9 research outputs found
Health Professional Training and Capacity Strengthening Through International Academic Partnerships: The First Five Years of the Human Resources for Health Program in Rwanda
Abstract
Background: The Rwanda Human Resources for Health Program (HRH Program) is a 7-year (2012-2019) health
professional training initiative led by the Government of Rwanda with the goals of training a large, diverse, and competent
health workforce and strengthening the capacity of academic institutions in Rwanda.
Methods: The data for this organizational case study was collected through official reports from the Rwanda Ministry of
Health (MoH) and 22 participating US academic institutions, databases from the MoH and the College of Medicine and
Health Sciences (CMHS) in Rwanda, and surveys completed by the co-authors.
Results: In the first 5 years of the HRH Program, a consortium of US academic institutions has deployed an average of 99
visiting faculty per year to support 22 training programs, which are on track to graduate almost 4600 students by 2019.
The HRH Program has also built capacity within the CMHS by promoting the recruitment of Rwandan faculty and the
establishment of additional partnerships and collaborations with the US academic institutions.
Conclusion: The milestones achieved by the HRH Program have been substantial although some challenges persist.
These challenges include adequately supporting the visiting faculty; pairing them with Rwandan faculty (twinning);
ensuring strong communication and coordination among stakeholders; addressing mismatches in priorities between
donors and implementers; the execution of a sustainability strategy; and the decision by one of the donors not to renew
funding beyond March 2017. Over the next 2 academic years, it is critical for the sustainability of the 22 training programs
supported by the HRH Program that the health-related Schools at the CMHS significantly scale up recruitment of new
Rwandan faculty. The HRH Program can serve as a model for other training initiatives implemented in countries affected
by a severe shortage of health professionals
Dwindling Utilization of Central Venous Catheter Tip Cultures: An Analysis of Sampling Trends and Clinical Utility at 128 US Hospitals, 2009–2014
Health Characteristics and Medical Service Use Patterns of Sheltered Homeless and Low-Income Housed Mothers
OBJECTIVE: To compare the health characteristics and service utilization patterns of homeless women and low-income housed women who are heads of household. DESIGN: Case-control study. SETTING: Community of Worcester, Massachusetts. PARTICIPANTS: A sample of 220 homeless mothers and 216 low-income housed mothers receiving welfare. MEASUREMENTS AND MAIN RESULTS: Outcome measures included health status, chronic conditions, adverse lifestyle practices, outpatient and emergency department use and hospitalization rates, and use of preventive screening measures. Both homeless mothers and housed mothers demonstrated low levels of physical and role functioning and high levels of bodily pain. Prevalence rates of asthma, anemia, and ulcer disease were high in both groups. More than half of both groups were current smokers. Compared with the housed mothers, homeless mothers reported more HIV risk behaviors. Although 90% of the homeless mothers had been screened for cervical cancer, almost one third had not been screened for tuberculosis. After controlling for potential confounding factors, the homeless mothers, compared with the housed mothers, had more frequent emergency department visits in the past year (adjusted mean, homeless vs housed, 1.41 vs .95, p = .10) and were significantly more likely to be hospitalized in the past year (adjusted odds ratio 2.22; 95% confidence interval 1.13, 4.38). CONCLUSIONS: Both homeless mothers and low-income housed mothers had lower health status, more chronic health problems, and higher smoking rates than the general population. High rates of hospitalization, emergency department visits, and more risk behaviors among homeless mothers suggest that they are at even greater risk of adverse health outcomes. Efforts to address gaps in access to primary care and to integrate psychosocial supports with health care delivery may improve health outcomes for homeless mothers and reduce use of costly medical care services
The Effectiveness of Bacteriophages against Methicillin-Resistant Staphylococcus aureus ST398 Nasal Colonization in Pigs
Aluminium toxicokinetics after intramuscular, subcutaneous, and intravenous injection of Al citrate solution in rats
DHA-enriched high–oleic acid canola oil improves lipid profile and lowers predicted cardiovascular disease risk in the canola oil multicenter randomized controlled trial
Proteomic Profiling of Rabbit Embryonic Stem Cells Derived from Parthenotes and Fertilized Embryos
Fertility in classical galactosaemia, a study of N-glycan, hormonal and inflammatory gene interactions.
BACKGROUND
Classical Galactosaemia (CG) (OMIM #230400) is a rare inborn error of galactose metabolism caused by deficiency of the enzyme galactose-1-phosphate uridylyltransferase (GALT). Long-term complications persist in treated patients despite dietary galactose restriction with significant variations in outcomes suggesting epigenetic glycosylation influences. Primary Ovarian Insufficiency (POI) is a very significant complication affecting females with follicular depletion noted in early life. We studied specific glycan synthesis, leptin system and inflammatory gene expression in white blood cells as potential biomarkers of infertility in 54 adults with CG adults (27 females and 27 males) (age range 17-51 yr) on a galactose-restricted diet in a multi-site Irish and Dutch study. Gene expression profiles were tested for correlation with a serum Ultra-high Performance Liquid Chromatography (UPLC)-Immunoglobulin (IgG)-N-glycan galactose incorporation assay and endocrine measurements.
RESULTS
Twenty five CG females (93%) had clinical and biochemical evidence of POI. As expected, the CG female patients, influenced by hormone replacement therapy, and the healthy controls of both genders showed a positive correlation between log leptin and BMI but this correlation was not apparent in CG males. The strongest correlations between serum leptin levels, hormones, G-ratio (galactose incorporation assay) and gene expression data were observed between leptin, its gene and G-Ratios data (r = - 0.68) and (r = - 0.94) respectively with lower circulating leptin in CG patients with reduced IgG galactosylation. In CG patients (males and females analysed as one group), the key glycan synthesis modifier genes MGAT3 and FUT8, which influence glycan chain bisecting and fucosylation and subsequent cell signalling and adhesion, were found to be significantly upregulated (p < 0.01 and p < 0.05) and also the glycan synthesis gene ALG9 (p < 0.01). Both leptin signalling genes LEP and LEPR were found to be upregulated (p < 0.01) as was the inflammatory genes ANXA1 and ICAM1 and the apoptosis gene SEPT4 (p < 0.01).
CONCLUSIONS
These results validate our previous findings and provide novel experimental evidence for dysregulation of genes LEP, LEPR, ANXA1, ICAM1 and SEPT4 for CG patients and combined with our findings of abnormalities of IgG glycosylation, hormonal and leptin analyses elaborate on the systemic glycosylation and cell signalling abnormalities evident in CG which likely influence the pathophysiology of POI