Barriers in the Transition of Care for Heart Failure Patients Attending Clinics in Mwanza City, Tanzania

Introduction: Transition of care strategies have shown to improve quality of lives of heart failure patients, but it has little implemented in clinical settings. Objective: To evaluate context-specific perceived barriers and experiences of heart failure patients during their admission and after they were discharged from hospital. Methods: A cross-sectional qualitative study was conducted among 13 heart failure patients at two large referral hospitals in northwestern Tanzania. In-depth interviews among heart failure patients, in line with the Consolidated Criteria for Reporting Qualitative research checklist, were used to collect data. Interviews were audio recorded, transcribed, and translated into English. Results: Three key barriers were identified, as well as possible solutions that could improve the transition of care for heart failure patients. These include strengthening healthcare provider communications, organizing medication management, and assisting with follow-up appointments. Conclusion: The barriers identified are real and challenging in clinical resource- limited settings. Findings suggest they can be overcome when realistic and tailor-made interventions are in place.

Race, the microbiome and colorectal cancer

In the past decade,more cancer researchers have begun to understand the significance of cancer prevention,which has prompted a shift in the increasing body of scientific literature.An area of fascination and great potential is the human microbiome.Recent studies suggest that the gut microbiota has significant roles in an individual’s ability to avoid cancer,with considerable focus on the gut microbiome and colorectal cancer.That in mind,racial disparities with regard to colorectal cancer treatment and prevention are generally understudied despite higher incidence and mortality rates among Non-Hispanic Blacks compared to other racial and ethnic groups in the United States.A comprehension of ethnic differences with relation to colorectal cancer,dietary habits and the microbiome is a meritorious area of investigation.This review highlights literature that identifies and bridges the gap in understanding the role of the human microbiome in racial disparities across colorectal cancer.Herein,we explore the differences in the gut microbiota,common short chain fatty acids produced in abundance by microbes,and their association with racial differences in cancer acquisition.

Dowry practices and their negative consequences from a female perspective in Karachi, Pakistan <br>—A qualitative study

Aim: To assess the pattern, demand and opinion of dowry among women in urban Karachi, Pakistan and their perceived negative consequences of dowry. Setting: Pakistan is a low income country, predominantly Muslim, with around 190 million inhabitants. Karachi is the biggest city with roughly 13 million inhabitants. Method: Qualitative study, using content analysis of five focus group discussions with women. Results: The theme “Dowry practices and their consequences” emerged, along with five categories and 14 subcategories, describing the “burden of dowry”, “dowry in society”, “dowry problems created by parents-in-law”, “negative consequences of dowry practice” and “good intentions”. Conclusion: Problems due to dowry practices are something which women of all socioeconomic classes in Karachi are aware of. A number of negative consequences of these practices create a current, pressing problem in Karachi society. These consequences affect women’s status and their possibilities to grow and educate themselves. It seems that change is being brought on slowly, following the country’s development and increasing educational level of the younger generation. Awareness of dowry issues needs to be raised and steps need to be taken to speed up this process of change by empowering women and ensuring equality in Pakistan.

Preventing Pregnant Women’s Exposure to Secondhand Smoke: Development and Suitability Assessment of an Educational Comic Booklet

Aim: The aim of this mixed methods research was to develop an educational comic booklet to prevent pregnant women’s exposure to secondhand smoke. Methods: We assessed the suitability of the comic booklet by measuring participant response to content, literacy demand, graphics, layout and typography, learning stimulation, motivation, and cultural appropriateness. The participants were 17 Indonesians living in Japan who were recruited through Respondent-Driven-Sampling and met all criteria for the survey. Means and standard deviations were used to determine the suitability of the educational comic. Results: About 80% of participants rated the comic as “superior” on a rating scale with options of “superior”, “adequate”, “not suitable”, or “not applicable”. The most successful aspects of the comic were content and cultural appropriateness, as it provided clear contents and the graphics showed realistic Indonesian smoking behavior. The least successful aspect of the comic was the literacy demand because there were long sentences using difficult words. Conclusions: The results of this study may be used to conduct a randomized controlled trial using this comic booklet with some modifications.

Testing-Related and Geo-Demographic Indicators Strongly Predict COVID-19 Deaths in the United States during March of 2020

The COVID-19 pandemic has wreaked havoc around the globe and caused significant disruptions across multiple domains[1].Moreover,different countries have been differentially impacted by COVID-19—a phenomenon that is due to a multitude of complex and often interacting determinants[2].

A public health approach to rapid scale-up of free antiretroviral treatment in China： an ounce of prevention is worth a pound of cure

China＇s rapidly evolving HIV/AIDS epidemic calls for a dramatic expansion of both prevention and treatment services. Official state media recently reported that for the first time, in 2008, HIV/AIDS became China＇s leading cause of death among infectious diseases. Estimates from the Ministry of Health indicate that around 700 000 people were living with HIV and 85 000 people had AIDS in 2007. Initially, HIV-1 infection was confined primarily to certain high-risk populations such as injection drug users （IDU） along drug-trafficking routes, and former plasma donors （FPD） in rural communities in east-central China. Now, however, HIV prevalence is increasing among female sex workers （FSW） and men who have sex with men （MSM）.

中国学龄儿童肥胖和超重性别差异的25年趋势：应用世界卫生组织和国际肥胖工作组标准进行的多次横断面研究

目的探索1985—2010年中国城乡儿童肥胖和超重率性别差异的长期趋势。方法研究对象来自全国学生体质与健康调研，该调研是中国最大的可代表全国学龄儿童的调研，包括1280239名7～18岁儿童。按照世界卫生组织（wH0）和国际肥胖工作组（[OTV）的标准对肥胖和超重进行判定。使用Logistic回归对不同年度超重、肥胖率的性别差异进行估计。结果过去25年以来，中国城乡儿童肥胖率迅速增长（WHO标准：从0．10％上升到4．3％；IOTF标准：从0．03％上升到2．2％），在每一调查年男生肥胖率均高于女生（P〈0．01）。各年龄组均出现增长趋势（P〈0．01）。尽管肥胖率在男女生中都出现增长，但是男生的增长速度快于女生。肥胖率的男女生性别比有随时间增加的趋势，在每一调查年，城市地区肥胖率的男女生性别比都高于乡村地区。结论在城乡地区逐步增加的性别差异显示男生的肥胖和超重，特别是城市男生的肥胖和超重，导致了儿童肥胖和超重的比例不断增加。

不同时间注射吸毒者艾滋病知识影响因素分析

目的了解不同注射吸毒时间的吸毒者艾滋病知识的影响因素。方法于2003-2005年对四川省注射吸毒者进行3次横断面调查,调查内容包括人口学、注射吸毒行为、性行为及艾滋病相关知识等。应用K-means聚类法对调查对象的艾滋病知识水平进行聚类,然后对所有被调查者和不同注射吸毒时间(<1年,1～3年和>3年)的吸毒者进行累积Logistic回归分析。结果4310例被调查者中,注射吸毒<1年者占14.1%,1～3年占40.3%,>3年占45.6%。调查对象按艾滋病知识掌握的程度,被聚类为3类,I类2547人(好),II类共1447人(中),III类共313人(差)。注射吸毒<1年者艾滋病知识的独立影响因素包括少数民族、注射频率低、未戒过毒、未曾得到发放的安全套、未得到过性病艾滋病预防知识讲解及未曾得到宣传材料。注射吸毒1～3年者艾滋病知识的独立影响因素包括文化程度低、未曾得到宣传材料、未参与针具交换、未曾接受性病检查或治疗、2004年及2005年招募者、招募于达州、凉山、自贡。注射吸毒大于3年者艾滋病知识的独立影响因素包括文化程度低、少数民族、未戒过毒、未参与针具交换、2004年及2005年招募者。结论调查显示半数以上注射吸毒者吸毒时间小于3年。文化程度低、少数民族、未曾得到HIV干预服务者艾滋病知识水平较低。,提示针对不同吸毒时间吸毒者的干预宣传侧重有所不同。

Burden of onchocerciasis-associated epilepsy:first estimates and research priorities

Background:Since the 1990s,evidence has accumulated of an increased prevalence of epilepsy in onchocerciasisendemic areas in Africa as compared to onchocerciasis-free areas.Although the causal relationship between onchocerciasis and epilepsy has yet to be proven,there is likely an association.Here we discuss the need for disease burden estimates of onchocerciasis-associated epilepsy(OAE),provide them,detail how such estimates should be refined,and discuss the socioeconomic impact of OAE,including a cost-estimate for anti-epileptic drugs.Main body:Providing OAE burden estimates may aid prevention of epilepsy in onchocerciasis-endemic areas by inciting and informing collaboration between onchocerciasis control programmes and mental health services.Epilepsy not only massively impacts the health of those affected,but it also carries a high socioeconomic burden for the households and communities involved.We used previously published geospatial estimates of onchocerciasis in Africa and a separately published logistic regression model quantifying the association between onchocerciasis and epilepsy to estimate the number of OAE cases.We then applied disability weights for epilepsy to quantify the burden in terms of years of life lived with disability(YLD)and estimate the cost of treatment.We estimate that in 2015 roughly 117000 people were affected by OAE across onchocerciasis-endemic areas previously under the African Programme for Onchocerciases control(APOC)mandate where OAE has ever been reported or suspected,and another 264000 persons in onchocerciasis-endemic areas where OAE has never been investigated before.The total number of YLDs due to OAE was 39300 and 88700 in these areas respectively,based on a weighted mean disability weight of 0.336.The burden of OAE is approximately 13%of the total YLDs attributable to onchocerciasis and 10%of total YLDs attributable to epilepsy.We estimated that by 2015 the total costs of treatment with antiepileptic drug for OAE cases would have been a minimum of 12.4 million US$.Conclusions:These estimates suggest a considerable health,social and economic burden of OAE in Africa.The treatment and care for people with epilepsy,especially in hyperendemic onchocerciasis areas with high epilepsy prevalence thus requires more financial and human resources.

Incidence and consequences of varicella in children treated for cancer in Guatemala

Background:Varicella-zoster virus infection is associated with significant morbidity and mortality in immune-compromised children,despite treatment with antiviral agents.Universal varicella vaccine programs have significantly decreased this risk in many highincome countries,but in most low-income and middleincome countries,the burden of varicella in children treated for malignancy is poorly defi ned.Methods:We retrospectively reviewed records of children at the National Unit of Pediatric Oncology(UNOP)in Guatemala diagnosed with varicella between January 2009 and March 2013 in order to calculate incidence of varicella and evaluate morbidity,mortality,treatment interruption,and cost.Results:Fifty-nine cases of varicella were identified.Incidence was 23.4 cases per 1000 person-years(p-y).66.1%of cases occurred in children with leukemia(median age 5.2 years;interquantile range 3.4-7 years)and 41.0%of these occurred during maintenance therapy.Source of exposure was identified for 14/59(23.7%)children.Most were hospitalized(71.2%)and given intravenous acyclovir(64.4%).Eight(13.6%)children required critical care,and two(3.4%)died from disseminated varicella with multiorgan failure.Chemotherapy was delayed or omitted due to varicella in 50%.No signifi cant differences in outcomes based on nutritional and immunologic status were detected.The minimum average cost of treatment per episode was 598.75 USD.Conclusions:Varicella is a significant problem in children treated for cancer in Guatemala,where effective post-exposure prophylaxis is limited.In the absence of universal varicella vaccination,strategies to improve recognition of exposure and the future use of novel inactivated vaccines currently under investigation in clinical trials could mitigate this burden.

Socio-ecological dynamics and challenges to the governance of Neglected Tropical Disease control

The current global attempts to control the so-called“Neglected Tropical Diseases(NTDs)”have the potential to significantly reduce the morbidity suffered by some of the world’s poorest communities.However,the governance of these control programmes is driven by a managerial rationality that assumes predictability of proposed interventions,and which thus primarily seeks to improve the cost-effectiveness of implementation by measuring performance in terms of pre-determined outputs.Here,we argue that this approach has reinforced the narrow normal-science model for controlling parasitic diseases,and in doing so fails to address the complex dynamics,uncertainty and socio-ecological context-specificity that invariably underlie parasite transmission.We suggest that a new governance approach is required that draws on a combination of non-equilibrium thinking about the operation of complex,adaptive,systems from the natural sciences and constructivist social science perspectives that view the accumulation of scientific knowledge as contingent on historical interests and norms,if more effective control approaches sufficiently sensitive to local disease contexts are to be devised,applied and managed.At the core of this approach is an emphasis on the need for a process that assists with the inclusion of diverse perspectives,social learning and deliberation,and a reflexive approach to addressing system complexity and incertitude,while balancing this flexibility with stability-focused structures.We derive and discuss a possible governance framework and outline an organizational structure that could be used to effectively deal with the complexity of accomplishing global NTD control.We also point to examples of complexity-based management structures that have been used in parasite control previously,which could serve as practical templates for developing similar governance structures to better manage global NTD control.Our results hold important wider implications for global health policy aiming to effectively control and eradicate parasitic diseases across the world.