Study protocol for a type-II hybrid effectiveness-implementation trial to reach teenagers using mobile money shops to reduce unintended pregnancies in Uganda.

INTRODUCTION: Unintended teenage pregnancies have become a global public health challenge, particularly in sub-Saharan Africa. There is a notably high prevalence of unintended pregnancies among unmarried teenagers in Uganda. This study will develop an intervention programme using mobile money shops (vendors) as a platform to deliver sexual and reproductive health and rights (SRHR) services to teenagers and assess its effectiveness and scalability in Uganda. METHODS AND ANALYSES: This hybrid study comprises two integral components: an intervention study to assess the effectiveness of vendor-mediated intervention and implementation research to evaluate the implementation process. 30 vendors will be recruited for both intervention and control arms in 2 municipalities in Eastern Uganda, which have a high unintended pregnancy prevalence rate among unmarried teens aged 15-19 years. A preintervention and postintervention repeated survey involving 600 participants for each arm will be conducted over 4 months. The primary outcome is the rate of condom users among teenage vendor users. The secondary outcomes include the rate of preference for receiving SRHR services at vendors and knowledge regarding SRHR. A difference-in-differences analysis will be used to determine the effectiveness of the intervention. The Bowen model will be employed to evaluate the implementation design. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Ethics Review Committee of Uganda Christen University and JICA Ogata Sadako Research Institute for Peace and Development in Japan. The findings will be widely disseminated. This study was registered with the University Hospital Medical Information Network in Japan (UMIN000053332) on 12 January 2024. TRIAL REGISTRATION NUMBER: UMIN000053332.

Impact of Hospital Closure on Patients with Communicable and Non-Communicable Diseases During the COVID-19 Pandemic in Uganda: A Cross-Sectional and Mixed-Methods Study.

Background: The COVID-19 pandemic and its measures have had a profound impact on universal access to health services. We investigated the impact of the closure of the Entebbe Regional Referral Hospital (ERRH) for two years on the accessibility to necessary healthcare among non-COVID-19 patients. Methods: This mixed-methods study focused on ERRH patients with tuberculosis (TB), human immunodeficiency virus (HIV), diabetes/hypertension, and mental illness. A quantitative study used a structured-questionnaire with a primary outcome measure to assess the discontinuation of healthcare accessibility. A qualitative study with a focus group discussion (FGD) was conducted on eight patients. Results: Of the 202 quantitative survey participants, 17.8% discontinued necessary healthcare due to the ERRH closure, and the discontinuation rates differed by disease: 48.1% of TB patients, 16.0% of HIV patients, 7.8% of diabetes/hypertension patients, and 4.0% of mental health patients (P < 0.001). Almost 90% of the patients reported a worsened health condition, regardless of the disease. Multivariable logistic regression analysis showed that patients with diabetes/hypertension (adjusted odds ratio [AOR], 12.69; 95% confidence interval [CI], 2.57-62.52) and HIV (AOR, 7.52; 95% CI, 1.37-41.27) were more likely to discontinue healthcare than those with mental illness. The factors associated with discontinued healthcare included age ≥50 years vs ≤30 years (AOR, 4.88; 95% CI, 1.07-22.34), and high transportation cost vs low cost (AOR, 3.15; 95% CI, 1.13-8.75). The FGD also identified difficulties in obtaining medication, especially for TB, even though ERRH provided the outreach services. Conclusion: Our study revealed that the ERRH closure and lockdowns had an overall profound negative impact on access to healthcare and health conditions. Younger patients and those with TB were the most affected patients. This study provides practical suggestions from the field for policy makers to strengthen universal health access during health crises in Uganda and other sub-Saharan countries.

Enhancing community health system resilience: lessons learnt during the COVID-19 pandemic in Uganda through the qualitative inquiry of the COVID Task Force.

Objective: This study aimed to explore the elements of a resilient community health system during the COVID-19 pandemic and discuss whether the frameworks described in previous studies can be applied to real-world situations with those who implemented the Community Engagement Strategy, a strategy to make health systems work in their communities during health crises in Uganda. Methods: Focus group discussions (22 participants in total) were conducted with COVID Task Force members in four districts in Uganda in March 2022. These districts implemented a Community Engagement Strategy to ensure that health systems in their communities continued to function during health scares, and have been evaluated to ensure that the strategies have been implemented. Results: A thematic analysis was applied. From the results some factors which can enhance the resiliency of community health systems were identified: including health "knowledge," "communication," "governance," and "resources" health. The most important elements changed depending on the phase of the outbreak. VHTs are the key players in the transition from knowledge-and resource-oriented initiatives to communication and governance by community residents. Conclusion: COVID-19, a new infectious disease, provides lessons for a resilient community health system. First, the health system should be flexible enough to be able to change the elements on which it is focused, and second, VHTs play an important role in the flexibility of the health system. This suggests that it is time to assess whether VHTs are still able to continue their activities after the pandemic is over, and whether the environment, including financial and non-financial support, has improved.

COVID-19 Vaccination Willingness in Four Asian Countries: A Comparative Study including Thailand, Indonesia, the Philippines, and Vietnam.

Globally, 67% of the population has received at least one COVID-19 vaccine dose, but coverage varies across countries. This study aimed to compare people's willingness to receive COVID-19 vaccination across Thailand, Indonesia, Philippines, and Vietnam, where vaccination intention tends to be high, to determine factors associated with willingness, and to obtain suggestions for developing strategies. We conducted a secondary data analysis of the Japan International Cooperation Agency survey "Building Resilience: COVID-19 Impact and Responses in Urban Areas-Case of Southeast Asia," including1842 unvaccinated participants from Thailand (n = 461), Indonesia (n = 246), the Philippines (n = 609), and Vietnam (n = 526). Vaccination willingness was high in all countries (69.6%), but the social and psychological factors motivating people to undergo vaccination differed among these countries. The highest vaccination willingness was in the Philippines, followed by Vietnam and Indonesia, whereas the lowest vaccination willingness was in Thailand. Vaccination willingness was affected by not only sociodemographic attributes, but also risk perception and beliefs, which, in turn, were shaped by social factors such as infection trends and vaccine policies. To achieve effective vaccination promotion programs, a system allowing the flexible modification of promotion methods in response to social conditions must be established.

Overcoming Current and Preventing Future Nosocomial Outbreaks during the COVID-19 Pandemic: Lessons Learned at Three Hospitals in Japan.

Hospitals are increasingly challenged by nosocomial infection (NI) outbreaks during the ongoing coronavirus disease 2019 (COVID-19) pandemic. Although standardized guidelines and manuals regarding infection prevention and control (IPC) measures are available worldwide, case-studies conducted at specified hospitals that are required to cope with real settings are limited. In this study, we analyzed three hospitals in Japan where large-scale NI outbreaks occurred for hints on how to prevent NI outbreaks. We reviewed openly available information from each hospital and analyzed it applying a three domain framework: operation management; identification of infection status; and infection control measures. We learned that despite having authorized infection control teams and using existing standardized IPC measures, SARS-CoV-2 may still enter hospitals. Early detection of suspected cases and confirmation by PCR test, carefully dealing with staff-to-staff transmission were the most essential factors to prevent NI outbreaks. It was also suggested that ordinary training on IPC for staff does not always provide enough practical knowledge and skills; in such cases external technical and operational supports are crucial. It is expected that our results will provide insights into preventing NI outbreaks of COVID-19, and contribute to mitigate the damage to health care delivery systems in various countries.

A prostacyclin receptor antagonist inhibits the sensitized release of substance P from rat sensory neurons.

Prostacyclin, one of the cyclooxygenase metabolites, causes various biological effects, including vasodilation and antithrombogenicity, and is also involved in several pathophysiological effects, such as inflammatory pain and bladder disorders. The prostacyclin receptor (IP receptor) agonists iloprost, cicaprost, and carbacyclin have been useful for clarifying the role of the IP receptor signaling, since the endogenous ligand, prostacyclin, is very unstable. On the other hand, only a few IP receptor antagonists have been reported to date. Here, we characterized the biological activities of 2-[4-(1H-indol-4-yloxymethyl)-benzyloxycarbonylamino]-3-phenyl-propionic acid (compound A) in various in vitro systems. Compound A inhibited the accumulation of the second messenger cyclic AMP in the UMR-108 rat osteosarcoma cell line and primary cultured rat dorsal root ganglion (DRG) neurons in a concentration-dependent manner up to 10 microM, without affecting other eicosanoid receptors. Functionally, the IP receptor plays an important role in DRG neuron sensitization, which is measured by release of the neurotransmitter substance P. Although the effects of iloprost or Lys-bradykinin, an inflammatory peptide, alone on substance P release were limited, stimulation of the neurons with both these ligands induced substantial amounts of substance P release. This synergistic effect was suppressed by compound A. Collectively, these results suggest that compound A is a highly selective IP receptor antagonist that inhibits iloprost-induced sensitization of sensory neurons. Furthermore, these findings suggest that IP receptor antagonist administration may be effective for abnormal neural activities of unmyelinated sensory afferents. Compound A should prove useful for further investigations of the IP receptor in various biological processes.

[A case of gastric carcinoma with metachronous liver metastases that responded to percutaneous ethanol injection therapy (PEIT) and TS-1].

A 57-year-old male underwent a total gastrectomy with D1 lymph node dissection for gastric carcinoma. The main tumor was located in area UM, measuring 15 x 6 cm and was classified as type 5. Histopathologically, the cancer cells invaded the subserosal layer with a moderately differentiated tubular pattern. Lymph node metastases (No. 1, 3, 7 and 9) were detected. Lymphatic involvement was revealed (ly 2). Three years after the first surgery, a liver metastasis (area S4) with a diameter of 30 mm was detected by abdominal ultrasonography. Percutaneous ethanol injection therapies (PEIT) were performed twice for the lesion. After PEIT, a TS-1 intake program (80 mg/day, for 4 weeks) was started for the metastatic lesion. Both treatments were effective. The patient has survived without recurrence for over 5 years after the total gastrectomy.

Development of a simple homogeneous assay to screen for inhibitors of N-acetylglucosamine-6-sulfotransferases.

L-selectin, a leukocyte adhesion molecule, plays a central role in lymphocyte homing to secondary lymphoid tissue and to certain sites of inflammation. Carbohydrate sulfation was implicated in this process, when it was demonstrated that carbohydrate sulfotransferase-mediated sulfation of N-acetylglucosamine (GlcNAc) within sialyl Lewis X of cognate endothelial ligands for L-selectin was an essential modification for L-selectin binding. The recently identified GlcNAc-6-sulfotransferases GlcNAc6ST-1 and -2, which facilitate GlcNAc sulfation by catalyzing the transfer of a sulfonyl group from 3(')-phosphoadenosine 5(')-phosphosulfate (PAPS) to the 6-hydroxy group of the acceptor GlcNAc moiety, contribute to the biosynthesis of the 6-sulfosialyl Lewis X motif. Due to their pivotal role in L-selectin ligand biosynthesis, this enzyme class has recently emerged as an important and relatively unexplored class of potential targets for anti-inflammatory therapy. However, no inhibitors have been reported to date and screening for lead inhibitors has been hampered by the lack of simple assay formats suitable for high-throughput screening. Here, we report the development of a simple homogeneous in vitro sulfotransferase assay using a newly synthesized biotinylated glycoside as a substrate. The assay is based on GlcNAc6ST-2-mediated [35S]sulfate transfer from [35S]PAPS to the biotinylated glycoside and subsequent detection using streptavidin-coated SPA beads. K(m) values with partially purified GlcNAc6ST-2 for PAPS and the biotinylated glycoside were estimated to be 8.4 and 34.5 microM, respectively. The sulfotransferase reaction could be inhibited by 3('),5(')-ADP with an IC(50) of 2.1 microM. The assay can be operated in 384-well format; is characterized by a high signal-to-noise ratio, low variation, and excellent Z factors; and is highly suitable for high-throughput screening.