risk factors associated with road traffic injuries in Mozambique: results of the 2016 INCOMAS study

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Use of a Community Center Primary Care Clinic and Subsequent Emergency Department Visits among Unhoused Women

Funding/Support: Dr Stewart was supported by grants T32AI007044 and K23MH124466 from the National Institutes of Health (NIH), and Dr Stadeli was supported by training grant T32DK070555 from the NIH. The use of REDCap (Research Electronic Data Capture) software (Vanderbilt University) was supported by grants UL1TR002319, KL2TR002317, and TL1TR002318 from the Institute of Translational Health Science and from the National Center for Advancing Translational Sciences/NIH. The Safe. Healthy. Empowered (SHE) Clinic pilot program was supported by grants from Lahai Health for the period of April 1, 2018 through March 31, 2019, and by the City of Seattle Human Services Department. A mobile van owned and operated by Puget Sound Christian Clinic was used in the study.This cohort study evaluates the association between use of a community center primary care clinic and subsequent nonemergent emergency department (ED) visits by unhoused women who exchange sex and inject drugs.Peer reviewe

Plasma proteomic signatures of enteric permeability among hospitalized and community children in Kenya and Pakistan

We aimed to establish if enteric permeability was associated with similar biological processes in children recovering from hospitalization and relatively healthy children in the community. Extreme gradient boosted models predicting the lactulose-rhamnose ratio (LRR), a biomarker of enteric permeability, using 7,500 plasma proteins and 34 fecal biomarkers of enteric infection among 89 hospitalized and 60 community children aged 2–23 months were built. The R2 values were calculated in test sets. The models performed better among community children (R2: 0.27 [min-max: 0.19, 0.53]) than hospitalized children (R2: 0.07 [min-max: 0.03, 0.11]). In the community, LRR was associated with biomarkers of humoral antimicrobial and cellular lipopolysaccharide responses and inversely associated with anti-inflammatory and innate immunological responses. Among hospitalized children, the selected biomarkers had few shared functions. This suggests enteric permeability among community children was associated with a host response to pathogens, but this association was not observed among hospitalized children

Plasma proteomic signatures associated with enteric permeability among hospitalized and community children under two years of age in Kenya and Pakistan

We aimed to establish if enteric permeability was associated with similar biological processes in children recovering from hospitalization and relatively healthy children in the community. Extreme gradient boosted models predicting the lactulose-rhamnose ratio (LRR), a biomarker of enteric permeability, using 7,500 plasma proteins and 34 fecal biomarkers of enteric infection among 89 hospitalized and 60 community children aged 2–23 months were built. The R2 values were calculated in test sets. The models performed better among community children (R2 : 0.27 [min-max: 0.19, 0.53]) than hospitalized children (R2 : 0.07 [min-max: 0.03, 0.11]). In the community, LRR was associated with biomarkers of humoral antimicrobial and cellular lipopolysaccharide responses and inversely associated with anti-inflammatory and innate immunological responses. Among hospitalized children, the selected biomarkers had few shared functions. This suggests enteric permeability among community children was associated with a host response to pathogens, but this association was not observed among hospitalized children

What Does Soil-Transmitted Helminth Elimination Look Like? Results From a Targeted Molecular Detection Survey in Japan

Background: Japan is one of the few countries believed to have eliminated soil-transmitted helminths (STHs). In 1949, the national prevalence of Ascaris lumbricoides was 62.9%, which decreased to 0.6% in 1973 due to improvements in infrastructure, socioeconomic status, and the implementation of national STH control measures. The Parasitosis Prevention Law ended in 1994 and population-level screening ceased in Japan; therefore, current transmission status of STH in Japan is not well characterized. Sporadic cases of STH infections continue to be reported, raising the possibility of a larger-scale recrudescence of STH infections. Given that traditional microscopic detection methods are not sensitive to low-intensity STH infections, we conducted targeted prevalence surveys using sensitive PCR-based assays to evaluate the current STH-transmission status and to describe epidemiological characteristics of areas of Japan believed to have achieved historical elimination of STHs. Methods: Stool samples were collected from 682 preschool- and school-aged children from six localities of Japan with previously high prevalence of STH. Caregivers of participants completed a questionnaire to ascertain access to water, sanitation and hygiene (WASH), and potential exposures to environmental contamination. For fecal testing, multi-parallel real-time PCR assays were used to detect infections of Ascaris lumbricoides, Necator americanus, Ancylostoma duodenale and Trichuris trichiura. Results: Among the 682 children, no positive samples were identified, and participants reported high standards of WASH. Conclusions: To our knowledge, this is the first STH-surveillance study in Japan to use sensitive molecular techniques for STH detection. The results suggest that recrudescence of STH infections has not occurred, and that declines in prevalence have been sustained in the sampled areas. These findings suggest that reductions in prevalence below the elimination thresholds, suggestive of transmission interruption, are possible. Additionally, this study provides circumstantial evidence that multi-parallel real-time PCR methods are applicable for evaluating elimination status in areas where STH prevalence is extremely low.[Figure not available: see fulltext.

Aðgerðasjúklingar liggja ekki aðgerðalausir II : um hjúkrun sjúklinga á skurðdeildum [rafbók]

Titill á kápu á: Hjúkrun aðgerðasjúklinga IINeðst á síðunni er hægt að nálgast bókina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)- ÚR FORMÁLA - Bók þessi er önnur bóka í röðinni sem ber heitið: Aðgerðarsjúklingar liggja ekki aðgerðalausir og er innihald bókarinnar byggt á verkefnum hjúkrunarfræðinga sem stunduðu nám á meistarastigi í hjúkrun skurðsjúklinga við hjúkrunarfræðideild Háskóla Íslands. Innihald bókarinnar verður hvati til umræðu og til þróunar á hjúkrunarmeðferðum aðgerðasjúklinga. Nokkrir hjúkrunarfræðingar sem starfa á handlækningadeildum Sjúkrahússins á Akureyri eru í hópi þeirra sem eiga verkefni í bókinni, en hjúkrunarfræðideildin hefur undanfarin ár skapað hjúkrunarfræðingum jafnræði óháð búsetu til framhaldsnáms í hjúkrun. Aukin þekking þessara hjúkrunarfræðinga í hjúkrun aðgerðasjúklinga verður ómetanlegur styrkur fyrir hjúkrunina á sjúkrahúsinu og stofnunina í heild sinni. Mikil þrýstingur hefur verið undanfarin ár á almenna hjúkrunarfræðinga og stjórnendur í hjúkrun innan íslenska heilbrigðiskerfisins að þróa meðferðarárangur í hjúkrun, auka afköst um leið og krafan hefur verið um að lækka kostnað. Í dag og næstu ár verður staðan í ríkisfjármálum þannig háttað að kröfur verða gerðar um meiri hagræðingu en með þeim formerkjum að aðgengi íbúa skerðist ekki né innihald þjónustunnar. Mikilvægt er að hjúkrunarfræðingar taki ríkan þátt í þeim breytingum sem verða ákveðnar og hver og einn hjúkrunarfræðingur standi vörð um menntun og störf hjúkrunarfræðinga og það sem hefur áunnist í stöðu og þróun hjúkrunar sem fræðigreinar til heilla fyrir skjólstæðinga okkar.Í þágu sjúklingaFasta fyrir skurðaðgerð : „ekkert eftir miðnætti” er gömul klisjaEr þinn sjúklingur í hættu á vannæringu? Hlutverk hjúkrunarfræðinga í næringarmeðferð eldri sjúklinga sem fara í kransæðahjáveituaðgerðHlutverk næringar í sáragræðsluÁhættumat og varnir gegn myndun þrýstingssáraSárameðferð með sárasuguÁhrif fótanudds á svefn eldri skurðsjúklingaFóta- og handanudd sem viðbótarmeðferð við verkjum eftir hjáveituaðgerð á hjarta (CABG)Verkjameðferð við drentöku úr brjóstholi : bætir staðdeyfing á húð verkjameðferðina?Verkjamat aldraðra eftir skurðaðgerðBráðaverkjameðferð aldraðra á bæklunarskurðdeildVerkjamat hjá börnum eftir skurðaðgerðSamskipti og samvinna hjúkrunarfræðinga og læknaViðbrögð kvenna sem fara í endursköpun á brjóstum eftir brjóstnám vegna krabbameinsÚtskriftaráætlun eftir skurðaðgerð vegna brjóstakrabbameinsÚtskrift sjúklinga eftir mjaðmarbrotSjúklingafræðsla : símaeftirfylgd eftir hjartaskurðaðger

Cost of community-based human papillomavirus self-sampling in Peru : A micro-costing study

Declaration of Interest The authors declare no conflict of interest. Thomas Francis Jr. Fellowship provided funding for data collection. The Hope Project was funded by grants from Grand Challenges Canada (TTS-1812-21131), Uniting for Health Innovation, Global Initiative Against HPV and Cervical Cancer, University of Manitoba, and the John E. Fogarty International Center (5D43TW009375-05). None of the funders had any role in the study design, implementation, the process of data collection, data analysis, interpretation, or writing of the manuscript or the decision to submit it for publication. No authors have been paid to write this article by a pharmaceutical company or other agency. The authors were not precluded from accessing data in the study, and they accept responsibility to submit for publication. Publisher Copyright: © 2021 The Author(s)Background: Cost data of human papillomavirus (HPV) self-sampling programs from low-and-middle-income countries is limited. We estimated the total and unit costs associated with the Hope Project, a community-based HPV self-sampling social entrepreneurship in Peru. Methods: We conducted a micro-costing analysis from the program perspective to determine the unit costs of (1) recruitment/training of community women (Hope Ladies); (2) Hope Ladies distributing HPV self-sampling kits in their communities and the laboratory testing; and (3) Hope Ladies linking screened women with follow-up care. A procedural manual was used to identify the program's activities. A structured questionnaire and in-depth interviews were conducted with administrators to estimate the resource/time associated with activities. We obtained unit costs for each input previously identified from budgets and expenditure reports. Findings: From November 2018 to March 2020, the program recruited and trained 62 Hope Ladies who distributed 4,882 HPV self-sampling kits in their communities. Of the screened women, 586 (12%) tested HPV positive. The annual cost per Hope Lady recruited/trained was $147·51 (2018 USD). The cost per HPV self-sampling kit distributed/tested was$45·39, the cost per woman followed up with results was $55·64, and the cost per HPV-positive woman identified was$378·14. Personnel and laboratory costs represented 56·1% and 24·7% of the total programmatic cost, respectively. Interpretation: Our findings indicate that implementation of a community-based HPV self-sampling has competitive prices, which increases its likelihood to be feasible in Peru. Further economic evaluation is needed to quantify the incremental benefits of HPV self-sampling compared to more established options such as Pap tests. Funding: Thomas Francis Jr. Fellowship provided funding for data collection. The Hope Project was funded by grants from Grand Challenges Canada (TTS-1812-21131), Uniting for Health Innovation, Global Initiative Against HPV and Cervical Cancer, University of Manitoba, and the John E. Fogarty International Center (5D43TW009375-05).Peer reviewe

Enteric permeability, systemic inflammation, and post-discharge growth among a cohort of hospitalized children in Kenya and Pakistan

Objectives: To determine whether gut permeability is associated with post-discharge growth and systemic inflammation among hospitalized children in low- and middle-income countries. Methods: Children aged 2–23 months being discharged from Civil Hospital Karachi (Pakistan) and Migori County Referral Hospital (Kenya) underwent lactulose-rhamnose ratio (LRR) permeability testing and were compared to age-matched children from their home communities. Linear mixed effect models estimated the associations between LRR among discharged children with change in length-for-age (LAZ) and weight-for-age z score (WAZ) at 45, 90, and 180 days after discharge. Linear regression tested if relationships between LRR, systemic inflammation [C-reative protein (CRP), Cluster of Differentiation 14 (CD14), Tumour Necrosis Factor Alpha (TNFα), Interleukin-6 (IL-6)], and enterocyte damage [Intestinal Fatty-Acid Binding protein (I-FABP)] differed between the hospitalized and community groups. Results: One hundred thirty-seven hospitalized and 84 community participants were included. The hospitalized group had higher log-LRR [0.43, 95% confidence interval (CI): 0.15–0.71, P = 0.003] than the community children. Adjustment for weight-for-length z score at discharge attenuated this association (0.31, 95% CI: 0.00–0.62, P = 0.049). LRR was not associated with changes in WAZ or LAZ in the post-discharge period. Associations between LRR and CRP (interaction P = 0.036), TNFα (P = 0.017), CD14 (P = 0.078), and IL-6 (P = 0.243) differed between community and hospitalized groups. LRR was associated with TNFα (P = 0.004) and approached significance with CD14 (P = 0.078) and IL-6 (P = 0.062) in community children, but there was no evidence of these associations among hospitalized children. Conclusions: Although increased enteric permeability is more prevalent among children being discharged from hospital compared to children in the community, it does not appear to be an important determinant of systemic inflammation or post-discharge growth among hospitalized children

Evaluation of Women's Empowerment in a Community-Based Human Papillomavirus Self-Sampling Social Entrepreneurship Program (Hope Project) in Peru : A Mixed-Method Study

Funding Information: This work was supported by the University of Washington: School of Nursing, the United States Agency for International Development (USAID-DIV 7200AA19FA00001), Duke Universities Bass Connections project titled Analysis of Bringing Elements of Referral Services to Community Care, and GMaP Region 5 program of the Fred Hutch/University of Washington Cancer Consortium 3P30CA015704-46S5. Publisher Copyright: Copyright © 2022 Shin, Garcia, Dotson, Valderrama, Chiappe, Ramanujam, Krieger, Ásbjörnsdóttir, Barnabas, Iribarren and Gimbel.Introduction: Understanding community women's relational and financial empowerment in social entrepreneurship could be the key to scaling up community-based human papillomavirus (HPV) self-sampling programs in low- and middle-income countries. The Hope Project, social entrepreneurship in Peru, trains women (Hope Ladies) to promote HPV self-sampling among other women in their communities. This study aims to evaluate the Hope Ladies' relational and financial empowerment after participating in the program. Materials and Methods: We evaluated the Hope Ladies' experiences of empowerment in social entrepreneurship using a parallel convergent mixed methods design. The Hope Ladies participated in semi-structured in-depth interviews (n = 20) and an eight-questions five-point Likert scale survey that evaluated their relational (n = 19)/financial (n = 17) empowerment. The interview and the survey questions were developed using three empowerment frameworks: Kabeer's conceptual framework, International Center for Research on Women's economic empowerment indicators, and the Relational Leadership Theory. Deductive content analysis was used to evaluate the interviews with pre-determined codes and categories of empowerment. Descriptive statistics were used to analyze the survey results. Qualitative and quantitative data were integrated through a cross-case comparison of emergent themes and corresponding survey responses during the results interpretation. Results: All Hope Ladies reported experiencing increased empowerment in social entrepreneurship. Interviews: The women reported challenges and improvement in three categories of empowerment: (1) resources (balancing between household and Hope Lady roles, recognition from the community as a resource, camaraderie with other Hope Ladies); (2) agency (increased knowledge about reproductive health, improved confidence to express themselves, and ability to speak out against male-dominant culture); and (3) achievement (increased economic assets, improved ability to make financial decisions, and widened social network and capital, and technology skills development). Survey: All (100%) agreed/totally agreed an increase in social contacts, increased unaccompanied visits to a healthcare provider (86%), improved confidence in discussing reproductive topics (100%), improved ability to make household decisions about money (57% pre-intervention vs. 92% post-intervention). Conclusions: The Hope Ladies reported improved relational and financial empowerment through participating in community-based social entrepreneurship. Future studies are needed to elucidate the relationship between empowerment and worker retention/performance to inform the scale-up of HPV self-sampling social entrepreneurship programs.Peer reviewe

Sustaining Progress towards NTD Elimination: An Opportunity to Leverage Lymphatic Filariasis Elimination Programs to Interrupt Transmission of Soil-Transmitted Helminths

Copyright © 2016 Means et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The attached file is the published version of the article