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Multidisciplinary team meetings: dynamic routines that (re)make palliative care.
Get PDFMultidisciplinary team meetings are part of the everyday working life of palliative care staff. Based on ethnographic material from community and hospital palliative care teams in England, this article examines these meetings as dynamic routines. Although intended to have a prescribed format to review deaths and collect standardised information to monitor service performance, in practice, the content and conduct of the meetings were fluid, reflecting how this structure did not always match the concerns held by the team. The meetings provided a means for the team to collectively enact and weigh up different values through distributing the care and responsibility for individual patients across the team; jointly 'feeling their way' to determine what care should be offered and in what form; and by caring for their own professional wellbeing in the context of metric-driven healthcare. We observed how staff experienced tensions in 'documenting care' because of a concern that this misrepresented what they felt were core aspects of their role. Whilst team meetings may be considered a formal, routine part of teamwork and care, we interpret them as a dynamic social practice during which palliative care teams continually question 'what really matters' and (re)make what palliative care practice should entail
Establishing the value of regional cooperation and a critical role for regional organisations in managing future health emergencies.
Get PDFThe COVID-19 pandemic revealed the failures of global, multilateral cooperation to respond and adapt to health emergencies while observing the principles of solidarity and equity. This response has raised the question of whether the global architecture for health emergencies is fit for purpose. In this Health Policy, amid proposals to reform this architecture, we consider the potential value of regional cooperation and the role regional organisations might play in delivering effective and equitable solutions to the challenges posed by public health emergencies. Drawing on our multidisciplinary perspectives and diverse experience of geographical regions, we explore the value of regional cooperation, the role of regional organisations, where they could have the greatest impact, and the major factors affecting regional cooperation and regional organisations in managing public health emergencies. As the COVID-19 pandemic reshapes our approach to health emergencies, leveraging and integrating the capabilities of regional organisations will be crucial for improving preparedness and response efforts globally
Quantitative measures of human Cytomegalovirus infection and their associations with tuberculosis disease progression and Mycobacterium tuberculosis infection.
Get PDFInteractions between human cytomegalovirus (HCMV) and the host immune response to Mycobacterium tuberculosis (M.tb) may influence the risk of tuberculosis (TB) disease progression. Data on an association between HCMV and risk of initial infection with M.tb are lacking. In this correlation analysis, serological measures of HCMV were investigated in two cohorts: a TB case-control study nested within a Ugandan general population epidemiology cohort with serum samples from 25 TB disease cases up to 10 years prior to diagnosis, and a paediatric M.tb infection study with 22 matched pairs of highly-TB-exposed children from The Gambia, where one of each pair was infected with M.tb and the other was not (as determined by a tubeculin skin test (TST)). Among individuals in the Ugandan case-control study, we found a relationship between odds of progression to active TB disease and (i) increased levels of HCMV IgM (odds ratio (OR) 2.5 (99% CI 0.84-7.54) for medium tertile, and OR 3.55 (1.27-9.96) for high tertile), (ii) HCMV IgG avidity (OR 2.82 (0.88-9.01) for medium and OR 3.08 (1.25-11.82) for high), and (iii) C-reactive protein (CRP) levels (OR 1.70 (0.58-5.00) for medium and OR 3.59 (1.20-10.74) for high tertile of response). Among Gambian children, no association was found between TB infection and measures of HCMV exposure. Further evaluation of such associations in larger prospective studies and experimental testing for a causal relationship are needed.This article is part of the discussion meeting issue 'The indirect effects of cytomegalovirus infection: mechanisms and consequences'
AMRnet: a data visualization platform to interactively explore pathogen variants and antimicrobial resistance.
Get PDFAntimicrobial resistance (AMR) poses a substantial threat to global public health. Whole genome sequencing is increasingly used as a core method for pathogen characterization to support AMR surveillance. As a result, a vast amount of bacterial sequence data are available in public archives, yet the AMR-related information they encode is not readily accessible to those without bioinformatics expertise and is essentially invisible to policy makers. The AMRnet platform aims to make publicly available genome-derived AMR data accessible to a diverse user base. The underlying data are drawn from public genomic databases and used to calculate pooled estimates of national annual prevalence that can be visualized interactively, and broken down and explored in terms of underlying pathogen variants, resistance mechanisms, and geographic and temporal distributions. Users can download dynamically generated reports, summary and line-list data from the web-based dashboard (https://www.amrnet.org), and query the database via application programming interface. For selected organisms, data are curated for purpose of sampling, to reduce the public data bias towards sequencing of resistant or severe infections. By improving the accessibility and utility of publicly archived data, AMRnet aims to encourage wider sequencing initiatives and collaborative data-sharing efforts while providing crucial data insights for researchers and policy makers
A study protocol to co-develop and evaluate interventions that strengthen healthcare resilience to extreme weather events in three African countries: the ASTRA study
Get PDFExtreme weather events (EWEs) are becoming more frequent and intense due to climate change, disrupting healthcare systems and increasing risks for vulnerable populations. In low- and middle-income countries, these disruptions threaten progress in HIV and tuberculosis (TB) care by limiting access, straining services, and worsening health outcomes. Building health system resilience through environmentally sustainable infrastructure and processes, adequate and skilled workforce, and community engagement is essential to ensure continuity of care. In this four-year study (ASTRA), we aim to co-design, prioritise and evaluate interventions to strengthen community and health system resilience to EWEs for people living with HIV/TB. This multi-phase, mixed-methods study will be conducted in Mozambique, South Africa, and Zambia, countries which are highly vulnerable to EWEs such as storms, cyclones and flooding and bear a high burden of HIV and TB. Phase 1 will focus on understanding the context through stakeholder mapping, scoping interviews, a Delphi consensus process, and assessments of community and health facility vulnerability and adaptive capacity. We will carry out rapid ethnographic assessments [also known as Broad Brush Surveys (BBS)], spatial and statistical modelling, and a policy and programme analysis in this phase. Phase 2 will involve four sequential co-creation workshops in each country to produce prototype interventions that will be refined and prioritised for evaluation. In Phase 3, we will evaluate selected interventions using system dynamics modelling and economic analysis. Using systems dynamics modelling, we will model the final set of interventions, individually and in combination, to explore their potential effects on service delivery during EWEs. The economic evaluation will estimate the costs of inaction, assess the benefits of interventions through multi-criteria decision analysis, and determine their value for money to inform priority setting and policy action. Overall, the innovative use of participatory co-creation processes, system dynamics modelling, and economic evaluation, provides a model for designing and assessing adaptation interventions that are both evidence-based and locally relevant. ASTRA will inform national policy and planning and offer transferable knowledge for other climate-vulnerable settings facing similar challenges
Altered effort and deconditioning are not valid explanations of myalgic encephalomyelitis/chronic fatigue syndrome.
Get PDFMyalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex, systemic disease with significant pathophysiological uncertainties and variable presentations(1). Here, we challenge Walitt et al.’s(2) conclusion that post-infectious (PI) ME/CFS is a disorder defined by altered effort preference, leading to activity avoidance and subsequent deconditioning. We believe this interpretation risks reinforcing skepticism about the serious biological nature of ME/CFS and its hallmark of post-exertional malaise (PEM), as well as its potential misclassification as a mental health condition
Picturing a mental health journey: experience of a participatory photovoice approach to presenting recovery narratives of people with lived experiences and caregivers in Ethiopia.
Get PDFBACKGROUND: PhotoVoice is a participatory approach that uses photography to offer a useful platform for sharing the stories of people with mental health conditions whose voices are often marginalized. This study aimed to explore the experiences of people with lived experiences and caregivers in constructing brief recovery narratives presented at training sessions that highlight their experiences before, during, and after mental health treatment.
METHOD: A participatory photovoice study was carried out with 16 participants from the Sodo district, Ethiopia. The participants were people with lived experiences (n = 8) and caregivers (n = 8) selected via purposive sampling. Field notes, photographs and testimonies arising from the PhotoVoice sessions were analysed together with in-depth interviews with participants. The data were analysed via narratives used during photovoice sessions and thematic analysis.
RESULTS: The PhotoVoice training experience was mostly positively received and brought to light a variety of perceived benefits through providing an inclusive understanding of mental health and related misconceptions and by addressing stigma and discrimination-related myths in the community. Furthermore, the participants reported the benefit of being engaged in productive activities that improved their communication and relationships with other people. The photographs revealed the stigmatized experiences of participants seeking alternative treatment solutions and challenges in accessing and gaining awareness of mental health. Stress and fear of public speaking and negative feedback from their family and community were the main barriers to participation in the photoVoice sessions.
CONCLUSIONS: This study shows that PhotoVoice training has important value in eliciting insights from participants' lived experiences. The findings indicate that this approach is important for the empowerment of people with lived experiences and their family members and for coping with the stigma and discrimination they encounter. Stakeholders working in mental health can use and adapt this participatory technique to empower service users and family members and reduce the impacts of stigma associated with mental illnesses
Preparing to Respond to the Next Pandemic: Impact of Key WHO IPC COVID-19 Response Products.
Get PDFAn outcomes/impact evaluation was undertaken (July 2023-April 2024) to evaluate the work of the World Health Organization (WHO) infection prevention and control (IPC) coronavirus disease (COVID-19) response team during the COVID-19 pandemic and to identify how to better prepare for the next pandemic. The evaluation used mixed methods, focusing on three pillars of the team's work: (1) interim guidance and guidelines; (2) OpenWHO IPC courses; and (3) risk communication and community engagement (RCCE) interventions. A literature review, interviews with WHO headquarters and regional staff, case studies, and multicountry surveys were undertaken. Of the national representatives surveyed, 97% reported that the guidelines impacted their work; overall 76% of Member States used RCCE interventions and products; and 99% of course participants used what they learned professionally or personally. Member States identified gaps relating to national contextualization, availability of feedback and monitoring mechanisms, and knowledge sharing. There is strong evidence of the impact, effectiveness, and use of this team's work in developing IPC COVID-19 guidelines and through courses developed and shared via OpenWHO; however, there is weaker evidence on the impact of RCCE products/interventions as a standalone activity. To be better prepared for the next pandemic, Member States and the WHO need to collectively identify how best to sustain the IPC gains and address the gaps
Do doctors contribute to socioeconomic inequalities in health care provision? An audit experiment in Tunisia.
Get PDFIn this paper, we explore an important but understudied driver of health inequalities: whether doctors treat patients from different socioeconomic backgrounds differently during a clinical encounter. We design an audit experiment in Tunisia, sending standardised patients with the same symptoms to 130 public and private primary care doctors for consultation. Informed by in-depth qualitative work, we vary the attitude and appearance of the patients so that they appear to be "poor" or "middle-class". We find no evidence that doctors manage patients differently, but they respond to the socioeconomic profile of patients by prescribing fewer expensive drugs and giving out more free drugs to poorer patients. We also show significant differences in communication between patients: doctors are more likely to provide more explanation to richer patients about the diagnosis, the drugs prescribed and the treatment plan. These differences are not explained by time constraints as doctors spent comparable time with both types of patients. To the extent that differences in communication with patients can lead to differences in patients' health decisions, our results suggest that doctors could contribute indirectly to health inequalities
Environmental drivers of Ixodes ricinus tick population dynamics: Mechanistic modelling using longitudinal field surveys and climate data.
Get PDFIxodes ricinus is the primary vector for Lyme disease and tick-borne encephalitis across Europe. However, the environmental drivers of the tick's complex life cycle have not been quantified with real-world data, making it challenging to incorporate tick demography into tick-borne disease transmission models. To address this gap, we fitted a mechanistic model to a detailed 10-year longitudinal dataset from four sites in Northern France, where I. ricinus is abundant and Lyme disease and tick-borne encephalitis have been reported for decades. By incorporating key demographic processes and the influence of environmental conditions on these processes, our model estimated oviposition, hatching, and moulting rates across a range of temperature or saturation deficit, as well as questing and vertebrate host contact rates. In the studied tick population, moulting peaked at 14.2 °C (95 %HDI: 12.5-16.1 °C), substantially lower than commonly suggested by laboratory-based studies, whereas oviposition and hatching peaked at 24.4 °C (95 %HDI: 10.9-27.2 °C) and 24.7 °C (95 %HDI: 17.8-27.2 °C), respectively. Furthermore, the parameter scaling the empirical baseline vertebrate host contact rates was found to vary significantly between the four study sites, with one site presenting up to 2.90 (95 %HDI: 2.15-3.86) times higher contact rates than the other three sites. Additionally, for ticks overwintering through diapause, moulting in spring more accurately matched the predominantly unimodal questing patterns observed, compared to moulting in summer. Finally, model projections under pessimistic climate change scenarios indicated decreasing tick abundance trends over the next two decades, while no significant decrease was predicted under moderate scenarios. This study provides a foundation for models of I. ricinus-borne pathogen transmission and can be adapted to other Ixodidae populations of public health significance