Critical medical ecology and intersectionality perspectives in schistosomiasis prevention and control in selected communities in Mindanao, the Philippines

Schistosomiasis japonica remains a public health concern in many areas of the Philippines. Periodic Mass Drug Administration (MDA) to at-risk populations is the main strategy for morbidity control of schistosomiasis. Attaining MDA coverage targets is important for the reduction of morbidity and prevention of complications due to the disease, and towards achieving Universal Health Care. The study employed a qualitative case study design. Key informant interviews and focus group discussions were conducted to provide in-depth and situated descriptions of the contexts surrounding the implementation of MDA in two selected villages in known schistosomiasis-endemic provinces in Mindanao in the Philippines. Data analysis was done using the Critical Ecology for Medical Anthropology (CEMA) model coupled with the intersectionality approach. It was found that within various areas in the CEMA model, enabling as well as constraining factors have been encountered in MDA in the study settings. The interplay of income class, geographical location, gender norms and faith-based beliefs may have led to key populations being missed during the conduct of MDA in the study sites. The constraints faced by the target beneficiaries of MDA, as well as programme implementers, must be addressed to enhance service delivery and to control morbidity due to schistosomiasis. Improving compliance with MDA also requires a holistic, integrated approach to addressing barriers to participation, which are shaped by wider socio-political and power structures.

Associations between early efficiency in language processing and learning outcomes in children born full term and preterm: Similarities and differences

Associations between children’s early language processing efficiency and later language, literacy, and non-verbal outcomes shed light on the extent to which early information processing skills support later learning across domains. Examining whether the strengths of associations are similar in typically developing and at risk populations provides an additional lens into the varying routes to learning that children take across development. We compared patterns of associations between early language processing efficiency (accuracy and reaction time) in the looking-while-listening (LWL) task and school-relevant skills in children born full-term (FT) and preterm (PT). Participants (n=94, 49 FT, 45 PT) were assessed in the LWL task at 18 months (corrected for degree of prematurity in PT group) and on standardized tests of expressive language, pre-literacy (print knowledge and phonological awareness), and non-verbal IQ at 4 ½ years. Early language processing efficiency was associated with later language and pre-literacy outcomes (r2 change ranged from 19.8 to 7.1, p < 0.01) to a similar extent in PT and FT children, controlling for age at test and SES, suggesting similar mechanisms of learning in these domains for PT and FT children. However, birth group moderated the association between reaction time and non-verbal IQ (r2 change 4.5, p < 0.05), such that an association was found in the PT but not the FT group. This finding suggests that information processing skills reflected in efficiency of real-time language processing may be recruited to support learning in a broader range of domains in the PT compared to the FT group.

Efficacy of current treatments against hepatitis C virus

It is estimated that currently, in the world, approximately 3% of the population has chronic hepatitis, the hepatitis C virus is the etiological agent most related to the development of this pathology. The diversity of genotypes (7) and quasi-species of HCV, due to its high mutation rate, interferes with an effective humoral immunity. The aim of this work is precisely to evoke those usual drugs used in HCV therapy, as well as cutting-edge drugs. The goal of treatment is the eradication of HCV infection. One strategy offered by the WHO is to eradicate the virus in at-risk populations. Alternatives to the previously used treatment with interferon and ribavirin are shown in this paper; protease inhibitors and other targets have now been developed to make eradication of the virus more effective.

Awareness and Use of Post-exposure Prophylaxis for HIV Prevention Among Men Who Have Sex With Men: A Systematic Review and Meta-Analysis

Background: The use of post-exposure prophylaxis (PEP) is effective in reducing HIV risk, but it is underused by men who have sex with men (MSM) due to certain psychological and sociostructural factors. This article assessed the awareness and use of PEP among MSM in an effort to increase the visibility and uptake of PEP among at-risk populations.Methods: We conducted a systematic literature search of the PubMed, Web of Science, PsycINFO, and Google Scholar electronic databases. Studies were screened for inclusion, and relevant data were abstracted, assessed for bias, and synthesized. Pooled effect estimates were calculated using random effects meta-analysis, meta-regression and subgroup analysis, and a qualitative review and risk of bias assessment were performed (PROSPERO, CRD42019123815).Results: Twenty eligible studies involving 12,579 MSM were included in the meta-analysis. The pooled estimate of the proportions of MSM who were aware of PEP was modest at 59.9% (95% CI: 50.5~68.7) and that of MSM who previously used PEP was very low at 4.9% (95% CI: 2.4~9.8). PEP awareness showed no clear change over time, while PEP use significantly changed over time. Multiple factors affected awareness, including educational attainment, race/ethnicity, levels of HIV stigma, access to condoms, and so on. Many factors could potentially impede or facilitate the use of PEP, such as income, lack of PEP information, and partnership.Conclusion: We observed that PEP is an underused HIV prevention strategy among MSM and that once MSM become aware of PEP, the majority are willing to use it if they are supported appropriately in terms of a range of individual, social, and structural barriers.Systematic Review Registration: http://www.cdr.york.ac.uk/prospero, PROSPERO [CRD42019123815].

Using antibody synergy to engineer a high potency biologic cocktail against C. difficile

We applied a mathematical framework originally used to model the effects of multiple inhibitors on enzyme activity to guide the development a therapeutic antibody cocktail, LMN-201, to prevent and treat C. difficile infection (CDI). CDI causes hundreds of thousands of cases of severe, often recurrent diarrhea and colitis in the United States annually and is associated with significant morbidity and mortality worldwide. Current therapies for preventing recurrent CDI are only partially successful, and there are no options available to prevent initial bouts of CDI in at-risk populations. Almost all antibody therapies have been developed and administered as monotherapies. Antibody cocktails are relatively rare even though they have the potential to greatly increase efficacy. One reason for this is our limited understanding of how antibody interactions can enhance potency, which makes it difficult to identify and develop antibodies that can be assembled into optimally effective cocktails. In contrast to the view that antibody synergies depend on unusual instances of cooperativity or allostery, we show that synergistic efficacy requires nothing more than that the antibodies bind independently to distinct epitopes on a common target. Therefore, synergy may be achieved much more readily than is generally appreciated. Due to synergy the LMN-201 antibody cocktail, which targets the C. difficile exotoxin B (TcdB), is 300- to 3000-fold more potent at neutralizing the most clinically prevalent TcdB toxin types than bezlotoxumab, the only monoclonal antibody currently approved for treatment or prevention of CDI. The efficacy of LMN-201 is further enhanced by inclusion of a phage-derived endolysin that destroys the C. difficile bacterium, and which therefore has a complementary mechanism of action to the antibody cocktail. These observations may serve as a paradigm for the development of high potency biologic cocktails against targets that have proven challenging for single-agent therapies.

Launching PLTL for MATH: Building on the Foundation of Supplemental Instruction

The paper describes the launch of Peer-Led Team Learning for Precalculus Engineering and Math at the University of Texas at Arlington (UTA) and the results that PLTL has had on pass rates. Historically, students placed into Precalculus, instead of being Calculus ready, have experienced higher failure rates than any other student grouping. While UTA has invested in many studies, programs and techniques that aid these underprepared students, a few strategies have emerged as being effective. These strategies have included the previous implementation of Supplemental Instruction (SI), with separate sections devoted specifically to Precalculus co-enrolled engineering-course students, peer-based instruction, and active learning activities as opposed to additional lectures. As a result of these findings, in the Fall 2020 semester, UTA combined all these strategies into a learning course integrating these best practices into a required PLTL learning lab with problem-based activities and studying practices for the engineering course and a self-selected PLTL option for the math course. The goal was to aid in increasing success rates in these classes. The students engaged in effective “study habits” and problem-based learning practices with a Peer-Led Team Learning (PLTL) leader. What we have found is the positive impact that PLTL has on pass rates for at-risk populations in addition to positive satisfaction surveys. This paper will show the effectiveness of PLTL by discussing success rates for the Fall 2020 and Spring 2021 semesters versus the other singular implementations from previous semesters, in this case Supplemental Instruction.

Characterizing and mapping the spatial variability of HIV risk among adolescent girls and young women: A cross-county analysis of population-based surveys in Eswatini, Haiti, and Mozambique

Background To stem the HIV epidemic among adolescent girls and young women (AGYW), prevention programs must target services towards those most at risk for HIV. This paper investigates approaches to estimate HIV risk and map the spatial heterogeneity of at-risk populations in three countries: Eswatini, Haiti and Mozambique. Methods We analyzed HIV biomarker and risk factor data from recent population-based household surveys. We characterized risk using three approaches: complementary log-log regression, latent class analysis (LCA), and presence of at least one risk factor. We calculated the proportion and 95 percent confidence intervals of HIV-negative AGYW at risk across the three methods and employed Chi-square tests to investigate associations between risk classification and HIV status. Using geolocated survey data at enumeration clusters and high-resolution satellite imagery, we applied algorithms to predict the number and proportion of at-risk AGYW at hyperlocal levels. Results The any-risk approach yielded the highest proportion of at-risk and HIV-negative AGYW across five-year age bands: 26%-49% in Eswatini, 52%-67% in Haiti, and 32%-84% in Mozambique. Using LCA, between 8%-16% of AGYW in Eswatini, 37%-62% in Haiti, and 56%-80% in Mozambique belonged to a high vulnerability profile. In Haiti and Mozambique, the regression-based profile yielded the lowest estimate of at-risk AGYW. In general, AGYW characterized as “at risk” across the three methods had significantly higher odds of HIV infection. Hyperlocal maps indicated high levels of spatial heterogeneity in HIV risk prevalence and population density of at-risk AGYW within countries. Conclusion Characterizing risk among AGYW can help HIV prevention programs better understand the differential effect of multiple risk factors, facilitate early identification of high-risk AGYW, and design tailored interventions. Hyperlocal mapping of these at-risk populations can help program planners target prevention interventions to geographic areas with populations at greatest risk for HIV to achieve maximal impact on HIV incidence reduction.

Perspective Chapter: Fallout from the Pandemic—A Social and Psychological Description of COVID-19 Related Traumatic Sequelae

Pandemics are not new phenomena in human history but in a globalised and interconnected planet the differential impact upon each generation may be distinctive. The concept of trauma has been widely discussed over the last 18 months with emphasis on a collective stress and distress but also in respect of those who are vulnerable to psychological adversity because of established prior mental health diagnoses. Much debate has centred on the impact of the pandemic on mental illness, both new and established, and this chapter will examine the utility of interpreting the psychological outcome at individual and societal level through the lens of collective trauma. At risk populations, such as healthcare workers and those recovering from infection will be a special focus of this chapter.

Development and Initial Evaluation of a Nurse-Led Healthcare Clinic for Homeless and At-Risk Populations in Tasmania, Australia: A Collaborative Initiative

People who are homeless experience significantly poorer health than the general population and often face multifaceted challenges engaging with public healthcare services. Mission Health Nurse-led Clinic (MHNC) was established in 2019 to meet the healthcare needs of this marginalised population in Launceston, Tasmania. This study examines barriers to healthcare access amongst individuals who experience homelessness, client and staff perceptions of the MHNC services and explored opportunities for service expansion. Descriptive statistics were drawn from administrative data, and all interviews were thematically analysed. A total of 426 presentations were reported for 174 individuals experiencing homelessness over 26 months. The median client age was 42 years and 60.9% were male; A total of 38.5% were homeless or lived in a supported accommodation. The predominant reasons for clinic visits included prescription requests (25.3%) and immunisations (20.1%). A total of 10 clients and 5 City Mission staff were interviewed with three themes emerging from the findings: personal vulnerability, disconnectedness and acceptability of the MHNC. The MHNC services were reported to be highly appreciated by all clients. Mental health and allied health, extra operating hours and maintaining the flexibility of walk-in appointments were suggested as expansion areas for the service and were highlighted as ways to increase engagement for improved health outcomes. Continued partnerships with interprofessional primary healthcare providers would contribute to addressing unmet healthcare needs in this vulnerable population.

Factors Associated With State Mandate of Nursing Home Staff Testing During COVID-19

COVID-19 has presented challenges for nursing homes (NHs) and other congregate living settings which serve older adults at high risk for morbidity and death from the virus. This study identified factors associated with states’ adopting a mandate for regular staff testing for COVID-19 in NHs. Potential correlates included state government ideology and capacity, NH supply and demand, prevailing economic conditions, existing state policies, and NH characteristics. Findings indicate that percent for profit NHs is most strongly associated with adoption of a state staff testing mandate. Governing capacity (average legislative salary), percent population at risk for COVID-19, and existing public policy (percent Medicaid spending devoted to long-term services and supports (LTSS) were also associated with the probability of adoption. Based on these results, states with more proprietary facilities and greater capacities for government action, investment in Medicaid LTSS, and at-risk populations were more likely to mandate regular staff testing in NHs.