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Collaborating for change: reimagining medical education in Jordan through international partnerships
Get PDFMedical education in Jordan has evolved rapidly in the last 50 years as successive governments and higher education leaders have responded swiftly to developing healthcare sector demands. Despite significant progress being made, there remain a substantial number of challenges for the Jordanian medical education system that require careful attention in the years and decades ahead. This article provides a historical summary of medical education in Jordan, outlines some of the important areas that require development, and describes plans for a new medical school and teaching hospital in Amman at the newly established Kingdom University of Health Sciences, due to open in 2026. This ambitious project is being funded by the Saudi Jordanian Investment Fund and is being supported by partnerships with high-ranking, well-established institutions in the UK and USA. This article highlights the significant value in a partnership approach to developing a medical education program as it strives to overcome some of the existing challenges facing medical education in Jordan
Acanthamoeba castellanii as a model for unveiling Campylobacter jejuni host-pathogen dynamics.
Get PDFThe persistence of the major enteric pathogen Campylobacter jejuni in the natural environment, despite being microaerophilic, remains unsolved. Its survival in the natural atmospheric environment likely stems from several factors, including interactions with amoebae. C. jejuni transiently interacts with Acanthamoeba, and this is thought to provide protection against unfavorable atmospheric conditions and subsequently prime the bacteria for interactions with warm-blooded hosts. Acanthamoeba play vital roles in microbial ecosystems by preying on bacterial species, some of which are clinically important. We analyzed the whole transcriptome of A. castellanii infected with C. jejuni 11168H. Our findings provide evidence that infection of A. castellanii with C. jejuni triggers distinct and reproducible cellular responses. Upregulated genes were associated with protein synthesis, DNA damage and repair, gluconeogenic pathways, and protein folding and targeting, while downregulated genes were involved in calcium ion transport, osmotic stress response, energy reserve metabolic processes, and protein hydroxylation. From these data, we characterized Cj0979c, named here C. jejuni endonuclease (CjeN), which induces DNA damage in A. castellanii. High-resolution microscopy revealed an unexpected association between C. jejuni and host mitochondria, while infected cells show elevated cytosolic calcium levels and metabolic changes favoring "Warburg-like" metabolism. A. castellanii cells showed increased lactate production, which was subsequently depleted, suggesting that this host metabolic by-product may support C. jejuni survival. These findings identify an unexpected interaction between amoebae and a microaerophilic bacterium and provides a useful model for further research on host-pathogen interactions
The Effect of Community Based Intervention on People with Type 2 Diabetes Mellitus: Systematic Review
Get PDFBackground:The rising prevalence of Type 2 Diabetes Mellitus (T2D) has become a significant global health burden, with profound implications for healthcare systems and affected individuals. Strengthening primary healthcare services by integrating health and community-based interventions is critical for improving health outcomes. This rapid systematic review aimed to evaluate the effectiveness of community-based interventions in enhancing health outcomes for patients with T2D.
Objectives:To evaluate the effectiveness of community-based interventions in managing T2D, focusing on their impact on health outcomes
Methods:This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data collection involved five major databases: Scopus, Cochrane Library, PubMed, Web of Science, and Clinical Key, covering publications from January 2013 to May 2024. Eligible studies included randomized controlled trials, mixed-methods research, clinical trials, prospective studies, experimental repeated-measures designs, and quasi-experimental designs. The risk of bias in the included studies was assessed using the RevMan 5.4.1 software. Article selection, risk of bias evaluation, data extraction, and synthesis were conducted independently by the authors, with discrepancies resolved through discussion and consensus.
Results:Out of 4.463 identified articles, 13 met the eligibility criteria for inclusion in the review. The community-based intervention strategies identified in these studies involved three primary approaches: family-centered interventions, peer support, and community volunteer programs.
Conclusion:This systematic review concludes that community-based interventions are effective in improving health outcomes for individuals with T2D. Integrating and strengthening health and community-based collaborations within the broader healthcare system is crucial for achieving optimal health outcomes. Nurses are encouraged to collaborate with community-based networks to bridge the gap between healthcare providers and communities, thereby enhancing public health outcomes.
Keywords:community participation; diabetes mellitus; family; peer; volunteer
Machine learning derived retinal pigment score from ophthalmic imaging shows ethnicity is not biology.
Get PDFFew metrics exist to describe phenotypic diversity within ophthalmic imaging datasets, with researchers often using ethnicity as a surrogate marker for biological variability. We derived a continuous, measured metric, the retinal pigment score (RPS), that quantifies the degree of pigmentation from a colour fundus photograph of the eye. RPS was validated using two large epidemiological studies with demographic and genetic data (UK Biobank and EPIC-Norfolk Study) and reproduced in a Tanzanian, an Australian, and a Chinese dataset. A genome-wide association study (GWAS) of RPS from UK Biobank identified 20 loci with known associations with skin, iris and hair pigmentation, of which eight were replicated in the EPIC-Norfolk cohort. There was a strong association between RPS and ethnicity, however, there was substantial overlap between each ethnicity and the respective distributions of RPS scores. RPS decouples traditional demographic variables from clinical imaging characteristics. RPS may serve as a useful metric to quantify the diversity of the training, validation, and testing datasets used in the development of AI algorithms to ensure adequate inclusion and explainability of the model performance, critical in evaluating all currently deployed AI models. The code to derive RPS is publicly available at: https://github.com/uw-biomedical-ml/retinal-pigmentation-score
LLIN Evaluation in Uganda Project (LLINEUP2) - Effect of long-lasting insecticidal nets (LLINs) treated with pyrethroid plus pyriproxyfen vs LLINs treated with pyrethroid plus piperonyl butoxide in Uganda: A cluster-randomised trial.
Get PDFLong-lasting insecticidal nets (LLINs) are the cornerstone of malaria control, but their effectiveness is threatened by pyrethroid resistance. We embedded a pragmatic, cluster-randomised trial into Uganda's national LLIN distribution campaign in 2020-2021, comparing pyrethroid-piperonyl butoxide (PBO) LLINs to pyrethroid-pyriproxyfen LLINs. Target communities surrounding public health facilities (clusters, n=64), covering 32 districts were included. Clusters were randomised 1:1 in blocks of two by district to receive: (1) pyrethroid-PBO LLINs (PermaNet 3.0, n=32) or (2) pyrethroid-pyriproxyfen LLINs (Royal Guard, n=32). LLINs were delivered from 7 November 2020 to 26 March 2021. Malaria surveillance data were collected from health facilities from 1 November 2019 until 31 March 2023. Cluster-level estimates of malaria incidence in residents of all ages (primary outcome) were generated from enhanced health facility surveillance data. Cross-sectional community surveys were conducted in randomly selected households (at least 50 per cluster) at 12-months (24 November 2021 to 1 April 2022) and 24-months (23 November 2022 to 21 March 2023) post-LLIN distribution. Overall, 186,364 clinical malaria episodes were diagnosed in cluster residents during 398,931 person-years of follow-up. At 24-months, malaria incidence was lower than baseline in both arms (pyrethroid-PBO: 465 vs 676 episodes per 1000 person-years; pyrethroid-pyriproxyfen: 469 vs 674 episodes per 1000 person-years); but there was no evidence of a difference between the arms (incidence rate ratio 1.06, 95% confidence interval [CI] 0.91-1.22, p=0.47). Two years post-distribution, ownership of at least one LLIN for every two household residents was low in both arms (41.1% pyrethroid-PBO vs 38.6% pyrethroid-pyriproxyfen). Parasite prevalence in children aged 2-10 years was no different between the arms in either survey (24-months: 26.1% pyrethroid-PBO; 29.5% pyrethroid-pyriproxyfen; odds ratio 1.29 [95% CI: 0.81-2.05], p=0.29). The effectiveness of pyrethroid-PBO LLINs and pyrethroid-pyriproxyfen LLINs was no different in Uganda, but two years after mass distribution, LLIN coverage was inadequate. Trial registration: NCT04566510. Registered 28 September 2020, https://clinicaltrials.gov/ct2/show/NCT04566510
Researching health and internal displacement: Introduction to the special series
Get PDFThis special series on ‘health and internal displacement’ is concerned primarily with the health needs of internally displaced persons (IDPs) in conflict contexts. Curated by editors from the recently established Health and Internal Displacement Network (HIDN), the series brings together a selection of thirteen new research articles from among many submitted in response to an open call for papers by HIDN and the Journal of Migration and Health. The aims of this series are to increase engagement with the health needs of IDPs and to support research, policy and programming in this relatively neglected area. The series focuses on IDP health but is not prescriptive in terms of health conditions, age groups, geographic region, or camp or urban setting, and reflects the diversity of IDP populations, contexts and needs
Exploring the application of the capability approach to the health and well-being of Indigenous Peoples: a scoping review.
Get PDFThis scoping review synthesizes existing literature on the application of the capability approach (CA) to address the health and well-being of Indigenous Peoples across the globe. Academic and grey literature searches led to the identification of 20 papers for inclusion in the review. Findings reveal a growing interest in applying the CA to Indigenous health and well-being research, highlighting its potential to guide interventions and policies. The included studies indicate that the CA has been applied to individual capabilities such as facilitating access to services and collective capabilities linked to identity and traditional knowledge preservation. A key finding across the reviewed literature is the importance of incorporating Indigenous values into defining programmes and policies aimed at improving Indigenous Peoples' well-being. The review underscores the varied application of the CA by researchers aligning with the position of either Sen or Nussbaum, leading to contrasting methodological approaches. Results underscore the CA's potential as a culturally sensitive framework for participatory and locally embedded development of well-being interventions and policies
Assessing trachoma elimination progress in districts with persistent trachoma, Western Province, Zambia.
Get PDFBACKGROUND: Trachoma is a public health problem in Zambia. We aimed to estimate the prevalence of trachomatous inflammation-follicular (TF) in 1-9-y-olds and of trachomatous trichiasis (TT) in ≥15-y-olds after the implementation of trachoma elimination interventions to determine if the trachoma elimination thresholds had been achieved: <5% for TF in 1-9-y-olds and <0.2% TT for ≥15-y-olds. METHODS: Two rounds of impact prevalence surveys in two evaluation units (EUs) comprising four districts of Western Province were conducted; the first in 2018, the second in 2023. All individuals aged ≥1 year from 30 households of 24 clusters in each EU were examined for trachoma. Data were captured electronically. RESULTS: In 2018, TF prevalence in 1-9-y-olds was 13.9% in Kalabo/Sikongo and 17.9% in Shang'ombo/Sioma. Following further interventions, TF prevalence among 1-9-y-olds in 2023 was 7.7% and 12.5%, respectively. TT prevalences in ≥15-y-olds were 0.10% and 0.79% in 2018, and 0.4% and 0.2% in 2023, respectively. CONCLUSIONS: These EUs did not attain trachoma elimination thresholds as a public health problem. They fulfilled the WHO definition for persistent trachoma. Therefore, they warrant further investigation, including collection of Chlamydia trachomatis infection data, to inform future programmatic decision-making. Further TT surgical services are also needed
Recent emergence of cephalosporin-resistant Salmonella Typhi in India due to the endemic clone acquiring IncFIB(K) plasmid encoding blaCTX-M-15 gene.
Get PDFUNLABELLED: The emergence and spread of Salmonella Typhi (S. Typhi) resistant to third-generation cephalosporins is a serious global health concern. In this study, we genomically characterized 142 cephalosporin-resistant S. Typhi strains isolated from India. Comparative genome analysis revealed the emergence of a new clone of ceftriaxone-resistant S. Typhi harboring three plasmids of the incompatibility groups IncFIB(K), IncX1, and IncFIB(pHCM2). Among these, the IncFIB(K) plasmid confers resistance to third-generation cephalosporins through the blaCTX-M-15 gene, along with other resistance determinants such as aph(3"), aph(6'), sul2, dfrA14, qnrS, and tet(A). Phylogenetic analysis showed that the isolates from Gujarat (n = 140/142) belong to a distinct subclade (genotype 4.3.1.2.2) within genotype 4.3.1.2 (H58 lineage II). Single nucleotide polymorphism-based phylogenetic analysis of the core genes in IncFIB(K) suggested a close relatedness of the plasmid backbone to that of IncFIB(K) from other Enterobacteriales, indicating that H58 lineage II possesses the capability to acquire MDR plasmids from these organisms. This could indicate the potential onset of a new wave of ceftriaxone-resistant S. Typhi in India. The implementation of control measures-such as vaccination and improved water, sanitation, and hygiene systems-is crucial in areas where MDR or extensively drug-resistant S. Typhi strains are prevalent to curb the spread and impact of these resistant strains. IMPORTANCE: Typhoid fever remains a global health concern, especially in areas lacking sanitation and clean water. The rise of drug-resistant strains complicates treatment, increasing illness, death, and healthcare expenses. Travel facilitates the spread of these strains worldwide. Multidrug-resistant and extensively drug-resistant (XDR) strains, including those resistant to first-line antibiotics and fluoroquinolones, pose significant challenges. Azithromycin and third-generation cephalosporins are now preferred treatments. Recently, XDR typhoid emerged in Pakistan, resistant even to third-generation cephalosporins. India also faces challenges, with sporadic cases initially declining but now re-emerging. New strains in India show resistance to third-generation cephalosporins due to plasmid acquisition from other bacteria, particularly blaCTX-M-carrying IncFIB(K). Due to the ongoing nature of this outbreak, the data from this study deserve further consideration in order to control its spread in India
Primary Enucleation for Intraocular Unilateral Retinoblastoma Can Save Life in Lower-Income Settings.
No full textOBJECTIVE: To investigate the outcomes of primary enucleation and adjuvant systemic chemotherapy, when deemed appropriate, on a cohort of children with unilateral intraocular Rb (AJCC 8th edition, cT2 and cT3) from diverse economic groupings. METHODS: A prospective analysis including treatment-naïve Rb patients were presented to 11 centers from 10 countries from January 1 to December 31, 2019, and were followed-up thereafter. Only children with unilateral intraocular Rb that underwent primary enucleation were included in the present analysis. Systemic metastasis and survival were investigated. RESULTS: Of the 692 children with Rb, 191 (27.6%) were included in the study cohort. Among them, 24 (12.6%) were from low-income countries (LICs), 89 (46.6%) from lower-middle-income countries (LMICs), 59 (30.9%) from upper-middle-income countries (UMICs), and 19 (9.9%) from high-income countries (HICs). High-risk histopathological features were observed in 110 eyes (57.6%) following enucleation, and 102 of these children (92.7%) received adjuvant intravenous chemotherapy. The three-year survival rate for the entire cohort was 95.0%. Stratified by economic grouping, survival rates were 87.5% (LIC), 96.6% (LMIC), 93.2% (UMIC), and 100% (HIC). Children from LICs demonstrated a higher prevalence of HRHF compared to HICs. Residing in a lower-income country was associated with a higher risk of systemic metastasis and poorer outcomes. CONCLUSION: In the present multinational cohort of children with unilateral intraocular Rb who underwent upfront enucleation coupled with adjuvant chemotherapy as needed, overall survival was favorable, especially for children from low-income countries. Prompting early diagnosis, while the tumor remains intraocular can be life-saving, particularly in low-resource settings where primary enucleation and adjuvant chemotherapy can cure unilateral Rb