Strengthening capacity for clinical research in sub-Saharan Africa: partnerships and networks.

Global research collaboration, through partnerships and networks, is an effective way to deliver highly impactful and sustainable research that is collectively owned and promoted for the global good. Many models exist for effective North-South collaborations that are built on trust and balanced benefits. The European & Developing Countries Clinical Trials Partnership (EDCTP) model emphasises capacity development in clinical trials and product-focused implementation research. To ensure effectiveness and sustainability, capacity development requires a long-term perspective, an integrated system-wide approach, and local ownership and leadership from countries experiencing high disease burdens. Guided by these principles, the EDCTP2 programme, established in 2014, has developed and strengthened human capital and institutional capacities in 39 countries in sub-Saharan Africa to undertake high-quality clinical research guided by good clinical and regulatory practices. Projects in these countries have involved 238 African and 163 European institutions. To date, EDCTP has supported 171 Fellows and 232 postgraduate trainees. EDCTP-short-term training activities have equipped 9628 researchers and medical personnel. The EDCTP capacity-building described here includes its Regional Networks of Excellence and its Consortia for public health emergencies which provide the foundation for sustained efforts against emerging and re-emerging global health threats.

Working with cancer: A pilot study of work participation among cancer survivors in Western Sydney.

BACKGROUND: Around 40% of cancers occur in working-age adults. Improvements in screening and treatment mean that most are expected to live years beyond their diagnosis. However, many experience persistent impairments from treatment such as fatigue, cognitive difficulties, and emotional distress. Work is a key occupation for this population and is an important occupational performance area for occupational therapy intervention. However, little is understood about working with cancer in the Australian context. AIM: To pilot a survey to identify factors associated with work participation among cancer survivors, and to determine if the survey collected useful information to build on for further study. METHODS: A cross-sectional online survey was developed to measure work participation and factors associated with successful work. Study participants aged 20-65 years, employed at diagnosis, with basic English and computer literacy were recruited from a cancer clinic in Western Sydney over a 3-month period. RESULTS: Nineteen survey responses were received and analysed. Participants had returned or remained at work (n = 9, 47.4%), unsuccessfully attempted to return to work (RTW; n = 2, 10.5%), or were on leave from work (n = 8, 42.1%). Of those on leave, most did not plan to RTW (n = 6, 31.6%). Fatigue (n = 15, 78.9%), difficulty concentrating (n = 8, 42.1%), memory issues (n = 8, 42.1%), stomach upset (n = 7, 36.8%), sleep disturbance, (n = 7, 36.8%), and psychological distress (n = 7, 36.8%) impacted perceived work ability. Physically demanding work (n = 8, 42.1%), length of the workday (n = 6, 31.6%), productivity demands (n = 5, 26.3%), and commuting (n = 4, 21.1%) were challenging to manage after cancer. A supportive workplace was a facilitator for work. CONCLUSION: Cancer survivors in Western Sydney may face challenges engaging in work after treatment. Work participation may be influenced by side effects of treatment, difficulty performing work demands, and the work environment. Services may be needed for cancer survivors to navigate RTW.

Enhancing HIV Treatment Access and Outcomes Amongst HIV Infected Children and Adolescents in Resource Limited Settings.

Introduction Increasing access to HIV-related care and treatment for children aged 0-18 years in resource-limited settings is an urgent global priority. In 2011-2012 the percentage increase in children accessing antiretroviral therapy was approximately half that of adults (11 vs. 21 %). We propose a model for increasing access to, and retention in, paediatric HIV care and treatment in resource-limited settings. Methods Following a rapid appraisal of recent literature seven main challenges in paediatric HIV-related care and treatment were identified: (1) lack of regular, integrated, ongoing HIV-related diagnosis; (2) weak facility-based systems for tracking and retention in care; (3) interrupted availability of dried blood spot cards (expiration/stock outs); (4) poor quality control of rapid HIV testing; (5) supply-related gaps at health facility-laboratory interface; (6) poor uptake of HIV testing, possibly relating to a fatalistic belief about HIV infection; (7) community-associated reasons e.g. non-disclosure and weak systems for social support, resulting in poor retention in care. Results To increase sustained access to paediatric HIV-related care and treatment, regular updating of Policies, review of inter-sectoral Plans (at facility and community levels) and evaluation of Programme implementation and impact (at national, subnational, facility and community levels) are non-negotiable critical elements. Additionally we recommend the intensified implementation of seven main interventions: (1) update or refresher messaging for health care staff and simple messaging for key staff at early childhood development centres and schools; (2) contact tracing, disclosure and retention monitoring; (3) paying particular attention to infant dried blood spot (DBS) stock control; (4) regular quality assurance of rapid HIV testing procedures; (5) workshops/meetings/dialogues between health facilities and laboratories to resolve transport-related gaps and to facilitate return of results to facilities; (6) community leader and health worker advocacy at creches, schools, religious centres to increase uptake of HIV testing and dispel fatalistic beliefs about HIV; (7) use of mobile communication technology (m-health) and peer/community supporters to maintain contact with patients. Discussion and Conclusion We propose that this package of facility, community and family-orientated interventions are needed to change the trajectory of the paediatric HIV epidemic and its associated patterns of morbidity and mortality, thus achieving the double dividend of improving HIV-free survival.

Erbium:YAG laser resurfacing in patients with inflamed cystic acne.

BACKGROUND: Inflammatory cystic acne has been treated by a variety of modalities including antibiotics, topical agents, isotretinoin and chemical peels with variable degrees of success. Erbium:YAG lasers have been used for the treatment of acne scarring and photoaged skin but have not been thought of as treatment for actively inflamed lesions. OBJECTIVE: We sought to ascertain the effectiveness of using low fluence erbium:YAG settings without topical anesthesia for the treatment of two patients with inflamed cystic acne. METHODS: Two female patients with type 4 skin of Hispanic (32 years old) and south Asian (21 years old) origin were treated with the 2940 erbium:YAG LaserPeel laser. The Hispanic patient was treated twice with a 2-month interval between treatments using the 200 mJ setting. The Asian patient had a combination of 200 and 400 mJ settings for her first treatment and 400 mJ for the subsequent two treatments. She was treated three times with an interval of 1 month between the first two treatments and a 2-month interval between the second and third treatments. RESULTS: Both patients healed within 6 days of each treatment and demonstrated progressive improvement. Results were excellent in both. CONCLUSION: Low fluence erbium:YAG facial resurfacing was effective for the treatment of inflamed cystic acne. Its use as a treatment modality should be further explored.

Effects of anonymous information about potential organ transplant recipients on attitudes toward organ transplantation and the willingness to donate organs.

Two approaches for educating college students about the need for organ donors were compared. The experimental group (N = 162) watched a video-taped dramatization of an organ procurement coordinator asking the family members of a recently deceased loved one if they would donate their loved one's organs. Contained in this videotape was demographic information about three adults who needed an organ transplant. The control group (N = 169) saw the same videotape minus the demographic information. Extrapolating from research on altruism, we hypothesized that information about potential organ recipients would increase the viewer's willingness to donate a next-of-kin's organs and their own willingness to become an organ donor. Results supported this hypothesis. Compared to the control group, the experimental group was more willing to donate a next-of-kin's organs and take action to become an organ donor. We tentatively conclude that providing information about potential organ recipients increases the willingness of college students to become organ donors.