Assessing evidence of interventions addressing inequity among migrant populations: a two-stage systematic review

Background: Everyone has the right to achieve the standard of health and well-being. Migrants are considered as vulnerable populations due to the lack of access to health services and financial protection in health. Several interventions have been developed to improve migrant population health, but little is known about whether these interventions have considered the issue of equity as part of their outcome measurement. Objective: To assess the evidence of health interventions in addressing inequity among migrants. Methods: We adopted a two-stage searching approach to ensure the feasibility of this review. First, reviews of interventions for migrants were searched from five databases: PubMed, Cochrane, CINAHL, PsycINFO, and EMBASE until June 2017. Second, full articles included in the identified reviews were retrieved. Primary studies included in the identified reviews were then evaluated as to whether they met the following criteria: experimental studies which include equity aspects as part of their outcome measurement, based on equity attributes defined by PROGRESS-Plus factors (place of residence, race/ethnicity, occupation, gender, religion, education, socio-economic status, social capital, and others). We analysed the information extracted from the selected articles based on the PRISMA-Equity guidelines and the PROGRESSPlus factors. Results: Forty-nine reviews involving 1145 primary studies met the first-stage inclusion criteria. After exclusion of 764 studies, the remaining 381 experimental studies were assessed. Thirteen out of 381 experimental studies (3.41%) were found to include equity attributes as part of their outcome measurement. However, although some associations were found none of the included studies demonstrated the effect of the intervention on reducing inequity. All studies were conducted in high-income countries. The interventions included individual directed, community education and peer navigator-related interventions. Conclusions: Current evidence reveals that there is a paucity of studies assessing equity attributes of health interventions developed for migrant populations. This indicates that equity has not been receiving attention in these studies of migrant populations. More attention to equity-focused outcome assessment is needed to help policy-makers to consider all relevant outcomes for sound decision making concerning migrants

Equity-oriented toolkit for health technology assessment and knowledge translation: application to scaling up of training and education for health workers

Human resources for health are in crisis worldwide, especially in economically disadvantaged areas and areas with high rates of HIV/AIDS in both health workers and patients. International organizations such as the Global Health Workforce Alliance have been established to address this crisis. A technical working group within the Global Health Workforce Alliance developed recommendations for scaling up education and training of health workers. The paper will illustrate how decision-makers can use evidence and tools from an equity-oriented toolkit to scale up training and education of health workers, following five recommendations of the technical working group. The Equity-Oriented Toolkit, developed by the World Health Organization Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, has four major steps: (1) burden of illness; (2) community effectiveness; (3) economic evaluation; and (4) knowledge translation/implementation. Relevant tools from each of these steps will be matched with the appropriate recommendation from the technical working group

Axillary silicone lymphadenopathy presenting with a lump and altered sensation in the breast: a case report

<p>Abstract</p> <p>Introduction</p> <p>Silicone lymphadenopathy is a rare but recognised complication of procedures involving the use of silicone. It has a poorly understood mechanism but is thought to occur following the transportation of silicone particles from silicone-containing prostheses to lymph nodes by macrophages.</p> <p>Case presentation</p> <p>We report of a case involving a 35-year-old woman who presented to the breast clinic with a breast lump and altered sensation below her left nipple 5 years after bilateral cosmetic breast augmentations. A small lump was detected inferior to the nipple but clinical examination and initial ultrasound investigation showed both implants to be intact. However, mammography and magnetic resonance imaging of both breasts revealed both intracapsular and extracapsular rupture of the left breast prosthesis. The patient went on to develop a flu-like illness and tender lumps in the left axilla and right mastoid regions. An excision biopsy of the left axillary lesion and replacement of the ruptured implant was performed. Subsequent histological analysis showed that the axillary lump was a lymph node containing large amounts of silicone.</p> <p>Conclusion</p> <p>The exclusion of malignancy remains the priority when dealing with lumps in the breast or axilla. Silicone lymphadenopathy should however be considered as a differential diagnosis in patients in whom silicone prostheses are present.</p

EXIT-chart aided hybrid multiuser detector design for frequency-domain-spread chip-interleaved MC-CDMA

With the advent of EXtrinsic Information Transfer (EXIT) charts, we are capable of analyzing, predicting and visually comparing the convergence behaviours of different turbo Multi-User Detectector (MUD)s. The different MUDs have diverse EXIT characteristics and hence their superposition allows us to create a combined EXIT curve, which closely matches that of the channel decoder. Hence a near-capacity operation is facilitated by combining the benifits of different MUDs and therefore to create a superior MUD. Thus in this contribution, we propose a novel hybrid MUD combining scheme, which combines the advantages of a high performance and low complexity in form of an advanced hybrid MUD solution. The transmitted bits are unknown at the receiver, hence it is not feasible to directly evaluate the mutual information gain of the iterative MUD in consecutive iterations, hence we propose a realistic algorithm for estimating this mutual information gain, which is then used for activating the most appropriate constituent MUD as and when it is necessary. The constituent MUDs are the Matched Filter (MF) based Soft Interference Cancellation (SoIC) and the optimum Bayesian MUDs, which are invoked in the scenario of Frequency-Domain-Spread Chip-Interleaved (FDSCI) Multiple Carrier Code Division Multiple Access (MC-CDMA). The resultant hybrid MUD is capable of outperforming both the MF-SoIC and Bayesian turbo MUDs in the terms of the attainable complexity and Bit-Error-Rate (BER) performance

Standardized Outcomes in Nephrology-Transplantation: A Global Initiative to Develop a Core Outcome Set for Trials in Kidney Transplantation.

BACKGROUND: Although advances in treatment have dramatically improved short-term graft survival and acute rejection in kidney transplant recipients, long-term graft outcomes have not substantially improved. Transplant recipients also have a considerably increased risk of cancer, cardiovascular disease, diabetes, and infection, which all contribute to appreciable morbidity and premature mortality. Many trials in kidney transplantation are short-term, frequently use unvalidated surrogate endpoints, outcomes of uncertain relevance to patients and clinicians, and do not consistently measure and report key outcomes like death, graft loss, graft function, and adverse effects of therapy. This diminishes the value of trials in supporting treatment decisions that require individual-level multiple tradeoffs between graft survival and the risk of side effects, adverse events, and mortality. The Standardized Outcomes in Nephrology-Transplantation initiative aims to develop a core outcome set for trials in kidney transplantation that is based on the shared priorities of all stakeholders. METHODS: This will include a systematic review to identify outcomes reported in randomized trials, a Delphi survey with an international multistakeholder panel (patients, caregivers, clinicians, researchers, policy makers, members from industry) to develop a consensus-based prioritized list of outcome domains and a consensus workshop to review and finalize the core outcome set for trials in kidney transplantation. CONCLUSIONS: Developing and implementing a core outcome set to be reported, at a minimum, in all kidney transplantation trials will improve the transparency, quality, and relevance of research; to enable kidney transplant recipients and their clinicians to make better-informed treatment decisions for improved patient outcomes

Advancing the field of health systems research synthesis.

Those planning, managing and working in health systems worldwide routinely need to make decisions regarding strategies to improve health care and promote equity. Systematic reviews of different kinds can be of great help to these decision-makers, providing actionable evidence at every step in the decision-making process. Although there is growing recognition of the importance of systematic reviews to inform both policy decisions and produce guidance for health systems, a number of important methodological and evidence uptake challenges remain and better coordination of existing initiatives is needed. The Alliance for Health Policy and Systems Research, housed within the World Health Organization, convened an Advisory Group on Health Systems Research (HSR) Synthesis to bring together different stakeholders interested in HSR synthesis and its use in decision-making processes. We describe the rationale of the Advisory Group and the six areas of its work and reflects on its role in advancing the field of HSR synthesis. We argue in favour of greater cross-institutional collaborations, as well as capacity strengthening in low- and middle-income countries, to advance the science and practice of health systems research synthesis. We advocate for the integration of quasi-experimental study designs in reviews of effectiveness of health systems intervention and reforms. The Advisory Group also recommends adopting priority-setting approaches for HSR synthesis and increasing the use of findings from systematic reviews in health policy and decision-making

The Herschel Multi-tiered Extragalactic Survey: HerMES

The Herschel Multi-tiered Extragalactic Survey, HerMES, is a legacy program designed to map a set of nested fields totalling ~380 deg^2. Fields range in size from 0.01 to ~20 deg^2, using Herschel-SPIRE (at 250, 350 and 500 \mu m), and Herschel-PACS (at 100 and 160 \mu m), with an additional wider component of 270 deg^2 with SPIRE alone. These bands cover the peak of the redshifted thermal spectral energy distribution from interstellar dust and thus capture the re-processed optical and ultra-violet radiation from star formation that has been absorbed by dust, and are critical for forming a complete multi-wavelength understanding of galaxy formation and evolution. The survey will detect of order 100,000 galaxies at 5\sigma in some of the best studied fields in the sky. Additionally, HerMES is closely coordinated with the PACS Evolutionary Probe survey. Making maximum use of the full spectrum of ancillary data, from radio to X-ray wavelengths, it is designed to: facilitate redshift determination; rapidly identify unusual objects; and understand the relationships between thermal emission from dust and other processes. Scientific questions HerMES will be used to answer include: the total infrared emission of galaxies; the evolution of the luminosity function; the clustering properties of dusty galaxies; and the properties of populations of galaxies which lie below the confusion limit through lensing and statistical techniques. This paper defines the survey observations and data products, outlines the primary scientific goals of the HerMES team, and reviews some of the early results.Comment: 23 pages, 17 figures, 9 Tables, MNRAS accepte