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Adamu AA, Ndwandwe D, Jalo RI, Wiysonge CS. Positioning implementation science in national immunization programmes to improve coverage equity and advance progress toward Immunization Agenda 2030: An urgent global health imperative. Hum Vaccin Immunother 2024; 20:2331872. [PMID: 38556477 PMCID: PMC10984125 DOI: 10.1080/21645515.2024.2331872] [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: 02/14/2024] [Accepted: 03/14/2024] [Indexed: 04/02/2024] Open
Abstract
Despite the availability of effective vaccines for preventing common childhood infectious diseases, there is still significant disparities in access and utilization across many low- and middle-income countries (LMIC). The factors that drive these disparities are often multilevel, originating from individuals, health facilities, health systems and communities, and also multifaceted. Implementation science has emerged as a field to help address "know-do" gaps in health systems, and can play a significant role in strengthening immunization systems to understand and solve implementation barriers that limit access and uptake within their contexts. This article presents a reflexive perspective on how to position implementation research in immunization programmes to improve coverage equity. Furthermore, key points of synergy between implementation research and vaccination are highlighted, and some potential practice changes that can be applied within specific contexts were proposed. Using a human rights lens, it was concluded that the cost that is associated with implementation failure in immunization programmes is significant and unjust, and future directions for implementation research to optimize its application in practice settings have been recommended.
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Affiliation(s)
- Abdu A. Adamu
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Rabiu I. Jalo
- Department of Community Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Vaccine-Preventable Diseases Programme, World Health Organization Regional Office for Africa, Brazzaville, Congo
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Rahman F, Bhat V, Ozair A, Detchou DKE, Ahluwalia MS. Financial barriers and inequity in medical education in India: challenges to training a diverse and representative healthcare workforce. Med Educ Online 2024; 29:2302232. [PMID: 38194431 PMCID: PMC10778416 DOI: 10.1080/10872981.2024.2302232] [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] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 01/02/2024] [Indexed: 01/11/2024]
Abstract
India has been historically challenged by an insufficient and heterogeneously clustered distribution of healthcare infrastructure. While resource-limited healthcare settings, such as major parts of India, require multidisciplinary approaches for improvement, one key approach is the recruitment and training of a healthcare workforce representative of its population. This requires overcoming barriers to equity and representation in Indian medical education that are multi-faceted, historical, and rooted in inequality. However, literature is lacking regarding the financial or economic barriers, and their implications on equity and representation in the Indian allopathic physician workforce, which this review sought to describe. Keyword-based searches were carried out in PubMed, Google Scholar, and Scopus in order to identify relevant literature published till November 2023. This state-of-the-art narrative review describes the existing multi-pronged economic barriers, recent and forthcoming changes deepening these barriers, and how these may limit opportunities for having a diverse workforce. Three sets of major economic barriers exist to becoming a specialized medical practitioner in India - resources required to get selected into an Indian medical school, resources required to pursue medical school, and resources required to get a residency position. The resources in this endeavor have historically included substantial efforts, finances, and privilege, but rising barriers in the medical education system have worsened the state of inequity. Preparation costs for medical school and residency entrance tests have risen steadily, which may be further exacerbated by recent major policy changes regarding licensing and residency selection. Additionally, considerable increases in direct and indirect costs of medical education have recently occurred. Urgent action in these areas may help the Indian population get access to a diverse and representative healthcare workforce and also help alleviate the shortage of primary care physicians in the country. Discussed are the reasons for rural healthcare disparities in India and potential solutions related to medical education.
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Affiliation(s)
- Faique Rahman
- Faculty of Medicine, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University (AMU), Aligarh, UP, India
| | - Vivek Bhat
- St. John’s Medical College, Bangalore, KA, India
| | - Ahmad Ozair
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Faculty of Medicine, King George’s Medical University, Lucknow, UP, India
| | - Donald K. E. Detchou
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Manmeet S. Ahluwalia
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
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Khisa AM, Wao H, Brizuela V, Compaoré R, Baguiya A, López Gómez A, Bonet M, Kouanda S, Thorson A, Gitau E. Embedding research capacity strengthening in multi-country studies in low-and middle-income countries: learnings from sexual and reproductive health research. Glob Health Action 2024; 17:2338634. [PMID: 38607331 PMCID: PMC11018088 DOI: 10.1080/16549716.2024.2338634] [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: 10/02/2023] [Accepted: 03/31/2024] [Indexed: 04/13/2024] Open
Abstract
Research capacity strengthening (RCS) can empower individuals, institutions, networks, or countries to define and prioritize problems systematically; develop and scientifically evaluate appropriate solutions; and reinforce or improve capacities to translate knowledge into policy and practice. However, how to embed RCS into multi-country studies focusing on sexual and reproductive health and rights (SRHR) is largely undocumented. We used findings from a qualitative study, from a review of the literature, and from a validation exercise from a panel of experts from research institutions that work on SRHR RCS. We provide a framework for embedded RCS; suggest a set of seven concrete actions that research project planners, designers, implementers, and funders can utilise to guide embedded RCS activities in low- and middle-income countries; and present a practical checklist for planning and assessing embedded RCS in research projects.
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Affiliation(s)
- Anne M. Khisa
- Capacity Strengthening and SRHR Research, African Population and Health Research Center, Nairobi, Kenya
| | - Hesborn Wao
- Capacity Strengthening and SRHR Research, African Population and Health Research Center, Nairobi, Kenya
| | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rachidatou Compaoré
- Department of Biomedical and Public Health, Research Institute for Health Sciences, Ouagadougou, Burkina Faso
| | - Adama Baguiya
- Department of Biomedical and Public Health, Research Institute for Health Sciences, Ouagadougou, Burkina Faso
| | | | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Seni Kouanda
- Department of Biomedical and Public Health, Research Institute for Health Sciences, Ouagadougou, Burkina Faso
- African Institute of Public Health, Ouagadougou, Burkina Faso
| | - Anna Thorson
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Evelyn Gitau
- Capacity Strengthening and SRHR Research, African Population and Health Research Center, Nairobi, Kenya
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Wicaksana AL, Hertanti NS. A scoping review of Islamic pilgrimage to Mecca: Mapping the health concerns and proposed solutions. Public Health Nurs 2024; 41:487-502. [PMID: 38468445 DOI: 10.1111/phn.13299] [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: 05/23/2023] [Revised: 12/15/2023] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVES To map the current evidence about the health concerns and the potential solutions related to the Islamic pilgrimage to Mecca. DESIGN A scoping review was applied. Papers published in English between 2012 and 2023 were included but non-human research and sources without any related data were excluded. Data charting and extraction were used to map the current evidence. RESULTS The total of 36 papers were included with the total number of pilgrims of 17,075,887. The majority of studies were published in the Asia Pacific region (36.11%) as original articles (88.89%). The health concerns were grouped into five main aspects. There were 7603 deaths recorded or about 44 incidences of deaths per 100,000 pilgrims during the pilgrimage. There were recorded 11,018; 6178; 3393; and 17,810 cases for communicable diseases; non-communicable diseases; injuries and trauma; and health services (i.e., cardiac catheterization) and vaccination, respectively. CONCLUSION Relating to the five health concerns, this study identified the top seven issues in each category (i.e., hypertension, influenza vaccination), except for the death record. Moreover, there were three solutions (for general health, non- and communicable-diseases) presented. Stakeholders could use this evidence to improve healthcare quality particularly related to the annual Islamic pilgrimage to Mecca.
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Affiliation(s)
- Anggi Lukman Wicaksana
- Department of Medical Surgical Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- The Sleman Health and Demographic Surveillance System, Universitas Gadjah Mada, Yogyakarta, Indonesia
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan
| | - Nuzul Sri Hertanti
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan
- Center for Tropical Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Del Bianco T, Haartsen R, Mason L, Leno VC, Springer C, Potter M, Mackay W, Smit P, Plessis CD, Brink L, Johnson MH, Murphy D, Loth E, Odendaal H, Jones EJH. The importance of decomposing periodic and aperiodic EEG signals for assessment of brain function in a global context. Dev Psychobiol 2024; 66:e22484. [PMID: 38528816 DOI: 10.1002/dev.22484] [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: 12/20/2022] [Revised: 01/31/2024] [Accepted: 02/26/2024] [Indexed: 03/27/2024]
Abstract
Measures of early neuro-cognitive development that are suitable for use in low-resource settings are needed to enable studies of the effects of early adversity on the developing brain in a global context. These measures should have high acquisition rates and good face and construct validity. Here, we investigated the feasibility of a naturalistic electroencephalography (EEG) paradigm in a low-resource context during childhood. Additionally, we examined the sensitivity of periodic and aperiodic EEG metrics to social and non-social stimuli. We recorded simultaneous 20-channel EEG and eye-tracking in 72 children aged 4-12 years (45 females) while they watched videos of women singing nursery rhymes and moving toys, selected to represent familiar childhood experiences. These measures were part of a feasibility study that assessed the feasibility and acceptability of a follow-up data collection of the South African Safe Passage Study, which tracks environmental adversity and brain and cognitive development from before birth up until childhood. We examined whether data quantity and quality varied with child characteristics and the sensitivity of varying EEG metrics (canonical band power in the theta and alpha band and periodic and aperiodic features of the power spectra). We found that children who completed the EEG and eye-tracking assessment were, in general, representative of the full cohort. Data quantity was higher in children with greater visual attention to the stimuli. Out of the tested EEG metrics, periodic measures in the theta frequency range were most sensitive to condition differences, compared to alpha range measures and canonical and aperiodic EEG measures. Our results show that measuring EEG during ecologically valid social and non-social stimuli is feasible in low-resource settings, is feasible for most children, and produces robust indices of social brain function. This work provides preliminary support for testing longitudinal links between social brain function, environmental factors, and emerging behaviors.
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Affiliation(s)
- Teresa Del Bianco
- Centre for Brain and Cognitive Development, Birkbeck University of London, London, UK
| | - Rianne Haartsen
- Centre for Brain and Cognitive Development, Birkbeck University of London, London, UK
| | - Luke Mason
- Centre for Brain and Cognitive Development, Birkbeck University of London, London, UK
- Institute of Psychiatry, Psychology & Neuroscience, King's College, London, London, UK
| | - Virginia Carter Leno
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Cilla Springer
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Mandy Potter
- Department of Obstetrics and Gynaecology, Stellenbosch University, Cape Town, South Africa
| | - Wendy Mackay
- Department of Obstetrics and Gynaecology, Stellenbosch University, Cape Town, South Africa
| | - Petrusa Smit
- Department of Obstetrics and Gynaecology, Stellenbosch University, Cape Town, South Africa
| | - Carlie Du Plessis
- Department of Obstetrics and Gynaecology, Stellenbosch University, Cape Town, South Africa
| | - Lucy Brink
- Department of Obstetrics and Gynaecology, Stellenbosch University, Cape Town, South Africa
| | - Mark H Johnson
- Centre for Brain and Cognitive Development, Birkbeck University of London, London, UK
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Declan Murphy
- Institute of Psychiatry, Psychology & Neuroscience, King's College, London, London, UK
| | - Eva Loth
- Institute of Psychiatry, Psychology & Neuroscience, King's College, London, London, UK
| | - Hein Odendaal
- Department of Obstetrics and Gynaecology, Stellenbosch University, Cape Town, South Africa
| | - Emily J H Jones
- Centre for Brain and Cognitive Development, Birkbeck University of London, London, UK
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Strahan AG, Casas CG, Prasad S, Fuller LC, Peebles K, Carugno A, Leslie KS, Harp JL, Pumnea T, McMahon DE, Rosenbach M, Lubov JE, Chen G, Pacheco AM, Fox LP, McMillen A, Lim HW, Stratigos AJ, Cronin TA, Kaufmann MD, Hruza GJ, French LE, Freeman EE. HIV and mpox: Evaluation of clinical course and outcomes from an international dermatologic registry. J Am Acad Dermatol 2024; 90:1011-1013. [PMID: 38157988 DOI: 10.1016/j.jaad.2023.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Alexis G Strahan
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Mercer University School of Medicine, Savannah, Georgia
| | - Cristina Galvan Casas
- University Hospital Mostoles, Madrid, Spain; Fundación Lluita contra les infeccions, Hospital Germans Trias i Puyol, Badalona, Barcelona, Spain
| | - Sonya Prasad
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Icahn School of Medicine, The Mount Sinai Hospital, New York, New York
| | - Lucinda Claire Fuller
- Chelsea and Westminster NHS Foundation Trust, London, United Kingdom; International Foundation for Dermatology, London, United Kingdom
| | - Klint Peebles
- Department of Dermatology, Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland
| | - Andrea Carugno
- Dermatology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy; Ph.D. Program in Molecular and Translational Medicine (DIMET), University of Milan-Bicocca, Milan, Italy
| | - Kieron S Leslie
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Joanna L Harp
- Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Teodora Pumnea
- Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany
| | - Devon E McMahon
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Misha Rosenbach
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Janet E Lubov
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Geoffrey Chen
- Medical Practice Evaluation Foundation, Massachusetts General Hospital, Boston, Massachusetts
| | - Ann M Pacheco
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Lindy P Fox
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | | | - Henry W Lim
- Department of Dermatology, Henry Ford Health, Detroit, Michigan
| | - Alexander J Stratigos
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Terrence A Cronin
- University of Miami Department of Dermatology and Cutaneous Surgery, Melbourne, Florida
| | - Mark D Kaufmann
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - George J Hruza
- Department of Dermatology, Saint-Louis University, Saint-Louis, Missouri
| | - Lars E French
- Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany; Dr. Philip Frost, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Esther E Freeman
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; International Foundation for Dermatology, London, United Kingdom; Medical Practice Evaluation Foundation, Massachusetts General Hospital, Boston, Massachusetts.
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Reger C, Leitzmann MF, Rohrmann S, Kühn T, Sedlmeier AM, Jochem C. Sustainable diets and risk of overweight and obesity: A systematic review and meta-analysis. Obes Rev 2024; 25:e13707. [PMID: 38343095 DOI: 10.1111/obr.13707] [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: 08/28/2023] [Revised: 01/08/2024] [Accepted: 01/13/2024] [Indexed: 04/18/2024]
Abstract
Sustainable diets are gaining interest as a possible approach to tackle climate change and the global extent of obesity. Yet, the association between sustainable diets and adiposity remains unclear. We performed a systematic review and meta-analysis, calculating summary relative risks and 95% confidence intervals (CI). We pooled maximally adjusted risk estimates, assessed heterogeneity and publication bias, calculated the E-value, and evaluated the risk of bias across the included studies. A total of eight studies were eligible for analysis. Comparing the highest versus the lowest levels of adherence to sustainable diets, the pooled effect estimate was 0.69 (95% CI = 0.62-0.76) for overweight and 0.61 (95% CI = 0.47-0.78) for obesity. These results suggest that sustainable diets may decrease the risk of overweight/obesity and therefore could serve as enablers for improving both public and planetary health. An agreed-upon clear definition of sustainable diets would enhance the comparability of future studies in this area.
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Affiliation(s)
- Christoph Reger
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Michael F Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Tilman Kühn
- Center for Public Health, Medical University of Vienna, Vienna, Austria
- Department of Nutritional Sciences, University of Vienna, Vienna, Austria
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
- Institute of Global Food Security (IGFS), Queen's University Belfast, Belfast, UK
| | - Anja M Sedlmeier
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
- Center for Translational Oncology, University Hospital, Regensburg, Regensburg, Germany
- Bavarian Cancer Research Center (BZKF), Regensburg, Germany
| | - Carmen Jochem
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
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8
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Huang W, Chen J, Zheng L, Shi G, Feng Y. Factors affecting nurses' emergency competencies in public health emergency: A cross-sectional study based on the stress-coping adaptation model. Public Health Nurs 2024; 41:617-625. [PMID: 38556918 DOI: 10.1111/phn.13309] [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: 10/05/2023] [Revised: 02/25/2024] [Accepted: 03/01/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVES To investigate the factors associated with stress, resilience, coping styles, and emergency competencies when nurses are faced with a public health emergency. DESIGN This study used a cross-sectional design. SAMPLE Study data came from a survey of 646 nurses who were from a tertiary hospital in Southern China in March-June 2022. METHODS Participants responded to self-report questionnaires through a web-based survey. Stress, resilience, emergency competencies, and response to public emergencies were assessed using the Perceived Stress Scale, Connor-Davidson Resilience Scale, the core competencies of nurses in public health emergencies, and a simplified coping style questionnaire. RESULTS A total of 646 nurses participated in this study. Slightly over half of the participants were ≤30 years old, and almost all were female. Resilience, positive coping, and negative coping were positively correlated with emergency competencies. Multiple linear regression analysis demonstrated that resilience, working years, and participation in the treatment of infectious diseases were significant predictors of emergency competencies. CONCLUSION The findings suggest that nurses require additional training in emergency management and clinical practice to enhance their emergency competencies. More interventions and social support should be provided to improve nurses' resilience and positive coping strategies when they encounter public health emergencies.
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Affiliation(s)
- Wanmin Huang
- Nursing Department, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
- Department of Oncology, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Jinyu Chen
- Human Resources Department, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Lijiao Zheng
- Nursing Department, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Guang Shi
- Geriatrics Department, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Yanying Feng
- Nursing Department, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
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Prasad K, Peterson N, Nolen D, Macharia C, Mannion K, Rohde S, Sinard R. Building a sustainable free flap program in a resource-limited setting: A 12-year humanitarian effort. Head Neck 2024; 46:1051-1055. [PMID: 38233973 DOI: 10.1002/hed.27640] [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: 11/25/2023] [Revised: 01/01/2024] [Accepted: 01/02/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND We present a sustainable complex reconstructive program built through 12 years of surgical outreach work at Kijabe Hospital in Kenya. METHODS Retrospective chart review and anecdotal experiences. RESULTS In 2011, surgeons from a US-medical center performed Kijabe Hospital's first 3 successful free flap surgeries. Since then, they have returned 7 times, performing a total of 31 tumor excisions with microvascular reconstruction. One flap failure occurred that was reconstructed on a subsequent trip. In 2013, a US-trained missionary surgeon and a Kenyan-trained general surgeon began working with the visiting team with the goal of performing these surgeries independently. In 2016 they performed their first independent free flap reconstruction and have since performed 32 independent cases with only three flap losses. Establishing infrastructure, staff education, selective patient criteria, and continuous communication are the factors that enabled the success of this program. CONCLUSIONS Establishing a successful microvascular reconstruction program in a resource-limited setting is feasible.
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Affiliation(s)
- Kavita Prasad
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, USA
| | - Nathaniel Peterson
- Department of Otolaryngology - Head and Neck Surgery, Loma Linda University, Loma Linda, California, USA
| | - David Nolen
- Austin Ear, Nose, and Throat Clinic, Austin, Texas, USA
| | - Chege Macharia
- Department of Head and Neck Oncologic and Trauma Surgery, AIC Kijabe Hospital, Kijabe, Kenya
| | - Kyle Mannion
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, USA
| | - Sarah Rohde
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, USA
| | - Robert Sinard
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, USA
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10
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Kilpatrick C, Tartari E, Deeves M, Pittet D, Allegranzi B. World Health Organization World Hand Hygiene Day, 5 May 2024. SAVE LIVES: Clean Your Hands campaign: Promoting knowledge and capacity building on infection prevention and control, including hand hygiene, among health and care workers. J Infect Prev 2024; 25:49-50. [PMID: 38584712 PMCID: PMC10998551 DOI: 10.1177/17571774241239044] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 04/09/2024] Open
Abstract
The World Health Organization's (WHO) World Hand Hygiene Day continues to "bring people together and accelerate hand hygiene action at the point of care in health care to contribute to a reduction in health care-associated infections and the achievement of safer, quality health care for all."
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Affiliation(s)
- Claire Kilpatrick
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, World Health Organization (WHO), Geneva, Switzerland
| | - Ermira Tartari
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, World Health Organization (WHO), Geneva, Switzerland
| | - Miranda Deeves
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, World Health Organization (WHO), Geneva, Switzerland
| | - Didier Pittet
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Benedetta Allegranzi
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, World Health Organization (WHO), Geneva, Switzerland
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Santos GRDS, Ribeiro CJN, Lima SVMA, Neto JC, de Sousa AR, Bulcao CDS, Dellagostini PG, Batista OMA, de Oliveira LB, Mendes IAC, de Sousa ÁFL. Chemsex among men who have sex with men during the Mpox health crisis in Brazil: A nationwide web survey. Public Health Nurs 2024; 41:589-601. [PMID: 38528749 DOI: 10.1111/phn.13308] [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: 08/10/2023] [Revised: 02/26/2024] [Accepted: 03/01/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVE To understand the factors associated with the practice of chemsex among MSM in Brazil, especially during the Mpox health crisis, and to design effective prevention and intervention strategies specifically for this population. DESIGN A cross-sectional and analytical study using an electronic survey, conducted from September to December 2022, during the peak of the Mpox outbreak in Brazil. SAMPLE A total of 1452 MSM aged 18 and older. MEASUREMENTS Data were collected via the REDCap platform through a survey with 46 questions. These addressed demographic data, sexual affiliations, practices, experiences with Mpox, healthcare service usage, and stigma or fear related to Mpox. RESULTS The prevalence of chemsex was 19.42% (n = 282). Multivariate Poisson modeling indicated a high incidence of chemsex among those diagnosed with Mpox and those involved in high-risk behaviors. The practice of chemsex was six times higher among those diagnosed with Mpox (95% CI: 4.73-9.10). MSM who engage in bugchasing had a prevalence twice that of the main outcome (95% CI: 1.31-3.16). CONCLUSION There is a significant need for targeted interventions for MSM in Brazil, especially given the Mpox outbreak. This study highlights the strong relationships between chemsex, experiences with Mpox, and various sexual behaviors, underscoring the importance of effective public health initiatives.
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Affiliation(s)
| | - Caíque Jordan Nunes Ribeiro
- Graduate Program in Nursing, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
- Departament of Nursing, Federal University of Sergipe, Lagarto, Sergipe, Brazil
| | - Shirley Verônica Melo Almeida Lima
- Graduate Program in Nursing, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
- Departament of Nursing, Federal University of Sergipe, Lagarto, Sergipe, Brazil
| | - João Cruz Neto
- University for International Integration of the Afro-Brazilian Lusophony, Redenção, Ceará, Brazil
| | | | | | | | | | - Layze Braz de Oliveira
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Álvaro Francisco Lopes de Sousa
- NOVA National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
- Institute of Teaching and Research, Sírio-Libanese Hospital, São Paulo, São Paulo, Brazil
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12
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Abimbola S, van de Kamp J, Lariat J, Rathod L, Klipstein-Grobusch K, van der Graaf R, Bhakuni H. Unfair knowledge practices in global health: a realist synthesis. Health Policy Plan 2024:czae030. [PMID: 38642401 DOI: 10.1093/heapol/czae030] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 04/22/2024] Open
Abstract
Unfair knowledge practices easily beset our efforts to achieve health equity within and between countries. Enacted by people from a distance and from a position of power ('the centre') on behalf of and alongside people with less power ('the periphery'), these unfair practices have generated a complex literature of complaints across various axes of inequity. We identified a sample of this literature from 12 journals, and systematised it using the realist approach to explanation. We framed the outcome to be explained as 'manifestations of unfair knowledge practices'; their generative mechanisms as 'the reasoning of individuals or rationale of institutions'; and context that enable them as 'conditions that give knowledge practices their structure'. We identified four categories of unfair knowledge practices, each triggered by three mechanisms: 1. credibility deficit related to pose (mechanisms: 'the periphery's cultural knowledge, technical knowledge, and 'articulation' of knowledge do not matter); 2. credibility deficit related to gaze (mechanisms: 'the centre's learning needs, knowledge platforms, and scholarly standards must drive collective knowledge-making'); 3.interpretive marginalisation related to pose (mechanisms: 'the periphery's sensemaking of partnerships, problems, and social reality do not matter'); and 4. interpretive marginalisation related to gaze (mechanisms: 'the centre's learning needs, social sensitivities and status-preservation must drive collective sensemaking'). Together, six mutually overlapping, reinforcing and dependent categories of context influence all 12 mechanisms: mislabelling (the periphery as inferior); miseducation (on structural origins of disadvantage); under-representation (of the periphery on knowledge platforms); compounded spoils (enjoyed by the centre); under-governance (in making, changing, monitoring, enforcing, and applying rules for fair engagement); and colonial mentality (of/at the periphery). These context-mechanism-outcome links can inform efforts to redress unfair knowledge practices; investigations of unfair knowledge practices across disciplines and axes of inequity; and ethics guidelines for health system research and practice when working at a social or physical distance.
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Affiliation(s)
- Seye Abimbola
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Judith van de Kamp
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Joni Lariat
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Lekha Rathod
- Luxembourg Operational Research Unit, Médecins Sans Frontières, Luxembourg City, Luxembourg
| | - Kerstin Klipstein-Grobusch
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Rieke van der Graaf
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Himani Bhakuni
- York Law School, University of York, York, United Kingdom
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13
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Cui Y, Peng S, Czaplicki L, Yang T. Protecting minors from tobacco products: public interest litigation enables enforcement in China. Tob Control 2024; 33:395-397. [PMID: 36137746 DOI: 10.1136/tc-2022-057615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/14/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Yuxian Cui
- Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sihui Peng
- School of Medicine, Jinan University, Guangzhou, China
| | - Lauren Czaplicki
- Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tingzhong Yang
- Women's Hospital/Center for Tobacco Control Research, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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14
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Hilker S, Mancho A, Srivatsava G, Raman D, Mathias S, Brewster R, Britto C. A Proof-of-Concept Model for Implementing a "Smart-NICU" to Improve Infant Mortality. J Intensive Care Med 2024:8850666241247532. [PMID: 38632953 DOI: 10.1177/08850666241247532] [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: 04/19/2024]
Abstract
Low- and middle-income countries face limited critical care capacity due to constraints in staffing, resources, and technology. "Smart ICUs" that integrate telehealth to augment care delivery, communication, and data integration have the potential to bridge these gaps and reduce preventable morbidity and mortality. While their efficacy has been well validated in adult populations, applications of Smart-ICU services in the neonatal population have not been studied. Neonatal intensive care units (NICUs) in India using a common Smart-NICU platform, developed by CloudPhysician, utilize a hub-and-spokes framework along with locally designed technology to facilitate remote patient care in collaboration with local health systems. In this article, we investigate the operational characteristics and performance outcomes for Smart-NICU deployment from the 18 NICUs and 214 beds deployed to date. These findings highlight the potential impact of Smart-NICUs and establish generalizable principles for implementation in low-resource settings.
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Affiliation(s)
| | | | | | - Dileep Raman
- Cloudphysician Healthcare Pvt. Ltd., Bangalore, Karnataka, India
| | | | | | - Carl Britto
- Division of Critical Care, Department of Anaesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
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15
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Jackman JM, Yibrehu B, Doyle A, Alatise OI, Wuraola FO, Olasehinde O, Peter Kingham T. Updates in global oncology: Advancements and future directions. J Surg Oncol 2024. [PMID: 38624014 DOI: 10.1002/jso.27633] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 04/17/2024]
Abstract
Globally, cancer is the second leading cause of death, and low- and middle-income countries bear most of the disease burden. While cancer is increasingly recognized as a major global health issue, more work remains. Understanding the status of global cancer care will shape the next steps in ensuring equitable global access to cancer care. This article highlights ongoing initiatives in global oncology and the next steps in advancing the field.
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Affiliation(s)
- Julia M Jackman
- Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Betel Yibrehu
- Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Alex Doyle
- Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Caribbean Colon Cancer Initiative, Bridgetown, Barbados
| | - Olusegun Isaac Alatise
- Surgery Department, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - Olalekan Olasehinde
- Surgery Department, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - T Peter Kingham
- Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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16
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Du Z, Wang L, Bai Y, Liu Y, Lau EHY, Galvani AP, Krug RM, Cowling BJ, Meyers LA. A retrospective cohort study of Paxlovid efficacy depending on treatment time in hospitalized COVID-19 patients. eLife 2024; 13:e89801. [PMID: 38622989 DOI: 10.7554/elife.89801] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 04/03/2024] [Indexed: 04/17/2024] Open
Abstract
Paxlovid, a SARS-CoV-2 antiviral, not only prevents severe illness but also curtails viral shedding, lowering transmission risks from treated patients. By fitting a mathematical model of within-host Omicron viral dynamics to electronic health records data from 208 hospitalized patients in Hong Kong, we estimate that Paxlovid can inhibit over 90% of viral replication. However, its effectiveness critically depends on the timing of treatment. If treatment is initiated three days after symptoms first appear, we estimate a 17% chance of a post-treatment viral rebound and a 12% (95% CI: 0%-16%) reduction in overall infectiousness for non-rebound cases. Earlier treatment significantly elevates the risk of rebound without further reducing infectiousness, whereas starting beyond five days reduces its efficacy in curbing peak viral shedding. Among the 104 patients who received Paxlovid, 62% began treatment within an optimal three-to-five-day day window after symptoms appeared. Our findings indicate that broader global access to Paxlovid, coupled with appropriately timed treatment, can mitigate the severity and transmission of SARS-Cov-2.
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Affiliation(s)
- Zhanwei Du
- Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Lin Wang
- Department of Genetics, University of Cambridge, Cambridge, United Kingdom
| | - Yuan Bai
- Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Yunhu Liu
- Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Eric H Y Lau
- Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale University, New Haven, United States
| | - Robert M Krug
- Department of Molecular Biosciences, The University of Texas at Austin, Austin, United States
| | | | - Lauren A Meyers
- Department of Integrative Biology, The University of Texas at Austin, Austin, United States
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17
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Cohen LE, Hansen CL, Andrew MK, McNeil SA, Vanhems P, Kyncl J, Domingo JD, Zhang T, Dbaibo G, Laguna-Torres VA, Draganescu A, Baumeister E, Gomez D, Raboni SM, Giamberardino HIG, Nunes MC, Burtseva E, Sominina A, Medić S, Coulibaly D, Salah AB, Otieno NA, Koul PA, Unal S, Tanriover MD, Mazur M, Bresee J, Viboud C, Chaves SS. Predictors of Severity of Influenza-Related Hospitalizations: Results From the Global Influenza Hospital Surveillance Network (GIHSN). J Infect Dis 2024; 229:999-1009. [PMID: 37527470 PMCID: PMC11011157 DOI: 10.1093/infdis/jiad303] [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: 02/18/2023] [Revised: 07/13/2023] [Accepted: 07/26/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND The Global Influenza Hospital Surveillance Network (GIHSN) has since 2012 provided patient-level data on severe influenza-like-illnesses from >100 participating clinical sites worldwide based on a core protocol and consistent case definitions. METHODS We used multivariable logistic regression to assess the risk of intensive care unit admission, mechanical ventilation, and in-hospital death among hospitalized patients with influenza and explored the role of patient-level covariates and country income level. RESULTS The data set included 73 121 patients hospitalized with respiratory illness in 22 countries, including 15 660 with laboratory-confirmed influenza. After adjusting for patient-level covariates we found a 7-fold increase in the risk of influenza-related intensive care unit admission in lower middle-income countries (LMICs), compared with high-income countries (P = .01). The risk of mechanical ventilation and in-hospital death also increased by 4-fold in LMICs, though these differences were not statistically significant. We also find that influenza mortality increased significantly with older age and number of comorbid conditions. Across all severity outcomes studied and after controlling for patient characteristics, infection with influenza A/H1N1pdm09 was more severe than with A/H3N2. CONCLUSIONS Our study provides new information on influenza severity in underresourced populations, particularly those in LMICs.
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Affiliation(s)
- Lily E Cohen
- Ready2Respond p/o The Task Force for Global Health, Decatur, Georgia, USA
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Chelsea L Hansen
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
- Brotman Baty Institute, University of Washington, Seattle, Washington, USA
- PandemiX Center, Department of Science & Environment, Roskilde University, Denmark
| | - Melissa K Andrew
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shelly A McNeil
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Jan Kyncl
- Department of Infectious Diseases Epidemiology, National Institute of Public Health, Prague, Czech Republic
- Department of Epidemiology and Biostatistics, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Javier Díez Domingo
- Fundación Para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO–Public Health), Valencia, Spain
| | - Tao Zhang
- School of Public Health, Fudan University, Shanghai, China
| | - Ghassan Dbaibo
- Center for Infectious Diseases Research, American University of Beirut, Beirut, Lebanon
| | | | - Anca Draganescu
- National Institute for Infectious Diseases “Prof Dr Matei Bals”, Bucharest, Romania
| | - Elsa Baumeister
- Respiratory Virus Laboratory, Virology Department, INEI-ANLIS, Buenos Aires, Argentina
| | - Doris Gomez
- Grupo de Investigación UNIMOL, Facultad de Medicina, Universidad de Cartagena, Cartagena de Indias, Colombia
| | - Sonia M Raboni
- Virology Laboratory, Infectious Diseases Division, Universidade Federal do Paraná, Hospital Pequeno Principe, Curitiba, Paraná, Brazil
| | - Heloisa I G Giamberardino
- Virology Laboratory, Infectious Diseases Division, Universidade Federal do Paraná, Hospital Pequeno Principe, Curitiba, Paraná, Brazil
| | - Marta C Nunes
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elena Burtseva
- Gamaleya Federal Research Center for Epidemiology and Microbiology, Ministry of Health of Russian Federation, Moscow, Russia
| | - Anna Sominina
- Smorodintsev Research Institute of Influenza, St Petersburg, Russia
| | - Snežana Medić
- Institute for Public Health of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | | | - Afif Ben Salah
- Institut Pasteur de Tunis, Tunis, Tunisia
- Arabian Gulf University, Manama, Bahrain
| | - Nancy A Otieno
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Parvaiz A Koul
- Sheri Kashmir Institute of Medical Sciences, Srinagar, India
| | - Serhat Unal
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
- Turkish Society of Internal Medicine, Ankara, Turkey
| | - Mine Durusu Tanriover
- Turkish Society of Internal Medicine, Ankara, Turkey
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Marie Mazur
- Ready2Respond p/o The Task Force for Global Health, Decatur, Georgia, USA
| | - Joseph Bresee
- Ready2Respond p/o The Task Force for Global Health, Decatur, Georgia, USA
| | - Cecile Viboud
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Sandra S Chaves
- Foundation for Influenza Epidemiology, Fondation de France, Paris, France
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18
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Lorenzo C, Azat B, Nurdin S, Aidilet O, Gulzada M, Talant S, Mauro M, Daniela LT. Sleep medicine in the Kyrgyz Republic: past, present and future. J Clin Sleep Med 2024. [PMID: 38602060 DOI: 10.5664/jcsm.11156] [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: 04/12/2024]
Abstract
As in many other low and middle income countries (LMICs) around the world, sleep disorders in the Kyrgyz Republic remain mostly undiagnosed and untreated. This article aims to describe the current state of practice of sleep medicine in the Kyrgyz Republic from the perspective of local and international healthcare workers who are active in the field and to propose a strategy to challenge the status quo. After interviewing local primary care and specialist doctors, we identified 3 major barriers to the practice of sleep medicine in the Kyrgyz Republic and namely education and training, financial constraints and infrastructure and equipment. We then propose a multistep strategy to improve the current situation based on 3 pillars: knowledge sharing, implementation research activities and policy changes. We conclude that despite being at its early days and facing major challenges, sleep health in the Kyrgyz Republic is being recognized as a priority by healthcare workers in the field and now requires attention at local and government level. Also, north-south academic partnerships represent an effective tool for knowledge sharing and should be further incentivized.
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Affiliation(s)
- Cirri Lorenzo
- Lane Fox Unit/Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK
- Swiss-Kyrgyz Research Initiative on Sleep Health, Bishkek, Kyrgyz Republic
- Neurocenter of the Southern Switzerland, University of Italian Switzerland, Lugano, Switzerland
| | - Bolotbek Azat
- National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
- Swiss-Kyrgyz Research Initiative on Sleep Health, Bishkek, Kyrgyz Republic
| | - Shakiev Nurdin
- National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
- Swiss-Kyrgyz Research Initiative on Sleep Health, Bishkek, Kyrgyz Republic
| | - Omuralieva Aidilet
- National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
- Swiss-Kyrgyz Research Initiative on Sleep Health, Bishkek, Kyrgyz Republic
| | - Mirzalieva Gulzada
- National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
- Swiss-Kyrgyz Research Initiative on Sleep Health, Bishkek, Kyrgyz Republic
| | - Sooronbaev Talant
- National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
- Swiss-Kyrgyz Research Initiative on Sleep Health, Bishkek, Kyrgyz Republic
| | - Manconi Mauro
- Neurocenter of the Southern Switzerland, University of Italian Switzerland, Lugano, Switzerland
| | - Latshang Tsogyal Daniela
- Dept. of Respiratory and Sleep Medicine, Cantonal Hospital of the Grisons, Teaching Hospital of the University Zurich, Chur, Switzerland
- Swiss-Kyrgyz Research Initiative on Sleep Health, Bishkek, Kyrgyz Republic
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O'Brien N, Fernandez Crespo R, O'Driscoll F, Prendergast M, Chana D, Darzi A, Ghafur S. Usability and Feasibility Evaluation of a Web-Based and Offline Cybersecurity Resource for Health Care Organizations (The Essentials of Cybersecurity in Health Care Organizations Framework Resource): Mixed Methods Study. JMIR Form Res 2024; 8:e50968. [PMID: 38603777 DOI: 10.2196/50968] [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] [Received: 08/04/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Cybersecurity is a growing challenge for health systems worldwide as the rapid adoption of digital technologies has led to increased cyber vulnerabilities with implications for patients and health providers. It is critical to develop workforce awareness and training as part of a safety culture and continuous improvement within health care organizations. However, there are limited open-access, health care-specific resources to help organizations at different levels of maturity develop their cybersecurity practices. OBJECTIVE This study aims to assess the usability and feasibility of the Essentials of Cybersecurity in Health Care Organizations (ECHO) framework resource and evaluate the strengths, weaknesses, opportunities, and threats associated with implementing the resource at the organizational level. METHODS A mixed methods, cross-sectional study of the acceptability and usability of the ECHO framework resource was undertaken. The research model was developed based on the technology acceptance model. Members of the Imperial College Leading Health Systems Network and other health care organizations identified through the research teams' networks were invited to participate. Study data were collected through web-based surveys 1 month and 3 months from the date the ECHO framework resource was received by the participants. Quantitative data were analyzed using R software (version 4.2.1). Descriptive statistics were calculated using the mean and 95% CIs. To determine significant differences between the distribution of answers by comparing results from the 2 survey time points, 2-tailed t tests were used. Qualitative data were analyzed using Microsoft Excel. Thematic analysis used deductive and inductive approaches to capture themes and concepts. RESULTS A total of 16 health care organizations participated in the study. The ECHO framework resource was well accepted and useful for health care organizations, improving their understanding of cybersecurity as a priority area, reducing threats, and enabling organizational planning. Although not all participants were able to implement the resource as part of information computing technology (ICT) cybersecurity activities, those who did were positive about the process of change. Learnings from the implementation process included the usefulness of the resource for raising awareness and ease of use based on familiarity with other standards, guidelines, and tools. Participants noted that several sections of the framework were difficult to operationalize due to costs or budget constraints, human resource limitations, leadership support, stakeholder engagement, and limited time. CONCLUSIONS The research identified the acceptability and usability of the ECHO framework resource as a health-focused cybersecurity resource for health care organizations. As cybersecurity in health care organizations is everyone's responsibility, there is potential for the framework resource to be used by staff with varied job roles. Future research needs to explore how it can be updated for ICT staff and implemented in practice and how educational materials on different aspects of the framework could be developed.
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Affiliation(s)
- Niki O'Brien
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | | | - Fiona O'Driscoll
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Mabel Prendergast
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Deeph Chana
- Institute for Security Science and Technology, Imperial College London, London, United Kingdom
| | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Saira Ghafur
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
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Troisi G, Small R, Chestnov R, Andreasyan D, Khachatryan H, Phillips EA, Malcolm T, Kol H, Khodjaeva N, Gebremichael M, Worku Tessema A, Workneh AB, Davidson T, Harris M, Ibraeva N, Nurmatova A, Altymysheva A, Go JJ, Kontsevaya A, Hanbunjerd K, Bunluesin S, Nieveras O, Ekinci B, Keskinkiliç B, Erguder T, Akiya OC, Kasule H, Nakanjako A, Shukurov S, Kasymova N, Banda P, Kakoma E, Bakyaita NN, Kulikov A, Tarlton D, Putoud N, Chiossi S, Webb D, Banatvala N. The reported impact of non-communicable disease investment cases in 13 countries. BMJ Glob Health 2024; 9:e014784. [PMID: 38599663 PMCID: PMC11015227 DOI: 10.1136/bmjgh-2023-014784] [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: 12/08/2023] [Accepted: 03/14/2024] [Indexed: 04/12/2024] Open
Abstract
Non-communicable diseases (NCDs) are a leading health and development challenge worldwide. Since 2015, WHO and the United Nations Development Programme have provided support to governments to develop national NCD investment cases to describe the socioeconomic dimensions of NCDs. To assess the impact of the investment cases, semistructured interviews and a structured process for gathering written feedback were conducted between July and October 2022 with key informants in 13 countries who had developed a national NCD investment case between 2015 and 2020. Investment cases describe: (1) the social and economic costs of NCDs, including their distribution and projections over time; (2) priority areas for scaled up action; (3) the cost and returns from investing in WHO-recommended measures to prevent and manage NCDs; and (4) the political dimensions of NCD responses. While no country had implemented all the recommendations set out in their investment case reports, actions and policy changes attributable to the investment cases were identified, across (1) governance; (2) financing; and (3) health service access and delivery. The pathways of these changes included: (1) stronger collaboration across government ministries and partners; (2) advocacy for NCD prevention and control; (3) grounding efforts in nationally owned data and evidence; (4) developing mutually embraced 'language' across health and finance; and (5) elevating the priority accorded to NCDs, by framing action as an investment rather than a cost. The assessment also identified barriers to progress on the investment case implementation, including the influence of some private sector entities on sectors other than health, the impact of the COVID-19 pandemic, and changes in senior political and technical government officials. The results suggest that national NCD investment cases can significantly contribute to catalysing the prevention and control of NCDs through strengthening governance, financing, and health service access and delivery.
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Affiliation(s)
- Giuseppe Troisi
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Roy Small
- United Nations Development Programme, New York, New York, USA
| | - Roman Chestnov
- International Telecommunication Union, Geneva, Switzerland
| | - Diana Andreasyan
- National Institute of Health/National Health Information Analytic Center, Ministry of Health of the Republic of Armenia, Yerevan, Armenia
| | | | | | - Taraleen Malcolm
- Pan American Health Organization, Washington, District of Columbia, USA
| | - Hero Kol
- Department of Preventive Medicine, Royal Government of Cambodia Ministry of Health, Phnom Penh, Cambodia
| | | | - Mussie Gebremichael
- Disease Prevention and Control Directorate, Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | | | | | | | - Michelle Harris
- Pan American Health Organization, Washington, District of Columbia, USA
| | - Nurgul Ibraeva
- Ministry of Health and Social Development of the Kyrgyz Republic, Bishkek, Kyrgyzstan
| | | | | | | | - Anna Kontsevaya
- National Research Center for Preventive Medicine, Ministry of Health of the Russian Federation, Moskva, Russian Federation
| | - Krisada Hanbunjerd
- Division of NCDs, Department of Disease Control, Royal Thai Government Ministry of Public Health, Bangkok, Thailand
| | | | | | - Banu Ekinci
- Republic of Türkiye Ministry of Health, Cankaya, Türkiye
| | | | | | - Oyoo Charles Akiya
- Department of NCDs, Republic of Uganda Ministry of Health, Kampala, Uganda
| | | | - Aidah Nakanjako
- United Nations Development Programme Uganda, Kampala, Uganda
| | - Shukhrat Shukurov
- Healthy Lifestyle and Physical Activity Support Center, Ministry of Health of the Republic of Uzbekistan, Tashkent, Uzbekistan
| | | | | | | | | | - Alexey Kulikov
- United Nations Inter-Agency Task Force on the Prevention and Control of NCDs, WHO, Geneva, Switzerland
| | - Dudley Tarlton
- Health and Development, United Nations Development Programme, Geneva, Switzerland
| | - Nadia Putoud
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Grand-Saconnex, Switzerland
| | - Scott Chiossi
- United Nations Inter-Agency Task Force on the Prevention and Control of NCDs, WHO, Geneva, Switzerland
| | | | - Nicholas Banatvala
- United Nations Inter-Agency Task Force on the Prevention and Control of NCDs, WHO, Geneva, Switzerland
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Kobayashi K, Umekawa Y. Successful Gastrografin Vermifugation for Taenia saginata-associated Appendicitis. Intern Med 2024:3582-24. [PMID: 38599859 DOI: 10.2169/internalmedicine.3582-24] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024] Open
Abstract
In Japan, public health improvements have lessened parasitic infections, but increased global travel has introduced new disease risks. We report the case a Japanese man who had previously resided in Vietnam, who experienced appendicitis and the presence of segments in his stool. Gastrografin led to the expulsion of Taenia saginata, as confirmed by scolex identification. Remarkably, the appendicitis symptoms subsided after deworming. This case underscores the importance of considering cestode infections in the differential diagnosis of appendicitis, particularly for patients with relevant travel histories, and highlights the evolving challenges in global health and the significance of acquiring detailed patient histories.
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Affiliation(s)
- Keigo Kobayashi
- Department of Internal Medicine, Kurashiki Medical Center, Japan
| | - Yasuhiro Umekawa
- Department of Internal Medicine, Kurashiki Medical Center, Japan
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22
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Murphy J. Transforming health science libraries around the globe: The impact of technology. Health Info Libr J 2024. [PMID: 38590212 DOI: 10.1111/hir.12527] [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] [Received: 03/12/2024] [Accepted: 03/26/2024] [Indexed: 04/10/2024]
Abstract
This article presents an analysis of seven articles published within the International Perspectives and Initiatives regular feature series on the impact of technology on the provision of health information. The articles provide a road map of how technology is facilitating new and enhanced services for library users in seven countries: Australia, Bangladesh, China, England, Germany, Sweden and the United States. Although there are differences in how countries are implementing technological solutions, only one describes problems in leveraging technology to improve library services. Authors from the remaining six countries describe how they ensure that the 21st century library consults with its user groups and find way of using the latest applications.
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23
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Zhang Y, Sun Y, Yu Q, Song S, Brenna JT, Shen Y, Ye K. Higher ratio of plasma omega-6/omega-3 fatty acids is associated with greater risk of all-cause, cancer, and cardiovascular mortality: A population-based cohort study in UK Biobank. eLife 2024; 12:RP90132. [PMID: 38578269 PMCID: PMC10997328 DOI: 10.7554/elife.90132] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Background Circulating omega-3 and omega-6 polyunsaturated fatty acids (PUFAs) have been associated with various chronic diseases and mortality, but results are conflicting. Few studies examined the role of omega-6/omega-3 ratio in mortality. Methods We investigated plasma omega-3 and omega-6 PUFAs and their ratio in relation to all-cause and cause-specific mortality in a large prospective cohort, the UK Biobank. Of 85,425 participants who had complete information on circulating PUFAs, 6461 died during follow-up, including 2794 from cancer and 1668 from cardiovascular disease (CVD). Associations were estimated by multivariable Cox proportional hazards regression with adjustment for relevant risk factors. Results Risk for all three mortality outcomes increased as the ratio of omega-6/omega-3 PUFAs increased (all Ptrend <0.05). Comparing the highest to the lowest quintiles, individuals had 26% (95% CI, 15-38%) higher total mortality, 14% (95% CI, 0-31%) higher cancer mortality, and 31% (95% CI, 10-55%) higher CVD mortality. Moreover, omega-3 and omega-6 PUFAs in plasma were all inversely associated with all-cause, cancer, and CVD mortality, with omega-3 showing stronger effects. Conclusions Using a population-based cohort in UK Biobank, our study revealed a strong association between the ratio of circulating omega-6/omega-3 PUFAs and the risk of all-cause, cancer, and CVD mortality. Funding Research reported in this publication was supported by the National Institute of General Medical Sciences of the National Institute of Health under the award number R35GM143060 (KY). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Affiliation(s)
- Yuchen Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, University of GeorgiaAthens, GeorgiaUnited States
| | - Yitang Sun
- Department of Genetics, University of GeorgiaAthens, GeorgiaUnited States
| | - Qi Yu
- Department of Biostatistics and Bioinformatics, Emory UniversityAtlanta, GeorgiaUnited States
| | - Suhang Song
- Department of Health Policy and Management, College of Public Health, University of GeorgiaAthens, GeorgiaUnited States
| | - J Thomas Brenna
- Division of Nutritional Sciences, Cornell UniversityIthaca, New YorkUnited States
- Dell Pediatric Research Institute and the Depts of Pediatrics, of Nutrition, and of Chemistry, University of Texas at AustinAustin, TexasUnited States
| | - Ye Shen
- Department of Epidemiology and Biostatistics, College of Public Health, University of GeorgiaAthens, GeorgiaUnited States
| | - Kaixiong Ye
- Department of Genetics, University of GeorgiaAthens, GeorgiaUnited States
- Institute of Bioinformatics, University of GeorgiaAthens, GeorgiaUnited States
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24
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Lee TL, Sawai T. Navigating equity in global access to genome therapy expanding access to potentially transformative therapies and benefiting those in need requires global policy changes. Front Genet 2024; 15:1381172. [PMID: 38638119 PMCID: PMC11024294 DOI: 10.3389/fgene.2024.1381172] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
In December 2023, the US Food and Drug Administration and the UK Medicines and Healthcare Products Regulatory Agency granted the first regulatory approval for genome therapy for sickle cell disease. This approval brings hope to those suffering from this debilitating genetic disease. However, several barriers may hinder global patient access, including high treatment costs, obtaining informed consent for minors, inadequate public health infrastructure, and insufficient regulatory oversight. These barriers reflect the structural inequalities inherent in global health governance, where patient access often depends on social and institutional arrangements. This article addresses concerns around informed consent, treatment costs, and patient access, and proposes corresponding policy reforms. We argue that these discussions should be framed within a broader global context that considers social and institutional structures, global research priorities, and a commitment to health equity.
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Affiliation(s)
- Tsung-Ling Lee
- Graduate Institute of Health and Biotechnology Law, Taipei Medical University, Taipei, Taiwan
| | - Tsutomu Sawai
- Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima, Japan
- Institute for the Advanced Study of Human Biology (ASHBi), Kyoto University, Kyoto, Japan
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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25
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Wutor BM, Osei I, Sarwar G, Adefila WO, Galega LB, Hossain I, Abdulsalam Y, Lamin KM, Baldeh AM, Barry B, Ezeani E, Mackenzie G. Under-5 mortality surveillance in low-income and middle-income countries: insights from two Health and Demographic Surveillance Systems in rural Gambia. BMJ Glob Health 2024; 9:e014937. [PMID: 38569661 PMCID: PMC10989099 DOI: 10.1136/bmjgh-2023-014937] [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: 12/29/2023] [Accepted: 03/14/2024] [Indexed: 04/05/2024] Open
Abstract
Without complete data on under-5 mortality, tracking progress towards achieving Sustainable Development Goal 3.2 will be challenging. Such data are also needed to ensure proper planning and prioritisation of scarce resources in low-income and middle-income countries. However, most low-income and middle-income countries have weak Civil Registration and Vital Statistics (CRVS) systems, leaving a critical gap in understanding under-5 mortality dynamics. This paper outlines a community-based approach to enhance under-5 mortality surveillance in low-income countries, using The Gambia as a case study. The methodology involves Health and Demographic Surveillance Systems (HDSSs) in Basse and Fuladu West, employing unique identification numbers, periodical household visits and collaboration with communities, village reporters and project field workers to ensure comprehensive data collection. Verbal autopsies (VAs) are conducted by trained field workers, and causes of death are determined using the physician-certified VA method. Between 1 September 2019 and 1 September 2023, 1333 deaths were detected, for which causes of death were determined for 97.1% (1294 of 1333). The most common causes of death detected were acute respiratory infections including pneumonia, sepsis, diarrhoeal diseases and birth asphyxia. Challenges include the cost of maintaining the HDSSs, poor road infrastructure, Electronic Data Capture transition challenges, and the need for national integration of HDSS data into the CRVS system. The success of this model highlights its potential for scalable and adaptable under-5 mortality surveillance in resource-limited settings.
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Affiliation(s)
- Baleng Mahama Wutor
- Disease Control and Elimination, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Isaac Osei
- Disease Control and Elimination, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Golam Sarwar
- Disease Control and Elimination, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Williams Oluwatosin Adefila
- Disease Control and Elimination, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Lobga Babila Galega
- Disease Control and Elimination, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Ilias Hossain
- Disease Control and Elimination, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Yusuf Abdulsalam
- Disease Control and Elimination, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Keita Modou Lamin
- Disease Control and Elimination, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Alhagie Muya Baldeh
- Disease Control and Elimination, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Basiru Barry
- Disease Control and Elimination, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Esu Ezeani
- Disease Control and Elimination, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Grant Mackenzie
- Disease Control and Elimination, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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26
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Wintrup J. Relational Harm: On the Divisive Effects of Global Health Volunteering at a Hospital in Rural Zambia. Med Anthropol 2024; 43:189-204. [PMID: 38436972 DOI: 10.1080/01459740.2024.2322435] [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: 03/05/2024]
Abstract
Drawing on ethnographic research at a hospital in rural Zambia, I show how the presence of white Christian medical volunteers from the United States damaged relations between local health workers and patients. Working from a position of economic and racial privilege, medical volunteers received praise from many patients and residents. However, these positive attitudes incited resentment among many Zambian health workers who felt that their own efforts and expertise were being undervalued or ignored. Focusing on these disrupted relationships, I argue that it is crucial to understand how global health volunteering can produce enduring forms of "relational harm".
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27
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Agarwal A, Tromp J, Almahmeed W, Angermann C, Chandramouli C, Cho H, Choi DJ, Damasceno A, Filippatos G, Fonarow GC, Harikrishnan S, Lund L, Masoudi F, Mensah GA, Pathan A, Perel P, Pinto F, Ribeiro AL, Rich S, Sakata Y, Sliwa K, Sundstrom J, Wong R, Yancy C, Yiu K, Zhang J, Zhang Y, Lam CSP, Roth GA. Toward a Universal Definition of Etiologies in Heart Failure: Categorizing Causes and Advancing Registry Science. Circ Heart Fail 2024; 17:e011095. [PMID: 38626067 PMCID: PMC11027941 DOI: 10.1161/circheartfailure.123.011095] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/26/2024] [Indexed: 04/18/2024]
Abstract
Heart failure (HF) is a well-described final common pathway for a broad range of diseases however substantial confusion exists regarding how to describe, study, and track these underlying etiologic conditions. We describe (1) the overlap in HF etiologies, comorbidities, and case definitions as currently used in HF registries led or managed by members of the global HF roundtable; (2) strategies to improve the quality of evidence on etiologies and modifiable risk factors of HF in registries; and (3) opportunities to use clinical HF registries as a platform for public health surveillance, implementation research, and randomized registry trials to reduce the global burden of noncommunicable diseases. Investment and collaboration among countries to improve the quality of evidence in global HF registries could contribute to achieving global health targets to reduce noncommunicable diseases and overall improvements in population health.
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Affiliation(s)
- Anubha Agarwal
- Washington University in St. Louis School of Medicine, MO (A.A.)
| | - Jasper Tromp
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System (J.T.)
| | - Wael Almahmeed
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates (W.A.)
| | - Christiane Angermann
- Comprehensive Heart Failure Center, University Hospital Wuerzburg, Germany (C.A.)
| | | | - Hyunjai Cho
- Seoul National University Hospital, Korea (H.C., D.-J.C.)
| | - Don-Ju Choi
- Seoul National University Hospital, Korea (H.C., D.-J.C.)
| | | | - Gerasimos Filippatos
- University of Cyprus, School of Medicine and National and Kapodistrian University of Athens, School of Medicine, Department of Cardiology, Attikon University Hospital, Greece (G.F.)
| | | | | | - Lars Lund
- Karolinska University Hospital, Stockholm, Sweden (L.L.)
| | - Fred Masoudi
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora (F.M.)
| | - George A Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.)
| | - Asad Pathan
- Tabba Heart Institute Karachi, Pakistan (A.P.)
| | - Pablo Perel
- London School of Hygiene and Tropical Medicine, United Kingdom (P.P.)
| | - Fausto Pinto
- Santa Maria University Hospital, University of Lisbon, Portugal (F.P.)
| | - Antonio Luiz Ribeiro
- Hospital das Clinicas and School of Medicine, Unversidade Federal de Minas Gerais, Belo Horizonte, Brazil (A.L.R.)
| | - Stuart Rich
- Northwestern University Feinberg School of Medicine, Chicago, IL (S.R., C.Y.)
| | - Yasuhiko Sakata
- Tohoku University Graduate School of Medicine, Sendai, Japan (Y.S.)
- National Cerebral and Cardiovascular Center, Suita, Japan (Y.S.)
| | - Karen Sliwa
- University of Cape Town, South Africa (K.S.)
| | | | - Renee Wong
- Heart Failure and Arrhythmias Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (R.W.)
| | - Clyde Yancy
- Northwestern University Feinberg School of Medicine, Chicago, IL (S.R., C.Y.)
| | - Kelvin Yiu
- Institute of Cardiovascular Science and Medicine, Hong Kong University, Hong Kong and Department of Medicine, University of Hong Kong-Shenzhen Hospital, China (K.Y.)
| | - Jian Zhang
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (J.Z., Y.Z.)
| | - Yuhui Zhang
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (J.Z., Y.Z.)
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore (C.S.P.L.)
- Duke-NUS Medical School, Singapore and University Medical Centre Groningen, the Netherlands (C.S.P.L.)
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28
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Lupieri A, S A Passos L, Levine RA, Nizet V, Aikawa E. Lymphangiogenesis in Rheumatic Heart Valve Disease: A New Factor in the Pathogenic Conundrum. Arterioscler Thromb Vasc Biol 2024; 44:822-825. [PMID: 38357818 PMCID: PMC10978236 DOI: 10.1161/atvbaha.124.320708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Affiliation(s)
- Adrien Lupieri
- The Center for Excellence in Vascular Biology, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.L., L.S.A.P., E.A.)
- Harvard Medical School, Boston, MA (A.L., L.S.A.P., R.A.L., E.A.)
| | - Livia S A Passos
- The Center for Excellence in Vascular Biology, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.L., L.S.A.P., E.A.)
- Harvard Medical School, Boston, MA (A.L., L.S.A.P., R.A.L., E.A.)
| | - Robert A Levine
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston, MA (R.A.L.)
- Harvard Medical School, Boston, MA (A.L., L.S.A.P., R.A.L., E.A.)
| | - Victor Nizet
- Department of Pediatrics and Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla (V.N.)
| | - Elena Aikawa
- The Center for Excellence in Vascular Biology, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.L., L.S.A.P., E.A.)
- Center for Interdisciplinary Cardiovascular Sciences, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (E.A.)
- Harvard Medical School, Boston, MA (A.L., L.S.A.P., R.A.L., E.A.)
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29
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Schroeder LF, Rebman P, Kasaie P, Kenu E, Zelner J, Dowdy D. A Generalizable Decision-Making Framework for Selecting Onsite versus Send-out Clinical Laboratory Testing. Med Decis Making 2024; 44:307-319. [PMID: 38449385 PMCID: PMC10987262 DOI: 10.1177/0272989x241232666] [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] [Indexed: 03/08/2024]
Abstract
BACKGROUND Laboratory networks provide services through onsite testing or through specimen transport to higher-tier laboratories. This decision is based on the interplay of testing characteristics, treatment characteristics, and epidemiological characteristics. OBJECTIVES Our objective was to develop a generalizable model using the threshold approach to medical decision making to inform test placement decisions. METHODS We developed a decision model to compare the incremental utility of onsite versus send-out testing for clinical purposes. We then performed Monte Carlo simulations to identify the settings under which each strategy would be preferred. Tuberculosis was modeled as an exemplar. RESULTS The most important determinants of the decision to test onsite versus send-out were the clinical utility lost due to send-out testing delays and the accuracy decrement with onsite testing. When the sensitivity decrements of onsite testing were minimal, onsite testing tended to be preferred when send-out delays reduced clinical utility by >20%. By contrast, when onsite testing incurred large reductions in sensitivity, onsite testing tended to be preferred when utility lost due to delays was >50%. The relative cost of onsite versus send-out testing affected these thresholds, particularly when testing costs were >10% of treatment costs. CONCLUSIONS Decision makers can select onsite versus send-out testing in an evidence-based fashion using estimates of the percentage of clinical utility lost due to send-out delays and the relative accuracy of onsite versus send-out testing. This model is designed to be generalizable to a wide variety of use cases. HIGHLIGHTS The design of laboratory networks, including the decision to place diagnostic instruments at the point-of-care or at higher tiers as accessed through specimen transport, can be informed using the threshold approach to medical decision making.The most important determinants of the decision to test onsite versus send-out were the clinical utility lost due to send-out testing delays and the accuracy decrement with onsite testing.The threshold approach to medical decision making can be used to compare point-of-care testing accuracy decrements with the lost utility of treatment due to send-out testing delays.The relative cost of onsite versus send-out testing affected these thresholds, particularly when testing costs were >10% of treatment costs.
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Affiliation(s)
- Lee F. Schroeder
- Department of Pathology, University of Michigan School of Medicine, USA
| | - Paul Rebman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
| | - Parastu Kasaie
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
| | - Ernest Kenu
- School of Public Health, University of Ghana, Ghana
| | - Jon Zelner
- Department of Epidemiology, University of Michigan School of Public Health, USA
- Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, USA
| | - David Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
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30
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Ho FDV, De Luna DV, Cubarrubias DLPF, Ong EP, Abello RMR, Ansay MFM, Taliño MKV, Robredo JPG, Eala MAB, Dee EC. Palliative and Supportive Care in the Philippines: Systems, Barriers, and Steps Forward. J Palliat Care 2024; 39:87-91. [PMID: 36740938 DOI: 10.1177/08258597231153381] [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: 02/07/2023]
Abstract
Although integral to alleviating serious health-related suffering, global palliative care remains systemically and culturally inaccessible to many patients living in low- and middle-income countries. In the Philippines, a lower-middle income country in Southeast Asia of over 110 million people, up to 75% of patients with cancer suffer from inadequate pain relief. We reviewed factors that preclude access to basic palliative care services in the Philippines. PubMed and Google Scholar were searched thoroughly; search terms included but were not limited to "palliative care," "supportive care," "end-of-life care," and "Philippines." We found that a limited palliative care workforce, high out-of-pocket healthcare costs, and low opioid availability all hinder access to palliative care in the archipelago. Religious fatalism, strong family-orientedness, and physician reluctance to refer to palliative care providers represent contributory sociocultural factors. Efforts to improve palliative care accessibility in the country must address health systems barriers while encouraging clinicians to discuss end-of-life options in a timely manner that integrates patients' unique individual, familial, and spiritual values. Research is needed to elucidate how Filipinos-and other global populations-view end-of-life, and how palliative care strategies can be individualised accordingly.
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Affiliation(s)
| | | | | | - Erika P Ong
- College of Medicine, University of the Philippines, Manila, Philippines
| | | | | | | | | | - Michelle Ann B Eala
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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31
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Nteyumwete H, Civantos AM, Stanford-Moore GB, Yau J, Tuyishimire G, Umutoni J, Nyabyenda V, Ncogoza I, Shaye DA. Factors Influencing Delay in Diagnosis of Head and Neck Cancer in Rwanda. Laryngoscope 2024; 134:1663-1669. [PMID: 37847111 DOI: 10.1002/lary.31103] [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: 05/22/2023] [Revised: 09/13/2023] [Accepted: 09/27/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVE Head and neck cancer is a significant contributor to global otolaryngologic disease burden, with a disproportionate impact on low- and middle-income countries. This study investigates the factors contributing to delays in head and neck cancer diagnosis at the University Teaching Hospital of Kigali (CHUK). METHODS Cross-sectional study of all patients with a pathologic diagnosis of head and neck cancer presenting to CHUK between January 2021 and June 2022. Sociodemographic data, tumor characteristics, and reasons for delay were collected. Univariate and multivariable analyses were undertaken to evaluate risk factors for delays. RESULTS Eighty-one patients met criteria for inclusion. Median duration from patient first reported symptoms to initial medical consultation was 52 weeks, from initial medical consultation to referral to CHUK was 4 weeks, and from referral to final pathologic diagnosis was 6 weeks. The most common reason for delay to referral to CHUK was financial (37.04%). Patients who visited traditional healers had higher odds of delay between symptom onset and medical consultation (OR 3.51, CI 1.05-11.70). Delays in final diagnosis after referral were most commonly due to OR availability for biopsy (37.04%) and time for pathology results after biopsy (35.80%). OR availability had a significant impact on duration to final diagnosis (OR 59.48, CI 7.17-493.67). Stage 4 disease had the shortest time to final diagnosis (OR 0.05, CI 0.01-0.45). CONCLUSION Understanding the reasons for delayed diagnosis of head and neck cancer may help guide improvements in care, with the goal of reducing global head and neck burden of disease. LEVEL OF EVIDENCE 3; prospective non-random follow-up study Laryngoscope, 134:1663-1669, 2024.
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Affiliation(s)
- Hirwa Nteyumwete
- Department of ENT, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Alyssa M Civantos
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Gaelen B Stanford-Moore
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Jenny Yau
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye & Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Gratien Tuyishimire
- Department of ENT, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Josiane Umutoni
- Department of ENT, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Victor Nyabyenda
- Department of ENT, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Isaie Ncogoza
- Department of ENT, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - David A Shaye
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye & Ear, Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
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Shlobin NA, Rosseau G. Opportunities and Considerations for the Incorporation of Artificial Intelligence into Global Neurosurgery: A Generative Pre-Trained Transformer Chatbot-Based Approach. World Neurosurg 2024:S1878-8750(24)00535-7. [PMID: 38561032 DOI: 10.1016/j.wneu.2024.03.149] [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] [Received: 02/29/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Global neurosurgery is a public health focus in neurosurgery that seeks to ensure safe, timely, and affordable neurosurgical care to all individuals worldwide. Although investigators have begun to explore the promise of AI for neurosurgery, its applicability to global neurosurgery has been largely hypothetical. We characterize opportunities and considerations for the incorporation of AI into global neurosurgery by synthesizing key themes yielded from a series of generative pre-trained transformers (GPTs), discuss important limitations of GPTs and cautions when using AI in neurosurgery, and develop a framework for the equitable incorporation of AI into global neurosurgery. METHODS ChatGPT, Bing Chat / Copilot, You, Perplexity.ai, and Google Bard were queried with the prompt "How can artificial intelligence be incorporated into global neurosurgery?". A layered ChatGPT-based thematic analysis was performed. The authors synthesized the results into opportunities and considerations for the incorporation of AI in global neurosurgery. A Pareto analysis was conducted to determine common themes. RESULTS Eight opportunities and fourteen important considerations were synthesized. Six opportunities related to patient care, one to education, and another to public health planning. Four of the important considerations were deemed specific to global neurosurgery. The Pareto analysis included all eight opportunities and five considerations. CONCLUSION AI may be incorporated into global neurosurgery in a variety of capacities requiring numerous considerations. The framework presented in this manuscript may facilitate the incorporation of AI into global neurosurgery initiatives while balancing contextual factors and the reality of limited resources.
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Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Gail Rosseau
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Barrow Global, Barrow Neurological Institute, Phoenix, Arizona, USA.
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Fenech A, Baatjes N, Gunasuntharam K. Fifteen-minute consultation: What paediatricians need to know about vaping. Arch Dis Child Educ Pract Ed 2024; 109:60-65. [PMID: 36600454 DOI: 10.1136/archdischild-2022-324752] [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: 08/05/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
The prevalence of vaping among children and young people (CYP) is on the rise. This is perhaps a result of perceiving vaping as 'harmless', especially after an extensive public acceptance through the UK Government's promotion of vaping in smoking cessation as well as lax regulations on advertisements. More awareness and research of the effects of vaping is necessary and a call for immediate public health strategies to be implemented in the UK. This article highlights essential facts about vaping, signs of addiction and cessation support for CYP as part of health promotion.
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Affiliation(s)
- Amanda Fenech
- Evelina London Community Services, Sunshine House, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Paediatric Department, Mater Dei Hospital, Msida, Malta
| | - Nikki Baatjes
- Evelina London Community Services, Sunshine House, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kavitha Gunasuntharam
- Evelina London Community Services, Sunshine House, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Paredes MI, Ahmed N, Figgins M, Colizza V, Lemey P, McCrone JT, Müller N, Tran-Kiem C, Bedford T. Underdetected dispersal and extensive local transmission drove the 2022 mpox epidemic. Cell 2024; 187:1374-1386.e13. [PMID: 38428425 PMCID: PMC10962340 DOI: 10.1016/j.cell.2024.02.003] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/15/2023] [Accepted: 02/02/2024] [Indexed: 03/03/2024]
Abstract
The World Health Organization declared mpox a public health emergency of international concern in July 2022. To investigate global mpox transmission and population-level changes associated with controlling spread, we built phylogeographic and phylodynamic models to analyze MPXV genomes from five global regions together with air traffic and epidemiological data. Our models reveal community transmission prior to detection, changes in case reporting throughout the epidemic, and a large degree of transmission heterogeneity. We find that viral introductions played a limited role in prolonging spread after initial dissemination, suggesting that travel bans would have had only a minor impact. We find that mpox transmission in North America began declining before more than 10% of high-risk individuals in the USA had vaccine-induced immunity. Our findings highlight the importance of broader routine specimen screening surveillance for emerging infectious diseases and of joint integration of genomic and epidemiological information for early outbreak control.
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Affiliation(s)
- Miguel I Paredes
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.
| | - Nashwa Ahmed
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA; Molecular and Cellular Biology Program, University of Washington, Seattle, WA, USA
| | - Marlin Figgins
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA; Department of Applied Mathematics, University of Washington, Seattle, WA, USA
| | - Vittoria Colizza
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, Paris, France
| | - Philippe Lemey
- Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, Leuven, Belgium
| | - John T McCrone
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Nicola Müller
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Cécile Tran-Kiem
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Trevor Bedford
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA; Howard Hughes Medical Institute, Seattle, WA, USA
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Osaigbovo II, Igbarumah IO, Obaseki DE. Instituting coronavirus disease 2019 testing: opportunities and challenges of molecular laboratory diagnosis in a Southern Nigerian teaching hospital. Int Health 2024:ihae023. [PMID: 38477188 DOI: 10.1093/inthealth/ihae023] [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] [Received: 10/22/2023] [Revised: 02/12/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
The coronavirus disease 2019 pandemic emphasised the importance of laboratory preparedness, including molecular diagnostic capacity, in the control of infectious disease outbreaks. This article reflects on diagnostic capacity-building opportunities presented by the pandemic, the challenges experienced along the way and the lessons learned from the perspective of a university teaching hospital in Southern Nigeria. We advocate for these lessons to inform strategic planning for laboratory preparedness at subnational, national and continental levels.
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Affiliation(s)
- Iriagbonse I Osaigbovo
- Departme nt of Medical Microbiology, School of Medicine, College of Medical Sciences, University of Benin, Benin City 300213, Edo state, Nigeria
- Department of Medical Microbiology, University of Benin Teaching Hospital, Benin City 300001, Edo state, Nigeria
| | - Isaac O Igbarumah
- Molecular Diagnostic and Virology Laboratory, University of Benin Teaching Hospital, Benin City 300001, Edo state, Nigeria
| | - Darlington E Obaseki
- Office of the Chief Medical Director, University of Benin Teaching Hospital, Benin City 300001, Edo state, Nigeria
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Cakouros BE, Gum J, Levine DL, Lewis J, Wright AH, Dahn B, Talbert-Slagle K. Exploring equity in global health collaborations: a qualitative study of donor and recipient power dynamics in Liberia. BMJ Glob Health 2024; 9:e014399. [PMID: 38485141 PMCID: PMC10946382 DOI: 10.1136/bmjgh-2023-014399] [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: 11/02/2023] [Accepted: 02/16/2024] [Indexed: 03/19/2024] Open
Abstract
IntroductionGlobal health collaborations between individuals from high-resource and low-resource settings are complex and often built on hierarchical structures and power differentials that are difficult to change. There have been many calls and frameworks developed to facilitate more equity within these collaborations, yet little is known about the lived experiences of global health donors and recipients working within such collaborations and how those experiences can facilitate more equitable collaboration. Liberia, a postconflict, post-Ebola country, provides an ideal setting to study lived experiences of global health collaborations.MethodsOur qualitative analysis used key informant interviews representing the perspectives of those working on behalf of the Liberian government, Liberian academics, foreign donors and non-governmental organisations and implementing partners. Thematic analysis guided this analysis to explore topics such as financial control, accountability and decision making.ResultsThe first phase of the analysis mapped the existing patterns of priority setting. Priority-setting power was most strongly held by those with financial control (donors), and implementation plans tended to be built on metrics that aim to meet donor expectations. The second phase of the analysis explored the interplay between underlying factors that we identified in our data associated with driving collaborative inequity: history of prior of engagement, level of transparency and patterns of accountability.ConclusionsOur findings highlight that global health collaborations in Liberia are structured to hinder equitable partnerships. The power structure tied to financial ownership offers little space for recipients to have an equitable role in collaborations, which maintains dependence on external aid and ensures that weak systems remain weak. While our study is limited to Liberia, we anticipate that these dynamics are common elsewhere and reinforce the importance of intentional efforts to ensure equitable decision making and power structures in similar settings worldwide.
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Affiliation(s)
| | | | | | | | | | - Bernice Dahn
- College of Health Sciences, University of Liberia, Monrovia, Liberia
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Omofoye TS, Rooney TB, Ganti R, Mvere M, Iqbal N, Musa B, Minja FJ. Designing a Collaborative Breast Radiology Training Program to Tackle Tanzania's Breast Cancer Crisis. J Am Coll Radiol 2024:S1546-1440(24)00277-1. [PMID: 38461915 DOI: 10.1016/j.jacr.2024.02.033] [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] [Received: 09/12/2023] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 03/12/2024]
Abstract
Breast cancer incidence and mortality continue to increase in Africa. In Tanzania, breast cancer is the second leading cause of cancer death for women, and breast cancer incidence and mortality are projected to increase by 80% by 2030. Education gaps among health care workers, delayed presentation, limited screening, and low health literacy all pose significant challenges to providing optimal breast cancer care. Considering these factors, it is imperative to train expert breast radiologists. We present a collaborative breast radiology training program in Tanzania aimed at building local capacity to address national breast cancer challenges. Although cancer control in Africa faces many challenges, developing customized training programs for breast radiology, in conjunction with national cancer programs, may represent a key strategy for addressing breast cancer.
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Affiliation(s)
- Toma S Omofoye
- Strategic Director of Education, Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston Texas.
| | - Timothy B Rooney
- Chief of Breast Imaging, Division of Breast Imaging, Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia
| | - Ramapriya Ganti
- Division of Breast Imaging, Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia
| | | | - Natasha Iqbal
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Balowa Musa
- Radiology and Imaging Department, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Frank J Minja
- Associate Chief of Radiology, and Medical Director Diagnostic Imaging Hospital Service Line, Emory University School of Medicine, Emory University, Atlanta, Georgia. https://twitter.com/frankminja
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Dako F, Omofoye TS, Scheel J. Radiologists' Role in Decolonizing Global Health. J Am Coll Radiol 2024:S1546-1440(24)00272-2. [PMID: 38461914 DOI: 10.1016/j.jacr.2023.10.027] [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] [Received: 05/18/2023] [Revised: 08/29/2023] [Accepted: 10/16/2023] [Indexed: 03/12/2024]
Abstract
The colonial origins and power imbalances between Western high-income countries and low- and middle-income countries (LMICs) are barriers to self-reliance and sustained structural improvements to health care systems. Radiologists working in global health (global radiologists) are tasked with improving the state of imaging in LMICs while mitigating the effects of colonial structures and processes. To accomplish this, we need to be aware of factors such as colonialism, neocolonialism, parachute research, and brain drain that contribute to global health inequities. Potential solutions to decolonizing global radiology include commitment to understanding local context; strengthening local capacity for technology advancement, research, and development; and policies and educational programs to combat medical brain drain from LMICs. In this article, we describe how the legacies of colonialism can interfere with improving health in LMICS, despite the best intentions, and provide a call to action for decolonizing our field with intentional approaches and equitable partnerships that emphasize investments in sustainable infrastructure, robust training of personnel, and policies that support self-reliance to match true health system strengthening with our passion for addressing health equity.
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Affiliation(s)
- Farouk Dako
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Director of the Center for Global and Population Health Research in Radiology.
| | - Toma S Omofoye
- Strategic Director of Education, Department of Breast Imaging, Department of Clinical Radiology and Radiological Sciences, Vanderbilt University Medical Center. Nashville, Tennessee. https://twitter.com/TomaOmofoyeMD
| | - John Scheel
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center. Houston, Texas; Vice Chair of Global and Planetary Health. https://twitter.com/JohnRScheel
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Sukhampha R. Diffusion of global health norms through a national medical professional movement in the universal healthcare of Thailand. Front Public Health 2024; 12:1249497. [PMID: 38515593 PMCID: PMC10956689 DOI: 10.3389/fpubh.2024.1249497] [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: 06/29/2023] [Accepted: 02/13/2024] [Indexed: 03/23/2024] Open
Abstract
Commonly, research investigations on social policy reform primarily examine the national processes at the core of policy formation rather than considering their global context. Concerns are raised regarding the diffusion and influence of global health norms on Thai universal health coverage policymaking. The findings demonstrate that global health ideas and actors have an impact on national policymaking and that they can share ideas in a variety of ways, including glocalization, vernacularization, policy learning, and policy entrepreneur intervention, in setting the agenda for national universal health coverage. Global and universal health coverage (UHC) concepts have existed for decades; success would not be possible without the efforts of policy entrepreneurs such as the Rural Doctor Movement, who localize and vernacularize global concepts for implementation. These concepts must be compatible with the national and local sociopolitical contexts in which they exist. The Thai case contributed to a better understanding of the influences of global ideas and actors on transnational health policy transfer, as well as the intervention of the national medical professional movement as policy entrepreneurs in healthcare policymaking and policy change for equity in health.
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Affiliation(s)
- Rangsan Sukhampha
- Faculty of Sociology, Bielefeld University, Bielefeld, Germany
- Department of Public Administration, Faculty of Humanities and Social Sciences, Valaya Alongkorn Rajabhat University, Pathum Thani, Thailand
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Hynes J, Ridge A, Murphy A. HIV seroconversion during pregnancy: paediatric recurrent candidiasis - a clue for diagnosis. BMJ Case Rep 2024; 17:e259354. [PMID: 38453217 PMCID: PMC10921425 DOI: 10.1136/bcr-2023-259354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Affiliation(s)
- Jason Hynes
- Department of Dermatology, Galway University Hospitals, Galway, Ireland
| | - Amy Ridge
- Department of Dermatology, Galway University Hospitals, Galway, Ireland
| | - Annette Murphy
- Department of Dermatology, Galway University Hospitals, Galway, Ireland
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Kovacevic A, Smith DRM, Rahbé E, Novelli S, Henriot P, Varon E, Cohen R, Levy C, Temime L, Opatowski L. Exploring factors shaping antibiotic resistance patterns in Streptococcus pneumoniae during the 2020 COVID-19 pandemic. eLife 2024; 13:e85701. [PMID: 38451256 PMCID: PMC10923560 DOI: 10.7554/elife.85701] [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: 12/20/2022] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
Non-pharmaceutical interventions implemented to block SARS-CoV-2 transmission in early 2020 led to global reductions in the incidence of invasive pneumococcal disease (IPD). By contrast, most European countries reported an increase in antibiotic resistance among invasive Streptococcus pneumoniae isolates from 2019 to 2020, while an increasing number of studies reported stable pneumococcal carriage prevalence over the same period. To disentangle the impacts of the COVID-19 pandemic on pneumococcal epidemiology in the community setting, we propose a mathematical model formalizing simultaneous transmission of SARS-CoV-2 and antibiotic-sensitive and -resistant strains of S. pneumoniae. To test hypotheses underlying these trends five mechanisms were built into the model and examined: (1) a population-wide reduction of antibiotic prescriptions in the community, (2) lockdown effect on pneumococcal transmission, (3) a reduced risk of developing an IPD due to the absence of common respiratory viruses, (4) community azithromycin use in COVID-19 infected individuals, (5) and a longer carriage duration of antibiotic-resistant pneumococcal strains. Among 31 possible pandemic scenarios involving mechanisms individually or in combination, model simulations surprisingly identified only two scenarios that reproduced the reported trends in the general population. They included factors (1), (3), and (4). These scenarios replicated a nearly 50% reduction in annual IPD, and an increase in antibiotic resistance from 20% to 22%, all while maintaining a relatively stable pneumococcal carriage. Exploring further, higher SARS-CoV-2 R0 values and synergistic within-host virus-bacteria interaction mechanisms could have additionally contributed to the observed antibiotic resistance increase. Our work demonstrates the utility of the mathematical modeling approach in unraveling the complex effects of the COVID-19 pandemic responses on AMR dynamics.
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Affiliation(s)
- Aleksandra Kovacevic
- Institut Pasteur, Université Paris Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE) unitParisFrance
- Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Inserm U1018, CESP, Anti-infective evasion and pharmacoepidemiology teamMontigny-Le-BretonneuxFrance
| | - David RM Smith
- Institut Pasteur, Université Paris Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE) unitParisFrance
- Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Inserm U1018, CESP, Anti-infective evasion and pharmacoepidemiology teamMontigny-Le-BretonneuxFrance
- Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire national des arts et métiersParisFrance
- Health Economics Research Centre, Nuffield Department of Health, University of OxfordOxfordUnited Kingdom
| | - Eve Rahbé
- Institut Pasteur, Université Paris Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE) unitParisFrance
- Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Inserm U1018, CESP, Anti-infective evasion and pharmacoepidemiology teamMontigny-Le-BretonneuxFrance
| | - Sophie Novelli
- Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Inserm U1018, CESP, Anti-infective evasion and pharmacoepidemiology teamMontigny-Le-BretonneuxFrance
| | - Paul Henriot
- Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire national des arts et métiersParisFrance
- PACRI unit, Institut Pasteur, Conservatoire national des arts et métiersParisFrance
| | - Emmanuelle Varon
- Centre National de Référence des Pneumocoques, Centre Hospitalier Intercommunal de CréteilCréteilFrance
| | - Robert Cohen
- Institut Mondor de Recherche Biomédicale-Groupe de Recherche Clinique Groupe d’Etude des Maladies Infectieuses Néonatales et Infantiles (IMRB-GRC GEMINI), Université Paris Est, 94000CréteilFrance
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), 06200NiceFrance
- Unité Court Séjour, Petits Nourrissons, Service de Néonatologie, Centre Hospitalier, Intercommunal de CréteilCréteilFrance
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), 94000CréteilFrance
- Association Française de Pédiatrie Ambulatoire (AFPA), 45000OrléansFrance
| | - Corinne Levy
- Institut Mondor de Recherche Biomédicale-Groupe de Recherche Clinique Groupe d’Etude des Maladies Infectieuses Néonatales et Infantiles (IMRB-GRC GEMINI), Université Paris Est, 94000CréteilFrance
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), 06200NiceFrance
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), 94000CréteilFrance
- Association Française de Pédiatrie Ambulatoire (AFPA), 45000OrléansFrance
| | - Laura Temime
- Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire national des arts et métiersParisFrance
- PACRI unit, Institut Pasteur, Conservatoire national des arts et métiersParisFrance
| | - Lulla Opatowski
- Institut Pasteur, Université Paris Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE) unitParisFrance
- Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Inserm U1018, CESP, Anti-infective evasion and pharmacoepidemiology teamMontigny-Le-BretonneuxFrance
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Kalandarova M, Ahmad I, Aung TNN, Moolphate S, Shirayama Y, Okamoto M, Aung MN, Yuasa M. Association Between Dietary Habits and Type 2 Diabetes Mellitus in Thai Adults: A Case-Control Study. Diabetes Metab Syndr Obes 2024; 17:1143-1155. [PMID: 38465346 PMCID: PMC10924810 DOI: 10.2147/dmso.s445015] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/01/2024] [Indexed: 03/12/2024] Open
Abstract
Background The prevalence of T2DM is escalating in Thailand affecting over 10% of adults aged 20-79 years old. It is imperative to identify modifiable risk factors that can potentially help mitigate the risk of developing diabetes. Objective This study aimed to investigate the relationship between dietary habits and type 2 diabetes in Chiang Mai, Thailand. Methods This case-control study involved 300 individuals aged 25-74 years residing in Chiang Mai, Thailand including 150 newly diagnosed T2DM patients (cases) and 150 community residents without diabetes (controls). Dietary habits were assessed based on Food Frequency Questionnaire (FFQ). Socio-demographic characteristics and anthropometric information of the participants were collected. Data analysis was performed using the STATA-17. Results The case group participants were older and had a higher proportion of males compared to the control group. The case group exhibited a significantly higher consumption of meat, beans, nuts, soft drinks, and topping seasonings (p<0.001), conversely, a lower intake of vegetables (p<0.001), fruits (p=0.006), fish, rice (p<0.001), eggs (p=0.032), milk products, coffee, and tea (p<0.001) compared to the control group. Furthermore, the case group demonstrated a higher level of certain dietary practices such as a greater frequency of having meals with family, not removing visible fat from food (p<0.001), and eating snacks between meals compared to controls. Multiple logistic regression analysis showed that after adjusting for potential confounding factors not removing visible fat from food (aOR 5.61, 95% CI: 2.29-13.7, p<0.001) and using topping seasonings (aOR 3.52 95% CI: 1.69-7.32 p=0.001) were significantly associated with the risk of T2DM, whereas daily vegetable intake (aOR 0.32 95% CI: 0.15-0.68 p=0.003) was inversely associated with T2DM. Conclusion The study findings caution against the consumption of food rich in fat and using salty seasonings, while advocating for an increased intake of vegetables to prevent the prevalence of T2DM.
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Affiliation(s)
- Makhbuba Kalandarova
- Department of Global Health Research, Juntendo University Graduate School of Medicine, Tokyo, 113-8421, Japan
| | - Ishtiaq Ahmad
- Department of Global Health Research, Juntendo University Graduate School of Medicine, Tokyo, 113-8421, Japan
| | - Thin Nyein Nyein Aung
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Saiyud Moolphate
- Department of Public Health, Faculty of Science and Technology, Chiang Mai Rajabhat University, Chiang Mai, 50300, Thailand
| | - Yoshihisa Shirayama
- Department of Global Health Research, Juntendo University Graduate School of Medicine, Tokyo, 113-8421, Japan
- Faculty of International Liberal Arts, Juntendo University, Tokyo, 113-8421, Japan
| | - Miyoko Okamoto
- Department of Global Health Research, Juntendo University Graduate School of Medicine, Tokyo, 113-8421, Japan
| | - Myo Nyein Aung
- Department of Global Health Research, Juntendo University Graduate School of Medicine, Tokyo, 113-8421, Japan
- Faculty of International Liberal Arts, Juntendo University, Tokyo, 113-8421, Japan
- Juntendo Advanced Research Institute for Health Sciences, Juntendo University, Tokyo, 113-8421, Japan
| | - Motoyuki Yuasa
- Department of Global Health Research, Juntendo University Graduate School of Medicine, Tokyo, 113-8421, Japan
- Faculty of International Liberal Arts, Juntendo University, Tokyo, 113-8421, Japan
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Ricciardone MD, Baker L, Twesten J, Parascandola M. Portfolio analysis of global tobacco control research funding at the National Cancer Institute, 2000-2019. Tob Prev Cessat 2024; 10:TPC-10-13. [PMID: 38440159 PMCID: PMC10910547 DOI: 10.18332/tpc/184041] [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: 11/22/2023] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Research in low- and middle-income countries (LMICs), where the majority of global tobacco users reside, is critical to addressing the global tobacco epidemic. This analysis describes the global tobacco control research portfolio funded by the National Cancer Institute from fiscal years 2000 to 2019. METHODS We used the National Institutes of Health Query, View, Report database to identify extramural grants relevant to global tobacco control research. Abstracts were analyzed to describe grant characteristics, including topic areas, tobacco products, countries, and regions of focus. Bibliometric and co-authorship network analyses were performed for publications associated with relevant grants. RESULTS Of the 93 relevant grants with foreign (non-US) involvement, the majority (83.9%) supported research in upper and lower middle-income countries. The majority of grants (86.0%) focused on cigarettes, with a small subset of grants addressing smokeless tobacco, waterpipe use, or other non-cigarette products. Most grants focused on at least one of the six tobacco control policy measures in the World Health Organization MPOWER package; almost half (48.4%) focused on monitoring tobacco use and around one-third (32.3%) focused on offering tobacco cessation treatment, while other MPOWER measures received less attention in the research portfolio. While most of these grants, and the funding initiatives that supported them, emphasized research in low- and middle-income countries (LMICs), only 3 of 93 grants were awarded directly to LMIC-based institutions. CONCLUSIONS There is a critical need for research to develop and test strategies to adapt, implement, and scale up evidence-based interventions across diverse LMIC settings. This study identified gaps in research activity that should be addressed to strengthen global tobacco control research capacity.
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Affiliation(s)
| | - Laura Baker
- Strategix Management, LLC, Washington, DC 20036, USA
| | - Jenny Twesten
- The Bizzell Group, LLC, New Carrollton, MD 20785, USA
| | - Mark Parascandola
- Center for Global Health, National Cancer Institute, Bethesda, MD 20892, USA
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Reza N, Gerada A, Stott KE, Howard A, Sharland M, Hope W. Challenges for global antibiotic regimen planning and establishing antimicrobial resistance targets: implications for the WHO Essential Medicines List and AWaRe antibiotic book dosing. Clin Microbiol Rev 2024:e0013923. [PMID: 38436564 DOI: 10.1128/cmr.00139-23] [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: 03/05/2024] Open
Abstract
SUMMARYThe World Health Organisation's 2022 AWaRe Book provides guidance for the use of 39 antibiotics to treat 35 infections in primary healthcare and hospital facilities. We review the evidence underpinning suggested dosing regimens. Few (n = 18) population pharmacokinetic studies exist for key oral AWaRe antibiotics, largely conducted in homogenous and unrepresentative populations hindering robust estimates of drug exposures. Databases of minimum inhibitory concentration distributions are limited, especially for community pathogen-antibiotic combinations. Minimum inhibitory concentration data sources are not routinely reported and lack regional diversity and community representation. Of studies defining a pharmacodynamic target for ß-lactams (n = 80), 42 (52.5%) differed from traditionally accepted 30%-50% time above minimum inhibitory concentration targets. Heterogeneity in model systems and pharmacodynamic endpoints is common, and models generally use intravenous ß-lactams. One-size-fits-all pharmacodynamic targets are used for regimen planning despite complexity in drug-pathogen-disease combinations. We present solutions to enable the development of global evidence-based antibiotic dosing guidance that provides adequate treatment in the context of the increasing prevalence of antimicrobial resistance and, moreover, minimizes the emergence of resistance.
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Affiliation(s)
- Nada Reza
- Department of Antimicrobial Pharmacodynamics and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Alessandro Gerada
- Department of Antimicrobial Pharmacodynamics and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Katharine E Stott
- Department of Antimicrobial Pharmacodynamics and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Alex Howard
- Department of Antimicrobial Pharmacodynamics and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Mike Sharland
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George's, University of London, London, United Kingdom
| | - William Hope
- Department of Antimicrobial Pharmacodynamics and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
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Thapa S, Gibbs P, Ross N, Newman J, Allan J, Dalton H, Mahmood S, Kalinna BH, Ross AG. Are adverse childhood experiences (ACEs) the root cause of the Aboriginal health gap in Australia? BMJ Glob Health 2024; 9:e014901. [PMID: 38442985 DOI: 10.1136/bmjgh-2023-014901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/04/2024] [Indexed: 03/07/2024] Open
Affiliation(s)
- Subash Thapa
- Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia
| | - Peter Gibbs
- Regional Enterprise Development Institute (REDI.E), Dubbo, New South Wales, Australia
| | - Nancy Ross
- School of Social Work, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jamie Newman
- Orange Aboriginal Medical Service, Orange, New South Wales, Australia
| | - Julaine Allan
- Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia
| | - Hazel Dalton
- Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia
| | - Shakeel Mahmood
- Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia
| | - Bernd H Kalinna
- Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia
| | - Allen G Ross
- Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia
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Rambabu L, Smith BG, Tumpa S, Kohler K, Kolias AG, Hutchinson PJ, Bashford T. Artificial intelligence-enabled ophthalmoscopy for papilledema: a systematic review protocol. Int J Surg Protoc 2024; 28:27-30. [PMID: 38433865 PMCID: PMC10905490 DOI: 10.1097/sp9.0000000000000016] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/24/2023] [Indexed: 03/05/2024] Open
Abstract
Papilledema is a pathology delineated by the swelling of the optic disc secondary to raised intracranial pressure (ICP). Diagnosis by ophthalmoscopy can be useful in the timely stratification of further investigations, such as magnetic resonance imaging or computed tomography to rule out pathologies associated with raised ICP. In resource-limited settings, in particular, access to trained specialists or radiological imaging may not always be readily available, and accurate fundoscopy-based identification of papilledema could be a useful tool for triage and escalation to tertiary care centres. Artificial intelligence (AI) has seen a rise in neuro-ophthalmology research in recent years, but there are many barriers to the translation of AI to clinical practice. The objective of this systematic review is to garner and present a comprehensive overview of the existing evidence on the application of AI in ophthalmoscopy for papilledema, and to provide a valuable perspective on this emerging field that sits at the intersection of clinical medicine and computer science, highlighting possible avenues for future research in this domain.
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Affiliation(s)
- Lekaashree Rambabu
- University of Leicester, Leicester
- NIHR Global Health Research Group on Acquired Brain and Spine Injury
| | - Brandon G. Smith
- NIHR Global Health Research Group on Acquired Brain and Spine Injury
- Engineering Design Centre, Department of Engineering, University of Cambridge, Cambridge
| | - Stasa Tumpa
- NIHR Global Health Research Group on Acquired Brain and Spine Injury
- West Suffolk NHS Foundation Trust, Bury Saint Edmunds, Suffolk
| | - Katharina Kohler
- NIHR Global Health Research Group on Acquired Brain and Spine Injury
- Engineering Design Centre, Department of Engineering, University of Cambridge, Cambridge
- Division of Anaesthesia, Addenbrooke’s Hospital, Cambridge
| | - Angelos G. Kolias
- NIHR Global Health Research Group on Acquired Brain and Spine Injury
- Division of Academic Neurosurgery, Addenbrooke’s Hospital, Cambridge, UK
| | - Peter J. Hutchinson
- NIHR Global Health Research Group on Acquired Brain and Spine Injury
- Division of Academic Neurosurgery, Addenbrooke’s Hospital, Cambridge, UK
| | - Tom Bashford
- NIHR Global Health Research Group on Acquired Brain and Spine Injury
- Engineering Design Centre, Department of Engineering, University of Cambridge, Cambridge
- Division of Anaesthesia, Addenbrooke’s Hospital, Cambridge
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Gavilanes JS, Saengpattrachai M, Rivera-Tutsch AS, Robinson L, Petchkrua W, Gold JA. A Train-the-Trainer Simulation Program Implemented Between Two International Partners. ATS Sch 2024; 5:32-44. [PMID: 38585578 PMCID: PMC10994222 DOI: 10.34197/ats-scholar.2023-0025ps] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 10/10/2023] [Indexed: 04/09/2024] Open
Abstract
With the expansion of global health initiatives focused on healthcare professional training, it is important to ensure that such training is scalable and sustainable. Simulation-based education (SBE) is a highly effective means to achieve these goals. Although SBE is widely used in the United States, its integration globally is limited, which can impact the potential of SBE in many countries. The purpose of this perspective piece is to demonstrate how a train-the-trainer program can help in the development of an international SBE program and specifically what unique issues must be considered in operationalizing this strategy.
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Affiliation(s)
| | | | | | - Lish Robinson
- Oregon Health & Science University, Portland, Oregon; and
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48
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Kobashi Y, Goto A, Chi C. The role of stakeholder structure in fostering community ownership: A case study of community-based projects. Int J Health Plann Manage 2024; 39:593-601. [PMID: 38155527 DOI: 10.1002/hpm.3750] [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: 04/02/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023] Open
Abstract
Community health projects have played a crucial role in improving health issues. Listening to communities' voices and achieving community ownership are essential for conducting effective health projects. However, there are limited studies on the frameworks for collecting, aggregating, and operationalizing community preferences and values. In this study, we selected two cases of community field surveys from Japan and Cambodia to discuss who may represent a community and propose a practical approach to achieving community ownership. Both cases involved various stakeholders. From the insights of these two cases, we suggested the following three key components in the community project: the community representative, the communicator, and the institute outside the community. Notably, the community representative's role as the community's direct voice should be properly recognized and institutionalised to establish community ownership. We proposed the following key terms of the qualifications of community representatives: they should be able to represent voices from the community, should have extensive experience to decide the project direction and manage the project, and should be independent of outside actors. Our theoretical model of the structure of different stakeholder groups in community-based projects will be helpful to accelerate community capacity strengthening; moreover, it can help build the appropriate community institution and process, including multi-stakeholder groups to promote community ownership in health programs.
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Affiliation(s)
| | - Aya Goto
- Center for Integrated Science and Humanities, Fukushima Medical University, Fukushima, Japan
| | - Chunhuei Chi
- Center for Global Health, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
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49
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Jephcott FL, Wood JLN, Cunningham AA, Bonney JHK, Nyarko-Ameyaw S, Maier U, Geissler PW. Ineffective responses to unlikely outbreaks: Hypothesis building in newly-emerging infectious disease outbreaks. Med Anthropol Q 2024; 38:67-83. [PMID: 37948592 DOI: 10.1111/maq.12827] [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: 06/10/2022] [Accepted: 08/20/2023] [Indexed: 11/12/2023]
Abstract
Over the last 30 years, there has been significant investment in research and infrastructure aimed at mitigating the threat of newly emerging infectious diseases (NEID). Core epidemiological processes, such as outbreak investigations, however, have received little attention and have proceeded largely unchecked and unimproved. Using ethnographic material from an investigation into a cryptic encephalitis outbreak in the Brong-Ahafo Region of Ghana in 2010-2013, in this paper we trace processes of hypothesis building and their relationship to the organizational structures of the response. We demonstrate how commonly recurring features of NEID investigations produce selective pressures in hypothesis building that favor iterations of pre-existing "exciting" hypotheses and inhibit the pursuit of alternative hypotheses, regardless of relative likelihood. These findings contribute to the growing anthropological and science and technology studies (STS) literature on the epistemic communities that coalesce around suspected NEID outbreaks and highlight an urgent need for greater scrutiny of core epidemiological processes.
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Affiliation(s)
- Freya L Jephcott
- Centre for the Study of Existential Risk (CSER), University of Cambridge, Cambridge, UK
- Institute of Zoology, Zoological Society of London, London, UK
| | - James L N Wood
- Centre for the Study of Existential Risk (CSER), University of Cambridge, Cambridge, UK
| | | | - J H Kofi Bonney
- Virology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Stephen Nyarko-Ameyaw
- Disease Control Unit, Techiman Municipal Health Directorate, Ghana Health Service, Techiman, Ghana
| | - Ursula Maier
- Paediatrics Department, Holy Family Hospital, Techiman, Ghana
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50
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Mwakisha J, Adika B, Nyawade S, Phori PM, Nidjergou NN, Silouakadila C, Fawcett S. Kenya's Experience: Factors Enabling and Impeding the COVID-19 Response. Health Promot Pract 2024; 25:220-226. [PMID: 36734323 PMCID: PMC9899671 DOI: 10.1177/15248399221117566] [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] [Indexed: 02/04/2023]
Abstract
This case study describes the country-level response to the COVID-19 pandemic in Kenya between February 2020 and May 2021. We organize the presentation of COVID-19 response strategies across the five stages of (a) engagement, (b) assessment, (c) planning, (d) action/implementation, and (e) evaluation. We describe the participatory monitoring and evaluation (M&E) process implemented in collaboration with the WHO Regional Office for Africa Monitoring and Evaluation Team. The M&E system was used to organize and make sense of emerging data regarding specific response activities and changing COVID incidence. We share the results of that collaborative sensemaking, with particular attention to our analysis of the factors that facilitated and those that impeded our pandemic response. We conclude with lessons learned and practical implications from Kenya's experience to help guide future country-level responses to rapidly changing public health crises.
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Affiliation(s)
| | - Ben Adika
- World Health Organization, Kenya
Country Office Nairobi, Kenya
| | | | | | | | - Cleph Silouakadila
- World Health Organization Regional
Office for Africa, Brazzaville, Congo
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