Correction: What is the qualitative evidence concerning the risks, diagnosis, management and consequences of gastrointestinal infections in the community in the United Kingdom? A systematic review and meta-ethnography

[This corrects the article DOI: 10.1371/journal.pone.0227630.]

What is the impact on health and wellbeing of interventions that foster respect and social inclusion in community-residing older adults? A systematic review of quantitative and qualitative studies

Abstract Background Many interventions have been developed to promote respect and social inclusion among older people, but the evidence on their impacts on health has not been synthesised. This systematic review aims to appraise the state of the evidence across the quantitative and qualitative literature. Methods Eligible studies published between 1990 and 2015 were identified by scanning seven bibliographic databases using a pre-piloted strategy, searching grey literature and contacting experts. Studies were included if they assessed the impact (quantitatively) and/or perceived impact (qualitatively) of an intervention promoting respect and social inclusion on the physical or mental health of community-residing people aged 60 years and older. Titles and abstracts were screened for eligibility by one reviewer. A second reviewer independently screened a 10% random sample. Full texts were screened for eligibility by one reviewer, with verification by another reviewer. Risk of bias was assessed using standardised tools. Findings were summarised using narrative synthesis, harvest plots and logic models to depict the potential pathways to health outcomes. Results Of the 27,354 records retrieved, 40 studies (23 quantitative, 6 qualitative, 11 mixed methods) were included. All studies were conducted in high and upper middle-income countries. Interventions involved mentoring, intergenerational and multi-activity programmes, dancing, music and singing, art and culture and information-communication technology. Most studies (n = 24) were at high or moderate risk of bias. Music and singing, intergenerational interventions, art and culture and multi-activity interventions were associated with an overall positive impact on health outcomes. This included depression (n = 3), wellbeing (n = 3), subjective health (n = 2), quality of life (n = 2), perceived stress and mental health (n = 2) and physical health (n = 2). Qualitative studies offered explanations for mediating factors (e.g. improved self-esteem) that may lead to improved health outcomes and contributed to the assessment of causation. Conclusions Whilst this review suggests that some interventions may positively impact on the health outcomes of older people, and identified mediating factors to health outcomes, the evidence is based on studies with heterogeneous methodologies. Many of the interventions were delivered as projects to selected groups, raising important questions about the feasibility of wider implementation and the potential for population-wide benefits. Systematic review registration PROSPERO registration number CRD4201401010

Involving medical students in re-orienting health services: a photovoice study

Introduction: Healthcare reorientation aims for health services focused not exclusively on diseases but also on prevention and health promotion. The implementation depends strongly on professionals' willingness to actively participate in the reorientation. An effective strategy to boost reorientation is to reorient education and role definition of future professionals. This paper examines whether photovoice can be a suitable method to i) increase future health professionals' awareness of users' needs and expectations; and ii) enable a process of critical reflection on role definition and health services organisation. Methods: One hundred and seventy-two medical students participated in the photovoice project. Participants were asked to produce one photo combined with a caption, responding to a pre-identified question: "What is, in your opinion, the main aspect affecting users' satisfaction/dissatisfaction in a healthcare facility?". Participants discussed their photos in group discussions (n = 16) and participated in data analysis sessions (n = 4). Results: Participants' contributions revolved around how services were delivered (e.g., kindness, accessibility, attention to additional needs) rather than the service provided. The students showed their empathic side and proposed smart and inclusive solutions to improve overall users' experience. Conclusions: This study demonstrated the value of using photovoice to reach medical students and to integrate health promotion into their professional identities. The photovoice process, teamwork, and discussions opened a breach into traditional thinking regarding aspects of healthcare services that are taken for granted or are overlooked. Furthermore, participants' proposals often implied a change in the behaviour of professionals - their future selves - towards patients and low-cost improvements of organisational practices

Examining the effectiveness of place-based interventions to improve public health and reduce health inequalities: an umbrella review.

BackgroundLocally delivered, place-based public health interventions are receiving increasing attention as a way of improving health and reducing inequalities. However, there is limited evidence on their effectiveness. This umbrella review synthesises systematic review evidence of the health and health inequalities impacts of locally delivered place-based interventions across three elements of place and health: the physical, social, and economic environments.MethodsSystematic review methodology was used to identify recent published systematic reviews of the effectiveness of place-based interventions on health and health inequalities (PROGRESS+) in high-income countries. Nine databases were searched from 1st January 2008 to 1st March 2020. The quality of the included articles was determined using the Revised Assessment of Multiple Systematic Reviews tool (R-AMSTAR).ResultsThirteen systematic reviews were identified - reporting 51 unique primary studies. Fifty of these studies reported on interventions that changed the physical environment and one reported on changes to the economic environment. Only one primary study reported cost-effectiveness data. No reviews were identified that assessed the impact of social interventions. Given heterogeneity and quality issues, we found tentative evidence that the provision of housing/home modifications, improving the public realm, parks and playgrounds, supermarkets, transport, cycle lanes, walking routes, and outdoor gyms - can all have positive impacts on health outcomes - particularly physical activity. However, as no studies reported an assessment of variation in PROGRESS+ factors, the effect of these interventions on health inequalities remains unclear.ConclusionsPlace-based interventions can be effective at improving physical health, health behaviours and social determinants of health outcomes. High agentic interventions indicate greater improvements for those living in greater proximity to the intervention, which may suggest that in order for interventions to reduce inequalities, they should be implemented at a scale commensurate with the level of disadvantage. Future research needs to ensure equity data is collected, as this is severely lacking and impeding progress on identifying interventions that are effective in reducing health inequalities.Trial registrationPROSPERO CRD42019158309

Intersectionality and public understandings of health inequity in England: learning from the views and experiences of young adults

Objectives Attempts to reduce health inequities in England frequently prioritise some equity dimensions over others. Intersectionality highlights how different dimensions of inequity interconnect and are underpinned by historic and institutionalised power imbalances. We aimed to explore whether intersectionality could help us shed light on young adults’ understanding of health inequities. Study design The study incorporatedqualitative thematic analysis of primary data. Methods Online focus groups with young adults (n = 25) aged 18–30 living in three English regions (Greater London; South Yorkshire/Midlands; North-East England) between July 2020 and March 2021. Online semistructured interviews (n = 2) and text-based communication was conducted for participants unable to attend online groups. Results Young adults described experiencing discrimination, privilege, and power imbalances driving health inequity and suggested ways to address this. Forms of inequity included cumulative, within group, interacting, and the experience of privilege alongside marginalisation. Young adults described discrimination occurring in settings relevant to social determinants of health and said it adversely affected health and well-being. Conclusion Intersectionality, with its focus on discrimination and identity, can help public health stakeholders engage with young adults on health equity. An upstream approach to improving health equity should consider multiple and intersecting forms of discrimination along with their cultural and institutional drivers

Antibody Complementarity-Determining Regions (CDRs) Can Display Differential Antimicrobial, Antiviral and Antitumor Activities

Background: Complementarity-determining regions (CDRs) are immunoglobulin (Ig) hypervariable domains that determine specific antibody (Ab) binding. We have shown that synthetic CDR-related peptides and many decapeptides spanning the variable region of a recombinant yeast killer toxin-like antiidiotypic Ab are candidacidal in vitro. An alanine-substituted decapeptide from the variable region of this Ab displayed increased cytotoxicity in vitro and/or therapeutic effects in vivo against various bacteria, fungi, protozoa and viruses. the possibility that isolated CDRs, represented by short synthetic peptides, may display antimicrobial, antiviral and antitumor activities irrespective of Ab specificity for a given antigen is addressed here.Methodology/Principal Findings: CDR-based synthetic peptides of murine and human monoclonal Abs directed to: a) a protein epitope of Candida albicans cell wall stress mannoprotein; b) a synthetic peptide containing well-characterized B-cell and T-cell epitopes; c) a carbohydrate blood group A substance, showed differential inhibitory activities in vitro, ex vivo and/or in vivo against C. albicans, HIV-1 and B16F10-Nex2 melanoma cells, conceivably involving different mechanisms of action. Antitumor activities involved peptide-induced caspase-dependent apoptosis. Engineered peptides, obtained by alanine substitution of Ig CDR sequences, and used as surrogates of natural point mutations, showed further differential increased/unaltered/decreased antimicrobial, antiviral and/or antitumor activities. the inhibitory effects observed were largely independent of the specificity of the native Ab and involved chiefly germline encoded CDR1 and CDR2 of light and heavy chains.Conclusions/Significance: the high frequency of bioactive peptides based on CDRs suggests that Ig molecules are sources of an unlimited number of sequences potentially active against infectious agents and tumor cells. the easy production and low cost of small sized synthetic peptides representing Ig CDRs and the possibility of peptide engineering and chemical optimization associated to new delivery mechanisms are expected to give rise to a new generation of therapeutic agents.Department of Education, Universities and Research, Basque GovermentFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Istituto Superiore di Sanita, National Research Project on A.I.D.S.Cariparma Banking FoundationBrazilian National Research CouncilUniv Parma, Sez Microbiol, Dipartimento Patol, I-43100 Parma, ItalyUniv Basque Country, Fac Med Odontol, Dept Inmunol, Microbiol Parasitol, Bilbao, SpainUniv Basque Country, Dept Enfermeria I, Bilbao, SpainUniv Milan, Dipartimento Sci Cliniche L Sacco, Sez Malattie Infettive Immunopatol, Milan, ItalyUniv Studi Parma, Dipartimento Clin Med, Nefrol Sci Prev, Parma, ItalyUniversidade Federal de São Paulo, Departamento Microbiol, Imunol Parasitol, Unidade Oncol Expt, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Biofis, São Paulo, BrazilUniversidade Federal de São Paulo, Departamento Microbiol, Imunol Parasitol, Unidade Oncol Expt, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Biofis, São Paulo, BrazilDepartment of Education, Universities and Research, Basque Goverment: IT-264-07FAPESP: 06/50634-2Istituto Superiore di Sanita, National Research Project on A.I.D.S.: 50G.30Istituto Superiore di Sanita, National Research Project on A.I.D.S.: 40D.14Cariparma Banking Foundation: 2004.0190Brazilian National Research Council: research fellowshipWeb of Scienc

Investigations into, and development of, a lyophilized and formulated recombinant human factor IX produced from CHO cells

Objectives: To develop a recombinant human factor IX (rFIX) formulation equivalent to commercially available products in terms of cake appearance, residual moisture, proportion of soluble aggregates and activity maintenance for 3 months at 4–8 °C. Results: NaCl and low bulking agent/cryoprotectant mass ratio had a negative impact on cake quality upon lyophilisation for a wide range of formulations tested. Particular devised formulations maintained rFIX activity after lyophilization with a similar performance when compared with the rFIX formulated using the excipients reported for a commercially available FIX formulation (Benefix). rFIX remained active after 3 months when stored at 4 °C, though this was not the case with samples stored at 40 °C. Interestingly, particular formulations had an increase in residual moisture after 3 months storage, but not above a 3% threshold. All four formulations tested were equivalent to the Benefix formulation in terms of particle size distribution and cake appearance. Conclusions: Three specific formulations, consisting of surfactant polysorbate-80, sucrose or trehalose as cryoprotectant, mannitol or glycine as bulking agent, l-histidine as buffering agent, and NaCl added in the reconstitution liquid at 0.234% (w/v) were suitable for use with a CHO cell-derived recombinant FIX

Promoting respect and social inclusion for healthy ageing in the urban setting: a juxtaposition of research evidence, stakeholder perspectives and the views of older people.

Introduction: Population ageing and increasing urbanisation present challenges for public health policy and practice. Creating a supportive environment – as promoted by the WHO Age-Friendly Cities (AFCs) Initiative – is especially important for older people’s health. This thesis examines how views on strengthening respect and social inclusion in the urban setting differ among older people and city stakeholders, the extent to which their priorities are supported by evidence for health benefits, and the implications for public health policy. Methods: A systematic review was conducted of quantitative and qualitative evidence for the impact on health and wellbeing of interventions fostering respect and social inclusion in community-resident older adults. Photovoice was used to explore respect and social inclusion among 26 older people aged 60+ from four contrasting areas of Liverpool (UK). Perspectives on respect and social inclusion among 23 local policy makers and service providers were explored at interview. A photo-exhibition was then organised to generate meaningful discussions between the two groups. Synthesis compared findings for older people and city stakeholders, and assessed the extent to which priorities of both groups were supported by evidence from the systematic review. Results: Thirty-four quantitative evaluations included in the systematic review suggest that interventions on respect and social inclusion, particularly intergenerational and music and singing initiatives, may have an impact on psychological outcomes, wellbeing, subjective and physical health of older people. Fourteen qualitative studies identified some of the factors in the pathways to improved health outcomes (e.g. improved self-esteem and social relationships). Through photovoice methods, older people identified a wide range of enablers, barriers and potential solutions spanning services, the environment and city facilities. City stakeholders identified similar issues as older people, but were additionally concerned by impacts of budget cuts on provision and planning of respect and social inclusion. While some older people’s and city stakeholders’ priorities were supported by evidence (e.g. art and culture initiatives), there were no evaluations of the health/wellbeing impact of other important aspects for respect and social inclusion identified by older people and/or city stakeholders (e.g. attempts to promote affordability and accessibility of transportation). Discussion and Conclusions: Although city stakeholders appeared to understand many of the views of older people and vice versa, the former’s views were driven more by their need to address budgets constraints. Photovoice can be an effective tool to (i) engage older people, and (ii) incorporate their views into city planning. However, participants’ concerns about photographing difficult topics and producing ‘expected’ images need to be addressed. Future research should address previously neglected priorities identified by older people and city stakeholders. Systems thinking would help structure more inclusive evaluation of health impacts of AFC initiatives