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What works for anemia reduction among women of reproductive age? Synthesized findings from the exemplars in anemia project
Get PDFBackground: Few countries have succeeded to decrease the prevalence of anemia in women of reproductive age (WRA), and where improvements have been observed, contributing factors are not well understood. Objectives: To synthesize cross-cutting findings from specific exemplar studies in Uganda, Senegal, the Philippines, and Pakistan by reviewing anemia trends, policies, and programs, comparing drivers of change, and proposing strategies to achieve further reductions in WRA anemia. Methods: A mixed-methods approach was used for exemplar case studies: 1) descriptive analyses of Demographic and Health Surveys and national survey data; 2) review of relevant policies/programs; 3) stakeholder in-depth interviews and focus group discussions with WRA and community members; and 4) Oaxaca–Blinder decomposition to identify determinants of hemoglobin change over time. This cross-country analysis performs triangulation of qualitative and quantitative analyses. Results: Compound annual change rates for anemia from the ∼2005–2018 period were –0.7% in Senegal, –2.4% in Uganda, –3.4% in Pakistan, and –6.2% in the Philippines. Despite these reductions, WRA anemia burden in Senegal and Pakistan continues to be a severe public health problem. Direct and indirect health sector strategies, such as iron–folic acid supplementation in pregnancy, vitamin A supplementation during lactation, malaria control (Uganda and Senegal), investments in family planning, and better access to health services through community-based approaches, contributed to a median of 36.5% (range: 30%–66%) change in hemoglobin. Nonhealth sector strategies, including social protection and poverty alleviation schemes, empowering of girls and women, and improving household conditions, contributed to a 21% (18%–58%) change in hemoglobin. Large-scale food fortification (for example, wheat flour with iron) could have also contributed to improved micronutrient intakes and reduction in iron deficiency anemia. Conclusions: A context-specific, multisectoral approach is needed to decrease WRA anemia, incorporating direct nutritional interventions and indirect strategies within the health and nonhealth sectors. Lessons from the successes and challenges from exemplar countries could help accelerate global anemia reduction
Acinetobacter baumannii: Much more than a human pathogen
Get PDFAcinetobacter baumannii is a major human nosocomial pathogen. Due to this, a significant amount of knowledge has been gained about human clinical isolates over a substantial period of time. More recently, studies have begun to pay attention to non-human isolates of A. baumannii. In reviewing these studies, we highlight some major trends. First, A. baumannii has been found in a variety of sources/hosts: from diverse types of animals, to food products, to plants and even aquatic environments. Second, considering the molecular epidemiology of A. baumannii, two scenarios are possible. One implies transmission between human and non-human populations, and this has been described in several international clones (ICs): IC1, IC2, IC5, IC7, and IC8. In the other scenario, human populations are well differentiated from non-human populations, and there is no exchange between them. Third, in terms of antibiotic resistance in the non-human populations, these populations tend to have fewer antibiotic resistance genes, mostly intrinsic in nature. However, when non-clinical bacterial populations come into closer contact with humans, the antibiotic resistance profiles of the non-human bacterial population become more similar to those of clinical populations. Also, there are some instances of non-human isolates showing extensive drug resistance phenotypes. By far, the least studied aspect is the virulence potential of A. baumannii from non-human sources. A small number of studies suggest that some non-human isolates can be as virulent as the human isolates. Finally, we discuss gaps in knowledge and future research avenues when considering non-human populations of A. baumannii and their relationship with human populations
Can we create customized polypills for personalized drug formulation?
No full textThe concept of polypills has existed for decades. A polypill is a fixed-dose combination of multiple drugs designed to target specific health conditions. One of the most well-known examples is the cardiovascular polypill, which combines blood pressure-lowering agents, statins, and antiplatelet drugs to prevent heart attacks and strokes [Citation1]. The synergistic effects of these active pharmaceutical ingredients (APIs) have been shown in multiple randomized controlled trials to significantly reduce cardiovascular risk factors and events while minimizing side effects [Citation2]. Personalized polypills take this concept a step further by tailoring both drug combinations and dosages to individual patients. Why is this necessary? Traditional ‘one-size-fits-all’ drug formulations fail to account for genetic variations, leading to suboptimal efficacy and a higher risk of side effects. A pharmacogenomics report by the Royal College of Physicians and the British Pharmacological Society found that 99.5% of people have at least one genetic variant affecting drug response, with 25% carrying four or more [Citation3]. This means that polypills with fixed-dose combinations may not provide optimal therapeutic benefits for every patient. Additionally, the rising prevalence of multimorbidity, affecting 37.2% of adults globally and up to 67% of those over 74 [Citation4,Citation5], poses a major global health challenge. Patients with multiple chronic conditions often face complex medication regimens, leading to poor patient compliance and diminished quality of life. Alarmingly, 65% of older adults with multimorbidity do not adhere to their prescribed medications [Citation6]. This highlights the urgent need for solutions to reduce pill burden, such as personalized polypills, which could simplify treatment regimens and improve treatment outcomes
Patient research priorities in melanoma: A national qualitative interview study
Get PDFBackground: Outcomes for advanced melanoma have improved following the advent of immunotherapy and targeted therapy. This heralds a need for reconsideration of future research agendas. Patients can – and are keen to – help identify and prioritize research topics to ensure future research benefits patients. No previous peer-reviewed research has reported patient research priorities for melanoma. Objectives: To determine the prioritized research topics of patients with melanoma in England. Methods: Patients aged ≥ 18 years, diagnosed with melanoma in the past 10 years, were recruited across England by skin cancer charities. Preinterview questionnaires obtained demographic, tumour and treatment information. Semi-structured interviews were conducted where patients were asked what they thought were important topics to research in melanoma. Using a grounded theory approach, transcripts were analysed in an iterative process to identify themes for patient research priorities. Results: Twenty patients were individually interviewed from eight of nine English regions. Five key themes were identified: (1) ‘Risk factors and prevention of melanoma’ – patients voiced a desire for research into modifiable risk factors and public campaigns to prevent melanoma; (2) ‘Diagnostic delay and misdiagnosis of melanoma’ – patients felt diagnostic delays could be reduced through research to support nonspecialists and integrating technology such as teledermatology or artificial intelligence’; (3) ‘Indications, outcomes, side-effects and interactions of treatments for melanoma’ – novel treatments inspired patients to encourage future research into the indications, outcomes and side-effects of therapeutic options; (4) ‘Optimizing follow-up for melanoma’ – with increased survivorship, research to support the delivery of a personalized approach to follow-up was valued; and (5) ‘Factors that influence survival from melanoma’ – patients prioritized research to accurately predict recurrence and survival based on patient-specific factors. Conclusions: This is the first peer-reviewed study to report patient research priorities in melanoma. Many of the themes identified align with National Institute for Health and Care Excellence research recommendations. Additionally, novel themes were identified that provide a rationale to develop a James Lind Alliance Priority Setting Partnership for melanoma. If research addresses topics relevant to patients, decision-makers will be equipped to deliver services that meet patient needs
Examining the impact of learning about a resolved conflict on attitudes in an ongoing conflict: Evidence from the Israeli–Palestinian context
Get PDFA popular intervention for increasing support for peace in violent intergroup conflicts is to describe the peaceful resolution of other conflicts. In four experiments, we tested the effectiveness of this approach in the context of the Israeli–Palestinian conflict by exposing Jewish-Israelis to information about the Northern Ireland conflict and peace process, or about tourism in Northern Ireland as a control. We found that learning about the historical peace process generally led participants to view conflicts as more malleable, their own conflict as less unique, and led to unfreezing of conflict-related beliefs. However, it neither increased hope nor consistently boosted support for conciliatory policies. We explored boundary conditions and found effects were often stronger among leftist and centrist compared with rightists. Moreover, explicitly drawing analogies between conflicts at the outset proved ineffective, whereas exposing participants to the historical conflict and peace process without mentioning the proximal conflict was more successful
A qualitative investigation of the modifiable determinants of medication adherence in bipolar disorder (BD): Views of patients and their family and friends
Get PDFBackground Medication nonadherence in bipolar disorder (BD) can lead to adverse outcomes including relapse, hospitalisation and suicidility. Adherence research traditionally excludes mental health populations and their family and friends, contributing to inequity between physical and mental health. We used behavioural science to characterise modifiable adherence determinants in BD from the perspectives of patients and their family and friends. Method Between April-June 2020, we conducted two focus groups and 26 interviews with adults with BD and their family and friends. We explored modifiable adherence determinants which were mapped to the Theoretical Domains Framework (TDF), followed by a thematic analysis and prioritisation of determinants. Results Sixty-three (including 13 new) adherence determinants, mapped to nine TDF domains, were prioritised. Four themes of adherence determinants emerged: the medication itself; practicalities; how patients perceive themselves, their illness, and treatments; and collaboration between patients, their family and friends, and healthcare professionals. Nine prioritised TDF domains were: ‘Environmental context and resources’, ‘Intentions’, ‘Emotion’, ‘Social Influences’, ‘Goals’, ‘Memory, attention and decision processes’, ‘Beliefs about consequences’, ‘Knowledge’ and ‘Social/professional role and identity’. Respective examples include side effects, treatment preferences, fear of not being ‘myself’, relationships with healthcare team, medication affecting life goals, forgetfulness, beliefs about negative consequences, not knowing the risk of stopping medication, and involvement in treatment decisions. Conclusion Targeting antecedents of forgetfulness as well as newly identified determinants linked to ‘Emotion’ and ‘Intentions’, may improve adherence. Mapping adherence determinants to TDF domains provides a framework for designing personalised adherence interventions by selecting appropriate behaviour change techniques