in English, French, and Spanish from 18 countries for the specific sexual health services and information to which access is ensured or prohibited, and the non-discrimination provisions within these laws. Overall, there was wide variation across countries in the types of laws covering these services and the types and number of services and information ensured. Some countries covered different services through multiple laws, and most of the laws dedicated specifically to sexual health addressed only a narrow aspect of sexual health and covered a small range of services. The protected characteristics in non-discrimination provisions and the specificity of these provisions with regard to sexual health services also varied. Findings may inform national legal and policy dialogues around sexual health to identify opportunities for positive change, as well as to guide further investigation to understand the relationship between such legal provisions, the implementation of these laws within countries, and relevant sexual health outcomes.
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Affiliation(s)
- Laura Ferguson
- Director of Research, Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
| | - Sarah Emoto
- Program Specialist, Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
| | - Sofia Gruskin
- Director, Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
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Brown A, Ferguson L, Castillo J, Nguyen HXT, Ervin C, Whishaw DM, Bower W. Determinants of Bladder Care at Night in a Subacute Ward for Aged Patients: An Observational Study. J Wound Ostomy Continence Nurs 2024; 51:146-151. [PMID: 38215216 DOI: 10.1097/won.0000000000001057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
PURPOSE The purpose of this study was to evaluate how bladder care at night correlates to patients' mobility status. DESIGN This was an observational study. SUBJECTS AND SETTING The sample comprises 63 aged care subacute patients who were observed over 3 consecutive nights in an inpatient subacute aged care ward located in Melbourne, Australia. Half of the participants were female; their mean age was 82.0 (standard deviation 8.2) years. Data were collected from December 2020 to March 2021. METHODS Outcome variables included demographic and pertinent clinical characteristics, type and timing of toileting and/or bladder care provided, and mobility classification. Descriptive statistics were used to summarize the frequency of nocturnal bladder care provided each night and as a mean over the 3 nights. The relationship between the type of care units provided and other variables was explored using a 1-way analysis of variance; values ≤.05 were deemed statistically significant. RESULTS Findings indicate that 27% (n = 17), 41% (n = 26), and 48% (n = 30) of participants required assistance to move in bed, sit up in bed, and stand from sitting, respectively. Care episodes for both incontinence and assistance with voiding were significantly associated with functional mobility in bed ( F = 5.52, P < .001; F = 2.14, P = .02) and with ambulation independence ( F = 3.52, P = .001; F = 2.04, P = .03) but not with age or ambulation distance. CONCLUSIONS Care provided for urinary incontinence during the night was related to the need for physical support of ambulation and poor mobility in bed. Targeted input from a multidisciplinary team is warranted to facilitate change of practice at night.
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Affiliation(s)
- Adelle Brown
- Adelle Brown, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Laura Ferguson, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Jasper Castillo, BSN, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Huong Xuan Thi Nguyen, FRACP, MBBS, BiomedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Memory Loss and Dementia Support Service, Merri Health, and Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Australia
- Claire Ervin, RN, MNurs (Urology), GradDipNurse (Comm Health), Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
- David Michael Whishaw, FRACP, MBBS, BMedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Wendy Bower, FACP, PhD, Grad Dip Epid & Biostat, BAppSc (Physio), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, and Department of Medicine and Aged Care, Royal Melbourne Hospital, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, and Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - Laura Ferguson
- Adelle Brown, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Laura Ferguson, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Jasper Castillo, BSN, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Huong Xuan Thi Nguyen, FRACP, MBBS, BiomedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Memory Loss and Dementia Support Service, Merri Health, and Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Australia
- Claire Ervin, RN, MNurs (Urology), GradDipNurse (Comm Health), Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
- David Michael Whishaw, FRACP, MBBS, BMedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Wendy Bower, FACP, PhD, Grad Dip Epid & Biostat, BAppSc (Physio), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, and Department of Medicine and Aged Care, Royal Melbourne Hospital, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, and Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - Jasper Castillo
- Adelle Brown, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Laura Ferguson, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Jasper Castillo, BSN, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Huong Xuan Thi Nguyen, FRACP, MBBS, BiomedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Memory Loss and Dementia Support Service, Merri Health, and Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Australia
- Claire Ervin, RN, MNurs (Urology), GradDipNurse (Comm Health), Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
- David Michael Whishaw, FRACP, MBBS, BMedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Wendy Bower, FACP, PhD, Grad Dip Epid & Biostat, BAppSc (Physio), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, and Department of Medicine and Aged Care, Royal Melbourne Hospital, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, and Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - Huong Xuan Thi Nguyen
- Adelle Brown, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Laura Ferguson, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Jasper Castillo, BSN, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Huong Xuan Thi Nguyen, FRACP, MBBS, BiomedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Memory Loss and Dementia Support Service, Merri Health, and Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Australia
- Claire Ervin, RN, MNurs (Urology), GradDipNurse (Comm Health), Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
- David Michael Whishaw, FRACP, MBBS, BMedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Wendy Bower, FACP, PhD, Grad Dip Epid & Biostat, BAppSc (Physio), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, and Department of Medicine and Aged Care, Royal Melbourne Hospital, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, and Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - Claire Ervin
- Adelle Brown, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Laura Ferguson, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Jasper Castillo, BSN, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Huong Xuan Thi Nguyen, FRACP, MBBS, BiomedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Memory Loss and Dementia Support Service, Merri Health, and Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Australia
- Claire Ervin, RN, MNurs (Urology), GradDipNurse (Comm Health), Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
- David Michael Whishaw, FRACP, MBBS, BMedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Wendy Bower, FACP, PhD, Grad Dip Epid & Biostat, BAppSc (Physio), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, and Department of Medicine and Aged Care, Royal Melbourne Hospital, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, and Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - David Michael Whishaw
- Adelle Brown, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Laura Ferguson, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Jasper Castillo, BSN, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Huong Xuan Thi Nguyen, FRACP, MBBS, BiomedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Memory Loss and Dementia Support Service, Merri Health, and Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Australia
- Claire Ervin, RN, MNurs (Urology), GradDipNurse (Comm Health), Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
- David Michael Whishaw, FRACP, MBBS, BMedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Wendy Bower, FACP, PhD, Grad Dip Epid & Biostat, BAppSc (Physio), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, and Department of Medicine and Aged Care, Royal Melbourne Hospital, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, and Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - Wendy Bower
- Adelle Brown, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Laura Ferguson, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Jasper Castillo, BSN, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Huong Xuan Thi Nguyen, FRACP, MBBS, BiomedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Memory Loss and Dementia Support Service, Merri Health, and Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Australia
- Claire Ervin, RN, MNurs (Urology), GradDipNurse (Comm Health), Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
- David Michael Whishaw, FRACP, MBBS, BMedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Wendy Bower, FACP, PhD, Grad Dip Epid & Biostat, BAppSc (Physio), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, and Department of Medicine and Aged Care, Royal Melbourne Hospital, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, and Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
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Ferguson L, Anderson ME, Liang M, Filmer-Wilson E. Why a good law is not always good enough: a global review of restrictions to supportive laws for sexual and reproductive health and rights. BMJ Glob Health 2024; 9:e014100. [PMID: 38365430 PMCID: PMC10875527 DOI: 10.1136/bmjgh-2023-014100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/01/2024] [Indexed: 02/18/2024] Open
Abstract
Laws and regulations provide the framework for implementing sexual and reproductive health and rights (SRHR)-related policies, programmes and services. They can promote the fulfilment of health and human rights; however, they may also limit the achievement of these goals. This study uses data collected under Sustainable Development Goal Indicator 5.6.2 to analyse SRHR-related laws and restrictions from 153 countries. Looking beyond the existence of supportive laws to assess the constellation of legal restrictions and contradictions such as criminalisation and plural legal systems provides a more nuanced understanding of factors involved in achieving full and equal access to SRHR.The interaction between restrictions and contradictions within the law disproportionately impacts some populations' health access and outcomes. Restrictions based on third-party authorisations and age are the most common restriction types, disproportionately impacting young women. Contraception, emergency contraception and abortion face the greatest number of restrictions, indicating a significant layering of barriers to family planning services. Further, plural legal systems commonly contradict guarantees of contraceptive services and emergency contraception. Our analyses suggest that one of the populations most affected by restrictions to SRH services as they appear in legal and regulatory frameworks is adolescent girls and young women in sub-Saharan Africa seeking abortion or contraceptive services.Study findings provide a critical starting point for advocacy to address legal barriers to SRH services and evidence for future policy and programming. For individual countries, this study can serve as a model for analysis of their own legal and regulatory frameworks to identify priority areas for reform efforts.
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Affiliation(s)
- Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
| | | | - Mengjia Liang
- United Nations Population Fund, New York, New York, USA
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Kuria-Ndiritu S, Karanja S, Mubita B, Kapsandui T, Kutna J, Anyona D, Murerwa J, Ferguson L. Impact of the COVID-19 pandemic and policy response on access to and utilization of reproductive, maternal, child and adolescent health services in Kenya, Uganda and Zambia. PLOS Glob Public Health 2024; 4:e0002740. [PMID: 38271454 PMCID: PMC10810520 DOI: 10.1371/journal.pgph.0002740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/29/2023] [Indexed: 01/27/2024]
Abstract
Global health crises can negatively impact access to and utilisation of essential health services. Access to and utilisation of reproductive health services were already challenged in Sub-Saharan Africa with the COVID-19 pandemic further complicating the critical situation. This cross-sectional qualitative study aimed to assess the impact of the COVID-19 pandemic and policy responses to it on the access to, and utilization of reproductive, maternal, child and adolescent health services in Kenya, Uganda, and Zambia. It sought to explore the perspectives of women of reproductive age (18-49), frontline health workers and government representatives, all from geographies that are under-researched in this context. Using purposive sampling, key informant and in-depth interviews were carried out with 63 participants across the three countries between November 2020 and February 2021. The study population included women of reproductive age (18-49 years), front-line health service providers, and government representatives We established that COVID-19 and the policy response to it affected access to and utilization of services in the three countries, the most affected being antenatal care, delivery, family planning, and immunization services. Women reported not accessing the health facilities for various reasons. Barriers to access and utilization of services cut across all the socioecological levels. Movement restrictions, particularly in Uganda where they were most severe, and fear of contracting COVID-19 at health facilities were the most reported barriers. Weak structures at community level and inadequate supply of commodities in health facilities exacerbated the situation. Mitigation factors were put in place at different levels. There is need to strengthen the health system, particularly the supply chain and to have services closer to the community to enhance access to and utilisation of services at all times and particularly during crises such as the Covid-19 pandemic.
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Affiliation(s)
| | | | | | | | - John Kutna
- Amref Health Africa in Kenya, Nairobi, Kenya
| | - Dona Anyona
- Amref Health Africa, Headquarters, Nairobi, Kenya
| | | | - Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, United States of America
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Ferguson L, Anderson ME, Satchi K, Capron AM, Kaplan CD, Redfield P, Gruskin S. The ubiquity of 'self-care' in health: Why specificity matters. Glob Public Health 2024; 19:2296970. [PMID: 38214311 DOI: 10.1080/17441692.2023.2296970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 12/14/2023] [Indexed: 01/13/2024]
Abstract
Despite increased interest in self-care for health, little consensus exists around its definition and scope. The World Health Organization has published several definitions of self-care, including in a 2019 Global Guideline rooted in sexual and reproductive health and rights (SRHR), later expanded to encompass health more generally. To establish a robust understanding of self-care, this exploratory study inventorises, consolidates, presents and analyses definitions of self-care beyond the SRHR field. A pragmatic review identified definitions and conceptualisations of self-care from peer-reviewed and grey literature published between 2009 and 2021. The search identified 91 definitions of self-care from 116 relevant publications. Data extraction informed analysis to identify recurring themes and approaches, revealing three key areas of variation: self-care being: (1) defined directly or descriptively; (2) situated within individual, interpersonal or structural contexts; (3) defined broadly or topic-specifically. A multilevel conceptualisation can guide a more broadly applicable understanding of self-care: first, as an aspect of healthcare; second, as a concept operating at individual, interpersonal and institutional levels; third, as a concept that impacts specific health fields and contexts differently. A comprehensive but adaptable framework works in service of improving health and wellbeing for all, acknowledging the linkages between self-care and health-related human rights.
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Affiliation(s)
- Laura Ferguson
- Institute on Inequalities in Global Health, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michelle E Anderson
- Institute on Inequalities in Global Health, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Krishni Satchi
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alexander M Capron
- Gould School of Law, University of Southern California, Los Angeles, CA, USA
| | - Charles D Kaplan
- Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Peter Redfield
- Department of Anthropology, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA, USA
| | - Sofia Gruskin
- Institute on Inequalities in Global Health, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Smyth P, Ferguson L, Burrows JF, Burden RE, Tracey SR, Herron ÚM, Kovaleva M, Williams R, Porter AJ, Longley DB, Barelle CJ, Scott CJ. Evaluation of variable new antigen receptors (vNARs) as a novel cathepsin S (CTSS) targeting strategy. Front Pharmacol 2023; 14:1296567. [PMID: 38116078 PMCID: PMC10728302 DOI: 10.3389/fphar.2023.1296567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/16/2023] [Indexed: 12/21/2023] Open
Abstract
Aberrant activity of the cysteine protease Cathepsin S (CTSS) has been implicated across a wide range of pathologies. Notably in cancer, CTSS has been shown to promote tumour progression, primarily through facilitating invasion and migration of tumour cells and augmenting angiogenesis. Whilst an attractive therapeutic target, more efficacious CTSS inhibitors are required. Here, we investigated the potential application of Variable New Antigen Receptors (vNARs) as a novel inhibitory strategy. A panel of potential vNAR binders were identified following a phage display panning process against human recombinant proCTSS. These were subsequently expressed, purified and binding affinity confirmed by ELISA and SPR based approaches. Selected lead clones were taken forward and were shown to inhibit CTSS activity in recombinant enzyme activity assays. Further assessment demonstrated that our lead clones functioned by a novel inhibitory mechanism, by preventing the activation of proCTSS to the mature enzyme. Moreover, using an intrabody approach, we exhibited the ability to express these clones intracellularly and inhibit CTSS activity whilst lead clones were also noted to impede cell invasion in a tumour cell invasion assay. Collectively, these findings illustrate a novel mechanistic approach for inhibiting CTSS activity, with anti-CTSS vNAR clones possessing therapeutic potential in combating deleterious CTSS activity. Furthermore, this study exemplifies the potential of vNARs in targeting intracellular proteins, opening a range of previously "undruggable" targets for biologic-based therapy.
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Affiliation(s)
- P. Smyth
- Patrick G. Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast, United Kingdom
| | | | - J. F. Burrows
- School of Pharmacy, Queen’s University Belfast, Belfast, United Kingdom
| | - R. E. Burden
- School of Pharmacy, Queen’s University Belfast, Belfast, United Kingdom
| | - S. R. Tracey
- Patrick G. Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast, United Kingdom
| | - Ú. M. Herron
- Patrick G. Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast, United Kingdom
| | | | - R. Williams
- Patrick G. Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast, United Kingdom
| | - A. J. Porter
- Elasmogen Ltd., Aberdeen, United Kingdom
- Scottish Biologics Facility, Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - D. B. Longley
- Patrick G. Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast, United Kingdom
| | | | - C. J. Scott
- Patrick G. Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast, United Kingdom
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Zucchi EM, Ferguson L, Magno L, Dourado I, Greco D, Ferraz D, Tupinambas U, Grangeiro A. When Ethics and the Law Collide: A Multicenter Demonstration Cohort Study of Pre-Exposure Prophylaxis Provision to Adolescent Men Who Have Sex With Men and Transgender Women in Brazil. J Adolesc Health 2023; 73:S11-S18. [PMID: 37953003 DOI: 10.1016/j.jadohealth.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 06/16/2023] [Accepted: 08/04/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE To explore legal and ethical challenges related to adolescents' participation in human immunodeficiency virus (HIV) research that may affect their best interests. METHODS We analyzed the ethical principles and legal aspects of the participation of 15-17-year-old men who have sex with men and transgender women in the pre-exposure prophylaxis (PrEP) 1519 study, a PrEP demonstration cohort study in three Brazilian cities. The analyses of ethics review committees' (ERCs) evaluations and court decisions followed ethical and human rights principles. An HIV vulnerability score was created, and descriptive statistics and multivariate logistic regression were performed using data from 347 participants. RESULTS The ERCs evaluated the benefits and risks of research participation, all finding that the benefits outweighed the risks. ERCs deferred responsibility for decisions about waiving parental consent to the judiciary. State courts reached different decisions about waiving parental consent, reflecting variation in recognition of adolescents' evolving capacities and the adolescent as a subject of sexual rights and the primary agent capable of deciding on their health and best interests. The most vulnerable adolescent participants were found in sites where the blanket waiver was in place. DISCUSSION Judicializing the ethical review process is detrimental to fulfilling the ethical principle of justice and vulnerable adolescents' access to health research. ERCs must be sufficiently independent and autonomous and have the capacity to respect, protect, and help fulfill the rights of participants while ensuring the generation of adequate evidence to inform public health practice.
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Affiliation(s)
- Eliana Miura Zucchi
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Católica de Santos, Santos, São Paulo, Brazil.
| | - Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California
| | - Laio Magno
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Bahia, Brazil
| | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Dirceu Greco
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Dulce Ferraz
- Fundação Oswaldo Cruz (Fiocruz), Diretoria Regional de Brasília, Brasília, Brazil; UMR Inserm 1296 - Radiations: Défense Santé Environnement, Université Lumière Lyon 2, Lyon, France
| | - Unai Tupinambas
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Alexandre Grangeiro
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
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Ferguson L, Gruskin S, Bolshakova M, Rozelle M, Yagyu S, Kasoka K, Oraro-Lawrence T, Motala A, Stackpool-Moore L, Hempel S. Systematic review and quantitative and qualitative comparative analysis of interventions to address HIV-related stigma and discrimination. AIDS 2023; 37:1919-1939. [PMID: 37352492 PMCID: PMC10552822 DOI: 10.1097/qad.0000000000003628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 06/03/2023] [Accepted: 06/09/2023] [Indexed: 06/25/2023]
Abstract
A strong global commitment exists to eliminate HIV-related stigma and discrimination, and multiple strategies to reduce or eliminate stigma and discrimination have been tried. Using a PICOTS framework and applying the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria, we undertook a systematic review to determine the success of interventions aiming to address internalized stigma, stigma and discrimination in healthcare, and at the legal or policy level, and to identify their critical success factors. Random effects meta-analyses summarized results wherever possible. We carried out a component analysis to identify and characterize successful interventions. Internalized stigma interventions were diverse: across all studies, we found a reduction of stigma but it was not statistically significant [standardized mean difference (SMD) 0.56; confidence interval (CI) 0.31-1.02; 17 studies). For interventions to address stigma and discrimination in healthcare settings, effect estimates varied considerably but most studies showed positive effects (SMD 0.71; CI 0.60-0.84, 8 studies). Boosted regression analyses found that a combined approach comprising education, counseling, community participation, support person, and access to a HIV specialist often yielded success. Studies of efforts to address stigma and discrimination through law and policy documented, mostly qualitatively, the effect of court cases and directives. Across a range of settings and populations, promising interventions have been identified that, through diverse pathways, have positively impacted the types of stigma and discrimination studied. This evidence base must be built upon and brought to scale to help reach global HIV-related targets and, most importantly, improve the health and quality of life of people with HIV.
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Affiliation(s)
- Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California
| | - Sofia Gruskin
- Institute on Inequalities in Global Health, University of Southern California
| | - Maria Bolshakova
- Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Mary Rozelle
- Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Sachi Yagyu
- Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | | | | | - Aneesa Motala
- Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | | | - Susanne Hempel
- Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
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Gizamba JM, Wilson JP, Mendenhall E, Ferguson L. A review of place-related contextual factors in syndemics research. Health Place 2023; 83:103084. [PMID: 37437495 DOI: 10.1016/j.healthplace.2023.103084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/16/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023]
Abstract
This review investigates the extent to which a place-based approach has been used to conceptualize context, as well as the place-related contextual factors explored in studies that explicitly invoked a syndemic framework. The literature search focused on 29 peer-reviewed empirical syndemic studies. Only 11 studies used a place-based approach to define and measure contextual factors and the spatial context was denoted using administrative boundaries such as census tracts, counties, and countries. A narrow range of place-related contextual factors were explored and most of them were related to social and economic factors that were used to define a place. Methodological gaps like a paucity of multilevel studies and studies using a place-based approach to measure context were identified. Future syndemics research should leverage multidimensional geospatial approaches to decipher the role of place-related contextual factors in syndemic dynamics.
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Affiliation(s)
| | - John P Wilson
- Spatial Science Institute, University of Southern California, Los Angeles, USA
| | - Emily Mendenhall
- School of Foreign Service, Georgetown University, Washington, DC, USA
| | - Laura Ferguson
- Institute on Inequalities in Global Health, Keck School of Medicine, University of Southern California, Los Angeles, USA
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10
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Everhart AR, Ferguson L, Wilson JP. Measuring Geographic Access to Transgender Hormone Therapy in Texas: A Three-step Floating Catchment Area Analysis. Spat Spatiotemporal Epidemiol 2023; 45:100585. [PMID: 37301600 DOI: 10.1016/j.sste.2023.100585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/31/2022] [Accepted: 04/07/2023] [Indexed: 06/12/2023]
Abstract
While the extant literature has established that transgender people face significant barriers to accessing healthcare, no studies to date have offered an explicitly spatial analysis of their access to trans-specific care. This study aims to fill that gap by providing a spatial analysis of access to gender-affirming hormone therapy (GAHT) using Texas as a case study. We used the three-step floating catchment area method, which relies on census tract-level population data and location data for healthcare facilities to quantify spatial access to healthcare within a specific drive-time window, in our case 120 min. For our tract-level population estimates we adapt estimates of the rates of transgender identification from a recent data source, the Household Pulse Survey, and use these in tandem with a spatial database of GAHT providers of the lead author's creation. We then compare results of the 3SFCA with data on urbanicity and rurality, as well as which areas are deemed medically underserved. Finally, we conduct a hot-spot analysis that identifies specific areas where health services could be planned in ways that could improve both access to GAHT for trans people and access to primary care for the general population. Ultimately, we conclude that our results illustrate that patterns of access to trans-specific medical care, like GAHT, do not neatly follow patterns of access to primary care for the general population and that therefore trans communities' access to healthcare warrants specific, further investigation.
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Affiliation(s)
- Avery R Everhart
- Center for Applied Transgender Studies, Chicago, IL, USA; School of Information, University of Michigan, Ann Arbor, MI, USA; Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - Laura Ferguson
- Keck School of Medicine, Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
| | - John P Wilson
- Dana & David Dornsife College of Letters, Arts and Sciences, Spatial Sciences Institute, University of Southern California, Los Angeles, CA, USA
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11
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Leach A, Finnegan M, Machado MS, Ferguson L, Steven J, Smyth P, Porter A, Barelle C, Themistou E, Scott CJ. Functionalization of polymeric nanoparticles with targeting VNAR ligands using vinyl sulfone conjugation. J Mater Chem B 2023; 11:4181-4190. [PMID: 37092346 DOI: 10.1039/d2tb01985j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Actively targeted drug loaded nanoparticles represent an exciting new form of therapeutics for cancer and other diseases. These formulations are complex and in order to realize their ultimate potential, optimization of their preparation is required. In this current study, we have examined the conjugation of a model targeting ligand, conjugated in a site-specific manner using a vinyl sulfone coupling approach. A disulfide-functionalized poly(L-lactide)-b-poly(oligo(ethylene glycol) methacrylate)-stat-(bis(2-methacryloyl)oxyethyl disulfide) (PLA-b-P(OEGMA-stat-DSDMA)) diblock copolymer was synthesized by simultaneous ring opening polymerization (ROP) and reversible addition-fragmentation chain transfer (RAFT) polymerization. Subsequently, the disulfide bonds of the polymer were reduced to thiols and divinyl sulfone was attached to the polymer using thiol-ene chemistry to produce the vinyl sulfone (VS)-functionalized PLA-b-P(OEGMA-stat-VSTEMA) amphiphilic block copolymer. Single emulsion - solvent evaporation was employed using a blend of this polymer with poly(D,L-lactide-co-glycolide) (PLGA) to produce VS-functionalized polymeric nanoparticles. The ability of these novel nanoparticles to attach ligands was then exemplified using a single domain variable new antigen receptor (VNAR) with a free carboxyl terminal cysteine residue. The resulting VNAR-functionalized nanoparticles were found to maintain specific affinity to their cognate antigen (DLL4) for at least 72 h at 4 °C. The simplicity of the degradable amphiphilic block copolymer synthesis and the efficiency of VNAR conjugation to the VS-functionalized nanoparticles show the potential of this platform for therapeutic development.
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Affiliation(s)
- Adam Leach
- The Patrick G. Johnston Centre for Cancer Research, School of Medicine, Queen's University Belfast, Belfast, UK.
| | - Marie Finnegan
- School of Chemistry and Chemical Engineering, Queen's University Belfast, Belfast, UK.
| | - Mariana S Machado
- School of Chemistry and Chemical Engineering, Queen's University Belfast, Belfast, UK.
| | | | | | - Peter Smyth
- The Patrick G. Johnston Centre for Cancer Research, School of Medicine, Queen's University Belfast, Belfast, UK.
| | - Andrew Porter
- Elasmogen Ltd, Aberdeen, UK
- The Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Efrosyni Themistou
- School of Chemistry and Chemical Engineering, Queen's University Belfast, Belfast, UK.
| | - Christopher J Scott
- The Patrick G. Johnston Centre for Cancer Research, School of Medicine, Queen's University Belfast, Belfast, UK.
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12
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Ferguson L. Health Justice in the Context of Health and Human Rights. Am J Public Health 2023; 113:182-184. [PMID: 36652651 PMCID: PMC9850618 DOI: 10.2105/ajph.2022.307184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Laura Ferguson
- Laura Ferguson is with the Institute on Inequalities in Global Health, University of Southern California, Los Angeles
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13
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Ferraz D, Rossi TA, Zucchi EM, de Deus LFA, Mabire X, Ferguson L, Magno L, Grangeiro A, Préau M, Botelho FC, Rodrigues A, Steele S, Dourado I. "I Can't Take This Shitty Quarantine Anymore": Sexual Behavior and PrEP Use Among Young Men Who Have Sex with Men and Transgender Women in Brazil During the COVID-19 Pandemic. Arch Sex Behav 2023; 52:689-702. [PMID: 35881251 PMCID: PMC9321283 DOI: 10.1007/s10508-022-02364-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
This study analyzes how the COVID-19 pandemic affected sexual behavior and use of HIV prevention methods among young transgender women (YTGW) and young gay, bisexual and other men who have sex with men (YGBMSM) participating in an HIV pre-exposure prophylaxis (PrEP) demonstration study in Brazil. Online interviews with 39 participants aged 15-22 years old were conducted between September and November 2020 and analyzed based on social constructionism and human rights-based approaches to health. The pandemic disrupted interviewees' routines, negatively affecting their life conditions. Among those who did not have a steady partner, social distance measures led to temporary interruption of sexual encounters and increased sexting and solo sex. Conversely, for those who had a steady relationship such measures contributed to increasing sexual practices and intimacy. Participants who had sexual encounters during the pandemic reported having continued to use PrEP. However, home confinement with family, lack of privacy, loss of daily routines and changes in housing impaired PrEP adherence and attendance at follow-up consultations. These results highlight the importance of maintaining HIV-service delivery for these groups during a public health crisis, as well as to address the structural drivers of the epidemic with comprehensive HIV prevention policies and by ensuring access of YGBMSM and YTGW to social protection policies.
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Affiliation(s)
- Dulce Ferraz
- UMR 1296 "Radiations: Défense, Santé, Environnement", Université Lyon 2, Lyon, France.
- Institut de Psychologie, Université de Lausanne, Lausanne, Switzerland.
- Escola FIOCRUZ de Governo, Fundação Oswaldo Cruz (FIOCRUZ), Brasília, Brazil.
| | - Thais Aranha Rossi
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, Brazil
| | - Eliana Miura Zucchi
- Programa de Pós-Graduação em Saúde Coletiva, Mestrado Profissional em Psicologia e Políticas Públicas, Universidade Católica de Santos (UniSantos), Santos, Brazil
| | - Luiz Fabio Alves de Deus
- Programa de Pós-Graduação em Psicologia Social e Institucional, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Xavier Mabire
- UMR 1296 "Radiations: Défense, Santé, Environnement", Université Lyon 2, Lyon, France
- Institut de Psychologie, Université de Lausanne, Lausanne, Switzerland
| | - Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
| | - Laio Magno
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, Brazil
| | - Alexandre Grangeiro
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marie Préau
- UMR 1296 "Radiations: Défense, Santé, Environnement", Université Lyon 2, Lyon, France
| | - Fernanda Cangussu Botelho
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ayra Rodrigues
- Programa de Pós-Graduação em Saúde Coletiva, Mestrado Profissional em Psicologia e Políticas Públicas, Universidade Católica de Santos (UniSantos), Santos, Brazil
| | - Sabrina Steele
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, Brazil
| | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA), Salvador, Brazil
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Katwan E, Bisoborwa G, Butron-Riveros B, Bychkov S, Dadji K, Fedkina N, Jayathilaka CA, Kumar D, Li Z, Mehta R, Raina N, Siddeeg K, Ferguson L, Handlos LN, Sheffel A, Kiarie J, Festin MR, Diaz T. Creating a Global Legal and Policy Database and Document Repository: Challenges and Lessons Learned From the World Health Organization Sexual, Reproductive, Maternal, Newborn, Child and Adolescent Health Policy Survey. Int J Health Policy Manag 2022; 11:2415-2421. [PMID: 34861763 PMCID: PMC9818120 DOI: 10.34172/ijhpm.2021.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 11/03/2021] [Indexed: 01/21/2023] Open
Abstract
The World Health Organization (WHO) has collected information on policies on sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH) over many years. Creating a global survey that works for every country context is a well-recognized challenge. A comprehensive SRMNCAH policy survey was conducted by WHO from August 2018 through May 2019. WHO regional and country offices coordinated with Ministries of Health and/or national institutions who completed the questionnaire. The survey was completed by 150 of 194 WHO Member States using an online platform that allowed for submission of national source documents. A validation of the responses for selected survey questions against content of the national source documents was conducted for 101 countries (67%) for the first time in the administration of the survey. Data validation draws attention to survey questions that may have been misunderstood or where there was a lot of missing data, but varying methods for validating survey responses against source documents and separate analysis of laws from policies and guidelines may have hindered the overall conclusions of this process. The SRMNCAH policy survey both provided a platform for countries to track their progress in adopting WHO recommendations in national SRMNCAH-related legislation, policies, guidelines and strategies and was used to create a global database and searchable document repository. The outputs of the SRMNCAH policy survey are resources whose importance will be enriched through policy dialogues and wide utilization. Lessons learned from the methodology used for this survey can help to improve future updates and inform similar efforts.
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Affiliation(s)
- Elizabeth Katwan
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization (WHO), Geneva, Switzerland
| | - Geoffrey Bisoborwa
- Universal Health Coverage - Life Course, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Betzabe Butron-Riveros
- Department of Family, Health Promotion and Life Course, Pan American Health Organization, Washington, DC, USA
| | - Sergei Bychkov
- WHO European Office for Prevention and Control of Noncommunicable Diseases, WHO Regional Office for Europe, Moscow, Russia
| | - Kwami Dadji
- WHO Country Office for the Democratic Republic of the Congo, Kinshasa, Democratic Republic of the Congo
| | - Natalia Fedkina
- WHO European Office for Prevention and Control of Noncommunicable Diseases, WHO Regional Office for Europe, Moscow, Russia
| | - C. Anoma Jayathilaka
- Department of Reproductive, Maternal, Newborn, Child, Adolescent Health and Ageing, WHO Regional Office for South-East Asia, New Delhi, India
| | - Dhiraj Kumar
- Department of Reproductive, Maternal, Newborn, Child, Adolescent Health and Ageing, WHO Regional Office for South-East Asia, New Delhi, India
| | - Zhao Li
- Division of Health Systems and Services, WHO Regional Office for the Western Pacific, Manila, Philippines
| | - Rajesh Mehta
- Department of Reproductive, Maternal, Newborn, Child, Adolescent Health and Ageing, WHO Regional Office for South-East Asia, New Delhi, India
| | - Neena Raina
- Department of Reproductive, Maternal, Newborn, Child, Adolescent Health and Ageing, WHO Regional Office for South-East Asia, New Delhi, India
| | - Khalid Siddeeg
- Department of Healthier Population, WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Laura Ferguson
- Institute on Inequalities in Global Health, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Ashley Sheffel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - James Kiarie
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Mario R. Festin
- Department of Obstetrics and Gynecology, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Theresa Diaz
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization (WHO), Geneva, Switzerland
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Ferguson L, Jardell W, Gruskin S. Leaving No One Behind: Human Rights and Gender as Critical Frameworks for U=U. Health Hum Rights 2022; 24:1-11. [PMID: 36579322 PMCID: PMC9790944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Experience has shown the need to explicitly address human rights and gender-related barriers in the rollout of HIV-related biomedical innovations, including "undetectable equals untransmittable" (U=U). This paper brings to light rights and gender considerations relevant to supporting U=U, recognizing a range of barriers that remain to be addressed for all people to benefit equally from U=U. We conducted a literature review to ascertain how human rights and gender were addressed in relevant publications, including peer-reviewed articles published between 2006 and 2020, relevant nongovernmental and global organizations' publications, and abstracts presented at the 2019 International AIDS Conference, that explicitly addressed U=U or "treatment as prevention." Despite evidence to illustrate the importance of attention to human rights and gender within U=U policies and interventions, there remains a lack of explicit attention to human rights and gender considerations in research and programming, particularly with regard to the rights principles of participation and accountability. Explicitly engaging all of these dimensions is key to informing interventions and improving people's lives, health, and well-being.
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Affiliation(s)
- Laura Ferguson
- The research director at the USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, United States.,Please address correspondence Laura Ferguson. .
| | - William Jardell
- A program specialist in the USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, United States
| | - Sofia Gruskin
- The director of the USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, United States
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Ferguson L, Gruskin S, Bolshakova M, Yagyu S, Fu N, Cabrera N, Rozelle M, Kasoka K, Oraro-Lawrence T, Stackpool-Moore L, Motala A, Hempel S. Frameworks and measures for HIV-related internalized stigma, stigma and discrimination in healthcare and in laws and policies: a systematic review. J Int AIDS Soc 2022; 25 Suppl 1:e25915. [PMID: 35818866 PMCID: PMC9274352 DOI: 10.1002/jia2.25915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 04/28/2022] [Indexed: 12/21/2022] Open
Abstract
Introduction There is strong global commitment to eliminate HIV‐related stigma, and work in this area continues to evolve. Wide variation exists in frameworks and measures used. Methods Building on the existing knowledge syntheses, we carried out a systematic review to identify frameworks and measures aiming to understand or assess internalized stigma, stigma and discrimination in healthcare, and in law and policy. The review addressed two questions: Which conceptual frameworks have been proposed to assess internalized stigma, stigma and discrimination experienced in healthcare settings, and stigma and discrimination entrenched in national laws and policies? Which measures of these different types of stigma and discrimination have been proposed and what are their descriptive properties? Searches, completed on 6 May 2021, cover publications from 2008 onwards. The review is registered in PROSPERO (CRD42021249348), the protocol incorporated stakeholder input, and the data are available in the Systematic Review Data Repository. Results and discussion Sixty‐nine frameworks and 50 measures met the inclusion criteria. Critical appraisal figures and detailed evidence tables summarize these resources. We established a compendium of frameworks and a catalogue of measures of HIV‐related stigma and discrimination. Seventeen frameworks and 10 measures addressed at least two of our focus domains, with least attention to stigma and discrimination in law and policy. The lack of common definitions and variability in scope and structure of HIV‐related frameworks and measures creates challenges in understanding what is being addressed and measured, both in relation to stigma and efforts to mitigate or reduce its harmful effects. Having comparable data is essential for tracking change over time within and between interventions. Conclusions This systematic review provides an evidence base of current understandings of HIV‐related stigma and discrimination and how further conceptual clarification and increased adaptation of existing tools might help overcome challenges across the HIV care continuum. With people living with HIV at the centre, experts from different stakeholder groups could usefully collaborate to guide a more streamlined approach for the field. This can help to achieve global targets and understand, measure and help mitigate the impact of different types of HIV‐related stigma on people's health and quality of life.
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Affiliation(s)
- Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
| | - Sofia Gruskin
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
| | - Maria Bolshakova
- Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Sachi Yagyu
- Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Ning Fu
- School of Economics, Shanghai University of Finance and Economics, Shanghai, China
| | - Nicky Cabrera
- Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Mary Rozelle
- Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | | | | | | | - Aneesa Motala
- Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Susanne Hempel
- Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
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Everhart AR, Ferguson L, Wilson JP. Construction and validation of a spatial database of providers of transgender hormone therapy in the US. Soc Sci Med 2022; 303:115014. [PMID: 35594740 DOI: 10.1016/j.socscimed.2022.115014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 04/04/2022] [Accepted: 05/04/2022] [Indexed: 11/26/2022]
Abstract
What little data on transgender healthcare is available often focuses on transgender people's negative experiences in accessing healthcare. However, no research has been conducted that illustrates where gender-affirming hormone therapy, one part of transgender-specific medical care, is available. Without these data, large scale research to discern patterns of availability of and access to gender-affirming medical care is nearly impossible. Community-based organizations, and even trans individuals themselves have constructed repositories and databases of healthcare providers to inform other care seekers where they can access transition-related care providers, but their data are often incomplete, and usually formatted to be user-facing rather than streamlined for research purposes. To fill this gap, this article outlines the methodology for the construction of a spatial database of providers of gender-affirming hormone therapy for transgender people in the US, which is available on GitHub, created from existing community-based resources and the accompanying verification process. The completeness of the database is tested via comparison to data from the US Transgender Survey in which respondents reported travel distance to access transgender-specific care providers. The database accounted for all but 7.5% of respondents who may have accessed unknown facilities based on self-reported travel distance. Results indicate that existing methodologies for database construction regarding healthcare providers are difficult to apply when working with transgender-specific medical care and that tests for replicability and validation often take for granted the wide availability of relevant data and information. While the database unto itself can only demonstrate where care is available, it will enable future research into why these geographic patterns in care availability exist. Finally, the methodology can be replicated to produce databases for other kinds of specialized or politicized medical care such as abortion, gender-affirming surgery, or HIV treatment.
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Affiliation(s)
- Avery R Everhart
- University of Southern California, Dornsife College of Letters, Arts, and Sciences, Spatial Sciences Institute, 3616 Trousdale Parkway, AHF B55, Los Angeles, CA, 90089, USA; Center for Applied Transgender Studies, Chicago, IL, USA.
| | - Laura Ferguson
- University of Southern California, Keck School of Medicine, Institute on Inequalities in Global Health, 2001 N Soto St, Los Angeles, CA, 90032, USA.
| | - John P Wilson
- University of Southern California, Dornsife College of Letters, Arts, and Sciences, Spatial Sciences Institute, 3616 Trousdale Parkway, AHF B55, Los Angeles, CA, 90089, USA.
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Ferguson L, Jardell W, Lambert-Peck M, Guo L, Lopez S, Canaves V, Filmer-Wilson E. Mind the Gap: Understanding Differences Between Sexual and Reproductive Health-Related Legal Frameworks on Paper and in Practice. Front Glob Womens Health 2022; 3:838976. [PMID: 35602852 PMCID: PMC9120771 DOI: 10.3389/fgwh.2022.838976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 04/14/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction UNFPA recently developed a composite indicator to assess sexual and reproductive health (SRH)-related laws as part of the Sustainable Development Goals monitoring framework (Indicator 5.6.2). However, there is still little understanding of how best to ensure a supportive SRH-related legal framework can improve SRH outcomes. This research draws on country case studies (Colombia, Malawi, Uruguay, Zambia) to provide more generalizable lessons on the processes by which these laws are translated into practice and their impact on lived realities. Methods Peer-reviewed and gray literature on laws and policies related to maternity care, contraception, sexuality education, HIV and HPV was reviewed. Key informant interviews were carried out with 8–16 people in each country, including representatives of government, civil society and academia to understand factors affecting implementation of relevant laws and policies. Findings were thematically analyzed by country and contextualized within each country's score on Indicator 5.6.2 and relevant SRH outcome data. Findings Across these countries, some common organizational steps help move from laws on paper to impacting people's lives including budget allocation, development of technical guidance, health worker training, population awareness creation and demand generation. It is also important to address sociocultural challenges such as entrenched inequalities, conservative cultural and religious beliefs and the potential existence of customary law. Challenges can be encountered across all these steps and can vary based on the area of SRH: implementation of laws to reduce maternal mortality is generally less controversial than laws around abortion, often making the latter harder to implement. Local specificities in structures, systems and cultures bring opportunities and challenges, highlighting the need for tailored actions. Discussion A legal framework supportive to SRH is critical, particularly in the face of backlash against sexual and reproductive rights, but alone it is insufficient. Understanding that a generic pathway exists for moving laws into practice is a critical starting point for exploring the specificities of each national context as a way of identifying entry points for action. These findings can be used to inform advocacy and monitoring to help ensure that the potential benefits of supportive SRH-related laws can be realized in these four countries and around the world.
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Affiliation(s)
- Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, United States
- *Correspondence: Laura Ferguson
| | - William Jardell
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, United States
| | - Miles Lambert-Peck
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, United States
| | - Lillie Guo
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, United States
| | - Sophia Lopez
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, United States
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Stackpool-Moore L, Nkosi S, Kasune Zulu P, Presley J, Ferguson L. Addressing stigma and discrimination at scale: uniting for a common vision while acknowledging local realities. J Int AIDS Soc 2022; 25:e25893. [PMID: 35229482 PMCID: PMC8886176 DOI: 10.1002/jia2.25893] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/10/2022] [Indexed: 12/21/2022] Open
Affiliation(s)
| | | | | | - Josie Presley
- Global Health Division-HIV, Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | - Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
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Stangl AL, Pliakas T, Izazola-Licea JA, Ayala G, Beattie TS, Ferguson L, Orza L, Mathur S, Pulerwitz J, Iovita A, Bendaud V. Removing the societal and legal impediments to the HIV response: An evidence-based framework for 2025 and beyond. PLoS One 2022; 17:e0264249. [PMID: 35192663 PMCID: PMC8863250 DOI: 10.1371/journal.pone.0264249] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/07/2022] [Indexed: 02/04/2023] Open
Abstract
Societal and legal impediments inhibit quality HIV prevention, care, treatment and support services and need to be removed. The political declaration adopted by UN member countries at the high-level meeting on HIV and AIDS in June 2021, included new societal enabler global targets for achievement by 2025 that will address this gap. Our paper describes how and why UNAIDS arrived at the societal enabler targets adopted. We conducted a scoping review and led a participatory process between January 2019 and June 2020 to develop an evidence-based framework for action, propose global societal enabler targets, and identify indicators for monitoring progress. A re-envisioned framework called the '3 S's of the HIV response: Society, Systems and Services' was defined. In the framework, societal enablers enhance the effectiveness of HIV programmes by removing impediments to service availability, access and uptake at the societal level, while service and system enablers improve efficiencies in and expand the reach of HIV services and systems. Investments in societal enabling approaches that remove legal barriers, shift harmful social and gender norms, reduce inequalities and improve institutional and community structures are needed to progressively realize four overarching societal enablers, the first three of which fall within the purview of the HIV sector: (i) societies with supportive legal environments and access to justice, (ii) gender equal societies, (iii) societies free from stigma and discrimination, and (iv) co-action across development sectors to reduce exclusion and poverty. Three top-line and 15 detailed targets were recommended for monitoring progress towards their achievement. The clear articulation of societal enablers in the re-envisioned framework should have a substantial impact on improving the effectiveness of core HIV programmes if implemented. Together with the new global targets, the framework will also galvanize advocacy to scale up societal enabling approaches with proven impact on HIV outcomes.
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Affiliation(s)
- Anne L. Stangl
- Hera Solutions, Baltimore, MD, United States of America
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Triantafyllos Pliakas
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Impact Epilysis, Thessaloniki, Greece
| | | | - George Ayala
- Alameda County Public Health Department, Oakland, CA, United States of America
- MPact Global Action for Gay Men’s Health and Rights, Oakland, CA, United States of America
| | - Tara S. Beattie
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, United States of America
| | - Luisa Orza
- Frontline AIDS, Brighton, United Kingdom
| | - Sanyukta Mathur
- Population Council, Washington, DC, United States of America
| | - Julie Pulerwitz
- Population Council, Washington, DC, United States of America
| | | | - Victoria Bendaud
- Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland
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Abstract
INTRODUCTION Novel mechanisms of service delivery are needed to expand access to pre-exposure prophylaxis (PrEP) for HIV prevention. Providing PrEP directly through pharmacies could offer an additional option for reaching potential users. METHODS We conducted a systematic review of studies examining effectiveness, values and preferences of end users and health workers, and cost of PrEP initiation and continuation through pharmacies (pharmacy access). We searched PubMed, CINAHL, LILACS and EMBASE through 2 December 2020. We also searched clinical trial registries and recent HIV conference abstracts. Standardised methods were used to search, screen and extract data from included studies. RESULTS No studies met the inclusion criteria for the effectiveness review, for either PrEP initiation or continuation. However, six 'case studies' presenting non-comparative data from PrEP pharmacy programmes demonstrated feasibility of this model in the USA. Eleven studies reported values and preferences of end users and health workers. In the USA, Kenya and South Africa, potential PrEP clients generally supported pharmacy access, although some preferred clinics. One study of PrEP pharmacy clients found all would 'definitely recommend' the programme. Six studies found pharmacists were generally supportive of offering PrEP; one study including doctors found more limited favour, while one study of diverse Kenyan stakeholders found broad support. Three studies reported cost data indicating client willingness to pay in the USA and Kenya and initial sustainability of a clinic financial model in the USA. CONCLUSION Provision of PrEP through pharmacies has been demonstrated to be feasible in the USA and acceptable to potential end users and stakeholders in multiple settings. Limited evidence on effectiveness and requirements for laboratory testing and assurance of high-quality services may limit enthusiasm for this approach. Further research is needed to determine if pharmacy access is a safe and effective way to help achieve global HIV prevention goals. PROSPERO REGISTRATION NUMBER CRD42021231650.
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Affiliation(s)
- Caitlin E Kennedy
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ping Teresa Yeh
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kaitlyn Atkins
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Laura Ferguson
- Keck School of Medicine, Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
| | - Rachel Baggaley
- Department of HIV, Viral Hepatitis, and STIs, World Health Organization, Geneva, Switzerland
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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22
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Logie CH, Berry I, Ferguson L, Malama K, Donkers H, Narasimhan M. Uptake and provision of self-care interventions for sexual and reproductive health: findings from a global values and preferences survey. Sex Reprod Health Matters 2022; 29:2009104. [PMID: 35100942 PMCID: PMC8812803 DOI: 10.1080/26410397.2021.2009104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Self-care interventions hold the potential to improve sexual and reproductive health (SRH) and well-being. Yet key knowledge gaps remain regarding how knowledge and uptake vary across different types of self-care interventions. There is also limited understanding of health workers’ confidence in promoting SRH self-care interventions, and how this may differ based on personal uptake experiences. To address these knowledge gaps, we conducted a web-based cross-sectional survey among health workers and laypersons from July to November 2018. We investigated the following information about SRH self-care interventions: knowledge and uptake; decisions for use; and associations between health workers’ uptake and providing prescriptions, referrals, and/or information for these interventions. Participants (n = 837) included laypersons (n = 477) and health workers (n = 360) from 112 countries, with most representation from the WHO European Region (29.2%), followed by the Americas (28.4%) and African (23.2%) Regions. We found great heterogeneity in knowledge and uptake by type of SRH self-care intervention. Some interventions, such as oral contraception, were widely known in comparison with interventions such as STI self-sampling. Across interventions, participants perceived benefits of privacy, convenience, and accessibility. While pharmacies and doctors were preferred access points, this varied by type of self-care intervention. Health workers with knowledge of the self-care intervention, and who had themselves used the self-care intervention, were significantly more likely to feel confident in, and to have provided information or referrals to, the same intervention. This finding signals that health workers can be better engaged in learning about self-care SRH interventions and thereby become resources for expanding access.
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Affiliation(s)
- Carmen H Logie
- Associate Professor, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Correspondence: .,Adjunct Professor, United Nations University Institute for Water, Environment and Health, Hamilton, Ontario, Canada
| | - Isha Berry
- Doctoral Candidate, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Laura Ferguson
- Adjunct Professor, United Nations University Institute for Water, Environment and Health, Hamilton, Ontario, Canada
| | - Kalonde Malama
- Associate Professor, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Correspondence:
| | - Holly Donkers
- Associate Professor, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Correspondence:
| | - Manjulaa Narasimhan
- Scientist, Department of Sexual and Reproductive Health and Research, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction - HRP, World Health Organization, Geneva, Switzerland
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23
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Lyons C, Bendaud V, Bourey C, Erkkola T, Ravichandran I, Syarif O, Stangl A, Chang J, Ferguson L, Nyblade L, Amon J, Iovita A, Janušonytė E, Looze P, Sprague L, Sabin K, Baral S, Murray SM. Global assessment of existing HIV and key population stigma indicators: A data mapping exercise to inform country-level stigma measurement. PLoS Med 2022; 19:e1003914. [PMID: 35192602 PMCID: PMC8903269 DOI: 10.1371/journal.pmed.1003914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 03/08/2022] [Accepted: 01/14/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Stigma is an established barrier to the provision and uptake of HIV prevention, diagnostic, and treatment services. Despite consensus on the importance of addressing stigma, there are currently no country-level summary measures to characterize stigma and track progress in reducing stigma around the globe. This data mapping exercise aimed to assess the potential for existing data to be used to summarize and track stigma, including discrimination, related to HIV status, or key population membership at the country level. METHODS AND FINDINGS This study assessed existing indicators of stigma related to living with HIV or belonging to 1 of 4 key populations including gay men and other men who have sex with men, sex workers, people who use drugs, and transgender persons. UNAIDS Strategic Information Department led an initial drafting of possible domains, subdomains, and indicators, and a 3-week e-consultation was held to provide feedback. From the e-consultation, 44 indicators were proposed for HIV stigma; 14 for sexual minority stigma (including sexual behavior or orientation) related to men who have sex with men; 12 for sex work stigma; 10 for drug use stigma; and 17 for gender identity stigma related to transgender persons. We conducted a global data mapping exercise to identify and describe the availability and quality of stigma data across countries with the following sources: UNAIDS National Commitments and Policies Instrument (NCPI) database; Multiple Indicator Cluster Surveys (MICS); Demographic and Health Surveys (DHS); People Living with HIV Stigma Index surveys; HIV Key Populations Data Repository; Integrated Biological and Behavioral Surveys (IBBS); and network databases. Data extraction was conducted between August and November 2020. Indicators were evaluated based on the following: if an existing data source could be identified; the number of countries for which data were available for the indicator at present and in the future; variation in the indicator across countries; and considerations of data quality or accuracy. This mapping exercise resulted in the identification of 24 HIV stigma indicators and 10 key population indicators as having potential to be used at present in the creation of valid summary measures of stigma at the country level. These indicators may allow assessment of legal, societal, and behavioral manifestations of stigma across population groups and settings. Study limitations include potential selection bias due to available data sources to the research team and other biases due to the exploratory nature of this data mapping process. CONCLUSIONS Based on the current state of data available, several indicators have the potential to characterize the level and nature of stigma affecting people living with HIV and key populations across countries and across time. This exercise revealed challenges for an empirical process reliant on existing data to determine how to weight and best combine indicators into indices. However, results for this study can be combined with participatory processes to inform summary measure development and set data collection priorities going forward.
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Affiliation(s)
- Carrie Lyons
- Epidemiology Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | | | - Christine Bourey
- Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Ishwarya Ravichandran
- Epidemiology Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Omar Syarif
- Global Network of People Living with HIV (GNP+), Amsterdam, the Netherlands
| | - Anne Stangl
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Hera Solutions, Baltimore, Maryland, United States of America
| | - Judy Chang
- International Network of People Who Use Drugs (INPUD) Secretariat, London, United Kingdom
| | - Laura Ferguson
- Keck School of Medicine, USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, United States of America
| | - Laura Nyblade
- Global Health Division, International Development Group, RTI International, Washington, DC, United States of America
| | - Joseph Amon
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Alexandrina Iovita
- Communities, Rights and Gender Department, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Eglė Janušonytė
- International Federation of Medical Students’ Associations, Copenhagen, Denmark
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Pim Looze
- Global Network of People Living with HIV (GNP+), Amsterdam, the Netherlands
| | | | | | | | - Stefan Baral
- Epidemiology Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Sarah M. Murray
- Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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24
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Maina BW, Sikweyiya Y, Ferguson L, Kabiru CW. Conceptualisations of masculinity and sexual development among boys and young men in Korogocho slum in Kenya. Cult Health Sex 2022; 24:226-240. [PMID: 33289439 DOI: 10.1080/13691058.2020.1829058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/21/2020] [Indexed: 06/12/2023]
Abstract
Youth and adolescence are times when young men negotiate their identity in relation to social and cultural expectations of being a man, with enduring implications for sexual health and wellbeing. This study explored how boys aged 10-14 years living in Korogocho slum in Nairobi, Kenya conceptualised masculinity, their perceptions of how masculinities are performed, and the linkage between conceptualisations of masculinity and sexual development. Three bases of gender socialisation were identified: (1) verbal messaging (mainly from parents and teachers); (2) observing the behaviours of older men in the community; and (3) information received from mainstream and social media. Masculinity conceptualisations focussed on financial stability, family life and responsibility, physical attributes, character and religion. Two contrasting portrayals of masculinity emerged in the form of idealised and dominant masculinities. A close linkage was found between masculinity conceptualisations and sexual development. Findings are important for programmes that aim to transform harmful gender norms and signal the need for longitudinal research exploring how gender beliefs may change over time.
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Affiliation(s)
- Beatrice W Maina
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Population Dynamics, Sexual and Reproductive Health and Rights Unit, African Population and Health Research Centre, Nairobi, Kenya
| | - Yandisa Sikweyiya
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Gender and Health Research Unit, South Africa Medical Research Council, Pretoria, South Africa
| | - Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California, USA
| | - Caroline W Kabiru
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Population Dynamics, Sexual and Reproductive Health and Rights Unit, African Population and Health Research Centre, Nairobi, Kenya
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25
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Ferguson L, Boudreaux C, Cheyassin Phall M, Jallow B, Fofana MN, Njie L, Ceesay AA, Gibba CK, Njie M, Bittaye M, Loum MM, Sankareh A, Darboe ML, Barjo Y, Dibba M, Safreed-Harmon K, Fink G, Hasan R. Facility and Community Results-Based Financing to Improve Maternal and Child Nutrition and Health in The Gambia. Health Syst Reform 2022; 8:2117320. [PMID: 36084280 DOI: 10.1080/23288604.2022.2117320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
In 2013, the Government of The Gambia implemented a novel results-based financing (RBF) intervention designed to improve maternal and child nutrition and health through a combination of community, facility and individual incentives. In a mixed-methods study, we used a randomized 2 × 2 study design to measure these interventions' impact on the uptake of priority maternal health services, hygiene and sanitation. Conditional cash transfers to individuals were bundled with facility results-based payments. Community groups received incentive payments conditional on completion of locally-designed health projects. Randomization occurred separately at health facility and community levels. Our model pools baseline, midline and endline exposure data to identify evidence of the interventions' impact in isolation or combination. Multivariable linear regression models were estimated. A qualitative study was embedded, with data thematically analyzed. We analyzed 5,927 household surveys: 1,939 baseline, 1,951 midline, and 2,037 endline. On average, community group interventions increased skilled deliveries by 11 percentage points, while the facility interventions package increased them by seven percentage points. No impact was found, either in the community group or facility intervention package arms on early ANC. The community group intervention led to 49, 43 and 48 percentage point increases in handwashing stations, soaps at station and water at station, respectively. No impact was found on improved sanitation facilities. The qualitative data help understand factors underlying these changes. No interaction was found between the community and facility interventions. Where demand-side barriers predominate and community governance structures exist, community group RBF interventions may be more effective than facility designs.
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Affiliation(s)
- Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
| | - Chantelle Boudreaux
- Department of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Bakary Jallow
- Planning and Resource Mobilization Unit, National Nutrition Agency (NaNA), Banjul, The Gambia
| | - Malang N Fofana
- Programme Implementation Unit, National Nutrition Agency (NaNA), Banjul, The Gambia
| | - Lamin Njie
- Finance and Administration Unit, National Nutrition Agency (NaNA), Banjul, The Gambia
| | | | - Catherine K Gibba
- Planning and Resource Mobilization Unit, National Nutrition Agency (NaNA), Banjul, The Gambia
| | - Matty Njie
- Finance and Administration Unit, National Nutrition Agency (NaNA), Banjul, The Gambia
| | - Mustapha Bittaye
- Directorate of Health Services, Ministry of Health, Banjul, The Gambia
| | - Musa M Loum
- Directorate of Health Services, Ministry of Health, Banjul, The Gambia
| | - Alhagie Sankareh
- Directorate of Health Services, Ministry of Health, Banjul, The Gambia
| | - Momodou L Darboe
- Directorate of Health Services, Ministry of Health, Banjul, The Gambia
| | - Yaya Barjo
- Directorate of Planning and Information, Ministry of Health, Banjul, The Gambia
| | | | | | - Günther Fink
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Rifat Hasan
- Health, Nutrition and Population Global Practice, World Bank Group, Washington, DC, USA
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Ferguson L, Narasimhan M. Centring rights-based access to self-care interventions. Sex Reprod Health Matters 2022; 29:2138053. [PMID: 36368037 PMCID: PMC9662043 DOI: 10.1080/26410397.2022.2138053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Laura Ferguson
- Associate Professor of Population and Public Health Sciences, Director of Research, USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, USA. Correspondence:
| | - Manjulaa Narasimhan
- Scientist, Department of Sexual and Reproductive Health and Research, World Health Organization, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction – HRP, Geneva, Switzerland
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Ferguson L, Narasimhan M, Gutierrez J, Jardell W, Gruskin S. Law, human rights and gender in practice: an analysis of lessons from implementation of self-care interventions for sexual and reproductive health. Sex Reprod Health Matters 2022; 29:2105284. [PMID: 35975874 PMCID: PMC9387312 DOI: 10.1080/26410397.2022.2105284] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Self-care interventions for health are becoming increasingly available, and among the preferred options, including during the COVID-19 pandemic. This research assessed the extent of attention to laws and policies, human rights and gender in the implementation of self-care interventions for sexual and reproductive health (SRH), to identify where additional efforts to ensure an enabling environment for their use and uptake will be useful. A literature review of relevant studies published between 2010 and 2020 was conducted using PubMed, Scopus and Web of Science. Relevant data were systematically abstracted from 61 articles. In March–April 2021, semi-structured interviews were conducted with 10 key informants, selected for their experience implementing self-care interventions for SRH, and thematically analysed. Laws and policies, rights and gender are not being systematically addressed in the implementation of self-care interventions for SRH. Within countries, there is varied attention to the enabling environment including the acceptability of interventions, privacy, informed consent and gender concerns as they impact both access and use of specific self-care interventions, while other legal considerations appear to have been under-prioritised. Operational guidance is needed to develop and implement supportive laws and policies, as well as to ensure the incorporation of rights and gender concerns in implementing self-care interventions for SRH.
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Affiliation(s)
- Laura Ferguson
- Associate Professor of Population and Public Health Sciences, Director of Research, USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA. Correspondence:
| | - Manjulaa Narasimhan
- Scientist, Department of Sexual and Reproductive Health and Research, World Health Organization, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction – HRP, Geneva, Switzerland
| | - Jose Gutierrez
- Student, University of Southern California, Los Angeles, CA, USA
| | - William Jardell
- Project Specialist, USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
| | - Sofia Gruskin
- Professor of Population and Public Health Sciences and Law, Director, USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
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Hempel S, Ferguson L, Bolshakova M, Yagyu S, Fu N, Motala A, Gruskin S. Frameworks, measures, and interventions for HIV-related internalised stigma and stigma in healthcare and laws and policies: systematic review protocol. BMJ Open 2021; 11:e053608. [PMID: 34887280 PMCID: PMC8663079 DOI: 10.1136/bmjopen-2021-053608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION There is strong global commitment to eliminate HIV-related stigma. Wide variation exists in frameworks and measures, and many strategies to prevent, reduce or mitigate stigma have been proposed but critical factors determining success or failure remain elusive. METHODS AND ANALYSIS Building on existing knowledge syntheses, we designed a systematic review to identify frameworks, measures and intervention evaluations aiming to address internalised stigma, stigma and discrimination in healthcare, and stigma and discrimination at the legal or policy level. The review addresses four key questions (KQ): KQ1: Which conceptual frameworks have been proposed to assess internal stigma, stigma and discrimination experienced in healthcare settings, and stigma and discrimination entrenched in national laws and policies? KQ2: Which measures of stigma have been proposed and what are their descriptive properties? KQ3: Which interventions have been evaluated that aimed to reduce these types of stigma and discrimination or mitigate their adverse effects and what are the effectiveness and unintended consequences? KQ4: What common 'critical factors for success or failure' can be identified across interventions that have been evaluated? We will search PubMed, PsycINFO, Web of Science, Universal Human Rights Index, HeinOnline, PAIS, HIV Legal Network, CDSR, Campbell Collaboration, PROSPERO and Open Science Framework. Critical appraisal will assess the source, processes and consensus finding for frameworks; COnsensus-based Standards for the selection of health Measurement Instruments criteria for measures; and risk of bias for interventions. Quality of evidence grading will apply . A gap analysis will provide targeted recommendations for future research. We will establish a compendium of frameworks, a comprehensive catalogue of available measures, and a synthesis of intervention characteristics to advance the science of HIV-related stigma. PROSPERO REGISTRATION NUMBER CRD42021249348.
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Affiliation(s)
- Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
| | - Maria Bolshakova
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Sachi Yagyu
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Ning Fu
- Department of Economics, Shanghai University of Finance and Economics, Shanghai, China
| | - Aneesa Motala
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Sofia Gruskin
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
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29
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Gruskin S, Jardell W, Ferguson L, Zacharias K, Khosla R. Integrating human rights into sexual and reproductive health research: moving beyond the rhetoric, what will it take to get us there? Sex Reprod Health Matters 2021; 29:1881206. [PMID: 33595424 PMCID: PMC8011684 DOI: 10.1080/26410397.2021.1881206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The integration of human rights principles in sexual and reproductive health (SRH) research is often recognised to be of value. Good examples abound but lack of clarity persists as to what defines rights-inclusive SRH research. To help move the field forward, this article seeks to explore how key stakeholders responsible for funding and supporting rights in SRH research understand the strengths and weaknesses of what is being done and where, and begins to catalogue potential tools and actions for the future. Interviews with a range of key stakeholders including international civil servants, donors and researchers committed to and supportive of integrating rights into SRH research were conducted and analysed. Interviews confirmed important differences in what is understood to be SRH rights-oriented research and what it can accomplish. General barriers include lack of understanding about the importance of rights; lack of clarity as to the best approach to integration; fear of adding more work with little added benefit; as well as the lack of methodological guidance or published research methodologies that integrate rights. Suggestions include the development of a comprehensive checklist for each phase of research from developing a research statement through ultimately to publication; development of training modules and workshops; inclusion of rights in curricula; changes in journal requirements; and agreement among key funding sources to mandate the integration of rights principles in research proposals they receive. As a next step, cataloguing issues and concerns at local levels can help move the integration of human rights in SRH research from rhetoric to reality.
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Affiliation(s)
- Sofia Gruskin
- Director, USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA. Correspondence:
| | - William Jardell
- Program Specialist, USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
| | - Laura Ferguson
- Director, Program on Global Health and Human Rights, USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
| | - Kristin Zacharias
- Research Associate, USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
| | - Rajat Khosla
- Human Rights Advisor, World Health Organization, Geneva, Switzerland
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Gruskin S, Zacharias K, Jardell W, Ferguson L, Khosla R. Inclusion of human rights in sexual and reproductive health programming: Facilitators and barriers to implementation. Glob Public Health 2021; 16:1559-1575. [PMID: 33019904 PMCID: PMC8475719 DOI: 10.1080/17441692.2020.1828986] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/21/2020] [Indexed: 12/02/2022]
Abstract
The need to prioritise those furthest behind is well understood in global health circles, and how human rights norms and standards can help often touted. As rights concerns are particularly recognised in sexual and reproductive health (SRH) programming, as part of a larger exercise, a review was conducted to identify documented barriers and facilitators to implementation. Given the role global guidance plays in implementing rights-based approaches to SRH, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) guidelines, tools, recommendations and guidance that include the explicit mention of human rights principles served as the basis for this exercise. This was followed by an extensive review of the literature. Sources reviewed confirmed barriers include not only broad structural, policy and health systems barriers but financial, staffing and time constraints, as well as lack of understanding of concretely how to include human rights in these efforts. Facilitators include the existence of human rights champions, leadership, strong civil society participation, training, and funding made available specifically for implementation. Investment in indicators and documentation sensitive to human rights is warranted in sexual and reproductive health, as well as other health topics, to best serve populations who need them most.
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Affiliation(s)
- Sofia Gruskin
- USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
| | - Kristin Zacharias
- USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
| | - William Jardell
- USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
| | - Laura Ferguson
- USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
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Haq M, Reyal Y, Tiffin N, Szakacs S, Ferguson L. T-cell pseudolymphoma secondary to ixazomib for multiple myeloma. Skin Health Dis 2021; 1:e57. [PMID: 35663138 PMCID: PMC9060122 DOI: 10.1002/ski2.57] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/13/2022]
Abstract
We present a case of a 54‐year‐old male with multiple myeloma (MM) who presented with widespread pruritic erythematous lesions following ixazomib treatment. This occurred after his third cycle of treatment with ixazomib, thalidomide and dexamethasone and was controlled by potent steroids and temporary cessation of ixazomib. The strong correlation between the timeline of the rash, ixazomib treatment and subsequent cessation led to a diagnosis of a drug‐induced rash. Skin biopsy histology, immunochemistry and the absence of monoclonal T‐cell receptor gene rearrangement further confirmed the diagnosis of a T‐cell pseudolymphoma secondary to ixazomib. Ixazomib is an oral proteasome inhibitor used in the treatment of MM. Other proteasome inhibitors have been reported to trigger cutaneous adverse effects. However, to our knowledge, this is the first report of pseudolymphoma following proteasome inhibitor use. Dermatologists should be aware of this potential effect and the possible management pathways such as cessation and dose reduction.
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Affiliation(s)
- M Haq
- Faculty of Medicine St George's, University of London London UK
| | - Y Reyal
- Department of Haematology St George's Healthcare NHS Trust London UK
| | - N Tiffin
- South West London Pathology St George's Healthcare NHS Trust London UK
| | - S Szakacs
- Department of Histopathology William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust Ashford UK
| | - L Ferguson
- Department of Dermatology St George's Healthcare NHS Trust London UK
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Huang J, Bhargava E, Walsh M, Pennell D, Attya H, Jablenska L, Ferguson L, Lilly I, Pepper C, Tweedie D, Possamai V. 786 Retrospective analysis of paediatric ENT surgery outcomes during the COVID pandemic. Br J Surg 2021. [PMCID: PMC8135831 DOI: 10.1093/bjs/znab134.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Introduction Studies show high morbidity/mortality for adults with peri-operative SARS-CoV-2 infection, leading to recommendations curtailing elective operations during the height of the pandemic. Our understanding of the risks associated with paediatric surgery is more limited, with preliminary data suggesting lower morbidity/mortality than in adults. A < 1% incidence of COVID-19 in paediatric patients undergoing preoperative universal screening is reported, and even in those testing positive, morbidity and mortality seem to be low. As waiting lists swell and the detriment associated with delaying surgery mounts, it is imperative to accurately quantify the risks of surgery in the paediatric population. Method Retrospective review of all paediatric ENT operations performed at the Evelina Children’s Hospital at the height of lockdown, from March to May 2020. Results 61 procedures were performed on 56 patients. 50% had a pre-operative SARS-CoV-2 nasopharyngeal swabs. All cases involved a change in anesthetic practice; 2 cases involved a change in surgical practice. We noted 2 medical complications and 1 surgical complication. All patients are currently extant. No staff or patients subsequently developed COVID. Conclusions Our perioperative infection rates and mortality/morbidity figures concord with figures published elsewhere in literature. We are cautiously optimistic regarding risks associated with paediatric ENT surgery.
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Affiliation(s)
- J Huang
- Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - E Bhargava
- Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - M Walsh
- Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - D Pennell
- Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - H Attya
- Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - L Jablenska
- Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - L Ferguson
- Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - I Lilly
- Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - C Pepper
- Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - D Tweedie
- Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - V Possamai
- Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
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Ferraz D, Dourado I, Zucchi EM, Mabire X, Magno L, Grangeiro AD, Couto MT, Ferguson L, Westin M, Alves Dos Santos L, Préau M. Effects of the COVID-19 pandemic on the sexual and mental health of adolescent and adult men who have sex with men and transgender women participating in two PrEP cohort studies in Brazil: COBra study protocol. BMJ Open 2021; 11:e045258. [PMID: 33795308 PMCID: PMC8024057 DOI: 10.1136/bmjopen-2020-045258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic and its control measures have impacted health and healthcare provision in various levels. Physical distancing measures, for instance, may affect sexual health, impacting access to HIV prevention supplies and changing sexual behaviour, as well as mental health, increasing feelings of unsafety and weakening community support ties. These effects can be worsened among socially marginalised groups, such as men who have sex with men (MSM) and transgender women (TGW). Brazil is among the countries most affected by COVID-19 in the world, where control measures have been inconsistently implemented. We aim to investigate the effects of the COVID-19 pandemic on the sexual and mental health of adolescent and adult MSM and TGW in Brazil. METHODS Convergent mixed-method prospective cohort study, nested in two ongoing HIV pre-exposure prophylaxis (PrEP) cohorts in Brazil, named PrEP1519 and Combina. Participants will be invited to answer, at baseline and after 6 months, a questionnaire about the effects of the COVID-19 pandemic on sexual behaviour, HIV prevention and mental health. Data on HIV infection and sexually transmitted infections (STI) will be collected as part of routine follow-up from the cohorts. Main outcome measures (HIV infection, STI and depression symptoms) will be observed within 12 months after baseline. Sample size is estimated at 426 participants. Complementarily, 50 participants will be invited to in-depth interviews through video calls or interactive voice response, and 20 will be invited to chronicle their lives during the pandemic through digital diaries. Triangulation will be done across qualitative methods and with the quantitative data. ETHICS AND DISSEMINATION The study was approved by Research Ethics Committees from the Brazilian Universities coordinating the study. Findings will be published in scientific journals and presented at meetings. Informative flyers will be elaborated to communicate study findings to participants and key stakeholders.
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Affiliation(s)
- Dulce Ferraz
- Escola FIOCRUZ de Governo, FIOCRUZ Brasília, Fundação Oswaldo Cruz, Brasília, DF, Brazil
- Groupe de Recherche en Psychologie Sociale (EA 4163), Université Lumière Lyon 2 - Campus Porte des Alpes, Bron, France
| | - Inês Dourado
- Instituto de Saúde Coletiva (ISC), Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Eliana Miura Zucchi
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Catolica de Santos, Santos, SP, Brazil
| | - Xavier Mabire
- Groupe de Recherche en Psychologie Sociale (EA 4163), Université Lumière Lyon 2 - Campus Porte des Alpes, Bron, France
| | - Laio Magno
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, BA, Brazil
| | - Alexandre D Grangeiro
- Departamento de Medicina Preventiva, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, São Paulo, Brazil
| | - Márcia Thereza Couto
- Departamento de Medicina Preventiva, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, São Paulo, Brazil
| | - Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
| | - Mateus Westin
- Departamento de Doenças Infecciosas e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Lorruan Alves Dos Santos
- Departamento de Medicina Preventiva, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, São Paulo, Brazil
| | - Marie Préau
- Groupe de Recherche en Psychologie Sociale (EA 4163), Université Lumière Lyon 2 - Campus Porte des Alpes, Bron, France
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Ferguson L, Ho B, Weir J, Francis N, West K, Rathbone B, Larkin J, Heelan K. Extensive mucocutaneous, oesophageal and otic lichen planus secondary to nivolumab therapy. Skin Health Dis 2021; 1:e8. [PMID: 35664814 PMCID: PMC9060137 DOI: 10.1002/ski2.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 02/01/2023]
Abstract
We report a 73-year-old female with metastatic renal cell carcinoma who developed a widespread lichenoid reaction following nivolumab treatment. The timeline of the reaction strongly correlated with the nivolumab treatment and subsequent cessation. Our patient had cutaneous, mucosal, otic, ophthalmic and oesophageal involvement, demonstrating the potentially extensive nature of lichenoid reactions to anti-programmed cell death receptor-1 (anti-PD1) therapies. Although lichenoid reactions to anti-PD1 therapies are now well recognized, there have been no previous reports of otic or oesophageal involvement in the literature. Although cutaneous lichenoid reactions do not tend to be severe or treatment limiting, more widespread systemic lichenoid reactions are challenging to manage, particularly in the context of malignancy. This very unusual case highlights the importance of considering involvement beyond the skin in all lichenoid skin reactions.
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Affiliation(s)
| | - B. Ho
- Dermatology DepartmentSt George's University Hospitals NHS Foundation TrustLondonUK
| | - J. Weir
- Department of HistopathologyImperial College Healthcare NHS TrustLondonUK
| | - N. Francis
- Department of HistopathologyImperial College Healthcare NHS TrustLondonUK
| | - K. West
- Histopathology DepartmentLeicester Royal InfirmaryLeicesterUK
| | - B. Rathbone
- Gastroenterology DepartmentLeicester Royal InfirmaryLeicesterUK
| | - J. Larkin
- Royal Marsden Hospital NHS TrustLondonUK
| | - K. Heelan
- Royal Marsden Hospital NHS TrustLondonUK
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Kennedy CE, Yeh PT, Byrne J, van der Merwe LLA, Ferguson L, Poteat T, Narasimhan M. Self-administration of gender-affirming hormones: a systematic review of effectiveness, cost, and values and preferences of end-users and health workers. Sex Reprod Health Matters 2021; 29:2045066. [PMID: 35312467 PMCID: PMC8942532 DOI: 10.1080/26410397.2022.2045066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Self-administration of quality gender-affirming hormones is one approach to expanding access to hormone therapy for individuals seeking secondary sex characteristics more aligned with their gender identity or expression and can be empowering when provided within safe, supportive health systems. To inform World Health Organization guidelines on self-care interventions, we systematically reviewed the evidence for self-administration compared to health worker-administration of gender-affirming hormones. We conducted a comprehensive search for peer-reviewed articles and conference abstracts that addressed effectiveness, values and preferences, and cost considerations. Data were extracted in duplicate using standardised forms. Of 3792 unique references, five values and preferences articles were included; no studies met the criteria for the effectiveness or cost reviews. All values and preferences studies focused on self-administration of unprescribed hormones, not prescribed hormones within a supportive health system. Four studies from the U.S. (N = 2), Brazil (N = 1), and the U.K. (N = 1) found that individuals seeking gender-affirming hormone therapy may self-manage due to challenges finding knowledgeable and non-stigmatising health workers, lack of access to appropriate services, exclusion, and discomfort with health workers, cost, and desire for a faster transition. One study from Thailand found health worker perspectives were shaped by restrictive legislation, few transgender-specific services or guidelines, inappropriate communication with health workers, and medical knowledge gaps. There is limited literature on self-administration of gender-affirming hormone therapy. Principles of gender equality and human rights in the delivery of quality gender-affirming hormones are critical to expand access to this important intervention and reduce discrimination based on gender identity.
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Affiliation(s)
- Caitlin E. Kennedy
- Associate Professor, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ping Teresa Yeh
- Research Associate, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jack Byrne
- Co-investigator, Counting Ourselves, Trans Health Research Lab, the Aotearoa New Zealand Trans and Non-binary Health Survey, University of Waikato, Hamilton, New Zealand
| | - L. Leigh Ann van der Merwe
- Founder/Director & Research Lead, Social, Health and Empowerment Feminist Collective of Transgender Women of Africa, East London, South Africa
| | - Laura Ferguson
- Assistant Professor, Institute on Inequalities in Global Health, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tonia Poteat
- Associate Professor, Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Manjulaa Narasimhan
- Scientist, Department of Sexual and Reproductive Health and Research, World Health Organization, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction – HRP, Geneva, Switzerland
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Ferguson L, Hasan R, Boudreaux C, Thomas H, Jallow M, Fink G. Results-based financing to increase uptake of skilled delivery services in The Gambia: using the 'three delays' model to interpret midline evaluation findings. BMC Pregnancy Childbirth 2020; 20:712. [PMID: 33228543 PMCID: PMC7686684 DOI: 10.1186/s12884-020-03387-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 10/30/2020] [Indexed: 11/10/2022] Open
Abstract
Background Delays in accessing skilled delivery services are a major contributor to high maternal mortality in resource-limited settings. In 2015, the government of The Gambia initiated a results-based financing intervention that sought to increase uptake of skilled delivery. We performed a midline evaluation to determine the impact of the intervention and explore causes of delays. Methods A mixed methods design was used to measure changes in uptake of skilled delivery and explore underlying reasons, with communities randomly assigned to four arms: (1) community-based intervention, (2) facility-based intervention, (3) community- and facility-based intervention, and (4) control. We obtained quantitative data from household surveys conducted at baseline (n = 1423) and midline (n = 1573). Qualitative data came from semi-structured interviews (baseline n = 20; midline n = 20) and focus group discussions (baseline n = 27; midline n = 39) with a range of stakeholders. Multivariable linear regression models were estimated using pooled data from baseline and midline. Qualitative data were recorded, transcribed, translated and thematically analyzed. Results No increase was found in uptake of skilled delivery services between baseline and midline. However, relative to the control group, significant increases in referral to health facilities for delivery were found in areas receiving the community-based intervention (beta = 0.078, p < 0.10) and areas receiving both the community-based and facility-based interventions (beta = 0.198, p < 0.05). There was also an increase in accompaniment to health facilities for delivery in areas receiving only community-based interventions (beta = 0.095, p < 0.05). Transportation to health facilities for delivery increased in areas with both interventions (beta = 0.102, p < 0.05). Qualitative data indicate that delays in the decision to seek institutional delivery usually occurred when women had limited knowledge of delivery indications. Delays in reaching a health facility typically occurred due to transportation-related challenges. Although health workers noted shortages in supplies and equipment, women reported being supported by staff and experiencing minimal delays in receiving skilled delivery care once at the facility. Conclusions Focusing efforts on informing the decision to seek care and overcoming transportation barriers can reduce delays in care-seeking among pregnant women and facilitate efforts to increase uptake of skilled delivery services through results-based financing mechanisms.
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Affiliation(s)
- Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California, 2001 N Soto St, SSB318H, MC-9239, Los Angeles, CA, 90089, USA.
| | - Rifat Hasan
- World Bank Group, 70, Lodhi Estate, New Delhi, 110003, India
| | | | - Hannah Thomas
- Institute on Inequalities in Global Health, University of Southern California, 2001 N Soto St, SSB318H, MC-9239, Los Angeles, CA, 90089, USA
| | - Mariama Jallow
- Centre for Reproductive Sexual Health, Tanji, Kombo South, West Coast Region, The Gambia
| | - Günther Fink
- Swiss Tropical and Public Health Institute, Socinstrasse 57, CH-4051, Basel, Switzerland
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Cloonan K, Rizzato AR, Ferguson L, Hillier NK. Detection of heliothine sex pheromone components in the Australian budworm moth, Helicoverpa punctigera: electrophysiology, neuroanatomy, and behavior. J Comp Physiol A Neuroethol Sens Neural Behav Physiol 2020; 206:939-950. [PMID: 33098446 DOI: 10.1007/s00359-020-01450-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 10/01/2020] [Accepted: 10/09/2020] [Indexed: 11/24/2022]
Abstract
This study examined electrophysiological responses of the Australian budworm moth Helicoverpa punctigera, to heliothine sex pheromone components, via single sensillum recordings (SSR), and examined male neuroanatomy using confocal microscopy and 3D imaging tools. We found that male H. punctigera have three distinct regions of the macroglomerular complex (MGC) in the antennal lobe. Male antennae have only two functional types of sensilla trichoidea (A and C) and type A sensilla contain an olfactory sensory neuron (OSN) that responds to the major sex pheromone component (Z)-11-hexadecenal (Z11-16:Ald) with axons projecting to the cumulus of the macroglomerular complex (MGC) in the antennal lobe. Type C sensilla contained large-spiking receptor neurons which responded primarily to (Z)-9-tetradecenal (Z9-14:Ald) and to a lesser degree to (Z)-11-hexadecenol (Z11-16:OH). These were co-compartmentalized with small-spiking receptor neurons in type C sensilla which responded strongly to Z9-14:Ald and (Z)-9-hexadecenal (Z9-16:Ald), and to a lesser degree to (Z)-11-hexadecenyl acetate (Z11-16:OAc) and Z11-16:OH. Axons from the two co-localized neurons in Type C sensilla projected to the two small MGC units, the dorsomedial anterior and dorsomedial posterior, respectively. In wind tunnel assays, the addition of Z9-16:Ald to an otherwise attractive blend completely shut down male H. punctigera upwind flight.
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Affiliation(s)
- Kevin Cloonan
- Department of Biology, Acadia University, Wolfville, NS, B4P 2R6, Canada. .,Kevin Cloonan, Trécé Inc, PO Box 129, Adair, OK, 74330, USA.
| | - A Rebecca Rizzato
- Kentville Research and Development Centre, Agriculture and Agri-Food Canada, Kentville, NS, Canada
| | - Laura Ferguson
- Department of Biology, Acadia University, Wolfville, NS, B4P 2R6, Canada
| | - N Kirk Hillier
- Department of Biology, Acadia University, Wolfville, NS, B4P 2R6, Canada
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Leach A, Smyth P, Ferguson L, Steven J, Greene MK, Branco CM, McCann AP, Porter A, Barelle CJ, Scott CJ. Anti-DLL4 VNAR targeted nanoparticles for targeting of both tumour and tumour associated vasculature. Nanoscale 2020; 12:14751-14763. [PMID: 32626858 DOI: 10.1039/d0nr02962a] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Whilst there is an extensive body of preclinical nanomedicine research, translation to clinical settings has been slow. Here we present a novel approach to the targeted nanoparticle (NP) concept: utilizing both a novel targeting ligand, VNAR (Variable New Antigen Receptor), a shark-derived single chain binding domain, and an under-investigated target in delta-like ligand 4 (DLL4). We describe the development of an anti-DLL4 VNAR and the site-specific conjugation of this to poly(lactic-co-glycolic) acid PEGylated NPs using surface maleimide functional groups. These nanoconjugates were shown to specifically bind DLL4 with high affinity and were preferentially internalized by DLL4-expressing pancreatic cancer cell lines and endothelial cells. Furthermore, a distinct anti-angiogenic effect endowed by the anti-DLL4 VNAR was evident in in vitro tubulogenic assays. Taken together these findings highlight the potential of anti-DLL4 targeted polymeric NPs as a novel therapeutic approach in pancreatic cancer.
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Affiliation(s)
- Adam Leach
- The Patrick G. Johnston Centre for Cancer Research, School of Medicine, Queen's University Belfast, Belfast, UK.
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Cato-Addison WB, Ferguson L, Strachan RD, Clark R, Murray JS, Moore I. Intra-dialytic intracranial pressure monitoring in a patient with lumbo-peritoneal shunt for idiopathic intracranial hypertension. Br J Neurosurg 2020:1-3. [DOI: 10.1080/02688697.2020.1774509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- W. B. Cato-Addison
- Department of Neurosurgery, James Cook University Hospital, Middlesbrough, UK
| | - L. Ferguson
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - R. D. Strachan
- Department of Neurosurgery, James Cook University Hospital, Middlesbrough, UK
| | - R. Clark
- Renal Unit, James Cook University Hospital, Middlesbrough, UK
| | - J. S. Murray
- Renal Unit, James Cook University Hospital, Middlesbrough, UK
| | - I. Moore
- Renal Unit, James Cook University Hospital, Middlesbrough, UK
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De Brito M, Ferguson L, Mansour S, Khan I. An unusual manifestation of X‐linked hypohidrotic ectodermal dysplasia with palmoplantar keratoderma. Clin Exp Dermatol 2020; 45:352-353. [DOI: 10.1111/ced.14096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/11/2019] [Indexed: 11/30/2022]
Affiliation(s)
- M. De Brito
- Department of Dermatology St George’s Healthcare NHS Trust London UK
| | - L. Ferguson
- Department of Dermatology St George’s Healthcare NHS Trust London UK
| | - S. Mansour
- St George’s Healthcare NHS Trust St George’s, University of London London UK
| | - I. Khan
- Department of Dermatology St George’s Healthcare NHS Trust London UK
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Siegfried N, Narasimhan M, Logie CH, Thomas R, Ferguson L, Moody K, Remme M. Prioritising gender, equity, and human rights in a GRADE-based framework to inform future research on self care for sexual and reproductive health and rights. BMJ Glob Health 2020; 5:e002128. [PMID: 32337081 PMCID: PMC7170423 DOI: 10.1136/bmjgh-2019-002128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/28/2020] [Accepted: 02/15/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction In January 2019, the WHO reviewed evidence to develop global recommendations on self-care interventions for sexual and reproductive health and rights (SRHR). Identification of research gaps is part of the WHO guidelines development process, but reliable methods to do so are currently lacking with gender, equity and human rights (GER) infrequently prioritised. Methods We expanded a prior framework based on Grading of Evidence, Assessment, Development and Evaluation (GRADE) to include GER. The revised framework is applied systematically during the formulation of research questions and comprises: (1) assessment of the GRADE strength and quality rating of recommendations; (2) mandatory inclusion of research questions identified from a global stakeholder survey; and (3) selection of the GER standards and principles most relevant to the question through discussion and consensus. For each question, we articulated: (1) the most appropriate and robust study design; (2) an alternative pragmatic design if the ideal design was not feasible; and (3) the methodological challenges facing researchers through identifying potential biases. Results We identified 39 research questions, 7 overarching research approaches and 13 discrete feasible study designs. Availability and accessibility were most frequently identified as the GER standards and principles to consider when planning studies, followed by privacy and confidentiality. Selection and detection bias were the primary methodological challenges across mixed methods, quantitative and qualitative studies. A lack of generalisability potentially limits the use of study results with non-participation in research potentially highest in more vulnerable populations. Conclusion A framework based on GRADE that includes stakeholders’ values and identification of core GER standards and principles provides a practical, systematic approach to identifying research questions from a WHO guideline. Clear guidance for future studies will contribute to an anticipated ‘living guidelines’ approach within WHO. Foregrounding GER as a separate component of the framework is innovative but further elaboration to operationalise appropriate indicators for SRHR self-care interventions is required.
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Affiliation(s)
- Nandi Siegfried
- Independent Clinical Epidemiologist, Cape Town, South Africa
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, including UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Rebekah Thomas
- Guideline Review Committee Secretariat (Science Division), World Health Organization, Geneva, Switzerland
| | - Laura Ferguson
- Institute on Inequalities in Global Health, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kevin Moody
- Independent Consultant, Amsterdam, The Netherlands
| | - Michelle Remme
- International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia
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Wirya A, Larasati A, Gruskin S, Ferguson L. Expanding the role of paralegals: supporting realization of the right to health for vulnerable communities. BMC Int Health Hum Rights 2020; 20:8. [PMID: 32228564 PMCID: PMC7106642 DOI: 10.1186/s12914-020-00226-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/17/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND All around the world, the paralegal program prepares members of marginalized communities to face the legal system. Having a common background with their clients and being capable of conducting flexible work, paralegals' role moves beyond enlarging the beneficiaries of legal aid to addressing intersectional issues around health-related rights. This study assesses the health and other impacts of paralegals recruited by Lembaga Bantuan Hukum Masyarakat (LBHM), a human rights organization which provides legal assistance and operates in Jakarta, Indonesia. The positive results these paralegals can bring in the specific context can contribute to the development of community-based paralegals elsewhere. METHODS This mixed methods research was carried out in 2016-2018. In 2016, a quantitative survey was administered to LBHM-trained paralegals and a sub-set of paralegals who completed the survey were then also interviewed. Quantitative data were analysed using SPSS, and, for the qualitative data, thematic analysis was conducted. RESULTS The paralegals make important contributions to health-related rights in four distinct ways. Firstly, most of the paralegals checked their clients' health in all stages of detention, especially regarding their drug dependency status and checking for signs of torture. Secondly, paralegals help clients to be more aware of their health-related rights, especially regarding their rights to obtain health services inside detention. Thirdly, paralegals can ensure that their clients obtain health services by taking medicines directly to the clients or encouraging the law enforcement agencies to refer the clients to health services. Lastly, in drug cases, paralegals help their clients to obtain alternative sentences besides imprisonment. CONCLUSIONS These four contributions verify the positive impacts paralegals, recruited from marginalized communities, can deliver for community members facing criminal justice processes. The shifting role of paralegals from merely an intermediary between clients and lawyers to champions of the health-related rights of their clients can happen as a result of adequate training, support, and networks with other agents in criminal justice system.
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Affiliation(s)
- Albert Wirya
- Lembaga Bantuan Hukum Masyarakat (Community Legal Aid Institute), Tebet Timur Dalam VI E No 3, Jakarta, 12820, Indonesia.
| | - Ajeng Larasati
- Lembaga Bantuan Hukum Masyarakat (Community Legal Aid Institute), Tebet Timur Dalam VI E No 3, Jakarta, 12820, Indonesia
| | - Sofia Gruskin
- Lembaga Bantuan Hukum Masyarakat (Community Legal Aid Institute), Tebet Timur Dalam VI E No 3, Jakarta, 12820, Indonesia
| | - Laura Ferguson
- USC Institute on Inequalities in Global Health, University of Southern California, 2001 N Soto St, Los Angeles, USA
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Steven J, Ubah OC, Buschhaus M, Kovaleva M, Ferguson L, Porter AJ, Barelle CJ. In Vitro Maturation of a Humanized Shark VNAR Domain to Improve Its Biophysical Properties. Methods Mol Biol 2020; 2070:115-142. [PMID: 31625093 DOI: 10.1007/978-1-4939-9853-1_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
VNAR domains are the binding regions of new antigen receptor proteins (IgNAR) which are unique to sharks, skates, and rays (Elasmobranchii). Individual VNAR domains can bind antigens independently and are the smallest reported adaptive immune recognition entities in the vertebrate kingdom. Sharing limited sequence homology with human immunoglobulin domains, their development and use as biotherapeutic agents require that they be humanized to minimize their potential immunogenicity. Efforts to humanize a human serum albumin (HSA)-specific VNAR, E06, resulted in protein molecules that initially had undesirable biophysical properties or reduced affinity for cognate antigen. Two lead humanized anti-HSA clones, v1.10 and v2.4, were subjected to a process of random mutagenesis using error-prone PCR. The mutated sequences for each humanized VNAR variant were screened for improvements in affinity for HSA and biophysical properties, achieved without a predicted increase in overall immunogenicity.
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Affiliation(s)
| | | | | | | | | | - Andrew J Porter
- Elasmogen Ltd., Aberdeen, UK
- Scottish Biologics Facility, School of Medical Sciences, University of Aberdeen, Aberdeen, UK
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Affiliation(s)
- Julia Hussein
- Editor-in-Chief, Sexual and Reproductive Health Matters, London, UK
| | - Laura Ferguson
- Associate Editor, Sexual and Reproductive Health Matters, London, UK; Assistant Professor and Director, Program on Global Health and Human Rights, Institute on Inequalities in Global Health, University of Southern California, USA
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Coleman KA, Boscan P, Ferguson L, Twedt D, Monnet E. Evaluation of gastric motility in nine dogs before and after prophylactic laparoscopic gastropexy: a pilot study. Aust Vet J 2019; 97:225-230. [PMID: 31236930 DOI: 10.1111/avj.12829] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 03/22/2019] [Accepted: 04/07/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the effect of a prophylactic laparoscopic gastropexy on gastric motility in healthy large-breed dogs. METHODS This was a prospective pilot study with nine healthy client-owned dogs. Each dog was its own control. Gastric motility was evaluated before and after laparoscopic gastropexy. Dogs were fed a standard diet three weeks before and after surgery. Gastric motility was measured before and 3 weeks after surgery. A wireless motility capsule (WMC) was used to measure gastric pH, intragastric pressure, temperature, frequency of contractions, motility index (MI) and transit time. Non-parametric statistical analysis was used to compare the paired data. Clients were contacted for follow-up information 2 years postoperatively. RESULTS Median frequency of gastric contractions was 1.3 (range, 0.6-1.9 contractions/min) before gastropexy and 1.0 (range, 0.3-2.6 contractions/min) after gastropexy (P = 0.820). Median MI was 49.2 (range, 23.7-96.6) before gastropexy and 28.1 (range, 12.2-148.9) after gastropexy (P = 0.652). Median gastric emptying time was 1140 (range, 486-1230 min) before gastropexy and 1110 (range, 306-2610 min) after gastropexy (P = 0.570). During the hour before the WMC passed through the pylorus, median MI was 72.2 (range, 48.2-549.3) before gastropexy and 52.9 (range, 15.20-322.8) after gastropexy (P = 0.734), and frequency of contractions was 1.1 (range, 0.9-4.1 contractions/min) before gastropexy and 1.2 (range, 0.5-3.0 contractions/min) after gastropexy (P = 0.652). CONCLUSION Motility in the stomach did not change in healthy dogs after prophylactic laparoscopic gastropexy. We conclude that preventive laparoscopic gastropexy does not induce gastroparesis.
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Affiliation(s)
- K A Coleman
- Department of Clinical Sciences, Colorado State University Veterinary Teaching Hospital, 300 West Drake Road, Fort Collins, CO 80523, USA
| | - P Boscan
- Department of Clinical Sciences, Colorado State University Veterinary Teaching Hospital, 300 West Drake Road, Fort Collins, CO 80523, USA
| | - L Ferguson
- Department of Clinical Sciences, Colorado State University Veterinary Teaching Hospital, 300 West Drake Road, Fort Collins, CO 80523, USA
| | - D Twedt
- Department of Clinical Sciences, Colorado State University Veterinary Teaching Hospital, 300 West Drake Road, Fort Collins, CO 80523, USA
| | - E Monnet
- Department of Clinical Sciences, Colorado State University Veterinary Teaching Hospital, 300 West Drake Road, Fort Collins, CO 80523, USA
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Carvalho PGCD, Cabral CDS, Ferguson L, Gruskin S, Diniz CSG. 'We are not infertile': challenges and limitations faced by women in same-sex relationships when seeking conception services in São Paulo, Brazil. Cult Health Sex 2019; 21:1257-1272. [PMID: 30633635 DOI: 10.1080/13691058.2018.1556343] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 12/03/2018] [Indexed: 06/09/2023]
Abstract
The use of reproductive technologies has expanded beyond cases of infertility, and opportunities for individuals of different sexual orientations to use such technologies for conception have increased. The authors examined the challenges and limitations faced by women in same-sex relationships seeking conception services in São Paulo, Brazil. They interviewed 16 women in same-sex relationships who conceived children using reproductive technologies. Access to public health services for conception remains limited and exclusive to infertile heterosexual couples. Women in same-sex relationships are forced to select between costly medical treatments in the private sector, or self-insemination with sperm from a known donor. In this study, individuals reported that they experienced adverse effects of treatments; were treated with technologies for infertility when they were, in fact, fertile; and were exposed to unnecessary and invasive interventions. Growing political conservatism and the reduction of investment in public health services are factors that can directly affect sexual and reproductive health, including that of lesbians. Public policies that enable same-sex couples to conceive have yet to be developed in many countries, and a clearer articulation of the right to evidence-informed, rights-based care, consistent with national and international guidelines is a much-needed next step.
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Affiliation(s)
| | - Cristiane da Silva Cabral
- Department of Health, Life Cycles and Society, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Laura Ferguson
- Institute for Global Health, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sofia Gruskin
- Institute for Global Health, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Carmen Simone Grilo Diniz
- Department of Health, Life Cycles and Society, School of Public Health, University of São Paulo, São Paulo, Brazil
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García-Ruiz NS, Nejad B, Wilson M, Ferguson L. 2485 Identifying Barriers for Same-Day Discharge of Minimally Invasive Hysterectomies. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Palar K, Lemus Hufstedler E, Hernandez K, Chang A, Ferguson L, Lozano R, Weiser SD. Nutrition and Health Improvements After Participation in an Urban Home Garden Program. J Nutr Educ Behav 2019; 51:1037-1046. [PMID: 31601420 PMCID: PMC6949143 DOI: 10.1016/j.jneb.2019.06.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 05/18/2023]
Abstract
OBJECTIVE To elucidate the perceived health benefits of an urban home gardening and nutritional education program in a population at high cardiometabolic risk. DESIGN Qualitative data collected via in-depth, semistructured interviews in Spanish or English. SETTING Community-based program offering supported urban home gardening together with nutrition education in Santa Clara County, CA. PARTICIPANTS A total of 32 purposively sampled low-income participants in an urban home gardening program. Participants were primarily female (n = 24) and Latino/a (n = 22). PHENOMENON OF INTEREST Perceptions of the nutrition and health benefits of education-enhanced urban home gardening. ANALYSIS Bilingual researchers coded transcripts using a hybrid inductive and deductive approach. Two coders double coded at intervals, independently reviewed coding reports, organized content into key themes, and selected exemplary quotations. RESULTS The most salient perceived impacts were greater food access, increased consumption of fresh produce, a shift toward home cooking, and decreased fast food consumption. Participants attributed these changes to greater affordability, freshness, flavor, and convenience of their garden produce; increased health motivation owing to pride in their gardens; and improved nutritional knowledge. Participants also reported improved physical activity, mental health, and stress management; some reported improved weight and adherence to diabetes-healthy diets. CONCLUSIONS AND IMPLICATIONS Education-enhanced urban home gardening may facilitate multidimensional nutrition and health improvements in marginalized populations at high cardiometabolic risk.
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Affiliation(s)
- Kartika Palar
- Division of HIV, Infectious Disease, and Global Medicine, University of California, San Francisco, San Francisco, CA.
| | - Emiliano Lemus Hufstedler
- Division of HIV, Infectious Disease, and Global Medicine, University of California, San Francisco, San Francisco, CA; University of California, Berkeley-UCSF Joint Medical Program, School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Karen Hernandez
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Annie Chang
- University of California, Berkeley-UCSF Joint Medical Program, School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Laura Ferguson
- Global Health Sciences, University of California, San Francisco, San Francisco, CA
| | | | - Sheri D Weiser
- Division of HIV, Infectious Disease, and Global Medicine, University of California, San Francisco, San Francisco, CA; Institute for Global Health, Keck School of Medicine of the University of Southern California, Los Angeles, CA
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Ferraioli D, Ferguson L, Carberry M. Quality improvement project aimed at improving the reliability of spontaneous awakening trials in a district general intensive care unit. BMJ Open Qual 2019; 8:e000518. [PMID: 31206059 PMCID: PMC6542449 DOI: 10.1136/bmjoq-2018-000518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/21/2018] [Accepted: 04/24/2019] [Indexed: 01/02/2023] Open
Abstract
Traditionally regarded as good practice, continuous infusions of sedation and analgesic medications are used to reduce anxiety and distress and facilitate care of mechanically ventilated patients in the intensive care unit (ICU). Growing evidence has demonstrated that use of such infusions prolongs days spent invasively ventilated, increases the incidence of ICU acquired weakness and delirium and subsequently increasing the duration of their ICU and hospital stay. Several critical care guidelines recommend titrating to light sedation ±a daily sedation hold or spontaneous awakening trial (SAT). Given the known beneficial effects of sedation holds, we aimed to increase their use within our ICU, a 10-bedded unit with mixed ICU and high-ependency unit facilities in National Health Service Scotland. A retrospective case note review was performed to obtain baseline data of SAT eligible patients who received a sedation hold. The model for improvement 1 was used to implement an ICU protocol based on the ‘Wake up and breath’ guidelines 2 and measure the improvements made. The median percentage of SAT eligible patients that received a sedation hold increased from 47% to 96% during the project period. No significant adverse events were reported during this period and a reduction in ventilation and unit stay was observed. Quality improvement methods have facilitated successful and safe integration of a daily sedation hold protocol in our ICU.
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Abstract
Understanding the user, the health system, and the environment is key to ensuring that self care interventions for sexual and reproductive health are not only available but safe and empowering for all, say Laura Ferguson and colleagues
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Affiliation(s)
- Laura Ferguson
- Keck School of Medicine of the University of Southern California, Institute on Inequalities in Global Health, Los Angeles, California, USA
| | - Susana Fried
- Yale Law School, Global Health Justice Partnership, New Haven, Connecticut, USA
| | - Thabo Matsaseng
- Reproductive Medicine Unit, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Sundari Ravindran
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Sofia Gruskin
- Keck School of Medicine of the University of Southern California, Institute on Inequalities in Global Health, Los Angeles, California, USA
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