Operational research to support equitable non-communicable disease policy in low-income and middle-income countries in the sustainable development era : a scoping review

Introduction Non-communicable diseases (NCDs) represent a growing health burden in low-income and middle-income countries (LMICs). Operational research (OR) has been used globally to support the design of effective and efficient public policies. Equity is emphasised in the Sustainable Development Goal (SDG) framework introduced in 2015 and can be analysed within OR studies. Methods We systematically searched MEDLINE, Embase, Scopus and Web of Science for studies published between 2015 and 2018 at the intersection of five domains (OR, LMICs, NCDs, health and decision-making and/or policy-making). We categorised the type of policy intervention and described any concern for equity, which we defined as either analysis of differential impact by subgroups or, policy focus on disadvantaged groups or promoting universal health coverage (UHC). Results A total of 149 papers met the inclusion criteria. The papers covered a number of policy types and a broad range of NCDs, although not in proportion to their relative disease burden. A concern for equity was demonstrated by 88 of the 149 papers (59%), with 8 (5%) demonstrating differential impact, 47 (32%) targeting disadvantaged groups, and 68 (46%) promoting UHC. Conclusion Overall, OR for NCD health policy in the SDG era is being applied to a diverse set of interventions and conditions across LMICs and researchers appear to be concerned with equity. However, the current focus of published research does not fully reflect population needs and the analysis of differential impact within populations is rare

Black-faced Bunting Emberiza spodocephala on Taliabu Island, Sula Island group: The first record for Indonesia

No abstract availabl

A call for systems epidemiology to tackle the complexity of schistosomiasis, its control, and elimination

Ever since the first known written report of schistosomiasis in the mid-19th century, researchers have aimed to increase knowledge of the parasites, their hosts, and the mechanisms contributing to infection and disease. This knowledge generation has been paramount for the development of improved intervention strategies. Yet, despite a broad knowledge base of direct risk factors for schistosomiasis, there remains a paucity of information related to more complex, interconnected, and often hidden drivers of transmission that hamper intervention successes and sustainability. Such complex, multidirectional, non-linear, and synergistic interdependencies are best understood by looking at the integrated system as a whole. A research approach able to address this complexity and find previously neglected causal mechanisms for transmission, which include a wide variety of influencing factors, is needed. Systems epidemiology, as a holistic research approach, can integrate knowledge from classical epidemiology, with that of biology, ecology, social sciences, and other disciplines, and link this with informal, tacit knowledge from experts and affected populations. It can help to uncover wider-reaching but difficult-to-identify processes that directly or indirectly influence exposure, infection, transmission, and disease development, as well as how these interrelate and impact one another. Drawing on systems epidemiology to address persisting disease hotspots, failed intervention programmes, and systematically neglected population groups in mass drug administration programmes and research studies, can help overcome barriers in the progress towards schistosomiasis elimination. Generating a comprehensive view of the schistosomiasis system as a whole should thus be a priority research agenda towards the strategic goal of morbidity control and transmission elimination

REM: A Collaborative Framework for Building Indigenous Cultural Competence

© 2015, © The Author(s) 2015. The well-documented health disparities between the Australian Indigenous and non-Indigenous population mandates a comprehensive response from health professionals. This article outlines the approach taken by one faculty of health in a large urban Australian university to enhance cultural competence in students from a variety of fields. Here we outline a collaborative and deeply respectful process of Indigenous and non-Indigenous university staff collectively developing a model that has framed the embedding of a common faculty Indigenous graduate attribute across the curriculum. Through collaborative committee processes, the development of the principles of “Respect; Engagement and sharing; Moving forward” (REM) has provided both a framework and way of “being and doing” our work. By drawing together the recurring principles and qualities that characterize Indigenous cultural competence the result will be students and staff learning and bringing into their lives and practice, important Indigenous cultural understanding

Life-history innovation to climate change:Can single-brooded migrant birds become multiple breeders?

When climatic conditions change and become outside the range experienced in the past, species may show life-history innovations allowing them to adapt in new ways. We report such an innovation for pied flycatchers Ficedula hypoleuca. Decades of breeding biological studies on pied flycatchers have rarely reported multiple breeding in this long-distance migrant. In two populations, we found 12 recent incidents of females with second broods, all produced by extremely early laying females in warm springs. As such early first broods are a recent phenomenon, because laying dates have gradually advanced over time, this innovation now allows individual females to enhance their reproductive success considerably. If laying dates continue advancing, potentially more females may become multiple breeders and selection for early (and multiple) breeding phenotypes increases, which may accelerate adaptation to climatic change

Clinical characteristic of campylobacteriosis in hospitalised patients

Bolest izazavana gram-negativnim bakterijama iz roda Campylobacter u ljudi najčešće prolazi kao akutna proljevna bolest u trajanju do tjedan dana. Komplikacije bolesti su rijetke, a najznačajnije su među njima sepsa, bakterijemija s vancrijevnim žarištima zaraze, septički pobačaj, te imunološki uvjetovan Guillain-Barréov sindrom. Među 1632 bolesnika s kampilobakteriozom hospitalizirana od 1994.–2002. godine analizom pojedinih kliničkih parametara logističkom regresijom uočeno je značajno duže trajanje proljeva u bolesnika zaraženih s C. jejuni (p = 0,014, OR 1,06, 95 % CI 1,01–1,11). Komplikacije bolesti su zabilježene u 4,6 % bolesnika, a smrtni ishod ili naknadna hospitalizacija zbog Guillain-Barréovog sindroma u klinikama zagrebačkog područja nisu u njih zabilježeni. S učestalošću od 7,2 % komplikacije su bile značajno češće u dobnoj skupini mlađih od tri godine (p = 0,010). Odgovarajućim antimikrobnim lijekom je liječeno 78,7 %, neodgovarajućim antimikrobnim lijekom 6,7 %, a simptomatski 14,6 % bolesnika. Kliničke osobine u naših bolesnika s kampilobakteriozom ne odudaraju znatnije od onih opisanih u populacijama razvijenih zemalja. Kao osobitost bilježi se česta primjena antimikrobnog liječenja, a azitromicin, kojeg je dobijalo 46,4 % bolesnika liječenih odgovarajućim antimikrobnim lijekom, je najčešće primjenjivani lijek.Diseases caused by gram-negative bacteria from genus Campylobacter in humans are most often presented as an acute diarrhoeal illness, which lasts up to seven days. Complications are rare, and among them the most important are: sepsis, bacteremia with extraintestinal sites of infection, septic abortion, and immunologically triggered Guillain-Barré syndrome. Among 1632 hospitally treated patients in the period from 1994–2002, the analysis of a particular clinical parameters using logistic regression showed significantly longer duration of diarrhoea among patients with C. jejuni infection (p = 0.014, OR 1.06, 95 % CI 1.01–1.11). Disease complications were observed in 4.6 % patients, and no fatalities or hospitalisations of observed patients due to Guillain-Barré syndrome in any of the hospitals from Zagreb region were recorded. Complications were significantly more frequent (7.2 %) in the age group younger than three years (p = 0.010). Adequate antimicrobial treatment received 78.7 % of patients, unadequate antimicrobial treatment 6.7 %, and 14.6 % of patients were treated symptomaticaly. Clinical characteristics in our patients with campylobacteriosis do not differ significantly from those described in populations of developed countries. As a peculiarity, a common use of antimicrobial therapy is recorded, and azithromycin, used in 46.4 % of patients treated with adequate antimicrobial treatment, was the most frequently used drug

Epidemiologic characteristics of campylobacteriosis in hospitalized patients

Među 1632 bolesnika s kampilobakteriozom hospitalizirana od 1994.–2002. godine, nije utvrđen porast udjela kampilobakterioza u odnosu na sve druge uzročnike proljeva (p=0,333), niti u odnosu na salmoneloze (p=0,751), te je utvrđen porast bolesnika s C. jejuni (71,7%) u odnosu na one s C. coli (28,3%) infekcijom (p<0,001). Najviše je bolesnika u dobnoj skupini mlađih od tri godine (38,5 %), zatim u skupini 18–29 g. (9,9 %). Mu{karci prevladavaju u svim dobnim skupinama, osim u najstarijoj (≥60 g.) (p<0,001). Značajno najveći broj bolesnika je hospitaliziran u toplijim mjesecima godine; 14,3% bolesnika s C. jejuni tijekom lipnja, a po 11,5 % bolesnika s C. coli u lipnju i kolovozu (p<0,001). U skupinama seoskog, prigradskog i gradskog stanovništva je omjer bolesnika s C. jejuni i C. coli infekcijom podjednak (p=0,289). Bolest se u 83,9% bolesnika javila sporadično, a u 13,1% bolesnika nakon putovanja. Pohađanje kolektiva se pokazalo značajnim u odnosu na epidemijski oblik pojavnosti bolesti (p<0,001).Among 1632 patients with campylobacteriosis hospitalized in the period from 1994–2002, we did not record an increase in the ratio of campylobacteriosis compared to all other causative agents of diarrhoeal diseases (p=0.333), nor in comparison to salmonelloses (p=0.751), but a significant increase in the number of C. jejuni (71.7%) compared to C. coli infections (28.3 %) was noticed (p<0.001). The majority of patients belonged to age group of three years and younger (38.5 %), and to 18 –29 years group (9.9 %), respectively. Males predominated in all age groups, except in the oldest one (≥60 years) (p<0.001). Significantly highest number of patients was hospitalized during warm months of the year; 14.3% patients with C. jejuni infection during June, and 11.5 % of patients with C. coli infection in both June and August (p<0.001). In the groups of rural and urban population, the difference in the ratio between C. jejuni and C. coli infections was not recorded (p=0.289). The disease appeared in 83.9% of patients sporadically, and in 13.1% after travelling. Community setting was a significant factor in epidemic pattern of the disease (p<0.001)

Society for Endocrinology UK guidance on the initial evaluation of an infant or an adolescent with a suspected disorder of sex development (Revised 2015)

It is paramount that any child or adolescent with a suspected disorder of sex development (DSD) is assessed by an experienced clinician with adequate knowledge about the range of conditions associated with DSD. If there is any doubt, the case should be discussed with the regional DSD team. In most cases, particularly in the case of the newborn, the paediatric endocrinologist within the regional team acts commonly as the first point of contact. This clinician should be part of a multidisciplinary team experienced in management of DSD and should ensure that the affected person and parents have access to specialist psychological support and that their information needs are comprehensively addressed. The underlying pathophysiology of DSD and the strengths and weaknesses of the tests that can be performed should be discussed with the parents and affected young person and tests undertaken in a timely fashion. Finally, in the field of rare conditions, it is imperative that the clinician shares the experience with others through national and international clinical and research collaboration

Society for Endocrinology UK guidance on the initial evaluation of an infant or an adolescent with a suspected disorder of sex development (Revised 2015).

It is paramount that any child or adolescent with a suspected disorder of sex development (DSD) is assessed by an experienced clinician with adequate knowledge about the range of conditions associated with DSD. If there is any doubt, the case should be discussed with the regional DSD team. In most cases, particularly in the case of the newborn, the paediatric endocrinologist within the regional team acts commonly as the first point of contact. This clinician should be part of a multidisciplinary team experienced in management of DSD and should ensure that the affected person and parents have access to specialist psychological support and that their information needs are comprehensively addressed. The underlying pathophysiology of DSD and the strengths and weaknesses of the tests that can be performed should be discussed with the parents and affected young person and tests undertaken in a timely fashion. Finally, in the field of rare conditions, it is imperative that the clinician shares the experience with others through national and international clinical and research collaboration

Fecal occult blood and fecal calprotectin as point-of-care markers of intestinal morbidity in Ugandan children with Schistosoma mansoni infection.

BACKGROUND: Calprotectin is a calcium-binding cytoplasmic protein found in neutrophils and increasingly used as a marker of bowel inflammation. Fecal occult blood (FOB) is also a dependable indicator of bowel morbidity. The objective of our study was to determine the applicability of these tests as surrogate markers of Schistosoma mansoni intestinal morbidity before and after treatment with praziquantel (PZQ). METHODS: 216 children (ages 3-9 years old) from Buliisa District in Lake Albert, Uganda were examined and treated with PZQ at baseline in October 2012 with 211 of them re-examined 24 days later for S. mansoni and other soil transmitted helminths (STH). POC calprotectin and FOB assays were performed at both time points on a subset of children. Associations between the test results and infection were analysed by logistic regression. RESULTS: Fecal calprotectin concentrations of 150-300 µg/g were associated with S. mansoni egg patent infection both at baseline and follow up (OR: 12.5 P = 0.05; OR: 6.8 P = 0.02). FOB had a very strong association with baseline anemia (OR: 9.2 P = 0.03) and medium and high egg intensity schistosomiasis at follow up (OR: 6.6 P = 0.03; OR: 51.3 P = 0.003). Both tests were strongly associated with heavy intensity S. mansoni infections. There was a significant decrease in FOB and calprotectin test positivity after PZQ treatment in those children who had egg patent schistosomiasis at baseline. CONCLUSIONS: Both FOB and calprotectin rapid assays were found to correlate positively and strongly with egg patent S. mansoni infection with a positive ameloriation response after PZQ treatment indicative of short term reversion of morbidity. Both tests were appropriate for use in the field with excellent operational performance and reliability. Due to its lower-cost which makes its scale-up of use affordable, FOB could be immediately adopted as a monitoring tool for PC campaigns for efficacy evaluation before and after treatment