69832 research outputs found
Sort by
Immunological and pathobiological characteristics of a novel live Salmonella Typhimurium-vectored Campylobacter vaccine candidate for layer chickens.
Get PDFINTRODUCTION: Spotty liver disease (SLD) poses a significant economic and animal welfare threat to the global cage-free egg industry, primarily due to infection by the emerging pathogen Campylobacter hepaticus. SLD can lead to a significant decline in egg production and increased mortality rates. Antibiotics remain the most effective measure for controlling the disease. However, the rise of antibiotic resistance is a growing global concern for public health, promoting efforts to reduce antibiotic usage in animal production. Poultry vaccination offers an alternative approach to decreasing C. hepaticus levels. Although autogenous vaccines are in use in some countries with limited efficacy, no vaccine is currently licensed for widespread use. METHODS: This study developed and characterized a live Salmonella Typhimurium vector strain designed to deliver the conserved Campylobacter N-glycan heptasaccharide as a target antigen against C. hepaticus. RESULTS: The replacement of the S. Typhimurium aroA gene with the Campylobacter pgl locus attenuated the vaccine strain, allowing the conjugation of the heptasaccharide to S. Typhimurium endogenous lipopolysaccharide (LPS). Commercial layer hens vaccinated with the S. Typhimurium strain producing the Campylobacter heptasaccharide induced significantly higher IgY antibody titres specific to the Campylobacter heptasaccharide compared to the birds vaccinated with the vector strain not expressing the heptasaccharide. Modification of the S. Typhimurium endogenous LPS with the heptasaccharide had no significant impact on IgY antibody responses against S. Typhimurium. DISCUSSION: This study provides evidence that using S. Typhimurium to deliver Campylobacter heptasaccharide is a feasible approach to providing bi-valent immunogenicity against both S. Typhimurium and C. hepaticus
The role of neighbourhood greenspace quantity on mental health and cognitive development in early to middle childhood: a multilevel growth curve analysis of the UK Millennium Cohort Study.
Get PDFBACKGROUND: Childhood shapes lifelong wellbeing, making it crucial to understand how environmental factors impact development. This study examines the impact of neighbourhood greenspace quantity on the trajectories of emotional, behavioural and cognitive outcomes across childhood (at ages 3, 5, 7 and 11 years) with data from the UK's Millennium Cohort Study. METHODS: Using multilevel growth curve models, we assessed the role of neighbourhood greenspace in small standard areas on trajectories of conduct problems, hyperactivity/inattention, peer problems, emotional symptoms and cognitive ability. RESULTS: There was no direct association between greenspace and these child outcomes at the intercept (~ aged 7 years). However, greenspace was related to the slope of both conduct problems and cognitive ability, suggesting possible benefits in the early years, mainly before the start of formal education. CONCLUSION: The study highlights the potential effect of greenspace quantity on child development, but in the context of age. Longitudinal research tracking outcomes beyond childhood can shed more light on age-related effects of greenspace across areas of development
Implementation strategies to improve outcomes in patients with established cardiovascular disease in sub-Saharan Africa: A systematic review.
Get PDFThe protocol was registered in PROSPERO prior to the study implementation (ID: CRD42023465781). The protocol can be accessed at crd.york.ac.uk/PROSPERO/display_record.php?RecordID=465781
Post-pandemic excess mortality of COVID-19 in Hong Kong: a retrospective study.
Get PDFBACKGROUND: As the COVID-19 pandemic shifted into the post-pandemic period in early 2023, following the COVID-19 normalization with relaxation of stringent control measures and high vaccination coverage in Hong Kong, its long-term impact on mortality remains challenging with necessary needs of data-driven insights. This study examined the pattern of post-pandemic excess mortality in Hong Kong. METHODS: We analyzed weekly inpatient death data from public hospitals from January 1, 2013, to June 1, 2024, using a mixed model with over-dispersed Poisson regression. Expected mortality was estimated as the difference between observed mortality and baseline derived from pre-pandemic data. Age-stratified analyses of overall and cause-specific mortality were conducted across the pre-Omicron pandemic, Omicron, and post-pandemic periods. FINDINGS: In the post-pandemic period, the excess mortality declined but remained six-fold higher (37.66 [95% CI: 32.72-42.60] per 100,000) than pre-Omicron level, maintaining significance after adjusting for age (32.79 [95% CI: 28.13-37.46] per 100,000). The older population experienced sustained excess mortality, with crude estimates of 100.51 and 586.74 per 100,000 among those aged 65-79 years and ≥80 years, respectively, primarily due to respiratory diseases. Younger population showed near-zero overall excess mortality, whereas increased excess mortality among them occurred in heart disease, cerebrovascular disease, and injuries. INTERPRETATION: Our findings highlight the lasting mortality impact of pandemic among vulnerable populations, specifically the older population, possibly due to the post-COVID conditions and circulating COVID-19, suggesting the need for targeted interventions for this group. FUNDING: Health and Medical Research Fund
Community Resilience to Cholera Epidemics in Uganda: A Realist-informed review of Vulnerability and Intervention mechanisms.
Get PDF
Background Uganda experiences recurring cholera epidemics. Current interventions prioritize strengthening health systems, neglecting community resilience. This paper explored pathways to enhancing community resilience against cholera. Methods We utilized a realist-informed review approach, employing the conceptual framework of Pawson and Tilley (1997) for data extraction, synthesis, and presentation and Blanchet
et al.
2017’s theoretical framework to interpret Mechanisms and Outcome patterns necessary for community resilience. Data sources included peer-reviewed and other literature about Non-Governmental Organizations (NGOs) and government interventions. Findings Current literature on cholera focuses heavily on aspects like community vulnerability, outbreak surveillance, and response strategies and less on broader concepts of community resilience. Kinship resilience literature helped fill the gaps around valuable perspectives on how communities navigate and bounce back from cholera outbreaks. Contextual vulnerability factors include weak detection systems, limited community health worker capacity, and sub-optimal Water, Sanitation, and Hygiene(WASH) practices and inadequate WASH infrastructure within refugee, fishing, and slum communities. Upstream water sources contamination impacts the spread of cholera to downstream areas, while cross-border movement of infected individuals worsens its transmission and spread. Preventive resilience mechanisms involve health system interventions focused on capacity building, WASH programs, community engagement and WASH infrastructures establishment crucially bolster community resilience. Community knowledge acquired through training or experiential learnings in managing cholera, alongside social cohesion reduce vulnerability. While most mechanisms focus on building absorptive resilience capacities, it is not clear how these mechanisms lead to intermediate health outcomes and broader resilience capabilities like adaptation and transformation. Conclusions Realist evaluations provide deeper understanding of how interventions guide effective cholera prevention strategies, leading to resilience. However, further research about community-led actions and external interventions that effectively build resilience is needed. Integrated approaches combining health system strengthening with community-based interventions need to be prioritized, while enhancing social capital, and supporting adaptive and transformative mechanisms for resilience.
</ns3:p
Exploring water-energy-food nexus connections between climate action and regional development in the East African community
Get PDFPolicy siloes between national adaptation plans (NAPs), nationally determined contributions (NDCs) and sustainable development hinder effective climate action and resource governance in East Africa. Further, rapid population growth and climate change impacts intensify demands for water, energy, and food (WEF), fuelling resource exploitation. This study employs a mixed-qualitative methodology using document analysis, and semi-structured interviews to examine the interlinkages between NAPs, NDC and regional development priorities. Results show implied connections between policy instruments, sustainable development, and climate action form the crux of WEF interlinkages. In practice, incoherence between these instruments create competition and trade-offs that increase WEF resource security. For example, the focus on food security, mostly through extensification, has created tradeoffs with water and energy security, undermining development goals. There are implicit interlinkages in policy and, to a certain extent, in practice. Although insufficient, these are foundations for a bottom-up approach to implementing integrated climate action commitments. Understanding the interconnectedness and interdependencies between sector policies, climate actions, and supranational development plans could catalyse and accelerate sustainable development while building resilience, through a multi-sectoral approach. We posit the need for a transdisciplinary, WEF approach to catalyse cooperation for development and climate action in East Africa. Ultimately, a transdisciplinary approach focused on equity, social justice, sustainability, and a just transition is required to support development agendas
The role of artificial intelligence in maternal and child health: Progress, controversies, and future directions.
Get PDFThis debate paper examines the transformative potential of Artificial Intelligence (AI), specifically through Machine Learning (ML), in enhancing preventive measures in maternal and child health (MCH). With the proliferation of Big Data, ML has become crucial in handling complex, non-linear interactions among health determinants to not only predict but also prevent adverse outcomes. This paper underscores AI's applications in early interventions that could decrease the incidence of MCH issues. It reviews technological advancements while addressing ethical, practical, and data-related challenges in applying AI in preventive healthcare. Emphasis is placed on recent supervised, unsupervised, and reinforcement learning applications that significantly advance preventive care, particularly in low-resource settings. The manuscript discusses the development of AI models for early diagnosis, comprehensive risk assessments, and customized preventive interventions, while highlighting challenges like data diversity, privacy issues, and integrating multimodal health data
Preliminary field evaluation of black soldier fly frass as an organic fertilizer on maize (Zea mays L.) growth and yield in southeastern Madagascar
Get PDFFood insecurity remains a critical challenge for many farming communities in Madagascar, underscoring the need for sustainable strategies to improve crop yields. Black soldier fly frass (BSFF) is an emerging organic fertilizer, and composting may enhance its agronomic effectiveness. This study evaluated the effects of composted BSFF (CBSFF), fresh BSFF (FBSFF), cattle manure (CM), and a no-fertilizer control on maize (Zea mays L.) germination, height growth, grain yield, and agronomic efficiency of nitrogen (AEN) in southeastern Madagascar’s acidic sandy clay soils. Fertilizers were applied at 43 kg N/ha, reflecting actual farmer practices in the region. This rate represents one-third of the recommendation by FOFIFA (Madagascar’s national agricultural research institute). Farmers in this region rarely apply the full recommended dose due to limited access, high input costs, and low return on investment, factors that contribute to persistent yield gaps even where recommended rates are followed. Maize treated with FBSFF had significantly lower germination rate than all other treatments. In contrast, there were no statistically significant differences in final plant height or grain yield among CBSFF and CM. However, CBSFF-treated plants were on average 6 and 13% taller than those receiving CM and FBSFF, respectively, and produced 38% more grain than CM. All fertilizer treatments yielded significantly more grain than the unfertilized control, which produced no harvestable maize. CBSFF also showed the highest agronomic efficiency of nitrogen (AEN: 46 kg grain/kg N), although this difference was not statistically significant. These results suggest that BSFF, particularly in composted form, can supply sufficient nitrogen to support maize growth. Overall trends point to composted BSFF as the most agronomically effective option. Timing of application should depend on the frass form: composted BSFF is better suited for pre-planting use, while fresh BSFF may be more appropriate after germination. Even at sub-recommended doses, BSFF has the potential to enhance maize productivity and contribute to local food security. Further research across diverse agroecological zones, including trials comparing BSFF with the full recommended fertilizer dose, and economic analyses incorporating frass cost, labor, and transport are recommended to identify optimal application strategies and support widespread adoption by smallholder farmers
Feasibility and acceptability of the Alarm Distress Baby Scale (ADBB) in universal health visiting practice in England: a mixed-methods study using Normalisation Process Theory.
Get PDFBACKGROUND: The Alarm Distress Baby Scale (ADBB) is a validated observation tool, designed for use by healthcare practitioners to identify infant social withdrawal. A modified version (m-ADBB) was later developed as a clinically useful behavioural tool. However, neither version has been tested in the UK context. This study aimed to test the feasibility and acceptability of using the ADBB and m-ADBB within universal health visiting practice in England.
METHODS: A mixed methods convergent parallel design was used. Five health visitors were trained in the ADBB and 20 in the m-ADBB, from two National Health Service (NHS) community sites in England. Quantitative data were collected from health visitors, while qualitative semistructured interviews were conducted with health visitors and service managers, guided by Normalisation Process Theory (NPT). Thematic analysis was used to analyse the qualitative data and descriptive analysis for the quantitative data. NPT provided a framework for analysing the implementation process in routine health visitor practice.
RESULTS: The m-ADBB was used with 225 babies and behaviour concerns were identified in 23 babies (10%). Eleven themes were identified, aligned with the four NPT constructs: (1) Coherence: perceived uniqueness of the scale, new vocabulary for articulating baby behaviour, enrichment of existing knowledge and skills; (2) Cognitive participation: commitment to the use of the ADBB/m-ADBB, consolidation of new practice; (3) Collective action: implementation of the m-ADBB scale in routine practice, organisation and management support, existing systems and pathways for children and families and (4) Reflexive monitoring: perceived benefits of integrating the scales in practice, quality assurance for embedding the scales in practice, appraisal of the training and scales in practice.
CONCLUSIONS: The ADBB/m-ADBB was perceived to have enhanced the health visitors' skills and knowledge in infant observation. The m-ADBB required minimal additional time and was highly acceptable to health visitors. These findings have significant implications for health visiting practice and future research
The reality of neonatal nursing work in Kenya and implications for quality and safety: Direct observation of tasks and time utilisation.
Get PDFBACKGROUND: Little is known about how nurses working in care settings affected by remarkably high workloads and workforce constraints manage their work and time to deliver needed care.
OBJECTIVE: This study aimed to characterise nursing workflows and examine time allocated to care in high mortality, intermediate care Kenyan neonatal units.
DESIGN AND METHODS: Using 'shadowing' as a time and motion technique, we directly observed 1-2 nurses per 12-hour shift in 8 Kenyan county hospitals. We used an Activity Log Sheet to document their activities during the shift and thematic content analysis of observation notes to classify and group tasks performed. In a second phase, we documented the time spent on specific critical tasks and instances of multi-tasking and care interruptions.
RESULTS: We directly observed 499 person-hours over 36 day shifts and 15 night shifts. A typical day and night shift had a median of 38 (25-47) and 32 (18-44) babies respectively with a median nursing hours per-patient per-shift of 0.9 (0.5-1.2) hours. We recorded 1891 task episodes comprised of 36 different tasks that we grouped into eight workflow domains. Most tasks involved: direct patient care (37 %) or indirect patient care (23 %) with communications, documentation and reporting, staff or student supervision and mentorship, interruptions, personal breaks, and rest less frequently performed tasks. Nurses commonly devoted up to 20 minutes even to critical tasks while continuing to multi-task and managing more than 2 instances of interruptions during a newborn caring task.
CONCLUSIONS: Kenyan neonatal nurses perform direct and indirect patient caring tasks while grappling with demanding housekeeping, administrative, and clinical teaching and mentorship roles under extremely limited time availability. Time allocated even to complex tasks is minimal and rarely given full focus, threatening patient safety. Our findings highlight opportunities to redistribute basic non-clinical roles for enhanced patient and caregiver experience. Even so, nurse staffing must be substantially improved