Acceptability and feasibility of using actigraphy to assess habitual physical activity and sleep parameters in men and women living in rural communities in conflict-affected Eastern Democratic Republic of Congo.

BACKGROUND: The goals of this study were to (1) determine the feasibility and acceptability of using actigraphy to objectively measure sleep quality and habitual physical activity in rural Democratic Republic of Congo (DRC) and (2) examine the relationship between sleep parameters, self-report symptoms, daytime physical activity, and physical function, including the ability to work. METHOD: Thirty individuals were asked to wear a wrist-worn accelerometer for 5 nights and 4 days. Nighttime sleep parameters derived were average and intra-individual variability (IIV) in total sleep time (TST), sleep onset latency (SOL), sleep efficiency (SE), and wake after sleep onset (WASO). Daytime habitual physical data derived were average and peak activity and daytime napping. RESULTS: Ninety-three percent (n = 28) of participants completed the study. All participants who wore the device marked sleep and wake cycles and periods of non-wear using the marker. Trauma-related symptoms were not associated with mean or IIV in TST, SE, SOL, or WASO (p > 0.01). Those with higher levels of bodily pain slept longer (ß = 0.633, p = 0.003, adjusted R 2 = 0.279), were more likely to report that their physical health limited their physical activities (ß = 0.71, p < 0.001, adjusted R 2 = 0.679) and had greater difficulty doing daily work (ß = 0.84, p = 0.001, adjusted R 2 = 0.665). CONCLUSION: The use of actigraphy to collect objective measures of activity and sleep quality in rural post-conflict settings is feasible and acceptable. Our preliminary findings suggest that bodily pain and not trauma-related symptoms have a significant impact on sleep and functional outcomes in men and women survivors of prolonged conflict in the DRC.

Pretreatment With PCSK9 Inhibitor Protects the Brain Against Cardiac Ischemia/Reperfusion Injury Through a Reduction of Neuronal Inflammation and Amyloid Beta Aggregation.

Background Cardiac ischemic/reperfusion (I/R) injury leads to brain damage. A new antihyperlipidemic drug is aimed at inhibiting PCSK 9 (proprotein convertase subtilisin/kexin type 9), a molecule first identified in a neuronal apoptosis paradigm. Thus, the PCSK 9 inhibitor ( PCSK 9i) may play a role in neuronal recovery following cardiac I/R insults. We hypothesize that PCSK 9i attenuates brain damage caused by cardiac I/R via diminishing microglial/astrocytic hyperactivation, ß-amyloid aggregation, and loss of dendritic spine. Methods and Results Adult male rats were divided into 7 groups: (1) control (n=4); (2) PCSK 9i without cardiac I/R (n=4); (3) sham (n=4); and cardiac I/R (n=40). Cardiac I/R rats were divided into 4 subgroups (n=10/subgroup): (1) vehicle; (2) PCSK 9i (10 µg/kg, IV) before ischemia; (3) PCSK 9i during ischemia; and (4) PCSK 9i at the onset of reperfusion. At the end of cardiac I/R protocol, brains were removed to determine microglial and astrocytic activities, ß-amyloid aggravation, and dendritic spine density. The cardiac I/R led to the activation of the brain's innate immunity resulting in increasing Iba1+ microglia, GFAP + astrocytes, and CD 11b+/ CD 45+high cell numbers. However, CD 11b+/ CD 45+low cell numbers were decreased following cardiac I/R. In addition, cardiac I/R led to reduced dendritic spine density, and increased ß-amyloid aggregation. Only the administration of PCSK 9i before ischemia effectively attenuated these deleterious effects on the brain following cardiac I/R. PCSK 9i administration under the physiologic condition did not affect the aforementioned parameters. Conclusions Cardiac I/R injury activated microglial activity in the brain, leading to brain damage. Only the pretreatment with PCSK 9i prevented dendritic spine loss via reduction of microglial activation and Aß aggregation.

Expanding the population coverage of evidence-based interventions with community health workers to save the lives of mothers and children: an analysis of potential global impact using the Lives Saved Tool (LiST).

BACKGROUND: Evidence has been accumulating that community health workers (CHWs) providing evidence-based interventions as part of community-based primary health care (CBPHC) can lead to reductions in maternal, neonatal and child mortality. However, investments to strengthen and scale-up CHW programs still remain modest. METHODS: We used the Lives Saved Tool (LiST) to estimate the number of maternal, neonatal and child deaths and stillbirths that could be prevented if 73 countries effectively scaled up the population coverage of 30 evidence-based interventions that CHWs can deliver in these high-burden countries. We set population coverage targets at 50%, 70%, and 90% and summed the country-level results by region and by all 73 high-burden countries combined. We also estimated which specific interventions would save the most lives. FINDINGS: LiST estimates that a total of 3.0 (sensitivity bounds 1.8-4.0), 4.9 (3.1-6.3) and 6.9 (3.7-8.7) million deaths would be prevented between 2016 and 2020 if CBPHC is gradually scaled up during this period and if coverage of key interventions reaches 50%, 70%, and 90% respectively. There would be 14%, 23%, and 32% fewer deaths in the final year compared to a scenario assuming no intervention coverage scale up. The Africa Region would receive the most benefit by far: 58% of the lives saved at 90% coverage would be in this region. The interventions contributing the greatest impact are nutritional interventions during pregnancy, treatment of malaria with artemisinin compounds, oral rehydration solution for childhood diarrhea, hand washing with soap, and oral antibiotics for pneumonia. CONCLUSIONS: Scaling up CHW programming to increase population-level coverage of life-saving interventions represents a very promising strategy to achieve universal health coverage and end preventable maternal and child deaths by 2030. Numerous practical challenges must be overcome, but there is no better alternative at present. Expanding the coverage of key interventions for maternal nutrition and treatment of childhood illnesses, in particular, may produce the greatest gains. Recognizing the millions of lives of mothers and their young offspring that could be achieved by expanding coverage of evidence-based interventions provided by CHWs and strengthening the CBPHC systems that support them underscores the pressing need for commitment from governments and donors over the next 15 years to prioritize funding, so that robust CHW platforms can be refined, strengthened, and expanded.

Exploring workplace violence among home care workers in a consumer-driven home health care program.

Nominal research has examined sexual harassment and workplace violence against home care workers within consumer-driven home care models such as those offered in Oregon. This study examined home care workers' experiences of violence while providing care to consumer employers, the patients who hire and manage home care workers. Focus groups and interviews were conducted in Oregon with 83 home care workers, 99 Oregon Department of Human Services (DHS) employees, and 11 consumer employers. Home care workers reported incidents of workplace physical violence (44%), psychological abuse (65%), sexual harassment (41%), and sexual violence (14%). Further, three themes were identified that may increase the risk of workplace violence: (1) real and perceived barriers to reporting violence; (2) tolerance of violence; and (3) limited training to prevent violence. To ensure worker safety while maintaining quality care, safety policies and training for consumer employers, state DHS employees, and home care workers must be developed.

Sexual and gender based violence against men in the Democratic Republic of Congo: effects on survivors, their families and the community.

Media and service provider reports of sexual and gender based violence (SGBV) perpetrated against men in armed conflicts have increased. However, response to these reports has been limited, as existing evidence and programs have primarily focused on prevention and response to women and girl survivors of SGBV. This study aims to contribute to the evidence of SGBV experienced by males by advancing our understanding of the definition and characteristics of male SGBV and the overlap of health, social and economic consequences on the male survivor, his family and community in conflict and post-conflict settings. The qualitative study using purposive sampling was conducted from June-August 2010 in the South Kivu province of Eastern DRC, an area that has experienced over a decade of armed conflict. Semi structured individual interviews and focus group discussions were conducted with adult male survivors of SGBV, the survivors' wife and/or friend, health care and service providers, community members and leaders. This study found that SGBV against men, as for women, is multi-dimensional and has significant negative physical, mental, social and economic consequences for the male survivor and his family. SGBV perpetrated against men and boys is likely common within a conflict-affected region but often goes unreported by survivors and others due to cultural and social factors associated with sexual assaults, including survivor shame, fear of retaliation by perpetrators and stigma by community members. All key stakeholders in our study advocated for improvements and programs in several areas: (1) health care services, including capacity to identify survivors and increased access to clinical care and psychosocial support for male survivors; (2) economic development initiatives, including microfinance programs, for men and their families to assist them to regain their productive role in the family; (3) community awareness and education of SGBV against men to reduce stigma and discrimination and increase acceptance of survivors by family and larger community.