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Childhood immunization in Ghana: Tracing the history and projecting the future 加纳的儿童免疫接种:追溯历史,展望未来
Pub Date : 2024-05-19 DOI: 10.1002/puh2.176
Williams Walana, Mahmoud Al‐Azab, I. Yabasin, A. Abdul-Mumin
Childhood immunization has contributed significantly to child survival globally. Ghana adopted the Expanded Program on Immunization (EPI) in the year 1972, and since then Ghana's immunization program has chalked huge successes in disease prevention, particularly the drastic reduction in the incidence of the six childhood killer diseases. Despite these successes, there are shortfalls that affect childhood vaccinations in Ghana. Here, we look at the evolution of childhood vaccine adoption in Ghana, the disease burden in the pre‐vaccination era and the vaccination era, the benefits of the immunization program, and the identified shortfalls. More importantly, the impact of childhood immunization on the current state of vaccine‐preventable diseases and the prospects the future holds for vaccine development and disease prevention in Ghana were discussed. Undoubtedly, Ghana has made significant progress in vaccine adoption and expansion of immunization program, resulting in a significant reduction in vaccine‐preventable deaths particularly in children. However, challenges pertaining to vaccine coverage, periodic shortages of vaccine, untimely immunization, and logistics constraints persist, which need redress. Moreover, there is currently no continuous post‐vaccine surveillance to evaluate long‐term vaccine impact. Additionally, Ghana lacks the technology and skill to manufacture its own vaccines. Following the establishment of the National Vaccine Institute, Ghana should be in the position to start the production of established vaccines such as those covered under EPI, whereas collaborative research is needed to discover new vaccines. Finally, it is critical to network childhood immunization records across the nation to ensure enhanced data for planning.
儿童免疫接种为全球儿童的生存做出了巨大贡献。加纳于 1972 年通过了扩大免疫计划 (EPI),从那时起,加纳的免疫计划在疾病预防方面取得了巨大成功,尤其是儿童六大致命疾病的发病率大幅下降。尽管取得了这些成就,加纳的儿童疫苗接种工作仍存在不足之处。在此,我们将探讨加纳儿童疫苗接种的演变、接种前和接种后的疾病负担、免疫计划的益处以及已发现的不足之处。更重要的是,讨论了儿童免疫接种对加纳疫苗可预防疾病现状的影响以及疫苗开发和疾病预防的未来前景。毫无疑问,加纳在采用疫苗和扩大免疫计划方面取得了重大进展,从而大大降低了可通过疫苗预防的死亡人数,尤其是儿童。然而,疫苗覆盖率、疫苗周期性短缺、免疫不及时和后勤制约等方面的挑战依然存在,需要加以解决。此外,目前还没有持续的疫苗接种后监测来评估疫苗的长期影响。此外,加纳缺乏自己生产疫苗的技术和技能。在国家疫苗研究所成立后,加纳应能开始生产已有的疫苗,如扩大免疫方案所涵盖的疫苗,而发现新疫苗则需要合作研究。最后,必须将全国儿童免疫接种记录联网,以确保加强规划数据。
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引用次数: 0
Barriers to mental health service utilization among African immigrants in the United Kingdom: A systematic review 英国非洲移民利用心理健康服务的障碍:系统回顾
Pub Date : 2024-05-19 DOI: 10.1002/puh2.181
Archibong Bassey, Rachael Zaka
African immigrants in the United Kingdom (UK) face unique challenges in accessing mental health services (MHSs), in contrast to their peers born in the UK, contributing to their worsening mental and physical health outcomes. This study aims to uncover barriers to MHS utilization and proffer evidence‐based recommendations toward addressing the mental health needs of African immigrants residing in the UK.A systematic literature search was conducted across six databases: Medline, PsycINFO, Web of Science, CIHNAL, Scopus, and Embase published up to September 2022. To assess methodological quality of the included studies, the Critical Appraisal Skills Program qualitative checklist and the Mixed Methods Appraisal Tool Version 2018 were used. Consecutively, a deductive thematic analysis was employed to group related barriers within overarching themes.The study selection process yielded eight studies conducted in the UK, encompassing African populations identifying as African/Afro‐Caribbean origin, Somali refugees, and ethnic minorities of Black/British descent. The findings highlight the complex interplay of key barriers such as stigma, residential instability, cultural influences, discrimination, and accessibility issues, among others, that continue to hinder African populations from accessing and utilizing MHSs. These barriers were categorized into predisposing,enabling and need factors (themes), aligning with Anderson's model of health service utilization, reflecting a comprehensive range of challenges affecting this population.This systematic review illuminates the myriad barriers faced by African immigrants in utilizing MHSs in the UK, underlining the urgent need for targeted interventions. The findings advocate for the development of culturally sensitive, affordable, and accessible MHSs and policies that address the personal, sociocultural, and structural barriers identified. Collaboration across key stakeholders is highly recommended for advancing equitable and inclusive MHSs for all.
与在英国出生的同龄人相比,英国的非洲移民在获得心理健康服务(MHS)方面面临着独特的挑战,这也是导致他们身心健康状况恶化的原因之一。本研究旨在揭示使用心理健康服务的障碍,并提出循证建议,以满足居住在英国的非洲移民的心理健康需求:对截至 2022 年 9 月发表的 Medline、PsycINFO、Web of Science、CIHNAL、Scopus 和 Embase 六个数据库进行了系统性文献检索。为了评估纳入研究的方法学质量,研究人员使用了 "批判性评估技能计划 "定性检查表和2018版 "混合方法评估工具"。在研究筛选过程中,共产生了八项在英国进行的研究,涵盖了被认定为非洲/加勒比海非裔、索马里难民以及黑人/英国后裔的少数民族。研究结果凸显了主要障碍之间复杂的相互作用,如污名化、居住不稳定、文化影响、歧视和可及性问题等,这些障碍继续阻碍着非洲人获得和利用移动保健服务。根据安德森的医疗服务利用模式,这些障碍被分为倾向性因素、有利因素和需求因素(主题),反映了影响这一人群的一系列挑战。这项系统性综述揭示了非洲移民在英国利用移动医疗服务时面临的无数障碍,强调了采取针对性干预措施的迫切需要。研究结果提倡制定文化敏感、可负担、可获得的医疗保健服务和政策,以解决已发现的个人、社会文化和结构性障碍。强烈建议各主要利益相关者开展合作,为所有人推进公平、包容的移动保健服务。
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引用次数: 0
Addressing the challenges of dementia care in Nigeria: A call for a comprehensive national strategy 应对尼日利亚痴呆症护理方面的挑战:呼吁制定全面的国家战略
Pub Date : 2024-05-15 DOI: 10.1002/puh2.186
Oluwagbemiga Oyinlola
Despite the growing prevalence of dementia, driven by an ageing population and compounded by cultural misunderstandings and stigma, Nigeria lacks a coherent national plan to address this issue. The article points out that although Nigeria has enacted policies such as the National Aging Policy, which do not sufficiently address the specific needs of people living with dementia. It underscores the necessity of integrating a dementia strategy within the broader health and social care systems of Nigeria. The article draws on the World Health Organization's Global Dementia Action Plan to elaborates on several critical areas for action, including public health prioritization of dementia, awareness and stigma reduction, improved diagnosis, treatment, care, and support, alongside bolstering support for caregivers. It stresses the importance of a dementia‐friendly infrastructure, research and innovation, and leveraging community support to foster a more inclusive society. Furthermore, the article outlines current state of healthcare and social support systems in Nigeria, pointing to significant gaps in infrastructure, healthcare workforce, and financial mechanisms that hinder effective dementia care. Hence, elevating dementia care as a national health priority, and increasing access to quality care and support, Nigeria is well positioned to mitigate the impact of dementia on families and the person with dementia. The call to action is clear: a national dementia strategy, informed by global best practices and tailored to Nigeria's unique cultural and societal context, is essential for addressing the challenges of dementia care and improving the well‐being of affected individuals and their families in Nigeria.
尽管在人口老龄化的推动下,痴呆症的发病率越来越高,再加上文化上的误解和污名化,尼日利亚仍然缺乏一个连贯的国家计划来解决这个问题。文章指出,尽管尼日利亚颁布了《国家老龄化政策》等政策,但这些政策并没有充分满足痴呆症患者的具体需求。文章强调,有必要将痴呆症战略纳入尼日利亚更广泛的卫生和社会保健系统。文章借鉴了世界卫生组织的《全球痴呆症行动计划》,详细阐述了几个关键的行动领域,包括将痴呆症列为公共卫生优先事项、提高认识和减少耻辱感、改善诊断、治疗、护理和支持,以及加强对护理人员的支持。文章强调了对痴呆症友好的基础设施、研究和创新以及利用社区支持来促进一个更具包容性的社会的重要性。此外,文章还概述了尼日利亚医疗保健和社会支持系统的现状,指出基础设施、医疗保健人才队伍和金融机制方面的巨大差距阻碍了有效的痴呆症护理。因此,将痴呆症护理提升为国家卫生优先事项,并增加获得优质护理和支持的机会,尼日利亚完全有能力减轻痴呆症对家庭和痴呆症患者的影响。行动的号召是明确的:借鉴全球最佳做法并根据尼日利亚独特的文化和社会背景量身定制的国家痴呆症战略,对于应对痴呆症护理的挑战和改善尼日利亚受影响的个人及其家庭的福祉至关重要。
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引用次数: 0
COVAX and COVID‐19 Vaccine Inequity: A case study of G‐20 and African Union COVAX 和 COVID-19 疫苗不公平:20 国集团和非洲联盟案例研究
Pub Date : 2024-05-09 DOI: 10.1002/puh2.185
Anjali Pushkaran, V. Chattu, Prakash Narayanan
As the world has a history of vaccine nationalism, especially during the 2009 Swine flu pandemic, the COVAX alliance, a globally collaborated mechanism, was created by World Health Organization (WHO), GAVI, and UNICEF to address the inequity of COVID‐19 vaccines. One of the primary aims of this alliance was to deliver vaccines to low‐ and middle‐income countries (LMICs), which otherwise have less or no capacity to access vaccines from the open market. It is crucial to explore the contribution of COVAX in bridging the gap in equity, accessibility, and affordability of COVID‐19 vaccines between high‐ and low‐income countries (LICs). We selected Group 20 (G20) COVAX participants and the African Union (AU) as case studies to estimate these gaps. The bilateral purchase data shows that by December 2021, the G20 countries had vaccines more than double their population, whereas the AU could procure only about one fifth (19%) of their population. Out of 52 AU countries whose data was available, only 21 of them could strike a bilateral deal with vaccine manufacturers. Even after COVAX delivery, the share of the population that could be vaccinated in AU was just 36.8%, less than the target of WHO (40%) for December 2021. It was found that the COVAX alliance worked better than the open market competition for LMICs and LICs. The cost of vaccinating 20% of the population was 0.7% of the current health expenditure for G20 countries, whereas AU countries had to spend 5.5%. COVAX bears more cost (1%–3%) for AU countries than G20 countries (less than 1%). COVAX made COVID‐19 vaccines more affordable and accessible to these countries. However, LICs were disproportionately affected even with the COVAX Facility mechanism owing to their lack of vaccine deployment infrastructure.
由于世界上存在疫苗民族主义的历史,尤其是在 2009 年猪流感大流行期间,世界卫生组织(WHO)、全球疫苗免疫联盟(GAVI)和联合国儿童基金会(UNICEF)创建了 COVAX 联盟这一全球合作机制,以解决 COVID-19 疫苗的不公平问题。该联盟的主要目标之一是向中低收入国家(LMICs)提供疫苗,否则这些国家从公开市场获得疫苗的能力较低或根本没有能力。探讨 COVAX 在缩小高收入国家和低收入国家 (LIC) 之间 COVID-19 疫苗的公平性、可获得性和可负担性方面的差距方面的贡献至关重要。我们选择了 20 国集团 (G20) COVAX 参与国和非洲联盟 (AU) 作为案例研究,以估算这些差距。双边采购数据显示,到 2021 年 12 月,20 国集团国家的疫苗采购量是其人口数量的两倍多,而非盟的采购量仅为其人口数量的五分之一(19%)。在有数据可查的 52 个非盟国家中,只有 21 个国家能与疫苗制造商达成双边协议。即使在提供 COVAX 后,非盟可接种疫苗的人口比例也仅为 36.8%,低于世界卫生组织 2021 年 12 月的目标(40%)。研究发现,对于低收入和中等收入国家以及低收入和中等收入国家而言,COVAX 联盟的效果要好于公开市场竞争。为 20% 的人口接种疫苗的成本占 20 国集团国家当前卫生支出的 0.7%,而非盟国家则需要支出 5.5%。COVAX 为非盟国家带来的成本(1%-3%)高于 20 国集团国家(低于 1%)。COVAX 使这些国家更能负担得起和更容易获得 COVID-19 疫苗。然而,由于缺乏疫苗部署基础设施,即使有 COVAX 基金机制,低收入国家也受到了极大的影响。
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引用次数: 0
Strategic threat health response in Australia capital cities: Predicting the optimum locations for field hospitals through geospatial analysis 澳大利亚首府城市的战略性健康威胁应对措施:通过地理空间分析预测野战医院的最佳位置
Pub Date : 2024-05-08 DOI: 10.1002/puh2.177
Mazen Baazeem, E. Kruger, M. Tennant
The advent of the COVID‐19 pandemic has accentuated the critical importance of epidemic preparedness within national healthcare systems. This study presents a geospatial analysis aimed at optimising the placement of field hospitals in Australia to ensure adequate healthcare access during pandemics.The latest census data from the Australian Bureau of Statistics were integrated with the spatial locations of current emergency departments within Australian capitals. Buffer zones with a 7.5 km radius were created around the public emergency departments (EDs). Buffer zones outside the 7.5 km radius that exhibited high population densities were categorised into high‐density (red), moderate‐density (yellow) and low‐density (green) zones to prioritise and tailor healthcare responses during a pandemic. The identification of high‐density population areas outside the ED radius enabled the stratification of potential sites for ED facilities.Ninety‐one potential field hospital sites were identified across Australia's capital cities. The findings indicate that the addition of these sites would place over 95% of the population within a 7.5 km radius of an ED facility. This network of proposed sites is designed to serve a spectrum of population densities, ensuring equitable healthcare access for both densely populated urban centres and less populated areas.This study underscores the potential of field hospitals to strengthen Australia's public health system against emergencies. By advocating for the creation of 91 field hospitals within a 7.5 km reach for over 95% of urban dwellers across major cities, it demonstrates a strategic approach to ensure comprehensive ED coverage. Drawing on international examples, including China's Fangcang hospitals, the USA's post‐acute care (PAC) facilities and the United Kingdom's National Health Service (NHS) Nightingale Hospitals, it highlights the need for healthcare agility and scalability, especially during pandemic outbreaks. The research presents a blueprint for field hospital deployment, marking a significant advancement in public health logistics and protection across Australia's varied demographic and geographical landscapes.
COVID-19 大流行的出现凸显了国家医疗保健系统内流行病防备工作的极端重要性。本研究介绍了一种地理空间分析方法,旨在优化澳大利亚野战医院的布局,以确保在大流行病期间提供充足的医疗服务。澳大利亚统计局提供的最新人口普查数据与澳大利亚各首府现有急诊科的空间位置进行了整合。以 7.5 公里为半径,在公立急诊室周围建立了缓冲区。半径为 7.5 千米以外的缓冲区人口密度较高,被划分为高密度区(红色)、中等密度区(黄色)和低密度区(绿色),以便在大流行期间优先采取有针对性的医疗保健应对措施。通过识别急诊室半径外的高密度人口区,对急诊室设施的潜在选址进行了分层。研究结果表明,如果增加这些地点,将有超过 95% 的人口处于急诊室设施 7.5 公里半径范围内。该研究强调了野战医院在加强澳大利亚公共卫生系统应对突发事件方面的潜力。这项研究强调了澳大利亚加强公共卫生系统应对突发事件的潜力,主张在各大城市中为超过95%的城市居民在7.5公里的范围内建立91所野战医院,从而展示了一种确保紧急医疗救援全面覆盖的战略方法。通过借鉴国际范例,包括中国的芳村医院、美国的急性期后护理(PAC)设施和英国国家医疗服务系统(NHS)的南丁格尔医院,该研究强调了医疗灵活性和可扩展性的必要性,尤其是在大流行病爆发期间。这项研究为野战医院的部署描绘了蓝图,标志着澳大利亚不同人口和地理环境下的公共卫生后勤和保护工作取得了重大进展。
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引用次数: 0
Indoor and outdoor NO2 and SO2 levels in 13 randomly selected preschools from 7 districts in Mpumalanga Province, South Africa 南非姆普马兰加省 7 个地区随机抽取的 13 所幼儿园的室内外二氧化氮和二氧化硫水平
Pub Date : 2024-05-08 DOI: 10.1002/puh2.175
Mudau Rodney, Voyi Kuku, Shirinde Joyce
Air pollution is a serious worldwide issue, where both outdoor and indoor air quality have a substantial impact on the health of children. Children are more vulnerable to the effects of air pollution due to their developing respiratory systems and higher respiration rates than adults. These children dedicate a substantial amount of time to the preschool setting. The study sought to evaluate the concentration of NO2 and SO2 in both outdoor and indoor environments of preschool facilities.Concurrently, the levels of NO2 and SO2 were measured indoors and outdoors at 13 randomly selected preschools in 7 districts in Mpumalanga Province, South Africa. Radiello passive air samplers were employed to collect gaseous samples.The mean levels of NO2 indoors and outdoors were within the recommended criteria outlined by the World Health Organization (WHO), specifically target levels 1–3. Additionally, these values were also below the air quality guides outlined by South Africa, both for yearly and 1‐h mean measurements. Nevertheless, both levels remained above the suitable threshold of 10 µg m−3 outlined by the WHO air quality guidelines.It is important to implement proactive measures such as enhancing airflow systems, employing air filters and reducing potential sources of air pollution in preschools, to aid in reducing exposure to indoor and outdoor NO2 and SO2.
空气污染是一个严重的世界性问题,室外和室内的空气质量都会对儿童的健康产生重大影响。儿童的呼吸系统正在发育,呼吸频率高于成人,因此更容易受到空气污染的影响。这些儿童在学前环境中花费了大量时间。这项研究旨在评估学前教育机构室外和室内环境中的二氧化氮和二氧化硫浓度。同时,在南非姆普马兰加省 7 个地区随机抽取的 13 所学前教育机构的室内和室外测量了二氧化氮和二氧化硫的含量。室内和室外的二氧化氮平均水平均在世界卫生组织(WHO)建议的标准范围内,特别是目标值 1-3 级。此外,无论是全年平均值还是 1 小时平均值,这些数值都低于南非制定的空气质量指南。重要的是要采取积极主动的措施,如加强空气流通系统、使用空气过滤器和减少学龄前学校潜在的空气污染源,以帮助减少室内外二氧化氮和二氧化硫的暴露量。
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引用次数: 0
A new era for African health systems: Market shaping and the African Continental Free Trade Area (AfCFTA) 非洲卫生系统的新时代:市场塑造与非洲大陆自由贸易区(AfCFTA)
Pub Date : 2024-05-07 DOI: 10.1002/puh2.172
Jonta Kamara, Ukeme Essien, Alain B. Labrique
The COVID‐19 pandemic has forced a reflection on the origins of supplies in African healthcare market and underscored the need for an increase in local manufacturing of medical supplies. Several African countries’ health markets have been heavily reliant on imports. First, this article demonstrates how the African healthcare market has had a high import dependency and the role that the African Continental Free Trade Area (AfCFTA) could play to reverse this. It is estimated that African countries import between 80% and 94% of medical supplies, 75% of testing kits, between 70% and 95% of pharmaceuticals, and 99% of vaccines. Second, during the COVID‐19 pandemic, countries imposed export restrictions which impacted the flow of medical supplies to African countries. This finding highlighted the limited production capabilities on the African continent and reiterated the need to strengthen continental value chains and local manufacturing capacity to establish the continent's New Public Health Order. Third, there was the emergence of local innovations seeking to minimize the impact of these supply chain disruptions. Using case studies on the local production of COVID‐19 testing kits and personal protective equipment, the article highlights progress made toward health market reform. It calls attention to the implementation of the AfCFTA to strengthen the supply, manufacturing, and trade of medical resources. Fourth, this article highlights countries that have African‐made pharmaceuticals and vaccinations and the importance of regional hubs to expand these products in African healthcare markets. It concludes by discussing investments made to expand local manufacturing of health products.
COVID-19 大流行迫使人们反思非洲医疗市场用品的来源,并强调了增加本地医疗用品制造的必要性。一些非洲国家的医疗市场一直严重依赖进口。首先,本文展示了非洲医疗市场如何高度依赖进口,以及非洲大陆自由贸易区(AfCFTA)在扭转这一局面方面可以发挥的作用。据估计,非洲国家 80% 至 94% 的医疗用品、75% 的检测试剂盒、70% 至 95% 的药品和 99% 的疫苗需要进口。其次,在 COVID-19 大流行期间,各国实施了出口限制,影响了医疗用品流向非洲国家。这一发现凸显了非洲大陆有限的生产能力,并重申有必要加强非洲大陆的价值链和本地制造能力,以建立非洲大陆的公共卫生新秩序。第三,当地出现了一些创新举措,力求将这些供应链中断的影响降至最低。文章通过对当地生产 COVID-19 检测包和个人防护设备的案例研究,重点介绍了在卫生市场改革方面取得的进展。文章呼吁关注非洲自由贸易区的实施,以加强医疗资源的供应、制造和贸易。第四,本文重点介绍了拥有非洲制造的药品和疫苗的国家,以及区域中心在非洲医疗市场拓展这些产品的重要性。最后,文章讨论了为扩大保健产品的本地制造而进行的投资。
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引用次数: 0
Health intervention trials involving transgender, transabled and transracial persons in Africa: A scoping review 涉及非洲变性人、变性人和变性人的健康干预试验:范围界定审查
Pub Date : 2024-05-06 DOI: 10.1002/puh2.182
J. Amzat, K. Kanmodi, K. Aminu, Abbas Ismail, A. Salami
Health intervention trials constitute important research efforts to find appropriate solutions to health issues affecting different populations. In many cases, it involves high‐risk groups such as the trans‐communities. This scoping review aims to review the existing health intervention trials involving transgender, transabled and transracial persons in Africa.This scoping review adopted the research design by Arskey and O'Malley. Using the Population–Concept–Context framework, a robust systematic search of four research databases, including APA PsycINFO, SCOPUS, CINAHL Complete and PubMed, was conducted to retrieve literature relevant to the review's question. Duplicate copies in the retrieved literature were removed using the Rayyan web‐based application. The residual literature was screened for relevance based on the review's inclusion and exclusion criteria, and only those eligible articles were included in this review. From the included literature, data were charted, collated, summarized and presented as results.The scoping review included and reviewed only four articles, which reported studies involving transgender persons. No peer‐reviewed original research article on transabled and transracial persons in Africa was found eligible for inclusion in this review. All the reviewed articles focused on at‐risk, healthy and human immunodeficiency virus (HIV)‐uninfected adult participants ranging between the ages of 18 and 65 years. The domains investigated in those articles were on sexual health, HIV preventive drugs and vaccine trials. The reviewed findings showed the use of HIV‐inhibiting medications and HIV screening or testing as vital preventive interventions among transgender persons in Africa. The available research evidence shows sexuality reductionism about trans behaviour by neglecting other health domains.Health trial research on transracial, transgender and transabled persons is a largely underexplored research domain in Africa. More health intervention trials, beyond the domain of sexual health, are required to improve the health and well‐being of this highly marginalized population group in Africa.
健康干预试验是一项重要的研究工作,旨在为影响不同人群的健康问题找到适当的解决方案。在许多情况下,它涉及变性群体等高风险群体。本范围界定综述旨在综述现有的涉及非洲变性人、变性人和跨种族人的健康干预试验。采用 "人群-概念-背景 "框架,对四个研究数据库(包括 APA PsycINFO、SCOPUS、CINAHL Complete 和 PubMed)进行了强大的系统搜索,以检索与综述问题相关的文献。使用 Rayyan 网络应用程序删除了检索到的文献中的重复内容。根据综述的纳入和排除标准对剩余文献进行相关性筛选,只有符合条件的文章才被纳入本综述。此次范围界定审查仅纳入并审查了四篇文章,这些文章报告了涉及变性人的研究。经同行评审,没有发现任何关于非洲变性者和跨种族者的原创研究文章符合纳入本综述的条件。所有经审查的文章都以高危、健康和未感染人类免疫缺陷病毒(HIV)的 18 至 65 岁成年参与者为研究对象。这些文章调查的领域包括性健康、艾滋病预防药物和疫苗试验。审查结果表明,在非洲变性人中使用艾滋病毒抑制药物和艾滋病毒筛查或检测是至关重要的预防干预措施。现有的研究证据表明,对变性行为的性还原论忽视了其他健康领域。在非洲,对跨种族、变性和变性者的健康试验研究在很大程度上是一个未得到充分开发的研究领域。需要在性健康领域之外开展更多的健康干预试验,以改善非洲这一高度边缘化人群的健康和福祉。
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引用次数: 0
The School Suicide Policy Evaluation Tool (SSPET): A proof‐of‐concept for assessing school suicide prevention policies 学校自杀政策评估工具 (SSPET):评估学校自杀预防政策的概念验证
Pub Date : 2024-05-02 DOI: 10.1002/puh2.178
Douglas Wirthlin, Zeke Richards, Cody Crandall, Shad Mortensen, Jackson R. Richards, Amanda Bakian
As adolescent suicide rates have increased, there has been a nationwide increase in legislation requiring schools to create suicide prevention policies. In Utah, school districts must implement a youth suicide program for grades 7–12. Currently, there have been no systematic analyses of Utah school district suicide prevention policies. Thus, we developed a new evaluation instrument, the School Suicide Policy Evaluation Tool (SSPET).The SSPET was derived from the “Model School District Policy” and evaluates criteria on prevention, intervention, re‐entry, and postvention. Four raters used the SSPET in a systematic analysis of suicide prevention policies for all school districts in the state of Utah.Analysis revealed a right‐skewed distribution of policy scores, and a median total score was 2.25/36. The mean percentage of inclusion of the four subsections in policies was less than 20% for most criteria. Median scores were totaled for the four subsections as follows: Prevention score was 1/9, intervention score was 1/14, re‐entry score was 0/4, and postvention score was 0/9.This proof‐of‐concept study demonstrates the utility of the SSPET in identifying shortcomings of school district policies on suicide while generating specific recommendations for improvement. With further validity testing, we expect this tool to be useful to school district administrators, education policymakers, and those studying suicide interventions and outcomes in school‐aged children and adolescents.
随着青少年自杀率的上升,全国范围内要求学校制定自杀预防政策的立法也在增加。在犹他州,学区必须在 7 到 12 年级实施青少年自杀计划。目前,还没有针对犹他州学区自杀预防政策的系统分析。因此,我们开发了一种新的评估工具--"学校自杀政策评估工具"(School Suicide Policy Evaluation Tool,SSPET)。SSPET 源自 "校区政策范本",评估标准包括预防、干预、重返校园和后期干预。四名评估员使用 SSPET 对犹他州所有学区的自杀预防政策进行了系统分析。分析显示,政策得分呈右斜分布,总分中位数为 2.25/36。在大多数标准中,政策中包含四个小节的平均比例低于 20%。四个小节的总分中位数如下:这项概念验证研究证明了 SSPET 在发现校区自杀政策的不足之处并提出具体改进建议方面的实用性。通过进一步的有效性测试,我们希望该工具能对学区管理人员、教育政策制定者以及研究学龄儿童和青少年自杀干预措施和结果的人员有所帮助。
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Addressing cervical cancer prevention in Bhutan: A study on the use of loop electrosurgical excision procedures at the primary health care level 在不丹预防宫颈癌:关于在初级保健中使用环形电切术的研究
Pub Date : 2024-05-01 DOI: 10.1002/puh2.180
Sangay Tshering, N. Dorji, Zimba Letho, Nishal Chhetri
Cervical cancer is the top and fourth leading cause of death among women in Bhutan and worldwide, respectively. The cervical cancer elimination flagship program initiated by the Ministry of Health aims to achieve the 90–70–90 goals by 2030. To achieve this, detection and treatment of pre‐cancerous lesions of the cervix through colposcopy and loop electrosurgical excision procedure (LEEP) are being carried out through the outreach health camps.This descriptive study aimed to assess the safety and tolerability of LEEP under local anesthesia and assess the margin status of high‐grade lesion (HGL). We analyzed 193 records of clients who underwent LEEP at Wangdue Phodrang Hospital from 26 September to 5 October 2022. The sociodemographic profile, intraoperative pain, complications, and histopathological reports were described using structured pro forma.The mean age of clients was 40.9 ± 8.5 years (range 25–66 years). There were 3.1% who had intraoperative and 2.6% who had postoperative bleeding. There were 18.6% who had foul‐smelling vaginal discharge, and 8.3% had moderate‐to‐severe intraoperative pain. Histopathological assessment revealed 29.5% with chronic cervicitis, 34.2% with HGL, and 1.6% with microinvasive cervical carcinoma. The margin positivity for HGL was 36.4%.Given the safety profile of LEEP under local anesthesia in our setting, the scope of providing a complete cervical cancer screening and treatment package at the primary health care level looks promising. Based on the higher rate of overtreatment and margin positivity, we recommend the practical implementation of standard colposcopy guidelines.
宫颈癌分别是不丹和全球妇女的第一大和第四大死因。卫生部发起的消除宫颈癌旗舰计划旨在到 2030 年实现 90-70-90 目标。这项描述性研究旨在评估局部麻醉下宫颈环形电切术(LEEP)的安全性和耐受性,并评估高级别病变(HGL)的边缘状态。我们分析了2022年9月26日至10月5日期间在旺度普德朗医院接受LEEP术的193份病历。患者的平均年龄为 40.9 ± 8.5 岁(25-66 岁)。术中出血者占 3.1%,术后出血者占 2.6%。18.6%的患者有恶臭的阴道分泌物,8.3%的患者术中有中度至重度疼痛。组织病理学评估显示,29.5%的患者患有慢性宫颈炎,34.2%患有HGL,1.6%患有微小浸润性宫颈癌。鉴于 LEEP 在局部麻醉下的安全性,在基层医疗机构提供一整套宫颈癌筛查和治疗方案的前景看好。鉴于过度治疗和边缘阳性率较高,我们建议切实执行标准阴道镜检查指南。
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Public health challenges
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