Routine health check-ups for adolescents in Mwanza City, Tanzania: stakeholders' recommendations on its content, venue, and mode of delivery.

BACKGROUND: Routine adolescent health screening aiming at the detection of unnoticed medical problems may increase awareness among policy makers and contribute to improved health in this population. Research is needed to inform the World Health Organization (WHO) and national health programs to provide evidence-based guidance on whether public health systems should offer comprehensive adolescent health screening, what should be included in different contexts, and how it should be delivered. We conducted formative research to define the content and delivery strategies for health check-ups to be performed in young (10-14 years) and older (15-19 years) adolescents, and to assess whether such services are likely to be acceptable and feasible in Tanzania. METHODS: As part of a collaborative research program coordinated by WHO in Chitungwiza, Zimbabwe; Mwanza City, Tanzania; and Cape Coast, Ghana a series of key informant interviews were conducted from April to July 2020, using a semi-structured guide with purposively selected stakeholders from government departments, non-governmental and community-based organisations, schools and health facilities. Data transcripts were coded using NVivo 12 software and thematic analysis was performed. RESULTS: We report results from 31 key informant interviews to address four main domains: proposed health conditions for routine health check-ups, health interventions to be combined with such check-ups, preferable venues, and the mode for delivering such screening activities. Stakeholders were supportive of introducing routine health check-ups among adolescents. They recommended focusing on non-communicable diseases, physical disabilities, common mental health problems, reproductive health problems, specific communicable diseases, and hygiene-related problems. They also recommended combining counselling and family planning information with these check-ups. Three venues were proposed: schools, community settings (to reach out-of-school adolescents), and youth-friendly health facilities (for conditions requiring a high level of confidentiality). CONCLUSIONS: Stakeholders were supportive of the proposed routine health check-ups for adolescents, recommending specific health conditions to be screened for in both community and school settings. Based on the above, we plan to conduct implementation research to determine the number of new treatable conditions detected, and the costs of offering such services. In the longer term, evaluation of their health impact and cost-effectiveness will be required to guide policy.

Red blood cell-derived microparticles isolated from blood units initiate and propagate thrombin generation.

BACKGROUND: Red blood cell-derived microparticles (RMPs) are small phospholipid vesicles shed from RBCs in blood units, where they accumulate during storage. Because microparticles are bioactive, it could be suggested that RMPs are mediators of posttransfusion complications or, on the contrary, constitute a potential hemostatic agent. STUDY DESIGN AND METHODS: This study was performed to establish the impact on coagulation of RMPs isolated from blood units. Using calibrated automated thrombography, we investigated whether RMPs affect thrombin generation (TG) in plasma. RESULTS: We found that RMPs were not only able to increase TG in plasma in the presence of a low exogenous tissue factor (TF) concentration, but also to initiate TG in plasma in absence of exogenous TF. TG induced by RMPs in the absence of exogenous TF was neither affected by the presence of blocking anti-TF nor by the absence of Factor (F)VII. It was significantly reduced in plasma deficient in FVIII or F IX and abolished in FII-, FV-, FX-, or FXI-deficient plasma. TG was also totally abolished when anti-XI 01A6 was added in the sample. Finally, neither Western blotting, flow cytometry, nor immunogold labeling allowed the detection of traces of TF antigen. In addition, RMPs did not comprise polyphosphate, an important modulator of coagulation. CONCLUSIONS: Taken together, our data show that RMPs have FXI-dependent procoagulant properties and are able to initiate and propagate TG. The anionic surface of RMPs might be the site of FXI-mediated TG amplification and intrinsic tenase and prothrombinase complex assembly.

Results of a Global Survey of Experts to Categorize the Suitability of Interventions for Inclusion in School Health Services.

PURPOSE: This global survey of experts assessed the suitability of different health-related interventions for inclusion in school health services (SHSs) to inform development of the World Health Organization global guideline on SHSs. METHODS: A review of 138 global World Health Organization publications identified 406 health service interventions for 5- to 19-year-old individuals. These were consolidated, pretested, and pilot-tested in a questionnaire as 86 promotion, prevention, care, or treatment interventions. A total of 1,293 experts were identified through purposive sampling of journal databases and professional networks. In July 2019, experts were invited to complete the questionnaire online in Arabic, Chinese, English, French, Russian, or Spanish. Respondents categorized each intervention as essential, highly suitable, suitable, or unsuitable in SHSs (everywhere or in certain geographic areas only). They could also suggest interventions. RESULTS: Interventions categorized most often as "Essential in SHSs everywhere" (70%-80%) are related to health promotion and health education. Clinical interventions categorized most often in this way (60%-68%) are related to immunization, screening, assessment, and general care. Interventions categorized most often as "Essential in SHSs in certain geographic areas only" (27%-49%) are related to immunization, mass drug administration, and health promotion. Interventions categorized most often as "Unsuitable in SHSs anywhere" (12%-14%) are related to screening of noncommunicable conditions. There were no important regional differences. Of 439 respondents from 81 countries, 188 suggested 378 additional interventions. Question order effect and/or purposive sampling biases may have influenced both quantitative and qualitative results for different types of intervention. CONCLUSIONS: Favorable responses to almost all interventions supported their World Health Organization guideline inclusion but provided little guidance for intervention prioritization.

Priority Areas for Adolescent Health Measurement.

PURPOSE: We establish priority areas for adolescent health measurement and identify current gaps, aiming to focus resources on the most relevant data to improve adolescent health. METHODS: We collected four critical inputs to inform priority setting: perspectives of youth representatives, country priorities, disease burden, and existing measurement efforts. Health areas identified from the inputs were grouped, mapped, and summarized according to their frequency in the inputs. Using a Delphi-like approach, international experts then selected core, expanded, and context-specific priority areas for adolescent health measurement from all health areas identified. RESULTS: Across the four inputs, we identified 99 measurement areas relevant to adolescent health and grouped them under six domains: policies, programs, laws; systems performance and interventions; health determinants; health behaviors and risks; subjective well-being; and health outcomes and conditions. Areas most frequently occurring were mental health and weight status in youth representatives' opinions; sexual and reproductive health and HIV/AIDS in country policies and perspectives; road injury, self-harm, skin diseases, and mental disorders in the disease burden analysis; and adolescent fertility in measurement initiatives. Considering all four inputs, experts selected 33 core, 19 expanded, and 6 context-specific adolescent health measurement areas. CONCLUSION: The adolescent health measurement landscape is vast, covering a large variety of topics. The foci of the measurement initiatives we reviewed do not reflect the most important health areas according to youth representatives' or country-level perspectives, or the adolescent disease burden. Based on these inputs, we propose a set of priority areas to focus national and global adolescent health measurement.

Designing Routine Health Checkups for Adolescents in Zimbabwe.

PURPOSE: The absence of routine health check-ups during adolescence in low- and middle-income countries is a missed opportunity for prevention, early identification, and treatment of health issues, and health promotion. We aimed to codesign the content and delivery for routine adolescent health checkups in Zimbabwe, with adolescents and key adults in their lives. METHODS: We held participatory workshops with adolescents (16 workshops; 96 adolescents) and parents (8 workshops; 95 parents), and in-depth interviews with key informants including policymakers, programmers, and healthcare workers (n = 25). Analysis was iterative and the design of the checkups was refined based on participant preferences, document review of burden of disease data, and feasibility considerations. RESULTS: Participants overwhelmingly supported the introduction of routine health checkups. Reported facilitators to attendance included free cost and desire to know one's health status. Barriers included tendencies for health service seeking only when ill, fear of diagnosis and judgment, and religious beliefs. Delivery preferences were by nonjudgmental medical professionals, in a youth friendly environment, and accompanied by youth engagement activities. Preferred location was schools for younger adolescents (10-14 years), and community settings for older adolescents (15-19 years). Prioritized content included sexual health, oral health, mental health, hearing, eyesight, growth and nutrition, anemia, immunization, and deworming, based on health burden and participant preferences. DISCUSSION: This study resulted in an outline design of two routine health checkups with stakeholders in Zimbabwe, in schools for young adolescents, and in community settings for older adolescents. Evidence of feasibility, effectiveness, and cost-effectiveness of such checkups is required.

Investigating the effectiveness of school health services delivered by a health provider: A systematic review of systematic reviews.

Schools are the only institution regularly reaching the majority of school-age children and adolescents across the globe. Although at least 102 countries have school health services, there is no rigorous, evidence-based guidance on which school health services are effective and should be implemented in schools. To investigate the effectiveness of school health services for improving the health of school-age children and adolescents, a systematic review of systematic reviews (overview) was conducted. Five databases were searched through June 2018. Systematic reviews of intervention studies that evaluated school-based or school-linked health services delivered by a health provider were included. Review quality was assessed using a modified Ballard and Montgomery four-item checklist. 1654 references were screened and 20 systematic reviews containing 270 primary studies were assessed narratively. Interventions with evidence for effectiveness addressed autism, depression, anxiety, obesity, dental caries, visual acuity, asthma, and sleep. No review evaluated the effectiveness of a multi-component school health services intervention addressing multiple health areas. From the limited amount of information available in existing systematic reviews, the strongest evidence supports implementation of anxiety prevention programs, indicated asthma education, and vision screening with provision of free spectacles. Additional systematic reviews are needed that analyze the effectiveness of comprehensive school health services, and specific services for under-researched health areas relevant for this population.

Adolescent Mental Health Program Components and Behavior Risk Reduction: A Meta-analysis.

CONTEXT: Although adolescent mental health interventions are widely implemented, little consensus exists about elements comprising successful models. OBJECTIVE: We aimed to identify effective program components of interventions to promote mental health and prevent mental disorders and risk behaviors during adolescence and to match these components across these key health outcomes to inform future multicomponent intervention development. DATA SOURCES: A total of 14 600 records were identified, and 158 studies were included. STUDY SELECTION: Studies included universally delivered psychosocial interventions administered to adolescents ages 10 to 19. We included studies published between 2000 and 2018, using PubMed, Medline, PsycINFO, Scopus, Embase, and Applied Social Sciences Index Abstracts databases. We included randomized controlled, cluster randomized controlled, factorial, and crossover trials. Outcomes included positive mental health, depressive and anxious symptomatology, violence perpetration and bullying, and alcohol and other substance use. DATA EXTRACTION: Data were extracted by 3 researchers who identified core components and relevant outcomes. Interventions were separated by modality; data were analyzed by using a robust variance estimation meta-analysis model, and we estimated a series of single-predictor meta-regression models using random effects. RESULTS: Universally delivered interventions can improve adolescent mental health and reduce risk behavior. Of 7 components with consistent signals of effectiveness, 3 had significant effects over multiple outcomes (interpersonal skills, emotional regulation, and alcohol and drug education). LIMITATIONS: Most included studies were from high-income settings, limiting the applicability of these findings to low- and middle-income countries. Our sample included only trials. CONCLUSIONS: Three program components emerged as consistently effective across different outcomes, providing a basis for developing future multioutcome intervention programs.

Importance of polyphosphate in the Leishmania life cycle.

Protozoan parasites contain negatively charged polymers of a few up to several hundreds of phosphate residues. In other organisms, these poly-phosphate (polyP) chains serve as an energy source and phosphate reservoir, and have been implicated in adaptation to stress and virulence of pathogenic organisms. In this study, we confirmed first that the polyP polymerase vacuolar transporter chaperone 4 (VTC4) is responsible for polyP synthesis in Leishmania parasites. During Leishmaniain vitro culture, polyP is accumulated in logarithmic growth phase and subsequently consumed once stationary phase is reached. However, polyP is not essential since VTC4-deficient (vtc4- ) Leishmania proliferated normally in culture and differentiated into infective metacyclic parasites and into intracellular and axenic amastigotes. In in vivo mouse infections, L. majorVTC4 knockout showed a delay in lesion formation but ultimately gave rise to strong pathology, although we were unable to restore virulence by complementation to confirm this phenotype. Knockdown of VTC4 did not alter the course of L. guyanensis infections in mice, suggesting that polyP was not required for infection, or that very low levels of it suffice for lesion development. At higher temperatures, Leishmania promastigotes highly consumed polyP, and both knockdown or deletion of VTC4 diminished parasite survival. Thus, although polyP was not essential in the life cycle of the parasite, our data suggests a role for polyP in increasing parasite survival at higher temperatures, a situation faced by the parasite when transmitted to humans.

Magnesium uptake by connecting fluid-phase endocytosis to an intracellular inorganic cation filter.

Cells acquire free metals through plasma membrane transporters. But, in natural settings, sequestering agents often render metals inaccessible to transporters, limiting metal bioavailability. Here we identify a pathway for metal acquisition, allowing cells to cope with this situation. Under limited bioavailability of Mg2+, yeast cells upregulate fluid-phase endocytosis and transfer solutes from the environment into their vacuole, an acidocalcisome-like compartment loaded with highly concentrated polyphosphate. We propose that this anionic inorganic polymer, which is an avid chelator of Mg2+, serves as an immobilized cation filter that accumulates Mg2+ inside these organelles. It thus allows the vacuolar exporter Mnr2 to efficiently transfer Mg2+ into the cytosol. Leishmania parasites also employ acidocalcisomal polyphosphate to multiply in their Mg2+-limited habitat, the phagolysosomes of inflammatory macrophages. This suggests that the pathway for metal uptake via endocytosis, acidocalcisomal polyphosphates and export into the cytosol, which we term EAPEC, is conserved.