Desenvolvimento e validação de uma escala de estigma social no local de trabalho associado ao novo vírus de Hepatite C

Aim: The purpose of this study was to develop a new scale to measure the social stigma of hepatitis C virus (HCV) in the workplace using a refined version of Link and colleagues’ (Link & Phelan, 2001, https://doi.org/10.1146/annurev.soc.27.1.363; Link, Yang, Phelan, & Collins, 2004, https://doi.org/10.1093/oxfordjournals.schbul.a007098) definition of social stigma. Methods: The new scale was developed over a multistage process that was guided by existing scales and focus groups. Two studies were conducted to validate the scale. The first, collected data from 224 employees and used exploratory factor analysis to remove unsatisfactory items. The second study collected data from 254 employees and used confirmatory factor analysis. Results: Results indicated that the new 32 item scale had acceptable reliability and validity. These results support the conceptualization of stigma as a latent construct that abstracts stereotyping, prejudice and intention to discriminate. Conclusion: Findings elucidate that HCV stigma can be operationalized as a general factor behind stereotyping, prejudice and intentions to discriminate in the workplace. This is an important conclusion because it may bring parsimony and coherence to a complex and dispersed literature. Additionally, the new scale may be used to study HCV stigma in the workplace.Objetivo: O objetivo do presente estudo foi desenvolver uma nova escala para medir o estigma social associado ao Vírus da Hepatite C (VHC) no local de trabalho utilizando uma versão melhorada da definição de estigma social de Link e colegas (Link & Phelan, 2001, https://doi.org/10.1146/annurev.soc.27.1.363; Link, Yang, Phelan, & Collins, 2004, https://doi.org/10.1093/oxfordjournals.schbul.a007098). Método: A nova escala foi desenvolvida através de um processo multifásico que foi guiado por escalas existentes e grupos focais. Dois estudos foram realizados para validar a escala. No primeiro, recolheram-se dados de 224 funcionários e recorreu-se à análise exploratória fatorial para remover itens insatisfatórios. No segundo estudo recolheram-se 254 funcionários e recorreu-se à análise fatorial confirmatória. Resultados: Os resultados indicaram que os novos 32 itens apresentam fiabilidade e validade aceitáveis. Estes resultados suportam a conceptualização do estigma enquanto um construto latente que transforma a e tereotipação, o preconceito e a intenção para discriminar em conceitos abstratos. Conclusão: Os resultados indicam que o estigma em relação ao VHC pode ser operacionalizado como um fator geral inerente à estereotipação, ao preconceito e à intenção para discriminar no local de trabalho. Esta conclusão é relevante no sentido em que pode trazer parcimónia e coerência a uma literatura complexa e dispersa. Adicionalmente, a nova escala poder ser usada para estudar o estigma associado ao VHC no local de trabalho

Disparity Outcomes in Patients Undergoing Pancreas Surgery at an Urban Tertiary Care Center

INTRODUCTION: Previous studies have shown significant disparities in pancreas cancer outcomes in African American (AA) compared to non-AA patients. Pancreas surgery continues to be associated with significant morbidity, however, there is little reported data on pancreas surgical outcomes by race. We sought to evaluate how race would affect surgical outcomes in an urban tertiary care center for patients undergoing pancreas surgery. METHODS: A retrospective single-center analysis of patients undergoing pancreas surgery between January 2013 and September 2021 was performed. Patient demographics and post-surgical complications were collected and stratified by race. Area Deprivation Index (ADI) was used to determine patient socioeconomic status. Charlson Comorbidity Index (CCI) was calculated for comorbidities. Clavien-Dindo (CD) complications, as well as postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE) and postpancreatectomy hemorrhage (PPH) were evaluated. Patient reoperation, readmission, and mortality in the 30- and 90- day period were collected and univariate and multivariate analyses were performed. RESULTS: Among 461 patients, 82% (N = 378) were nonAA and 18% (N = 83) were AA. Age and sex were found to be significantly different between the two groups, while ADI and CCI were not. Length of stay (LOS), POPF, PPH, PPH grade C and intra-abdominal abscess (IAA) were found to be significant on univariate analysis in the AA cohort. On multivariate analysis, LOS (OR 4.0; 95% CI 2.0-5.7; p \u3c 0.001), POPF (OR 0.6; 95% CI 0.4-1.0; p = 0.043), PPH (OR 0.5; 95% CI 0.2-0.9; p = 0.022), PPH grade C (OR 0.2; 95% CI 0.1-0.7; p = 0.017) and IAA (OR 0.4; 95% CI 0.2-0.9; p = 0.017) were still significantly higher in the AA cohort. CONCLUSIONS: AA patients undergoing pancreas surgery were noted to have a longer LOS, higher incidence of POPF, PPH and IAA compared to non-AA patients. However, no significant difference was seen in reoperation rates, major CD complications, or 30- and 90-day readmission. Elucidating patient selection, tumor biology, and preoperative treatment algorithms may shed additional insight on the differences in surgical outcomes in this particular patient cohort

Barriers, challenges and way forward for implementation of person centered care model of patient and physician consultation: a survey of patients’ perspective from Eastern Mediterranean countries

Background: Person-Centered Care (PCC) is now considered a mandatory approach in Patient-Physician consultation. The aim of the study was to identify patients’ perception regarding barriers and possible remedies for implementation of PCC in Eastern Mediterranean Region (EMR). Methods: A cross-sectional multi-country study was conducted in six countries of EMR during May 2014 to October 2014. Expert Family Physicians from each country were identified and asked to participate in the study. The Family Physicians then recruited Patients from their own clinics (\u3e18 years). Data analysis was performed on SPSS 19 and results are reported in the form of proportions, odds ratios and 95% confidence intervals. Results: A total of 234 patients were recruited, 60.6% were aged between 20 to 30 years and 36.3% of them were males. 56% of the patients preferred Person-Centered Care model for patient-physician consultation. The major barriers identified by patients in its implementing were; time constraints (73.9%, OR: 1.5; 95% CI: 0.86-2.78), doctors desire to control patient (OR: 2.6; 95% CI: 1.55-4.49), cultural and religious reasons (52.1%), increased cost (50.9%). Patients responded that increased cost related to Person-Centered Care practice would be acceptable (58.1%), if increase proved to be in the interest of better health and care outcomes (40.6%). Conclusion: Person-Centered Care (PCC) is associated with significant barriers in its implementation in Eastern Mediterranean Region. These barriers can be overcome in the interest of better health and care related outcomes

Health promotion, disease prevention and periodic health checks: perceptions and practice among family physicians in Eastern Mediterranean region

Introduction: The aim of this study was to identify the current practices and perceptions of family physicians regarding health promotion, disease prevention including periodic screening and health checks in Eastern Mediterranean Region. Methods: A multi-country cross-sectional study was conducted in six countries of EMR, from September 2014 to March 2015. Family Physicians who were currently practicing in different countries of EMR were invited to participate in the study through email. A pre-tested structured questionnaire was used for data collection. Data was entered and analyzed on SPSS 19 and logistic regression analysis was performed. Results: A total of 100 physicians’ data was included in the final analysis. The majority were female physicians (76%): 63% were 25 to 35 years of age. Approximately 53% of Family physicians always recommend periodic screening and health checks to their patients. The common screening question asked to patients in medical history was related to their blood pressure (86%). Almost all (99%) of the Family physicians believe they should conduct periodic health checks. Those who had postgraduate training in Family Medicine (OR: 0.5; 95% CI: 0.39-1.67) and attended CME sessions regularly (OR: 0.11; 95% CI: 0.01-0.93), are more likely to recommend periodic screening and health checks to their patients. Conclusion: Periodic screening and health check is an important strategy to prevent disease and maintain health. It is an underutilized practice and a great need exists for its implementation in family practice

Preparation, characterization, and radiolabeling of [68Ga]Nodaga-pamidronic acid: a potential PET bone imaging agent

Early diagnosis of bone metastases is crucial to prevent skeletal-related events, and for that, the non-invasive techniques to diagnose bone metastases that make use of image-guided radiopharmaceuticals are being employed as an alternative to traditional biopsies. Hence, in the present work, we tested the efficacy of a gallium-68 (68Ga)-based compound as a radiopharmaceutical agent towards the bone imaging in positron emitting tomography (PET). For that, we prepared, thoroughly characterized, and radiolabeled [68Ga]Ga-NODAGA-pamidronic acid radiopharmaceutical, a 68Ga precursor for PET bone cancer imaging applications. The preparation of NODAGA-pamidronic acid was performed via the N-Hydroxysuccinimide (NHS) ester strategy and was characterized using liquid chromatography-mass spectrometry (LC-MS) and tandem mass spectrometry (MSn). The unreacted NODAGA chelator was separated using the ion-suppression reverse phase-high performance liquid chromatography (RP-HPLC) method, and the freeze-dried NODAGA-pamidronic acid was radiolabeled with 68Ga. The radiolabeling condition was found to be most optimum at a pH ranging from 4 to 4.5 and a temperature of above 60 °C. From previous work, we found that the pamidronic acid itself has a good bone binding affinity. Moreover, from the analysis of the results, the ionic structure of radiolabeled [68Ga]Ga-NODAGA-pamidronic acid has the ability to improve the blood clearance and may exert good renal excretion, enhance the bone-to-background ratio, and consequently the final image quality. This was reflected by both the in vitro bone binding assay and in vivo animal biodistribution presented in this research

Eucalyptus-derived essential oils alleviate microbes and modulate inflammation by suppressing superoxide and elastase release

The Eucalyptus tree, belonging to the myrtle family, grows all over the world for its pharmaceutical and industrial benefits. In this article, we present a comparative analysis of the chemical composition of the hydrodistilled oils obtained from three different Eucalyptus species growing in Egypt viz. E. citriodora, E. camaldulensis, and E. ficifolia. Gas Chromatography-Mass Spectrometric guided analysis resulted in the identification of a total of 20 metabolites in E. citriodora oil with citronellal (54.9%) and citronellol (25.4%) being the most dominant components. β-cymene (12.7%) and 1,8-cineole (11.7%) were the major volatile constituents identified in E. camaldulensis oil, while trans-β-ocimene (22.4%), 1,8-cineole (13.5%), and L-trans-pinocarveol (12.5%) were the dominating components in the oil of E. ficifolia. The essential oils of the studied species were evaluated for their in vitro anti-inflammatory, antiviral including anti-SARS-CoV-2 (severe acute respiratory syndrome corona virus 2), antibacterial, and antifungal activities. E. citriodora oil displayed the highest inhibitory activity on the release of the superoxide radical (32%) and elastase enzyme (31%) in human neutrophils, while E. ficifolia oil had enhancing effects on elastase. The latter showed significant antiviral effects against hepatitis A, herpes simplex, and coxsackie viruses with IC50 values at 2.1, 2.5, and 5.6 μg/mL, respectively. Moderate antibacterial and antifungal activities were observed for Eucalyptus oils with Staphylococcus aureus being the most susceptible bacterial strain. E. ficifolia oil, similarly, displayed the best antibacterial activity with minimum inhibitory concentration (MIC) value at ca. 25 μg/mL (for S. aureus). On the contrary, E. camaldulensis oil was the most active against Candida albicans with an MIC value at 45 μg/mL. In silico studies were performed with a number of macromolecular drug targets for confirming the biological activities of the identified compounds and for interpreting their ADME (absorption-distribution-metabolism-elimination) parameters

Countdown to 2030 : tracking progress towards universal coverage for reproductive, maternal, newborn, and child health

Building upon the successes of Countdown to 2015, Countdown to 2030 aims to support the monitoring and measurement of women's, children's, and adolescents' health in the 81 countries that account for 95% of maternal and 90% of all child deaths worldwide. To achieve the Sustainable Development Goals by 2030, the rate of decline in prevalence of maternal and child mortality, stillbirths, and stunting among children younger than 5 years of age needs to accelerate considerably compared with progress since 2000. Such accelerations are only possible with a rapid scale-up of effective interventions to all population groups within countries (particularly in countries with the highest mortality and in those affected by conflict), supported by improvements in underlying socioeconomic conditions, including women's empowerment. Three main conclusions emerge from our analysis of intervention coverage, equity, and drivers of reproductive, maternal, newborn, and child health (RMNCH) in the 81 Countdown countries. First, even though strong progress was made in the coverage of many essential RMNCH interventions during the past decade, many countries are still a long way from universal coverage for most essential interventions. Furthermore, a growing body of evidence suggests that available services in many countries are of poor quality, limiting the potential effect on RMNCH outcomes. Second, within-country inequalities in intervention coverage are reducing in most countries (and are now almost non-existent in a few countries), but the pace is too slow. Third, health-sector (eg, weak country health systems) and non-health-sector drivers (eg, conflict settings) are major impediments to delivering high-quality services to all populations. Although more data for RMNCH interventions are available now, major data gaps still preclude the use of evidence to drive decision making and accountability. Countdown to 2030 is investing in improvements in measurement in several areas, such as quality of care and effective coverage, nutrition programmes, adolescent health, early childhood development, and evidence for conflict settings, and is prioritising its regional networks to enhance local analytic capacity and evidence for RMNCH

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Subnational mapping of HIV incidence and mortality among individuals aged 15–49 years in sub-Saharan Africa, 2000–18 : a modelling study

Background: High-resolution estimates of HIV burden across space and time provide an important tool for tracking and monitoring the progress of prevention and control efforts and assist with improving the precision and efficiency of targeting efforts. We aimed to assess HIV incidence and HIV mortality for all second-level administrative units across sub-Saharan Africa. Methods: In this modelling study, we developed a framework that used the geographically specific HIV prevalence data collected in seroprevalence surveys and antenatal care clinics to train a model that estimates HIV incidence and mortality among individuals aged 15–49 years. We used a model-based geostatistical framework to estimate HIV prevalence at the second administrative level in 44 countries in sub-Saharan Africa for 2000–18 and sought data on the number of individuals on antiretroviral therapy (ART) by second-level administrative unit. We then modified the Estimation and Projection Package (EPP) to use these HIV prevalence and treatment estimates to estimate HIV incidence and mortality by second-level administrative unit. Findings: The estimates suggest substantial variation in HIV incidence and mortality rates both between and within countries in sub-Saharan Africa, with 15 countries having a ten-times or greater difference in estimated HIV incidence between the second-level administrative units with the lowest and highest estimated incidence levels. Across all 44 countries in 2018, HIV incidence ranged from 2 ·8 (95% uncertainty interval 2·1–3·8) in Mauritania to 1585·9 (1369·4–1824·8) cases per 100 000 people in Lesotho and HIV mortality ranged from 0·8 (0·7–0·9) in Mauritania to 676· 5 (513· 6–888·0) deaths per 100 000 people in Lesotho. Variation in both incidence and mortality was substantially greater at the subnational level than at the national level and the highest estimated rates were accordingly higher. Among second-level administrative units, Guijá District, Gaza Province, Mozambique, had the highest estimated HIV incidence (4661·7 [2544·8–8120·3]) cases per 100000 people in 2018 and Inhassunge District, Zambezia Province, Mozambique, had the highest estimated HIV mortality rate (1163·0 [679·0–1866·8]) deaths per 100 000 people. Further, the rate of reduction in HIV incidence and mortality from 2000 to 2018, as well as the ratio of new infections to the number of people living with HIV was highly variable. Although most second-level administrative units had declines in the number of new cases (3316 [81· 1%] of 4087 units) and number of deaths (3325 [81·4%]), nearly all appeared well short of the targeted 75% reduction in new cases and deaths between 2010 and 2020. Interpretation: Our estimates suggest that most second-level administrative units in sub-Saharan Africa are falling short of the targeted 75% reduction in new cases and deaths by 2020, which is further compounded by substantial within-country variability. These estimates will help decision makers and programme implementers expand access to ART and better target health resources to higher burden subnational areas

Estimating global injuries morbidity and mortality : methods and data used in the Global Burden of Disease 2017 study

Background: While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria. Methods: In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced. Results: GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes. Conclusions: GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future