Quantifying the association between psychological distress and low back pain in urban Europe: a secondary analysis of a large cross-sectional study.

OBJECTIVES: This study aims to estimate the prevalence of low back pain (LBP) in Europe and to quantify its associated mental and physical health burdens among adults in European urban areas. DESIGN: This research is a secondary analysis of data from a large multicountry population survey. SETTING: The population survey on which this analysis is based was conducted in 32 European urban areas across 11 countries. PARTICIPANTS: The dataset for this study was collected during the European Urban Health Indicators System 2 survey. There were a total of 19 441 adult respondents but data from 18 028, 50.2% female (9 050) and 49.8% male (8 978), were included in these analyses. PRIMARY AND SECONDARY OUTCOME MEASURES: Being a survey, data on the exposure (LBP) and outcomes were collected simultaneously. The primary outcomes for this study are psychological distress and poor physical health. RESULTS: The overall European prevalence of LBP was 44.6% (43.9-45.3) widely ranging from 33.4% in Norway to 67.7% in Lithuania. After accounting for sex, age, socioeconomic status and formal education, adults in urban Europe suffering LBP had higher odds of psychological distress aOR 1.44 (1.32-1.58) and poor self-rated health aOR 3.54 (3.31-3.80). These associations varied widely between participating countries and cities. CONCLUSION: Prevalence of LBP, and its associations with poor physical and mental health, varies across European urban areas.

Checkpoints and immunity in cancers: Role of GNG12.

Cancer progression is enhanced through cell proliferation, with the crucial role of the transducer and transmembrane -signal regulator (GNG12) bringing it to the fore. Dysregulation of cancer cell metabolism, evasion of the immune system, cell cycle, apoptosis, and chemoresistance result from inconsistent initiation of the NF-kB signaling pathway. We excerpt from previous studies that overactivation of the canonic NF-kB cascade occurs in varieties of tumor cells, which results in the growth of lymphovascular invasion, as well as neural invasion. Recently, research has adduced that a particular G protein- coupled receptor (GNG12) is silently involved in the activation of the NF-kB signal, which supports the evasion of cancer immunity and in turn activates cancer proliferation, angiogenesis, and immunotherapeutic resistance. While the likely impact of GNG12 in relation to the progression of tumors is being established, there is insufficient knowledge regarding the functions and mechanisms of GNG12 in cancer immunity. Furthermore, the cancer-associated role as well as the clinical correlation of GNG12 have long been unknown; thus, their identification is more likely to pave the path for a novel regime of tumor suppression. In this study, we established the silent role of GNG12 in activating NF-kB genes and the synergism between NF-kB and PD-L1 expression. Captivatingly, we reported that silencing GNG12 gene downregulates the transcription of PD-L1 gene. We therefore suggested that GNG12 is a risk factor for several cancers, and a possible target for immunotherapy.

A qualitative inquiry of rural-urban inequalities in the distribution and retention of healthcare workers in southern Nigeria.

INTRODUCTION: Globally, the population in rural communities are disproportionately cared for by only 25% and 38% of the total physicians and nursing staff, respectively; hence, the poor health outcomes in these communities. This condition is worse in Nigeria by the critical shortage of skilled healthcare workforce. This study aimed to explore factors responsible for the uneven distribution of healthcare workers (physicians and nurses) to rural areas of Ebonyi State, Nigeria. METHODS: Qualitative data were obtained using semi-structured in-depth interviews and focus group discussions from purposively selected physicians, nurses, and policymakers in the state. Data was analysed for themes related to factors influencing the mal-distribution of healthcare workers (physicians and nurses) to rural areas. The qualitative analysis involved the use of both inductive and deductive reasoning in an iterative manner. RESULTS: This study showed that there were diverse reasons for the uneven distribution of skilled healthcare workers in Ebonyi State. This was broadly classified into three themes; socio-cultural, healthcare system, and personal healthcare workers' intrinsic factors. The socio-cultural factors include symbolic capital and stigma while healthcare system and governance issues include poor human resources for health policy and planning, work resources and environment, decentralization, salary differences, skewed distribution of tertiary health facilities to urban area and political interference. The intrinsic healthcare workers' factors include career progression and prospect, negative effect on family life, personal characteristics and background, isolation, personal perceptions and beliefs. CONCLUSIONS: There may be a need to implement both non-financial and financial actions to encourage more urban to rural migration of healthcare workers (physicians and nurses) and to provide incentives for the retention of rural-based health workers.

Population seroprevalence of SARS-CoV-2 antibodies in Anambra State, South-East, Nigeria.

OBJECTIVE: The objective of this study was to determine the proportion of the Anambra State population that had been infected by the SARS-CoV-2 virus and developed antibodies before the second wave. METHODS: The WHO-recommended health facility-based cross-sectional approach was adapted for this survey. Between 8th and 15th December 2020, 3142 participants across the 21 local government areas (LGAs) of the State, aged one year and over, attending randomly selected health facilities, were recruited. Demographic and symptom-related information were collected from the participants as well as whole peripheral blood, which was tested for SARS-CoV-2 IgG and IgM with rapid test kits. RESULTS: 425 participants tested positive for IgG only, 74 for IgM only, while 54 were positive for both IgG and IgM. Overall, 553 positives were recorded, giving a crude seroprevalence of 17.6% (95% CI = 16.26 - 18.98). It ranged widely from 31.9% (95% CI = 24.43 - 40.22) in Onitsha North LGA to 5.4% (95% CI = 2.19 - 10.78) in Awka north. Bayesian Adjustments yielded a state seroprevalence of 16.1%. CONCLUSION: One in six state residents had been infected by SARS-CoV-2 and developed antibodies before the second wave. All LGAs, age groups, sexes, and settlement types were affected by COVID-19. A large proportion of the population remained susceptible to SARS-CoV-2.

Addressing gaps in adolescent tuberculosis programming and policy in Nigeria from a public health perspective.

OBJECTIVES: Tuberculosis (TB) is a leading infectious cause of death globally. Of the estimated 10 million people who developed active TB in 2019, 1.8 million (18%) were adolescents and young adults aged 15-24 years. Adolescents have poorer rates of TB screening, treatment initiation and completion compared to adults. Unfortunately, there is relatively less programme, research and policy focus on TB for adolescents aged 10-19 years. This article reviews the scope of health services and the relevant policy landscape for TB case notification and care/treatment, TB/HIV management, and latent TB infection for adolescents in Nigeria. Additionally, it discusses considerations for TB vaccines in this population. CONTENT: All Nigeria Federal Ministry of Health policy documents relevant to adolescent health services and TB, and published between 2000 and 2020 underwent narrative review. Findings were reported according to the service areas outlined in the Objectives. SUMMARY AND OUTLOOK: Nine policy documents were identified and reviewed. While multiple policies acknowledge the needs of adolescents in public health and specifically in TB programming, these needs are often not addressed in policy, nor in program integration and implementation. The lack of age-specific epidemiologic and clinical outcomes data for adolescents contributes to these policy gaps. Poor outcomes are driven by factors such as HIV co-infection, lack of youth-friendly health services, and stigma and discrimination. Policy guidelines and innovations should include adaptations tailored to adolescent needs. However, these adaptations cannot be developed without robust epidemiological data on adolescents at risk of, and living with TB. Gaps in TB care integration into primary reproductive, maternal-child health and nutrition services should be addressed across multiple policies, and mechanisms for supervision, and monitoring and evaluation of integration be developed to guide comprehensive implementation. Youth-friendly TB services are recommended to improve access to quality care delivered in a patient-centered approach.