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Abstract Background In sub-Saharan Africa, the prevalence of non-communicable diseases (NCDs) has risen sharply amidst a high burden of communicable diseases. An integrated approach to HIV and NCD care offers the potential of strengthening disease control programmes. We used qualitative methods to explore patients’ and care-providers’ experiences and perspectives on the acceptability of integrated care for HIV-infection, diabetes mellitus (DM), and hypertension (HT) in Tanzania. Methods A qualitative study was conducted in selected health facilities in Dar es Salaam and Coastal regions, which had started to provide integrated care and management for HIV, DM, and HT using a single research clinic for patients with one or more of these conditions. In-depth interviews were held with patients and healthcare providers at three time points: At enrolment (prior to the patient receiving integrated care, at the mid-line and at the study end). A minimum of 16 patients and 12 healthcare providers were sampled for each time point. Observation was also carried out in the respective clinics during pre- and mid-line phases. The Theoretical Framework of Acceptability (TFA) underpinned the structure and interpretation of the combined qualitative and observational data sets. Results Patients and healthcare providers revealed a positive attitude towards the integrated care delivery model at the mid-line and at study end-time points. High acceptability was related to increased exposure to service integration in terms of satisfaction with the clinic setup, seating arrangements and the provision of medical care services. Satisfaction also centred on the patients’ freedom to move from one service point to another, and to discuss the services and their own health status amongst themselves. Adherence to medication and scheduling of clinic appointments appeared central to the patient-provider relationship as an aspect in the provision of quality services. Multi-condition health education, patient time and cost-saving, and detection of undiagnosed disease conditions emerged as benefits. On the other hand, a few challenges included long waiting times and limited privacy in lower and periphery health facilities due to infrastructural limitations. Conclusion The study reveals a continued high level of acceptability of the integrated care model among study participants in Tanzania. This calls for evaluation in a larger and a comparative study. Nevertheless, much more concerted efforts are necessary to address structural challenges and maximise privacy and confidentiality.

Introduction: Previous research has raised concerns about high prevalence of drug-related problems, polypharmacy and inappropriate benzodiazepine prescribing in nursing homes (NHs) and confirmed lack of studies from Central and South-Eastern Europe. The aim of our study was to determine the prevalence and characteristics of polypharmacy, hyperpolypharmacy and inappropriate benzodiazepine prescribing in NH residents in Croatia. Methods: Data from 226 older NH residents from five Croatian NHs were collected using the InterRAI Long-Term Care Facilities assessment form. The prevalence and determinants of polypharmacy/hyperpolypharmacy and patterns of inappropriate benzodiazepine prescribing were documented. Results: The prevalence of polypharmacy (49.6%) and hyperpolypharmacy (25.7%) among NH residents was high. In our study, 72.1% of NH residents were prescribed at least one psychotropic agent, 36.7% used 2-3 psychotropics and 6.6% used 4+ psychotropics. Among benzodiazepine users (55.8%), 28% of residents were prescribed benzodiazepines in higher than recommended geriatric doses, 75% used them for the long term and 48% were prescribed concomitant interacting medications. The odds of being prescribed polypharmacy/hyperpolypharmacy were significantly higher for older patients with polymorbidity (6+ disorders, proportional odds ratio (POR) = 19.8), type II diabetes (POR = 5.2), ischemic heart disease (POR = 4.6), higher frailty (Clinical Frailty Scale (CFS ≥5); POR = 4.3) and gastrointestinal problems (POR = 4.8). Conclusions: Our research underscores the persistent challenge of inappropriate medication use and drug-related harms among older NH residents, despite existing evidence and professional campaigns. Effective regulatory and policy interventions, including the implementation of geriatrician and clinical pharmacy services, are essential to address this critical issue and ensure optimal medication management for vulnerable NH populations. [ABSTRACT FROM AUTHOR]

This review aimed at evaluating the state of availability, accessibility and model of delivery of oral health services in prisons, globally. Five databases of peer‐reviewed literature and potential sources of grey literature were systematically searched. Inclusion criteria encompassed oral health papers related to prisons globally, with exclusion of certain article types. Selection involved independent evaluations by two researchers, followed by quality assessment. Data on the availability of oral health interventions in prisons came from 18 countries, while information on the model of delivery of the services is scarce. In addition, two sets of individual and organizational barriers toward oral health service uptake in prisons were revealed and discussed in the text. Lack of oral health services in prisons affects people living in prisons and jeopardizes their reintegration. Urgent and concrete international actions are required to ensure the availability, accessibility, and quality of oral health services among people living in prisons. [ABSTRACT FROM AUTHOR]

Practicing pronunciation through language learning systems incorporating Automatic Speech Recognition (ASR) technology has been effective in helping improve foreign language pronunciation. One of the ASR affordances is that it can provide immediate, personalized feedback on learners' pronunciation. We investigated the effects of two ASR-based language learning systems, I Love Indonesia (ILI) and NovoLearning (NOVO), on learners' word-level and sentence-level pronunciation. ILI offers global corrective feedback, while NOVO is equipped with corrective feedback on phonetic details. 117 Indonesian high school students participated in a five-week-long experiment; 52 students used ILI and 65 NOVO. Three pronunciation measures were calculated on a pre and post reading test: phonetic edit distances plus accentedness and comprehensibility ratings. Results indicate significant improvements in learners' pronunciation, confirming that both systems are promising learning tools, with NOVO leading to more progress. Future studies should examine the long-term effects of ASR-based global and phonetic feedback on learners' pronunciation quality. [ABSTRACT FROM AUTHOR]

Although most second language learning studies involve high-educated participants, addressing low-educated participants seems important as research suggests that education background impacts second language (L2) learning efficiency. A controversial point in the L2 learning literature is the role of corrective feedback (CF). Research on CF in relation to individual differences, including education background, requires controlled experimental environments. This article presents a study in such a controlled environment: a computer assisted language learning (CALL) system with logging capabilities and automatic speech processing to provide CF on spoken grammar practice. In the experiment, 68 Dutch L2 learners were randomly assigned to either an automatic grammaticality CF condition or a NOCF (no corrective feedback) condition. We analysed learning outcome, evaluative measures, and practice behaviour logged by the CALL system. Practice behaviour differed with education background, which in turn related to learning outcome. Learners with high and medium education levels benefitted from speaking practice in both conditions, while low-educated learners did not benefit from practice, in neither condition. For medium and high educated learners there was a trend for CF to increase practice effectiveness. Education level therefore is an important individual difference in L2 learning research that influences the effectiveness of CF.

This article reports on the academic performance and experiences of non-native university students, specifically German students in a Dutch academic environment. These students have a substantial dropout rate. In an earlier study, we found correlations between results on language tests and study results. In this study, we used semi-structured interviews with student advisors, students and teachers to investigate in more detail the role of foreign language proficiency in academic success. We identified three major language-related issues: (1) listening and speaking in discussion groups, (2) writing in examinations and assignments, and (3) the negative impact of language proficiency on grades. The quality and readability of the written assignments was repeatedly highlighted as the core problem. Additionally, we investigated the influence of the use of English as an additional foreign language.

The Internet offers increased availability and accessibility of medicinal pharmaceuticals including those containing opioids, sedatives and gamma-aminobutyric acid (GABA) drugs through both legal and illegal routes. Sourcing concerns have been further heightened due to the current severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic which reduced face-to-face access for non-COVID-19 related health conditions and to drug treatment services. This study is the second of a two stage study comprising interviews with three key stakeholders who were policy makers, health care professionals or police, and three individuals who sourced medicinal products online (ISOs). An in-depth case study approach was adopted. Thematic analysis of in-depth case narratives revealed the following key themes; Motivations, initiation, and making the move online; Process of sourcing online; Supply issues and COVID-19; Perception of control; Quality of medications; and Public health recommendations. Motivations for purchasing online are complex and methods to divert and control the supply of medicinal pharmaceuticals are equally complex and difficult to navigate. Novel routes to access now include Telegram, a cross-platform messaging service with enhance encryption and privacy. Whilst stakeholders and ISOs had similar views on the prevalence and ease of access to medication, there were also some substantial differences primarily in terms of perceptions of risk. This study highlights the need for enhanced pharmacovigilance of non-regulated online vendors and the imperatives of continued health messaging around the potential self-directed use of these controlled drugs and the dangers of using websites purporting to be regulated pharmacies.

Angiopoietin-like 4 (ANGPTL4) is an endogenous inhibitor of lipoprotein lipase that modulates lipid levels, coronary atherosclerosis risk, and nutrient partitioning. We hypothesize that loss of ANGPTL4 function might improve glucose homeostasis and decrease risk of type 2 diabetes (T2D). We investigate protein-altering variants in ANGPTL4 among 58,124 participants in the DiscovEHR human genetics study, with follow-up studies in 82,766 T2D cases and 498,761 controls. Carriers of p.E40K, a variant that abolishes ANGPTL4 ability to inhibit lipoprotein lipase, have lower odds of T2D (odds ratio 0.89, 95% confidence interval 0.85-0.92, p = 6.3 × 10-10), lower fasting glucose, and greater insulin sensitivity. Predicted loss-of-function variants are associated with lower odds of T2D among 32,015 cases and 84,006 controls (odds ratio 0.71, 95% confidence interval 0.49-0.99, p = 0.041). Functional studies in Angptl4-deficient mice confirm improved insulin sensitivity and glucose homeostasis. In conclusion, genetic inactivation of ANGPTL4 is associated with improved glucose homeostasis and reduced risk of T2D.

Abstract Background Although HIV continues to have a high prevalence among adults in sub-Saharan Africa (SSA), the burden of noncommunicable diseases (NCD) such as diabetes and hypertension is increasing rapidly. There is an urgent need to expand the capacity of healthcare systems in SSA to provide NCD services and scale up existing chronic care management pathways. The aim of this study was to identify key components, outcomes, and best practice in integrated service provision for the prevention, identification and treatment of HIV, hypertension and diabetes. Methods An international, multi stakeholder e-Delphi consensus study was conducted over two successive rounds. In Round 1, 24 participants were asked to score 27 statements, under the headings ‘Service Provision’ and ‘Benefits of Integration’, by importance. In Round 2, the 16 participants who completed Round 1 were shown the distribution of scores from other participants along with the score that they attributed to an outcome and were asked to reflect on the score they gave, based on the scores of the other participants and then to rescore if they wished to. Nine participants completed Round 2. Results Based on the Round 1 ranking, 19 of the 27 outcomes met the 70% threshold for consensus. Four additional outcomes suggested by participants in Round 1 were added to Round 2, and upon review by participants, 22 of the 31 outcomes met the consensus threshold. The five items participants scored from 7 to 9 in both rounds as essential for effective integrated healthcare delivery of health services for chronic conditions were improved data collection and surveillance of NCDs among people living with HIV to inform integrated NCD/HIV programme management, strengthened drug procurement systems, availability of equipment and access to relevant blood tests, health education for all chronic conditions, and enhanced continuity of care for patients with multimorbidity. Conclusions This study highlights the outcomes which may form key components of future complex interventions to define a model of integrated healthcare delivery for diabetes, hypertension and HIV in sub-Saharan Africa.

Abstract Background Accurate identification of older persons at risk of unplanned hospital visits can facilitate preventive interventions. Several risk scores have been developed to identify older adults at risk of unplanned hospital visits. It is unclear whether risk scores developed in one country, perform as well in another. This study validates seven risk scores to predict unplanned hospital admissions and emergency department (ED) visits in older home care recipients from six countries. Methods We used the IBenC sample (n = 2446), a cohort of older home care recipients from six countries (Belgium, Finland, Germany, Iceland, Italy and The Netherlands) to validate four specific risk scores (DIVERT, CARS, EARLI and previous acute admissions) and three frailty indicators (CHESS, Fried Frailty Criteria and Frailty Index). Outcome measures were unplanned hospital admissions, ED visits or any unplanned hospital visits after 6 months. Missing data were handled by multiple imputation. Performance was determined by assessing calibration and discrimination (area under receiver operating characteristic curve (AUC)). Results Risk score performance varied across countries. In Iceland, for any unplanned hospital visits DIVERT and CARS reached a fair predictive value (AUC 0.74 [0.68–0.80] and AUC 0.74 [0.67–0.80]), respectively). In Finland, DIVERT had fair performance predicting ED visits (AUC 0.72 [0.67–0.77]) and any unplanned hospital visits (AUC 0.73 [0.67–0.77]). In other countries, AUCs did not exceed 0.70. Conclusions Geographical validation of risk scores predicting unplanned hospital visits in home care recipients showed substantial variations of poor to fair performance across countries. Unplanned hospital visits seem considerably dependent on healthcare context. Therefore, risk scores should be validated regionally before applied to practice. Future studies should focus on identification of more discriminative predictors in order to develop more accurate risk scores.

Abstract Background The use of anabolic androgenic steroids (AAS) and associated image and performance enhancing drugs (IPEDs) is now a global phenomenon. There is a need to develop evidence to support the development of interventions to prevent the commencement of use, to minimise the potential harms or to support those in their cessation of use. While the United Kingdom (UK) is no exception to this issue, its public health and legislative response to the phenomenon differs to other countries and requires the examination of research specific to the UK. Therefore, a scoping review has been conducted to examine the recent relevant literature to help inform the development and evaluation of effective interventions to reduce the harmful use of IPEDs. Methods A comprehensive search strategy was developed for multiple bibliographic databases, supported by and iterative citation searching process and complimented by expert input from the Anabolic Steroid UK Network. Research conducted by or UK academics or within the UK were eligible, if published in the previous five years. Results In total 87 eligible outputs were identified, including 26 review articles, 25 qualitative papers and 24 quantitative papers. together with small numbers of clinical studies/case reports (6) and commentaries/correspondence (6). The most common topics of research were public health, treatment and harm reduction (41), followed by studies focusing on epidemiology, sub-groups of people using IPEDs and motivations for use (34). The studies illustrated the diverse populations of people who use a range of enhancement drugs including concomitant psychoactive drug use. A number of papers focused on blood borne viruses and associated issues, while others reported on the uptake of needle and syringe programmes. No effectiveness evaluations related to any aspect of treatment, harm reduction or other intervention were published during study period. Conclusion There is a need for the development of effectiveness evaluations of current interventions and any future service provision for people using image and performance enhancing drugs. While there have been no studies of this nature to date, this review illustrates the rich data that has been gathered through diverse methodologies, that will assist in the development of future effectiveness evaluations.

Purpose To explore carers’ views and acceptability of internet-delivered, therapist-guided, self-help Acceptance and Commitment Therapy (ACT) for family carers of people with dementia (iACT4CARERS). Methods A qualitative approach with semi-structured interviews was employed with family carers (N = 23) taking part in a feasibility study of iACT4CARERS. The interviews were audio-recorded, transcribed and analysed using thematic analysis. Results Four overarching themes were identified: 1) usefulness and relevance of the content of the sessions, 2) sense of connectedness, 3) the impact of the intervention on participants and 4) acceptability of the online delivery. Positive carer experiences and intervention acceptability were facilitated by learning helpful ACT skills, perceiving the content of the session as relatable to the carers’ needs, feeling connected to other carers and the therapist during the intervention, noticing the benefits of the intervention and the user-friendliness of the online platform. Recommendations for a full-scale trial were identified, such as the inclusion of some “face-to-face” interactions (e.g., via video call) between carers and therapists to facilitate a bidirectional interaction and the provision of an additional aide-memoire to improve the learning experiences. Conclusion Overall, the intervention was acceptable to the family carers. The proposed recommendations should be considered in a full-scale trial.

Within the heterogenous global prison population of about 11.7 million, transgender prisoners have unique vulnerabilities and are exposed to substantial risks and harm. Their situation has been viewed as a ‘‘double punishment’’ by encompassing the system lack of gender recognition and exposure to traumatic experiences of detention often tantamount to torture. In Africa, sexual minority rights remain a contentious issue, and there is little documented about the situation of incarcerated transgender people.South Africa is one of the most progressive African countries in terms of equality legislation and advancing the rights of sexual and gender minorities. A legal realist review was conducted of the 2019 South African Equality Court judgement of September v Subramoney, based on case decisions and by scrutinizing the international and regional human rights protections and rights assurance mechanisms which encompass the fundamental rights of detained transgender individuals. These are not limited to protection from custodial violence, prohibition of torture and discrimination but include conditions of accommodation, right to express their gender identity and access to gender affirming healthcare. The subsequent legal realist account critiques the impact of this judgement based on extant published literature (empirical, humanitarian, and UN Committee reporting) and jurisprudence in other jurisdictions cognisant of increasing strategic litigation in the field of transgender rights. The implications of this ground-breaking judgement are considered, with a particular lens focusing on the rights of trans-prisoners (particularly trans-women as most vulnerable) to equality, but also dignity, freedom of expression, dignified detention, and the prohibition of inhumane treatment or punishment. These rights are positioned within the boundaries of safe and reasonable accommodation, ability to gender express and prison system capacity to deal with security tensions in high risk cis-normative detention environments.

Sexual minority rights in contemporary Africa is a contentious issue, where in some countries, same-sexuality is portrayed by media and politicians as “un-African” and a “white disease” imported from the West. Same-sex sexual activity is criminalised in 31 African countries. Political, legal and religious frameworks exacerbate homophobic attitudes, and related discrimination and hate crimes toward individuals who identify as lesbian, gay, bisexual or transgender (LGBT). We focus here on the rights of people in prison to protection from harm (same-sex sexual violence and sexually transmitted diseases), and who (in many African countries) are ignored in national HIV prevention programming. Prison conditions in Africa are harsh and congested, with inadequate basic needs provisions and this fuels exposure of the vulnerable to sexual violence and engagement in survival sex. HIV rates in prisons are also disproportionately higher than in the community. We present a socio-legal assessment on Malawi where same-sex sexual behaviours are criminalised. The assessment highlights how inmates’ exposure to sexual violence is invisible in political, legal, human rights and public health/HIV agendas in Malawi. Notwithstanding that the Malawi Penal Code and Prison Act prohibits same-sex sexual activity, there are enormous complications with victim disclosure, as claims of rape infer that sodomy has occurred, resulting in victim arrest. We focus here on tackling sexual violence and HIV, and advocate for broad based torture prevention initiatives in prisons to protect the vulnerable from inter-personal sexual violence, and consequent acquisition and onward transmission of HIV. The voices of people in prison in Malawi are regrettably still kept out of societal and public health discourses.