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Climate-related bilateral official development assistance (ODA) and vulnerability: A comparative study of allocation and effectiveness
Get PDFOfficial Development Assistance (ODA) has emerged as a crucial tool for supporting nations worldwide in mitigating and adapting to the impacts of climate change. This study investigates bilateral ODA allocated to climate change mitigation and adaptation from 2002 to 2021. Data from OECD iLibrary and World Risk Reports were analyzed to explore temporal patterns and sectoral distribution of climate-related ODA. Polynomial regression calculated the estimated average annual percentage change (EAAPC) in adaptation-focused ODA and vulnerability. We also evaluated the relationship between adaptation-focused ODA, vulnerability, and GDP per capita between 2011 and 2021. In 2021, Japan, Germany, and France provided 75% of total bilateral ODA dedicated to climate change. From 2002 to 2021, major donors directed substantial portions of climate-related ODA towards infrastructure, energy, water & sanitation, agriculture, and environmental protection. From 2011 to 2021, the highest EAAPC in vulnerability was observed in the Central African Republic (0.62; 95% CI: 0.60 to 0.64), followed by Papua New Guinea (0.57; 0.55 to 0.59), Yemen (0.50; 0.49 to 0.52), and Guinea-Bissau (0.33; 0.32 to 0.34). Despite their high vulnerability, some of these countries received disproportionately less adaptation-focused ODA. The correlation between vulnerability and adaptation-focused ODA revealed a complex regional relationship. Variations in adaptation-focused ODA and vulnerabilities underscore the dynamic relationship between international aid and a nation’s intrinsic capacity to address challenges. This investigation highlights the importance of understanding these dynamics and calls for a re-evaluation of aid allocation. Strengthening climate change initiatives within the ODA framework and tailoring aid distribution to the specific needs of recipient nations in mitigation and adaptation can enhance its effectiveness, resulting in sustainable and impactful outcomes
Women's experiences of and satisfaction with childbirth: Development and validation of a measurement scale for low- and middle-income countries.
Get PDFBACKGROUND: Measuring person-centered maternity care outcomes typically consists of two types of measures: experiences of care and satisfaction with care. There are limited validated measurement tools for these measures, particularly in low- and middle-income countries (LMICs). The QUALI-DEC study aims to improve decision-making around caesarean section. We describe development of the QUALI-DEC Study Birth Experience and Satisfaction (QD-BES) scale, and scale validation in Argentina, Burkina Faso, Thailand, and Viet Nam. METHODS: We used a three-phase scale development and validation approach: 1) item development, 2) scale development, and 3) scale evaluation. We systematically identified existing tools, and assessed them using the QUALI-DEC theory of change, study context, and psychometric qualities. We proposed the 10-item QD-BES scale to balance feasibility, theoretical coverage, and comprehensiveness. We conducted a baseline exit survey with post-partum women in 32 hospitals in 4 countries. We conducted exploratory factor analysis (EFA), and confirmatory factor analysis (CFA). RESULTS: 3127 women participated, most were multiparous (61.0%), without previous caesarean section (77.2%), and preferred vaginal birth (72.8%) despite high rates of caesarean section (39.4%). EFA identified three dimensions: emotional satisfaction (3-items), support and respect by providers (4-items), and communication with providers (3-items), with high loading coefficients (0.5-0.97). CFA confirmed the three-dimension scale, with good model fit (CFI and IFI: 0.95, Cronbach's alpha: 0.70-0.90). Criterion validity was assessed by exploring characteristics of women, obstetric histories, and birth experiences. CONCLUSIONS: We present psychometric validation of a scale measuring women's satisfaction with care and experiences of childbirth care, using a systematic approach to development and validation in four LMICs. The 10-item QD-BES-scale is short, easily-administered, valid, and reliable. The QD-BES-scale is useful to contribute to the generation of new knowledge about quality of maternity care in LMICs, as well as help to meet the major challenge of implementing and measuring respectful care at scale
Estimating contamination effects on measured trial results in TB active case finding cluster randomised trials
Get PDFParticipant mobility and interactions between study clusters or the general population can introduce contamination, which may contribute to these
negative trial results. Contamination can dilute the effects of the
intervention, resulting in an underestimation of its true impact.
The influence of contamination is important for understanding trial results
and can play a role in optimising future study design and analysis
Advancing drug discovery and development through GPT models: a review on challenges, innovations and future prospects
Get PDFAdvanced AI algorithms, notably generative pre-trained transformer (GPT) models, are revolutionizing healthcare and drug discovery and development by efficiently processing and interpreting large volumes of medical data. Specialized models, such as ProtGPT2 and BioGPT, extend their capabilities to protein engineering and biomedical text mining. Our study will contribute to ongoing discussions to revolutionize drug development, leading to a faster and more reliable validation of new therapeutic agents that are crucial for healthcare advancement and patient outcomes. GPT models, such as MTMol-GPT, are robust, generalizable, and provide important information for developing treatments for complicated disorders. SynerGPT utilizes a genetic algorithm to optimize prompts and select drug combinations for testing based on individual patient characteristics. Ligand generation for specific target proteins with potential drug activity is a significant stage in the drug design process, which enhances the quality of the synthesized compounds and augments the precision of capturing chemical structures and their activity correlations, highlighting the model's creativity and capability for innovative ligand design. Despite these advancements, there are still problems with the data volume, scalability, interpretability, and validation. Ethical considerations, robust methods, and omics data must be successfully integrated to develop AI for drug discovery and ensure successful deployment. In summary, these models significantly influence drug research and development, specifically in the earlier stages from initial target selection to post-marketing surveillance for medication safety monitoring
Estimating social contact rates for the COVID-19 pandemic using Google mobility and pre-pandemic contact surveys.
Get PDFDuring the COVID-19 pandemic, aggregated mobility data was frequently used to estimate changing social contact rates. By taking pre-pandemic contact matrices, and transforming these using pandemic-era mobility data, infectious disease modellers attempted to predict the effect of large-scale behavioural changes on contact rates. This study explores the most accurate method for this transformation, using pandemic-era contact surveys as ground truth. We compared four methods for scaling synthetic contact matrices: two using fitted regression models and two using "naïve" mobility or mobility squared models. The regression models were fitted using the CoMix contact survey and Google mobility data from the UK over March 2020 - March 2021. The four models were then used to scale synthetic contact matrices-a representation of pre-pandemic behaviour-using mobility data from the UK, Belgium and the Netherlands to predict the number of contacts expected in "work" and "other" settings for a given mobility level. We then compared partial reproduction numbers estimated from the four models with those calculated directly from CoMix contact matrices across the three countries. The accuracy of each model was assessed using root mean squared error. The fitted regression models had substantially more accurate predictions than the naïve models, even when models were applied to out-of-sample data from the UK, Belgium and the Netherlands. Across all countries investigated, the linear fitted regression model was the most accurate and the naïve model using mobility alone was the least accurate. When attempting to estimate social contact rates during a pandemic without the resources available to conduct contact surveys, using a model fitted to data from another pandemic context is likely to be an improvement over using a "naïve" model based on mobility data alone. If a naïve model is to be used, mobility squared may be a better predictor of contact rates than mobility per se
An international comparison of longitudinal health data collected on long COVID in nine high income countries: a qualitative data analysis.
Get PDFBACKGROUND: Long coronavirus disease (COVID) presents a significant health challenge. Long-term monitoring is critical to support understanding of the condition, service planning and evaluation. We sought to identify and examine longitudinal health data collected on long COVID to inform potential decisions in England regarding the rationale for data collection, the data collected, the sources from which data were collected and the methods used for collection. METHODS: We included datasets in high-income countries that experienced similar coronavirus disease 2019 (COVID-19) waves to England pre-vaccine rollout. Relevant datasets were identified through literature searches, the authors' networks and participants' recommendations. We undertook semi-structured interviews with individuals involved in the development and running of the datasets. We held a focus group discussion with representatives of three long COVID patient organisations to capture the perspective of those with long COVID. Emergent findings were tested in a workshop with country interviewees. RESULTS: We analysed 17 datasets from nine countries (Belgium, Canada, Germany, Italy, the Netherlands, New Zealand, Sweden, Switzerland and the United Kingdom). Datasets sampled different populations, used different data collection tools and measured different outcomes, reflecting different priorities. Most data collection was research (rather than health care system)-funded and time-limited. For datasets linked to specialist services, there was uncertainty surrounding how long these would continue. Definitions of long COVID varied. Patient representatives' favoured self-identification, given challenges in accessing care and receiving a diagnosis; New Zealand's long COVID registry was the only example identified using this approach. Post-exertion malaise, identified by patients as a critical outcome, was absent from all datasets. The lack of patient-reported outcome measures (PROMs) was highlighted as a limitation of datasets reliant on routine health data, although some had developed mechanisms to extend data collection using patient surveys. CONCLUSIONS: Addressing research questions related to the management of long COVID requires diverse data sources that capture different populations with long COVID over the long-term. No country examined has developed a comprehensive long-term data system for long COVID, and, in many settings, data collection is ending leaving a gap. There is no obvious model for England or other countries to follow, assuming there remains sufficient policy interest in establishing a long-term long COVID patient registry
HEalth professionals Responding to MEn for Safety (HERMES): Mixed methods evaluation of a pilot sexual health intervention for gay, bisexual and other men who have sex with men experiencing domestic violence and abuse.
Get PDFBACKGROUND: Domestic violence and abuse (DVA) is a violation of human rights that damages the health and well-being of-gay, bisexual and other men who have sex with men (gbMSM). Sexual health services provide a unique opportunity to assess for DVA and provide support. This study explores the feasibility and acceptability of Healthcare Responding to Men for Safety (HERMES), a pilot intervention aimed to improve the identification and referral of gbMSM experiencing DVA in a London NHS Trust. METHODS: The before and after mixed method evaluation of the intervention included semi-structured interviews with 21 sexual health practitioners, 20 matched pre-post questionnaires, and an audit of 533 patient records to assess identification and referral of gbMSM experiencing DVA. RESULTS: HERMES increased practitioners' self-reported preparedness and confidence in enquiring, identifying and responding to gbMSM experiencing DVA. HERMES increased staff awareness of DVA among these patients, which led to higher identification practices in their work. There was a significant increase in the identification and reporting practices of trained staff (0% to 30%), with 6 (5%) DVA cases identified. However, as far as we could determine, none of these patients contacted the support agency. CONCLUSIONS: HERMES proved successful in raising staff awareness, provided tools that increased identification and a referral pathway to an external specialist DVA service for the LGBT community. However, the poor uptake of the referral service indicates a need for further exploration of the help-seeking behaviour of gbMSM experiencing DVA and whether they would prefer to receive support within a sexual health service. Reinforcement training and clinical supervision is needed to sustain positive changes in practice over time and address potential challenges posed by staff turnover. Initial training should be conducted through face-to-face sessions with a combination of in-person and e-learning materials and followed by in-person and online reinforcement activities
The Importance of Lived Experience: A Scoping Review on the Value of Patient and Public Involvement in Health Research.
Get PDFBACKGROUND: Recently, patient and public involvement (PPI) in research has gained significant attention, particularly within the United Kingdom. Although there has been a growing focus on the impact of PPI on research outcomes, there remains an important gap in understanding its effects on the individuals involved and the value they gain from their participation. OBJECTIVE: This scoping review aims to critically examine how PPI benefits both people with lived experience and researchers, shedding light on the value of their involvement in shaping research. METHODS: We searched MEDLINE, PsycINFO, EMBASE, Cochrane and Web of Science for full-text articles published in English after 1996. Grey literature searches reviewed policies from international research funders and patient organisations. Two reviewers independently carried out the abstract, title and full-text article screening stages. Data abstraction was performed by one reviewer and verified by a second reviewer. Thematic analysis synthesised the findings. RESULTS: After searching 3024 citations, 107 published articles and nine unpublished resources were included in the review. Most of the studies were conducted in the United Kingdom in the last 10 years. Thematic analysis of the value of PPI revealed four main themes: (1) value from contributing to research, (2) importance of relationships, (3) attitudes and support for PPI and (4) emotional labour of involvement. DISCUSSION: This scoping review reveals the significant contributions alongside systemic challenges of PPI in health research. Being valued was framed as an impact of PPI to both PPI advisors and researchers. It emphasises the importance of social capital in developing relationships between researchers and people with lived experience yet highlights barriers that can hinder effective collaboration. This can lead to experiential knowledge being undervalued as a crucial perspective to inform research. Despite people being chosen to take part on account of their knowledge, skills and lived experience, these resources were not always used to their full potential due to researchers' expectations and restrictive research and institutional processes. The review calls for coordinated efforts to improve how PPI is valued and practised beyond a process or method to ensure PPI is done thoughtfully and effectively
There Is No Place Like Home: A Meta-Ethnography Exploring The Experiences of International Medical Graduates Following Return Migration to Their Home Country.
Get PDFMedical migration describes the movement of doctors across national boundaries and has historically followed a gradient from low- and middle-income countries (LMIC) to high-income countries (HIC), typically for training and income opportunities. Whilst the challenges of being an international medical graduate (IMG) are well-documented, not all doctors stay in their host country, and comparatively little is known about the experiences of those who return to their home country. Qualitative studies examining the experiences of IMGs returning to home countries were identified through database (Ovid, ProQuest, Medline, Scopus and EBSCOhost) and manual searching and were synthesised following a meta-ethnographic approach. A total of seven studies were included in the synthesis, published between 1975 and 2019, charting the experiences of 134 doctors returning to Africa, South America, Europe, Asia or Oceania. A total of 10 third-order constructs were identified that were developed into overarching third-order constructs: reflections on personal development, social and cultural connection to home countries and challenges associated with professional reintegration. Return migration in doctors has received little attention, indicating a need for further research in this area. The commonality of experiences in this review suggests that whilst family trumps finances in reasons to return, disillusionment with state healthcare systems in home countries encourages a drive to private practice and the wasted opportunity for valuable knowledge transfer. These findings can enable medical educators to better support IMGs considering and experiencing return migration, and inform policymakers seeking to optimise conditions for return migration as part of medical workforce planning
Young Men's Experiences of Violence and Poverty and the Relationship With Sexually Transmissible HIV: A Cross-Sectional Study From Rural South Africa.
Get PDFBACKGROUND: Young men are inadequately engaged in HIV prevention and treatment globally, including in South Africa, increasing the likelihood of them having sexually transmissible HIV (ie, living with HIV but with high viral loads). We sought to understand how men's experiences of poverty and violence affected transmissible HIV, directly or indirectly through mental health and substance misuse. SETTING: Rural communities in northern KwaZulu-Natal, South Africa. METHODS: Cross-sectional population-based sample (September 2018-June 2019), assessing transmissible HIV (living with HIV and viral load ≥400 copies/mL, compared with individuals either not living with HIV, or living with HIV and viral load <400 copies/mL) through dried blood spots, and sociodemographic data. Structural equation models (SEM) assessed direct and indirect pathways from food insecurity and violence experience to transmissible-HIV, with mediators common mental disorders, alcohol use, gender inequitable attitudes, and perceptions of low life chances. RESULTS: In total, 2,086 (ages 13-35 years) men and 8.6% (n = 178) men had transmissible HIV. There was no direct pathway from food insecurity, or violence experience, to transmissible HIV. Low perceptions of life chances mediated the relationship between food insecurity and transmissible HIV. In addition, increased poor mental health, through increased alcohol use, also mediated these relationships. CONCLUSIONS: Transmissible HIV was common among young men. The analysis highlights the need to address the proximate "drivers" of low perceptions of life chances and substance misuse, and men's experiences of poverty and violence. Building multicomponent interventions that engage these multiple challenges is critical for improving HIV among young men