Interventions to maintain essential services for maternal, newborn, child, and adolescent health during the COVID-19 pandemic: a scoping review of evidence from low- and middle-income countries

Background: The coronavirus disease 2019 (COVID-19) pandemic had challenged health systems worldwide, including those in low- and middle-income countries (LMICs). Aside from measures to control the pandemic, efforts were made to continue the provision and use of essential services. At that time, information was not organised and readily available to guide country-level decision-making. This review aims to summarise evaluated interventions to maintain essential services for maternal, newborn, child, and adolescent health in response to COVID-19 in LMICs, in order to learn from the interventions and facilitate their use in the next disruption. Methods: We conducted a scoping review by Embase, MEDLINE, and Global Health for literature published between 1 January 2020 and 26 December 2022, without restrictions for language. We extracted information about the setting, population targeted, service type, intervention, and evaluation from the included studies and summarised it both quantitatively and narratively. Results: We retrieved 11 395 unique references and included 30 studies describing 32 evaluated interventions. Most interventions (84%) were implemented in 2020, with a median duration of five months (interquartile range (IQR) = 3-8), and were conducted in Africa (34%) or Southeast Asia (31%). Interventions focussed on maintaining services for maternal and newborn health (56%) or children and adolescents (56%) were most common. Interventions aimed to address problems related to access (94%), fear (31%), health workers shortage (25%), and vulnerability (22%). Types of interventions included telehealth (69%), protocols/guidelines to adapt care provision (56%), and health education (40%); a few entailed health worker training (16%). The described interventions were mostly led by the public (56%) or non-profit (34%) sectors. Methodologies of their evaluations were heterogeneous; the majority used quantitative methods, had a prospective research design, and used output- and outcome-based indicators. Conclusions: In this review, we identified an important and growing body of evidence of evaluated interventions to maintain essential services for maternal, newborn, child, and adolescent health during COVID-19 in LMICs. To improve preparedness and responsiveness for future disruptions, managers for decision-makers in LMICs could benefit from up-to-date inventories describing implemented interventions and evaluations to facilitate evidence-based implementation of strategies, as well as tools for conducting optimal quality operational and implementation research during disruptions (e.g. rapid ethical approvals, access to routine data)

Finding Nemo’s clock reveals switch from nocturnal to diurnal activity

Timing mechanisms play a key role in the biology of coral reef fish. Typically, fish larvae leave their reef after hatching, stay for a period in the open ocean before returning to the reef for settlement. During this dispersal, larvae use a time-compensated sun compass for orientation. However, the timing of settlement and how coral reef fish keep track of time via endogenous timing mechanisms is poorly understood. Here, we have studied the behavioural and genetic basis of diel rhythms in the clown anemonefish Amphiprion ocellaris. We document a behavioural shift from nocturnal larvae to diurnal adults, while juveniles show an intermediate pattern of activity which potentially indicates flexibility in the timing of settlement on a host anemone. qRTPCR analysis of six core circadian clock genes (bmal1, clocka, cry1b, per1b, per2, per3) reveals rhythmic gene expression patterns that are comparable in larvae and juveniles, and so do not reflect the corresponding activity changes. By establishing an embryonic cell line, we demonstrate that clown anemonefish possess an endogenous clock with similar properties to that of the zebrafish circadian clock. Furthermore, our study provides a first basis to study the multi-layered interaction of clocks from fish, anemones and their zooxanthellae endosymbionts

Community engagement to support COVID-19 vaccine uptake: a living systematic review protocol

Introduction: Widespread vaccination against COVID-19 is one of the most effective ways to control, and ideally, end the global COVID-19 pandemic. Vaccine hesitancy and vaccine rates vary widely across countries and populations and are influenced by complex sociocultural, political, economic and psychological factors. Community engagement is an integral strategy within immunisation campaigns and has been shown to improve vaccine acceptance. As evidence on community engagement to support COVID-19 vaccine uptake is emerging and constantly changing, research that lessens the knowledgeto-practice gap by providing regular and up-to-date evidence on current best-practice is essential. Methods and analysis: A living systematic review will be conducted which includes an initial systematic review and bimonthly review updates. Searching and screening for the review and subsequent updates will be done in four streams: a systematic search of six databases, grey literature review, preprint review and citizen sourcing. The screening will be done by a minimum of two reviewers at title/abstract and full-text in Covidence, a systematic review management software. Data will be extracted across predefined fields in an excel spreadsheet that includes information about article characteristics, context and population, community engagement approaches, and outcomes. Synthesis will occur using the convergent integrated approach. We will explore the potential to quantitatively synthesise primary outcomes depending on heterogeneity of the studies. Ethics and dissemination: The initial review and subsequent bimonthly searches and their results will be disseminated transparently via open-access methods. Quarterly briefs will be shared on the reviews’ social media platforms and across other interested networks and repositories. A dedicated web link will be created on the Community Health-Community of Practice site for sharing findings and obtaining feedback. A mailing list will be developed and interested parties can subscribe for updates.University College Dubli

Killer-like receptors and GPR56 progressive expression defines cytokine production of human CD4+ memory T cells

All memory T cells mount an accelerated response on antigen reencounter, but significant functional heterogeneity is present within the respective memory T-cell subsets as defined by CCR7 and CD45RA expression, thereby warranting further stratification. Here we show that several surface markers, including KLRB1, KLRG1, GPR56, and KLRF1, help define low, high, or exhausted cytokine producers within human peripheral and intrahepatic CD4+ memory T-cell populations. Highest simultaneous production of TNF and IFN-γ is observed in KLRB1+KLRG1+GPR56+ CD4 T cells. By contrast, KLRF1 expression is associated with T-cell exhaustion and reduced TNF/IFN-γ production. Lastly, TCRβ repertoire analysis and in vitro differentiation support a regulated, progressive expression for these markers during CD4+ memory T-cell differentiation. Our results thus help refine the classification of human memory T cells to provide insights on inflammatory disease progression and immunotherapy development

Evidenzbasierte Psychotherapie der Panikstörung mit und ohne Agoraphobie : ein Überblick zur S1-Leitlinie der Deutschen Gesellschaft für Psychologie

Alpers GW, Gerlach AL, Heinrichs N. Evidence-based psychotherapy of panic disorder with or without agoraphobia. Psychotherapeut. 2011;56(6):535-548.From the evidence reported in the recent guidelines [Heinrichs et al. (2009) Evidenzbasierte Leitlinie zur Psychotherapie der Panikstorung mit und ohne Agoraphobie. Hogrefe, Gottingen] the following conclusions can be drawn with respect to the treatment of panic disorder with or without agoraphobia, as well as for agoraphobia without panic disorder: Every psychotherapy should be preceded by suitable diagnostics and a case formulation. The effectiveness of every psychotherapy should be evaluated with well established measures. For the treatment of panic disorder without agoraphobia, cognitive behavioral treatment (CBT) and applied relaxation have been shown to be effective (evidence grade 1). For panic disorder with agoraphobia, CBT, combination treatment (CBT plus medication), as well as panic-focused psychodynamic psychotherapy in the outpatient setting have shown short-term effectiveness (evidence grade 1). Longer lasting effects have been documented for CBT (evidence grade 1). For agoraphobia without panic disorder, CBT with a focus on situational exposure can be recommended (evidence grade 1)

Behavioural and functional evidence revealing the role of RBFOX1 variation in multiple psychiatric disorders and traits

Common variation in the gene encoding the neuron-specific RNA splicing factor RNA Binding Fox-1 Homolog 1 (RBFOX1) has been identified as a risk factor for several psychiatric conditions, and rare genetic variants have been found causal for autism spectrum disorder (ASD). Here, we explored the genetic landscape of RBFOX1 more deeply, integrating evidence from existing and new human studies as well as studies in Rbfox1 knockout mice. Mining existing data from large-scale studies of human common genetic variants, we confirmed gene-based and genome-wide association of RBFOX1 with risk tolerance, major depressive disorder and schizophrenia. Data on six mental disorders revealed copy number losses and gains to be more frequent in ASD cases than in controls. Consistently, RBFOX1 expression appeared decreased in post-mortem frontal and temporal cortices of individuals with ASD and prefrontal cortex of individuals with schizophrenia. Brain-functional MRI studies demonstrated that carriers of a common RBFOX1 variant, rs6500744, displayed increased neural reactivity to emotional stimuli, reduced prefrontal processing during cognitive control, and enhanced fear expression after fear conditioning, going along with increased avoidance behaviour. Investigating Rbfox1 neuron-specific knockout mice allowed us to further specify the role of this gene in behaviour. The model was characterised by pronounced hyperactivity, stereotyped behaviour, impairments in fear acquisition and extinction, reduced social interest, and lack of aggression; it provides excellent construct and face validity as an animal model of ASD. In conclusion, convergent translational evidence shows that common variants in RBFOX1 are associated with a broad spectrum of psychiatric traits and disorders, while rare genetic variation seems to expose to early-onset neurodevelopmental psychiatric disorders with and without developmental delay like ASD, in particular. Studying the pleiotropic nature of RBFOX1 can profoundly enhance our understanding of mental disorder vulnerability

Analysis of the Claudin protein family in Drosophila

Epithelien sind Zellschichten, die die Funktion haben, Körperkompartimente abzugrenzen. Dabei müssen die Zellzwischenräume abgedichtet werden, so dass eine Diffusion von Molekülen über das Epithel nur kontrolliert erfolgen kann (transepitheliale Barriere). Diese Aufgabe wird in Wirbeltieren von den Tight junctions erfüllt, deren wichtigster struktureller und funktioneller Bestandteil eine Gruppe von Transmembranproteinen ist, die Claudine heißen. In Arthropoden wie der Taufliege Drosophila melanogaster gibt es zu den Tight junctions analoge Strukturen, die Septate junctions, die sich strukturell, aber nicht funktionell von den Tight junctions unterscheiden. Auch in Drosophila sind Claudine an der Ausbildung der parazellulären Barriere beteiligt und sind Bestandteile der Septate junctions. Ausgehend von der Proteinstruktur eines dieser Claudine, von Megatrachea (Mega), wurden in Datenbanksuchen fünf neue potentielle Claudingene identifiziert und charakterisiert. Die Untersuchung eines dieser Proteine, Sesam, ergab, dass es sich um eine essentielle Komponente der Septate junctions handelt. RNA-Interferenz-Experimente zeigen, dass Sesam eine essenzielle Funktion in epithelialen Geweben besitzt und deshalb neben Mega ein wichtiger Baustein der Septate junctions ist. Die Analyse eines weiteren Proteins, Ali baba genannt, ergab, dass es sich bei diesem Protein nicht um eine Komponente der Septate junctions, sondern um einen Bestandteil der Adherens junctions handelt. Die Untersuchung von ali-Mutanten ergab, dass Ali kein essenzieller Bestandteil der Adherens junctions ist. Aufgrund von genetischen Untersuchen kann angenommen werden, dass Ali eine modulierende Funktion für die Adhäsion hat. In vivo-Analysen von Mega, für die zunächst der mega-mutante Phänotyp mit Hilfe eines genomischen Konstrukts gerettet wurde, zeigten, dass der C-terminale cytoplasmatische Teil von Mega eine wichtige Funktion für die transepitheliale Barriere und die Morphologie der Tracheenäste besitzt.Epithelia are sheets of cells that separate body compartments from each other. They control the flow of molecules through the paracellular space and establish a transepithelial barrier. The structure that controls this barrier function is the tight junction. The most important components of the tight junctions are the Claudin proteins. In arthropods, where no tight junctions can be found, an analogous structure, the septate junction, establishes the barrier. In Drosophila the Claudins have been identified as components of the septate junction. Using the protein sequence of one of these Claudins, Megatrachea, five novel Claudin-like proteins have been identified via database searches within the Drosophila genome. Further analysis showed that one of these named Sesam is an essential component of the septate junction and is a true Claudin. Analysis of Ali baba revealed that it is a component of the adherens rather than the septate junctions. Ali mutants are viable and fertile and show no obvious phenotypes. Genetic analysis suggests that it plays a modulating role in cell adhesion and is a Claudin-like molecule. In vivo-analysis of Megatrachea with a rescue construct determined that the C-Terminus of Mega is essential for its function and influences the barrier and the morphology of the tracheal system