Contextually appropriate communication strategies for COVID-19 prevention in Kenya border regions: evidence from a mixed methods observational study in Busia and Mandera counties

Kenya has long and porous borders with its neighbouring countries. These regions, predominantly inhabited by highly mobile rural communities with strong cross-border cultural ties, present major challenges in managing movement of people and COVID-19 preventive measures. Our study sought to assess knowledge of COVID-19 prevention behaviours, how these varied by socioeconomic (SEC) factors and the challenges of engagement and implementation, in two border counties of Kenya. We conducted a mixed methods study using a household e-survey (Busia, N=294; Mandera, N=288; 57% females, 43% males), and qualitative telephone interviews (N=73: Busia 55; Mandera 18) with policy actors, healthcare workers, truckers and traders, and community members. Interviews were transcribed, English translated and analysed using the framework method. Associations between SEC (wealth quintiles, educational level) and knowledge of COVID-19 preventive behaviours were explored using Poisson regression. Participants were mostly educated to primary school level (54.4% Busia, 61.6% Mandera). Knowledge of COVID-19 prevention varied by behaviour: hand washing-86.5%, use of hand sanitiser-74.8%, wearing a face mask-63.1%, covering the mouth when sneezing or coughing-56.3% and social distancing-40.1%. Differences in knowledge by area, educational level and the wealth index were marked, greatest for Mandera, the less educated and the poor. Interviews with stakeholders revealed challenges in health messaging, psychosocial and socioeconomic factors, lack of preparedness for truck border crossings, language barrier, denial and livelihood insecurity as key challenges to engagement with and implementation of COVID-19 prevention behaviours in the border regions. The influence of SEC disparities and border dynamics on knowledge and engagement with COVID-19 prevention behaviours calls for contextually appropriate risk communication strategies that are cognisant of community needs and local patterns of information flow. Coordinating response measures across border points is crucial in winning communities' trust and maintaining essential economic and social activities. [Abstract copyright: © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.

Decreased microvascular funtional vasodilatory reserve and features of the metabolic syndrome

We have investigated insulin-induced changes in microvascular conductance in individuals with features of the metabolic syndrome using laser Doppler fluximetry (LDF) and a novel 785 nm, 20 mW, 4 mm separation probe (Moor Instruments Ltd, UK). 33 volunteers [52±9 y (mean ±SD); 15 men)] were studied. All gave written informed consent. LDF was measured above the anterior tibialis muscle of the non-dominant lower limb and insulin sensitivity by hyperinsulinaemic euglycaemic clamp. Measurements were made at rest and during reactive hyperaemia (RH) to arterial occlusion, before and during the clamp. Vascular conductance (VC) calculated as LDF/MABP (arbitrary units), at baseline and during RH, decreased with >3 features of the metabolic syndrome (p=0.01) and calculated overall CVD risk (p=0.01). VC at was significantly increased by insulin at baseline (0.8±0.4 vs 1.1±0.6, p=0.001) but reduced during peak RH (before insulin: 413±32 vs high dose insulin: 363±35 %baseline, p=0.01). The impaired RH response (peak VC and rate of recovery from peak) was associated with plasma total cholesterol (r2=0.51, p=0.01) and LDL cholesterol concentrations (r2=0.49, p=0.05). We conclude that individuals with features of the metabolic syndrome show a reduced functional vasodilatory reserve and that this impaired response contributes to a reduced insulin sensitivity and glucose handling by muscle

State of the evidence: a survey of global disparities in clinical trials

Introduction Ideally, health conditions causing the greatest global disease burden should attract increased research attention. We conducted a comprehensive global study investigating the number of randomised controlled trials (RCTs) published on different health conditions, and how this compares with the global disease burden that they impose.Methods We use machine learning to monitor PubMed daily, and find and analyse RCT reports. We assessed RCTs investigating the leading causes of morbidity and mortality from the Global Burden of Disease study. Using regression models, we compared numbers of actual RCTs in different health conditions to numbers predicted from their global disease burden (disability-adjusted life years (DALYs)). We investigated whether RCT numbers differed for conditions disproportionately affecting countries with lower socioeconomic development.Results We estimate 463 000 articles describing RCTs (95% prediction interval 439 000 to 485 000) were published from 1990 to July 2020. RCTs recruited a median of 72 participants (IQR 32–195). 82% of RCTs were conducted by researchers in the top fifth of countries by socio-economic development. As DALYs increased for a particular health condition by 10%, the number of RCTs in the same year increased by 5% (3.2%–6.9%), but the association was weak (adjusted R2=0.13). Conditions disproportionately affecting countries with lower socioeconomic development, including respiratory infections and tuberculosis (7000 RCTs below predicted) and enteric infections (9700 RCTs below predicted), appear relatively under-researched for their disease burden. Each 10% shift in DALYs towards countries with low and middle socioeconomic development was associated with a 4% reduction in RCTs (3.7%–4.9%). These disparities have not changed substantially over time.Conclusion Research priorities are not well optimised to reduce the global burden of disease. Most RCTs are produced by highly developed countries, and the health needs of these countries have been, on average, favoured

Sickle cell anemia: iron availability and nocturnal oximetry.

STUDY OBJECTIVE: To test the hypothesis that low iron availability, measured as transferrin saturation, is associated with low nocturnal hemoglobin oxygen saturation (SpO(2)) in children with homozygous sickle cell anemia (SCA; hemoglobin SS). METHODS: This was a cross-sectional study of Tanzanian children with SCA who were not receiving regular blood transfusions. Thirty-two children (16 boys) with SCA (mean age 8.0, range 3.6-15.3 years) underwent motion-resistant nocturnal oximetry (Masimo Radical) and had steady state serum transferrin saturation and hematological indices assessed. RESULTS: Higher transferrin saturation, adjusted for age and α-thalassemia deletion, was associated with lower nocturnal mean SpO(2) (p = 0.013, r(2) = 0.41), number of SpO(2) dips/h > 3% from baseline (p = 0.008, r(2) = 0.19) and with min/h with SpO(2) < 90% (p = 0.026 r(2) = 0.16). Transferrin saturation < 16% (indicative of iron deficiency) was associated with a 2.2% higher nocturnal mean SpO(2). CONCLUSIONS: Contrary to our hypothesis, higher iron availability, assessed by transferrin saturation, is associated with nocturnal chronic and intermittent hemoglobin oxygen desaturation in SCA. Whether these associations are causal and are driven by hypoxia-inducible factor and hepcidin-mediated upregulation of demand for iron warrants further investigation

Development of the use of the decimal classification in the Czech ambient

Cílem bakalářské práce je shrnutí vývoje a využití desetitmého třídění v českých knihovnách a jiných informačních institucích. V práci jsou nejprve popsány hlavní rozdíly mezi nejvýznamnějšími pořádacími systematyckými jazyky: Deweyho desetinném třídění, Mezinárodním desetinném tříděním a Tříděním Kongresové knihovny. Hlavní důraz je kladen na podání jejich charakteristiky a popsání jejich struktury. Pozornost je zejména věnována prvním pokusům o zavedení desetinného třídění v českém prostředí -je zde uveden výčet nejvýznamnějších osobnosti, které se u nás ponejvíce zasloužily o propagaci a rozšiřování věcného pořádání informací. V navazujících částech jsou popsány snahy o všeobecné zavedení tabulek a pokusy o jejich příslušná vydání. Na něž navazuje modifikace desetinného třídění L. N. Tropovského a následující vydání Tabulek desetinného třídění ÚTEINu a dále tvorba oborových a odvětvových výtahů. Poslední část je věnována pokusům o vydání úplných československých tabulek. V závěru je shrnut celkový přínos desetinného třídění pro české země.Ústav informačních studií a knihovnictvíInstitute of Information Studies and LibrarianshipFaculty of ArtsFilozofická fakult