Improving Access to Mental Health Care in an Orthodox Jewish Community: A Critical Reflection Upon the Accommodation of Otherness

The English National Health Service (NHS) has significantly extended the supply of evidence based psychological interventions in primary care for people experiencing common mental health problems. Yet despite the extra resources, the accessibility of services for ‘under-served’ ethnic and religious minority groups, is considerably short of the levels of access that may be necessary to offset the health inequalities created by their different exposure to services, resulting in negative health outcomes. This paper offers a critical reflection upon an initiative that sought to improve access to an NHS funded primary care mental health service to one ‘under-served’ population, an Orthodox Jewish community in the North West of England

Processus hydrogéochimiques et origine des sources naturelles dans le degré carré de Daloa (Centre ouest de la Côte d’Ivoire)

L’étude des processus hydrogéochimiques des aquifères du degré carré de Daloa à travers la caractérisation des paramètres physico-chimiques et l’analyse des équilibres eau-minéraux a permis de déterminer l’origine des sources naturelles de cette région. Les eaux sont dans l’ensemble acides et faiblement minéralisées. La signature chimique des eaux de sources marquée par de faibles conductivités se rapproche nettement de celle des eaux de puits qui captent les altérites, et s’éloigne de celle des eaux de forages qui interceptent le socle fissuré. Le calcul des indices de saturation par rapport à la dolomie et la calcite, et l’utilisation du diagramme de korjinski montre que les eaux de source et de puits se caractérisent par une faible minéralisation traduisant un bref temps de séjour, contrairement aux eaux de forages plus minéralisées et donc plus anciennes. Ces caractéristiques hydrogéochimiques suggèrent que les sources naturelles du degré carré de Daloa sont des exutoires de nappes d’altérites.Mots clés : Nappes d’altérites et de fissures, émergence, minéralisation, altération, lessivage

A phase 2a randomized study to evaluate the safety and immunogenicity of the 1790GAHB GMMA vaccine against Shigella sonnei administered intramuscularly to adults from a shigellosis-endemic country

Shigellosis is a mild-to-severe diarrheal infection caused by the genus Shigella and responsible for significant morbidity and mortality worldwide. We evaluated the safety and immunogenicity of an investigational Shigella sonnei vaccine (1790GAHB) based on Generalized Modules for Membrane Antigens (GMMA) in Kenya, a Shigella-endemic country. This phase 2a, observer-blind, controlled study (NCT02676895) enrolled and randomized 74 healthy adults aged 18–45 years, of whom 72 were vaccinated. Participants, randomized with a 1:1:1 ratio, received 2 vaccinations with the 1790GAHB vaccine at doses of either 1.5/25 μg of O antigen/protein (group 1.5/25 μg) or 5.9/100 μg (group 5.9/100 μg) at day [D] 1 and D29, or vaccination with a quadrivalent meningococcal vaccine at D1 and diphtheria, tetanus and acellular pertussis vaccine at D29 (control group). Solicited and unsolicited adverse events (AEs), serious AEs and AEs of special interest (neutropenia and reactive arthritis) were collected. Anti-S. sonnei LPS serum IgG geometric mean concentrations (GMC) were evaluated at D1, D29 and D57 and compared to anti-S. sonnei LPS antibody levels in convalescent patients naturally-exposed to S. sonnei. The percentages of participants with seroresponse were calculated. The most frequently reported solicited local and systemic AEs across all groups were pain and headache, respectively. Only 1 case of severe systemic reaction was reported (severe headache after first vaccination in group 5.9/100 µg). Ten cases of transient and asymptomatic neutropenia, assessed as probably or possibly related to vaccination, were recorded in 6 participants from all 3 groups. No other serious AEs were reported. Despite very high baseline anti-S. sonnei LPS serum IgG levels, the 1790GAHB vaccine induced robust antibody responses. At D29, GMC increased 2.10- and 4.43-fold from baseline in groups 1.5/25 µg and 5.9/100 µg, respectively, whereas no increase was observed in the control group. Antibody titers at D57 were not statistically different from those at D29. Seroresponse was 68% at D29 and 90% at D57 in group 1.5/25 μg, and 96% after each vaccination in group 5.9/100 μg. The 1790GAHB vaccine was well tolerated and, despite very high baseline antibody titers, elicited robust antibody response in a population of African adults, regardless of GMMA conten

A phase 2a randomized study to evaluate the safety and immunogenicity of the 1790GAHB GMMA vaccine against Shigella sonnei administered intramuscularly to adults from a shigellosis-endemic country

Shigellosis is a mild-to-severe diarrheal infection caused by the genus Shigella and responsible for significant morbidity and mortality worldwide. We evaluated the safety and immunogenicity of an investigational Shigella sonnei vaccine (1790GAHB) based on Generalized Modules for Membrane Antigens (GMMA) in Kenya, a Shigella-endemic country. This phase 2a, observer-blind, controlled study (NCT02676895) enrolled and randomized 74 healthy adults aged 18–45 years, of whom 72 were vaccinated. Participants, randomized with a 1:1:1 ratio, received 2 vaccinations with the 1790GAHB vaccine at doses of either 1.5/25 μg of O antigen/protein (group 1.5/25 μg) or 5.9/100 μg (group 5.9/100 μg) at day [D] 1 and D29, or vaccination with a quadrivalent meningococcal vaccine at D1 and diphtheria, tetanus and acellular pertussis vaccine at D29 (control group). Solicited and unsolicited adverse events (AEs), serious AEs and AEs of special interest (neutropenia and reactive arthritis) were collected. Anti-S. sonnei LPS serum IgG geometric mean concentrations (GMC) were evaluated at D1, D29 and D57 and compared to anti-S. sonnei LPS antibody levels in convalescent patients naturally-exposed to S. sonnei. The percentages of participants with seroresponse were calculated. The most frequently reported solicited local and systemic AEs across all groups were pain and headache, respectively. Only 1 case of severe systemic reaction was reported (severe headache after first vaccination in group 5.9/100 µg). Ten cases of transient and asymptomatic neutropenia, assessed as probably or possibly related to vaccination, were recorded in 6 participants from all 3 groups. No other serious AEs were reported. Despite very high baseline anti-S. sonnei LPS serum IgG levels, the 1790GAHB vaccine induced robust antibody responses. At D29, GMC increased 2.10- and 4.43-fold from baseline in groups 1.5/25 µg and 5.9/100 µg, respectively, whereas no increase was observed in the control group. Antibody titers at D57 were not statistically different from those at D29. Seroresponse was 68% at D29 and 90% at D57 in group 1.5/25 μg, and 96% after each vaccination in group 5.9/100 μg. The 1790GAHB vaccine was well tolerated and, despite very high baseline antibody titers, elicited robust antibody response in a population of African adults, regardless of GMMA conten