Implementing prevention interventions for non-communicable diseases within the Primary Health Care system in the Federal Capital Territory, Nigeria

Background: Nigeria as well as other low and middle-income countries have double burden of communicable diseases and non-communicable diseases (NCD). This study examined the implementation of the NCD component of the National Minimum Health Care Package in Nigeria’s Federal Capital Territory where the prevalence of diabetes and hypertension is increasing.Methods: This descriptive study was organised along two lines of inquiry: document review (guidelines, policies, programme documents and services records in the Federal Capital Territory, Nigeria) and a qualitative study (focus group discussions with community representatives and frontline health workers, interviews with health program managers and non-participant observations of primary care facilities).Results: Existing policies and guidelines for NCD prevention have several implementation shortfalls including insufficient recognition of the burden of disease at primary care level and associated low prioritisation of NCDs; poor resourcing of NCD-related activities and poor operationalisation of relevant guidelines. Other constraints were: inadequate human resources for PHC services in numbers and mix of cadres, deficiencies in knowledge on management of diabetes and hypertension by PHC workers, insufficient job aids in primary care facilities for prevention, management and referral of hypertension and diabetes, weak information systems and referral linkages between primary care and secondary/tertiary care facilities for NCDs.Conclusion: The capacity of the PHC system to implement NCDs interventions is weak, necessitating a need to strengthen coordination, partnership and funding for better response to NCD prevention in primary care. Capacity building specific to NCD prevention should involve tools/technology, skills, infrastructure, manpower, referral linkages and community participation. Keywords: Non-Communicable Diseases; Essential Health Package; Primary Health Care; Federal Capital Territor

Language Policy, Politics and Ideology in Mewat: Comparative Case Studies of Mewati in Two School Types

Recent years have witnessed a growing interest in multilingualism, language maintenance and managing language diversity both inside and outside the educational context. However, much of this work, especially in the educational context, has focused on (minority) languages and relatively little attention has been paid to ‘dialects’. This study explores the status and role of Mewati, a dialect generally subsumed under Hindi (Government of India, 2001) in schools. While Mewati is spoken by most Meos as their first language (Srivastava, 2011, p. 250), there are currently no studies that examine the use and role of Mewati in education in Mewat. This thesis addresses an important gap in understanding what roles are assigned (or not) to local dialects in education. This project was guided by two research questions: What language-in-education policies (LiEPs) were in place in the two types of schools (rural and urban) chosen for this study; and what role did Mewati play in the overall language policy framework in these schools. The goal of this project was to develop an understanding about how teachers comprehended, negotiated and implemented LiEPs within classrooms. It also aimed at uncovering and critically analysing the underlying ideologies, policies and political processes that informed and influenced these LiEPs in the two schools studied and how these policies, affected the position of Mewati in these schools. The schools studied differed across multiple dimensions including medium of instruction, board of affiliation, textbooks and curricula, location, infrastructure and the socio-economic background of the students. However, they were similar in that most students in both schools spoke Mewati as their home language. The case study was based on data collected in interviews, informal conversations, artifacts, documents and field notes. The data was gathered from both Meo and non-Meo teachers, who differed across linguistic, ethnic and religious lines, in order to obtain a richer and holistic perspective on teachers’ views and practices. This project took an interdisciplinary approach and drew insights from sociolinguistics, applied linguistics, education and sociology. The study draws significantly on Spolsky’s (2004) model of language policy which was used both as an analytical framework as well as a tool for organizing data. The study revealed that the LiEP of the rural schools was largely Hindi monolingual and the urban school mostly Hindi-English bilingual. Both types of schools failed to make space for Mewati, the mother tongue of the majority of students. In both school types, Hindi was taught as the first language. The majority of teachers also held negative attitudes towards Mewati. The teachers perceived Mewati as a hindrance for the learning and overall development of students. There was a significant communication gap between teachers and students particularly in the early years of education. There was also a severe shortage of local Meo teachers. Most teachers in both schools were non-Meos who could not speak Mewati. A complex mix of inter-ethnic relations between these groups and the socio-historical and political structures greatly influenced language choice patterns and policy decisions. This study has important implications for the role of mother tongue in education for policymakers, government officials, educationists, and teachers as the findings indicate a need for change in language policy and procedures

Conservation science and discursive violence: a response to two rejoinders

We respond to two rejoinders to our review article “Science for Success,” which proposed fuller contextualization of epistemological approach, researcher position and interests in conservation research. This way readers—including reviewers and journal editors—can better understand and interpret findings. We suggest this contextualization is particularly important when conservation and development professionals undertake research about programs they are involved in, as this can potentially create a conflict of interest. Both rejoinders follow an extended process of complaint about our article that included academic and legal threats, and ad hominem attacks, with little engagement with the points made about researcher positionality. We consider this to be a form of “discursive violence” deployed to silence unfavorable perspectives, confirming our argument that positionality in conservation (research) begs self-reflection and transparent disclosure

Non-radiologist-performed abdominal point-of-care ultrasonography in paediatrics - a scoping review

Background Historically, US in the paediatric setting has mostly been the domain of radiologists. However, in the last decade, there has been an uptake of non-radiologist point-of-care US. Objective To gain an overview of abdominal non-radiologist point-of-care US in paediatrics. Materials and methods We conducted a scoping review regarding the uses of abdominal non-radiologist point-of-care US, quality of examinations and training, patient perspective, financial costs and legal consequences following the use of non-radiologist point-of-care US. We conducted an advanced search of the following databases: Medline, Embase and Web of Science Conference Proceedings. We included published original research studies describing abdominal non-radiologist point-of-care US in children. We limited studies to English-language articles from Western countries. Results We found a total of 5,092 publications and selected 106 publications for inclusion: 39 studies and 51 case reports or case series on the state-of-art of abdominal non-radiologist point-of-care US, 14 on training of non-radiologists, and 1 each on possible harms following non-radiologist point-of-care US and patient satisfaction. According to included studies, non-radiologist point-of-care US is increasingly used, but no standardised training guidelines exist. We found no studies regarding the financial consequences of non-radiologist point-of-care US. Conclusion This scoping review supports the further development of non-radiologist point-of-care US and underlines the need for consensus on who can do which examination after which level of training among US performers. More research is needed on training non-radiologists and on the costs-to-benefits of non-radiologist point-of-care US

Discrepancies Between Perceptions of the Parent-Adolescent Relationship and Early Adolescent Depressive Symptoms:An Illustration of Polynomial Regression Analysis

Adolescence is a critical period for the development of depressive symptoms. Lower quality of the parent-adolescent relationship has been consistently associated with higher adolescent depressive symptoms, but discrepancies in perceptions of parents and adolescents regarding the quality of their relationship may be particularly important to consider. In the present study, we therefore examined how discrepancies in parents' and adolescents' perceptions of the parent-adolescent relationship were associated with early adolescent depressive symptoms, both concurrently and longitudinally over a 1-year period. Our sample consisted of 497 Dutch adolescents (57 % boys, M (age) = 13.03 years), residing in the western and central regions of the Netherlands, and their mothers and fathers, who all completed several questionnaires on two occasions with a 1-year interval. Adolescents reported on depressive symptoms and all informants reported on levels of negative interaction in the parent-adolescent relationship. Results from polynomial regression analyses including interaction terms between informants' perceptions, which have recently been proposed as more valid tests of hypotheses involving informant discrepancies than difference scores, suggested the highest adolescent depressive symptoms when both the mother and the adolescent reported high negative interaction, and when the adolescent reported high but the father reported low negative interaction. This pattern of findings underscores the need for a more sophisticated methodology such as polynomial regression analysis including tests of moderation, rather than the use of difference scores, which can adequately address both congruence and discrepancies in perceptions of adolescents and mothers/fathers of the parent-adolescent relationship in detail. Such an analysis can contribute to a more comprehensive understanding of risk factors for early adolescent depressive symptoms.</p

Alcohol and illicit drug use among young people living with HIV compared to their uninfected peers from the Kenyan coast: prevalence and risk indicators

Background: In sub-Saharan Africa, there is paucity of research on substance use patterns among young people living with HIV (YLWH). To address the gap, we sought to: i) determine the prevalence of substance use, specifically alcohol and illicit drug use, among YLWH compared to their HIV-uninfected peers; ii) investigate the independent association between young people’s HIV infection status and substance use; iii) investigate the risk indicators for substance use among these young people. Methods: Between November 2018 and September 2019, a cross-sectional study was conducted at the Kenyan coast recruiting 819 young people aged 18–24 years (407 HIV-positive). Alcohol and drug use disorders identification tests (AUDIT and DUDIT) were administered via audio computer-assisted self-interview alongside other measures. Logistic regression was used to determine substance use risk indicators. Results: The point prevalence of current substance use was significantly lower among YLWH than HIV-uninfected youths: current alcohol use, 13% vs. 24%, p \u3c 0.01; current illicit drug use, 7% vs. 15%, p \u3c 0.01; current alcohol and illicit drug use comorbidity, 4 vs. 11%, p \u3c 0.01. Past-year prevalence estimates for hazardous substance use were generally low among young people in this setting (\u3c 10%) with no significant group differences observed. Being HIV-positive independently predicted lower odds of current substance use, but not hazardous substance use. There was overlap of some risk indicators for current substance use between young people with and without HIV including male sex, khat use and an experience of multiple negative life events, but risk indicators unique to either group were also identified. Among YLWH, none of the HIV-related factors was significantly associated with current substance use. Conclusions: At the Kenyan coast, substance use is a reality among young people. The frequency of use generally appears to be low among YLWH compared to the HIV-uninfected peers. Substance use prevention initiatives targeting young people, regardless of HIV infection status, are warranted in this setting to avert their potential risk for developing substance use disorders, including dependence. The multifaceted intrapersonal and interpersonal factors that place young people at risk of substance use need to be addressed as part of the substance use awareness and prevention initiatives

Positive Outcomes of a Comprehensive Health Literacy Communication Training for Health Professionals in Three European Countries:A Multi-centre Pre-post Intervention Study

Many professionals have limited knowledge of how to address health literacy; they need a wider range of health literacy competencies to enhance empowerment and person-centred prevention. We evaluated whether: (1) a comprehensive health literacy training increased self-rated competencies of health professionals to address health literacy related problems and support the development of people's autonomy and self-management abilities after training and 6-12 weeks later, (2) professionals were satisfied with the training, (3) outcomes differed for the three participating European countries. Health professionals (N = 106) participated in a multicentre pre-post intervention study in Italy, the Netherlands and Northern Ireland. The 8-hour training-intervention involved health literacy knowledge, the practice of comprehensible communication skills, shared decision-making, and enhancing self-management. Self-rated health literacy competencies and training satisfaction were assessed at baseline, immediately after training and 6-12 weeks later, and analysed by multi-level analysis. Professionals' self-rated health literacy competencies significantly improved following training in all three countries; this increase persisted at 6-12 weeks follow-up. The strongest increase regarded professional's skills to enhance shared-decision making and enabling self-management after training and follow-up respectively. Professionals perceived the training as relevant for practice. Competency increases seemed to be consistent across countries. In three countries, professionals' self-rated health literacy competencies increased following this comprehensive training. These promising findings should be confirmed in a further full effect study. Implementation of this training in European education and health care may improve person-centred communication by professionals and might help to tackle health literacy related problems and to strengthen people's abilities in achieving better health outcomes

Effectiveness of a Comprehensive Health Literacy Consultation Skills Training for Undergraduate Medical Students:A Randomized Controlled Trial

Comprehensible communication by itself is not sufficient to overcome health literacy related problems. Future doctors need a larger scope of capacities in order to strengthen a patient's autonomy, participation, and self-management abilities. To date, such comprehensive training-interventions are rarely embedded in curricula, nor systematically evaluated. We assessed whether comprehensive training increased these health literacy competencies, in a randomized controlled trial (RCT), with a waiting list condition. Participants were international undergraduate medical students of a Dutch medical faculty (intervention: 39; control: 40). The 11-h-training-intervention encompassed a health literacy lecture and five interactive small-group sessions to practise gathering information and providing comprehensible information, shared decision-making, and enabling of self-management using role-play and videotaped conversations. We assessed self-reported competencies (knowledge and awareness of health literacy, attitude, self-efficacy, and ability to use patient-centred communication techniques) at baseline, after a five and ten-week follow-up. We compared students' competencies using multi-level analysis, adjusted for baseline. As validation, we evaluated demonstrated skills in videotaped consultations for a subsample. The group of students who received the training intervention reported significantly greater health literacy competencies, which persisted up to five weeks afterwards. Increase was greatest for providing comprehensible information (B: 1.50; 95% confidence interval, CI 1.15 to 1.84), shared decision-making (B: 1.08; 95% CI 0.60 to 1.55), and self-management (B: 1.21; 95% CI 0.61 to 1.80). Effects regarding demonstrated skills confirmed self-rated competency improvement. This training enhanced a larger scope of health literacy competences and was well received by medical students. Implementation and further evaluation of this training in education and clinical practice can support sustainable health literacy capacity building of future doctors and contribute to better patient empowerment and outcomes of consultations

Development of parent- and teacher-reported emotional and behavioural problems in young people with intellectual disabilities: Does level of ID matter?

This study described similarities and differences in the 5-year stability and change of problem behaviour between youths attending schools for children with mild to borderline (MiID) versus moderate intellectual disabilities (MoID). A two-wave multiple-birth-cohort sample of 6 to 18-year-old was assessed twice across a 5-year interval using the Developmental Behaviour Checklist Primary Carer version (n = 718) and Teacher version (n = 313). For most types of problem behaviour youths with MiID and MoID showed similar levels of stability of individual differences, persistence and onset of psychopathology. Whenever differences were found, youths with MoID showed the highest level of stability, persistence and onset across informants. Mean levels of parent-reported, but not teacher-reported, problem behaviour, regardless of level of intellectual disability, decreased during the 5-year follow-up period. Youths with MoID and MiID are at risk for persistent psychopathology to a similar degree. Different informants showed to have a different evaluation of the level and the amount of change of problem behaviour, and should be considered complementary in the diagnostic process. © 2007 BILD Publications

Variants in MARC1 and HSD17B13 reduce severity of NAFLD in children, perturb phospholipid metabolism, and suppress fibrotic pathways

Background & aims: Genome-wide association studies in adults have identified variants in HSD17B13 and MARC1 as protective against NAFLD. It is not known if they are similarly protective in children and, more generally, whether the peri-portal inflammation of pediatric NAFLD and lobular inflammation seen in adults share common genetic influences. Therefore, we aimed to: establish if these variants are associated with NAFLD in children, and to investigate the function of these variants in hepatic metabolism using metabolomics. Methods: 960 children (590 with NAFLD, 394 with liver histology) were genotyped for rs72613567T>TA in HSD17B13, rs2642438G>A in MARC1. Genotype-histology associations were tested using ordinal regression. Untargeted hepatic proteomics and plasma lipidomics were performed in a subset of samples. In silico tools were used to model the effect of rs2642438G>A (p.Ala165Thr) on MARC1. Results: rs72613567T>TA in HSD17B13 was associated with lower odds of NAFLD diagnosis (OR 0.7 (95%CI 0.6-0.9) and lower grade of portal inflammation (PA in MARC1 was associated with lower grade of hepatic steatosis (P=0.02). Proteomics found reduced expression of HSD17B13 in carriers of the protective allele, whereas MARC1 levels were not affected by genotype. Both variants showed downregulation of hepatic fibrotic pathways, upregulation of retinol metabolism and perturbation of phospholipid species. Modelling suggests that p.Ala165Thr would disrupt the stability and metal-binding of MARC1. Conclusions: There are shared genetic mechanisms between pediatric and adult NAFLD, despite their differences in histology. MARC1 and HSD17B13 are involved in phospholipid metabolism and suppress fibrosis in NAFLD