bluuebunny/crossref_metadata_2025 huggingface dataset:
Sustaining the Elimination of Measles, Rubella and Congenital Rubella Syndrome in the Americas, 2019–2023: From Challenges to Opportunities
Authors: Rey-Benito Gloria , Pastor Desirée , Whittembury Alvaro , Durón Regina , Pacis-Tirso Carmelita , Bravo-Alcántara Pamela , Ortiz Claudia , Andrus Jon
Published: June 2024

This report reviews national data from all Member States on measles, rubella, and congenital rubella syndrome (CRS) elimination in the Region of the Americas during 2019–2023. It includes an analysis of compliance with vaccination coverage, surveillance indicators, and measles outbreaks, as well as an analysis of the response capacity of the laboratory network and a country case study that meets all indicators. The sources of information were the integrated epidemiological surveillance system for measles and rubella of the Pan American Health Organization (PAHO)/World Health Organization (WHO) and the Joint Reporting Form (eJRF), among others. From 2020 to 2022, regional coverage with first (MMR-1) and second doses (MMR-2) decreased to rates below 90%. The regional suspected case notification rate was maintained above the minimum expected 2.0 suspect cases per 100,000 population, except in 2021. During 2019 to 2023, 18 countries experienced outbreaks, with two of the outbreaks resulting in re-established endemic transmission. In conclusion, two countries in the Americas have not maintained measles elimination, but by the end of 2023 no country showed endemic measles transmission. One of the countries that lost its certification of elimination in 2018 managed to be reverified in 2023; the other is pending reverification. All countries maintained rubella elimination. Despite these challenges, the sustainability of the elimination of these diseases remains a health priority in the Region.
A World without Measles and Rubella: Addressing the Challenge of Vaccine Hesitancy
Authors: Higgins David M. , O’Leary Sean T.
Published: June 2024

The worldwide elimination of measles and rubella is feasible, but not without overcoming the substantial challenge of vaccine hesitancy. This challenge is complicated by the spread of misinformation and disinformation fueled by rapidly progressing technologies and evolving forms of online communication. The recent COVID-19 pandemic has only added further complexity to this challenge. However, considerable progress has been made in understanding the scope of the problem and the complex factors that influence vaccine hesitancy. Our understanding of evidence-based strategies for addressing vaccine hesitancy has grown significantly, including evidence for effective communication and behavioral interventions. In this article, we review measles and rubella vaccines and vaccine hesitancy. We then provide an overview of evidence-based strategies for addressing vaccine hesitancy, including communication strategies and behavioral interventions. This article is relevant to healthcare professionals, health system leaders, public health professionals, policymakers, community leaders, and any individuals who have a role in addressing vaccine hesitancy in their communities. Finally, we review future directions and major areas of research need.
Construction of Genetically Engineered Escherichia coli Cell Factory for Enhanced Cadmium Bioaccumulation in Wastewater
Authors: Tian Lingna , Wang Daiwei , Liu Yueying , Wei Mingjie , Han Xuexue , Sun Xiaomei , Yin Liang , Luo Guanghong
Published: June 2024

The heavy metal cadmium poses severe threats to both ecosystems and human health. Utilizing genetic engineering to enhance the microbial capability for efficient cadmium accumulation has emerged as a pivotal research direction. This study constructed a genetically engineered bacterium capable of expressing multivalent phytochelatins with a self-assembly ability and explored its efficacy in cadmium adsorption. Molecular biology techniques were adopted to fuse the recombinant human ferritin (rHF) gene and the synthetic phytochelatin (EC) gene, known for its robust adsorption capacity for heavy metals. The expression vector was constructed. Escherichia coli (E. coli) served as the host cell to express multivalent nanochelator rHF-ECs tailored for high-efficiency heavy metal adsorption. The results reveal the successful soluble expression of the recombinant fusion protein in E. coli cells, forming self-assembled multivalent nanoparticles with a size of about 13 nm, and the target protein rHF-EC20 (monomer) could adsorb approximately 9.2 μmol of Cd2+ in vitro. Moreover, this recombinant strain demonstrated cadmium adsorption across a temperature range of 16–45 °C and a pH range of 5–9, with the optimal performance observed at pH 7.0 and 37 °C. Compared with the control strain, the recombinant strain BL21 (FLE), expressing nano-chelating peptides, achieves an adsorption rate of 80% for Cd2+ at 60 min, resulting in an approximately 18% increase in the Cd2+ enrichment efficiency. The maximum adsorption capability of cadmium reached 12.62 mg per gram of dry cell weight. This work indicated that the synthesis of multivalent chelating peptides in E. coli cells could efficiently enhance the bioaccumulation of the heavy metal cadmium, which renders novel avenues and methodologies for addressing cadmium pollution, offering promising prospects for environmental remediation.
Evolution of Flood Prediction and Forecasting Models for Flood Early Warning Systems: A Scoping Review
Authors: Byaruhanga Nicholas , Kibirige Daniel , Gokool Shaeden , Mkhonta Glen
Published: June 2024

Floods are recognised as one of the most destructive and costliest natural disasters in the world, which impact the lives and livelihoods of millions of people. To tackle the risks associated with flood disasters, there is a need to think beyond structural interventions for flood protection and move to more non-structural ones, such as flood early warning systems (FEWSs). Firstly, this study aimed to uncover how flood forecasting models in the FEWSs have evolved over the past three decades, 1993 to 2023, and to identify challenges and unearth opportunities to assist in model selection for flood prediction. Secondly, the study aimed to assist in model selection and, in return, point to the data and other modelling components required to develop an operational flood early warning system with a focus on data-scarce regions. The scoping literature review (SLR) was carried out through a standardised procedure known as Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The SLR was conducted using the electronic databases Scopus and Web of Science (WoS) from 1993 until 2023. The results of the SLR found that between 1993 and 2010, time series models (TSMs) were the most dominant models in flood prediction and machine learning (ML) models, mostly artificial neural networks (ANNs), have been the most dominant models from 2011 to present. Additionally, the study found that coupling hydrological, hydraulic, and artificial neural networks (ANN) is the most used ensemble for flooding forecasting in FEWSs due to superior accuracy and ability to bring out uncertainties in the system. The study recognised that there is a challenge of ungauged and poorly gauged rainfall stations in developing countries. This leads to data-scarce situations where ML algorithms like ANNs are required to predict floods. On the other hand, there are opportunities to use Satellite Precipitation Products (SPP) to replace missing or poorly gauged rainfall stations. Finally, the study recommended that interdisciplinary, institutional, and multisectoral collaborations be embraced to bridge this gap so that knowledge is shared for a faster-paced advancement of flood early warning systems.
Enhancing Oil–Water Separation Efficiency with WO3/MXene Composite Membrane
Authors: Amari Abdelfattah , Osman Haitham , Boujelbene Mohamed , Abdulameer Maha Khalid , Scholz Miklas , Sammen Saad Sh.
Published: June 2024

In this study, a novel method for the high-performance treatment of oily wastewater was introduced using a tungsten (VI) oxide (WO3)/MXene composite membrane based on poly (arylene ether sulfone) (PAES). Composite membranes were fabricated with superhydrophilic (SH) and superoleophobic (SO) characteristics, which allow for the high-performance treatment of oily wastewater. The fabricated composite membrane can also photodegrade organic types of pollutants with just a short period of UV, enabling self-cleaning and anti-fouling properties. Moreover, the comprehensive characterization of the composite membrane through FTIR, SEM, and XRD analyses yielded valuable insights. The FTIR analysis revealed the characteristic peaks of WO3, MXene, PAES, and the synthesized composite membrane, providing essential information on the chemical composition and properties of the materials. The XRD results demonstrated the crystal structures of WO3, MXene, PAES, and the synthesized composite membrane, further enhancing our understanding of the composite membrane. Additionally, the SEM images illustrated the surface and cross-section of the fabricated membranes, highlighting the differences in pore size and porosity between the PAES membrane and the WO3–MXene composite membrane, which directly impact permeate flux. The study showed that the composite membrane had a remarkable recovery time of only 0.25 h, and the efficiency of the separation process and water flux recovered to 99.98% and 6.4 L/m2.h, respectively. The joint influence of WO3 and MXene on composite membranes degraded contaminants into non-polluting substances after sunlight irradiation. This process effectively solves the treatment performance and decrease in permeate flux caused by contamination. The technology is membrane-based filtration, which is a simple and advanced method for treating polluted water. This innovative work offers promising solutions to address water pollution challenges and holds potential for practical applications from a self-cleaning and anti-fouling point of view.
Application of Variable Weight Theory in the Suitability Evaluation of Regional Shallow Geothermal Energy Development
Authors: Wang Ruifeng , Shi Mingchuan , Zhai Yanliang , Zhu Ke , Zhao Lei , Liu Chenhui , Yan Guohong , Yin Zhiqiang
Published: June 2024

Blindly developing shallow geothermal energy (SGE) may lead to difficulties in reinjection, a low coefficient of performance (COP), and the waste of funds. In order to avoid these problems and improve development efficiency, it is necessary to scientifically conduct a development suitability evaluation and classify the suitability levels before development. This article takes Chengde City, Hebei Province, China as an example and constructs an evaluation index system based on the analysis of regional basic conditions. The Analytic Hierarchy Process (AHP) was used to calculate the constant weight. A Fuzzy C-means Clustering (FCM) analysis was used to determine the critical value of evaluation index classification and the interval threshold of variable weights. The parameters of the variable-weight model were calculated using the method of model backcalculation. Based on the constructed variable-weight model, the suitability of SGE development for groundwater sources in the study area was evaluated, and it was divided into five levels: most suitable area, suitable area, relatively suitable area, less suitable area, and unsuitable area. Through a verification analysis of engineering examples and a comparison with the evaluation results under traditional constant-weight models, it was found that the evaluation results based on variable weight theory have better data discreteness and a higher accuracy. Research has shown that variable-weight models can adjust the weight of each index based on its state value. Through this study, the accuracy of the suitability evaluation for regional SGE development can be improved. This can provide a certain reference for the suitability evaluation of SGE development in other regions.
Factors Influencing Women’s Health in Conflict Zones in Africa
Authors: Mlambo Courage , Mvuyana Bongekile , Sithole Vikela Liso
Published: June 2024

This study sought to examine the factors that influence women’s health in conflict zones for the period spanning 1975–2018. The investigation was motivated by the fact that war and violent conflict strain already underdeveloped healthcare systems and frequently put disadvantaged groups—particularly women and children—at risk of being denied access to essential services like healthcare. Living in or close to conflict zones puts women at a higher risk for sexual assault, poor reproductive health, unwanted pregnancy, and poor maternal health outcomes. By destroying infrastructure, food, water, and sanitation systems, armed conflict reduces access to healthcare. The results showed that the remittances and life expectancy have a negative relationship with maternal mortality. Development assistance, the number of refuges, and military expenditure were seen as having a positive relationship with maternal mortality, but no significant relationship was found with either economic growth or internet usage. This calls for new policy and self-care interventions. There is also a need to explore how to maximise the benefits of technology in delivering health interventions to hard-to-reach populations. There is also a need for policymakers to explore how to maximise the benefits of technology in delivering health interventions to hard-to-reach populations.
Rethinking continuity in primary care for people with mesothelioma
Authors: Couchman Emilie , Ejegi-Memeh Steph , Mitchell Sarah , Gardiner Clare
Published: June 2024

Background

Mesothelioma is a terminal disease that is linked to asbestos exposure. Continuity is difficult for GPs, and other healthcare professionals (HCPs), to provide within the current NHS primary care system, but is highly valued by people with mesothelioma.

Aim

To understand the experiences of continuity in primary care among people with mesothelioma, their close persons, and their HCPs; how they achieve this (or not); and how it affects their healthcare service use.

Method

Realist case studies of patient journeys through the healthcare system (involving longitudinal interviews with people with mesothelioma, their close persons, and HCPs; and exploration of the organisational context). Data analysis allowed understanding of hidden mechanisms (resources and reasoning), triggered in certain contexts, leading to specific outcomes.

Results

Forty-eight interviews (involving 9 patients, 8 close persons, and 12 HCPs) were undertaken (totalling 30.8 hours/1848 minutes). Context-Mechanism-Outcome configurations related to: challenges unique to mesothelioma; capacity of patients/close persons/HCPs to facilitate continuity; multidisciplinary (MDT) approach differs from the family doctor model; and ‘the NHS primary care system is broken’.

Conclusion

Patients perceive their continuity needs to be unmet by the inflexible primary care system, which needs to adapt to a society in which people receive increasingly novel treatments and live longer with complex healthcare needs. A societal perspective shift is required to understand that an MDT now shares responsibility for care, rather than an individual family doctor. Policy documents continue to focus on access, and still do not advocate strongly enough for continuity, despite unequivocal evidence demonstrating its worth.
Is pay for performance promoting inverse inequality in Irish general practice?
Authors: Linnane Sarah , Mullarkey Sarah , Kyne Eoin , Fallon John , O’Regan Andrew , Hannigan Ailish , Sharma Santosh , Healy Maeve , OConnor Raymond
Published: June 2024

Background

In 2020, the Chronic Disease Management (CDM) programme was introduced in Ireland. This programme resources GPs to review public (GMS) patients, diagnosed with eight named chronic diseases, twice yearly according to a structured protocol. This pay for performance initiative has been widely adopted by GPs. However, it is hypothesised that private patients (PPs) receive a poorer standard of care, as they may be reluctant to attend due to the cost involved.

Aim

To assess whether the management of eight chronic diseases named in the CDM programme is to the same standard among both PPs and GMS patients.

Method

A retrospective audit of GP practices in the Midwest of Ireland. Data relating to 25 GMS patients and 25 PPs, matched by age, gender, and clinical condition, is collected from each practice. Patients have at least 1 of the eight named chronic diseases. Parameters include vaccination status (influenza, pneumococcal, COVID); body mass index; blood pressure; smoking status; renal function; HbA1c; lipid profile; brain natriuretic peptide (BNP) in patients with heart failure; and lung function tests in patients with COPD or asthma. COVID vaccination status acts as a control because it is freely available for both PPs and GMS patients.

Results

Preliminary results from 2 GP practices show large consistent disparities in management between PPs and GMS patients in most parameters.

Conclusion

Limiting Pay for Performance to the care of GMS patients only, based on age or income, promotes inverse inequality. We argue that CDM care should be offered to all patients.
How can we improve support for women with perinatal anxiety in primary care? A qualitative study
Authors: Silverwood Victoria , Fisher Tamsin , Proctor Janine , Kingstone Tom , Turner Katrina , Shivji Noreen , Chew-Graham Carolyn
Published: June 2024

Background

Perinatal anxiety (PNA) occurs during pregnancy and up to 12 months post-partum. PNA affects more than 21% of women and can impact adversely on mothers, children and their families. National Institute for Health and Care Excellence (NICE) guidance identified evidence gaps around non-pharmacological interventions for PNA.

Aim

This qualitative study aimed to understand the perspectives of a variety of Perinatal Mental Health (PMH) stakeholders about non-pharmacological interventions for PNA.

Method

Ethics approval. Semi-structured interviews with women with lived experience of PNA, healthcare professionals (HCPs), voluntary community and social enterprise (VCSE) stakeholders and commissioners. Topic guide modified in response to emerging themes. Interviews digitally recorded with consent, transcribed, and analysed thematically. A patient advisory group was involved throughout the study.

Results

There were 25 interviews conducted. Women with PNA expressed a wish to choose from a range of non-pharmacological interventions, which are often delivered by VSCE organisations or not commissioned within the NHS. HCPs described a hierarchy of interventions that can be offered to women, often related to severity of a woman’s PNA. PMH VCSE stakeholders emphasised that their services are flexible and accessible for women with PNA.

Conclusion

Tension exists between what is currently recommended by NICE and thus commissioned, and the types of intervention that women want to access, including support from VCSE services. Clinicians should be aware of local VCSE organisations which provide care for women with PNA. There is an evidence gap around the effectiveness of various interventions delivered by VCSE organisations, which requires further exploration.
Effectiveness of post-COVID-19 primary care attendance in improving survival in very old patients with multimorbidity: a territory-wide target trial emulation
Authors: Wei Cuiling , Vincent  , Yan Ka Chun , Maringe Camille , Rachel  , Chu Yui Ki , Liu Wenlong , Liu Boyan , Hu Yuqi , Zhou Lingyue , Celine  , Chui Sze Ling , Li Xue , Eric  , Wan Yuk Fai , Cheung Ching Lung , Esther  , Chan Wai Yin , William  , Wong Chi Wai , Ian  , Wong Chi Kei , Lai Francisco
Published: June 2024

Background

Older adults with multimorbidity are at high risk of mortality following COVID-19 hospitalisation. However, the potential benefit of timely primary care follow-up on severe outcomes post-COVID-19 has not been well established.

Aim

To examine the effectiveness of attending general outpatient within 30 days after discharge from COVID-19 on 1-year survival among older adults aged ≥85 years, with multimorbidity.

Method

We emulated a target trial using a comprehensive public healthcare database in Hong Kong. The cloning-censoring-weighting technique was used to minimise immortal time bias and confounding bias by adjusting for demographics, hospitalisation duration and ICU admission, baseline chronic conditions, and medication history. The outcome included all-cause and cause-specific mortality.

Results

Of 6183 eligible COVID-19 survivors, the all-cause mortality rate following COVID-19 hospitalisation was lower in general out-patient clinics (GOPC) group compared to non-GOPC group (17.1 versus 42.8 deaths per 100 person-year). After adjustment, primary care consultations within 30 days after discharge were associated with a significantly greater 1-year survival (difference in 1-year survival: 11.2%, 95% CI = 8.1% to 14.4%). We also observed better survival from respiratory diseases in the GOPC group. In a sensitivity analysis for different grace period lengths, we found that the earlier participants had a GOPC visit after COVID-19 discharge, the better the survival.

Conclusion

Timely primary care consultations after discharge may improve survival following COVID-19 hospitalisation among older adults aged ≥85 years, with multimorbidity. Expanding primary care services and implementing follow-up mechanisms are crucial to support this vulnerable population’s recovery and well-being.
Moving beyond the ‘PPG’: co-production and inclusion health
Authors: McGeown Helen Rosemary , Potter Lucy , Stone Tracey , Swede Julie , Cramer Helen , Horwood Jeremy , Carvalho Maria , Connell Florrie , Feder Gene , Farr Michelle
Published: June 2024

Background

We frequently fail to meaningfully incorporate patient voice in the development of health services, in particular the voices of those who are most disadvantaged.

Aim

To share learning from a co-production project to improve primary care experience for those with multiple disadvantage and lived experience of trauma.

Method

We formed a collective of women (Bridging Gaps). Group members had lived experience of poverty, mental health challenges, addictions, homelessness, and sexual exploitation. Other members were researchers, GPs, and members of a third-sector organisation. We worked alongside local GPs to change how services were delivered. We collected interviews (n= 9), ethnographic data from group meetings (n= 3), and reflective notes from group members (n= 19). Data on our process were analysed using a framework approach drawn from the principles of trauma-informed care.

Results

We highlight the challenges for those with multiple disadvantages and trauma experience to meaningfully and safely engage in traditional Patient Participation Group (PPG) models. True co-production of services requires adequate resources and close collaborative working with local community organisations. Groups must be facilitated by those with relevant experience and the ability to both notice and manage power dynamics within the room. With sufficient support, co-production models have potential to empower group participants and improve health services.

Conclusion

Partnership working between GPs, the third sector, and other organisations is vital. This can allow GPs to benefit from the expertise of those with relevant lived experience in tackling health inequalities.
Clustering by health and social care need in multple long-term conditions (MLTC): an exploratory qualitative study to understand the views of professionals and people living with MLTC about future interventions
Authors: Holt Sian , Santer Miriam , Everitt Hazel , Farmer Andrew , Dambha-Miller Hajira , Morrison Leanne
Published: June 2024

Background

Around one in four people are living with multiple long-term conditions (MLTC). Integrated care to holistically manage both health and social needs could improve outcomes for people living with MLTC, including lower rates of hospitalisation and mortality. However, given the number of people with MLTC and increasing strain on health and social care, stratified approaches to identifying and addressing social care needs may be more efficient and cost-effective. We have developed data driven clusters that group people with similar health and social care needs, which could identify patients at the highest risk of poor outcomes related to social care need.

Aim

To explore views about a future intervention based on these clusters.

Method

We aim to plan a cluster-based intervention that engages people living with MLTC and health and social care professionals to consider social care needs (SCNs) when consulting in primary care. We have conducted 14 interviews with professionals to explore their priorities and concerns about care delivery by MLTC clusters and 19 remote interviews with people living with MLTC to find out how well they identify with the MLTC clusters we have defined. Data were analysed using reflexive thematic analysis.

Results

GPs are the ‘starting point’ for conversations about SCNs but need an efficient system to enable effective conversations. The cluster-based intervention could fill this gap.

Conclusion

This research identifies key considerations needed for an intervention to engage people with MLTC and health and social care professionals to consider SCNs in primary care.
Engagement of culturally diverse communities in primary care research
Authors: Bedzo-Nutakor Judith , Islam Mohammed , Hyde Elliott , Radwan Tarek , L’Esperance Veline
Published: June 2024

Background

The underrepresentation of ethnic minorities and low-income groups in primary care (PC) research hinders the development of effective treatments for diverse populations.

Aim

To develop a framework that general practice staff and researchers can use to improve the participation of underserved groups in PC research.

Method

This study was undertaken across 10 GP practices in South London serving 150 658 patients. Practices are distributed across ethnically diverse and highly deprived communities. A mixed-methods approach was utilised. Retrospective data were collected on patient participation in research studies across the practices between July 2022 and July 2023. Professional and patient focus groups, and a patient questionnaire, were undertaken to understand awareness and knowledge of, enablers for, and barriers to research participation.

Results

Over the 12-month period, 627 patients participated in PC research studies across the 10 practices. Black African and Black Caribbean patients accounted for 26% of the practices’ patient population but were significantly underrepresented in research, comprising only 11% of participants. Patients of Asian backgrounds accounted for 11% of the practices’ population but made up 20% of research participants. Lack of awareness of research participation opportunities, fear of side effects, language barriers, and mistrust of researchers were some of the barriers to participation. Participants highlighted that trust in their GP, education, and transparency of research processes were key to building long-term engagement.

Conclusion

This study provides insights into poor recruitment of specific ethnic minorities into primary care studies. The authors identified adaptations to research engagement activities, which are required to ensure that participation is improved.
Access to health services for people experiencing homelessness in Manchester, UK: a qualitative study
Authors: Howard Alya
Published: June 2024

Background

Homelessness is a significant social issue in the UK. A GP practice (name redacted) based in Manchester has provided a primary Homeless Healthcare Service (HHS) to people experiencing homelessness (PEH) for 21 years.

Aim

To assess primary healthcare provision at this practice from the perspectives of PEH at homeless day facilities in the Greater Manchester area.

Method

A qualitative multi-method study, including unstructured observations, was performed. Twenty semi-structured interviews were conducted with either staff or volunteers, and an additional 20 semi-structured interviews were held with PEH at four fixed sites. These sites were homeless day centres, which had previous or current outreach services with the practice. Participants were asked about their knowledge and opinions of the practice, experiences with the HHS, and recommendations for improvements.

Results

Five inductive themes were identified, consisting of PEH’s fears around communication, challenges navigating the health system, insufficient GP signposting, travel as a barrier to access, and the importance of outreach. Administrative, physical, and communication weaknesses were identified in the HHS.

Conclusion

Recommendations for future improvements were categorised as administrative, physical, service provision, and communication. The practice can further develop communication and advertising through Manchester, clarify pathways to care for PEH, and increase outreach services to ensure improved access to services.
Development and implementation of an online intervention and embedded decision aid to support self-management of acne vulgaris: qualitative interviews with healthcare professionals
Authors: Miah Fathema , Essery Rosie , Steele Mary , Le Feuvre Rebekah , Muller Ingrid , Santer Miriam
Published: June 2024

Background

Acne is common and has a significant impact on quality of life. Topical treatments are first-line and effective, but non-adherence is common due to slow onset of action, or lack of advice on how to manage side effects.

Aim

The Acne Care Online programme is developing an online intervention to support acne self-management and help-seeking. This project aims to explore experiences and views of healthcare professionals (HCPs) treating acne to assess the acceptability and feasibility of implementing this intervention and embedded decision aid in practice.

Method

This qualitative study recruited HCPs working in general practice. Email invitations were sent to eight research-active practices in Southwest England, and snowball sampling was used. Purposive sampling was used to seek diverse participants. Semi-structured virtual interviews were conducted, audio-recorded, and transcribed. Data were explored using thematic analysis.

Results

Nine interviews were conducted, including seven GPs, one nurse, and one pharmacist. Findings highlighted challenges faced by HCPs managing acne in time-limited consultations, particularly around patients’ limited understanding of effective treatments, frequent requests from patients for non-first-line treatments, treatment non-adherence, and addressing psychosocial impact. The intervention and embedded decision aid were perceived as beneficial in addressing these challenges, improving shared decision making, and providing a reliable resource for patients. Interviewees suggested integrating the intervention into electronic practice templates for effective implementation.

Conclusion

HCPs were positive about the potential for the intervention to be implemented as a useful tool in practice. Potential implementation barriers need to be considered, such as making the intervention quick to access in time-limited consultations.
Perimenopause management in defence primary healthcare: exploring GPs’ knowledge and confidence
Authors: Willman Antony
Published: June 2024

Background

The average age of the menopause in the United Kingdom is 52 but symptoms of the perimenopause (PMP) can start at 40 or earlier. The UK Armed Forces (UKAF) has a young demographic but women serving over the age of 40, potentially with PMP symptoms, has increased. Recent evidence suggested PMP management by Defence GPs was satisfactory but variable. Because of small numbers, Defence GPs have less exposure to the PMP than NHS GPs, a problem exacerbated for Uniformed GPs who have reduced clinical contact time due to military duties.

Aim

This study aimed to explore Defence GP knowledge and confidence in managing the PMP, identifying factors contributing to disparities.

Method

This study used a sequential mixed-methods approach. A survey with self-rating questions and vignettes was undertaken, followed by semi-structured interviews of selectively sampled respondents.

Results

164 out of 542 Defence GPs responded to a survey, which identified reasonable knowledge (91.3% managing cases per guidelines) but reduced confidence (54.3%). Regression analysis identified case exposure to the PMP, education, and gender as significant factors affecting confidence in PMP management. Themes identified from interviews which were felt to affect knowledge and confidence included: Characteristics of the GP (such as gender); lifelong learning and reflective practice; professional exposure to, and awareness of, the PMP; the changing demographic of Defence; an integrated PMP service to provide experiential learning. Case exposure and experiential learning emerged as the main drivers for confidence. For Uniformed GPs, this was affected by limited clinical time, but confidence returned once exposed to just a few PMP cases.

Conclusion

Establishing an integrated PMP service in Defence was seen as crucial for improving care as well as providing educational opportunities through experiential learning for Defence GPs.
Exploratory study of frequent attenders in general practice to better understand why patients seek help
Authors: Nur Samira , Coultas James , Jones Louise , Oesterling Christine , Tookman Adrian , Walker Steven
Published: June 2024

Background

Frequent attenders (defined as the top 10% of health care users or those making ≥10 visits per year) account for 30–50% of GP consultations. This has significant resource implications.

Aim

To understand the characteristics of frequent attenders (≥18-years) at an outer London general practice (list 5,876; deprivation index 5thdecile) and reasons for attending.

Method

A retrospective case note review was conducted using SystmOne of people attending on ≥10 occasions to see a health professional between March 2022 and February 2023. Data were extracted by hand: age, gender, reason and type of consultation, diagnoses, referrals, Charlson Comorbidity Index (CCI), mortality at one year. Patient notes for ≥30 contacts were reviewed by a senior GP.

Results

544 people (9.3%) attended ≥10 appointments. Of these, five interacted with a GP ≥50 occasions (Group 1;mean age:74.6yrs/female: 4 /CCI:5.0), eight ≥40 occasions (Group 2; 69.6yrs/6.0/5.5) and 35 ≥30 occasions (Group 3;70yrs/27/4.7). Forty-eight people accounted for 882 appointments, 29% face to face and 71% by telephone. Frequency increased with age and CCI. Patients in group 3 underwent more investigations (6.0/6.0/10.0). There was no difference in mean numbers of clinicians seen (6.4/7.1/7.4) or referrals (5.0/4.0/5.0) between the three groups. Frequent attenders tended to fall into two groups: people with chronic diseases, typically associated with anxiety and complex needs, and people with ongoing mental health conditions. Coding was challenging due to complexity.

Conclusion

Frequent attenders presented due to their medical complexity or mental health disorders rather than medically unexplained symptoms. Most interactions with a GP are understandable.
Co-development of breast cancer health promotion educational materials for ethnically diverse women working with hairdressing and beauty salons: BELONG study
Authors: Adhav Sakshi , de Vale Marjorie Lima , Zaman Maham , Coultas Clare , Goff Louise , Mernagh-iles Ashlyn , L’Esperance Veline , Karamanos Alexis , Ayis Salma , Ćurčin Vasa , Durbaba Stevo , Molokhia Mariam , Harding Seeromanie
Published: June 2024

Background

Improved screening uptake is essential for early breast cancer detection, women’s health and reducing health disparities. However, minority ethnic and deprived communities often face lower breast cancer screening rates and limited access to culturally tailored educational materials. A recent review found limited culturally tailored materials for breast cancer education.

Aim

To investigate the culturally appropriate interfaces and preferences of salon staff in educating their clients about breast cancer

Method

We used a two-stage approach, following the Double Diamond framework; discover and define phases. Relevant breast cancer materials (i.e., based on cultural appropriateness, English language presentation, and alignment with the UK context) were assessed using the Suitability Assessment of Materials (SAM) toolkit. Interviews with ethnically diverse salon staff provided insights into their needs and preferences for client education materials. Thematic analysis was applied to interview transcripts.

Results

Cultural appropriateness was evident in 9/14 (64%) of the materials identified (e.g., targeting black ethnicities with positive representations). Of those, six of them demonstrated an overall SAM rating of 76% (“Superior”). Thematic analysis of interviews identified seven key themes, including the importance of engagement strategies, education and awareness for health promotion, salon staff’s role, preferred training methods, supportive materials, inclusivity, representation, and participant satisfaction.

Conclusion

This study highlights the SAM toolkit’s role in selecting suitable educational materials for breast cancer prevention. The research offers prospects for improving breast cancer awareness in ethnically diverse communities and addressing healthcare access disparities, with salon hairdressers emerging as crucial advocates for health promotion.
العقل المؤدلج: بحث في بنية الفكر العربي المعاصر.
Authors: تركي الحمد
Published: June 2024

تناقش هذه الورقة الخلل الظاهر الذي يجعل العقل العربي غير قادر على استيعاب التحولات العظمى في العصر الحديث، ومن ثم إفراز فكر قادر على التعامل مع هذه التحولات - كما هي - لا كما يفترض أن تكون.
ونحن نعيش في عالم سريع التغير والتحول في كافة المجالات والمستويات فما هو موقفنا نحن العرب من هذه التغيرات والتحولات المتسارعة؟
لقد حاول العرب حل معضلاته السياسية منذ بداية القرن العشرين بما يعرف بالخطاب الثوري، وهو خطاب أحادي الاتجاه مهما تغيرت الألفاظ ويتصف الخطاب الثوري بالشعوبية والشمولية.
ويتربط الخطاب الثوري بخطاب أشمل وأوسع وهو الخطاب العربي، وهو يتصف بصفة الأحادية والابتعاد عن التعددية. وعلى الرغم من التعدد الأيديولوجي إلا أن بنية العقل المنتج للايديولوجيات تبقى ثابتة غير معرضة للنقد، ولأجل ذلك فإن الكوارث والأزمات العربية سوف تتكرر.
وهناك مجموعة من الأوهام تقف في طريق العقل العربي، ومن ثم تعطل هذا العقل وتجعله غير قادر على استجلاء حقيقة الأمر من حوله.
وهذه الأوهام تتمثل في: السيادة - المؤامرة أو العداء - السلطة - القيادة وأخيرًا وهم الزعامة.
وهذه الأوهام تشكل حجابًا وستاراً يفصل بين الخط السياسي العربي المعاصر وبين الواقع السياسي العربي المعاصر، وبين الواقع السياسي المتحرك، وبالتالي تحرم هذا الخطاب القدرة على التأثير والفاعلية.
وإذا أردنا الاتجاه نحو عقل عربي جديد فلا بد أن نفرق بين الثوابت والمتحولات. فالحرية مثلاً قيمة ثابتة لا تفهم ولا تدرك إلا من خلال تفرعاتها، ولكن العادات والسلوك الاجتماعي عرضة للتغيير البطيء بفعل التاريخ وأثر الزمان في تغيرات الحياة.
إن ثبات بعض القيم لا يعني جمودها، فالثابت يحدد مسارات المتحول العامة، والمتحول يقي الثابت من الجمود والتحجر.
ورغم أن ما ذكر أنفا نوع من البديهيات، فإن مأساتنا تأتي من أنه لم نستفد من مثل هذه البديهيات، ومأساتنا الحالية تأتي من عدم القدرة على التعامل مع الثابت والمتحرك (المتحول) في حياتنا، وشل قدرتنا الاجتماعية والحضارية، وبالتالي فاعليتنا التاريخية، فنحن نثبت المتحول من القيم، ونجمد ونحجر الثابت منها.
إن نقطة البدء تكمن في إعادة النظر إلى علاقة الثابت والمتحول، وفي ردم الفجوة بين الفكر والواقع، ويتحقق ذلك طريق الثقافة والمعرفة التي تستوعب الحديث ولا يرفض القديم.
السلطة في المجتمع العربي المعاصر بين الفكر والتطبيق.
Authors: حياة ناصر الحجي
Published: June 2024

السلطة بالمفهوم الحديث هي حاكم ونظام حكم. وقد مرّت السلطة بهذا المفهوم- في الوطن العربي- بمراحل متفاولة من المثالية والتراجع كما ارتبطت بالوعي العربي.
لم يواجه إنسان العصور الإسلامية الأولى أية أزمات دستورية، إذا كانت نصوص القرآن الكريم هي المواد الدستورية التي تقيد بها الحكم والحاكم والمجتمع أنذاك. ولكن البعد عن هذه النصوص أوجد منفذاً لحدوث تناقض بين الفكر والتطبيق، وكانت المبادىء الدستورية لإقامة حكم ترتضيه الشعوب الإسلامية هي العدل في الداخل والأمان في الخارج.
إن السلطة بجوهر معانيها الإنسانية تتجلى في العدل والصدق والإحسان ونكران الذات، وقد بدأ التراجع عن أسس السلطة العادلة يظهر بوضوح منذ القرن الثالث الهجري -التاسع الميلادي- بعد أن بدأ تكالب أصحاب السلطة على تحقيق المنافع الشخصية، وأصبح البحث عمن ينكر الذات ويخدم العباد أمرًا صعبًا.
وكانت الشورى في بدء الحكم الإسلامي عن المحور الأساسي الذي انبثقت منه القرارات الجماعية، ومع اتساع الدولة الإسلامية وطغيان الماديات-عرف الفقهاء الذين كانوا يسدون النصح إلى الحكام-عن مجالس الحكم. ومع تلاشي طابع الشورى تضاءلت قوة السلطة المركزية، وظهرت السلطات الصغرى شرقًا وغربًا، وكان ذلك سببًا في ظهور الخطر الصليبي، وبدأت مرحلة جديدة من حكم الأجانب - عرقا - المسلمين - عقيدة. ولم يشعر الإنسان العادي بهذا الفرق العرقي- حيث كانت الرابطة الأساسية بين تلك الشعوب هي الإسلام. وكانت هذه الرابطة الدينية هي التي تصدت للعدوان الصليبي، ولكن النزعة نحو المنفعة الخاصة كانت لانزال باقية، بل و تعمقت مع استمرار حكم الأجنبي.
لقد كان القضاء دائمًا هو ضمير الأمة، ومن هذا كانت الرابطة الوثيقة بين القضاة والشعب. ويظهر التلازم منطقياً في العلاقة المباشرة بين الحاكم والمحكوم وبين توفر مبدأ العدالة، ولكن بدأت هذه العلاقة تنتهي، حتى وصل الأمر إلى إقامة الحكام في قلاع ذات أسوار عالية وأصبحت المناداة بالحرية والأمان رمزيًا، وأصبح جل هم العامي الحصول على قوت يومه، وبدأت السلطة تصبح سيفًا مسلطاً على رقاب الناس، وخفتت مصابيح العلم واقتصر على شئون الدين. ومع انحسار مبدأ العدالة تلاشت هيمنة الملك مع تراجع مظلة الحرية.
ومن هنا انطلقت المحاولات للتخلص من السيطرة الأجنبية والسعي لتحقيق الوحدة العربية بعد أن شملت التجزئة الخضوع الشامل للاحتلال الأجنبي الغربي. وقد أتى الاستقلال من السيطرة الأجنبية لكل دولة على حدة، أي أن الاستقلال والحرية التي حصل عليها العرب جلبت معها التجزئة، وغاب إطار الوحدة السياسية التي عاشها العرب على مرّ القرون.
ومع فشل محاولات الوحدة في العصور الحديثة عن طريق المناداة بالقومية العربية بدأ التفكير على أساس العودة إلى الفكر الإسلامي، وإن كانت فكرة القومية العربية استمرت متوقدة ولها صدى إيجابي في نفوس الكثيرين.
وهناك فئة ثالثة تدعو إلى تطبيق مبادى الشريعة الإسلامية مع ما تهيئه من تسامح وانفتاح يتيح لها استيعاب جميع الذين لا ينتمون لأي جماعة، ويعتقدون أن حرية الفكر عند الإنسان أمر مفروغ منه، ويجب عدم الاعتداء عليه، أو إلغائه بل تأكيده بالمبادىء التي يقوم عليها الإسلام. ولاشك أن الزلزال الفكري الناتج عن العدوان العراقي على الكويت قد أكد فشل التيار القومي العربي، و عدم واقعية الشعارات التي رفعها دعاة الوحدة العربية، وبرز الشرخ الفكري واضحًا بين شعوب الخليج العربية،
وبعض الشعوب العربية الأخرى - مما جعل التيار الفكري العام في الخليج أبعد ما يكون عن الدعوة إلى الوحدة العربية وبدأت التوجهات إلى وحدة إقليمية خليجية تظهر واضحة بين شعوب الخليج العربي.
الخطاب الأصولي المعاصر: الملامح والقسمات.
Authors: محمود إسماعيل
Published: June 2024

كثرت الكتابات وتعددت في السنوات الأخيرة عن (( الحركة الأصولية الإسلامية المعاصرة))، سواء من قبل منظريها أو من لدن خصمها. بل ظهرت بعض الدراسات الجيدة عن نقد خطابها.
تتصدى هذه الدراسة للتعريف بمنطلقات الخطاب الأصولي المعاصر وغاياته بغية الوقوف على آلياته التي تحدد خصائصه وسماته، وفق منهج يعول على القراءة النقدية لبعض النصوص الأصولية المعاصرة توطئه للوقوف على السمات النوعية المشتركة التي تميز هذا الخطاب، برغم تنوع أطره دون مضامينه، الأمر الذي يزكي مشروعيه هذه الدراسة. وقد انتهت هذه الدراسة إلى الوقوف على عدة سمات مشتركة نوجزها فيما يلي:
1- الماضوية: حيث يجري التعويل على الماضي في صياغة المشروع الأصولي بغض النظر عن معطيات الواقع ومتغيراته.
2- الأدلجة: وتعني أن هذا الخطاب على الرغم من الزعم باستناده إلى الإسلام كعقيدة وشريعة، إلا أنه في التحليل الأخير يوظفه توظيفا إديولوجيا بغية الوصول إلى السلطة.
3- التطرف: وهي سمة جد هامة تفصح عن احتكار ((سدنة)) هذا الاتجاه حق تأويل النص الديني وتملك الحقيقة واليقين. وما خالف ذلك يعد كفرا وضلاله .
4- الانتقائية: وهي آفة يعول عليها الخطاب الأصولي المعاصر من حيث انتقاء تيارات واتجاهات تراثية نصية والتعويل عليها في صياغة الإديولوجية.
5- القصور المعرفي: ويعني افتقار منظري الأصولية إلى معرفة صحيحة سواء بالنسبة للماضي أو للآخر أو للحاضر. والحصاد المعرفي عندهم يفتقر إلى المصداقية نظرا لما تعنيه ((الأدلجة)) من إفساد ((للإبيستيمولوجيا)).
6- اللاعقلانية: وهي سمة ناجمة عن التشبث بالنص والنقل على حساب العقل والنظر، نظرا للاعتقاد بأن ما هو إلهي فهو يقيني، وما هو بشري فهو قاصر.
7- الانتهازية : وهي سمة تستشف من تغير الخطاب الأصولي يتغير الظروف والمعطيات، واعتبار هذا التلون ((تكتيكا)) يخدم المقاصد الأساسية وهي الوصول إلى الحكم.
8- الكليانية : ونقصد بها محاولة فرض ((الوحي)) كنص ثابت على سائر أمور الحياة دون مراعاة لدور الإنسان في
صنع مصيره.
9- الطوبوية: وتعني التصورات المثالية عن دولة إسلامية عالمية لا يمكن تحقيقها.
10- سمات وملامح أخرى: جرى الكشف عنها خلال قراءة ((سيميائي)) للمعجم الأصولي ولغة وأسلوب الخطاب ومفاهيمه ومصطلحاته، منها المماحكة والتبرير ونفي الآخر فضلا عن انتهاك ((آداب الحوار)).
نحو تناول علمي لمفهوم الأزمة.
Authors: سالم يفوت
Published: June 2024

غرضنا في هذا البحث، أن نتناول بالتحليل والفحص مفهوم الأزمة من منظور نقدي يستحضر تاريخ العلوم والفلسفة، أحياناً، قصد الاسترشاد به في فهم الكيفيات التي يتعامل بها العلماء مع الأزمات التي تصيب العلوم بين الفينة والأخرى، وذلك بهدف التأكيد على أن الأزمة أو الأزمات هي، على وجه العموم، وفي نهاية المطاف، "أزمات نمو" أو "أزمات تقدم"، وليست بأي حال علامات "فشل" أو "إخفاق": .... باعتبار أنها تعكس "منعطفات" أو لحظات "تحول" يتأكد فيها عجز الأساليب والأدوات القديمة والمعهودة عن استيعاب الوقائع والمعطيات الجديدة. لكن ردود فعل العلماء و"المثقفين" وتأويلاتهم بهذا الخصوص تختلف فتكون مواقفهم من: "الأزمات" متباينة. ذلك أنها إما أن تصاب بالهلع أمام المتغيرات الجديدة فتفقد جادة الصواب معتبرة الأزمة علامة إخفاق ذريع للعقل البشري وللعلم المعني بالأزمة، أو ترفض قبول الوقائع والمعطيات الجديدة المسب للأزمة، متمسكة بالقديم. أو أنها لا تصاب بالهلع أمام المتغيرات الجديدة معتبرة معطياتها بشائر تحول ضروري لا ينبغي التخوف من نتائجه ومضاعفاته الممكنة.
ويعني هذا أنه في مستوى الممارسة النظرية، يظل الحكم بوجود "أزمة" حكم قيمة، أما في مستوى الممارسة العملية، فإنه يظل حكم وجود أو حكم واقع. وما يحدث هو أنه يتم قياس المستوى الأول على المستوى الثاني بآليات قوامها الاعتقاد سلفاً أن المستويين متماثلان، وما ينسحب على أحدهما ينسحب على الثاني. وعليه، فإن الأزمة في الحقيقة هي أزمة المجتمع العربي الذي هو نهب لمفارقات تاريخية تعكس عنف المنعطفات التي أقبل عليها. وهي بالتالي أزمة الثقافة العربية بمعناها الواسع، أعني أسلوب الحياة في هذا المجتمع بكل ما ينطوي عليه من إرث مادي ومعنوي حي قابل للاستخدام والتطوير من أجل تسهيل التواصل بين أبنائه وتأكيد هويتهم. وهي أزمة استشعرها المثقفون العرب منذ قرنين من الزمان، لكنها ما فتئت تتقوى وتزداد عنفاً وحدة كلما جدت متغيرات جديدة، فيكون ذلك مناسبة أخرى لاستئناف الكلام في موضوع صيغته سؤال: "كيف تنهض"؟ أو "كيف نستوعب مكاسب الحداثة"؟ والفكر العربي المعاصر وهو يقترح حلولاً وأجوبة، يطلق "كلام أزمة"، أو "كلاما في الأزمة"، والتي هي أزمة نمو، أو من المفترض فيها أن تفهم كذلك، شريطة ألا نهاب المغامرة التاريخية والمتغيرات الجديدة.
في حدود الخطاب السياسي القومي: من الأزمة إلى البناء.
Authors: كمال عبداللطيف
Published: June 2024

تنطلق هذه الورقة من تصور محدد لمفهوم الأزمة، تقارب بواسطته أزمة الخطاب السياسي العربي القومي.
وهي تتوخى محاصرة جوانب من أزمة هذا الخطاب، على ضوء أسئلة الصراع التاريخي القومي والعالمي، وكذلك على ضوء العوائق النظرية التي تكشف مظاهر من القصور النظري المرافق لبنية هذا الخطاب منذ بدايات تشكله في دائرة الايديولوجيا العربية المعاصرة.
وتنجز هذه الورقة تشخيصًا أوليًا لحدود هذا الخطاب في ضوء حرب الخليج، وما تلاها من تداعيات في المحيط العربي والإقليمي، وتعاين النقد الجذري الموجه لهذا الخطاب، لتعيد التفكير في مشروعية إعادة بنائه.
ويتحدد الهاجس المركزي الموجه لهذه الورقة في الاعتقاد بأن تجاوز التأخر التاريخي العربي يعدُّ واحدًا من أبرز إشكالات الوضع العربي الراهن، وضمن هذا الأفق ترسم الورقة ملامح فكرية عامة لنقد يتجه صوب صياغة جديدة لأسئلة الراهن العربي، بهدف المساهمة في تكسير آليات الإحباط انتي ما فتئت تشلّ قدرات الفكر العربي على المجابهة والمواجهة، ثم إعادة المجابهة والمواجهة، وهي الوظائف التي تعتقد أنها تقف وراء كل فكر تاريخي حي.