Mobile and migrant populations (MMPs) pose a unique challenge to disease elimination campaigns as they are often hard to survey and reach with treatment. While some elimination efforts have had ...success reaching MMPs, other campaigns are struggling to do so, which may be affecting progress towards disease control and elimination. Therefore, this paper reviews the literature on elimination campaigns targeting MMPs across a selection of elimination diseases-neglected tropical diseases, malaria, trypanosomiasis, polio, smallpox, and rinderpest.
Through a systematic review process following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a three-person review team identified papers from databases, conference records, and citation searches using inclusion/exclusion criteria. Papers were divided into three key outcome domains during the synthetization process: (1) MMP movement patterns in East Africa including reasons for movement and consequences in terms of health outcomes and healthcare access; (2) MMP contribution to the transmission of disease across all geographies; (3) surveillance methods and treatment interventions used to implement programming in MMPs across all geographies. Experts in the field also provided supplemental information and gray literature to support this review.
The review identified 103 records which were descriptively analyzed using the outcome domains. The results indicate that in East Africa, there are various motivations for migration from economic opportunity to political unrest to natural disasters. Regardless of motivation, mobile lifestyles affect health service access such that MMPs in East Africa report barriers in accessing healthcare and have limited health knowledge. Often lower service delivery to these populations has resulted in higher disease prevalence. A minority of articles suggest MMPs do not pose challenges to reaching disease control and elimination thresholds. Finally, the literature highlighted surveillance methods (e.g., using satellite imagery or mobile phone data to track movement, participatory mapping, snowball sampling) and intervention strategies (e.g., integration with animal health campaigns, cross-border coordination, alternative mass drug administration MDA methods) to implement health interventions in MMPs.
Ultimately, the literature reviewed here can inform programmatic decisions as the community attempts to reach these never treated populations.
The protocol for this manuscript was registered with the International Prospective Registry of Systematic Reviews (PROSPERO) (No. CRD42021214743).
Because of the current emphasis and enthusiasm focused on integration of health systems, there is a risk of piling resources into integrated strategies without the necessary systems in place to ...monitor their progress adequately or to measure impact, and to learn from these efforts. The rush to intervene without adequate monitoring and evaluation will continue to result in a weak evidence base for decision making and resource allocation. Program planning and implementation are inextricability linked to monitoring and evaluation. Country level guidance is needed to identify country-specific integrated strategies, thereby increasing country ownership.
This paper focuses on integrated health services but takes into account how health services are influenced by the health system, managed by programs, and made up of interventions. We apply the principles in existing comprehensive monitoring and evaluation (M&E) frameworks in order to outline a systematic approach to the M&E of integration for the country level. The approach is grounded by first defining the country-specific health challenges that integration is intended to affect. Priority points of contact for care can directly influence health, and essential packages of integration for all major client presentations need to be defined. Logic models are necessary to outline the plausible causal pathways and define the inputs, roles and responsibilities, indicators, and data sources across the health system. Finally, we recommend improvements to the health information system and in data use to ensure that data are available to inform decisions, because changes in the M&E function to make it more integrated will also facilitate integration in the service delivery, planning, and governance components.
This approach described in the paper is the ideal, but its application at the country level can help reveal gaps and guide decisions related to what health services to prioritize for integration, help plan for how to strengthen systems to support health services, and ultimately establish an evidence base to inform investments in health care. More experience is needed to understand if the approach is feasible; similarly, more emphasis is needed on documenting the process of designing and implemented integrated interventions at the national level.
The COVID‐19 pandemic has had a dramatic impact on care delivery among health care institutions and providers in the United States. As a categorical cancer center, MD Anderson has prioritized care ...for our patients based on acuity of their disease. We continue to implement measures to protect patients and employees from acquiring the infection within our facilities, and to provide acute management of cancer patients with concomitant COVID‐19 infections who are considered at high risk of death. The Division of Patient Experience, formerly established in October 2016, has played an integral role in the institution's pandemic response from its inception. The team actively supported programs and processes in anticipation of the pandemic's effect on our patients and employees. We will describe how the team continues to serve in the ever‐dynamic environment as we approach the expected surge in COVID‐19 cases among our patient population, our employees, and in our community.
To report the results of a combined case series analysis of subcutaneous levetiracetam (Keppra) for the management of seizures in palliative care patients.
A comprehensive literature review on the ...use of subcutaneous levetiracetam was performed, and these data were combined with a prospective observational audit of its use in terminal care undertaken in a regional palliative care network.
7 papers were identified from the literature review-four case reports and three observational case series-reporting on a total of 53 cases where subcutaneous levetiracetam was administered.We report 20 further cases of subcutaneous levetiracetam administration from a prospective observational audit. Doses ranged from 250mg to 4000 mg daily. Oral to subcutaneous conversion ratios where stated were 1:1. Levetiracetam was reported as the sole administered antiepileptic drug (AED) in eight cases, and no seizures were reported until death in five cases. Five were switched back to enteral levetiracetam. In seven cases, levetiracetam was combined with AEDs to provide seizure control at the end of life. There was one report of a sterile abscess after 25 days of continuous subcutaneous administration.
Combined analysis of 73 reported cases of subcutaneous levetiracetam suggests this treatment may have a role in the management of seizures at the end of life. However, randomised controlled trials are urgently needed to establish the efficacy and tolerability of subcutaneous levetiracetam administration. If proven to be safe and effective, subcutaneous levetiracetam offers the potential to prevent and treat seizures without causing unnecessary sedation at the end of life.
Background
Binge alcohol exposure during adolescence results in long‐lasting alterations in the brain and behavior. For example, adolescent intermittent ethanol (AIE) exposure in rodents results in ...long‐term loss of functional connectivity among prefrontal cortex (PFC) and striatal regions as well as a variety of neurochemical, molecular, and epigenetic alterations. Interneurons in the PFC and striatum play critical roles in behavioral flexibility and functional connectivity. For example, parvalbumin (PV) interneurons are known to contribute to neural synchrony and cholinergic interneurons contribute to strategy selection. Furthermore, extracellular perineuronal nets (PNNs) that surround some interneurons, particularly PV+ interneurons, further regulate cellular plasticity. The effect of AIE exposure on the expression of these markers within the PFC is not well understood.
Methods
The present study tested the hypothesis that AIE exposure reduces the expression of PV+ and choline acetyltransferase (ChAT)+ interneurons in the adult PFC and striatum and increases the related expression of PNNs (marked by binding of Wisteria floribunda agglutinin lectin) in adulthood. Male rats were exposed to AIE (5 g/kg/day, 2‐days‐on/2‐days‐off, i.e., P25 to P54) or water (CON), and brain tissue was harvested in adulthood (>P80). Immunohistochemistry and co‐immunofluorescence were used to assess the expression of ChAT, PV, and PNNs within the adult PFC and striatum following AIE exposure.
Results
ChAT and PV interneuron densities in the striatum and PFC were unchanged after AIE exposure. However, PNN density in the PFC of AIE‐exposed rats was greater than in CON rats. Moreover, significantly more PV neurons were surrounded by PNNs in AIE‐exposed subjects than controls in both PFC subregions assessed: orbitofrontal cortex (CON = 34%; AIE = 40%) and medial PFC (CON = 10%; AIE = 14%).
Conclusions
These findings indicate that, following AIE exposure, PV interneuron expression in the adult PFC and striatum is unaltered, while PNNs surrounding these neurons are increased. This increase in PNNs may restrict the plasticity of the ensheathed neurons, thereby contributing to impaired microcircuitry in frontostriatal connectivity and related behavioral impairments.
Adolescent intermittent ethanol (AIE) exposure produces long‐term changes in perineuronal net (PNN) density within the prefrontal (prelimbic, orbitofrontal) cortex of adult male rats. AIE exposure did not change densities of cholinergic and parvalbumin interneurons within the prefrontal cortex or striatum. However, a greater proportion of parvalbumin interneurons in the prefrontal cortex were ensheathed by PNNs. As AIE exposure produces long‐term deficits in cognitive flexibility that is dependent upon prefrontal function, altered PNNs may contribute to this AIE effect.
Background and objectives Female sex workers (FSWs) are thought to be at heightened risk for unintended pregnancy, although sexual and reproductive health interventions reaching these populations are ...typically focused on the increased risk of sexually transmitted infections. The objective of this study of FSWs in Kenya is to document patterns of contraceptive use and unmet need for contraception.
Methods This research surveys a large sample of female sex workers (N = 597) and also uses qualitative data from focus group discussions.
Results The reported level of modern contraceptives in our setting was very high. However, like in other studies, we found a great reliance on male condoms, coupled with inconsistent use at last sex, which resulted in a higher potential for unmet need for contraception than the elevated levels of modern contraceptives might suggest. Dual method use was also frequently encountered in this population and the benefits of this practice were clearly outlined by focus group participants.
Conclusion These findings suggest that the promotion of dual methods among this population could help meet the broader reproductive health needs of FSWs. Furthermore, this research underscores the necessity of considering consistency of condom use when estimating the unmet or undermet contraceptive needs of this population.
Abstract
This publication addresses the limited use of qualitative methods in neglected tropical disease (NTD) programmes. It describes a scoping literature review conducted to inform the development ...of a guide to inform the use of rapid qualitative assessments to strengthen NTD mass drug administration (MDA) programmes. The review assessed how qualitative methods are currently used by NTD programmes and identified qualitative approaches from other health and development programmes with the potential to strengthen the design of MDA interventions. Systematic review articles were reviewed and searched using key terms conducted on Google Scholar and PubMed. Results show that methods used by NTD programmes rely heavily on focus group discussions and in-depth interviews, often with time-consuming analysis and limited information on how results are applied. Results from other fields offered insight into a wider range of methods, including participatory approaches, and on how to increase programmatic uptake of findings. Recommendations on how to apply these findings to NTD control are made. The topic of human resources for qualitative investigations is explored and a guide to improve MDAs using qualitative methods is introduced. This guide has direct applicability across the spectrum of NTDs as well as other public health programmes.
Patients receiving complementary and alternative medicine (CAM) therapies often report shifts in well-being that go beyond resolution of the original presenting symptoms. We undertook a research ...program to develop and evaluate a patient-centered outcome measure to assess the multidimensional impacts of CAM therapies, utilizing a novel mixed methods approach that relied upon techniques from the fields of anthropology and psychometrics. This tool would have broad applicability, both for CAM practitioners to measure shifts in patients' states following treatments, and conventional clinical trial researchers needing validated outcome measures. The US Food and Drug Administration has highlighted the importance of valid and reliable measurement of patient-reported outcomes in the evaluation of conventional medical products. Here we describe Phase I of our research program, the iterative process of content identification, item development and refinement, and response format selection. Cognitive interviews and psychometric evaluation are reported separately.
From a database of patient interviews (n = 177) from six diverse CAM studies, 150 interviews were identified for secondary analysis in which individuals spontaneously discussed unexpected changes associated with CAM. Using ATLAS.ti, we identified common themes and language to inform questionnaire item content and wording. Respondents' language was often richly textured, but item development required a stripping down of language to extract essential meaning and minimize potential comprehension barriers across populations. Through an evocative card sort interview process, we identified those items most widely applicable and covering standard psychometric domains. We developed, pilot-tested, and refined the format, yielding a questionnaire for cognitive interviews and psychometric evaluation.
The resulting questionnaire contained 18 items, in visual analog scale format, in which each line was anchored by the positive and negative extremes relevant to the experiential domain. Because of frequent informant allusions to response set shifts from before to after CAM therapies, we chose a retrospective pretest format. Items cover physical, emotional, cognitive, social, spiritual, and whole person domains.
This paper reports the success of a novel approach to the development of outcome instruments, in which items are extracted from patients' words instead of being distilled from pre-existing theory. The resulting instrument, focused on measuring shifts in patients' perceptions of health and well-being along pre-specified axes, is undergoing continued testing, and is available for use by cooperating investigators.
CONTEXT: Although the introduction of a new method is generally hailed as a boon to contraceptive prevalence, uptake of new methods can reduce the use of existing methods. It is important to examine ...changing patterns of contraceptive use and method mix after the introduction of new methods. METHODS: Demographic and Health Survey data from 13 countries were used to analyze changes in method use and method mix after the introduction of the injectable in the early 1990s. Subgroup analyses were conducted among married women who reported wanting more children, but not in the next two years (spacers), and those who reported wanting no more children (limiters). RESULTS: Modern method use and injectable use rose for each study country. Increases in modern method use exceeded those in injectable use in all but three countries. Injectable use rose among spacers, as well as among limiters of all ages, particularly those younger than 35. In general, the increase in injectable use was partially offset by declines in use of other methods, especially long-acting or permanent methods. CONCLUSION: Family planning programs could face higher costs and women could experience more unintended pregnancies if limiters use injectables for long periods, rather than changing to longer acting and permanent methods, which provide greater contraceptive efficacy at lower cost, when they are sure they want no more children. Contexto: Aunque la introducción de un nuevo método se recibe generalmente como algo muy positivo para la prevalencia del uso de anticonceptivos, la aceptación de un nuevo método puede reducir el uso de los métodos existentes. Es importante examinar cómo un nuevo método cambia los patrones del uso y la combinación de métodos usados. Métodos: Se usaron datos de las Encuestas Demográficas y de Salud de 13 países, desde los años noventa hasta fechas recientes, para analizar cambios en el uso de métodos y la combinación de métodos posteriores a la introducción de los inyectables a principios de los años noventa. Se realizó análisis de mujeres casadas según sus preferencias de fecundidad: las que deseaban tener más hijos pero no en los próximos dos años (buscaban espaciar sus hijos); y las que no deseaban tener más hijos (buscaban limitar el número de hijos). Resultados: El uso de métodos modernos, y del método moderno individual del inyectable, aumentó en cada país del estudio. Los aumentos en el uso de métodos modernos en total excedieron los aumentos en el uso del inyectable en todos los países con excepción de tres. El uso del inyectable aumentó entre las mujeres de todas las edades que querían espaciar los nacimientos; así como entre todas las que querían dejar de procrear, pero especialmente en las menores de 35 años de estas últimas. En general, el aumento en el uso del inyectable se compensó parcialmente por disminuciones en el uso de otros métodos, especialmente los de larga duración o permanentes. Conclusión: Los programas de planificación familiar podrían enfrentar costos mayores, y las mujeres podrían tener más embarazos no planeados, si las que quieren dejar de procrear usan los inyectables por períodos largos en lugar de cambiar a métodos de larga duración y métodos permanentes. Es decir, cuando las mujeres están seguras de que no desean más hijos, los métodos permanentes y los de larga duración proporcionan una mayor eficacia anticonceptiva a menor costo. Contexte: Bien que l'introduction d'une nouvelle méthode soit généralement saluée comme une aubaine pour la prévalence contraceptive, l'adoption de nouvelles méthodes peut réduire la pratique de celles existantes. Il importe d'examiner les tendances changeantes de la pratique contraceptive et de l'éventail de méthodes après l'introduction de nouveaux choix. Méthodes: Les données d'EDS de 13 pays ont servi à analyser les changements de pratique et d'éventail de méthodes après l'introduction de l'injectable au début des années 1990. Des analyses de sous-groupes ont été menées parmi les femmes mariées ayant déclaré désirer avoir encore des enfants mais pas durant les deux prochaines années (désir d'espacement) et celles ayant déclaré ne plus vouloir d'enfants (désir de limitation). Résultats: La pratique des méthodes modernes et celle de l'injectable ont augmenté dans chaque pays soumis à l'étude. La hausse de la pratique des méthodes modernes dépasse celle du choix de l'injectable dans tous les pays sauf trois. La pratique de l'injectable a augmenté parmi les femmes désireuses d'espacer leurs grossesses tout comme parmi celles désireuses de les limiter à tous âges, en particulier avant l'âge de 35 ans. En général, la hausse de la pratique de l'injectable est partiellement compensée par la baisse enregistrée au niveau d'autres méthodes, de longue durée ou permanentes surtout. Conclusion: Les programmes de planification familiale pourraient se trouver confrontés à des coûts supérieurs et les femmes à de plus grands nombres de grossesses non planifiées si celles désireuses de limiter leurs naissances recourent aux injectables à long terme, plutôt que de passer aux méthodes longue durée ou permanentes qui leur assureraient une plus grande efficacité contraceptive à moindre coût lorsqu'elles sont sûres de ne plus vouloir d'enfants.
Caribbean youth comprise about 30 percent of the English-speaking Caribbean population, and about 81,000 Caribbean and Latin American youth are HIV infected. AIDS is the leading cause of death for ...15- to 24-year-old English-speaking Caribbean youth. This article relies on intersectionality theory in the assessment of the macro-level, or structural variables, and micro-level, or individual level, variables that influence the risk-taking sexual behaviors of heterosexual English-speaking Caribbean youth and increase their vulnerability to HIV/sexually transmitted infections. This article offers macro- and micro-level prevention/intervention strategies for reducing the prevalence of sexually transmitted infections in English-speaking Caribbean youth, including the promotion of condom use, voluntary male circumcision, and HIV testing and counseling. Suggestions are offered for future research investigations to explore the contributing factors to youth’s vulnerability to sexually transmitted infections and to empirically verify the relationship between and among variables that account for desired outcomes, including decreases in risky sexual behaviors.
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