Planetary health benefits from strengthening health workforce education on the social determinants of health.

Social inequalities are perpetuating unhealthy living and working conditions and behaviours. These causes are commonly called 'the social determinants of health'. Social inequalities are also impacting climate change and vice-versa, which, is causing profound negative impacts on planetary health. Achieving greater sustainability for human and planetary health demands that the health sector assumes a greater leadership role in addressing social inequalities. This requires equipping health and social care workers to better understand how the social determinants of health impact patients and communities. Integration of the social determinants of health into education and training will prepare the workforce to adjust clinical practice, define appropriate public health programmes and leverage cross-sector policies and mechanisms being put in place to address climate change. Educators should guide health and social workforce learners using competency-based approaches to explore critical pathways of social determinants of health, and what measurements and interventions may apply according to the structural and intermediary determinants of health and health equity. Key institutional and instructional reforms by decision-makers are also needed to ensure that the progressive integration and strengthening of education and training on the social determinants of health is delivered equitably, including by ensuring the leadership and participation of marginalized and minority groups. Training on the social determinants of health should apply broadly to three categories of health and social workforce learners, namely, those acting on global or national policies; those working in districts and communities; and those providing clinical services to individual families and patients

Bacteriological Analysis and Plasmid Profiles of Surfaces of Some Hospital Kitchen Equipment in Benin City, Nigeria

The surfaces of hospital kitchen equipment could be a major source of transmission of resistant pathogens to patients. Hence, the objective of this paper was to assess the bacteriological and plasmid profiles of surfaces of tables, sinks, chopping-boards, gas cookers and freezer handles hospital kitchen equipment in Benin City, Nigeria using appropriate standard microbiological techniques. Bacterial plasmids were isolated and separated using the agarose gel electrophoresis. Plasmid curing was performed using acridine orange. The antimicrobial sensitivity pattern showed that the bacterial isolates exhibited varying degree of resistance to the antibiotics. Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa were highly resistant to the antibiotics, having multiple antibiotic resistances (MAR) index of 0.6. Micrococcus spp. and Klebsiella pneumoniae were the least resistant to the antibiotics. Plasmid analysis revealed the presence of single and multiple-banded plasmids with sizes ranging from 100-1000bp. After curing, all the isolates (except S. aureus, E. coli and P. aeruginosa) were sensitive to all the antibiotics, indicating a significant reduction in antibiotic resistance after curing. The results revealed that plasmids played a significant role in conferring resistance on the isolates. Regular cleaning and disinfection should be strictly observed in hospital kitchens to prevent outbreaks and spread of resistant pathogens in hospitals

Invariant natural killer T cells act as an extravascular cytotoxic barrier for joint-invading Lyme Borrelia

SignificanceInvariant natural killer T cells (iNKT) have been found primarily patrolling inside blood vessels in the liver, where they respond to bacterial glycolipids presented by CD1d on liver macrophages. We show joint iNKT cells are localized outside of blood vessels and respond directly to the joint-homing pathogen, Borrelia burgdorferi, which causes Lyme borreliosis using multichannel spinning-disk intravital microscopy. These iNKT cells interacted with B. burgdorferi at the vessel wall and disrupted its dissemination attempts into joints. Successful penetrance of B. burgdorferi out of the vasculature and into the joint tissue was met by a lethal attack by extravascular iNKT cells through a granzyme-dependent pathway. These results suggest a critical extravascular iNKT cell immune surveillance in joints that functions as a cytotoxic barrier

Digital education for health professionals: an evidence map, conceptual framework, and research agenda

Background: Health professions education has undergone major changes with the advent and adoption of digital technologies worldwide.Objective: This study aims to map the existing evidence and identify gaps and research priorities to enable robust and relevant research in digital health professions education.Methods: We searched for systematic reviews on the digital education of practicing and student health care professionals. We searched MEDLINE, Embase, Cochrane Library, Educational Research Information Center, CINAHL, and gray literature sources from January 2014 to July 2020. A total of 2 authors independently screened the studies, extracted the data, and synthesized the findings. We outlined the key characteristics of the included reviews, the quality of the evidence they synthesized, and recommendations for future research. We mapped the empirical findings and research recommendations against the newly developed conceptual framework.Results: We identified 77 eligible systematic reviews. All of them included experimental studies and evaluated the effectiveness of digital education interventions in different health care disciplines or different digital education modalities. Most reviews included studies on various digital education modalities (22/77, 29%), virtual reality (19/77, 25%), and online education (10/77,13%). Most reviews focused on health professions education in general (36/77, 47%), surgery (13/77, 17%), and nursing (11/77, 14%). The reviews mainly assessed participants' skills (51/77, 66%) and knowledge (49/77, 64%) and included data from high-income countries (53/77, 69%). Our novel conceptual framework of digital health professions education comprises 6 key domains (context, infrastructure, education, learners, research, and quality improvement) and 16 subdomains. Finally, we identified 61 unique questions for future research in these reviews; these mapped to framework domains of education (29/61, 47% recommendations), context (17/61, 28% recommendations), infrastructure (9/61, 15% recommendations), learners (3/61, 5% recommendations), and research (3/61, 5% recommendations).Conclusions: We identified a large number of research questions regarding digital education, which collectively reflect a diverse and comprehensive research agenda. Our conceptual framework will help educators and researchers plan, develop, and study digital education. More evidence from low-and middle-income countries is needed.Public Health and primary carePrevention, Population and Disease management (PrePoD

Bone marrow stromal cells attenuate sepsis via prostaglandin E2— dependent reprogramming of host macrophages to increase their interleukin-10 production

Sepsis causes over 200,000 deaths yearly in the US; better treatments are urgently needed. Administering bone marrow stromal cells (BMSCs—also known as mesenchymal stem cells) to mice before or shortly after inducing sepsis by cecal ligation and puncture reduced mortality and improved organ function. The beneficial effect of BMSCs was eliminated by macrophage depletion or pretreatment with antibodies specific for interleukin-10 (IL-10) or IL-10 receptor. Monocytes and/ or macrophages from septic lungs made more IL-10 when prepared from mice treated with BMSCs versus untreated mice. Lipopolysaccharide (LPS)-stimulated macrophages produced more IL-10 when cultured with BMSCs, but this effect was eliminated if the BMSCs lacked the genes encoding Toll-like receptor 4, myeloid differentiation primary response gene-88, tumor necrosis factor (TNF) receptor-1a or cyclooxygenase-2. Our results suggest that BMSCs (activated by LPS or TNF-α) reprogram macrophages by releasing prostaglandin E2 that acts on the macrophages through the prostaglandin EP2 and EP4 receptors. Because BMSCs have been successfully given to humans and can easily be cultured and might be used without human leukocyte antigen matching, we suggest that cultured, banked human BMSCs may be effective in treating sepsis in high-risk patient groups.Sepsis, a serious medical condition that affects 18 million people per year worldwide, is characterized by a generalized inflammatory state caused by infection. Widespread activation of inflammation and coagulation pathways progresses to multiple organ dysfunction, collapse of the circulatory system (septic shock) and death. Because as many people die of sepsis annually as from acute myocardial infarction1, a new treatment regimen is desperately needed. In the last few years, it has been discovered that BMSCs are potent modulators of immune responses2-5. We wondered whether such cells could bring the immune response back into balance, thus attenuating the underlying pathophysiology that eventually leads to severe sepsis, septic shock and death6,7. As a model of sepsis, we chose cecal ligation and puncture (CLP), a procedure that has been used for more than two decades8. This mouse model closely resembles the human disease: it has a focal origin (cecum), is caused by multiple intestinal organisms, and results in septicemia with release of bacterial toxins into the circulation. With no treatment, the majority of the mice die 24-48 h postoperatively. Originally published Nature Medicine, Vol. 15, No. 1, Jan 200

Liver Is Able to Activate Naïve CD8+ T Cells with Dysfunctional Anti-Viral Activity in the Murine System

The liver possesses distinct tolerogenic properties because of continuous exposure to bacterial constituents and nonpathogenic food antigen. The central immune mediators required for the generation of effective immune responses in the liver environment have not been fully elucidated. In this report, we demonstrate that the liver can indeed support effector CD8+ T cells during adenovirus infection when the T cells are primed in secondary lymphoid tissues. In contrast, when viral antigen is delivered predominantly to the liver via intravenous (IV) adenovirus infection, intrahepatic CD8+ T cells are significantly impaired in their ability to produce inflammatory cytokines and lyse target cells. Additionally, intrahepatic CD8+ T cells generated during IV adenovirus infection express elevated levels of PD-1. Notably, lower doses of adenovirus infection do not rescue the impaired effector function of intrahepatic CD8+ T cell responses. Instead, intrahepatic antigen recognition limits the generation of potent anti-viral responses at both priming and effector stages of the CD8+ T cell response and accounts for the dysfunctional CD8+ T cell response observed during IV adenovirus infection. These results also implicate that manipulation of antigen delivery will facilitate the design of improved vaccination strategies to persistent viral infection

Performance Evaulation of Locust Beans Dehuller/Separator for \"Dawadawa\" Production

Key words: Locust bean, Dehuller/Separator, Fermentation, \"Dawadawa\", Commercial Productio