Assessing whether medical language is a barrier to receiving healthcare services in Bangladesh: an exploratory study.

BACKGROUND: In many global settings, medical language acts as a barrier to accessing and using health services. However, this issue remained unexplored in Bangladesh, where the non-native English language is commonly used for health care. AIM: To examine whether medical language is an obstacle for obtaining health services in Bangladesh and to provide policy recommendations. DESIGN & SETTING: An exploratory study was undertaken to identify the impact of medical language on general practice. Data were collected online from Bangladeshi people between July-November 2014. METHOD: A semi-structured questionnaire was developed through Google Forms for data collection. The snowball technique was applied to obtain data purposively from 50 participants. With prior consent, the questionnaire along with the online link was sent to responders by email. When responders clicked on the 'submit' option of the questionnaire, responses were stored online automatically in the pre-built system. Quantitative data were analysed using SPSS (version 22). Textual data analyses (especially of suggestions of the responders) were conducted using a thematic approach. RESULTS: Among study participants, 44% (n = 22) said that English language was the choice for writing prescriptions by health service providers in Bangladesh, and 26% said that a mixture of Bengali and English was used. Around 30% of the study participants could not understand medical language used by doctors (this includes those who were not sure or preferred not to say). Among responders, 78% said that medical language was affecting the treatment process and 48% were of the opinion that it was acting as a barrier in receiving health services. CONCLUSION: Medical language is acting as a barrier in the health services of Bangladesh. Tailored interventions must be developed and implemented to overcome medical language barriers in health services in order to strengthen the health system

Equity and determinants of routine child immunisation programme among tribal and non-tribal populations in rural Tangail subdistrict, Bangladesh: A cohort study

Objectives The study estimated valid vaccination coverage of under 5 children in a rural area under Tangail subdistrict and examined their sociodemographic correlates including ethnicity. Setting The study sites are three primary areas where tribal and non-tribal population resides together in a rural subdistrict of Bangladesh. Participants Routine vaccination information of a cohort of 2802 children, born between 1 January 2011 and 31 December 2012, were retrieved from the Expanded Program on Immunization (EPI) registers maintained by the health assistants. Collected data were entered in an Oracle-based computer program. Univariate, bivariate and multivariate analyses were performed in SPSS V.20 to explore coverage and differentials for full valid vaccination coverage in the study area. Results Valid vaccination coverage was 90.6% among tribal population and 87.3% among non-tribal population(p=0.25). Compared with females, males had higher valid vaccination coverage (89.2% vs 85.9%) and lower invalid (5.4% vs 6.9%) and no-coverage (5.3% vs 7.3%) (p=0.03). Households with mobile phones had higher valid coverage (90.9% vs 86.5%) and lower invalid (4.5% vs 6.7%) and no coverage (4.5% vs 6.9%) compared with those without mobile phones (p=0.01). Coverage of valid vaccination was higher among children of Oronkhola union than in children of the other two unions. Conclusion The study documented that valid vaccination coverage was high in this rural area, and there was no significant ethnic variation which was one of the strengths of the national EPI. However, there is significant variation by gender of the child, household ownership of mobile phones and geographical location of households

Cryptosporidium Priming Is More Effective than Vaccine for Protection against Cryptosporidiosis in a Murine Protein Malnutrition Model

Cryptosporidium is a major cause of severe diarrhea, especially in malnourished children. Using a murine model of C. parvum oocyst challenge that recapitulates clinical features of severe cryptosporidiosis during malnutrition, we interrogated the effect of protein malnutrition (PM) on primary and secondary responses to C. parvum challenge, and tested the differential ability of mucosal priming strategies to overcome the PM-induced susceptibility. We determined that while PM fundamentally alters systemic and mucosal primary immune responses to Cryptosporidium, priming with C. parvum (106 oocysts) provides robust protective immunity against re-challenge despite ongoing PM. C. parvum priming restores mucosal Th1-type effectors (CD3+CD8+CD103+ T-cells) and cytokines (IFNγ, and IL12p40) that otherwise decrease with ongoing PM. Vaccination strategies with Cryptosporidium antigens expressed in the S. Typhi vector 908htr, however, do not enhance Th1-type responses to C. parvum challenge during PM, even though vaccination strongly boosts immunity in challenged fully nourished hosts. Remote non-specific exposures to the attenuated S. Typhi vector alone or the TLR9 agonist CpG ODN-1668 can partially attenuate C. parvum severity during PM, but neither as effectively as viable C. parvum priming. We conclude that although PM interferes with basal and vaccine-boosted immune responses to C. parvum, sustained reductions in disease severity are possible through mucosal activators of host defenses, and specifically C. parvum priming can elicit impressively robust Th1-type protective immunity despite ongoing protein malnutrition. These findings add insight into potential correlates of Cryptosporidium immunity and future vaccine strategies in malnourished children

Tetanus toxin Hc fragment induces the formation of ceramide platforms and protects neuronal cells against oxidative stress

Tetanus toxin (TeTx) is the protein, synthesized by the anaerobic bacteria Clostridium tetani, which causes tetanus disease. TeTx gains entry into target cells by means of its interaction with lipid rafts, which are membrane domains enriched in sphingomyelin and cholesterol. However, the exact mechanism of host membrane binding remains to be fully established. In the present study we used the recombinant carboxyl terminal fragment from TeTx (Hc-TeTx), the domain responsible for target neuron binding, showing that Hc-TeTx induces a moderate but rapid and sustained increase in the ceramide/sphingomyelin ratio in primary cultures of cerebellar granule neurons and in NGF-differentiated PC12 cells, as well as induces the formation of ceramide platforms in the plasma membrane. The mentioned increase is due to the promotion of neutral sphingomyelinase activity and not to the de novo synthesis, since GW4869, a specific neutral sphingomyelinase inhibitor, prevents neutral sphingomyelinase activity increase and formation of ceramide platforms. Moreover, neutral sphingomyelinase inhibition with GW4869 prevents Hc-TeTx-triggered signaling (Akt phosphorylation), as well as the protective effect of Hc-TeTx on PC12 cells subjected to oxidative stress, while siRNA directed against nSM2 prevents protection by Hc-TeTx of NSC-34 cells against oxidative insult. Finally, neutral sphingomyelinase activity seems not to be related with the internalization of Hc-TeTx into PC12 cells. Thus, the presented data shed light on the mechanisms triggered by TeTx after membrane binding, which could be related with the events leading to the neuroprotective action exerted by the Hc-TeTx fragment

Phytoremediation of heavy metal-contaminated sites: Eco-environmental concerns, field studies, sustainability issues and future prospects

Environmental contamination due to heavy metals (HMs) is of serious ecotoxicological concern worldwide because of their increasing use at industries. Due to non-biodegradable and persistent nature, HMs cause serious soil/water pollution and severe health hazards in living beings upon exposure. HMs can be genotoxic, carcinogenic, mutagenic, and teratogenic in nature even at low concentration. They may also act as endocrine disruptors and induce developmental as well as neurological disorders and thus, their removal from our natural environment is crucial for the rehabilitation of contaminated sites. To cope with HM pollution, phytoremediation has emerged as a low-cost and eco-sustainable solution to conventional physico-chemical cleanup methods that require high capital investment and labor alter soil properties and disturb soil microflora. Phytoremediation is a green technology wherein plants and associated microbes are used to remediate HM-contaminated sites to safeguard the environment and protect public health. Hence, in view of the above, the present paper aims to examine the feasibility of phytoremediation as a sustainable remediation technology for the management of metals-contaminated sites. Therefore, this paper provides an in-depth review on both the conventional and novel phytoremediation approaches, evaluate their efficacy to remove toxic metals from our natural environment, explore current scientific progresses, field experiences and sustainability issues and revise world over trends in phytoremediation research for its wider recognition and public acceptance as a sustainable remediation technology for the management of contaminated sites in 21st century

Action to protect the independence and integrity of global health research

Storeng KT, Abimbola S, Balabanova D, et al. Action to protect the independence and integrity of global health research. BMJ GLOBAL HEALTH. 2019;4(3): e001746

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)1.

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field

Development of a Shape Memory Alloy (SMA) based assistive hand

In Malaysia, every year approximately 40000 people suffer from stroke and many of them become immobilized as an after effect. Rehabilitation robotics to assist disabled people has drawn significant attention by the researchers recently. This project also aims to contribute to this field. This paper presents a Shape Memory Alloy (SMA) actuated wearable assistive robotic hand for grasping. The proposed design is compact and sufficiently light to be used as an assistive hand. It is a joint less structure, has the potential because the human skeleton and joint replace the robot’s conventional structure. This design has been implemented on index and thumb fingers to enable grasping. Shape memory alloy springs and bias force mechanism are used for purpose of hand’s flexion and extension. This paper describes the mechatronic design of the wearable hand, experimental study of actuation unit and sensory system. Open loop experiments are conducted to understand the hand characterization and grip force provided by index finger. Current, temperature, extension and contraction of shape memory alloy springs are reported. This mechanism requires approximately 2A current for the SMA to actuate which provides maximum of 1.6N of gripping force. Conducted experiments show promising results that encourage further developments