Understanding healthcare provider absenteeism in Kenya: a qualitative analysis

Background: Healthcare worker absenteeism is common in resource limited settings and contributes to poor quality of care in maternal and child health service delivery. There is a dearth of qualitative information on the scope, contributing factors, and impact of absenteeism in Kenyan healthcare facilities. Methods: In-depth semi-structured interviews were conducted between July 2015 and June 2016 with 20 healthcare providers in public and private healthcare facilities in Central and Western Kenya. Interviews were audiorecorded, transcribed, coded, and analyzed using an iterative thematic approach. Results: Half of providers reported that absenteeism occurs in both private and public health facilities. Absenteeism was most commonly characterized by providers arriving late or leaving early during scheduled work hours. The practice was attributed to institutional issues including: infrequent supervision, lack of professional consequences, limited accountability, and low wages. In some cases, healthcare workers were frequently absent because they held multiple positions at different health facilities. Provider absences result in increased patient wait times and may deter patients from seeking healthcare in the future. Conclusion: There is a significant need for policies and programs to reduce provider absenteeism in Kenya. Intervention approaches must be cognizant of the contributors to absenteeism which occur at the institutional level

Phosphorylation of Voltage-Dependent Anion Channel by Serine/Threonine Kinases Governs Its Interaction with Tubulin

Tubulin was recently found to be a uniquely potent regulator of the voltage-dependent anion channel (VDAC), the most abundant channel of the mitochondrial outer membrane, which constitutes a major pathway for ATP/ADP and other metabolites across this membrane. Dimeric tubulin induces reversible blockage of VDAC reconstituted into a planar lipid membrane and dramatically reduces respiration of isolated mitochondria. Here we show that VDAC phosphorylation is an important determinant of its interaction with dimeric tubulin. We demonstrate that in vitro phosphorylation of VDAC by either glycogen synthase kinase-3β (GSK3β) or cAMP-dependent protein kinase A (PKA), increases the on-rate of tubulin binding to the reconstituted channel by orders of magnitude, but only for tubulin at the cis side of the membrane. This and the fact the basic properties of VDAC, such as single-channel conductance and selectivity, remained unaltered by phosphorylation allowed us to suggest the phosphorylation regions positioned on the cytosolic loops of VDAC and establish channel orientation in our reconstitution experiments. Experiments on human hepatoma cells HepG2 support our conjecture that VDAC permeability for the mitochondrial respiratory substrates is regulated by dimeric tubulin and channel phosphorylation. Treatment of HepG2 cells with colchicine prevents microtubule polymerization, thus increasing dimeric tubulin availability in the cytosol. Accordingly, this leads to a decrease of mitochondrial potential measured by assessing mitochondrial tetramethylrhodamine methyester uptake with confocal microscopy. Inhibition of PKA activity blocks and reverses mitochondrial depolarization induced by colchicine. Our findings suggest a novel functional link between serine/threonine kinase signaling pathways, mitochondrial respiration, and the highly dynamic microtubule network which is characteristic of cancerogenesis and cell proliferation

COVID-19 cases and testing in 53 prison systems

Background: COVID-19 has entered United States prison systems at alarming rates. Disparities in social and structural determinants of health disproportionately affect those experiencing incarceration, making them more vulnerable to COVID-19. Additionally, prisons are sites of congregate living, making it impossible to practice social distancing, and most prisons have relied only on incremental measures to reduce risk and spread of COVID-19. To more fully understand the impact that COVID-19 is having on incarcerated populations, it is critical to have systematic data on testing, test positivity, cases, and case fatality. Using data from the COVID Prison Project, we present data on 53 prison systems COVID-19 testing, test positivity, case, and case fatality by state and compare these data with each state’s general population. We do this for the early stages of the pandemic, utilizing data through July 15, 2020. Results: Many states are not reporting full information on COVID testing with some also not reporting on case fatality. Among those reporting data, there is a wide variation between testing, test positivity, and case rates within prison systems and as compared to the general population. However, when more tests are deployed more cases are identified with the majority of state prisons having higher case rates than their general population. Conclusions: These findings underscore the need for the implementation and study of COVID-19 mitigation and surveillance strategies to flatten the COVID-19 curve in prisons across the country. We call for future research to build on these data from the COVID Prison Project to protect the health of our nations’ often forgotten residents

A Call to Action to Public Health Institutions and Teaching to Incorporate Mass Incarceration as a Sociostructural Determinant of Health

Mass incarceration refers to the system of social and racial control in the United States that arrests, convicts, incarcerates, and supervises racial and ethnic minority populations through probation and parole. Mass incarceration is referred to as “mass” because the current size of this system in the United States is historically and internationally unparalleled. Mass incarceration affects those who are incarcerated and under community supervision, as well as the families and communities where it is concentrated. Mass incarceration is a pervasive cause of health inequities in the United States

The association between intersystem prison transfers and COVID-19 incidence in a state prison system

Prisons are the epicenter of the COVID-19 pandemic. Media reports have focused on whether transfers of incarcerated people between prisons have been the source of outbreaks. Our objective was to examine the relationship between intersystem prison transfers and COVID-19 incidence in a state prison system. We assessed the change in the means of the time-series of prison transfers and their cross-correlation with the time-series of COVID-19 tests and cases. Regression with automatic detection of multiple change-points was used to identify important changes to transfers. There were over 20,000 transfers between the state’s prisons from January through October 2020. Most who were transferred (82%), experienced a single transfer. Transfers between prisons are positively related to future COVID-19 case rates but transfers are not reactive to current case rates. To mitigate the spread of COVID-19 in carceral settings, it is crucial for transfers of individuals between facilities to be limited

Minocycline Decreases Liver Injury after Hemorrhagic Shock and Resuscitation in Mice

Patients that survive hemorrhage and resuscitation (H/R) may develop a systemic inflammatory response syndrome (SIRS) that leads to dysfunction of vital organs (multiple organ dysfunction syndrome, MODS). SIRS and MODS may involve mitochondrial dysfunction. Under pentobarbital anesthesia, C57BL6 mice were hemorrhaged to 30 mm Hg for 3 h and then resuscitated with shed blood plus half the volume of lactated Ringer's solution containing minocycline, tetracycline (both 10 mg/kg body weight) or vehicle. Serum alanine aminotransferase (ALT), necrosis, apoptosis and oxidative stress were assessed 6 h after resuscitation. Mitochondrial polarization was assessed by intravital microscopy. After H/R with vehicle or tetracycline, ALT increased to 4538 U/L and 3999 U/L, respectively, which minocycline decreased to 1763 U/L (P < 0.01). Necrosis and TUNEL also decreased from 24.5% and 17.7 cells/field, respectively, after vehicle to 8.3% and 8.7 cells/field after minocycline. Tetracycline failed to decrease necrosis (23.3%) but decreased apoptosis to 9 cells/field (P < 0.05). Minocycline and tetracycline also decreased caspase-3 activity in liver homogenates. Minocycline but not tetracycline decreased lipid peroxidation after resuscitation by 70% (P < 0.05). Intravital microscopy showed that minocycline preserved mitochondrial polarization after H/R (P < 0.05). In conclusion, minocycline decreases liver injury and oxidative stress after H/R by preventing mitochondrial dysfunction

COVID-19 in corrections: Quarantine of incarcerated people

Carceral settings in the United States have been the source of many single site COVID-19 outbreaks. Quarantine is a strategy used to mitigate the spread of COVID-19 in correctional settings, and specific quarantine practices differ state to state. To better understand how states are using quarantine in prisons, we reviewed each state’s definition of quarantine and compared each state’s definition to the Centers for Disease Control’s (CDC) definition and recommendations for quarantine in jails and prisons. Most prison systems, 45 of 53, define quarantine, but definitions vary widely. No state published definitions of quarantine that align with all CDC recommendations, and only 9 states provide quarantine data. In these states, the highest recorded quarantine rate occurred in Ohio in May 2020 at 843 per 1,000. It is necessary for prison systems to standardize their definitions of quarantine and to utilize quarantine practices in accordance with CDC recommendations. In addition, data transparency is needed to better understand the use of quarantine and its effectiveness at mitigating COVID-19 outbreaks in carceral settings

Mass probation: Temporal and geographic correlation of county-level probation rates & mental health in North Carolina

High community incarceration rates are associated with worse community mental health. However, it remains unknown whether higher rates of probation, a form of criminal legal community supervision, are similarly associated with worse community mental health. Our objective was to evaluate temporal and geographic correlations of county-level probation and mental health rates separately and to assess the association between county-level probation and mental health rates, measured by self-inflicted injury and suicide. We performed ecological analyses using North Carolina administrative data (2009–2019) and used repeated cross-section, multivariable spatial error models. From 2009 to 2019, probation rates trended downward while self-inflicted injury and suicide remained stable. We found positive spatial autocorrelation suggesting that there are spatial determinants of probation and self-harm, though less so for suicide. Hot spot analyses showed local variation with high self-harm and suicide rates being clustered in rural Western North Carolina and high probation rates being clustered in rural Eastern North Carolina. Probation was positively associated with self-inflicted injury and suicide. For example, in 2018, a 1 percentage point increase in probation was associated with a 0.05 percentage point increase in self-harm in 2019 (95% CI: 0.03, 0.06), meaning that in a county of 100,000 people, an increase in 1000 county residents being on probation would be associated with an increase in 50 self-harm injuries. High county-level probation rates may exert collateral damage on the mental health of those living in areas with much of the population under state control. These findings emphasize that the criminal legal system is not separate from communities and that future public health research and advocacy must consider these collateral consequences of probation on communities