Adaptation with robustness: the case for clarity on the use of 'resilience' in health systems and global health

[Extract] In the last 3 years, the concept of resilience has received much attention in the health systems and global health literature, triggered by the Ebola outbreak in West Africa (which, in 2014, exposed a lack of health system and global health resilience) and followed in 2016 by the Global Symposium on Health Systems Research (with the theme ‘Resilient and responsive health systems in a changing world’). Resilience has been widely embraced in the literature,1–5 and also by the immediate past6 and current7 WHO Director General. BMJ Global Health has also published several reports applying the concept of resilience to how health systems respond to acute shocks and chronic stress

Call for papers-the Alma Ata Declaration at 40: reflections on primary healthcare in a new era

[Extract] The Declaration of AlmaAta was a watershed moment in global health. Indeed, in the four decades since its launch, there is a sense in which all declarations or communiques issued at global health conferences have been aiming for comparable historical impact. Launched in 1978 at the International Conference on Primary HealthCare, the declaration called for 'Health for All by the Year 2000 and promoted comprehen-sive primary healthcare as the preferred back-bone of national health systems alongside a number of other key elements including an emphasis on global cooperation and peace; a new economic order to underpin it; acknowledgement of the social determinants of health; involvement of all sectors in the promotion of health; community participation in planning, implementation and regulation of primary healthcare; and a focus on achieving equity in health status. In totality, these elements—which became known as the 'primary healthcare approach' —flagged a paradigm shift away from the medical model of health planning and service delivery and towards a 'social model' with an emphasis on addressing social determinants of health via intersectoral public health and preventive strategies based on local ownership and community participation

Etude comparative de deux produits de neem (huile et poudre) sur les stades préimaginaux du moustique Culex quinquefasciatus(Diptera : Culicidae)

Comparative study of two neem products (oil and powder) on preimaginal stages of  Culex quinquefasciatus mosquito (Diptera: Culicidae)Neem (Azadirachta indica) products (neem oil formulated 1 % and neem powder 0.3 %), manufactured by a Senegalese industry (SENCHIM), were applied to mosquito (Culex quinquefasciatus) larvae and nymphs. The doses products were from 0.02 to 0.038 %  (neem oil) and 0.2 to 2 % (powder). In laboratory conditions, results showed that neem powder was more toxic at larval stage (mortalities between 86.1 and 100 %) than nymphal stage (between 14.5 and 95.9 % adults flow away). Neem oil formulated was effective as well as larval stage (mortality between 52.1 and 80 %) than nymphal stage (between 0 and 14 % adults flown away). The histopathological study  reveals that neem products act upon larval digestive system after ingestion, whereas for nymphs only contact effects are showed. Neem oil formulated 1 % appears more effective than neem powder 0.3 % for mosquitoes control in aquatic environment

Aménagements hydro-agricoles et santé (vallée du fleuve Sénégal)

Les schistosomiases sont actuellement absentes du périmètre irrigué MO 6bis (moyenne vallée du fleuve Sénégal). Les hôtes intermédiaires (#Biomphalaria et #Bulinus) n'ont pas été, pour l'instant tout au moins, rencontrés dans la zone aménagée. Les analyses coprologiques effectuées sur bovins à proximité du périmètre, ont montré que 40% d'entre eux étaient atteints de strongyloses alors que les trématodoses sont absentes. (Résumé d'auteur

How to assess and prepare health systems in low- and middle-income countries for integration of services: a systematic review

Despite growing support for integration of frontline services, a lack of information about the pre-conditions necessary to integrate such services hampers the ability of policy makers and implementers to assess how feasible or worthwhile integration may be, especially in low- and middle-income countries (LMICs). We adopted a modified systematic review with aspects of realist review, including quantitative and qualitative studies that incorporated assessment of health system preparedness for and capacity to implement integrated services. We searched Medline via Ovid, Web of Science and the Cochrane library using terms adapted from Dudley and Garner’s systematic review on integration in LMICs. From an initial list of 10 550 articles, 206 were selected for full-text review by two reviewers who independently reviewed articles and inductively extracted and synthesized themes related to health system preparedness. We identified five ‘context’ related categories and four health system ‘capability’ themes. The contextual enabling and constraining factors for frontline service integration were: (1) the organizational framework of frontline services, (2) health care worker preparedness, (3) community and client preparedness, (4) upstream logistics and (5) policy and governance issues. The intersecting health system capabilities identified were the need for: (1) sufficiently functional frontline health services, (2) sufficiently trained and motivated health care workers, (3) availability of technical tools and equipment suitable to facilitate integrated frontline services and (4) appropriately devolved authority and decision-making processes to enable frontline managers and staff to adapt integration to local circumstances. Moving beyond claims that integration is defined differently by different programs and thus unsuitable for comparison, this review demonstrates that synthesis is possible. It presents a common set of contextual factors and health system capabilities necessary for successful service integration which may be considered indicators of preparedness and could form the basis for an ‘integration preparedness tool’

Global health security: where is the data to inform health system strengthening?

[Extract] The Ebola outbreak in West Africa (2013–2016) triggered a renewed interest and sense of urgency about global health security. A surge of reports and publications ensued, examining various aspects of emerging infectious disease outbreaks. In 2016, Olivero and colleagues published a biogeographical approach mapping favourable conditions that facilitated the Ebola outbreak, in terms of environmental factors and the presence of potential host animals.1 Constructing biological vulnerability maps has value to guide preparations for future emerging infectious disease outbreaks, especially in low-income and middle-income countries. But perhaps more important is the need to develop similar ‘vulnerability maps’ to capture the ability of health systems to prevent or respond to major infectious disease challenges. Without a health system vulnerability map, or the public availability of the data to generate it, efforts to achieve global health security in relation to emerging infectious disease outbreaks will likely be limited and post hoc, rather than pre-emptive and strategic. Unfortunately, the revived interest in global health security has not been matched with commensurate action. In 2014, the G7 (Group of Seven) endorsed the Global Health Security Agenda (GHSA), a partnership of governments and international organisations with the goal of accelerating the achievement of the core disease outbreak preparedness and response capacities as required by the International Health Regulations, but progress has been limited

Up-regulation of the P2Y2 receptor by cytokines in neuronal cells

Abstract only availableAlzheimer's Disease (AD) is characterized by inflammation and neurodegeneration in the brain due to the presence of extracellular amyloid beta (A β) plaques and neurofibrillary tangles. Microglial and astrocyte cells associated with these plaques and tangles have been shown to release cytokines in AD patients, which have a proinflammatory effect on the brain. The P2Y2 receptor (P2Y2R) is a receptor protein that is up-regulated in response to damage or stress in a variety of tissues, including blood vessels and salivary gland epithelium. Recently our laboratory has shown that activation of the P2Y2R enhances α -secretase-dependent amyloid precursor protein (APP) processing. APP is proteolytically processed by β - and γ -secretases to release neurodegenerative A β. Alternatively, APP can be cleaved within the A β domain by α -secretase releasing the non-amyloidogenic product, sAPP α, which has been shown to have neuroprotective properties. Primary neurons have low P2Y2R expression, however, it has been demonstrated that cytokines up-regulate P2Y2R in smooth muscle cells. Therefore, this study will explore if cytokines up-regulate P2Y2R expression in primary rat neurons and in SH-SY5Y human neuroblastoma cells. Primary rat neurons and SH-SY5Y human neuroblastoma cells were plated on glass cover slips 24 or 48 hours with individual treatment, or a combination of, human interleukin-1 β (IL1- β), tumor necrosis factor α (TNF α), and interferon γ (IF γ). P2Y2R activity was measured by increases in intracellular calcium concentration ([Ca2+]i ) in response to the P2Y2R agonist UTP. Results support the hypothesis that P2Y2R is up-regulated by cytokines in neuronal cells. Furthermore, real-time PCR results indicate a two-fold increase in P2Y2R mRNA after cytokine treatment. Therefore, activation of the up-regulated P2Y2R in stressed neurons generates a neuroprotective (sAPP α) rather than neurodegenerative (A β) peptide. These results could have a substantial impact on the understanding and treatment of neurological disorders such as AD.Life Sciences Undergraduate Research Opportunity Progra

Etudes comparatives sur les bovins N'Dama de haute Casamance pour évaluer leur trypanotolérance en fonction de la couleur de leur robe

Les techniques les plus modernes pour la diagnose des trypanosomoses: (technique de Woo, examen sur lames, immunofluorescence, test micro ELISA, test immunospécifique par comptage enzymatique) ont été utilisées sur du bétail N'Dama de Haute-Casamance, au Sénégal, pour vérifier si la qualité de leur trypanotolérance est en relation avec la couleur de leur robe, compte tenu de la réputation qu'ont les N'Dama de couleur fauve d'être les plus résistants. Des observations faites, qui ont porté sur 210 sujets pour les examens hématologiques et parasitaires, et sur 260 pour les études de sérologie, il résulte que les N'Dama de couleur fauve ne sont ni plus ni moins trypanotolérants que ceux à robe blanche, noire ou pie, ces derniers ayant souvent, par ailleurs, une remarquable conformation d'animaux de trait ou de boucherie. Il n'y a donc apparemment aucune raison qui justifie le choix de la seule couleur fauve comme critère de race plus résistante aux trypanosomoses. Les auteurs préconisent donc l'abandon de ce critère racial, avec le bénéfice a en attendre au plan de la sélection et de la diffusion d'animaux de cette rac