Platforms for community-led but globally connected knowledge and resource sharing can move us towards more equitable and more effective research and solutions for infectious diseases.

Introduction: The COVID-19 pandemic brought about an unprecedented shift in healthcare systems worldwide, impacting both inpatient and outpatient care and altering prescription and dispensing patterns, particularly for antibiotics. This study aimed to determine the effect of the COVID-19 pandemic on the outpatient dispensing of certain antibiotics in a Colombian city between 2018 and 2022. Materials and methods: A retrospective ecological interrupted time series study based on monthly outpatient dispensing records for the antibiotics: amoxicillin, amoxicillin/clavulanate, ampicillin, azithromycin, cephalexin, ciprofloxacin, clarithromycin, doxycycline, norfloxacin, sulfadiazine, trimethoprim/sulfamethoxazole, and vancomycin. The defined daily doses per 1,000 inhabitants per day (DHD) were calculated according to World Health Organization guidelines, using the monthly insured population as the denominator. Segmented regression analysis was performed across the pre-pandemic, pandemic, and post-pandemic periods. Results: During the pandemic, the median dispensing rate decreased by 42%, from 4.547 to 2.632 DHD. In the post-pandemic period, it increased to 2.759 DHD but did not reach pre-pandemic levels. A declining trend in dispensing was observed in the pre-pandemic period (-0.122; 95% CI-0.153 to-0.091), with an immediate level change of-1.268 (95% CI-1.824 to-0.711) at the onset of the pandemic, followed by an upward trend during the pandemic (0.149; 95% CI 0.107 to 0.190). Doxycycline (1.114 DHD) and amoxicillin (0.952 DHD) were the most frequently dispensed antibiotics. Amoxicillin/clavulanate showed an increasing trend in dispensing during and after the pandemic. Discussion: Reinforcing surveillance of antimicrobial resistance at the community level is required to understand the effect of differences in dispensing by active ingredient during and after the pandemic.

BACKGROUND:Zika produced the highest increase in the incidence of Guillain-Barré syndrome (GBS) in Latin America in the last decade. The Neuroinfections Emerging in the Americas Study (NEAS) was established in 2016 to investigate the association of emerging infectious disorders with GBS in Colombia. The present study assessed the role of preceding infections, including arboviruses and other pathogens, as risk factors for GBS. METHODS:A case-control study was conducted prospectively between June 2016 and December 2019 in 5 Colombian cities. We recruited newly diagnosed patients with GBS and a house control plus an age and season-matched-hospital control per case. Clinical information, blood, CSF, and urine samples were used to diagnose bacterial and viral infections. Anti-glycolipid antibodies were identified in serum. Statistical analyses were performed using conditional logistic regression. FINDINGS:Fifty-seven patients with GBS, 66·7% male, 52 years of median age, were recruited along with 77 (55 house and 22 hospital) controls. GBS was associated with presenting diarrhea (adjusted OR 10·94; 95% CI 1·8-66·29; p=0·009) and a history of recent upper respiratory tract infection (aOR 13·91; 95% CI 2·38-81·1 p=0·003). Specific recent infections did not significantly differ between cases and controls, but the number of infections was associated with GBS (aOR=1·77 95% CI 1·04-3·01 p=0·03). C. jejuni (74%), M. pneumoniae (23%), and Chikungunya (7%) were the most frequent infections. Anti-glycolipid IgG against GM1 and their heterodimer complexes were identified to be associated with GBS. CONCLUSIONS:After the Zika epidemic, infections causing diarrhea and upper respiratory diseases contributed to the burden of GBS in Colombia. Prevention and control of food-borne pathogens could reduce the incidence of GBS in Colombia.

[This corrects the article DOI: 10.1371/journal.pone.0282492.].

INTRODUCTION:Suicidal behaviors are one of the top ten causes of death worldwide. It is recommended to prioritize the surveillance of suicide attempts, as this is a useful risk factor in the short-term prediction of suicide. In Colombia, its surveillance was implemented in 2016. The study evaluated the performance of the suicide attempt surveillance system in Cali, Colombia, in the period 2016-2019. MATERIAL AND METHODS:The attributes of timeliness, data quality and representativeness were evaluated according to the CDC Guidelines for Violence and Injury Surveillance, in addition to describing patterns of occurrence through time series. RESULTS:The median timeliness of notification was 0 days (RIQ=3). The variables exposure to violence (73.5%), depressive disorder (49.6%) and personality disorder (44.1%) had the highest percentages of missing data. The system identifies priority populations similar to other sources of information, such as young people between 15 and 24 years of age (28.1%), women (64.8%), students (35.5%) and the single population (69.6%); triggering factors such as relationship problems (35.6%), economic problems (13.7%) and serious illness (7%); and mechanisms used such as intoxication (61.6%), short stabbing weapon (27.6%) and hanging (5.3%). The system predicts 22 cases (95% CI=21.6-22.3) per week of attempted suicide in the short term. CONCLUSIONS:The system meets the attributes of quality, timeliness and representativeness. It also allows the identification of an expected threshold of cases that needs to be validated to detect outbreak situations. This study contributes to the knowledge and prevention of the suicidal phenomenon.

BACKGROUND:Guillain-Barré Syndrome (GBS) can lead to significant functional impairments, yet little is understood about the recovery phase and long-term consequences for patients in low- and medium-income countries. OBJECTIVE:To evaluate the functional status and identify factors influencing outcomes among patients with GBS in Colombia. METHODS:Telephone interviews were conducted with GBS patients enrolled in the Neuroviruses Emerging in the Americas Study between 2016 and 2020. The investigation encompassed access to health services and functional status assessments, utilizing the modified Rankin Scale (mRS), GBS Disability Score (GDS), Barthel Index (BI), and International Classification of Functioning (ICF). Univariate analysis, principal component analysis, linear discriminant analysis, and linear regression were employed to explore factors influencing functional status. RESULTS:Forty-five patients (mean age = 50[±22] years) with a median time from diagnosis of 28 months (IQR = 9-34) were included. Notably, 22% and 16% of patients did not receive rehabilitation services during the acute episode and post-discharge, respectively. Most patients demonstrated independence in basic daily activities (median BI = 100, IQR = 77.5-100), improvement in disability as the median mRS at follow-up was lower than at onset (1 [IQR = 0-3] vs. 4.5 [IQR = 4-5], p < 0.001), and most were able to walk without assistance (median GDS = 2, IQR = 0-2). A shorter period from disease onset to interview was associated with worse mRS (p = 0.015) and ICF (p = 0.019). Negative outcomes on GDS and ICF were linked to low socioeconomic status, ICF to the severity of weakness at onset, and BI to an older age. CONCLUSIONS:This study underscores that the functional recovery of GBS patients in Colombia is influenced not only by the natural course of the disease but also by socioeconomic factors, emphasizing the crucial role of social determinants of health.

Introduction: Hepatitis B virus (HBV) and HIV coinfection is common, with reported prevalence of up to 20%. This coinfection is associated with an increased risk of chronicity and complications compared with the general population. HBV vaccination is the cornerstone of prevention; however, people living with HIV (PLWH) exhibit a reduce immune response to the vaccine. The objective of this study was to determine the incidence and factors associated with the lack of seroconversion after HBV vaccination in PLWH in Cali, Colombia. Materials and methods: This was a retrospective cohort study in two HIV outpatient clinics. We included HIV-confirmed adult patients admitted between 2017 and 2020, with no evidence of HBV infection and with under the protective levels of HBV surface antibodies (anti-HBs <= 10 IU/ml) on admission, who received at least one dose of HBV vaccine, and had reported anti-HBs post vaccination. The outcome was lack of seroconversion (anti-HBs <= 10 IU/ml post vaccination) Results: Of 512 patients screened, 73.8% (95% CI: 73.4-74.2) had anti-HBs <= 10 IU/ml on admission of whom 224 were included. The incidence of anti-HBs <= 10 IU/ ml post vaccination was 39.7% (95% CI: 39.5-39.9). Age (aOR 1.03 95% CI: 1-1.05), CD4 count <= 200 cells (aOR 7.8 95% CI: 2-29.8), BMI >30 kg/m(2) (aOR 5.1 95% CI: 1.9-14.1), and smoking in females (aOR 6.8 95% CI: 1-81) were risk factors for lack of seroconversion. In contrast, two (aOR 0.2 95% CI: 0.06-0.9) or three (aOR 0.2 95% CI: 0.06-0.6) HBV vaccine doses instead of one were protective. Discussion: A significant proportion of PLWH are eligible for HBV vaccination in Cali. In those who received at least one HBV vaccine dose, the incidence of lack of seroconversion is comparable to reports in Latin America. The factors associated with lack of seroconversion could be considered to adjust the guidelines for HBV vaccination in PLWH in Colombia.

Introduction Research mentorship is critical for advancing science, but there are few practical strategies for cultivating mentorship in health research resource-limited settings. WHO/TDR Global commissioned a group to develop a practical guide on research mentorship. This global qualitative evidence synthesis included data from a crowdsourcing open call and scoping review to identify and propose strategies to enhance research mentorship in low/middle-income country (LMIC) institutions.Methods The crowdsourcing open call used methods recommended by WHO/TDR and solicited descriptions of strategies to enhance research mentorship in LMICs. The scoping review used the Cochrane Handbook and predefined the approach in a protocol. We extracted studies focused on enhancing health research mentorship in LMICs. Textual data describing research mentorship strategies from the open call and studies from the scoping review were coded into themes. The quality of evidence supporting themes was assessed using the Confidence in the Evidence from Reviews of Qualitative research approach.Results The open call solicited 46 practical strategies and the scoping review identified 77 studies. We identified the following strategies to enhance research mentorship: recognising mentorship as an institutional responsibility that should be provided and expected from all team members (8 strategies, 15 studies; moderate confidence); leveraging existing research and training resources to enhance research mentorship (15 strategies, 49 studies; moderate confidence); digital tools to match mentors and mentees and sustain mentorship relations over time (14 strategies, 11 studies; low confidence); nurturing a culture of generosity so that people who receive mentorship then become mentors to others (7 strategies, 7 studies; low confidence); peer mentorship defined as informal and formal support from one researcher to another who is at a similar career stage (16 strategies, 12 studies; low confidence).Interpretation Research mentorship is a collective institutional responsibility, and it can be strengthened in resource-limited institutions by leveraging already existing resources. The evidence from the crowdsourcing open call and scoping review informed a WHO/TDR practical guide. There is a need for more formal research mentorship programmes in LMIC institutions.

We aimed to investigate the association of emerging infectious disorders with Guillain-Barré syndrome (GBS) in Colombia following the 2015–2016 Zika outbreak.

Background Many cities with traf fi c congestion lack accessibility assessments accounting for traf fi c congestion and equity considerations but have disaggregated georeferenced municipal-level open data on health services, populations, and travel times big data. We convened a multistakeholder intersectoral collaborative group that developed a digital, web-based platform integrating open and big data to derive dynamic spatial - temporal accessibility measurements (DSTAM) for haemodialysis services. We worked with stakeholders and data scientists and considered people ' s places of residence, service locations, and travel time to the service with the shortest travel time. Additionally, we predicted the impacts of strategically introducing haemodialysis services where they optimise accessibility. Methods Cross-sectional analyses of DSTAM, accounting for traf fi c congestion, were conducted using a web-based platform. This platform integrated traf fi c analysis zones, public census and health services datasets, and Google Distance Matrix API travel-time data. Predictive and prescriptive analytics identi fi ed optimal locations for new haemodialysis services and estimated improvements. Primary outcomes included the percentage of residents within a 20-min car drive of a haemodialysis service during peak and free- fl ow traf fi c congestion. Secondary outcomes focused on optimal locations to maximise accessibility with new services and potential improvements. Findings were disaggregated by sociodemographic characteristics, providing an equity perspective. The study in Cali, Colombia, used geographic and disaggregated sociodemographic data from the adjusted 2018 Colombian census. Predicted travel times were obtained for two weeks in 2020. Findings There were substantial traf fi c variations. Congestion reduced accessibility, especially among marginalised groups. For 6 - 12 July, free- fl ow and peak-traf fi c accessibility rates were 95.2% and 45.0%, respectively. For 23 - 29 November, free- fl ow and peak traf fi c accessibility rates were 89.1% and 69.7%. The locations where new services would optimise accessibility had slight variation and would notably enhance accessibility and health equity. Interpretation Establishing haemodialysis services in targeted areas has signi fi cant potential bene fi ts. By increasing accessibility, it would enhance urban health and equity. Funding No external or institutional funding was received. Copyright (c) 2024 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

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To characterize the epidemiological, clinical, and laboratory features of cases of encephalitis of unknown etiology included in the NEAS cohort.

Background and Objectives Recent outbreaks of Zika virus (ZIKV) in South and Central America have highlighted significant neurologic side effects. Concurrence with the inflammatory neuropathy Guillain-Barré syndrome (GBS) is observed in 1:4,000 ZIKV cases. Whether the neurologic symptoms of ZIKV infection are immune mediated is unclear. We used rodent and human live cellular models to screen for anti-peripheral nerve reactive IgG and IgM autoantibodies in the sera of patients with ZIKV with and without GBS. Methods In this study, 52 patients with ZIKV-GBS were compared with 134 ZIKV-infected patients without GBS and 91 non-ZIKV controls. Positive sera were taken forward for target identification by immunoprecipitation and mass spectrometry, and candidate antigens were validated by ELISA and cell-based assays. Autoantibody reactions against glycolipid antigens were also screened on an array. Results Overall, IgG antibody reactivities to rat Schwann cells (SCs) (6.5%) and myelinated cocultures (9.6%) were significantly higher, albeit infrequent, in the ZIKV-GBS group compared with all controls. IgM antibody immunoreactivity to dorsal root ganglia neurones (32.3%) and SCs (19.4%) was more frequently observed in the ZIKV-GBS group compared with other controls, whereas IgM reactivity to cocultures was as common in ZIKV and non-ZIKV sera. Strong axonal-binding ZIKV-GBS serum IgG antibodies from 1 patient were confirmed to react with neurofascin 155 and 186. Serum from a ZIKV-infected patient without GBS displayed strong myelin-binding and putative antilipid antigen reaction characteristics. There was, however, no significant association of ZIKV-GBS with any known antiglycolipid antibodies. Discussion Autoantibody responses in ZIKV-GBS target heterogeneous peripheral nerve antigens suggesting heterogeneity of the humoral immune response despite a common prodromal infection.

COMMENTARY Int J Public Health, 22 December 2023 https://doi.org/10.3389/ijph.2023.1606967

Background: Many cities with traffic congestion lack accessibility assessments accounting for traffic congestion and equity considerations but have disaggregated georeferenced municipal-level open data on health services, populations, and travel times big data. We convened a multistakeholder intersectoral collaborative group that developed a digital, web-based platform integrating open and big data to derive dynamic spatial-temporal accessibility measurements (DSTAM) for haemodialysis services. We worked with stakeholders and data scientists and considered people’s places of residence, service locations, and travel time to the service with the shortest travel time. Additionally, we predicted the impacts of strategically introducing haemodialysis services where they optimise accessibility. Methods: Cross-sectional analyses of DSTAM, accounting for traffic congestion, were conducted using a web-based platform. This platform integrated traffic analysis zones, public census and health services datasets, and Google Distance Matrix API travel-time data. Predictive and prescriptive analytics identified optimal locations for new haemodialysis services and estimated improvements. Primary outcomes included the percentage of residents within a 20-minute car drive of a haemodialysis service during peak and free-flow traffic congestion. Secondary outcomes focused on optimal locations to maximise accessibility with new services and potential improvements. Findings were disaggregated by sociodemographic characteristics, providing an equity perspective. The study in Cali, Colombia, used geographic and disaggregated sociodemographic data from the adjusted 2018 Colombian census. Predicted travel times were obtained for two weeks in 2020. Findings: There were substantial traffic variations. Congestion reduced accessibility, especially among marginalised groups. For 6-12 July, free-flow and peak-traffic accessibility rates were 95.2% and 45.0%, respectively. For 23-29 November, free-flow and peak traffic accessibility rates were 89.1% and 69.7%. The locations where new services would optimise accessibility had slight variations and would notably enhance accessibility and health equity. Interpretation: Establishing haemodialysis services in targeted areas has significant potential benefits. By increasing accessibility, it would enhance urban health and equity.

OBJECTIVE:The objective of this scoping review was to explore and synthesize the available literature on health research mentorship in low- and middle-income countries (LMICs). INTRODUCTION:Research mentorship is broadly considered a useful strategy to improve research capacities and research outputs. Existing literature and guidance on research mentorship have focused on high-income countries and assumed resource-rich environments. Despite the successful endeavors to improve health research capacity in LMICs, the strategies that work best under different circumstances are poorly understood. There is a need to map and understand the evidence on health research mentorship in the context of LMICs. INCLUSION CRITERIA:Sources that reported existing practices, barriers, and mitigation strategies related to health research mentorship in LMICs were included. METHODS:We searched for published and unpublished studies and reports written in English, Spanish, or Portuguese. The search strategy was not limited by search dates and the last search was conducted on January 28, 2022. The databases searched included MEDLINE (PubMed), Embase, Web of Science Core Collection, CINAHL (EBSCOhost), Cochrane Database of Systematic Reviews, and JBI Evidence Synthesis . We also searched for gray literature in a selection of websites and digital repositories. The JBI scoping review methodology was used. RESULTS:A total of 77 studies and reports were included in the review. The majority of the papers were from Africa (n=28). Others were from the Americas (n=7), South East Asia (n=4), East Mediterranean (n=2), and Western Pacific (n=2). The remaining studies were from LMICs that included at least 2 regional offices. Most of the mentorship projects (n=55) were initiated and funded by institutions from high-income countries. The first authors of 41 papers were primarily affiliated with LMICs. The findings were categorized under a description of research mentorship practices, barriers related to research mentorship, and suggested mitigation strategies. Deliverable-driven training using intensive hands-on mentorship and ongoing peer mentorship programs were some of the non-regular, non-institutionalized approaches used to improve research capacity for junior researchers in LMICs. None of the included papers focused on institutional components of research mentorship in LMICs. The barriers to research mentorship activities in LMICs included lack of clarity on mentorship, cultural variations, unbalanced power dynamics, socio-political influences, language barriers, lack of experienced mentors, and limited local funding. Institutionalizing research mentorship, adapting mentoring methodologies relying on local resources, and addressing and respecting diversity in mentorship programs were among the main strategies identified to effectively implement research mentorship in LMICs. CONCLUSIONS:Research mentorship initiatives and practices are limited in LMICs. Few available practices have been introduced by researchers and research institutions from high-income countries and those that have are not yet institutionalized. The identified existing practices, barriers, and facilitators on health research mentorship could help the design, implementation, and evaluation of programs to institutionalize health research mentorship in LMICs. REVIEW REGISTRATION:Open Science Framework osf.io/jqa9z/. SUPPLEMENTAL DIGITAL CONTENT:A Spanish-language version of the abstract of this review is available as supplemental digital content: http://links.lww.com/SRX/A32.