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Relationship between perceived stress and blood pressure control in young adults with a family history of hypertension
No full textBackground: Hypertension is a primary reason for heart problems that lead to death or illness across the globe, and people with a family history are more prone to it. Stress is known to cause an increase in blood pressure, but the specific influence of stress perception on individuals in this high-risk group remains unclear. This study examines the relationship between perceived stress and blood pressure control in young adults with a family history of hypertension.Methods: This study employed a cross-sectional design, involving 385 young adults aged 18-35 years from universities, communities, and outpatient centres in Islamabad, Pakistan. Participants completed the Perceived Stress Scale (PSS) in conjunction with the Hill-Bone Compliance to High Blood Pressure Therapy Scale (HB-HBP). All data were run through IBM SPSS Version 26 using Pearson correlation, t-tests, ANOVA, and linear regression to examine the relationship between perceived stress and the effectiveness of blood pressure management. The data were gathered from February 2025 to May 2025.Results: Perceived stress showed a significant gender difference, with males reporting higher levels of stress (t=3.431, p=0.001). It was moderately positively correlated with blood pressure control (r=0.400, p \u3c 0.001). Regression analysis revealed that the greater the stress, the less effectively a person managed their blood pressure (b=0.400, p \u3c 0.001). Individuals adhering to a particular diet had improved control of their blood pressure (t=3.403, p=0.001). Although physical activity and marital status were found to have a statistically significant correlation with stress and blood pressure control (p \u3c 0.05), the higher values were negligible.Conclusion: It is shown that controlling blood pressure in young adults who have a family history of hypertension can be affected by their perceived stress. Researchers found that stress management may be very helpful in improving the blood pressure of such high-risk patients. More studies are required to find out how stress can lead to hypertension, including emotional and physical/health aspects
Home-based digital counselling by frontline community workers for anxiety and depression symptoms in rural Sindh, Pakistan: The mPareshan intervention
No full textBackground: There is limited evidence that interventions for improving mental well-being can be integrated sustainably into primary health care in Pakistan. We piloted \u27mPareshan digital intervention\u27 locally, adapted from WHO mhGAP and delivered by trained and supervised women lay workers to learn if it was feasible and possibly effective in reducing anxiety and depression prior to proposing implementation on a larger scale.Methods: Using Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9), a baseline household survey was conducted by independent data collectors to measure anxiety and depression. We trained 72 government Lady Health Workers (LHWs) and Lady Health Supervisors (LHSs) in District Badin, Sindh to screen and counsel adult men and women (\u3e 18 years) with mild and moderate symptoms of anxiety and depression. Supervised by LHSs, these screen positive participants (SPs) received 6 counselling sessions by LHWs through the mPareshan app during their routine household visits. The app had interactive audio/video psychoeducation features. Severe anxiety and depression cases were referred to nearest available mental health service.Results: Of the 366 individuals surveyed at baseline, 75% had minimal anxiety, 23% had mild to moderate anxiety, and 2% had severe anxiety. 74% had minimal depression, 24% had mild to moderate depression, and 2% had moderately severe to severe depression. 98 participants (53 men and 45 women, mean age 43.2 years) screened positive for mild and moderate anxiety and/or depression and were eligible for the mPareshan intervention. Six SPs did not complete the intervention for various reasons. Of the 92 SPs who completed all 6 monthly counselling sessions, their mean PHQ-9 score declined from 7.5 (SD 3.1) to 2.6 (SD 2.2) after intervention. Mean GAD-7 score fell from 6.6 (SD 3.0) to 2.1 (SD 2.2) after 6 sessions. No significant association between sociodemographic variables (age, gender, education, and income levels) and anxiety and depression scores was noted.Conclusion: Preliminary evidence suggests meaningful reduction in anxiety and depression using this locally adapted digital counselling intervention delivered by lay health workers in a rural setting of Sindh, Pakistan. An appropriately powered randomized control trial is needed to test effectiveness of this task-shifting model.Trial registration: Registered as non-randomized, pretest-posttest, feasibility trial on 14/07/2022 with Registration number ACTRN12622000989741 at the Australian New Zealand Clinical Trial Registry ( https://www.anzctr.org.au/Default.aspx )
Randomized controlled trial to assess the effectiveness of apnoeic oxygenation in adults using a low-flow or high-flow nasal cannula with head side elevation during endotracheal intubation in the emergency department
No full textObjective: Although apnoeic oxygenation has demonstrated efficacy in extending safe apnea time during intubation, a superiority comparison between high-flow nasal cannula (HFNC) and low-flow nasal cannula (LFNC) in emergency settings remains unexplored. This randomized controlled trial evaluated whether apnoeic oxygenation using HFNC or LFNC with head elevation improves oxygenation and intubation outcomes compared to standard care without oxygen delivery. Methods: We conducted a three-arm randomized trial using block randomization (1:1:1) at a tertiary care emergency department. Adult patients requiring intubation were randomized to receive apnoeic oxygenation via HFNC (20 L/min), LFNC (10 L/min), or standard care. The primary outcome was the lowest oxygen saturation 3 min post-intubation, and co-primary outcome was first-pass success rate. Secondary outcomes were safe apnea time, post-intubation complications (hypotension, desaturation, arrhythmia), laryngoscopic view, and the need for adjuncts. Intention-to-treat analysis was applied. Results: Our study investigated endotracheal intubation in 88 patients, divided into high flow, low flow, and standard care groups. The high flow group had the highest median SpO2 and less variability than other groups. The standard group had the highest first attempt success rate (93%). The high flow group had a statistically significant shorter Apnea duration than the low flow group. The low flow group had a higher prevalence of hypotension (46%) and oxygen desaturation (57%) post-intubation. Conclusion: HFNC with head-elevated positioning reduces post-intubation desaturation and hypotension compared to LFNC and standard care. HFNC may be a beneficial adjunct during emergency intubation, particularly in patients at risk of hypoxia or hemodynamic instability
Protocol for the redefining maternal anemia in pregnancy and postpartum (ReMAPP) study: A multisite, international, population-based cohort study to establish global hemoglobin thresholds for maternal anemia
No full textBackground: Anemia affects one in three pregnant women worldwide, with the greatest burden in South Asia and sub-Saharan Africa. During pregnancy, anemia has been linked to an increased risk of adverse maternal and neonatal health outcomes. Despite widespread recognition that anemia can complicate pregnancy, critical gaps persist in our understanding of the specific causes of maternal anemia and the cutoffs used to diagnose anemia in each trimester and in the postpartum period.Methods and analysis: The Redefining Maternal Anemia in Pregnancy and Postpartum (ReMAPP) study is a multisite, prospective, cohort study nested within the Pregnancy Risk, Infant Surveillance, and Measurement Alliance (PRISMA) Maternal and Newborn Health study. Research sites are located in Kenya, Ghana, Zambia, India, and Pakistan. Participants are up to 12,000 pregnant women who provide serial venous blood samples for hemoglobin assessment at five time points: at \u3c 20 weeks, 20 weeks, 28 weeks, and 36 weeks gestation and at six weeks postpartum. We will use two analytical approaches to estimate hemoglobin thresholds for defining anemia: (1) clinical decision limits for cutoffs in each trimester and at six weeks postpartum based on associations of hemoglobin levels with adverse maternal, fetal, and neonatal health outcomes and (2) reference limits for gestational-week-specific cutoffs and at six weeks postpartum for mild, moderate, and severe anemia based on tail statistical percentiles of hemoglobin values in a reference (i.e., clinically healthy) subpopulation. We will also conduct biomarker-intensive testing among a sub-sample of participants in each trimester to explore underlying contributing factors of maternal anemia.Ethics and dissemination: The study received local and national ethical approvals from all participating institutions. Findings from multisite analyses will be published among open-access, peer-reviewed journals and disseminated with local, national, and international partners.Strengths and limitations: Novel study design to allow multiple analytical approaches (clinical decision limits and reference limits) in the same population to establish hemoglobin thresholds.Use of gold standard methods and external quality assurance programs to ensure harmonized hemoglobin measurement across sites.Inclusion of biomarker-intensive study arm to examine the etiology of anemia among pregnant women.All data is contributed by populations historically underrepresented in research in low- and middle-income countries
PRIORITY IR: Protocol for implementation research on single-dose postpartum IV iron to treat iron-deficiency anemia among women in India and Pakistan
No full textBackground: Anemia among women of reproductive age has remained highly prevalent globally. Intravenous (IV) iron is well tolerated and proven effective for treating postpartum iron deficiency anemia in high-income countries, but evidence from LMICs, where oral iron is standard treatment, is limited. The PRIORITY trial will test the effectiveness of IV iron compared to oral iron for postpartum women with moderate anemia in eight LMIC sites. An implementation research (IR) study will be conducted alongside the PRIORITY trial in India and Pakistan to gather information on the intervention characteristics and the implementation process, and to assess feasibility, acceptability, fidelity, and cost of implementation for providing IV iron to postpartum women with moderate iron deficiency anemia.Methods: The PRIORITY IR study will use a mixed methods convergent parallel design guided by two frameworks: the Consolidated Framework for Implementation Research and Proctor\u27s implementation outcomes. The IR study will be conducted in the Belagavi, India and Karachi, Pakistan PRIORITY trial sites. Participants will include postpartum women in the IV iron intervention arm of the trial, family members, health workers administering IV iron, hospital administrators, postpartum women who refuse to be part of the trial (Pakistan only), and postpartum women in the oral iron arm of the trial (India only). Data collection methods will include surveys, in-depth interviews, a supervision checklist, and a cost assessment. Survey and supervision checklist data will be analyzed descriptively. Interview data will be analyzed using a directed content analysis approach.Discussion: The PRIORITY IR study will contribute important information about implementation processes and strategies and feasibility, acceptability, fidelity, and costs for postpartum IV iron implementation. Results of the study can provide guidance for implementing effective anemia treatment in LMIC contexts with a high anemia burden
COVID-19 vaccine attitudes, beliefs, intentions and behaviors among pregnant women within the context of dynamic national policy recommendations in Brazil, Ghana, Kenya, and Pakistan
No full textIntroduction: There are many factors associated with maternal immunization decision making. This study aimed to describe COVID-19 vaccination attitudes, beliefs, behaviors, and intentions among pregnant women across four countries within the context of varying and changing policy recommendations related to COVID-19 vaccination for pregnant women.Methods: This cross-sectional quantitative study surveyed pregnant women in antenatal care facilities serving mostly urban or peri-urban populations in Campinas, Brazil; Accra, Ghana; Nairobi, Kenya; and Karachi, Pakistan. Potential participants were approached in clinic waiting rooms, and if eligible, enrolled after informed consent was obtained.Results: A total of 1603 women were surveyed, with 64 % overall reporting they received a COVID-19 vaccine, ranging from 46 % in Pakistan to 97 % in Brazil. Among those ever vaccinated, 15 % received a COVID-19 vaccine during pregnancy, most received only one dose during pregnancy and the majority (53 %) reported they were vaccinated in their first trimester. The top two reasons for vaccination were the same across all countries: protecting themselves and protecting their baby. Among those not vaccinated against COVID-19, the majority of participants (68 %) indicated that they did not intend to be vaccinated, and fears that the vaccine was not safe was the highest rank among all countries as the primary reason for not getting vaccinated. In adjusted models, higher disease risk perception (aOR: 1.88; CI: 1.35-2.62), higher beliefs in vaccine effectiveness for the pregnant women (aOR: 1.75; CI: 1.19-2.55), belief in the safety of the vaccine for their baby (aOR: 2.30; CI: 1.46-3.64), and believing that peers were taking the vaccine (aOR: 1.54; CI: 1.14-2.08) were associated with vaccination status. Holding views consistent with vaccine hesitancy was associated with lower odds of vaccination (aOR: 0.28; CI: 0.20-0.40).Discussion: Enhancing risk perception of COVID-19 in pregnancy, knowledge about safety and benefits of the vaccine compared to the risks, and promoting supportive environments where vaccines are perceived as normative behavior can help increase vaccine uptake among pregnant women
Resilience and brain health in global populations
No full textResilience is a multifaceted concept that spans biological, psychological and social domains, and is critical for population health—particularly brain health. While most existing research originates from the global north, there is an urgent need to explore resilience in the majority world settings, where unique biological, exposomal, economic and sociocultural factors shape health. In this Review, we highlight resilience as a key modifier of brain health outcomes. We explore the biological correlates of resilience and the influence of the exposome. We propose future synergistic integrations of exposome, cultural reserve, community resilience, allostasis and whole-body health principles to promote an inclusive perspective in diverse settings. This approach is particularly relevant for majority world contexts, where resource constraints and cultural diversity demand adaptive, scalable and context-sensitive strategies. We discuss measurement approaches and operationalization strategies and, finally, we identify key priorities for future research and policy strategies, with an emphasis on local relevance, equity and sustainability
Endometrial carcinoma in Kenya: clinical and biomarker profiles of 123 cases seen at two tertiary referral centers authors
No full textEndometrial carcinoma (EC) is the second-most common gynecologic malignancy globally after cervical cancer, with varying incidence and outcomes across diHerent populations. It comprises a heterogeneous group of tumors with distinct histopathologic and molecular characteristics. This study aims to provide a comprehensive clinicopathologic characterization of EC in the Kenyan population, focusing on histologic types and immunohistochemical biomarker expression. This retrospective study was conducted on archival tissue blocks from 123 patients diagnosed with EC at two major referral hospitals in Kenya. A tissue microarray block was constructed, and immunohistochemistry for 11 biomarkers, including ER, PR, p16, p53, NapsinA, ARID1A, PTEN, and Mismatch repair (MMR) proteins, was performed. Data analysis included descriptive statistics with Fisher\u27s exact test performed to compare proportions, while diHerences in means were compared using the Mann-Whitney U-test, with p \u3c 0.05 considered significant. The median age at diagnosis was 63 years, with the most common histologic type being endometrioid carcinoma (55.2%), followed by serous carcinoma (26%). Most low FIGO-stage patients had low-grade endometrioid histology. Obesity was the most frequently reported risk factor. Though hormone receptor biomarkers and p16 showed heterogeneous staining across all histologic types, ER and PR showed more frequent strong expression associated with endometrioid histology, while strong diHuse p16 staining was observed more frequently in serous carcinoma. MMR protein loss was predominantly observed in endometrioid carcinoma (30.0%), while all cases of serous carcinoma showed aberrant p53 expression. Abnormal p53 expression was also observed in 53.5% of all ECs, pointing to a higher percentage of patients with poor prognostic factors. These findings provide valuable insights into the landscape of EC in a Kenyan population, emphasizing the role of IHC in the diagnosis and potential tailored therapeutic strategies for management in the region, where access to molecular testing may be limited