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A moving memoir of a full life, and of learning to walk over and over by the well-known CBC journalist Peter Kavanagh.

Las estrategias que permitieron erradicar la poliomielitis en la Región son las mismas que en este momento se están aplicando a nivel mundial, y son esencialmente las mismas que permitirán mantener a nuestros países libre de esta enfermedad. Dichas estrategias consisten en alcanzar y mantener altas coberturas de inmunización y asegurar una vigilancia epidemiológica adecuada. Esta guía presenta los conocimientos y estrategias necesarios para que el personal de salud pueda mantener el continente libre de polio y para que, en caso de aparecer nuevos brotes, los médicos, las enfermeras y otros trabajadores de la salud puedan controlarlos de manera rápida y eficaz. Más que una guía de erradicación es un manual de referencia para el mantenimiento de la erradicación de la poliomielitis.

Pandemics have become more frequent and more complex during the twenty-first century. Posttraumatic stress disorder (PTSD) following pandemics is a significant public health concern. We sought to provide a reliable estimate of the worldwide prevalence of PTSD after large-scale pandemics as well as associated risk factors, by a systematic review and meta-analysis. We systematically searched the MedLine, Embase, PsycINFO, Web of Science, CNKI, WanFang, medRxiv, and bioRxiv databases to identify studies that were published from the inception up to August 23, 2020, and reported the prevalence of PTSD after pandemics including sudden acute respiratory syndrome (SARS), H1N1, Poliomyelitis, Ebola, Zika, Nipah, Middle Eastern respiratory syndrome coronavirus (MERS-CoV), H5N1, and coronavirus disease 2019 (COVID-19). A total of 88 studies were included in the analysis, with 77 having prevalence information and 70 having risk factors information. The overall pooled prevalence of post-pandemic PTSD across all populations was 22.6% (95% confidence interval (CI): 19.9–25.4%, I2: 99.7%). Healthcare workers had the highest prevalence of PTSD (26.9%; 95% CI: 20.3–33.6%), followed by infected cases (23.8%: 16.6–31.0%), and the general public (19.3%: 15.3–23.2%). However, the heterogeneity of study findings indicates that results should be interpreted cautiously. Risk factors including individual, family, and societal factors, pandemic-related factors, and specific factors in healthcare workers and patients for post-pandemic PTSD were summarized and discussed in this systematic review. Long-term monitoring and early interventions should be implemented to improve post-pandemic mental health and long-term recovery.

It was not long ago that scientists proclaimed victory over polio, the dread disease of the 1950s. More recently polio resurfaced, not conquered at all, spreading across the countries of Africa. As we once again face the specter of this disease, along with other killers like AIDS and SARS, this powerful book reminds us of the personal cost, the cultural implications, and the historical significance of one of modern humanity's deadliest biological enemies. In Polio and Its Aftermath Marc Shell, himself a victim of polio, offers an inspired analysis of the disease. Part memoir, part cultural criticism and history, part meditation on the meaning of disease, Shell's work combines the understanding of a medical researcher with the sensitivity of a literary critic. He deftly draws a detailed yet broad picture of the lived experience of a crippling disease as it makes it way into every facet of human existence. Polio and Its Aftermath conveys the widespread panic that struck as the disease swept the world in the mid-fifties. It captures an atmosphere in which polio vied with the Cold War as the greatest cause of unrest in North America--and in which a strange and often debilitating uncertainty was one of the disease's salient but least treatable symptoms. Polio particularly afflicted the young, and Shell explores what this meant to families and communities. And he reveals why, in spite of the worldwide relief that greeted Jonas Salk's vaccine as a miracle of modern science, we have much more to fear from polio now than we know.

Vaccines are one of the great achievements of medical science. They have eradicated or drastically reduced the incidence of once common diseases. It is estimated that vaccines save between 2 and 6 million lives each year, but 1.5 million more lives could be saved if coverage was increased. Vaccine hesitancy, defined by the World Health Organization as “the reluctance or refusal to vaccinate despite the availability of vaccines”, is a barrier to increasing coverage that has received a great deal of attention from the media and public health academics in recent years. It is argued that many parents are reluctant to vaccinate their children because of concerns about vaccine safety, despite reassurances from doctors and public health authorities. Vaccine hesitancy is a particularly big problem in high-income countries. Observers have noted that the internet and social media play an important role in spreading fears about vaccine safety. It is, however, important to understand how the wider social and political context has influenced concerns about vaccine safety. Vaccine hesitancy appears to be one aspect of a broader breakdown in trust between some sections of the population on the one hand, and elites and experts on the other.

Designing effective public health campaigns in areas of armed conflict requires a nuanced understanding of how violence impacts the epidemiology of the disease in question. We examine the geographical relationship between violence (represented by the location of detonated Improvised Explosive Devices) and polio incidence by generating maps of IEDs and polio incidence during 2010, and by comparing the mean number of IED detonations in polio high-risk districts with non polio high-risk districts during 2004-2009. We demonstrate a geographic relationship between IED violence and incident polio. Districts that have high-risk for polio have highly statistically significantly greater mean numbers of IEDs than non polio high-risk districts (p-values 0.0010-0.0404). The geographic relationship between armed conflict and polio incidence provides valuable insights as to how to plan a vaccination campaign in violent contexts, and allows us to anticipate incident polio in the regions of armed conflict. Such information permits vaccination planners to engage interested armed combatants to co-develop strategies to mitigate the effects of violence on polio.

In 2021, 25 million children worldwide did not receive full basic childhood vaccinations, the highest figure in over a decade. There are large variations between countries in vaccination coverage. Globally, the lifetime prevalence of domestic violence among ever-partnered women is 30%. Exposure to domestic violence affects both maternal and child health. However, there is limited contemporary evidence on whether children born to women who are exposed to domestic violence are any more or less likely to be vaccinated. We conducted a cross-sectional study using data from the most recent Demographic and Health Surveys (DHS) from 7 West African countries (Benin, Gambia, Liberia, Mali, Nigeria, Senegal, Sierra Leone). We used multivariable logistic regression to examine the association between women's lifetime experience of any emotional, physical and/or sexual domestic violence and whether her most-recent born child aged 12-35 months old had received a full complement of basic childhood vaccinations (covering tuberculosis, diphtheria, tetanus, pertussis, polio and measles). Data from 9,104 mother-child pairs was analysed (range 480 from Senegal to 3,230 from Nigeria). Overall, 47% of children were fully vaccinated (range 31% in Nigeria to 81% in The Gambia). 41% of women reported any experience of domestic violence (range 20% in Senegal to 54% in Sierra Leone). After adjustment for a range of child, maternal, household and partner-level variables, children born to women who reported experience of domestic violence were no more or less likely to be fully vaccinated (adjusted odds ratio = 1.02, 95% confidence interval 0.90-1.17). There was some evidence that the association may vary by country; in Sierra Leone, children born to women who reported experience of domestic violence were significantly less likely to be fully vaccinated (adjusted odds ratio = 0.62, 95%CI 0.44-0.88). There was no significant association between a woman's exposure to domestic violence and whether her child was fully vaccinated. Further work is needed to understand the contextual factors which may explain potential variations between countries.

Background Vaccines have contributed to the disappearance of various diseases, and almost eradicated others across the world. Studies have shown that in Lebanon a profoundly small percentage of Syrian refugee children were fully immunized by routine vaccination services. Exploring the knowledge, attitudes, and practices of parents towards vaccination is of crucial importance, given the role of parents in children’s immunization. This study aims to investigate the knowledge, attitudes, and practices of the Syrian refugee mothers in Lebanon towards the immunization of their children. Methods This is a cross-sectional study conducted using questionnaires targeting Syrian refugee mothers whose children were born on Lebanese grounds, are below the age of five, and are following the Lebanese vaccination schedule. Results Majority of refugee mothers considered vaccination to be safe (89.9%) and stated that vaccination should be initiated at birth (87.2%). Almost all of the interviewed mothers plan to vaccinate their children according to the National Lebanese Vaccination Schedule. Concerning the children’s immunization status, 51.4% of Syrian refugee children were fully immunized and 48.6% had aberrant vaccination. Conclusion Although refugee mothers had some knowledge gaps regarding vaccines, the main issue lies within the accessibility. A collaborative coordinated approach involving governmental and non-governmental agencies seems to be an effective approach to improve rates of immunization.

Background New or increased impairments may develop several decades after an acute poliomyelitis infection. These new symptoms, commonly referred to as late effects of polio (LEoP), are characterised by muscular weakness and fatigue, generalised fatigue, pain at rest or during activities and cold intolerance. Growing older with LEoP may lead to increased activity limitations and participation restrictions, but there is limited knowledge of how these persons perceive the practical and psychological consequences of ageing with LEoP and what strategies they use in daily life. The aim of this qualitative study was therefore to explore how ageing people with LEoP perceive the their situation and what strategies they use for managing daily life. Methods Seven women and seven men (mean age 70 years) were interviewed. They all had a confirmed history of acute poliomyelitis and new impairments after a stable period of at least 15 years. Data were transcribed verbatim and analysed using systematic text condensation. Results The latent analysis resulted in three categories ‘Various consequences of ageing with LEoP’, ‘Limitations in everyday activities and participation restrictions’, and ‘Strategies for managing daily life when ageing with LEoP’ and 12 subcategories. The new impairments led to decreased physical and mental health. The participants perceived difficulties in performing everyday activities such as managing work, doing chores, partaking in recreational activities and participating in social events, thereby experiencing emotional and psychological distress. They managed to find strategies that mitigated their worries and upheld their self-confidence, for example finding practical solutions, making social comparisons, minimising, and avoidance. Conclusion Ageing with LEoP affected daily life to a great extent. The participants experienced considerable impact of the new and increased impairments on their life situation. Consequently, their ability to participate in various social activities also became restricted. Social comparisons and practical solutions are strategies that facilitate adaptation and acceptance of the new situation due to LEoP. This emphasises the need to design rehabilitation interventions that focus on coping, empowerment and self-management for people ageing with LEoP.

Background Health financing system in Tanzania changed in the early 1990s as a result of the introduction of cost-sharing policies by the 1990s health sector reforms. The reforms brought about user fees which has led to inequity in access to health care services and catastrophic health expenditure among the elderly. In efforts to reduce the inequity gap among vulnerable groups, in 1994, the government introduced an exemption and waiver policy. More than three decades later, inequity in health care services access has persisted with the elderly population being more affected. The latter poses questions on the implementation efficiency of the exemption policy. We aimed to assess the implementation of the exemption policy on access to health services among the elderly in Tanzania by learning from the experiences of the priority setting process in two districts of western Tanzania. Methods An exploratory qualitative case study adopting Key informant interviews (KIIs) was used to collect data in Nzega and Igunga districts. The key informants involved the representatives of the planning team and decision makers from the community, health facility and district level. Information saturation was attained after the 24th interview and thus data collection ended. The content analysis approach was used to analyse the data. Findings Although there is a designated office that deals with exemptions for the elderly in health facilities, there are challenges in accessing health services. The challenges include insufficient drugs, some laboratory tests not covered by the exemption, a lengthy process to access service, poor financial mechanisms for exempted services, inadequate information and clarity of the exemption categories, and limited to no involvement of different stakeholders in the exemption process. Conclusion The exemption policy was introduced to help disadvantaged groups, including the elderly. However, its implementation encountered challenges which burden both the elderly and the health facilities. Its implementation has thus become a controversy to its initial aim that was to relieve the elderly from high healthcare costs. Revisiting the policy through a thorough stakeholders’ engagement and establishing alternative financing of the exemption policy are recommended.