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Detection of Haemophilus ducreyi from environmental and animal samples in Cameroon.
Get PDFBACKGROUND: Children in parts of Africa, the South Pacific, and Southeast Asia frequently develop cutaneous ulcers caused by two bacteria: Haemophilus ducreyi (HD) and Treponema pallidum subspecies pertenue (causative agent of yaws). The World Health Organization (WHO) aims to eradicate yaws using mass administration of azithromycin. This also leads to a temporary decrease in ulcers caused by HD followed by a rebound suggesting an ongoing reservoir of infection. The aim of this study was to investigate whether HD could spread through the environment or animals. METHODS: Alongside detection of human cases of cutaneous ulcers from villages in Cameroon, we additionally collected samples from animals (dogs, cats, flies), fomites (bedsheets, clothing, benches, doors), and water sources (marigots and lakes). DNA was extracted and tested for HD and T. pallidum using two specific qPCR assays. RESULTS: HD was not detected in any of the environmental samples but it was on both clothing (13.3%) and in flies (27%). Flies also tested positive for T. pallidum, but at a lower rate (2.6%). CONCLUSIONS: These results suggest that flies and some fomites may contribute to the transmission of HD. Future research should focus on determining whether either of these are capable of carrying live bacteria that can cause onward transmission
Reply to Adzemovic et al.
Get PDFTo the Editor—We thank Adzemovic and colleagues for their correspondence and interest in our article. The points raised make for interesting discussion
Pricing combination products: not how but who?
Get PDFIn the last decade progress has been made in identifying solutions to the "technical problem" of attributing the value of combinations between component parts, but not in adapting mechanisms to implement solutions. We propose a way forward to address the "mechanism problem", arguing that it is essential HTA bodies and/or pricing and reimbursement authorities get actively involved in setting out attribution rules or methods. HTA and pricing/reimbursement authorities have, in essence, adopted one of three strategies: (i) "Do nothing"; (ii) Take a simplistic and arbitrary approach, such as the German law imposing a "haircut" of 20% on the prices of products used in combination or (iii) "Passing the parcel" to the companies and to competition authorities, hoping they will solve the problem for them. Even if a competition law compatible solution is possible, three challenges remain. First, the cost and effort of using it may be too high in relation to any likely gains. Second, the bargaining power of the backbone owner under current HTA / pricing rules is so high that, likely, no solutions that incentivise add-on therapy development will emerge from a process from which HTA bodies absent themselves. Third, most solutions emerging from such a process which give any returns to the add-on likely need the backbone to have a different price (i.e. lower) in combination use as compared to monotherapy use, requiring payer approval for multi-indication pricing. Resolution of the combination challenge thus requires HTA and reimbursement bodies involvement in value attribution
Adolescence as a Key Period of Identity Development and Connectedness: A Comparative Autophotography Study in England and Japan
Get PDFAdolescence is identified as a key period for identity development, but anthropological literature hints at cross-cultural variations. Past research suggests Japanese adolescents may experience more identity exploration/confusion compared to Western counterparts, but the reasons behind these findings remain unclear. This comparative study investigates how adolescents in England and Japan perceive and engage with their environments, and aims to identify similarities/differences that could explain cross-cultural variations in identity development. Using autophotography, 98 teenagers aged 13 to 15 years across 10 schools in England and Japan documented important aspects of their lives. We applied template analysis to qualitatively analyze these photographs/texts. Overall, we identified two shared themes between countries: “This Is Me,” reflecting personal identity through self-discovery and skill development, and “Connectedness,” emphasizing relationships and belonging. A Japan-specific theme, “Reflections Through Time,” captured the broader temporal lens of Japanese adolescents, sometimes with a sense of melancholy. This notably differed from English adolescents in our study, who focused on the present in a positive manner. These findings suggest cultural differences in how adolescents engage with their environments, which may contribute to cross-cultural variations in identity development. Our findings point to the importance of biocultural approaches in developmental research by considering the role of culture
What influences the impact of health financing reforms? Using qualitative comparative analysis to identify patterns in health financing systems and their effects on financial protection.
Get PDFBACKGROUND: Policy interventions to improve financial protection do not always work as expected and their impact can vary across settings, suggesting that underlying health financing attributes (i.e. system arrangements for revenue raising, pooling and purchasing) matter. The objective of this study is to systematically identify patterns of health financing system attributes which influence the impact of policy interventions on financial protection. METHODS: We conducted a systematic literature review to identify studies evaluating the impact of health financing interventions on financial protection. We searched across five databases from their earliest record to October 2023 and applied no geographic restrictions. Data were extracted on the measured outcome of catastrophic health expenditures and on underlying attributes of the health financing system. Patterns in the relationship between system attributes and financial protection were identified using qualitative comparative analysis (QCA). QCA compares and contrasts different combinations and assesses through formal statistical tests the degree to which combinations are present (or absent) when the intervention has been successful (or not) in obtaining the outcome of interest. Results from QCA tests were illustrated by selected studies. FINDINGS: We identified 128 studies in our literature review from which a rich dataset was formed, representing diverse health financing systems and country reform experiences. The QCA approach to synthesize the literature provided unique insights regarding the pathway from policy intervention to impact on financial protection. We found empirical support for the significance of system attributes influencing intervention impact on financial protection. Findings indicated that combinations of more than one attribute were needed for positive impact on catastrophic health expenditures whereas only an individual attribute was needed to avoid negative impact. Attributes can have a direct or indirect effect on impact and can be synergistic, opposing or mitigating in relation to improving financial protection. CONCLUSION: This is the first application of QCA to health financing data. The pathway between impact on financial protection and a health financing intervention is complex and mediated by combinations of explanatory factors. Further research is needed for more comprehensive analyses across all health financing functions. Taking into account the underlying attributes of the health financing system and their interactions is critical to ensuring effective policies and progress on financial protection
Therapeutics Dataset from COVID-19 Medicine Delivery Units in England: an OpenSAFELY Data Report
Get PDFBackground Between December 2021 and June 2023, COVID-19 medicine delivery units (CMDUs) in England offered antiviral medicines and neutralising monoclonal antibodies (paxlovid, sotrovimab, molnupiravir, remdesivir, and casirivimab/imdevimab) to non-hospitalised individuals with COVID-19, identified at high risk of developing severe outcomes. In order to prescribe and supply medicines CMDUs were required to notify NHS England of every prescription via an electronic form. This data was supplied to OpenSAFELY, a secure analytics platform for electronic patient records, as the COVID-19 “Therapeutics” dataset. We aimed to explore the analytic potential of the dataset for research into the use and effectiveness of these therapeutics offered by CMDUs. Methods Working on behalf of NHS England, we assessed the content and data quality of the COVID-19 Therapeutics dataset within OpenSAFELY. We focused on therapeutics provided in outpatient settings by CMDUs. We described for each field the: data format, completeness and summarised its content. Results The COVID-19 Therapeutics dataset contained 18 columns and 58,590 rows of data, for 54,435 distinct patient IDs (92.9%) treated in outpatient settings. The dataset was well-structured, with completeness of almost all fields of 100%. The dataset included details on the specific treatment received, date administered, high-risk group(s) to which the patient belonged and the region in which they were assessed. Conclusion The COVID-19 Therapeutics dataset is well-structured, complete, and is suitable for research. It is linked to other data sources in OpenSAFELY (e.g., primary care), enabling important research on the impact of treatment and health disparities.</ns3:p
The intercultural development and validation of the Indigenous 'Escala de Bienestar Kankuamo' (Kankuamo Well-Being Scale): A capability approach.
Get PDFThis article describes the development and validation of a capability-based well-being scale: 'Escala de Bienestar Kankuamo' (EBK; the Kankuamo Well-Being Scale). The EBK is designed to measure the well-being of the Indigenous Kankuamo community of Colombia from an intercultural perspective. The mixed-methods study was composed of two phases. In phase I, an initial 27 items, which had been generated using qualitative data from a previous study, were reviewed and adjusted through workshops with the Kankuamo community. In phase II, an adapted list of 28 items was piloted within the Kankuamo communities (sample N = 213). A preliminary exploratory factor analysis was carried out. The internal consistency of the EBK was measured using McDonald's ω. Convergent and divergent validity were tested with the World Health Organization-Five Well-Being Index (WHO-5) and the Patient Health Questionnaire-9. Incremental validity was tested through a hierarchical regression analysis to determine the effect on the WHO-5 of age, gender, community and EBK. The exploratory factor analysis resulted in a 14-item scale with seven domains: (1) Relating (to others and one's emotions), (2) Guiding principles, (3) Choice of healthcare, (4) Self-grown food, (5) Community contributions, (6) Agency and (7) Respect and equality. The EBK had high internal consistency (McDonald's ω = 0.86). Statistical analyses aimed at determining the convergent and divergent validity were inconclusive, suggesting a need for caution in using western standardised mental health measures in Indigenous communities because these may lack adequate cultural fit. The findings of the current study identify local priorities and needs, and evidence the feasibility of operationalising the capability approach for Indigenous populations
Formula Labelling in the United Kingdom: Manufacturers' Compliance With the Code, UK Law and Guidance Notes.
Get PDFThe International Code of Marketing of Breastmilk Substitutes ('the Code') was established to protect babies and young children from inappropriate marketing of formula milk, bottles and teats and avoid undue commercial influence on caregiver infant feeding practices, including undermining breastfeeding and safe and appropriate formula feeding. UK law encompasses some but not all of the Code. To address persisting concerns about the marketing of infant formula (IF) and follow-on formula (FoF), we assessed labelling compliance in the UK against relevant provisions in the Code, UK law and Department of Health and Social Care (DHSC) Guidance Notes which interpret UK law. Data were collected during July and August 2022 by taking pictures of labels from company websites, in shops and online. We developed three labelling checklists to systematically assess compliance and to compare compliance scores between the regulatory frameworks, formula types and brands. We assessed 57 labels (n = 32 IF and n = 25 FoF) and found low overall compliance: 50% complied with UK law, 32% with Guidance Notes and 40% with the Code. None of the labels complied with provisions prohibiting idealising text and photographs, nutrition and health claims (where relevant) and cross-promotion between formula types. In conclusion, UK IF and FoF labels violate many of the provisions of all three regulatory frameworks. This is evidence of inappropriate marketing. The UK law should be better enforced and strengthened in line with the Code to protect breastfeeding, support safer, appropriate formula feeding and lessen commercial influence on infant feeding practices
Research priorities for cardiometabolic syndrome in humanitarian settings: A global consensus-based agenda.
Get PDFNon-communicable diseases (NCDs) are a leading cause of global morbidity and mortality. The burden of NCDs largely falls on low- and middle- income countries, where the majority of humanitarian crises fall. Already fragile health care systems in acute and protracted crisis settings struggle to meet the increasing needs of people living with NCDs. Cardio-Metabolic Syndrome (CMS), in particular, is of growing concern, with little evidence on effectively managing cardiovascular disease care in emergency settings. A strategy that begins with identifying clear research priorities to inform a collective and integrated CMS care in humanitarian preparedness and response is needed. This study aimed to generate consensus-based research priorities for the humanitarian sector targeting CMS care. This was done by adopting an adapted approach of the Child Health and Nutrition Research Initiative (CHNRI). Our findings highlight the need to prioritize models of care, including processes and outcomes, for people living with CMS and NCDs in humanitarian settings. They also highlight the importance of adopting integrated, multidisciplinary approaches that address research, interventions, and policies involving local and international stakeholders. Sustainable approaches that facilitate continuity of care and ensure integration within existing health care systems are needed to adequately address the growing global burden of CMS and NCDs. The ranked priority questions from this research priority setting exercise serve as guidance for advocacy and the deployment of funds for future research, interventions, and policies
Staff motivation and schools' capacities to sustain an intervention to prevent bullying and promote wellbeing in English secondary schools: a qualitative study.
Get PDFINTRODUCTION: Discontinuing effective school health interventions prevents new practices from reaching wider student populations and wastes investment in implementation. While reviews have consistently identified facilitators and barriers to the sustainment of school health interventions, the social processes underlying sustainment remain unclear. We explored the post-trial sustainment of "Learning Together," a whole-school intervention, found to be effective in preventing bullying and promoting wellbeing in English secondary schools. We examined how staff and students described its sustainment in the 2 years post-trial, what factors staff referred to in explaining their motivation to sustain it, and how schools' capacities affected sustainment. METHODS AND MATERIALS: Learning Together involved training staff in restorative practice (RP) and supporting schools to implement a staff-student action group and a social and emotional learning curriculum. Using a case-study design, we collected qualitative data from five schools: staff and student interviews 1-year post-trial; staff interviews 2 years post-trial; and descriptive data from the original trial's process evaluation. The General Theory of Implementation guided our thematic analysis. RESULTS: No school sustained the intervention in its entirety. RP was continued by some individuals in all schools and was sustained at school-level in one school. The curriculum and action groups were discontinued in all schools, although actions initiated by the groups were sustained in two schools. Staff motivation to sustain components was affected by their perceived effectiveness, and individual motivations to sustain RP differed from whole-school commitment to sustaining the approach. Schools' capacities to sustain Learning Together were affected by: the prioritization of academic learning time; the frequent implementation of new initiatives; the timeliness of interventions with school improvements plans; and leadership engagement. Schools needed support to disseminate RP knowledge and skills school-wide and ensure consistent practice, and turnover adversely impacted on knowledge transfer. DISCUSSION: Sustainment was an intentional, labor-intensive, social process. Intervention developers should consider whether/how interventions are designed to work alongside, replace, or can refine existing practices, and should support schools to mainstream evidence-based interventions to sustain them at school-level