Declines in health service use during the Coronavirus Disease 2019 (COVID-19) pandemic could have important effects on population health. In this study, we used an interrupted time series design to assess the immediate effect of the pandemic on 31 health services in two low-income (Ethiopia and Haiti), six middle-income (Ghana, Lao People’s Democratic Republic, Mexico, Nepal, South Africa and Thailand) and high-income (Chile and South Korea) countries. Despite efforts to maintain health services, disruptions of varying magnitude and duration were found in every country, with no clear patterns by country income group or pandemic intensity. Disruptions in health services often preceded COVID-19 waves. Cancer screenings, TB screening and detection and HIV testing were most affected (26–96% declines). Total outpatient visits declined by 9–40% at national levels and remained lower than predicted by the end of 2020. Maternal health services were disrupted in approximately half of the countries, with declines ranging from 5% to 33%. Child vaccinations were disrupted for shorter periods, but we estimate that catch-up campaigns might not have reached all children missed. By contrast, provision of antiretrovirals for HIV was not affected. By the end of 2020, substantial disruptions remained in half of the countries. Preliminary data for 2021 indicate that disruptions likely persisted. Although a portion of the declines observed might result from decreased needs during lockdowns (from fewer infectious illnesses or injuries), a larger share likely reflects a shortfall of health system resilience. Countries must plan to compensate for missed healthcare during the current pandemic and invest in strategies for better health system resilience for future emergencies.

Aims/HypothesesWe hypothesized that there is decreased synthesis of glutathione (GSH) in type 2 diabetes (T2DM) especially in the presence of microvascular complications, and this is dependent on the degree of hyperglycemia.MethodsIn this case-control study, we recruited 16 patients with T2DM (7 without and 9 with microvascular complications), and 8 age- and sex-matched non-diabetic controls. We measured GSH synthesis rate using an infusion of [2H2]-glycine as isotopic tracer and collection of blood samples for liquid chromatography mass spectrometric analysis.ResultsCompared to the controls, T2DM patients had lower erythrocyte GSH concentrations (0.90 ± 0.42 vs. 0.35 ± 0.30 mmol/L; P = 0.001) and absolute synthesis rates (1.03 ± 0.55 vs. 0.50 ± 0.69 mmol/L/day; P = 0.01), but not fractional synthesis rates (114 ± 45 vs. 143 ± 82%/day; P = 0.07). The magnitudes of changes in patients with complications were greater for both GSH concentrations and absolute synthesis rates (P-values ≤ 0.01) compared to controls. There were no differences in GSH concentrations and synthesis rates between T2DM patients with and without complications (P-values > 0.1). Fasting glucose and HbA1c did not correlate with GSH concentration or synthesis rates (P-values > 0.17).ConclusionsCompared to non-diabetic controls, patients with T2DM have glutathione deficiency, especially if they have microvascular complications. This is probably due to reduced synthesis and increased irreversible utilization by non-glycemic mechanisms.

Introduction. Pyelonephritis is a common complication of pregnancy. It is also exacerbated by immunocompromised states and also the sickle cell gene. We reviewed this condition in Jamaican women. Method. We did a six year hospital database docket review. We found 102 confirmed cases. Results. Pyelonephritis was found in 0.7% of deliveries. The mean maternal age was 24 ± 5.83 years with 51% primiparity. Most (58.8%) occurred in the second trimester. The main symptoms were loin pain (96.2%) and abdominal pain (84.6%). It was more common on the right side in 67% of cases. On urinalysis, 81.4% had pyuria. The commonest organism was Escherichia coli, in 61% of cases. Patients given Antibiotics prior to admission had quicker resolution, P < 0.02. Haemoglobin S was found in 16% cases (general population 10%; P = 0.002). However diabetes was only found in 1.3% cases (1.5% expected). 61.3% had positive urine culture after treatment showed that 61.3% and 25% had recurrent pyelonephritis. Complications included 32% threatened preterm labour and 17% preterm delivery. About 6% of neonates had intrauterine growth restriction. There were no ICU admissions and no deaths. Conclusion. Early recognition and treatment of pyelonephritis result in good outcome. The condition is more prevalent in patients with the sickle cell gene and recurrence is high.

BackgroundChildhood overweight is not restricted to developed countries: a number of lower- and middle-income countries are struggling with the double burden of underweight and overweight. Another public health problem that concerns both developing and, to a lesser extent, developed countries is food insecurity. This study presents a comparative gender-based analysis of the association between household food insecurity and overweight among 10-to-11-year-old children living in the Canadian province of Québec and in the country of Jamaica.MethodsAnalyses were performed using data from the 2008 round of the Québec Longitudinal Study of Child Development and the Jamaica Youth Risk and Resiliency Behaviour Survey of 2007. Cross-sectional data were obtained from 1190 10-year old children in Québec and 1674 10-11-year-old children in Jamaica. Body mass index was derived using anthropometric measurements and overweight was defined using Cole's age- and sex-specific criteria. Questionnaires were used to collect data on food insecurity. The associations were examined using chi-square tests and multivariate regression models were used to estimate odds ratios (OR) and 95% confidence intervals.ResultsThe prevalence of overweight was 26% and 11% (p < 0.001) in the Québec and Jamaican samples, respectively. In Québec, the adjusted odds ratio for being overweight was 3.03 (95% CI: 1.8-5.0) among children living in food-insecure households, in comparison to children living in food-secure households. Furthermore, girls who lived in food-insecure households had odds of 4.99 (95% CI: 2.4-10.5) for being overweight in comparison to girls who lived in food-secure households; no such differences were observed among boys. In Jamaica, children who lived in food-insecure households had significantly lower odds (OR 0.65, 95% CI: 0.4-0.9) for being overweight in comparison to children living in food-secure households. No gender differences were observed in the relationship between food-insecurity and overweight/obesity among Jamaican children.ConclusionsPublic health interventions which aim to stem the epidemic of overweight/obesity should consider gender differences and other family factors associated with overweight/obesity in both developed and developing countries.

International Family Planning PerspectivesEmergency contraceptive pills are a postcoital contraceptive method that has been available since the 1970s. 1 Nevertheless, they are an underutilized option for preventing unwanted pregnancy, partly because knowledge of the method is often lacking, even among health care providers who typically serve as the primary gatekeepers to its access. For example, in a study of Indian paramedical workers, just 3% were familiar with the concept of emergency contraception; 2 in a survey of Turkish physicians, midwives and nurses, only 29% of those familiar with the method correctly identified the period of time after unprotected sexual intercourse in which the method was effective; 3 and in a recent survey, 39% of Kuwaiti retail pharmacists had heard of the method. 4 Furthermore, negative attitudes toward and inaccurate knowledge of the method among health care providers-including pharmacists, physicians and nursescan pose substantial barriers to women's timely access to the pills in the event of unprotected intercourse.In the English-speaking Caribbean, there is a great need for increased awareness of and access to emergency contraceptive pills. Barbados and Jamaica have high levels of sexual violence and unprotected sexual intercourse, particularly among young people. For example, 57% of pregnancies in Jamaica are unwanted or unplanned, and 20% of Jamaican women have experienced forced sexual intercourse. 5 Because abortion is highly restricted in this country, women with unplanned or unwanted pregnancies often resort to clandestine, unsafe abortions, which are a leading cause of disability and maternal mortality. 6 There are no comparable reproductive health data for Barbados. Despite the potential for emergency contraceptive pills to dramatically improve the reproductive health of women in the English-speaking Caribbean, little research has been conducted on the method in these countries, particularly in small nations such as Barbados.Emergency contraceptive pills are sold in pharmacies in both Jamaica and Barbados, but regulations regarding their provision differ. Since June 2003, Postinor-2 (a dedicated levonorgestrel product) has been available in Jamaica without a prescription, under the condition that pharmacists counsel women about the method at the time of purchase. In Barbados, Postinor-2 is also sold in pharmacies, but is legally available only by prescription. We are aware of no previous studies in Barbados on providers' knowledge of, attitudes toward or provision practices regarding the method. Because of the scarcity of information on the provision of emergency contraceptive pills in Caribbean countries, we conducted two surveys with the aim of addressing this research gap among Barbadian and Jamaican health care providers. Jamaican and Barbadian Health Care Providers' Knowledge, Attitudes and Practices Regarding Emergency Contraceptive Pills