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Healthcare services for low-wage migrant workers: A systematic review.
Get PDFLow-wage labour migrants often face health-damaging living and working conditions, but are frequently excluded from healthcare. The othering of migrants, bordering of healthcare and simple oversight and negligence create widening health inequalities for a society's essential workers. This review aimed to identify the forms and effectiveness of healthcare services designed to make healthcare accessible for migrant workers. We searched for literature through Medline, Embase, Global Health, Web of Science, and Global Index Medicus (from 1 January 2000 till 9 June 2023), focussing on selected work sectors (domestic work, construction, manufacturing, agriculture, mining). Primary research, reports, and grey literature from 2000 onwards containing descriptions or evaluations of healthcare services exclusively targeting low-wage migrant workers and their families were included. We excluded services focussing only on specific health conditions or disease screening. Quality appraisal was based on tools from the Joanna Briggs Institute. We narratively synthesised service characteristics and effects. This review follows the PRISMA reporting guidelines for systematic reviews and is registered with PROSPERO (CRD42023459360). Identified studies included 21 healthcare services targeting low-wage migrant workers in six countries (China, Dominican Republic, Italy, Qatar, South Africa, USA) in three sectors (agriculture, manufacturing, domestic work). Services included established medical facilities (e.g., general hospital care, semi-permanent primary healthcare (PHC) services); mobile clinics for PHC; and telehealth services. The healthcare services were provided by governmental, non-governmental, academic, and private actors. Most targeted migrant farmworkers and were primarily located in the United States. Common healthcare barriers were addressed, for example, via free care, outreach, or non-traditional hours. However, service effects on health, access and uptake, patient satisfaction, and acceptability were largely unclear, as only six studies offered some fragmentary evaluative evidence. Few healthcare services targeting migrant workers have been documented and evaluated, especially in LMICs. Although migrant workers are deemed to be mobile populations, once in the destination location, many are quite immobile when it comes to accessing healthcare. Thus, in the face of persistent exclusion of migrant workers, health systems cannot simply rely on the ability of this vital workforce to seek and use preventative or curative care, but healthcare services must be actively designed to be accessible to this mobile population in order to ensure health as a human right
Sustaining policy promise: rhetorics of disease elimination and sustainable development.
Get PDFThe focus of this paper is the discourse of the 'endgame' of disease elimination linked to the 2030 Agenda of Sustainable Development Goals (SDGs). The aim is to explore how policy promise is sustained in the face of faltering progress, such as when targets are missed or appear unreachable. Viewed via Lauren Berlant's work on the 'cruel optimism' of unmet promise, with Ben Anderson's work on affective attachments, the analysis looks first at the 2030 SDGs and then at disease elimination through the examples of hepatitis C and HIV. The materials for analysis include political declarations, global progress reports and strategy documents. These materials sustain imaginaries of a universal endgame promise as if there cannot be an otherwise. We see how 'crisis' is enacted to account for failure as well as to sustain promise. We also see that the threat of failure gives rise to recalibrated promise in what might be described as an emerging 'elimination otherwise'. Here, the figure of crisis affords increasing attention to disease elimination as a 'problem of the social'. Discourses of the disease elimination endgame act as sites of potential, even in crisis
Comparative Analysis of Septin Modifiers, Forchlorfenuron and UR214-9, on Mitochondrial Fragmentation and Lytic Cell Death.
Get PDFSeptins are conserved GTP-binding proteins that play key roles in cell division, mitochondrial dynamics and immune responses. Despite their importance to human health, pharmacological compounds to modify septins remain limited. Forchlorfenuron (FCF) was the first small molecule identified to modify septins, disrupting their organisation and promoting mitochondrial fragmentation. A more potent FCF analog (UR214-9) has recently been developed, but its effects on mitochondria were unknown. Here, we compare FCF and UR214-9 in vitro using macrophages and in vivo using zebrafish larvae. We demonstrate that both modifiers induce mitochondrial fragmentation in macrophages without altering mitochondrial mass or SEPT7 expression. Consistent with mitochondrial fragmentation, both modifiers trigger lytic cell death in a dose-dependent manner following lipopolysaccharide (LPS) priming. In vivo, both modifiers exhibit dose-dependent effects on the survival of zebrafish larvae, although UR214-9 was significantly more toxic. In agreement with in vitro results, we observed that FCF induces macrophage cell death and caspase-1 activity in zebrafish larvae. Together, our findings show that both septin modifiers impact mitochondrial integrity and macrophage survival. Understanding how septin modifiers regulate immune responses may have important implications for inflammatory disease research and could lead to the development of septin-based medicines for conditions characterised by dysregulated inflammation
Meeting Report on an Integrated Research Agenda for Mosquito-Borne Arboviruses.
Get PDFThe emergence and re-emergence of mosquito-borne arbovirus (MBV) diseases pose a rapidly expanding global health threat fueled by the convergence of multiple ecologic, economic, and social factors, including climate change, land use, poverty, deficiencies of water storage and sanitation, and limitations of vector control programs. On December 6, 2023, the Wellcome Trust and the University of Minnesota's Center for Infectious Disease Research and Policy held a meeting titled "An integrated approach to mosquito-borne arboviruses: a priority research agenda." The meeting comprised presentations, panels, and facilitated discussions aimed at describing the state of the field, highlighting recent accomplishments, identifying novel strategies, and defining priority research goals and approaches for addressing MBV disease preparedness and response. This report summarizes meeting discussions in 3 key areas: the changing epidemiology of MBV disease, current and potential transmission- and disease-monitoring strategies, and evolutionary impacts on disease burden and transmission. It concludes with a list of priority strategies for research and investment in MBV disease prevention, preparedness, and control. To prepare for future epidemics of MBV diseases, research and policy will benefit from a multipathogen approach to MBVs. Building on existing knowledge and systems, these efforts must address social and ecological factors and connect with other global health agendas
Dissemination of extended-spectrum beta-lactamase-producing Escherichia coli in poultry in Zimbabwe.
Get PDFExtended-spectrum beta-lactamase (ESBL)-producing Escherichia coli are resistant to the critically important third- and fourth-generation cephalosporin antibiotics and present a risk to animal and human health. In Zimbabwe, there is an evidence gap concerning the prevalence and diversity of ESBL-producing E. coli in poultry. In this study, we screened for ESBL-E. coli at farms (n=50) and markets (n=10) using MacConkey agar supplemented with 4 µg ml-1 ceftriaxone. ESBL-E. coli were detected at every market and at 21 farms, giving a farm-level prevalence of 42%. Seventy isolates were obtained and tested for antimicrobial susceptibility, whilst 69 of these were further analysed by whole-genome sequencing. A total of eight distinct bla CTX-M variants were identified, and 69 out of 70 isolates were multidrug-resistant. Genomic analysis revealed evidence for clonal expansion of an ESBL-producing clone and horizontal gene transfer via plasmids being responsible for the dissemination of ESBL-E. coli. Geographic Information System mapping was used to visualize the distribution of the ESBL-producing clones. For example, ST1141 isolates were clonal, having a highly conserved core genome, and harboured bla CTX-M-15 and 11 additional antimicrobial resistance genes on a ~338 kbp IncHI2 plasmid which was not present in other isolates. This clone was present at nine farms. In contrast, a conserved ~93 kbp IncFII plasmid harbouring bla CTX-M-55 was present in isolates from three different multilocus sequence types obtained from six farms. This study provides insight into the burden and distribution of ESBL-E. coli at poultry farms in Zimbabwe and provides molecular genetic evidence for clonal expansion and plasmid transfer as being important mechanisms for the dissemination of ESBL-E. coli in this setting. This study underscores the importance of adopting measures, such as prudent antimicrobial use and farm biosecurity, that can limit the development and dissemination of ESBL-producing E. coli
Adherence to RECORD reporting guidelines among observational studies using routinely collected health data published in general medical journals: a meta-epidemiologic study.
Get PDFOBJECTIVES: The REporting of studies Conducted using Observational Routinely Collected Data (RECORD) tool was developed to address gaps around reporting routinely collected health data. The objective of this study was to assess adherence to RECORD in general medical journals and to evaluate its correlation with study quality. METHODS: We searched PubMed using a filter to identify studies using routinely collected health data published in 8 high impact medical journals between 2016 and 2023. Four journals endorsed RECORD, while 4 did not. For each journal, 24 articles were randomly selected, with 3 studies per year. Study characteristics, RECORD and quality assessments were completed in duplicate and described using proportions and means with SDs. Linear regression was used to estimate the association between journal and study characteristics with adherence to RECORD items. RESULTS: Studies reported a mean of 70.7% (SD 1.8%) of RECORD items. There was no substantial difference in adherence in RECORD-endorsing journals compared to non-RECORD-endorsing journals (1.8% lower adherence; 95% CI: -5.8, 2.2). Adherence of >80% was reported for RECORD items 1.1, 1.2, 6.1, 7.1, 19.1 and 22.1. CONCLUSION: Studies in general medical journals had moderate adherence to RECORD, with no association between journals' endorsement of RECORD and reporting completeness. Other measures to improve adherence to RECORD should be explored, including refinements to the checklist itself. Authors and journals should be aware of and adhere to items required for RECORD reporting to improve the reproducibility of research using routinely collected health data
Determining genotype and antimicrobial resistance of Salmonella Typhi in environmental samples by amplicon sequencing.
Get PDFBACKGROUND: Estimates of the burden of typhoid fever due to Salmonella enterica serovar Typhi (S. Typhi) rely on data from clinical surveillance, which is rarely done in low income settings and is also limited by the poor sensitivity of the assays used and the reliance on health seeking by patients. Environmental surveillance for S. Typhi shed by symptomatic and asymptomatic individuals in wastewater offers a sensitive surveillance tool that could help to inform burden estimates. Sequencing S. Typhi direct from wastewater concentrates has the potential to identify circulating genotypes and associated antimicrobial resistance (AMR) genes, supporting public health interventions such as vaccination and antimicrobial usage. METHODOLOGY AND PRINCIPAL FINDINGS: We designed a multiplex targeted amplicon sequencing protocol for genotyping and determining AMR in S. Typhi from wastewater samples, targeting SNPs that identify genotypes of interest and both chromosomal and plasmid-borne AMR. PCR products were sequenced using the Oxford Nanopore Technologies (ONT) MinION, and genotypes and AMR identified using the GenoTyphi program. We tested this approach on samples from south India from both hospital outflow and wastewater collected from the community. All samples tested were suspected to be positive for S. Typhi following quantitative PCR for ttr, tviB, and staG gene targets. Out of 110 samples tested we were able to determine a genotype and/or AMR for 8. All samples that gave a genotype call suggested a genotype consistent with those found in clinical cases in India during the same time period and produced consensus sequences that clustered with S. Typhi when included in a phylogenetic tree. CONCLUSIONS: In this study, we provide proof of concept data for amplicon sequencing of S. Typhi in wastewater which with further optimisation could be used to complement clinical surveillance data or provide data on S. Typhi presence in the absence of clinical surveillance. This information can inform public health interventions, and the concept could be applied to other pathogens of interest for genotyping from environmental surveillance samples
Household costs associated with zoonotic Plasmodium knowlesi, P. falciparum, P. vivax and P. malariae infections in Sabah, Malaysia.
Get PDFBACKGROUND: Malaysia has free universal access to malaria care; however, out-of-pocket costs are unknown. This study estimated and compared household costs of illness during a unique time when four species of malaria were present, due to the emergence of zoonotic Plasmodium knowlesi during the elimination phase of non-zoonotic species in Sabah, Malaysia. METHODOLOGY/PRINCIPAL FINDINGS: Household costs were estimated from patient-level surveys collected from four hospitals between 2013 and 2016. Direct costs including medical and associated travel costs, and indirect costs due to lost productivity were included. One hundred and fifty-two malaria cases were enrolled: P. knowlesi (n=108), P. vivax (n=22), P. falciparum (n=16), and P. malariae (n=6). Costs were inflated to 2023 Malaysian Ringgits and reported in United States dollars (US131 (SD=102), with productivity losses accounting for 58% of costs (US199 (SD=174), followed by P. knowlesi and P. falciparum at US99; SD=42). Most patients (80%) experienced direct health costs above 10% of monthly income, with 58 (38%) patients experiencing health spending over 25% of monthly income, consistent with catastrophic health expenditure. CONCLUSIONS/SIGNIFICANCE: Despite Malaysia's free health-system care for malaria, patients and families face other related medical, travel, and indirect costs. Household out-of-pocket costs were driven by productivity losses; primarily attributed to infections in working-aged males in rural agricultural-based occupations. Costs for P. vivax were higher than those of P. knowlesi and P. falciparum. This may be attributable to a younger age profile and the longer treatment required to clear the liver-stage parasites of P. vivax
Risk of Depression and Anxiety in Those Who Gave Birth to Children Who Developed Invasive Group B Streptococcal Disease: A Population-Based Cohort Study.
Get PDFBACKGROUND: Mental disorders such as depression and anxiety are common for women of reproductive age and impact pregnancy and parenting. Invasive Group B Streptococcus disease (iGBS) is a leading cause of neonatal morbidity and mortality worldwide. Little is known about the short and long-term risk of common mental disorders in birthing parents whose infants had iGBS in the first 89 days after birth. We aimed to examine the risk of depression and anxiety in birthing parents with iGBS-affected infants in a cohort study with prospectively collected data from Danish registries. MATERIALS AND METHODS: Using Danish healthcare registries from 1997 to 2018, we obtained data on iGBS-affected children and their birthing parents. A comparison cohort was randomly sampled (1:50) through risk-set sampling, and matched on persons' age, year of child´s birth, and parity. The risk of using antidepressant medicines and depression or anxiety diagnosis was analyzed with cumulative incidence function and in Cox proportional hazards regression models. RESULTS: During the study period, we identified 1,552 women with iGBS-affected child and 76,879 matched comparators. During a median follow-up of 9∙9 years, the cumulative incidence of antidepressants use among birthing parents with iGBS-affected children was 31% (95% confidence interval, CI: 28-34%), as compared with 29% (95% CI: 28-30%) among members of the comparison cohort (hazard ratio 1∙12 [95% CI: 1∙01-1∙25]). A 16% increase in the rate of diagnosed depression or anxiety was observed in the overall follow-up period. CONCLUSION: Our findings provide evidence of a slightly increased risk of antidepressant use and diagnosed depression or anxiety in parents who gave birth to children with a history of iGBS compared to a matched cohort of birthing parents whose infants did not develop iGBS. Our findings highlight the importance of addressing the mental health needs of birthing parents affected by their children' iGBS
Machine learning-based equations for improved body composition estimation in Indian adults.
Get PDFBioelectrical impedance analysis (BIA) is commonly used as a lower-cost measurement of body composition as compared to dual-energy X-ray absorptiometry (DXA) in large-scale epidemiological studies. However, existing equations for body composition based on BIA measures may not generalize well to all populations. We combined BIA measurements (TANITA BC-418) with skinfold thickness, body circumferences, and grip strength to develop equations to predict six DXA-measured body composition parameters in a cohort of Indian adults using machine learning techniques. The participants were split into training (80%, 1297 males and 1133 females) and testing (20%, 318 males and 289 females) data to develop and validate the performance of equations for total body fat mass (kg), total body lean mass (kg), total body fat percentage (%), trunk fat percentage (%), L1-L4 fat percentage (%), and total appendicular lean mass (kg), separately for males and females. Our novel equations outperformed existing equations for each of these body composition parameters. For example, the mean absolute error for total body fat mass was 1.808 kg for males and 2.054 kg for females using the TANITA's built-in estimation algorithm, 2.105 kg for males and 2.995 kg for females using Durnin-Womersley equations, and 0.935 kg for males and 0.976 kg for females using our novel equations. Our findings demonstrate that supplementing body composition estimates from BIA devices with simple anthropometric measures can greatly improve the validity of BIA-measured body composition in South Asians. This approach could be extended to other BIA devices and populations to improve the performance of BIA devices. Our equations are made available for use by other researchers