Economic evaluation of safety-engineered devices and training in reducing needlestick injuries among healthcare workers in South Africa

Background. Healthcare workers (HCWs) are at increased risk of contracting various communicable diseases. Needlestick injuries (NSIs) are a common mechanism of exposure. Training in basic universal precautions and utilisation of safety-engineered devices (SEDs) are interventions known to reduce the risk of NSI. Objectives. To assess the cost-utility of SEDs v. a training programme in universal precautions (TP) v. a combination strategy to reduce NSIs among South African HCWs. Methods. A Markov model comparing SEDs v. a TP v. a combination strategy against current practice was developed. A hypothetical cohort of HCWs working in the SA public sector was followed from a payer’s perspective for a period of 45 years, and discounted costs and benefits were assessed. Data were obtained from the National Department of Health, suppliers and published literature. One-way and probabilistic sensitivity analysis was conducted. Results. Over the study time horizon, our model estimated that 2 209, 3 314 and 4 349 needlestick injuries per 1 000 HCWs could be prevented if a TP, SEDs or a combination strategy, respectively, was adopted compared with current practice. All three candidate interventions were cost-effective at a willingness to pay (WTP) of one times the gross domestic product per capita (USD6 483.90/quality adjusted life-year (QUALY) gained). SEDs as a stand-alone intervention was dominated by a combination strategy. Compared with current practice, the incremental cost-effectiveness of training was USD32.90/QALY v. USD432.32/QALY for SEDs and SD377.08/QALY for a combination strategy. Results were sensitive to the effectiveness of the interventions. Probabilistic sensitivity analysis showed that at a WTP of USD6 483.90/QALY gained, a combination strategy would be cost-effective 95.4% of the time. Conclusions. A combination strategy in which both SEDs and a TP are adopted is preferred

HIV risk perception and behavior among medically and traditionally circumcised males in South Africa

Abstract Background In South Africa, voluntary medical male circumcision (VMMC) has recently been implemented as a strategy for reducing the risk of heterosexual HIV acquisition among men. However, there is some concern that VMMC may lead to low risk perception and more risky sexual behavior. This study investigated HIV risk perception and risk behaviors among men who have undergone either VMMC or traditional male circumcision (TMC) compared to those that had not been circumcised. Methods Data collected from the 2012 South African national population-based household survey for males aged 15 years and older were analyzed using bivariate and multivariate multinomial logistic regression, and relative risk ratios (RRRs) with 95 % confidence interval (CI) were used to assess factors associated with each type of circumcision relative no circumcision. Results Of the 11,086 males that indicated that they were circumcised or not, 19.5 % (95 % CI: 17.9–21.4) were medically circumcised, 27.2 % (95 % CI: 24.7–29.8) were traditionally circumcised and 53.3 % (95 % CI: 50.9–55.6) were not circumcised. In the final multivariate models, relative to uncircumcised males, males who reported VMMC were significantly more likely to have had more than two sexual partners (RRR = 1.67, p = 0.009), and males who reported TMC were significantly less likely to be low risk alcohol users (RRR = 0.72, p < 0.001). Conclusion There is a need to strengthen and improve the quality of the counselling component of VMMC with the focus on education about the real and present risk for HIV infection associated with multiple sexual partners and alcohol abuse following circumcision

MuRF1 mono-ubiquitinates TRα to inhibit T3-induced cardiac hypertrophy in vivo

Thyroid hormone (TH) is recognized for its role in cellular metabolism and growth and participates in homeostasis of the heart. T3 activates pro-survival pathways including Akt and mTOR. Treatment with T3 after myocardial infarction is cardioprotective and promotes elements of physiological hypertrophic response after cardiac injury. Although T3 is known to benefit the heart, very little about its regulation at the molecular level has been described to date. The ubiquitin proteasome system (UPS) regulates nuclear hormone receptors such as estrogen, progesterone, androgen, and glucocorticoid receptors by both degradatory and non-degradatory mechanisms. However, how the UPS regulates T3-mediated activity is not well understood. In this study, we aim to determine the role of the muscle-specific ubiquitin ligase muscle ring finger-1 (MuRF1) in regulating T3-induced cardiomyocyte growth. An increase in MuRF1 expression inhibits T3-induced physiological cardiac hypertrophy, whereas a decrease in MuRF1 expression enhances T3’s activity both in vitro and in cardiomyocytes in vivo. MuRF1 interacts directly with TRα to inhibit its activity by posttranslational ubiquitination in a non-canonical manner. We then demonstrated that a nuclear localization apparatus that regulates/inhibits nuclear receptors by sequestering them within a subcompartment of the nucleus was necessary for MuRF1 to inhibit T3 activity. This work implicates a novel mechanism that enhances the beneficial T3 activity specifically within the heart, thereby offering a potential target to enhance cardiac T3 activity in an organ-specific manner

Access to safe drining water and availability of environmental sanitation facilities among Dukem town households in Ethiopia

The objective of this study was to assess the accessibility of water and environmental sanitation amongst households of Dukem town in Ethiopia. This was a cross-sectional study conducted among 391 households. Almost all the households had access to improved sources of drinking water. Majority of the households had access to water within a distance of up to 200 metres or less and had access to water within a time of 30 minutes or less. More than two-thirds of households had improved toilets (flush/pour-flush toilet, ventilated improved pit (VIP) latrine and traditional pit latrine). It is important to make water available by supplying with private or yard tap connections for underserved population and improved basic sanitation by promoting Total Sanitation Approach which aims to achieve universal access and use of toilets and the elimination of open defecation in the communities.NoneHealth Studie

Protecting healthcare workers during a pandemic : what can a WHO collaborating centre research partnership contribute?

Objectives. To ascertain whether and how working as a partnership of two World Health Organization collaborating centres (WHOCCs), based respectively in the Global North and Global South, can add insights on “what works to protect healthcare workers (HCWs) during a pandemic, in what contexts, using what mechanism, to achieve what outcome”. Methods. A realist synthesis of seven projects in this research program was carried out to characterize context (C) (including researcher positionality), mechanism (M) (including service relationships) and outcome (O) in each project. An assessment was then conducted of the role of the WHOCC partnership in each study and overall. Results. The research found that lower-resourced countries with higher economic disparity, including South Africa, incurred greater occupational health risk and had less acceptable measures to protect HCWs at the onset of the COVID-19 pandemic than higher-income more-equal counterpart countries. It showed that rigorously adopting occupational health measures can indeed protect the healthcare workforce; training and preventive initiatives can reduce workplace stress; information systems are valued; and HCWs most at-risk (including care aides in the Canadian setting) can be readily identified to trigger adoption of protective actions. The C-M-O analysis showed that various ways of working through a WHOCC partnership not only enabled knowledge sharing, but allowed for triangulating results and, ultimately, initiatives for worker protection. Conclusions. The value of an international partnership on a North-South axis especially lies in providing contextualized global evidence regarding protecting HCWs as a pandemic emerges, particularly with bi-directional cross-jurisdiction participation by researchers working with practitioners.Canadian Institutes of Health Research (CIHR

Back to your heart: Ubiquitin proteasome system-regulated signal transduction

Awareness of the regulation of cell signaling by post-translational ubiquitination has emerged over the past 2 decades. Like phosphorylation, post-translational modification of proteins with ubiquitin can result in the regulation of numerous cellular functions, for example, the DNA damage response, apoptosis, cell growth, and the innate immune response. In this review, we discuss recently published mechanisms by which the ubiquitin proteasome system regulates key signal transduction pathways in the heart, including MAPK JNK, calcineurin, FOXO, p53, and estrogen receptors α and β. We then explore how ubiquitin proteasome system-specific regulation of these signal transduction pathways plays a role in the pathophysiology of common cardiac diseases, such as cardiac hypertrophy, heart failure, ischemia reperfusion injury, and diabetes

Impacts of economic inequality on healthcare worker safety at the onset of the COVID-19 pandemic : cross-sectional analysis of a global survey

Objectives To assess the extent to which protection of healthcare workers (HCWs) as COVID-19 emerged was associated with economic inequality among and within countries. Design Cross-sectional analysis of associations of perceptions of workplace risk acceptability and mitigation measure adequacy with indicators of respondents’ respective country’s economic income level (World Bank assessment) and degree of within-country inequality (Gini index). Setting A global self-administered online survey. Participants 4977 HCWs and healthcare delivery stakeholders from 161 countries responded to health and safety risk questions and a subset of 4076 (81.2%) answered mitigation measure questions. The majority (65%) of study participants were female. Results While the levels of risk being experienced at the pandemic’s onset were consistently deemed as unacceptable across all groupings, participants from countries with less income inequality were somewhat less likely to report unacceptable levels of risk to HCWs regarding both workplace environment (OR=0.92, p=0.012) and workplace organisational factors (OR=0.93, p=0.017) compared with counterparts in more unequal national settings. In contrast, considerable variation existed in the degree to which mitigation measures were considered adequate. Adjusting for other influences through a logistic regression analysis, respondents from lower middle-income and low-income countries were comparatively much more likely to assess both occupational health and safety (OR=10.91, p≤0.001) and infection prevention and control (IPC) (OR=6.61, p=0.001) protection measures as inadequate, despite much higher COVID-19 rates in wealthier countries at the time of the survey. Greater within-country income inequality was also associated with perceptions of less adequate IPC measures (OR=0.94, p=0.025). These associations remained significant when accounting for country-level differences in occupational and gender composition of respondents, including specifically when only female care providers, our study’s largest and most at-risk subpopulation, were examined. Conclusions Economic inequality threatens resilience of health systems that rely on health workers working safely to provide needed care during emerging pandemics

Determinants of excellent/good self-rated health among HIV positive individuals in South Africa: evidence from a 2012 nationally representative household survey

Background: In South Africa, HIV is increasingly becoming a chronic disease as a result of advances in HIV treatment and prevention in the last three decades. This has changed the perception from a life threating to a potentially manageable disease. However, little is known about self-perceived health status of HIV-infected individuals. Self-rated health (SRH) has been shown to be a sensitive indicator of health-relatedchanges directly linked to HIV, but can also be influenced by differences in social and material conditions. The aim of this paper was to identify determinants of excellent/good SRH among HIV-infected individuals using socio-demographic, life style and health related data. Methods: The study used data from the nationally representative 2012 South African population-based household survey on HIV prevalence, incidence and behaviour conducted using multi-stage stratified cluster sampling design. Bivariate and multivariate logistic regression models were used to identify determinants of SRH among HIV-infected individuals. Results: Out of a total of 2632 HIV positive participants 74.1% (95% CI: 68.4-74.2) reported excellent/good SRH. Increased likelihood of reporting excellent/good SRH was significantly associated with being Black African [OR= 1.97 (95%CI: 1.12-3.46), p = 0.019] and belonging to least poor household [OR= 3.13 (95%CI: 1.26-7.78), p = 0.014]. Decreased likelihood of reporting excellent/good SRH was significantly associated with those aged 25 to 34 years [OR= 0.49 (95% CI: 0.31-0.78), p = 0.003], 35 to 44 years[OR= 0.27 (95% CI: 0.17-0.44), p < 0.001], 45 to 54 years [OR= 0. 20 (95% CI: 0.12-0.34), p < 0.001], and those 55 years and older [OR= 0.15 (95% CI: 0.09-0.26), p < 0.001], hospitalization in the past twelve months [OR= 0.40 (95% CI: 0.26-0.60), p < 0.001]. Conclusion: To have positive health effects and improve the perceived health status for PLWH social interventions should seek to enhance to support for the elderly HIV-positive individuals, and address the challenge of socioeconomic inequalities and underlying comorbid conditions resulting in hospitalization

Numbers of invasive house sparrows Passer domesticus in a rural landscape of Limpopo province, South Africa

The House Sparrow Passer domesticus is recognised as one of the commonest avian invasive species globally, with its occurrence associated with human existence. However, relatively little on population sizes of this species in rural landscapes has been documented. The study on House Sparrows was conducted in three areas in a rural landscape of Limpopo province, South Africa where it is an invasive, to 1) determine population numbers of the House Sparrow between the years 2014 and 2016, and 2) investigate the interaction between the number of House Sparrows and the number of their active nests. The House Sparrow population numbers showed no significant differences between 2014, 2015 and 2016. The House Sparrow numbers were influenced by the number of active nests in 2014 and 2016. The current study showed that the presence of House Sparrows was not affected by the house type they roosted in, and the number of active nests was not influenced by the house types available in each area. The results also showed that the House Sparrow occurs across a rural landscape with variation in numbers across seasons. The evidence reported provides significant insight into how invasive House Sparrows are well established in rural landscapes around human habitation, and it is recommended that this should be incorporated into the management of such alien invasive birds.Le Moineau Domestique Passer domesticus est considéré comme l’une des espèces aviaires communes à caractère invasif la plus répandue dans le monde, sa présence étant généralement associée à l’activité humaine. Cependant, la densité de population de cette espèce dans le paysage rural a très peu été documentée. Notre étude relative au Moineau Domestique a été menée dans trois zones rurales de la province de Limpopo, en Afrique du Sud afin de 1) dénombrer la population de Moineaux Domestiques entre 2014 et 2016 et 2) d’étudier les interactions entre le nombre de Moineaux Domestiques et le nombre de leurs nids actifs. Il n’y a pas de différence significative entre la population de Moineaux Domestiques en 2014, 2015 et 2016. Le nombre de Moineaux Domestiques a été influencé par le nombre de nids actifs en 2014 et 2016. Nous estimons que la présence des Moineaux Domestiques n’est pas liée au type d’habitation dans laquelle ils s’abritent et que le nombre de nids actifs n’est pas influencé par le type d’habitation présent dans chaque zone. Nos résultats montrent que le nombre de Moineaux Domestiques présents dans un paysage rural varie en fonction des saisons. L’étude menée prouve de manière significative que l’espèce invasive des Moineaux Domestiques est bien établie dans le paysage rural, à proximité des habitations humaines. Il est recommandé d’intégrer cela dans le management de cette espèce exotique invasive aviaire.The National Research Foundation (ZA) and the University of KwaZulu-Natal (ZA).http://www.tandfonline.com/loi/tost202021-08-25hj2021Zoology and Entomolog