CLTS plus : making CLTS ever more inclusive

If CLTS is to eliminate open defecation, issues of disability inclusion must be fully addressed. Research in Malawi aimed to discover if WASH practitioners, after a short training, could implement CLTS in a more inclusive way, and whether this made a difference to disabled people in the community, in terms of access to sanitation and hygiene facilities. After a 3-day training, CLTS implementers designed and implemented a CLTS+ Action Plan, in which additional triggering activities were introduced, and more attention paid to households with disabled and older people post-triggering. This CLTS+ intervention resulted in increased awareness among implementers and community members of the access needs of older and disabled people, and in adaptations to improve accessibility of some household latrines. Endline data will tell us whether this has resulted in improved outcomes for disabled and older people. Further piloting will be needed to explore how to incorporate this training into regular CLTS capacity building

Development of an international comorbidity education framework.

CONTEXT: The increasing number of people living with multiple chronic conditions in addition to an index condition has become an international healthcare priority. Health education curricula have been developed alongside single condition frameworks in health service policy and practice and need redesigning to incorporate optimal management of multiple conditions. AIM: Our aims were to evaluate current teaching and learning about comorbidity care amongst the global population of healthcare students from different disciplines and to develop an International Comorbidity Education Framework (ICEF) for incorporating comorbidity concepts into health education. METHODS: We surveyed nursing, medical and pharmacy students from England, India, Italy and Sweden to evaluate their understanding of comorbidity care. A list of core comorbidity content was constructed by an international group of higher education academics and clinicians from the same disciplines, by searching current curricula and analysing clinical frameworks and the student survey data. This list was used to develop the International Comorbidity Education Framework. RESULTS: The survey sample consisted of 917 students from England (42%), India (48%), Italy (8%) and Sweden (2%). The majority of students across all disciplines said that they lacked knowledge, training and confidence in comorbidity care and were unable to identify specific teaching on comorbidities. All student groups wanted further comorbidity training. The health education institution representatives found no specific references to comorbidity in current health education curricula. Current clinical frameworks were used to develop an agreed list of core comorbidity content and hence an International Comorbidity Education Framework. CONCLUSIONS: Based on consultation with academics and clinicians and on student feedback we developed an International Comorbidity Education Framework to promote the integration of comorbidity concepts into current healthcare curricula

Th2 and Th17 inflammatory pathways are reciprocally regulated in asthma

Increasing evidence suggests that asthma is a heterogeneous disorder regulated by distinct molecular mechanisms. Here, in a cross-sectional study of asthmatics of varying severity (n=51), endobronchial tissue gene expression analysis revealed three major patient clusters: Th2-high, Th17-high, and Th2/Th17-low. Th2-high and Th17-high patterns were mutually exclusive in individual patient samples, and their gene signatures were inversely correlated and differentially regulated by IL-13 and IL-17A. To understand this dichotomous pattern of Th2 and Th17 signatures, we investigated the potential of type 2 cytokine suppression in promoting Th17 responses in a preclinical model of allergen induced asthma. Neutralization of IL-4 and/or IL-13 resulted in increased Th17 cells and neutrophilic inflammation in the lung. However, neutralization of IL-1 and IL-17 protected subjects from eosinophilia, mucus hyperplasia, airway hyperreactivity and abolished the neutrophilic inflammation, suggesting that combination therapies targeting both pathways may maximize therapeutic efficacy across a patient population comprising both Th2 and Th17 endotypes