Comparison of social resistance to Ebola response in Sierra Leone and Guinea suggests explanations lie in political configurations not culture

Sierra Leone and Guinea share broadly similar cultural worlds, straddling the societies of the Upper Guinea Coast with Islamic West Africa. There was, however, a notable difference in their reactions to the Ebola epidemic. As the epidemic spread in Guinea, acts of violent or everyday resistance to outbreak control measures repeatedly followed, undermining public health attempts to contain the crisis. In Sierra Leone, defiant resistance was rarer. Instead of looking to ‘culture’ to explain patterns of social resistance (as was common in the media and in the discourse of responding public health authorities) a comparison between Sierra Leone and Guinea suggests that explanations lie in divergent political practice and lived experiences of the state. In particular, the structures of authority in which the government-sanctioned epidemic response was channeled relate very differently to communities of trust in each country. Predicting and addressing social responses to epidemic control measures should assess such political-trust configurations when planning interventions

Heart failure in COVID-19: the multicentre, multinational PCHF-COVICAV registry.

AIMS: We assessed the outcome of hospitalized coronavirus disease 2019 (COVID-19) patients with heart failure (HF) compared with patients with other cardiovascular disease and/or risk factors (arterial hypertension, diabetes, or dyslipidaemia). We further wanted to determine the incidence of HF events and its consequences in these patient populations. METHODS AND RESULTS: International retrospective Postgraduate Course in Heart Failure registry for patients hospitalized with COVID-19 and CArdioVascular disease and/or risk factors (arterial hypertension, diabetes, or dyslipidaemia) was performed in 28 centres from 15 countries (PCHF-COVICAV). The primary endpoint was in-hospital mortality. Of 1974 patients hospitalized with COVID-19, 1282 had cardiovascular disease and/or risk factors (median age: 72 [interquartile range: 62-81] years, 58% male), with HF being present in 256 [20%] patients. Overall in-hospital mortality was 25% (n = 323/1282 deaths). In-hospital mortality was higher in patients with a history of HF (36%, n = 92) compared with non-HF patients (23%, n = 231, odds ratio [OR] 1.93 [95% confidence interval: 1.44-2.59], P < 0.001). After adjusting, HF remained associated with in-hospital mortality (OR 1.45 [95% confidence interval: 1.01-2.06], P = 0.041). Importantly, 186 of 1282 [15%] patients had an acute HF event during hospitalization (76 [40%] with de novo HF), which was associated with higher in-hospital mortality (89 [48%] vs. 220 [23%]) than in patients without HF event (OR 3.10 [2.24-4.29], P < 0.001). CONCLUSIONS: Hospitalized COVID-19 patients with HF are at increased risk for in-hospital death. In-hospital worsening of HF or acute HF de novo are common and associated with a further increase in in-hospital mortality

The challenge of establishing a professional practice within practical education

Clinical teachers in the discipline of nursing in Denmark undergo additional education in addition to their registered nursing education to establish their teaching skill qualifications practicum. This ethnographic study examines some of the pedagogical initiatives clinical teachers are practicing as working professionals attempting to gain a foothold in their own jurisdiction. This study demonstrates that teaching practices contain implicit norms of what counts as knowledge among clinical teachers. Consequently, the classic knowledge hierarchy is continuously reproduced, and the intrinsic qualities of practice that are characterised as opaque, fluctuating, concrete, and highly personal are overlooked and downplayed in the clinical teacher’s teaching practices. Instead, bringing abstract, academic knowledge into play seems to be a strong marker that emerges when distinguishing the actual practice of nursing from clinical teaching. Organisational imperatives strongly disrupt the pedagogical agenda. When clinical teachers struggle to demarcate jurisdictions, their professional identities are at risk of being blurred and becoming unclear.<br/