British association for sexual health and HIV national guideline for the management of anogenital warts in adults (2024).

This guideline offers recommendations on the diagnosis, treatment and health promotion principles needed for the effective management of human papillomavirus (HPV)-related warts at anogenital sites including the external genitals, vagina, cervix, urethra, perianus and anal canal. The guideline is aimed primarily at patients aged 16 years or older presenting to healthcare professionals working in level 3 sexual health services in the United Kingdom. However, the principles of the recommendations may be applied in other care settings, including in primary care, using locally adapted care pathways where appropriate. The management of HPV-related anogenital dysplasia or warts at other extragenital sites is outside the scope of this guideline.

Aligning the principles and practice of research integrity and research fairness in global health: a mixed-methods study.

INTRODUCTION: In the past decade, global health research has seen a growing emphasis on research integrity and fairness. The concept of research integrity emerged in response to the reproducibility crisis in science during the late 2000s. Research fairness initiatives aim to enhance ownership and inclusivity in research involving partners with varying powers, decision-making roles and resource capacities, ultimately prioritising local health research needs. Despite extensive academic discussions, empirical data on these aspects, especially in the context of global health, remain limited. METHODS: To address this gap, we conducted a mixed-methods study focusing on research integrity and fairness. The study included an online frequency survey and in-depth key informant interviews with researchers from international research networks. The dual objectives were to quantify the frequency of practices related to research integrity and fairness and explore the determinants influencing these practices in global health. RESULTS: Out of 145 participants in the quantitative survey (8.4% response rate), findings indicate that global health researchers generally adhere to principles of research integrity and fairness, with variations in reported behaviours. The study identified structural, institutional and individual factors influencing these patterns, including donor landscape rigidity, institutional investments in relationship building, guidelines, mentoring and power differentials among researchers. CONCLUSION: This research highlights that, despite some variations, there is a substantial alignment between research integrity and fairness, with both sharing similar determinants and the overarching goal of enhancing research quality and societal benefits. The study emphasises the potential to explicitly recognise and leverage these synergies, aligning both agendas to further advance global health research.

Addressing health needs of the homeless in Delhi: Standardising on the issues of Street Medicine practice.

Due to barriers in accessing and using healthcare services, a large proportion of the care homeless populations receive comes from informal providers. In Delhi, one such informal programme, called Street Medicine, provides healthcare outreach to homeless communities. Clinical practice guidelines are set to be developed for Street Medicine teams in India and form the object of this research. This study uses a social-ecological model to understand the barriers facing Street Medicine teams and the homeless as they attempt to address the latter's healthcare needs; coupling it with an analytical approach which situates these barriers as the issues within practice through which standardisation can take place. A qualitative inquiry, comprising three months of observations of Street Medicine outreach and interviews with over 30 key informants, was conducted between April and July 2018. The analysis identified novel barriers to addressing the needs of homeless individuals, which bely a deficit between the design of health and social care systems and the agency homeless individuals possess within this system to influence their health outcomes. These barriers - which include user-dependent technological inscriptions, collaborating with untargeted providers and the distinct health needs of homeless individuals - are the entry points for standardising, or opening up, Street Medicine practices .

Why did informal sector workers stop paying for health insurance in Indonesia? Exploring enrollees' ability and willingness to pay.

Indonesia faces a growing informal sector in the wake of implementing a national social health insurance system-Jaminan Kesehatan Nasional (JKN)-that supersedes the vertical programmes historically tied to informal employment. Sustainably financing coverage for informal workers requires incentivising enrolment for those never insured and recovering enrolment among those who once paid but no longer do so. This study aims to assess the ability- and willingness-to-pay of informal sector workers who have stopped paying the JKN premium for at least six months, across districts of different fiscal capacity, and explore which factors shaped their willingness and ability to pay using qualitative interviews. Surveys were conducted for 1,709 respondents in 2016, and found that informal workers' average ability and willingness to pay fell below the national health insurance scheme's premium amount, even as many currently spend more than this on healthcare costs. There were large groups for whom the costs of the premium were prohibitive (38%) or, alternatively, they were both technically willing and able to pay (25%). As all individuals in the sample had once paid for insurance, their main reasons for lapsing were based on the uncertain income of informal workers and their changing needs. The study recommends a combination of strategies of targeting of subsidies, progressive premium setting, facilitating payment collection, incentivising insurance package upgrades and socialising the benefits of health insurance in informal worker communities.

Non-communicable diseases in Indian slums: re-framing the Social Determinants of Health.

BACKGROUND: The epidemic of non-communicable diseases (NCDs) in slums has pushed its residents to heightened vulnerability. The Social Determinants of Health (SDH) framework has been used to understand the social dynamics and impact of NCDs, especially in poorly resourced communities. Whilst the SDH has helped to discredit the characterisation of NCDs as diseases of affluence, its impact on policy has been less definite. Given the multitude of factors that interact in the presentation of NCDs, operationalising the SDH for policies and programmes that account for the contextual complexity of slums has stalled. OBJECTIVE: To organise the complex networks of relations between SDH in slums so as to identify options for Indian municipal policy that are feasible to implement in the short term. METHODS: The study reviews the literature describing SDH in Indian slums, specifically those that establish causal relations between SDH and NCDs. Root cause analysis was then used to organise the identified relations of SDH and NCDs. RESULTS: Although poverty remains the largest structural determinant of health in slums, the multi-dimensional relations between SDH and NCDs are structured around four themes that describe the dynamics of slums, namely scarce clean water, low education, physical (in)activity and transportation. From the reviewed literature, four logic trees visualising the relations between SDH in slums and NCDs were constructed. The logic trees separate symptomatic problems from their more distal causes, and recommendations were formulated based on features of these relationships that are amenable to policy intervention. CONCLUSION: Root cause analysis provides a means to focus the lens of examination of SDH, as evidenced here for Indian slums. It provides a guide for the development of policies that are grounded in the actual health concerns of people in slums, and takes account of the complex pathways through which diseases are socially constituted.

Ineffective Healthcare Technology Management in Benin's Public Health Sector: The Perceptions of Key Actors and Their Ability to Address the Main Problems.

BACKGROUND: Low-income countries face many contextual challenges to manage healthcare technologies effectively, as the majority are imported and resources are constrained to a greater extent. Previous healthcare technology management (HTM) policies in Benin have failed to produce better quality of care for the population and costeffectiveness for the government. This study aims to identify and assess the main problems facing HTM in Benin's public health sector, as well as the ability of key actors within the sector to address these problems. METHODS: We conducted 2 surveys in 117 selected health facilities. The first survey was based on 377 questionnaires and 259 interviews, and the second involved observation and group interviews at health facilities. The Temple-Bird Healthcare Technology Package System (TBHTPS), tailored to the context of Benin's health system, was used as a conceptual framework. RESULTS: The findings of the first survey show that 85% of key actors in Benin's HTM sector characterized the system as failing in components of the TBHTPS framework. Biomedical, clinical, healthcare technology engineers and technicians perceived problems most severely, followed by users of equipment, managers and hospital directors, international organization officers, local and foreign suppliers, and finally policy-makers, planners and administrators at the Ministry of Health (MoH). The 5 most important challenges to be addressed are policy, strategic management and planning, and technology needs assessment and selection - categorized as major enabling inputs (MEI) in HTM by the TBHTPS framework - and installation and commissioning, training and skill development and procurement, which are import and use activities (IUA). The ability of each key actor to address these problems (the degree of political or administrative power they possess) was inversely proportional to their perception of the severity of the problems. Observational data gathered during site visits described a different set of challenges including maintenance and repair, distribution, installation and commissioning, use and training and personnel skill development. CONCLUSION: The lack of experiential and technical knowledge in policy development processes could underpin many of the continuing problems in Benin's HTM system. Before solutions can be devised to these problems, it is necessary to investigate their root causes, and which problems are most amenable to policy development.

TRPM8 and Nav1.8 sodium channels are required for transthyretin-induced calcium influx in growth cones of small-diameter TrkA-positive sensory neurons.

BACKGROUND: Familial amyloidotic polyneuropathy (FAP) is a peripheral neuropathy caused by the extracellular accumulation and deposition of insoluble transthyretin (TTR) aggregates. However the molecular mechanism that underlies TTR toxicity in peripheral nerves is unclear. Previous studies have suggested that amyloidogenic proteins can aggregate into oligomers which disrupt intracellular calcium homeostasis by increasing the permeability of the plasma membrane to extracellular calcium. The aim of the present study was to examine the effect of TTR on calcium influx in dorsal root ganglion neurons. RESULTS: Levels of intracellular cytosolic calcium were monitored in dorsal root ganglion (DRG) neurons isolated from embryonic rats using the calcium-sensitive fluorescent indicator Fluo4. An amyloidogenic mutant form of TTR, L55P, induced calcium influx into the growth cones of DRG neurons, whereas wild-type TTR had no significant effect. Atomic force microscopy and dynamic light scattering studies confirmed that the L55P TTR contained oligomeric species of TTR. The effect of L55P TTR was decreased by blockers of voltage-gated calcium channels (VGCC), as well as by blockers of Nav1.8 voltage-gated sodium channels and transient receptor potential M8 (TRPM8) channels. siRNA knockdown of TRPM8 channels using three different TRPM8 siRNAs strongly inhibited calcium influx in DRG growth cones. CONCLUSIONS: These data suggest that activation of TRPM8 channels triggers the activation of Nav1.8 channels which leads to calcium influx through VGCC. We suggest that TTR-induced calcium influx into DRG neurons may contribute to the pathophysiology of FAP. Furthermore, we speculate that similar mechanisms may mediate the toxic effects of other amyloidogenic proteins such as the ß-amyloid protein of Alzheimer's disease.