Population Health Screening after Environmental Pollution

Following environmental pollution exposure, calls to screen the population for disease or disease markers are often made. Population screening is a cross-sectional review of a population to find latent cases or biomarkers of disease that indicate the possibility of disease development; it differs from environmental screening or an epidemiological survey. Recognized standard approaches have been developed over 60 years to ensure quality and effectiveness in complex programs. We surveyed the literature for papers on health screening following environmental exposures and checked them for reference to accepted criteria such as those of Wilson and Jungner. We applied these criteria to three situations covering source/hazard (arsenic contaminated land), pathway/exposure (radiation release), and receptor/disease (lead poisoning). We identified 36 relevant papers. Although across the papers the whole range of criteria were addressed, no paper or program utilized recognized criteria. Issues and gaps identified included limited strategic approaches, lack of treatment, environmental prevention being seen as the screening outcome instead of treatment of identified individuals, and programs which did not fit the World Health Organization screening description. Robust discussion in the literature is needed to consider the organization and role of health screening following environmental exposures

Did school characteristics affect the uptake of meningococcal quadrivalent vaccine in Greater Manchester, United Kingdom?

Objectives The objective of this study was to assess if school characteristics were associated with the uptake of the meningococcal ACWY (MenACWY) vaccine in Greater Manchester in 2017/18. Study design This is an ecological cross-sectional study. Methods We analysed data on all 129 schools in seven local authorities in Greater Manchester from the Department for Education and from local child health information systems to determine whether school characteristics, including school type and Ofsted effectiveness score, were associated with vaccine uptake. Schools with no eligible pupils were excluded. We undertook single-variable and multivariable analysis and considered key interactions. Results The overall uptake rate was 80.7%, with a median uptake per school of 80.6% (interquartile range, 69.0%–87.4%). Lower vaccination rates were associated with lower overall effectiveness scores (odds ratio [OR]: 3.54, 95% confidence interval [CI]: 3.00–4.19) and lower numbers of pupils eligible for vaccination (OR: 1.39, 95% CI: 1.28–1.51). Schools with a lower percentage of pupils for whom English is a second language and high deprivation were associated with lower uptake (OR: 1.58, 95% CI: 1.41–1.78). In addition, community schools (the schools with the most local authority oversight) had lower vaccination rates than other categories of schools. Conclusions In this study, uptake rates of the MenACWY vaccine were associated with all five school characteristics considered. Effectiveness scores for schools had the largest association with vaccine uptake, with poorer schools having lower uptake. These characteristics should be used by vaccination providers to prioritise their interventions to increase immunisation rates

Development of mental healthcare in Cambodia: barriers and opportunities

From Springer Nature via Jisc Publications RouterHistory: received 2019-08-12, accepted 2020-07-21, registration 2020-07-21, pub-electronic 2020-07-29, online 2020-07-29, collection 2020-12Publication status: PublishedAbstract: Background: Despite the increasing recognition globally of the importance of mental health for sustainable development, significant barriers remain to developing mental health services in low- and middle-income countries. This study explored the particular barriers and opportunities for developing mental health services in Cambodia and how these compared with those described in other low- and middle-income countries. Methods: For this qualitative study, 18 experienced mental health professionals from different disciplines were selected using purposive sampling. Semi-structured interviews were carried out in Phnom Penh and thematic analysis of the data was completed. Results: Five key themes were identified: (1) Prioritising mental health in Cambodia, (2) Strengthening collaborations between mental health stakeholders, (3) Developing a mental healthcare model appropriate for the Cambodian culture and context, (4) Increasing the quantity and (5) Improving the quality of mental healthcare. All five themes were referred to by all 18 participants and the two most repeated themes were (2) Strengthening collaborations and (5) Improving the quality of mental healthcare. Conclusions: The themes identified in this study both corroborate previous barriers identified to developing mental health services in low- and middle-income countries and shed new light on opportunities of particular importance in Cambodia. Strengthening collaborations between key stakeholders in mental health and prioritising the quality of mental health education, training and service provision were both cited as being significant opportunities for enhancing the development of mental health services in Cambodia. These have not been widely described before as being important factors

Sexual violence against migrants and asylum seekers. The experience of the MSF clinic on Lesvos Island, Greece.

Sexual violence can have destructive impact on the lives of people. It is more common in unstable conditions such as during displacement. On the Greek island of Lesvos, Médecins Sans Frontières provided medical care to survivors of sexual violence among the population of asylum seekers arriving there. This study aimed to describe the patterns of sexual violence reported by migrants and asylum seekers and the clinical care provided to them. Methods This is s a descriptive study using routine program data. The study population consisted of migrants and asylum seekers treated for conditions related to sexual violence at the Médecins Sans Frontières clinic on Lesvos Island (September 2017-January 2018). Results We enrolled 215 survivors of sexual violence who reported and were treated, of whom 60 (28%) were male. The majority of incidents reported (90%) were cases of rape; 174 (81%) of survivors were from Africa and 185 (86%) occurred over a month before presentation. Half the incidents (118) occurred in transit, mainly in Turkey, and 76 (35%) in the country of origin; 10 cases (5%) on Lesvos were also observed. The perpetrator was known in 23% of the cases. Only XXX received mental health care, and the need exceeded the capacity of available mental care services. Conclusion Even though the majority of cases delayed seeking medical care after the incident, it is crucial that access to mental health services is guaranteed for those in need. Such access and protection measures for people in transit need to be put in place along migration routes, including in countries nominally considered safe, and secure routes need to be developed

Establishing community mental health clinics increased the number of patients receiving care in rural Western Uganda

Background: Mental, neurological, and substance-use disorders cause medium to long term disability in all countries. They are amenable to treatment but often treatment is only available in hospitals, as few staff feel competent to give treatment. The WHO developed the “Mental Health GAP” (mhGAP) course to train non-specialist clinical staff in basic diagnosis and treatment. At Bwindi Community Hospital, in south-west Uganda, mental health care was initially only provided at the hospital. It was extended outside the hospital in two implementation phases, initially by establishing 17 clinics in the community, run by qualified mental health staff from the hospital. In the second implementation phase staff in 12 health centers were trained using mhGAP and ran their own clinics under supervision. Methods: Using routine data the defined data variables for the individuals attending the clinics was extracted. Results: A total of 2,617 people attended a mental health care clinic in the study period between January 2016 and March 2020. Of these 1,051 people attended more than once. The number of patients attending clinics increased from 288 during the baseline to 693 in the first implementation phase then to 839 patients in the second implementation phase. After mhGAP training, about 30% of patients were seen locally by mhGAP trained healthcare personnel. The average number of mental health patients seen each month increased from 12 to 65 over the time of the study. The number of patients living >20 km from the hospital increased from 69 in the baseline to 693 in the second implementation phase. The proportion of patients seen at the hospital clinic dropped from 100% to 27%. Conclusions: Providing mental health care in the community at a distance from the hospital substantially increased the number of people accessing mental health care. Training health center-based staff in mhGAP contributed to this. Not all patients could appropriately be managed by non-specialist clinical staff, who only had the five-day training in mhGAP. Supplies of basic medicines were not always adequate, which probably contributed to patients being lost to follow-up. About 50% of patients only attend the clinic once. Further work is required to understand the reasons

A Retrospective Cross Sectional Study of the Effectiveness of a Project in Improving Infant Health in Bwindi, South Western Uganda.

From Europe PMC via Jisc Publications Router.Publication status: PublishedIntroduction: Low-cost community-based interventions to improve infant health potentially offer an exciting means of progressing toward the Sustainable Development Goals (SDGs). However, the feasibility of such interventions in low-income settings remains unclear. Bwindi Community Hospital (BCH), Uganda implemented a 3-year nurse-led community project to address child-health issues. Nurses supported Community Health Volunteers (CHVs) and visited mothers pre- and/or postnatally to assess and educate mothers and infants. CHVs gathered data and gave basic advice on health and hygiene to mothers. We hypothesized that increased interventions by nurses and CHVs and increased contact with households, would improve health and reduce infant mortality. Methods: This was a retrospective cohort study analyzing routine data of all children born between January 2015 and December 2016. There were three interventions: antenatal nurse visit, postnatal nurse visit and CHV participation. Children received different numbers of interventions. We defined four diverse outcomes: facility-based delivery, immunization completeness, nutritional status, and infant mortality. Odds ratios, adjusted odds ratios, and multivariate logistic regression were used to assess associations between interventions and outcomes. Results: Of the 4,442 children born in 2015 and 2016, 91% were visited by a nurse (81% antenatally and 10% postnatally); 7% lived in villages with a high participating CHV. Households receiving a postnatal visit were more likely to complete immunization (aOR: 1.55, p = 0.016) and have the infant survive (aOR: 1.90, p = 0.05). Children from a hard-to-reach village (no road access) were less likely to be delivered in a health facility (aOR: 0.55, p < 0.001) and less likely to survive in their first year (aOR: 0.69, p = 0.03). Having two or more interventions was associated with a child having all four positive outcomes (aOR 0.78, p = 0.03). Lack of baseline data, a control area, or integrated assessment data limited more detailed evaluation. Conclusion: Visits to mothers after birth, by a nurse to educate and identify child illness, were associated with lower infant mortality and improved infant health as measured by completion of immunizations. Community health interventions could potentially have a greater impact if focused on hard-to-reach areas. Building evaluation into all project designs, whether local or internationally funded, would enable greater learning, and hence better use of resources

Exploring self-harm risk vulnerabilities in autism using the ‘thinking patterns profiling model’

From Springer Nature via Jisc Publications RouterHistory: received 2022-11-21, registration 2023-02-23, accepted 2023-02-23, epub 2023-03-20, online 2023-03-20, collection 2023-12Acknowledgements: This project was conducted through the Structured Operational Research and Training Initiative (SORT IT), a global partnership led by the Special Programme for Research and Training in Tropical Diseases at the World Health Organization. The training is based on a course developed jointly by the International Union Against Tuberculosis and Lung Disease (The Union) and Medécins sans Frontières. This specific SORT IT program was run by Cheshire and Wirral Partnership (CWP) NHS Foundation Trust as part of routine work. Mentorship and the coordination/facilitation of these SORT IT workshops were provided through the CWP NHS Foundation Trust; The Centre for Operational Research, The Union, Paris, France; The Institute of Medicine, University of Chester, UK; and College of Life and Environmental Science, University of Exeter. The authors would like to acknowledge the families who attended the autism diagnostic assessment profiling service, and to thank the experts by experience who shared their insight, contributed to interpretation of the study findings, and reviewed final versions of the manuscript. Experts by experience included Josef de la Moitie and Kevin Carrell who were happy to be named. The authors would also like to thank Professor Taj Nathan (Director of Research and Effectiveness), Dr Fiona Pender (Strategic Director), Anne Casey (Head of Clinical Services), Dr Ian Davidson (Consultant Psychiatrist and Royal College of Psychiatrists Autism Champion), and Heather Pearce (Advanced Specialist Speech and Language Therapist) all at Cheshire and Wirral Partnership NHS Foundation Trust. Finally, thank you to David Tollerfield for permission to use the ‘Thinking Patterns Profiling Model’ digital innovations as part of the diagnostic assessment profiling service.Publication status: PublishedBackground: Autism has been linked to higher rates of self-harm. Research is yet to establish the reason for the association between autism and self-harm as a distress response. Methods: Using the ‘thinking patterns profiling model’, this study explored characteristics associated with self-harm risk in 100 autistic young people. Secondary analysis of routinely collected clinical data was conducted using odds ratios and t-tests. Results: We found the prevalence of reported self-harm risk was 48%. Young people with reported self-harm risks had significantly lower regulation skills (p ≤ 0.01) and lower social flexibility skills (p ≤ 0.01) compared to those without reported self-harm risk. For those described as impulsive, mean scores on the following skills were significantly lower: perspective-taking skills (p ≤ 0.01), flexible thinking for creative problem-solving (p ≤ 0.05) and sensory tolerating (p ≤ 0.05). There was no relationship between reported self-harm risk and adverse childhood experiences. Conclusions: These findings suggest that profiling tools such as ‘Thinking Patterns Profiling Model’ can be used to explore unique patterns of vulnerability and resilience related to self-harm risk in autism. The findings suggest that autistic thinking patterns might interplay with other factors (e.g. impulsivity). Patterns are based on each person’s profile across four core skill-sets: regulation, flexible thinking, sensory coherence, and social perspective-taking. These findings motivate a person-centred and profile-informed approach to planning support and adjustments. Further studies are needed to confirm the ways in which mechanisms typically involved in self-harm risk, may interact with core cognitive and affective differences found in autism

The angular distribution of the reaction νˉe+p→e++n\bar{\nu}_e + p \to e^+ + n

The reaction $\bar{\nu}_e + p \to e^+ + n$ is very important for low-energy ($E_\nu \lesssim 60$ MeV) antineutrino experiments. In this paper we calculate the positron angular distribution, which at low energies is slightly backward. We show that weak magnetism and recoil corrections have a large effect on the angular distribution, making it isotropic at about 15 MeV and slightly forward at higher energies. We also show that the behavior of the cross section and the angular distribution can be well-understood analytically for $E_\nu \lesssim 60$ MeV by calculating to ${\cal O}(1/M)$, where $M$ is the nucleon mass. The correct angular distribution is useful for separating $\bar{\nu}_e + p \to e^+ + n$ events from other reactions and detector backgrounds, as well as for possible localization of the source (e.g., a supernova) direction. We comment on how similar corrections appear for the lepton angular distributions in the deuteron breakup reactions $\bar{\nu}_e + d \to e^+ + n + n$ and $\nu_e + d \to e^- + p + p$. Finally, in the reaction $\bar{\nu}_e + p \to e^+ + n$, the angular distribution of the outgoing neutrons is strongly forward-peaked, leading to a measurable separation in positron and neutron detection points, also potentially useful for rejecting backgrounds or locating the source direction.Comment: 10 pages, including 5 figure

Tuberculosis notification in a private tertiary care teaching hospital in South India: a mixed-methods study

From BMJ via Jisc Publications RouterHistory: received 2018-05-08, rev-recd 2018-10-31, accepted 2018-11-05, ppub 2019-02, epub 2019-02-05Publication status: PublishedFunder: Swedish Research CouncilFunder: Department for International Development, FundRef: http://dx.doi.org/10.13039/501100000278Funder: Welcome trust/ DBT AllianceFunder: La Fondation Veuve Emile Metz-Tesch, LuxumbergObjectives India contributes approximately 25% of the ‘missing’ cases of tuberculosis (TB) globally. Even though ~50% of patients with TB are diagnosed and treated within India’s private sector, few are notified to the public healthcare system. India’s TB notification policy mandates that all patients with TB are notified through Nikshay (TB notification portal). We undertook this study in a private hospital to assess the proportion notified and factors affecting TB notifications. We explored barriers and probable solutions to TB notification qualitatively from health provider’s perspective. Study setting Private, tertiary care, teaching hospital in Bengaluru, South India. Methodology This was a mixed-methods study. Quantitative component comprised a retrospective review of hospital records between 1 January 2015 and 31 December 2017 to determine TB notifications. The qualitative component comprised key informant interviews and focus groups to elicit the barriers and facilitators of TB notification. Results Of 3820 patients diagnosed and treated, 885 (23.2%) were notified. Notifications of sputum smear-positive patients were significantly more likely, while notifications of children were less likely. Qualitative analysis yielded themes reflecting the barriers to TB notification and their solutions. Themes related to barriers were: (1) basic diagnostic procedures and treatment promote notification; (2) misconceptions regarding notification and its process are common among healthcare providers; (3) despite a national notification system other factors have prevented notification of all patients; and (4) establishing hospital systems for notification will go a long way in improving notifications. Conclusions The proportion of patients with TB notified by the hospital was low. A comprehensive approach both by the hospital management and the national TB programme is necessary for improving notification. This includes improving awareness among healthcare providers about the requirement for TB notifications, establishing a single notification portal in hospital, digitally linking hospital records to Nikshay and designating one person to be responsible for notification

<i>APETALA2</i> functions as a temporal factor together with <i>BLADE-ON-PETIOLE2</i> and <i>MADS29</i> to control flower and grain development in barley

Cereal grain develops from fertilised florets. Alterations in floret and grain development greatly influence grain yield and quality. Despite this, little is known about the underlying genetic control of these processes, especially in key temperate cereals such as barley and wheat. Using a combination of near-isogenic mutant comparisons, gene editing and genetic analyses, we reveal that HvAPETALA2 (HvAP2) controls floret organ identity, floret boundaries, and maternal tissue differentiation and elimination during grain development. These new roles of HvAP2 correlate with changes in grain size and HvAP2-dependent expression of specific HvMADS-box genes, including the B-sister gene, HvMADS29 Consistent with this, gene editing demonstrates that HvMADS29 shares roles with HvAP2 in maternal tissue differentiation. We also discovered that a gain-of-function HvAP2 allele masks changes in floret organ identity and grain size due to loss of barley LAXATUM.A/ BLADE-ON-PETIOLE2 (HvBOP2) gene function. Taken together, we reveal novel, pleiotropic roles and regulatory interactions for an APETALA2-like gene controlling floret and grain development in a temperate cereal.Jennifer R. Shoesmith, Charles Ugochukwu Solomon, Xiujuan Yang, Laura G. Wilkinson, Scott Sheldrick, Ewan van Eijden ... et al