Global public health training in the UK: preparing for the future.

BACKGROUND: Many major public health issues today are not confined by national boundaries. However, the global public health workforce appears unprepared to confront the challenges posed by globalization. We therefore sought to investigate whether the current UK public health training programme adequately prepares its graduates to operate in a globalized world. METHODS: We used mixed methods involving an online cross-sectional survey of UK public health trainees on the international content of the Faculty of Public Health's written examination, a qualitative review of the Faculty's 2007 training curriculum and a questionnaire survey of all training deaneries in the UK. RESULTS: We found that global health issues are not addressed by the current training curriculum or in the written examination despite trainee interest for this. Many of the deaneries were also unreceptive to international placements. CONCLUSIONS: Despite the recognized educational legitimacy of global health placements and the favourable UK policy context, the opportunities and international content of public health training remain limited. In order to retain its position as a leader in the field of public health, the UK needs to adapt its training programme to better reflect today's challenges

Evaluation of HIV counseling and testing in ANC settings and adherence to short course antiretroviral prophylaxis for PMTCT in Francistown, Botswana

Worldwide, it is estimated that two million children are infected with HIV (USAID 2005). The vast majority of these infections are the result of mother-to-child transmission (MTCT) of the virus during pregnancy, labor, or breastfeeding. However, there are effective methods for prevention of mother-to-child transmission (PMTCT). Botswana is one of the first countries in the developing world with a national PMTCT program that uses an efficacious and complex regimen to reduce vertical transmission. At the time of this evaluation (August - December 2005), the standard of care for prevention of MTCT of HIV in Botswana included three-drug antiretroviral therapy for HIV-infected women with a CD4 count of 200 (300 mg AZT in the morning and 300 mg AZT in the evening); four weeks of AZT for their infants; single-dose maternal and infant nevirapine (NVP); and 12 months of free infant formula. Botswana's PMTCT program also provided routine HIV testing for all pregnant women during antenatal care (ANC) to identify HIV-positive women for prophylaxis or treatment. While programs often report the number of individuals beginning AZT and receiving nevirapine for PMTCT, effectiveness is dependent on the level of adherence of individuals to these regimens. To describe adherence of pregnant women to the current PMTCT regimen, the Horizons Program of the Population Council, in collaboration with the Centers for Disease Control and Prevention (CDC) and Premiere Personnel in Botswana, conducted an evaluation to describe HIV-related services provided to women during their pregnancies, document the content of post-test counseling sessions for HIV-positive pregnant women, whether HIV-positive women remembered what had been discussed, the extent of AZT adherence based on self-reports, and the operational successes and barriers to adherence to AZT for PMTCT

Biochemical Properties of a Decoy Oligodeoxynucleotide Inhibitor of STAT3 Transcription Factor.

Cyclic STAT3 decoy (CS3D) is a second-generation, double-stranded oligodeoxynucleotide (ODN) that mimics a genomic response element for signal transducer and activator of transcription 3 (STAT3), an oncogenic transcription factor. CS3D competitively inhibits STAT3 binding to target gene promoters, resulting in decreased expression of proteins that promote cellular proliferation and survival. Previous studies have demonstrated antitumor activity of CS3D in preclinical models of solid tumors. However, prior to entering human clinical trials, the efficiency of generating the CS3D molecule and its stability in biological fluids should be determined. CS3D is synthesized as a single-stranded ODN and must have its free ends ligated to generate the final cyclic form. In this study, we report a ligation efficiency of nearly 95 percent. The ligated CS3D demonstrated a half-life of 7.9 h in human serum, indicating adequate stability for intravenous delivery. These results provide requisite biochemical characterization of CS3D that will inform upcoming clinical trials

"I'm not the same person I was, she's not; none of us are": The experience of mothering a self-harming adolescent daughter

Self-harm is a pervasive phenomenon, with an increasing number of adolescents using such behaviours in response to their distress. Much research has been undertaken to establish the aetiology and management of self-harm, as well as the impact on those that self-harm. However, little research has been completed with a focus on the impact of self-harm on the primary caregiver, most often the mother. As many adolescents who self-harm do not connect with clinical services, how the primary caregiver is affected, challenged and able to cope is vital to their own wellbeing as well as the recovery of the child.Semi-structured interviews were completed with six participants, all mothers of daughters who self-harmed between the ages of 15 and 18 years. Their accounts were analysed using Interpretative Phenomenological Analysis (IPA), a qualitative methodology that explores the lived experience of a particular phenomenon using a small sample.Two main superordinate themes emerged from the data: 1) Impact of self-harm on the mothers’ self (with a focus on their ideology of mothering, destabilisation and loss) and 2) The existence of self-harm as an omnipresent phenomenon (with a focus on self-harm as relentless, isolating and creating fear). Additionally, this study supports the primary position that mothers may have to support and manage their child’s self-harm, thus indicating the vital requirement for greater practical and emotional support for the mothers themselves

Impact of Submaximal versus Supramaximal High-Intensity Interval Training on Blood Glucose Regulation in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

High-intensity interval training (HIIT) is an efficient form of exercise that can potentially induce significant and clinically meaningful blood glucose improvements in patients with Type 2 diabetes mellitus (T2DM). It is unknown whether certain HIIT interval intensities may be more effective than others in combating hyperglycemia in T2DM. PURPOSE: The purpose of this study was to determine if submaximal or supramaximal HIIT reduces blood glucose or improves markers of insulin resistance more than the other in T2DM patients using a systematic review and meta-analytical approach. METHODS: Three databases (Embase/MEDLINE, CENTRAL, and PubMed) were systematically searched in July 2021 and again in April 2022 to identify studies that used submaximal or supramaximal HIIT interventions on T2DM patients. Seventy-eight articles were compared to the defined inclusion and exclusion criteria, with a total of twenty-one selected for this meta-analysis. Six glycemic control outcome variables were analyzed, including HbA1c, FBG, and HOMA-IR. Pre- and post-HIIT means and SDs were used to calculate effect sizes, which were corrected and weighted to produce Hedges’ g values. 95% confidence intervals and p values were also reported. RESULTS: Multivariate meta-analytical analysis found that submaximal HIIT produces an effect size of -0.399 (95% CI [-0.916, -0.226], p = 0.000) in blood glucose metrics, while supramaximal HIIT produces a similar, but non-significant, effect size of -0.366 (95% CI [-0.916, 0.184], p = 0.192). Across five of six outcome variables, submaximal HIIT had a significant small to medium effect, while supramaximal HIIT had a negligible to medium effect. For both HbA1c (%) and fasting blood glucose (FBG), supramaximal HIIT produced effect size values 48% and 67.4% larger, respectively, when compared to submaximal HIIT. Graphing HIIT intensity and training load against HbA1c effect size revealed R2values of 0.08 and 0.2, respectively. CONCLUSION: Submaximal HIIT effectively reduces markers of blood glucose in T2DM patients. Supramaximal HIIT may induce greater and more clinically meaningful improvements in hyperglycemia, but more research is needed. Neither exercise intensity nor training load alone explain improvements to blood glucose homeostasis as measured by HbA1c

Self-assembling nanoparticles containing dexamethasone as a novel therapy in allergic airways inflammation.

Nanocarriers can deliver a wide variety of drugs, target them to sites of interest, and protect them from degradation and inactivation by the body. They have the capacity to improve drug action and decrease undesirable systemic effects. We have previously developed a well-defined non-toxic PEG-dendritic block telodendrimer for successful delivery of chemotherapeutics agents and, in these studies, we apply this technology for therapeutic development in asthma. In these proof-of-concept experiments, we hypothesized that dexamethasone contained in self-assembling nanoparticles (Dex-NP) and delivered systemically would target the lung and decrease allergic lung inflammation and airways hyper-responsiveness to a greater degree than equivalent doses of dexamethasone (Dex) alone. We found that ovalbumin (Ova)-exposed mice treated with Dex-NP had significantly fewer total cells (2.78 ± 0.44 × 10(5) (n = 18) vs. 5.98 ± 1.3 × 10(5) (n = 13), P<0.05) and eosinophils (1.09 ± 0.28 × 10(5) (n = 18) vs. 2.94 ± 0.6 × 10(5) (n = 12), p<0.05) in the lung lavage than Ova-exposed mice alone. Also, lower levels of the inflammatory cytokines IL-4 (3.43 ± 1.2 (n = 11) vs. 8.56 ± 2.1 (n = 8) pg/ml, p<0.05) and MCP-1 (13.1 ± 3.6 (n = 8) vs. 28.8 ± 8.7 (n = 10) pg/ml, p<0.05) were found in lungs of the Dex-NP compared to control, and they were not lower in the Dex alone group. In addition, respiratory system resistance was lower in the Dex-NP compared to the other Ova-exposed groups suggesting a better therapeutic effect on airways hyperresponsiveness. Taken together, these findings from early-stage drug development studies suggest that the encapsulation and protection of anti-inflammatory agents such as corticosteroids in nanoparticle formulations can improve efficacy. Further development of novel drugs in nanoparticles is warranted to explore potential treatments for chronic inflammatory diseases such as asthma

Risk Management Education for Kentucky Farm Women

This article describes how an agricultural and farm risk management education program, known as Annie’s Project, was adapted from a midwestern focus to meet the diversity of Kentucky agriculture and shares the results of a longer-term evaluation of the Kentucky program. The Annie’s Project program is geared specifically to the needs of farm women. The program adaption process, which began in late 2006, is detailed from inception through pilot testing to the full launch of the program. Over a four year period, the Kentucky Annie’s Project program reached 425 farm women in 41 of Kentucky’s 120 counties. The evaluation draws on the results of a questionnaire mailed to program participants 18 months to 5 years after programming. Participants reported statistically significant gains in all topical areas representing agricultural risk management education, including production, human resources, marketing, legal, and financial. Key actions which occurred as a result of participating in the program included increasing confidence in management abilities, reviewing personal/farm insurances policies, developing a network of peers and professionals, and using financial statements