New Zealand regions, 1986 – 2001: Hospitalisation and some related health facts

Once age and gender composition is controlled for, regional health differentials are a function of problems of health service delivery, of socio-economic variance, and overall Māori Pakeha health differences. They indicate relative levels of exclusion and of inequality. This paper shows that these differentials follow in general the patterns seen in other papers in this series

Value and effectiveness of National Immunization Technical Advisory Groups in low- and middle-income countries : A qualitative study of global and national perspectives

© The Author(s) 2019. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.The Global Vaccine Action Plan proposes that every country establish or have access to a National Immunization Technical Advisory Group (NITAG) by 2020. The NITAG role is to produce evidence-informed recommendations that incorporate local context, to guide national immunization policies and practice. This study aimed to explore the value and effectiveness of NITAGs in low- and middle-income countries (LMICs), identifying areas in which NITAGs may require further support to improve their functionality and potential barriers to global investment. A multi-methods study design was used, comprising 134 semi-structured interviews and 82 literature review sources that included 38 countries. Interviews were conducted with 53 global/regional and 81 country-level participants able to provide insight into NITAG effectiveness, including NITAG members, national immunization programme staff, and global agency representatives (e.g. the World Health Organisation, the Bill and Melinda Gates Foundation, Gavi the Vaccine Alliance). The review, including published and unpublished sources on NITAGs in LMICs, was conducted to supplement and corroborate interview findings. Data were analysed thematically. NITAGs were described as valuable in promoting evidence-informed vaccination decision-making, with NITAG involvement enhancing national immunization programme strength and sustainability. Challenges to NITAG effectiveness included: (1) unreliable funding; (2) insufficient diversity of member expertise; (3) inadequate conflicts of interest management procedures; (4) insufficient capacity to access and use evidence; (5) lack of transparency; and (6) limited integration with national decision-making processes that reduced the recognition and incorporation of NITAG recommendations. LMIC NITAGs have developed significantly in the past decade. Well-functioning NITAGs were trusted national resources that enhanced country ownership of immunization provision. However, many LMIC NITAGs require additional technical and funding support to strengthen quality and effectiveness, while maintaining impartiality and ensuring sufficient integration with national decision-making processes. Barriers to sustainable global support need to be addressed for LMIC NITAGs to both continue and develop further.Peer reviewedFinal Published versio

Implementing General Education: Initial Findings

The article reports on the first year activities of the Project on the Implementation of General Education. The project, conducted by the New England Resource Center for Higher Education (NERCHE), is funded by the Exxon Education Foundation. The focus of the research is to examine how general education curricula is actually developed and implemented on college campuses that have limited resources

X-linked Hyper IgM (HIGM1) in an African kindred: the first report from South Africa

BACKGROUND:The objective of this study was to describe the clinical and molecular features of the first South African family with X-linked hyper-IgM syndrome (HIGM1). METHODS: Diagnoses were based on immunoglobulin results and the absence of CD40 ligand (CD40L) expression on activated T-cells. Complete molecular characterisation involved CD40L cDNA sequencing, and genomic DNA analysis by polymerase chain reaction amplification, restriction enzyme digestion and sequencing. A PCR-based diagnostic assay was established for carrier detection and prenatal diagnosis in this family. RESULTS: There were originally six children, three males and three females. The eldest boy died after being diagnosed with hypogammaglobulinaemia, before HIGM1 was considered. This disorder was diagnosed in the second eldest boy at the age of 5 years, after failing to detect CD40L expression on his activated T-cells. A deficiency of CD40L was also confirmed in the youngest male at the age of 5 years. Both younger brothers have since died of infections relating to HIGM1. Molecular investigation showed that exon 3 was deleted from the CD40L mRNA of the affected males. Genomic DNA analysis identified a 1.5 kilobase deletion, spanning exon 3 and including extended flanking intronic sequence. Carrier status in the mother was confirmed by RT-PCR of her CD40L mRNA. Genetic analysis of the three female children was deferred because they were below the legal consenting age of 18 years. A PCR-based assay for genomic DNA was established for easy identification of female carriers and affected males in the future. CONCLUSIONS: This study confirmed the diagnosis of HIGM1 in the first South African family to be investigated and identified a novel mutation in the CD40L gene

The role of National Immunisation Technical Advisory Groups (NITAGs) in strengthening national vaccine decision-making: A comparative case study of Armenia, Ghana, Indonesia, Nigeria, Senegal and Uganda.

INTRODUCTION: Improving evidence informed decision-making in immunisation is a global health priority and many low and middle-income countries have established National Immunisation Technical Advisory Groups (NITAGs) as independent technical advisory bodies for this purpose. NITAG development and strengthening has received financial and technical support over the past decade, but relatively little evaluation. This study examined NITAGs in six low and middle-income countries (i.e. Armenia, Ghana, Indonesia, Nigeria, Senegal, Uganda), to examine functionality, quality of recommendation development, and integration with national decision-making bodies and processes. METHODS: A mixed-method case-series design, used semi-structured interviews, NITAG meeting observations, and document review. Data were analysed thematically. RESULTS: Five NITAGs had been legally established with terms of reference and appeared well functioning, with Ghana's in development. All NITAGs had standard operating procedures and nomination procedures to ensure a range of expertise, generally comprising 10-15 core, 1-5 secretariat, and several ex-officio members. Aside from economics, NITAGs reported a wide range of member expertise. Newer NITAGs had particular concerns about funding. Four used formal conflict of interest procedures, although some commented that implications were not always understood. NITAGs valued local data, and limited evidence suggested NITAG presence might reinforce data production through surveillance and local research studies. All observed meetings demonstrated due process and evidence-based decision-making processes were generally followed, with a critical role played by working-group data syntheses and assessments. NITAGs were seen as well integrated with ministry of health (MoH) decision-making and MoH interviewees were positive about NITAG contributions, indicating NITAGs had an important role. Collaboration with other bodies was more limited, but mitigated by NITAG members' cross-membership in other bodies. CONCLUSIONS: NITAGs have an important and valued role within national immunisation decision-making. However, their position remains insecure, with the need for sustainable technical and financial support

L-2 hydroxyglutaric aciduria in a South African Staffordshire Bull Terrier

L-2 hydroxyglutaric aciduria is an autosomal recessive error of metabolism that manifests as an encephalopathy. The most common presenting signs are seizures, tremors, ataxia and/ or dementia. Some affected dogs show only subtle behavioural changes. Amongst canines, the condition has been best described in Staffordshire Bull Terriers. Although this is the first reported case in South Africa, at least three other affected dogs have been indentified by polmerase chain reaction (PCR) in this country. Affected dogs have normal haematology, serum biochemistry and routine urine analysis. This report discusses the advantages and limitations of the three main diagnostic modalities, namely: magnetic resonance imaging, urine gas chromatography-mass spectrometry and genetic testing. The aim of this report is to increase awareness of the condition, assist diagnosis in encephalopathic dogs and improve detection of carriers amongst breeding stock

Does ethnicity, gender or age of physiotherapy students affect performance in the final clinical placements? An exploratory study

This is the post-print version of the final paper published in Physiotherapy. The published article is available from the link below. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. Copyright @ 2013 Elsevier B.V.Objectives - To explore demographic differences in awarded marks of the final clinical placement in a physiotherapy undergraduate programme. Design - Retrospective analysis of clinical placement assessment marks. Setting - A London university offering clinical placements throughout South East England. Participants - 333 physiotherapy students entering physiotherapy training between 2005 to 2009. Main outcome measures Marks awarded following assessment using a clinical placement assessment form. Results - The mean mark (SD) for age were standard entry 71 (7.4) vs. mature entry 72 (7.99) (ns); for gender male 72 (8.45) vs. female 71 (7.21) (ns); and ethnicity White British 72 (7.71) vs. ethnic minority 70 (7.01) (p = 0.023). No interaction effects were observed between the independent variables and only ethnicity demonstrated a statistically significant effect (mean difference (MD) 2.4% 95%CI 0.5 to 4.3, F = 5.24, p = 0.023). This difference was maintained in most subcategories. Significant differences were observed for the interpersonal section (MD 2.21% 95%CI 0.14 to 4.28, F = 4.409, p = 0.03), the clinical reasoning section (MD 2.39% 95%CI 0.53 to 4.25, F = 6.37, p = 0.012) and the treatment section (MD 2.93 95%CI 1.10 to 4.83, F = 9.198, p = 0.003). Conclusions - Physiotherapy students from minority ethnic backgrounds were awarded a significantly lower mark than their white majority peers in final clinical placements, although the difference was small. Potential reasons are considered, with the strongest recommendation being for further enquiry into the potential relationship between ethnicity and success in undergraduate physiotherapy education