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Implementation of virtual pathology teaching in health professions education: A systematic review: BEME Systematic Review No. 95.
Get PDFPURPOSE: Rapid changes to learning technologies, accelerated by the COVID-19 pandemic, have led to the widespread adoption of virtual education. Pathology is an important medical science that is central to many curricula in health professions education (HPE). It has been impacted by the broader transition to virtual education. This systematic review and meta-ethnography evaluated the experiences of virtual pathology education within HPE. METHODS: MEDLINE and EMBASE were systematically searched for peer-reviewed qualitative journal articles describing the experiences of virtual pathology in HPE. Of 1119 articles identified, 17 were synthesised using a meta-ethnographic approach. RESULTS: The final synthesis represented a total of 2126 participants, including 1256 undergraduate medical students, 297 resident doctors, 473 senior clinicians, and 100 teaching faculty. We identified the following third-order constructs: 'Adaptability to learner's needs', 'negative human consequences', and 'uncertainty about trajectory'. CONCLUSION: This review highlights both positive and negative impacts of transitioning pathology education to virtual delivery. The need to enhance current educational practice according to these findings is particularly pressing since the shift to virtual education in pathology looks set to accelerate in years to come
Mapping commercial practices of the pesticide industry to shape science and policymaking: a scoping review.
Get PDFThere is a growing body of evidence for how health harming industries (HHIs) engage in similar practices to influence science and policymaking. However, limited attention has been paid to the pesticide industry within the commercial determinants of health (CDOH) field. We conducted a scoping review to map practices adopted by the pesticide industry to influence science and policymaking and to assess the breadth and focus of the associated literature. We included 31 documents and categorized the extracted data using a typology of commercial practices. The documents described how major pesticide companies, and their trade bodies, have acted to influence science and maintain favourable regulatory environments while undermining the credibility of researchers and agencies that publish findings threatening to their commercial interests. A large proportion of the literature consists of historical analyses, narrative reviews, commentaries/perspective pieces, and investigative reports published in the grey literature, predominantly informed by analysis of internal industry documents and freedom of information requests. Most studies focus on high-income settings. There were a limited number of primary peer-reviewed empirical studies that explicitly aimed to study the practices of the pesticide industry from a CDOH perspective. However, our findings show that major pesticide companies adopt political and scientific practices highly similar to other HHIs. The review shows a critical need for research on the pesticide industry's current practices in low- and middle-income countries where the negative impacts of its activities on health and the environment are likely to be more marked
Perception and predictors of antenatal services utilization by left-behind wives of marginal solo outmigrants-empirical evidence from India
Get PDFBackground: Although antenatal care (ANC) services are offered free of charge at public healthcare facilities in India, Bihar state has a low ANC utilization rate due to service quality gaps. This study examines these gaps from the perspective of Left-Behind Wives (LBWs) residing in urban low socioeconomic environments in the absence of husbands. The research also aims to identify the predictors for efficient use of ANC services at government health centres and the effect of source of information on perception towards ANC services. Method: A cross-sectional survey was carried out to capture responses from 165 respondents residing in low socioeconomic regions of two administrative blocks of the Patna district of India. Effective utilization was measured as a binary variable, based on antenatal check-ups, iron-folic acid consumption, institutional delivery, and tetanus vaccination. Regression analysis was used to assess the predictors of utilization of ANC services. Analysis of Variance (ANOVA) was used to analyze the effect of source of information on perception towards ANC services. Results: The most significant aspect that predicts the efficient use of ANC services at government health centres was ‘human resource’ (AOR = 3.35, R2 = 0.80), followed by ‘counselling service’ (AOR = 2.41) and ‘infrastructure and equipment condition’ (AOR = 1.76). There was no significant effect of source of information on perception (p > 0.05). Conclusion: This study reveals reasons for underutilization, perception, and opportunities related to ANC services at government centres. It also provides vital insights for policymakers for the development of maternal healthcare in underperforming states of India, ultimately contributing to the health empowerment of LBWs
"Stop, don't touch, run away!": reconceptualizing firearm industry-funded youth education programs as corporate political activity.
Get PDFBACKGROUND: Injuries represent a major threat to child health globally. In the US, firearm injuries are the leading cause of death among children and adolescents. Despite limited evidence of their effectiveness industry-funded bodies promote the delivery of their youth education programs while lobbying against firearm control policies. This article analyzes how the National Rifle Association (NRA) frames issues of gun ownership, safety and the role of the Eddie Eagle GunSafe® program as an effective firearm safety intervention and examines how the design, promotion and delivery of the program serves the corporate political interests of the firearm industry at the expense of public health. METHODS: We conducted an analysis of Eddie Eagle Gunsafe® program-related materials and the NRA's practices to promote the program's legitimacy and effectiveness, by applying published taxonomies of corporate framing and action strategies. Data were collected from the program-specific websites and other NRA outlets to capture the breadth of strategies used by the NRA. RESULTS: The NRA's education-related practices support the firearm industry's political agenda. The NRA adopts framing and action strategies that present the presence of firearms in homes and communities as inevitable and normal, and the education of children through the delivery of their "lifesaving" program as the common-sense and effective way of keeping children safe from firearm injuries. They make misleading claims about the effectiveness of the Eddie Eagle Gunsafe® program while undermining the credibility of those who advocate for child safety, including mothers and public health actors. CONCLUSION: The delivery of the Eddie Eagle GunSafe® program needs critical scrutiny as is increasingly applied to other industry-funded initiatives. Policies based on a recognition that children and adolescents are safest when their homes and communities are free of firearms are needed. Findings from this analysis are relevant beyond the US and can be used to inform the governance of child safety and injury prevention globally. Analysis of the firearm industry extends the literature on the commercial determinants of health to an important new sector with significant impacts on global health
Factors influencing influenza vaccine uptake among adults in Johannesburg, South Africa: A qualitative study.
Get PDFBACKGROUND: Influenza vaccination coverage in South Africa is less than 3 % among the general adult population. We explored factors associated with influenza vaccine uptake using the World Health Organization's Strategic Advisory Group on Immunization (SAGE) 3C (confidence, complacency, convenience) model of vaccine hesitancy. METHODS: The present study forms part of the Bambisana project, a mixed-methods pre-test-post-test intervention study conducted from 29 April 2023 to 15 April 2024. Participants ≥18 years were enrolled in six Focus Group Discussions (FGDs), stratified by age (≥18-34 and ≥ 35 years). FGDs were audio-recorded, transcribed verbatim, and coded in Dedoose using framework analysis. RESULTS: Among the 48 participants, most (66.7 %, n = 30) were aged 18-34 years, 65.9 % (n = 29) had completed high school, and 70.2 % (n = 33) were unemployed. Overall, influenza vaccine uptake was associated with three key factors: low confidence, high complacency, and a lack of convenience. Low confidence in the influenza vaccine was associated with negative experiences with COVID-19 vaccines, fear of side effects, vaccine misconceptions, fear of needles, mistrust of public health institutions, and concerns about vaccine effectiveness. Complacency factors included reliance upon traditional and alternative medicines, lack of knowledge about vaccines, and minimising the seriousness of influenza illness. Convenience factors included perceived costs of the vaccine and a lack of influenza vaccine promotion. CONCLUSION: Addressing confidence, complacency and convenience factors is important to increase influenza vaccine acceptance and uptake in South Africa
Variation in acute myocardial infarction management by kidney function across hospitals in England: a cross-sectional study using the Myocardial Ischaemia National Audit Project (MINAP).
Get PDFOBJECTIVES: We hypothesised that there is substantial variation in acute myocardial infarction (AMI) treatment across English hospitals, particularly for people hospitalised for non-ST-elevation myocardial infarction (NSTEMI) and with reduced kidney function. This study aimed to describe this variation at the hospital and the individual level to understand treatment variation and potential disparities in AMI management among people with reduced kidney function. DESIGN: Cross-sectional study. SETTING: Secondary care in England. PARTICIPANTS: People hospitalised for AMI (ST-elevation myocardial infarction (STEMI) or NSTEMI) in English hospitals and captured in the Myocardial Ischaemia National Audit Project, 2014 to 2019. Kidney function was defined using estimated glomerular filtration rate (eGFR) derived from the serum creatinine recorded within 24 hours of AMI admission. OUTCOME MEASURE: The primary outcome was recorded invasive cardiac intervention (at least one of angiography, percutaneous coronary intervention and coronary artery bypass graft) compared with conservative management. RESULTS: We included 361 259 people with a first hospitalisation for AMI (STEMI or NSTEMI) at 209 hospitals for hospital-level analyses and 292 572 people with complete covariable data at 207 hospitals for individual-level analyses. We found substantial variation in the mean proportion of people with NSTEMI managed invasively across hospitals in England. At the individual level, using multivariable logistic regression to derive adjusted predicted probabilities to describe the association between kidney function and AMI management (invasive vs conservative management), we found that people had a lower adjusted predicted probability of being treated with invasive cardiac management with worsening eGFR range, particularly for NSTEMI cases (eGFR range 2: 76.6% (95% CI 76.3 to 76.8) vs eGFR range 5: 44.5% (95% CI 41.2 to 47.5)). CONCLUSIONS: There is substantial AMI treatment variation across hospitals in England, particularly among people hospitalised for NSTEMI with reduced kidney function. Further research is needed to evaluate the comparative effectiveness of NSTEMI management strategies for complex patients
Evaluating the performance of verbal autopsy for assigning cause of death in older adults: A population-based cohort study in Karonga, Malawi.
Get PDFBACKGROUND: Verbal autopsy, where a close caregiver or relative of someone who recently died reports on the signs, symptoms and circumstances preceding death, is useful for producing population-based cause of death estimates. However, the performance of verbal autopsy for older adult deaths is poorly understood. OBJECTIVES: To evaluate the performance of verbal autopsy in assigning cause of death for adults aged 50+ in a rural area of Malawi. METHODS: Cause of death was assigned to each death with a verbal autopsy in the Karonga Health and Demographic Surveillance site between 2002 and 2017 using two methods: (1) Physician review and (2) in silico verbal autopsy (a Bayesian probabilistic model). We calculated uncertainty in cause of death assignment for each method and calculated disagreement in cause of death between methods. Analyses were stratified by age group and sex. RESULTS: A total of 2378 adult deaths were included (1360 aged 50+). Cause of death assignment showed greater uncertainty at older ages in both methods. For example, 59.7% of men aged 80+ were assigned a specific cause of death using physician review, versus 77.5% of men aged 30-49. Population-level, broad cause of death distributions were similar across methods, but at the individual level there was over 30% disagreement on broad cause of death categories in those aged 50+. CONCLUSIONS: Verbal autopsy becomes more uncertain at assigning cause of death at older ages. The inclusion of any reports of medical diagnoses from a doctor and using a two-stage process of cause of death assignment (with simple cause of deaths assigned using algorithms and more complex cases being reviewed by physicians) could improve cause of death ascertainment using verbal autopsy at older ages
Emergence and spread of the SARS-CoV-2 omicron (BA.1) variant across Africa: an observational study.
Get PDFBACKGROUND: In mid-November, 2021, the SARS-CoV-2 omicron variant (B.1.1.529; BA.1 sublineage) was detected in southern Africa, prompting international travel restrictions. We aimed to investigate the spread of omicron BA.1 in Africa. METHODS: In this observational study, samples from patients infected with SARS-CoV-2 from 27 laboratories in 24 African countries, collected between June 1, 2021 and April 14, 2022, were tested for omicron BA.1 and delta (B.1.617.2) variants using real-time RT-PCR. Samples that tested positive for BA.1 by RT-PCR and were collected before estimated BA.1 emergence according to epidemiological properties were excluded from downstream analyses. The diagnostic precision of the assays was evaluated by high-throughput sequencing of samples from four countries. The observed spread of BA.1 was compared with mobility-based mathematical simulations and entries for SARS-CoV-2 in the Global Initiative on Sharing All Influenza Data (GISAID) genomic database. We estimated the effective reproduction number (Rt) at the country level considering the BA.1 fraction and the reported numbers of infections. Phylogeographical analyses were done in a Bayesian framework. FINDINGS: Through testing of 13 294 samples from patients infected with SARS-CoV-2, we established that, by November-December, 2021, omicron BA.1 had replaced the delta variant of SARS-CoV-2 in all African subregions, following a south-north gradient, with a median Rt of 2·60 (95% CI 2·46-2·71). This south-north spread, established on the basis of PCR data, was substantiated by phylogeographical reconstructions, ancestral state reconstructions, and GISAID data. PCR-based reconstructions of country-level BA.1 predominance and the availability of BA.1 genomic sequences in GISAID correlated significantly in time (p=0·0002, r=0·78). The first detections of BA.1 in high-income settings beyond Africa were predicted accurately in time by mobility-based mathematical simulations (p<0·0001). Comparing PCR-based reconstructions with mobility-based mathematical simulations suggested that SARS-CoV-2 infections in Africa were under-reported by approximately ten times. Inbound travellers infected with BA.1, departing from five continents, were identified in six African countries by early December, 2021. INTERPRETATION: Omicron BA.1 was widespread in Africa when travel bans were implemented, limiting their effectiveness. Combined with genomic surveillance and mobility-based mathematical modelling, PCR-based strategies can inform Rt and the geographical spread of emerging pathogens in a cost-effective and timely manner, and can guide evidence-based, non-pharmaceutical interventions such as travel restrictions or physical distancing. FUNDING: Bill & Melinda Gates Foundation. TRANSLATIONS: For the French, Portugese and Spanish translations of the abstract see Supplementary Materials section
A socio-ecological model of the management of leprosy reactions in Indonesia and India using the experiences of affected individuals, family members and healthcare providers.
Get PDFBACKGROUND: Leprosy reactions (LR) are immune-mediated complications of leprosy that may be associated with severe and irreversible nerve damage. Non-medical aspects, such as financing, service provision, and healthcare resources in the management of LR are generally overlooked as studies tend to concentrate on clinical features and treatment. Barriers to accessing care and services are a major cause of suboptimal care for people with leprosy. This study aims to explore the barriers to and facilitators of high-quality care and management of LR in two leprosy-endemic countries with different health care models - Indonesia and India - and identify areas for improvement. METHODS: A socio-ecological model was adopted. Data were obtained from 66 interviews with individuals who experienced LR and were seeking care at the two study sites. In addition, immediate family members of individuals with LR and healthcare workers attending to people with leprosy participated in seven focus group discussions (FGDs). RESULTS: This study highlights the significant impact of public health insurance regulations and uptake at the macrosystem level on the provision of healthcare services, clinical decision-making, care expenditure, and the psychological well-being of individuals with LR in Indonesia and India. Lack of specialized health professionals and communication challenges were identified in both study populations. Indonesian participants encounter additional challenges due to a fragmented information system and drug shortages. This study identifies key facilitators in providing high-quality care for LR-affected individuals, including financial assistance, availability of corticosteroid alternatives, timely provision of care, and counselling. It found that the high coverage of public health insurance cards in the Indonesian model has increased access to care among individuals affected by LR, despite the challenges. Conversely, the Indian model of care offers treatment subsidies. The advantage of the Indonesian model is its ability to provide wider access to high-quality care, whereas the Indian model focuses on those in most need. This study emphasizes the importance of addressing these challenges through improved communication strategies, education aimed at the affected individuals, and accessible medical care. Furthermore, variations in care-seeking behaviour and self-care practices were observed in both sites, underscoring the need for culturally sensitive and comprehensive approaches to the management of LR. CONCLUSION: The study findings demonstrate that the factors identified at the four systemic levels are interrelated and have an impact on the access, acceptability, and management of LR services. Despite its accessibility and wider coverage of public health insurance, the integrated service model in Indonesia faces challenges associated with complex regulations and the availability of medication. India's care model offers intensive, specialised care but has difficulties in ensuring sufficient health personnel, resources, and public health insurance coverage. These findings highlight the need to address these challenges to ensure timely, effective, and comprehensive care for individuals with LR
Impact of calorie labelling on online takeaway food choices: An online Menu-Based Choice Experiment in England.
Get PDFEating out-of-home is linked to higher calorie intake and body weight, risk factors for obesity, diabetes and other diseases. This study examined whether providing calorie information on online takeaway food menus leads to lower-calorie food choices. A Menu-based Choice Experiment was conducted in November 2022 among 1040 online takeaway consumers in England (Kantar's Worldpanel Out of Home Purchase Panel). Each participant chose their preferred items from ten hypothetical menus including starters/sides, mains, desserts, and drinks. Participants were randomly allocated to a group in which the ten menus included either: a) no calorie information (group A); b) individual item calorie content (group B); or c) individual item and total calorie content (group C). An orthogonal design was used to create the menus and the probability of choosing each of the food items was estimated using a Multivariate Probit Model (MVP). There was no statistically significant difference in calories ordered by respondents in group B or group C in comparison to the control group. by. While group B and C had on average a greater likelihood of choosing low-calorie items compared to group A, the effect was only statistically significant for the low-calorie main for respondents over 55 years old in group C in comparison to the control. For these respondents, calorie information increased the probability of choosing the low-calorie main by 11.1pp (p < 0.001). We found no evidence that including a calorie counter had a larger impact on food choices than providing calorie information for individual items. Choices were relatively inelastic to price changes although main meals were more price sensitive (own-price elasticity -0.5 to -0.62) compared to starters, deserts and drinks (-0.22 to -0.39)