Keeping the Lifeline Open: Remittances and Markets in Somalia

Somalia receives more money from migrants abroad than from humanitarian and development assistance and foreign direct investment combined. Now, these remittances to Somalia are under threat. Somali-American Money Transfer Operators (MTOs), a critical link to a country that has been mostly cut off from the international banking system, need bank accounts in the United States in order to complete money transfers to Somalia. Though these MTOs have invested significantly in compliance, banks in the US have steadily closed their accounts and declined to open new ones. Further account closures for Somali-American MTOs would be disastrous for Somalia's recovery and would dramatically reduce the transparency and security of remittances

Steelcase workshop

Présentation réalisée dans le cadre des rencontres du réseau ITREP (REPTIC

Macrophage Migration Inhibitory Factor Deficiency Is Associated With Impaired Killing of Gram-Negative Bacteria by Macrophages and Increased Susceptibility to Klebsiella pneumoniae Sepsis

The cytokine macrophage migration inhibitory factor (MIF) is an important component of the early proinflammatory response of the innate immune system. However, the antimicrobial defense mechanisms mediated by MIF remain fairly mysterious. In the present study, we examined whether MIF controls bacterial uptake and clearance by professional phagocytes, using wild-type and MIF-deficient macrophages. MIF deficiency did not affect bacterial phagocytosis, but it strongly impaired the killing of gram-negative bacteria by macrophages and host defenses against gram-negative bacterial infection, as shown by increased mortality in a Klebsiella pneumonia model. Consistent with MIF's regulatory role of Toll-like 4 expression in macrophages, MIF-deficient cells stimulated with lipopolysaccharide or Escherichia coli exhibited reduced nuclear factor κB activity and tumor necrosis factor (TNF) production. Addition of recombinant MIF or TNF corrected the killing defect of MIF-deficient macrophages. Together, these data show that MIF is a key mediator of host responses against gram-negative bacteria, acting in part via a modulation of bacterial killing by macrophage

Prevalence of patients “at risk of malnutrition” and nutritional routines among surgical and non-surgical patients at a large university hospital during the years 2008–2018

Background & aims: Being “at risk of malnutrition”, which includes both malnutrition and the risk to be so, is associated with increased morbidity and mortality in both surgical and non-surgical patients. Several strategies and guidelines have been introduced to prevent and treat this, but the effects are scarcely investigated. This study aims to evaluate the long-term effects of these efforts by examining trends concerning: 1) the prevalence of patients «at risk of malnutrition» and 2) the use of nutritional support and diagnostic coding related to malnutrition over an 11-year period in a large university hospital. Moreover, we wanted to investigate if there was a difference in trends between surgical and non-surgical patients. Methods: From 2008 to 2018, Haukeland University Hospital, Norway, conducted 34 point-prevalence surveys to investigate the prevalence of patients «at risk of malnutrition», as defined by Nutritional Risk Screening 2002, and the use of nutritional support at the hospital. Diagnostic coding included ICD-10 codes related to malnutrition (E43, E44 and E46) at hospital discharge, which were extracted from the electronic patient journal. Trend analysis by calendar year was investigated using logistic regression models with and without adjustment for age (continuous), gender (male/female) and Charlson Comorbidity Index (none, mild, moderate or severe). Results: The number of patients included in the study was 18 933, where 52.1% were male and the median (25th, 75th percentile) age was 65 (51, 76) years. Of these, 5121 (27%) patients were identified to be «at risk of malnutrition». Fewer surgical patients (21.2%) were «at risk of malnutrition», as compared to non-surgical patients (30.9%) (p < 0.001). Adjusted trend analysis did not identify any change in the prevalence of patients «at risk of malnutrition» from 2008 to 2018. The percentage of patients «at risk of malnutrition» who received nutritional support increased from 61.6% in 2008 to 71.9% in 2018 (p < 0.001), with a range from 55.6 to 74.8%. This trend was seen for both surgical and non-surgical patients (p < 0.001 for both). Similarly, dietitians were more involved in the patients’ treatment (range: 3.8–16.7%), and there was increased use of ICD-10 codes related to malnutrition during the study period (range: 13.0–41.8%) (p < 0.001). These trends were seen for both surgical patients and non-surgical patients (p < 0.001), despite use being less common for surgical patients, as compared to non-surgical patients (p < 0.001). Conclusions: This large hospital study shows no apparent change in the prevalence of patients «at risk of malnutrition» from 2008 to 2018. However, more patients «at risk of malnutrition», both surgical and non-surgical, received nutritional support, treatment from a dietitian and a related ICD-10 code over the study period, indicating improved nutritional routines as a result of the implementation of nutritional guidelines and strategies.publishedVersio

Nutritional risk, nutrition plan and risk of death in older health care service users with chronic diseases: A register-based cohort study

Background and aims Nutritional risk in older health care service users is a well-known challenge. Nutritional risk screening and individualised nutrition plans are common strategies for preventing and treating malnutrition. The aim of the current study was to investigate whether nutritional risk is associated with an increased risk of death and whether a nutrition plan to those at nutritional risk could reduce this potential risk of death in community health care service users over 65 years of age. Methods We conducted a register-based, prospective cohort study on older health care service users with chronic diseases. The study included persons ≥65 years of age receiving health care services from all municipalities in Norway from 2017 to 2018 (n = 45,656). Data on diagnoses, nutritional risk, nutrition plan and death were obtained from the Norwegian Registry for Primary Health Care (NRPHC) and the Norwegian Patient Registry (NPR). We used Cox regression models to estimate the associations of nutritional risk and use of a nutrition plan with the risk of death within three and six months. Analyses were performed within the following diagnostic strata: chronic obstructive pulmonary disease (COPD), dementia, type 2 diabetes, stroke, osteoporosis and heart failure. The analyses were adjusted for age, gender, living situation and comorbidity. Results Of the 45,656 health care service users, 27,160 (60%) were at nutritional risk, and 4437 (10%) and 7262 (16%) died within three and six months, respectively. Among those at nutritional risk, 82% received a nutrition plan. Health care service users at nutritional risk had an increased risk of death compared to health care service users not at nutritional risk (13% vs 5% and 20% vs 10% at three and six months). Adjusted hazard ratios (HRs) for death within six months were 2.26 (95% confidence interval (CI): 1.95, 2.61) for health care service users with COPD, 2.15 (1.93, 2.41) for those with heart failure, 2.37 (1.99, 2.84) for those with osteoporosis, 2.07 (1.80, 2.38) for those with stroke, 2.65 (2.30, 3.06) for those with type 2 diabetes and 1.94 (1.74, 2.16) for those with dementia. The adjusted HRs were larger for death within three months than death within six months for all diagnoses. Nutrition plans were not associated with the risk of death for health care service users at nutritional risk with COPD, dementia or stroke. For health care service users at nutritional risk with type 2 diabetes, osteoporosis or heart failure, nutrition plans were associated with an increased risk of death within both three and six months (adjusted HR 1.56 (95% CI: 1.10, 2.21) and 1.45 (1.11, 1.88) for type 2 diabetes; 2.20 (1.38, 3.51) and 1.71 (1.25, 2.36) for osteoporosis and 1.37 (1.05, 1.78) and 1.39 (1.13, 1.72) for heart failure). Conclusions Nutritional risk was associated with the risk of earlier death in older health care service users with common chronic diseases in the community. Nutrition plans were associated with a higher risk of death in some groups in our study. This may be because we could not control sufficiently for disease severity, the indication for providing a nutrition plan or the degree of implementation of nutrition plans in community health care.publishedVersio

The Parents under Pressure parenting programme for families with fathers receiving treatment for opioid dependency: the PuP4Dads feasibility study

Background: The impact of parental drug use on children is a major public health problem. However, opioid-dependent fathers have been largely ignored in parenting research. Objective: Implement and test the feasibility and acceptability of the ‘Parents under Pressure’ parenting programme for opioid-dependent fathers and their families (PuP4Dads) and determine whether a full scale evaluation could be conducted. Design: Mixed methods feasibility study. Setting: Two non-NHS family support services for parents who use drugs in Scotland. Participants: Fathers prescribed Opioid Substitution Therapy (n=25), their partners (n=17) and children; practitioners; supervisors, service managers; referrers. Intervention: Home-visiting programme, including an integrated theoretical framework, case formulation, collaborative goal setting, and modules designed to improve parenting, the caregiving environment and child welfare. Delivered flexibly over six months by accredited practitioners. Main outcome measures: Feasibility progression criteria: recruitment target (n=24 fathers); acceptability of PUP; father engagement in the study (66% complete programme; minimum 10 complete baseline and post-treatment interviews); engagement in qualitative interviews (fathers n=10 minimum; practitioners 90% uptake; managers 80% uptake); focus groups (referrers 80% uptake); adequate fidelity; no adverse events. Data sources: Researcher administered validated questionnaires: Brief Child Abuse Potential; Parenting Sense of Competence; Difficulties in Emotion Regulation; Paternal/Maternal Antenatal Attachment; Emotional Availability (video); Infant Toddler Social Emotional Assessment/Strengths and Difficulties; Conflict Tactics Scale; Treatment Outcomes Profile; EQ-5D-5L. Other sources: Parent-completed service use (economic measure); Social work child protection data; NHS opioid substitution therapy prescription data. Practitioner reported attendance data. Interviews with fathers, mothers, practitioners (n=8), supervisors (n=2), service managers (n=7); focus groups with referrers (n=28); ‘expert event’ with stakeholders (n=39). Results: PuP was successfully delivered within non-NHS settings and acceptable and suitable for the study population. Referrals (n=44) resulted in 38 (86%) eligible fathers, of whom 25 (66%) fathers and 17 partners/mothers consented to participate. Most fathers reported no previous parenting support. Intervention engagement: 248 sessions delivered to 20 fathers and 14 mothers who started the intervention; 14 fathers (10 mothers) completed ≥ six sessions; six fathers (4 mothers) completed ≤ five sessions. Father and mother attendance rates were equal (mean: 71%). Median length of engagement: fathers 26 weeks, mothers 30 weeks. Research interview completion rates for fathers: 23 at baseline, 16 follow-up one, 13 follow-up two. Measures: well tolerated; suitability of some measures dependent on family circumstances; researcher administered questionnaires resulted in little missing data. Perceived benefits of PuP4Dads from parent, practitioner and manager perspectives: therapeutic focus on fathers, improved parental emotion regulation; understanding and responding to child’s needs; better multi-agency working; programme a good fit with practice ‘ethos’ and policy agenda. Learning highlighted importance of: service-wide adoption and implementation support; strategies to improve recruitment and retention of fathers; managing complex needs of both parents concurrently; understanding contextual factors affecting programme delivery and variables affecting intervention engagement and outcomes. Limitations: Lack of emotional availability and economic (service use) data. Conclusions: A larger evaluation of PuP4Dads is feasible. Future work: Demonstrating the effectiveness of PuP4Dads and the cost implications. Better understanding of how the intervention works, for whom, under what circumstances, and why

Increased chromosomal radiosensitivity in asymptomatic carriers of a heterozygous BRCA1 mutation

Background: Breast cancer risk increases drastically in individuals carrying a germline BRCA1 mutation. The exposure to ionizing radiation for diagnostic or therapeutic purposes of BRCA1 mutation carriers is counterintuitive, since BRCA1 is active in the DNA damage response pathway. The aim of this study was to investigate whether healthy BRCA1 mutations carriers demonstrate an increased radiosensitivity compared with healthy individuals. Methods: We defined a novel radiosensitivity indicator (RIND) based on two endpoints measured by the G2 micronucleus assay, reflecting defects in DNA repair and G2 arrest capacity after exposure to doses of 2 or 4 Gy. We investigated if a correlation between the RIND score and nonsense-mediated decay (NMD) could be established. Results: We found significantly increased radiosensitivity in the cohort of healthy BRCA1 mutation carriers compared with healthy controls. In addition, our analysis showed a significantly different distribution over the RIND scores (p = 0.034, Fisher’s exact test) for healthy BRCA1 mutation carriers compared with non-carriers: 72 % of mutation carriers showed a radiosensitive phenotype (RIND score 1–4), whereas 72 % of the healthy volunteers showed no radiosensitivity (RIND score 0). Furthermore, 28 % of BRCA1 mutation carriers had a RIND score of 3 or 4 (not observed in control subjects). The radiosensitive phenotype was similar for relatives within several families, but not for unrelated individuals carrying the same mutation. The median RIND score was higher in patients with a mutation leading to a premature termination codon (PTC) located in the central part of the gene than in patients with a germline mutation in the 5′ end of the gene. Conclusions: We show that BRCA1 mutations are associated with a radiosensitive phenotype related to a compromised DNA repair and G2 arrest capacity after exposure to either 2 or 4 Gy. Our study confirms that haploinsufficiency is the mechanism involved in radiosensitivity in patients with a PTC allele, but it suggests that further research is needed to evaluate alternative mechanisms for mutations not subjected to NMD

RENEB accident simulation exercise

Purpose: The RENEB accident exercise was carried out in order to train the RENEB participants in coordinating and managing potentially large data sets that would be generated in case of a major radiological event. Materials and methods: Each participant was offered the possibility to activate the network by sending an alerting email about a simulated radiation emergency. The same participant had to collect, compile and report capacity, triage categorization and exposure scenario results obtained from all other participants. The exercise was performed over 27 weeks and involved the network consisting of 28 institutes: 21 RENEB members, four candidates and three non-RENEB partners. Results: The duration of a single exercise never exceeded 10 days, while the response from the assisting laboratories never came later than within half a day. During each week of the exercise, around 4500 samples were reported by all service laboratories (SL) to be examined and 54 scenarios were coherently estimated by all laboratories (the standard deviation from the mean of all SL answers for a given scenario category and a set of data was not larger than 3 patient codes). Conclusions: Each participant received training in both the role of a reference laboratory (activating the network) and of a service laboratory (responding to an activation request). The procedures in the case of radiological event were successfully established and tested