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A chronicle of crises and emergencies: (dis)continuity of care for Syrian refugee children with neglected non-communicable diseases in Lebanon
Get PDFLebanon's recent history has been marked by intersecting crises, including a severe economic collapse, the Beirut port explosion, and the COVID-19 pandemic. Amidst this "polycrisis," the healthcare system has become increasingly reliant on international humanitarian assistance. This paper examines how these overlapping crises have affected the provision of care for children with thalassemia, a neglected non-communicable disease (NCD), within a Médecins Sans Frontières (MSF) paediatric unit operating in Lebanon between 2018 and 2023. Drawing on a single-case study design, the research explores the dynamics of power between state and non-state actors as well as within international humanitarian organizations and their approaches to healthcare delivery. The study employed a mixed-methods approach, including audio diaries, interviews, document analysis, and co-development groups involving 11 staff members and 18 caregivers of Syrian paediatric patients. Participants shared insights into operational challenges, decision-making processes, and the lived experiences of navigating Lebanon's collapsing health system. Findings reveal three interconnected issues: (1) the polycrises created an unsustainable environment even for resource-rich international non-governmental organizations (iNGOs); (2) the withdrawal of humanitarian services exacerbated the suffering of structurally marginalized Syrian families reliant on no-cost thalassemia treatment; and (3) national staff experienced profound professional and personal challenges as navigated tensions between iNGO policies and patient needs, often leading to burnout and reduced well-being. The study underscores the need for a reorientation of humanitarian healthcare models in protracted crises. This includes greater equity in decision-making between international organisations and national actors, longer-term planning for chronic disease care, and deeper engagement with national staff and affected communities. Prioritising sustainability, health justice, and the lived realities of both providers and patients is essential. While rooted in the specific context of Lebanon's highly privatised and pluralistic health system, these findings hold broader relevance for fragile settings facing similar structural and political constraints
Finerenone for heart failure and risk estimated by the PREDICT-HFpEF model
No full textImportance:
Patients with heart failure (HF) and mildly reduced ejection fraction (HFmrEF) or preserved ejection fraction (HFpEF) have a spectrum of risk, and the effect of therapies may vary by risk.
Objectives:
To validate the Prognostic Models for Mortality and Morbidity in HFpEF (PREDICT-HFpEF) in the phase 3 randomized clinical trial Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients With Heart Failure (FINEARTS-HF) and to evaluate the effect of finerenone, compared with placebo, across the spectrum of risk in these patients.
Design, Setting, and Participants:
The FINEARTS-HF trial was conducted across 653 sites in 37 countries. Participants were adults 40 years and older with symptomatic HF and left ventricular EF of 40% or greater randomized between September 2020 and January 2023.
Intervention:
Finerenone (titrated to 20 mg or 40 mg) or placebo.
Main Outcomes and Measures:
The 3 PREDICT-HFpEF risk scores for the composite outcome of cardiovascular death or HF hospitalization, cardiovascular death, and all-cause death, respectively, were calculated. Predicted risk was compared with observed outcomes. Model performance was assessed using the Harrell C statistic. The rates of the predicted outcomes (plus the composite of cardiovascular death and worsening HF events, which was the primary end point in the trial) were examined according to quintiles of risk score, as was the effect of finerenone according to risk quintiles.
Results:
A total of 6001 patients (mean [SD] age, 72 [9.6] years; 3269 male [54.5%]) were randomized in the FINEARTS-HF trial. The C statistics for cardiovascular death or HF hospitalization, cardiovascular death, and all-cause death at 2 years were 0.71 (95% CI, 0.69-0.72), 0.68 (95% CI, 0.66-0.71), and 0.69 (95% CI, 0.67-0.71), respectively. The risk of the composite outcomes was approximately 8- to 10-fold higher in those in the highest compared with the lowest risk quintile. The relative risk reduction with finerenone compared with placebo was consistent across the spectrum of risk for all outcomes examined (eg, interaction P value for primary outcome = .24).
Conclusions and Relevance:
Results of the FINEARTS-HF randomized clinical trial demonstrate that the PREDICT-HFpEF models performed well in terms of calibration and discrimination. Baseline risk did not modify the benefit of finerenone.
Trial Registration: ClinicalTrials.gov Identifier: NCT0443562
The influence of social networks in adoption of integrated health interventions: a qualitative study of fishermen in Malawi
Get PDFIntroduction: Social networks play a vital role in influencing individual and collective health behaviors and facilitating the diffusion of health interventions. Fishing communities in sub-Saharan Africa face socio-cultural and occupational challenges such as low literacy rates and high mobility. However, their high social cohesion creates a unique social environment for spreading health interventions. We explored the role of social relationships in mediating health intervention adoption in these communities, to inform future intervention strategies. Methods: We conducted an exploratory phenomenological qualitative study between September and October 2024 nested within a large community cluster randomized trial (the FISH trial) in fishing communities in Mangochi district on the southern tip of Lake Malawi. We conducted four focus group discussions (N = 47) and 16 in-depth interviews. Data were analyzed thematically using a hybrid deductive and inductive data coding approach. Results: Fishermen’s social networks included fishing friendships, kin and broader community connections that facilitated knowledge exchange, resource sharing and support provision. Familiarity, trust, desire to conform to community norms and shared community ties enabled health knowledge exchange and encouraged uptake of targeted interventions for HIV and schistosomiasis, despite fishermen’s mobility. Other facilitators at individual level included perceived susceptibility and financial incentives. Occasionally, negative rumors spread through peer networks, e.g., a link between blood sample collection and malign government agenda, contributed to disengagement with health interventions. Other factors including HIV-related stigma and prohibitive traditional beliefs interacted with social networks to hinder uptake. Discussion: Fishermen’s health decisions are deeply embedded within their social structures. However, other factors operating at the individual and community level were noted to be crucial catalysts of the decision-making process. This study highlights the potential of leveraging social networks in public health strategies for mobile communities so long as they account for critical individual factors that influence health service engagement
Impact of stroke severity and vascular risk factors on early versus late anticoagulation in patients with stroke and atrial fibrillation
Get PDFNo abstract available
Towards a Godless Dominion: Unbelief in Interwar Canada. Elliot Hanowski
No full textNo abstract available
Characterising protective immune responses to SARS-CoV-2 in urban and rural Malawi between February 2021 and April 2022
Get PDFSARS-CoV-2 transmission in Malawi remains unclear due to high proportions of mild/asymptomatic infections and limited diagnostics. Existing seroprevalence studies in Malawi have primarily used convenience samples and enzyme-linked immunosorbent assays (ELISAs). We assessed SARSCoV-2 neutralisation in a longitudinal Malawian population-based cohort, assessing protective immunity post-infection and vaccination. Sera were obtained from rural (Karonga, n = 958) and urban (Lilongwe, n = 918) based participants at three-monthly intervals (February 2021-April 2022). Neutralising antibodies against SARS-CoV-2 were measured using human immunodeficiency (HIV)based pseudotype assays in HIV-uninfected participants, and vesicular stomatitis virus-based assays in HIV-infected participants and an HIV-uninfected subset. Nucleocapsid ELISAs identified vaccinated participants also infected. SARS-CoV-2 neutralisation profiles increased in complexity over time from rising vaccination coverage and emerging variants. Neutralising antibody prevalence was higher in Lilongwe than Karonga (68.1% (CI 63.5–72.4) vs. 45.4% (CI 41.6–49.3), Survey 4). Hybrid immune and solely vaccinated participants exhibited higher titres than those solely infected. Children < 15 years had the lowest neutralising antibody titres among infected (not vaccinated) participants. People living with HIV had lower neutralising responses than those HIV-uninfected, particularly post vaccination. We therefore recommend surveillance of children and people living with HIV as low neutralisation responses increase reinfection risk. COVID-19 vaccination should be prioritised for HIV-infected individuals
Young Warriors
No full textFlipping the script on young people and street culture. Young people are often demonised on the streets but what happens if we look through the stereotype and listen to what they can teach us? Young Warriors is a groundbreaking new podcast series exploring youth culture, streetlife and the power of youth-led change. Over six episodes in cities across the UK, the podcast passes the mic to young people, and the youth workers who work most closely with them, to learn inspiring lessons of hope in the face of adversity.
Hosted by criminologist Professor Ali Fraser, you’ll meet young people who have seen a lot of life - from police harassment to school exclusion and prison - yet defy society’s stereotypes and embody positive change. From a grassroots food charity in London to a transformative arts organisation in Manchester, you’ll hear from young warriors taking the fight from the streets to surprising locations
Can Gut Microbiome Signatures be Used as Indicators of Resilience During the Transition Period?
Get PDFSeal milk oligosaccharides rival human milk complexity and exhibit functional dynamics during lactation
Get PDFMilk oligosaccharides are crucial for neonatal development and health in mammals. Yet most milk research focuses on humans, or on domesticated mammals that are poor in milk oligosaccharide complexity. Here, we perform an exhaustive mass spectrometry-driven structural characterization of milk oligosaccharides in a wild mammal, female Atlantic grey seals ( Halichoerus grypus ), throughout their lactation period. Characterizing and quantifying 332 milk oligosaccharides, including 166 unreported structures, we reveal seals to rival human milk in complexity. We report seal free oligosaccharides to reach up to 28 monosaccharides in size. Paired glycomics and metabolomics time course analysis establishes a concerted regulatory process reshaping the seal milk glycome throughout lactation, similar to human milk. Functional analysis of the structures we here characterized reveals anti-biofilm effects and immunomodulatory functions of seal milk oligosaccharides. Our findings challenge long-held assumptions about milk complexity of non-human mammals and enable insights into the functional relevance of complex carbohydrates in milk
Getting to know decoloniality through dialogue: a critical reflection from students and educators
Get PDFAs part of one of the largest universities in the UK, and as an Ancient, research-intensive institution, the University of Glasgow Decolonising the Curriculum (DtC) Community of Practice (CoP) covers an incredible breadth of practitioners, and the challenges of bringing together the ideas, issues, challenges and needs of this body of students and staff around decoloniality can feel vast
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