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Identification of intrinsic capacity impairment: diagnostic performance of integrated care for older people (ICOPE) screening tools in Zimbabwe.
Get PDFINTRODUCTION: The World Health Organization (WHO) Integrated Care for Older People (ICOPE) framework proposes screening (Step-1) and subsequent in-depth assessment (Step-2) to inform personalised interventions to promote intrinsic capacity (IC) in older adults. We aimed to assess the diagnostic performance of screening approaches against in-depth assessments in Zimbabwe. METHODS: This cross-sectional study recruited older adults age ≥65 years in urban Zimbabwe. For both Steps 1 and 2, IC was assessed using WHO ICOPE-proposed and/or alternative assessments for seven domains: cognition, locomotion, vitality, vision, hearing, psychological, and urinary continence. Diagnostic performance of screening approaches was assessed using metrics, including sensitivity and specificity categorised as good (≥0.80), fair (≥0.50-0.79), poor (<0.50). RESULTS: The 763 adults were mean (standard deviation) age 74.5(7.2) years: 62.9 % female. Frequencies of IC impairments ranged from 18.1 % for hearing to 92.0 % for vision based on screening, and 13.4 % for urinary incontinence to 62.9 % for vision based on in-depth assessments. Performance of 37 different screening approaches and in-depth assessment comparisons were tested. Of the eight screening approaches with the best performance, sensitivity ranged from good (n = 7) to fair (n = 1), while five had fair and three had poor specificity. Sensitivity of screening approaches ranged from 0.65 (95 %CI: 0.58-0.71) for hearing to 0.93 (95 % CI: 0.89-0.96) for locomotion. Specificity ranged from 0.28 (0.22-0.33) for vision to 0.69 (0.65-0.73) for hearing. CONCLUSION: Each domain had a screening approach with good or fair sensitivity and mostly fair specificity, supporting use in ICOPE implementation in Zimbabwe, which is urgently needed given the high prevalence of IC impairments
Sex differences in social connectedness, health, and quality of life: evidence from a cross-sectional survey in urban Accra, Ghana.
Get PDFBACKGROUND: Social relationships are recognised as a determinant of health and well-being. However, cultural norms, including those related to sex roles, shape how individuals form and experience social connections, and may influence how they affect health and quality of life (QoL). Yet, most existing evidence on the links between social connectedness and well-being comes from high-income countries and focuses primarily on subjective outcomes. Less is known about these associations in low- and middle-income settings, particularly when considering both objective and subjective health and QoL measures. This study explored how indicators of social connectedness were associated with health and QoL outcomes among women and men in a low-income urban neighbourhood in Accra, Ghana. METHODS: We used data from the Contextual Awareness Response and Evaluation: Diabetes in Ghana project (CARE) community-based survey conducted in Ga Mashie, Ghana. We employed logistic and linear regression models to study associations between four indicators of social connectedness and a range of well-being and health outcomes, including QoL, self-rated health, diabetes risk, and overweight and obesity. RESULTS: Women reported, on average, lower levels of social connectedness compared to men. Moreover, most statistically significant associations were found for subjective rather than objective outcomes, and these associations varied by sex. Among men, participation in associations was positively linked to psychological and environmental dimensions of QoL. For women, group participation was associated with better self-rated health. A small association also suggested that friendships could be linked to a potential negative impact on some dimensions of women's QoL. CONCLUSION: Our study underscores the importance of examining sex-specific patterns in the relationships between social connectedness, QoL and health outcomes. Social connections appear to have both beneficial and non-beneficial effects, especially among women, although the magnitude of these effects was often small. This may reflect complex social dynamics shaped by cultural and traditional roles that differ by sex. Further research is needed to better understand these findings. This includes identifying potential mediating variables that explain the associations between social connectedness and individual health and QoL, and exploring why some of these associations differ by sex
Seeing the world upside down: historical insights for medical Education's future.
Get PDFIn a world that is increasingly globalised and fragmented, medical education is shaped by complex political, social, and economic forces at local and international levels. This article argues that preparing for the future of medical education in such a changing landscape requires engagement with long-term historical perspectives. Drawing on the history of empires, it highlights how former imperial metropoles, entrenched colonial legacies, and inequities in medicine influence governance and the professional mobility of students and practitioners, notably through international accreditation standards. The article emphasises the importance of recognising historical and regional specificities, cautioning against overly uniform narratives - such as the "Global North-Global South" divide. Through case studies of China and Pakistan, it aims to demonstrate how historical insights can reveal comparable yet divergent trajectories in medical education. It concludes that our present is not outside of history but shaped by it, urging educators to critically examine inherited assumptions and to imagine more equitable futures by metaphorically seeing the world "upside down.
Vaccination timeliness is a key measure of immunisation system performance: A call to address priority research, policy and practice issues
Get PDFHighlights
• Vaccination coverage is widely used to assess immunisation programme delivery and performance.
• Vaccination timeliness provides nuanced insights into hidden vulnerabilities in immunisation programmes, particularly for highly contagious diseases, yet it remains underexamined and under-utilised in research and policy.
• Multiple gaps persist including inconsistent definitions, limited fine-scale geospatial analyses, and how data missingness is handled in timeliness analyses.
• Building consensus on the definition and measurement of vaccination timeliness is essential for cross-country comparability and for integrating timeliness indicators into programme monitoring
Vaccination systems under pressure: what the UK COVID-19 Inquiry teaches us about preparedness.
No full textUrgent action is required to close gaps in routine programme delivery and strengthen pandemic preparedness. Synthesising pandemic learning from the United Kingdom (UK) Covid-19 Inquiry demonstrates that the potential of vaccine innovation to save lives will be undermined without robust and adaptable routine delivery strategies
Multi-Actor Collaborations in Primary Health Care (PHC) Implementation: A Social Network Analysis of the PHC Strategy in Ghana.
Get PDFBottom-up theory demonstrates that networks of actors play important roles in policy implementation, yet limited attention has so far been paid to the influence that actor networks might have on the implementation of PHC strategies and outcomes. This study examined the roles actor networks play in the implementation of Community-based Health Planning and Services (CHPS) in Ghana, focusing on the nature and patterns of relations and structure and strength of prevailing collaborations. This was a cross-sectional study using a social network analysis methodology in eight districts across two regions in Ghana. The study population was implementers of CHPS from the community, district, regional and national and development partners. Data were obtained using a modified pre-tested closed-ended social network questionnaire. To establish collaborative relationships, knowledge of other actors and the degree of communication on issues related to CHPS implementation were surveyed. Data were analysed using Gephi software version 0.9.2. The analysis demonstrated existing actor networks of Community Health Committees (CHCs), Community Health Officers (CHOs), Community Health Volunteers (CHVs), Sub-district, and district-level networks, including local government actors and political leaders, as well as regional, national, and development partner actors in CHPS implementation. The nature of relations showed isolated networks of CHCs, CHVs, and sub-districts across both regions. Patterns of interactions revealed that CHO networks collaborate with each other, while CHCs primarily collaborate with CHOs. Overall, weak collaborative relationships were noted among the actor networks (network density < 10%). The results suggest segmented, decentralized networks with limited involvement of critical actors, including community-level, local government, political leaders, national-level and development partners in CHPS implementation. The network analysis highlights weak collaborative relationships among actor networks in CHPS implementation, a practice which negatively impacts its implementation experience. The study highlights pathway to strengthen cohesion and improve collaborative relationships in addressing CHPS as a PHC strategy
The process of developing an HIV disclosure intervention for youth with perinatally acquired HIV: The HIV Empowering Adults' Decisions to Share - UK/Uganda Project (Heads-Up).
Get PDFSharing one's HIV status with others (onward HIV disclosure) for youth with perinatally acquired HIV (PAH) is often difficult but may assist with challenges associated with living with HIV. We describe the development of an intervention to help HIV-sharing decision-making for UK and Ugandan youth with PAH. The methods included : (1) semi-structured interviews with 50 participants (20 with PAH patients aged 18-25 years, 20 friends, family or partners and 10 professionals), (2) a survey of 57 UK participants with PAH patients aged ≥17, (3) the development of an intervention conceptual model, (4) intervention development, including obtaining intervention feedback from 13 youth with PAH. The survey showed that group (23/57; 40%) and mixed individual and group formats (21/57; 37%), mixed gender groups (52/57; 91%) and peer worker involvement (54/57; 95%) were preferred. The interviews highlighted the importance of overcoming feelings of shame and accepting one's status before sharing, having support to feel confident to share, personal values playing a part in sharing decisions and friends and partners explaining that they had not been educated about HIV until someone had shared their status with them. We describe the finalised intervention, and strengths and limitations of the intervention development process are outlined
Ambient temperature and child nutritional status of more than 6 million children in Brazil: a cohort study.
Get PDFBACKGROUND: Evidence regarding the association between temperature and children's nutritional status is scarce. We aimed to estimate the relationship between ambient temperature and the weight and height of Brazilian children aged 12-59 months. METHODS: This large longitudinal cohort study from all 5570 Brazilian municipalities used data from the 100 Million Brazilians Cohort linked with data from the Information System on Live Births (SINASC), Food and Nutrition Surveillance System (SISVAN), and temperature data from the Brazilian Daily Weather Gridded Data (BR-DWGD). The study included children aged between 12-59 months with nutritional monitoring recorded by SISVAN between Jan 1, 2008 and Dec 31, 2017. We applied distributed lag non-linear models to investigate the cumulative influence of temperature over the year preceding each child's measurement on weight and height (ie, lag: 0-51 weeks). Subgroup analyses were conducted to identify population groups facing greater risk of worse nutritional outcomes. FINDINGS: 6 498 546 children aged between 12-59 months were included in the study. 3 226 520 (49·65%) participants were male, 3 272 026 (50·35%) were female, and 4 194 195 (64·54%) were Parda or Brown ethnicity. For each 1°C increase in ambient temperature above the median (26°C), the cumulative odds over the weekly lags 0-51 increased by 10·0% (odds ratio [OR] 1·10 [95% CI 1·099-1·103]) for underweight (low weight-for-age), 8·0% (OR 1·08 [1·078-1·081]) for wasting (low weight-for-height), and 8·0% (OR 1·08 [95% CI 1·078-1·080]) for stunting (low height-for-age) in Brazil. In stratified analyses, the odds of malnutrition associated with a 1°C increase in ambient temperature were highest in the North (followed by the Northeast, the two poorest regions of Brazil), in municipalities with higher deprivation index, in rural areas, and among children of Indigenous mothers. INTERPRETATION: Children experiencing high temperatures in Brazil are more likely to suffer from malnutrition, with worse outcomes observed among more vulnerable social groups. Our results highlight the deep environmental injustice in Brazilian society, with the influence of temperatures interacting with existing social and economic inequalities and exacerbating nutritional outcomes in the most vulnerable groups. Further studies are needed to investigate causal pathways and identify strategies capable of mitigating the effects of climate change on child nutrition. FUNDING: National Council for Scientific and Technological Development (CNPq); the Department of Science and Technology of the Secretariat of Science, Technology, Innovation and Strategic Health Inputs of the Brazilian Ministry of Health; the Wellcome Trust
Listeria-infected macrophages promote biomechanical alterations in endothelial cell monolayers for transmigration.
Get PDFIntracellular pathogens, such as Listeria monocytogenes (LM), manipulate host cells to spread from the initial infection site to distant organs through the bloodstream. For that, LM hijacks mononuclear phagocytes to traverse vascular endothelial cell (EC) linings, but how transmigration is regulated by ECs is poorly understood. Here, we show that LM infection profoundly alters EC biomechanical responses to macrophages (MΦs). Videomicroscopy revealed that EC-MΦ contact induces EC polarization, alignment, and reduced motility. However, only interactions with uninfected MΦs increased EC traction and monolayer stresses and barrier integrity. This biomechanical response is largely contact-dependent and significantly attenuated during infection, thus contributing to the enhanced rate of LM-infected MΦ transmigration. Consistently, in the zebrafish model, infection increased endothelial permeability and phagocyte extravasation. These findings reveal that LM infection overrides MΦ-induced endothelial barrier strengthening to promote pathogen dissemination, a biomechanical strategy that could be harnessed for infection control
A systematic review and meta-analysis of Zika virus epidemiology.
Get PDFZika virus (ZIKV), classified as a priority pathogen by the World Health Organization, is an Aedes-borne arbovirus that can cause neurological complications and birth defects in newborns of mothers infected during pregnancy. We conducted a systematic review of peer-reviewed studies reporting ZIKV epidemiological parameters, transmission models and outbreaks (PROSPERO CRD42023393345) to characterize its transmissibility, seroprevalence, risk factors, disease sequelae and natural history. We performed meta-analyses of the proportions of congenital Zika syndrome, pregnancy loss among ZIKV-infected mothers and symptomatic cases. We extracted information from 574 studies. Across 418 included studies assigned a high-quality score, we extracted 969 parameters, 127 outbreak records and 154 models. Using random-effects models, we estimated proportions of congenital Zika syndrome (4.65%, 95% confidence interval (CI): 3.38-6.67%), pregnancy loss (2.48%, 95% CI: 1.62-3.78%) and symptomatic cases (51.20%, 95% CI: 38.00-64.23%). Seroprevalence estimates (n = 354) were retrieved beyond South America and French Polynesia. Basic reproduction number estimates (n = 77) ranged between 1.12 and 7.4. We found 66 human epidemiological delay estimates, including the intrinsic incubation period (n = 11, range: 4-12.1 days), infectious period (n = 15, range: 3-50 days), extrinsic incubation period (n = 22, range: 5.1-24.2 days) and serial interval (n = 27, range: 7.4-32.9 days). These data are available in the R package 'epireview' (version 1.4.5). We provide a comprehensive systematic summary of ZIKV epidemiology, revealing large heterogeneities and inconsistencies in the reporting of parameter estimates, study designs and parameter definitions and underscoring the need for standardized epidemiological definitions